What has gone wrong?
The appendix commonly gets infected. This causes cramping pains in the centre of the abdomen, often with vomiting. The appendix then swells; this is called appendicitis. It then irritates the overlying abdominal wall, giving pain around the umbilicus and in the right side of the abdomen.
If untreated, the appendix may burst inside the abdomen or form an abscess. Sometimes a slightly infected appendix will settle down by itself over three or four days or so.
The aim is to take out the infected appendix before it can cause serious damage. This operation is called an appendicectomy.
There are two possible operations to remove the appendix. Sometimes an open appendicectomy operation will be done. Other times laparoscopic surgery is done instead, with three or four tiny cuts in the lower abdominal wall and around the umbilicus. The choice is normally on a case-by-case basis and the experience or preference of the surgeon.
You should safely and quickly return to normal health. There would be no risk of appendicitis again. If there is another surgical cause for your pains, we can deal with that straight away while you are still under the anaesthetic.
The traditional operation for appendicitis is the open appendicectomy. Recently, laparoscopic surgery has become more common and laparoscopic appendicectomy is becoming routine. But laparoscopic surgery is not possible in all cases. You should discuss the type of operation to be done with your surgeon. Laparoscopic appendicectomy has a number of advantages over the open operation, namely:
- A quicker recovery.
- A shorter stay in hospital.
- Less pain.
- A lower risk of infection.
- Smaller wounds.
- Less formation of adhesions.
- The surgeon can examine the rest of the abdomen, especially important if the appendix appears normal through the laparoscope.
The main disadvantage is that the operation takes longer than a straightforward open operation.
Are there any alternatives?
There is no x-ray or laser treatment. An ultrasound scan of the abdomen is helpful in pointing to diseases in the ovaries or Fallopian tubes, but it cannot rule out appendicitis. There are no blood tests to find out whether you have appendicitis.
What if you do nothing?
If appendicitis is not clearly the cause of your pains, waiting to see if you get better over six hours or so is reasonable. Antibiotics and painkillers during this time are helpful.
There are many conditions that appear like appendicitis. Some can lead to serious illness if not operated on. They include cysts of the ovary, Meckel's diverticulitis, or even bowel cancer in an older person. Other conditions, such as virus infections of the nearby glands or bleeding into the ovary, settle down without surgery. Sometimes nothing abnormal is found, suggesting that the pains were a simple bowel cramp or colic.
If your appendix is infected and takes its natural course, you may become very ill and even die. We cannot be sure about the cause of your pains until we look inside your abdomen. The chance of finding nothing serious is about one in 10. However, it is safer to do the operation than to risk the problems of missing an infected appendix or other condition needing surgery.
Author: Mr Michael Edwards FRCSEng FRCSEd. Consultant general surgeon.
© Dumas Ltd 2006