Appendicitis; early detection prevents bigger complications

The appendix is a long, thin pouch that is shaped like a finger. It hangs down from the large intestine.

The appendix is of an unclear function in humans, and is an organ associated more with negative importance than positive. One theory is that the appendix acts as a storehouse for good bacteria, “rebooting” the digestive system after diarrheal illnesses. Other experts believe the appendix is just a useless remnant from our evolutionary past. Surgical removal of the appendix causes no observable health problems.

Appendicitis is one of the commonest surgical emergencies worldwide. Although it can occur at any age, it is most frequent in the second and third decades of life. The incidence is approximately 233/100,000 population and is highest in the 10 to 19 year-old age group. It is also higher among men (male to female ratio of 1.4:1), who have a lifetime incidence of 8.6 percent compared to 6.7 percent for women.

A blockage in the lining of the appendix often by stool, a foreign body, or cancer usually results into infection and can easily lead to appendicitis. The bacteria multiply rapidly, causing the appendix to become inflamed, swollen and filled with pus. If this is not treated promptly, the appendix can rupture causing wide spread infection which is a serious life threatening condition.

The usual symptoms of appendicitis can include; Severe pain in the lower part of the belly, on the right side. (For many people, the pain starts near the belly button and then gradually shifts to the lower right side.), Loss of appetite, nausea and vomiting, fever. Some people have a different set of symptoms that include stomach upset, having a lot of gas, feeling of irregular bowel movements, diarrhea.

The diagnosis of appendicitis is made largely through thorough history taking of the patient’s symptoms and a physical medical examination. Changes in the abdominal exam help doctors tell if appendicitis is progressing, as well. An ultrasound scan can be ordered to help locating any changes of the appendix suggestive of appendicitis.

An abdominal CT scan (computed tomography), uses X-rays and a computer to create detailed images. In appendicitis, CT scans can show the inflamed appendix, and whether it has ruptured.

Blood investigation tests can be done to look out for any features of bacterial infection in a patient suspected to have appendicitis.

Once the diagnosis of appendicitis has been confirmed, the main treatment for appendicitis is surgery to remove the appendix. This surgery can be done in 2 ways; Open surgery, where the doctor makes a cut near the appendix that is big enough to pull the appendix through or laparoscopic surgery, where the doctor makes a few cuts that are much smaller than those used in open surgery and then inserts long, thin tools into the belly. One of the tools has a camera (called a “laparoscope”) on the end, which sends pictures to a TV screen. The doctor can look at the image on the screen to know where to cut and what to remove. Then he or she uses the long tools to do the surgery of removing the appendix. During laparoscopic surgery, the doctor makes a few cuts that are much smaller than those used in open surgery, and hence laparoscopic surgery will have better cosmetic outcome than open surgery.

In addition to surgery, antibiotics will be given to clear off the present infection.

There is no way to prevent appendicitis. However, appendicitis is less common in people who eat foods high in fiber, such as fresh fruits and vegetables Basically, fiber softens your stool and increases its weight and size, making it easier to pass. This means that stool is less likely to become trapped in the appendix.

Dr. Ian Shyaka is a General Practitioner at Rwanda Military Hospital.