Operation of the appendix is amongst the commonest  surgeries.

The appendix is a wormlike appendage situated in the lower right side of the abdomen at the junction of the small and the large gut. This 1"-5" long tubular organ and is present since birth. This organ is believed to be a ‘vestigial’ organ.However, recent studies are showing that appendix may be harbouring useful bacteria which aid in digestion, control of infection and boost immunity.
Appendicitis generally affects people aged between 10 and 30 years, but it can affect any age group. Approximately 250,000 appendectomies are performed in the United States each year to treat appendicitis.
Appendicitis means swelling and infection of the appendix. The exact cause, though, not fully known , but the swelling can occur due to two causes.

1) Non-obstructive: Due to infection, the whole appendix gets affected.

2) Obstructive :Due to fecoliths or worms, the lumen of the appendix gets blocked. This results in severe swelling, which can increase rapidly and without timely surgical intervention, can result in the rupture of the appendix. This can form a localized collection of pus or the pus can spread all over the abdomen and can result in a very serious condition of the patient which can be fatal if not treated immediately.

Patient usually presents with following symptoms :
1)Progressively increasing abdominal pain which may start from upper or central abdomen but may localize in right lower abdomen.
2) Nausea and vomiting
3) Low grade fever
4) Diarrhea/constipation
5) Anorexia

Appendicitis is diagnosed  best by clinical examination when patient has abdominal pain.
In addition some tests are done to aid in establishing a diagnosis and even to rule out other causes of pain

Blood tests: In case of appendicitis, there is a rise in the WBC.

Urine examination: If there are red blood cells or pus cells in the urine, then there is a possibility of kidney stone or urinary infection.

Stool examination: If there is infection in the intestines, then cysts of the organisms may be seen.

Plain x-ray of the abdomen: The swollen appendix is not seen, but if it has ruptured then gas may be seen under the diaphragm. It may also show renal/ureteric stones

Ultrasound of the abdomen: A severely swollen appendix may be seen. Pus may be seen collected around a ruptured appendix. Other causes of abdominal pain in that area can be made out e.g.: right ureteric stone, in females swelling of the right tube or ovary.

CT Scan: It has a high sensitivity and specificity in diagnosing acute appedicitis.

Diagnostic Laparoscopy: A diagnosticlaparoscopy may be performed in cases of high clinical suspicion of Appendicitis but no clinical evidence. It helps to remove the appendix at the same time in addition to viewing rest of the abdomen if appendix is normal.

Treatment for appendicitis -Mild attacks ofappendicitis, may sometimes resolve by  medicines either oral or injectable. However, an established case of appendicitis should always be operated immediately to prevent the risk of perforation and peritonitis, lump and abscess formation, adhesions and acute intestinal obstruction etc. Sometimes, if pain resolves or appendicular lump forms then interval appendicectomy is performed i.e about 6 weeks after the acute attack.

Surgery---It is the mainstay of treatment. It can be done by open/ standard technique or laparoscopically with equally best results.

Open- A small 2"-3" oblique incision is givenin the right  lower abdomen.It is a cosmetic incision and does not show in postoperative period. In case of complications, the operation is more difficult and risky for the patient. A 4"-6" long vertical incision is given in lower midline of abdomen.

Laparoscopy/ minimal access surgery- In laparoscopic appendicectomy 3 small incisions of the size varying 0.5 to 1 cm is made in the abdomen. By watching on the monitor and performing with thin instruments appendix is removed. It has advantage of faster recovery, cosmesis and early return to work. However, some cases may not be fit for laparoscopy in which case we convert it into open procedure at the same time.
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