Appendicitis or appendicitis is an inflammation of the appendix (appendix vermiformis). The name appendicitis is common, but not applicable, since the inflammation is actually limited to the appendix, which attaches to the beginning of the cecum.
Causes of appendicitis
The appendix hangs like a worm on the cecum (diameter about 1 cm). Due to the narrowness in the area of the mouth, it can easily lead to a mechanical closure by foreign bodies (for example, cherry pits, feces, old scars and kinks in adhesions).
But even with inflammation of the rest of the intestine, with tonsillitis, flu, measles or scarlet fever, bacteria can enter the appendix via the blood. Its mouth closes then by the swelling of the tissue. The resulting secretion congestion and the associated accumulation of bacteria leads to a violent reaction, as the appendix does not serve as the rest of the intestine digestion, but is an organ of infection defense.
Other illnesses with similar symptoms include gastrointestinal influenza with diarrhea, inflammation of the gall bladder in stone disease (biliary colic), Crohn's disease and renal colic.
Appendicitis: signs and symptoms
The diagnosis of acute appendicitis is based on medical history and physical examination. There is a "classic" course, but many variations are possible, especially in children and elderly patients. Even for the experienced examiner, it is very difficult to detect appendicitis with certainty. The symptoms develop within 12 to 24 hours.
First, there is pain in the navel area or above. These relocate within a few hours in the right lower abdomen. Pain when walking can be alleviated by lifting the right leg. There is also nausea, which is more often associated with vomiting. At the so-called Mac Burney point (between the navel and iliac crest on the right) there are signs of local peritonitis with defensive tension, localized pressure and tapping pain.
The bowel sounds audible with the stethoscope are quieter than normal. In addition, there is a fever with a temperature difference of more than 0.8 ° C between the axis of the armpit and the anus. In the rectal examination, one often finds a pressure pain. The blood picture also often shows signs of inflammation. Children may experience diarrhea, high fever, loss of appetite and an early deterioration of their general condition. In old patients, the symptoms may be weaker, but may be more rapid.
The uncomplicated appendicitis is cured after surgery. In some cases, however, it can lead to adhesions in the area of the ablation site after years, which then lead to a mechanical intestinal obstruction.
Complications of appendicitis
The main complication of appendicitis is the eruption of purulent secretions from the appendix into the free abdominal cavity. At the moment of breakthrough, the patient may feel relief by removing the congestion, but the pain rapidly increases again. By spreading the bacteria in the abdomen, the patient's life can be acutely threatened. After a breakthrough, encapsulation and delimitation by adhesion to the mesh apron and surrounding small intestine loops is also possible (abscess).
Incidentally, similar complaints as appendicitis in women cause inflammation of the fallopian tubes, ovarian or peritoneal pregnancy, stilted ovarian cyst, and pain at the time of ovulation. Therefore, in women a gynecological disease should be excluded by appropriate studies. In children, inflammatory swelling of the lymph nodes in the abdomen or diaphragmatic pneumonia may simulate appendicitis.
Treatment of appendicitis
Any appendicitis-like finding in which appendicitis can not be ruled out after several hours of observation should be operated on. Conservative treatment may be attempted in appendiceal abscess and subacute appendicitis. For the patient this means bed rest, nutritional delay, antibiotic administration, laboratory control and repeated examinations. The operation in which the appendix is removed (appendectomy) - is done by opening the abdominal wall with a small incision on the right lower abdomen. In very thick patients or unclear diagnosis, the incision is made larger and along the middle of the lower abdomen, as the surgeon then has a better overview.
Laparoscopic appendectomy, which uses optical instruments, is usually only performed during planned procedures rather than emergencies. This may be an occasional appendectomy or removal after repeated mild inflammation at the symptom-free interval. To be sure of the cause of the inflammation, the distant appendix is always examined histologically.