Appendicitis

appendicitis

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Key People:

John B. Murphy

Related Topics:

appendectomy

appendicitis, inflammation of the appendix, the closed-end tube attached to the cecum, the first region of the large intestine. While some cases are mild and may resolve on their own, most require the removal of the inflamed appendix through abdominal surgery (usually via laparotomy or laparoscopy), often leaving a small scar or scars. If untreated, there is a high risk of peritonitis, in which the inflamed appendix bursts; shock and death can result.

The first person to describe acute appendicitis was American physician Reginald H. Fitz in 1886. His article, “Perforating Inflammation of the Vermiform Appendix with Special Reference to Its Early Diagnosis and Treatment,” was published in the American Journal of Medical Science and led to the recognition that appendicitis is one of the most common causes of trouble in the abdomen for humans worldwide.

The main factor that seems to precipitate a bout of appendicitis is obstruction of the appendix. Obstruction may arise from blockage by a hard mass of fecal matter (a fecal stone), by infection with parasites, or by the presence of a foreign object. Lymphoid hyperplasia, a rapid increase in the production of white blood cells known as lymphocytes, which may be associated with viral illness, can also cause obstruction. Excessive consumption of alcohol may exacerbate a case of appendicitis. Doctors try to establish whether a patient may have appendicitis by measuring the number of white blood cells (leukocytes), which often increase from the normal count of between 5,000 and 10,000 (for an adult) to an abnormal count of between 12,000 and 20,000. This takes place because of other acute inflammatory conditions that occur in the abdomen at the same time.

Those who suffer an attack of appendicitis usually feel pain all over the abdomen or sometimes in the upper abdomen around the area of the navel. The pain is usually not very severe initially. For a period of one to six hours after the first pain sensation, the abdominal pain becomes restricted to the lower right side, and it becomes sharper. There may also be nausea and vomiting, with patients often developing a fever, although this sometimes happens some hours, or even a day, later.

The basic method for treating appendicitis is for a surgeon to completely remove the appendix in a minor operation called an appendectomy. The operation, conducted under anesthesia, often is completed quickly. Problems arise if the diagnosis of acute appendicitis is not made straightaway. It is possible for doctors to wait for a while—often as long as 34 hours—so that a more definitive diagnosis can be made. During that time it is important for the patient to remain in the hospital in case of medical emergencies or when the need for surgical intervention arises.