Appendectomy and Appendicitis


An appendectomy is the surgical removal of the vermiform appendix and is the only effective treatment for acute appendicitis. Acute means it starts suddenly. Appendicitis usually develops without warning over a period of 6-12 hours. An appendectomy is usually performed to prevent rupture of an inflamed appendix, and is often done as emergency surgery. Emergency surgeries are urgent and life saving. If the appendix bursts, there is an overwhelming risk of infection and complications. If there is no evidence of rupture, most appendectomies are done laparoscopically. Before going further, let’s first understand the vermiform appendix and appendicitis.

The Appendix

Labeled structures in the abdomen The appendix, located in the right lower quadrant, is a 3-6 inch long, worm shaped process projecting from the end of the cecum and lined with a mucus membrane. The appendix is of no potential use to the functioning of the human body. The appendix is closed at one end and the other end is attached to the large intestine. The function of the large intestine is to move the waste from the body through the anus and absorb water. The appendix can get blocked with stool or bacteria causing it to produce mucus, which eventually thickens and blocks the appendix. When the appendix gets blocked, it gets swollen, inflamed and filled with pus. This condition is called appendicitis.

Appendicitis

Symptoms of Appendicitis

The first symptoms of appendicitis are on and off pain in right side of the abdomen, which gradually increases to a sharp and persistent pain in and around the bellybutton. The pain may move towards the right lower quadrant of the abdomen and gets worse with moving, taking a deep breath, coughing, sneezing, walking or being touched. Other symptoms include:
• fever (follows other symptoms) of 100°F to 101°F
• nausea, vomiting, loss of appetite
• frequent and/or painful urination
• diarrhea
• constipation, and can’t pass gas
• abdominal swelling in the later stages

Blood tests will show an elevated white blood count. Sometimes appendicitis can be hard to diagnose because many other illnesses cause sudden abdominal pain and similar symptoms. Early diagnosis is important to prevent rupture (when your appendix bursts) and complications.

If untreated, appendicitis can be fatal. When the infected appendix bursts, the contents of the lower gastrointestinal tract enters the abdominal cavity, and infects the entire peritoneal cavity. When this happens, the patient gets a high fever and the pain may suddenly stop.

Appendicitis is more common in men, occurs between the ages of 10 and 20, and rarely occurs after age 50. Acute appendicitis is an emergency and the appendix should be removed right away. There is no specific prevention for appendicitis.

Complications of Appendicitis

Complications of appendicitis include blocking of the intestine. When the appendix gets inflamed it can block the intestine and interferes with the function of the intestinal wall. This prevents passing of liquids and gas causing nausea and vomiting.

An infected appendix can rupture or burst within 24 hours after symptoms begin. This may cause abscesses, that is, pus-filled boils around the appendix; or diffuse peritonitis, that is, infection of the abdominal cavity which is a potentially life-threatening. Symptoms of peritonitis include mild to moderate abdominal pain, fever, change in bowel habits and feeling as if you don’t have enough energy to do your daily activities.

Appendicitis can also spread bacteria causing an infection in the blood stream—a life threatening illness called septicemia.

Diagnosis of Appendicitis

The initial diagnosis of appendicitis is done by a complete history and physical examination. The physical examination looks for signs of appendicitis like increased temperature, tenderness in the right lower part of the abdomen, especially when the doctor presses on the area, there is a sharp increase in pain when the pressure is removed—rebound tenderness. To confirm the diagnosis of appendicitis, the doctor may order some or all the following tests:

White Blood Count (WBC): The white blood cell count is usually elevated when an infection is present. An elevated WBC count helps confirm appendicitis. However, a WBC alone cannot determine appendicitis since a WBC increases in any kind of infection.

Urinalysis: This is the microscopic examination of the urine to determine the presence of red blood cells, white blood cells, or bacteria. An abnormal urinalysis means inflammation or kidney stones. The inflammation could be from the appendix since it is situated very close to the ureter and bladder.

Xray: Xray of the abdominal area can show an intestinal blockage. Stool may become hard and block the opening of the appendix which can be seen on xray.

Ultrasound: Ultrasound is a procedure that uses sound waves to examine various organs in the body. Ultrasound helps determine an enlarged appendix or abscess. Ultrasound also helps eliminate other health conditions that have symptoms similar to appendicitis, mostly in women, like complications of the ovaries or fallopian tubes.

CT Scan: A computerized tomography (CT) scan is very useful in case of pregnancy to identify appendicitis or other abscesses attached to the appendix and/or eliminate other diseases causing similar symptoms.

Treatment of Appendicitis

Appendicitis is treated surgically with an appendectomy.

Preparing for an Appendectomy

Preparations include the usual pre-surgery tests, including:
• complete blood count
• blood clotting tests
• urinalysis
• chest Xray

The anesthesiologist will want to know how long it’s been since you had something to eat or drink. General anesthesia can only be done on an empty stomach because of the risks of throwing up while sedated.

Anesthesia

Surgery can be done with either general anesthesia or spinal anesthesia.

The Appendectomy Procedure

Appendectomy or removal of the appendix can be done in two ways—the traditional open surgery or the newer technique called laparoscopic surgery. The procedure takes about an hour.

In an open appendectomy, a two- to three-inch incision is made in the skin of the abdomen and underlying layer of fat. The muscles and organs are separated and the peritoneum is cut to reveal the cecum (part of the colon). The appendix and other abscesses, if any, are identified and cut away from the colon. Any fluid or pus from the infected appendix is suctioned away. Sometimes a drain is left in place for a few days. The colon is sutured and blood vessels are tied off; the abdominal cavity is closed, followed by suturing or stapling the incision made on the skin of the abdomen. Stitches or staples are usually removed 7-10 days after surgery.

Laparoscopy - shows instruments in the abdomen

Laparoscopy - shows instruments in the abdomen

In a laparoscopic appendectomy, there are no large skin incisions, only a few small puncture wounds. The laparoscope, which is a thin tube with a video camera attached at one end, is inserted through one of these puncture wounds. The doctor is able to see inside the abdomen on a TV monitor that is attached to the video camera. The camera allows the surgeon to verify the diagnosis before removing the appendix. The appendix is removed with instruments inserted through one of the other puncture wounds on the abdomen. Laparoscopy is better for the patient than open surgery because there is less postoperative pain and less chance of complications. If you have a laparoscopy, you will most likely go home on the day of your surgery.

Sometimes the surgeon is unable to identify the appendix with the laparoscope or unable to remove the appendix due to scar tissue from prior abdominal surgery. In this case, the surgeon will have to do an open surgery. Depending on what he finds, the surgeon may do the open surgery immediately or he may close the punctures and schedule the open surgery for a later date.

In some cases, the surgeon may find the appendix to be normal with no signs of appendicitis. The surgeon may decide to remove the normal appendix since it’s better to remove the appendix than to have appendicitis later.

After surgery you will go to the recovery for room about an hour. If you had an open appendectomy you will be up and walking around within 6 hours. If there are no complications you will go home in a day or two.

Complications of an Appendectomy

As with all surgery, an appendectomy has possible complications. Complications may be due to anesthesia, breathing problems, bowel obstruction, side effects to medicines or the surgery.

The possible complications from surgery are excessive bleeding or infection of the incision site. Infection can range from mild to moderate to severe. In mild infections, there is mild tenderness and redness in the area. Moderate infections can be treated with antibiotics; severe infections may need surgical procedures in addition to antibiotics. Infections are rare with laparoscopic procedures.

An appendectomy that was performed for a ruptured appendix can have other complications requiring a longer hospital stay.

In very rare cases, appendectomy can have long-term effects such as increasing the risks for other diseases like Crohn’s disease.

Recovering From an Appendectomy

After an uncomplicated appendectomy, you will be released from the hospital within three days and can resume normal activities in about 2-3 weeks. Returning to normal activities can be a little longer if the appendectomy was done for a ruptured appendix or there were complications. Care during the healing process includes:

Eating and Drinking:

Start with a liquid diet if you have nausea and to allow your intestines to return to normal function. You can slowly resume your regular diet. It’s important to eat a balanced diet to speed up the healing process. You may need a stool softener to prevent constipation from pain medicine and the anesthesia.

Incision Care

The incision should be kept clean and dry as prescribed by your surgeon. Do not get your incision wet in a tub or shower until your surgeon says it’s OK. If you think you have a fever take your temperature. Check your incision every day for signs of infection like increased redness, swelling, pain in the incision site, drainage, or fever above 101.5°F. Call your surgeon right away:
• if you notice any signs of infection, bleeding or discharge at the incision site(s)
• if you have abdominal swelling
• if you have vomiting or diarrhea

If you had open surgery, you will have a short scar; if your surgery was done laparoscopically, you will have 3-4 scars about a half inch long where the instruments were inserted into the abdomen.

Returning to Normal Activities:

In most cases, you’ll be allowed to resume regular activities within two to three weeks after surgery. Your surgeon may give you certain restrictions to follow to avoid complications. Restrictions can include avoiding heavy lifting, not going to the gym, playing sports, running or jogging, or doing any heavy physical activities for 6 weeks. Avoid driving for 2 weeks.

Comments

  1. Since my husbands appendix burst,and were removed,he has loss energy,has a cough and pain in his right side (back) and has loss weight. he suffers from chronic COPD,and takes medication for this over 4 years.The surgeon said, the infection was in behind his intestines,they put him on Ciprofloxacin.He was off work for 6 weeks,has returned to work.He does not look well,and now tells me he has not been half of what he was before this,Is there a side effect he suffers from his appendix’s? I’m very concerned.He is 63 yrs. old Thank you,
    Shirley

  2. Media Partners says:

    Shirley, just having surgery is hard to come back from—the anesthesia, surgical pain and pain medicine can make you feel awful. Recovery takes time and everyone is different. Especially for someone that has an underlying health condition like COPD. A burst appendix is pretty serious, and his body is using all of its energy to heal and fight the infection. He should get as much rest as he can so his body can use the energy to heal. Have you told his doctors how he is doing an asked if there is anything your husband can do to speed healing? Maybe diet? Give him lots of support and be an advocate for his health. Hope he gets better soon.

  3. Thank you for the information.His copd has gotten much worse since this happened.His regular doctor takes this lightly., as he has never ordered any type of xray . i will be consulting a lung doctor. Is tthere a blood test that will determine other organs this could have effected? and lung xray of a different type?

    Shirley

  4. Media Partners says:

    Have you asked his regular doctor to refer him to a pulmonary specialist (lung and respiratory system specialist)?

  5. what are other long-term effects of an appendetomy?
    I had this procedure at age 25. I went on a diet and started exercising after my surgery, and now a year later, my stomach seems like it gets easily bloated after eating and my gas is bad. I sometimes get a sharp pain in the lower abdomen area. Can a stomach shrink after time from eating smaller portions? Something doesnt seem right. And no, I do not have a personal doctor.

    Michael A.

  6. Media Partners says:

    We don’t need our appendix so there isn’t anything your appendix was doing that it isn’t doing now that it’s gone. For instance, people that have their gallbladder out sometimes have trouble with fatty meals. The gas could be from a change in your eating habits—more what you eat than how much. Maybe you are eating healthier foods that is causing the gas? I had my appendix out when I was 8, a long, long time ago. I had an abscess and it almost burst. Years later when I had abdominal surgery, the surgeon mentioned that I had a lot of scar tissue in my abdomen and it was probably from the infection from the appendix. I too have those sharp pains on the lower right side, and have been told it is likely from adhesions (scar tissue) that grows to stuff in inside the abdomen and it pulls when I move a certain way. Sometimes it can just about take my breath away. I just try to avoid ever moving in a way that will pull that area. Have you been back to the surgeon who did the appendectomy? Sometimes they will want to see you after a year especially if you are having a problem. We don’t offer medical advice, just try to help educate so you can talk with your doctors. We do have an Ask-A-Doctor page where you can ask a doctor your question online. They are not expensive and are actually very good. Especially if you want some peace of mind about what to do.

  7. my 21 year old son’s appendix burst and he had an abcess formation. He had an open abdominal incision and a picc line post surgery. He has now healed completely but his belly looks like a butt. Is there anything we can do?

  8. Media Partners says:

    I know exactly what you’re talking about! My stomach looked like that after a c-section. It took plastic surgery to correct mine. Has he seen a plastic surgeon?

  9. no, he’s a bit overweight and was hoping if he lost the little belly bulge, his gut would even out. I just don’t know which excercises to recommend to regain his core. Any idea?

  10. Media Partners says:

    There is a great book that the trainer at my fitness club uses – Delavier’s Core Training Anatomy. It’s available at Amazon for $15. He should make sure he gets approval from his surgeon before he begins any exercise that uses muscles in the area where he had surgery or could have been affected by the abscess.

  11. Good day
    I am 23 years old and had Acute Appendicitis and was removed on Friday. I am recovering well but my stomach is still very bloated. How long will it tale fpr my stomach to go down to its normal size and when is the inside of my stomach fully healed?
    Kind regards

  12. Media Partners says:

    If you had it done lapracopically, they pump air into the abdominal cavity so they can see. It doesn’t take long for the air to be absorbed and your abdomen to go down. It takes 4-6 weeks to heal, including soreness from having your insides moved around to get to your appendix.

  13. Thank you very much for the reply but I had an appendetomy and my cut is quite big because the appendix was so close to burst. Doctor said it was a fat one.

  14. Hi,
    My mother in law has been in hospital for over a week with abdominal pains. She has been on an IV anti biotic. She had a scan 2 days ago and she says that she has been told that her appendix has burst. She also says that she has been told that there is no need for surgery.

    Can this be correct?

  15. Hi Neil
    I have read your question about your moms situation and struck me because I just had the same diagnosis of ruptured appendicitis, treated with antibiotic for 2 days in the hospital then released for 7-10days on oral antibiotics. Today, I am returned for a follow-up visit.

    The doctor told me upon discharge, I may never need a surgery if I am better, due to high level of antibiotic, ruptured appendix may all be healed and the chances of reoccurance is only 8-15%. So why take a chance on operation if not needed.

    And after 10 days on antibiotics, I am really feeling normal and much better. However, I do have one question, “where does all the murky liquids from the ruptured appendix bacteria go?

    I will probably get the answer today.
    If anybody knows or have similar experience, let me know.
    Thanks.

  16. jack charge says:

    I’m 16 and I had my appendix out last year some time it ruptured in surgery as they were taking it out ,and so I got back to the hosptal bed and my stomach was bubbling and in really bad pain and twisted bowlls so I had another opp and 2 enams and a caphata , and now I still get like a stingy sort of feeling in my scar have any idea what that is?

  17. Media Partners says:

    It could be from a nerve. I have a similar issue with my c-section scar and they said a nerve may have gotten a stitch in it at that spot. Mine only bothers me in certain positions or if I bump against something so there is pressure on the skin there.

  18. My ex husband had a ruptured appendix while out of town and had emergency surgery A subsequent CT showed part of the appendix is still there. Surgeon said this is normal and it will not be a problem. Now, a couple months after he is a local hospital being treated for “diverticulitis”.. he also recently had a colonoscopy and was not told he he even had diverticulosis.
    I am concerned that the real problem is the piece of appendix left behind because years ago they would go back in and remove it to prevent further problems? Is it okay for a piece of the appendix to be left behind?
    l

  19. Recovered very well following my appendectomy late May 2013. No complications and caught before any danger. However, I now seem to suffer a great great deal with unpleasant flatulence. Any tips on reducing this would be welcome.

    My diet contains very little processed food as I normally cook from scratch.

  20. chir chong lin says:

    I have a 13 years old son who was active in track and field since 9 years of age then last year end of October he got a acute appendicitis and had been removed… do he still can run or play basketball or any other activities? what are the activities he needs to avoid? because he want to be back and play again in the track…hoping for your help…thank you in advanced..God Bless..

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