Appendectomy

Your appendix is a long, thin tube-like pouch. It hangs down from the end of your large intestine, or colon, on the right lower part of your abdomen. The purpose of the appendix is not understood. We believe it is an organ leftover from evolution or it may have a role in our immune system.

An appendicitis is an infection and inflammation of the appendix. The appendix is a small tube-like structure that hangs off the colon. Its purpose is not well understood, but it is not essential. General treatment for appendicitis is to remove the appendix. This is done through surgery called appendectomy. You can either have an open appendectomy or a laparoscopic appendectomy.

Reproduced with permission from: Patient Information: Appendicitis in Adults (The Basics). In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA 2012. Copyright © 2012 UpToDate, Inc. For more information visit www.uptodate.com.

Appendicitis

We diagnose you with appendicitis when your appendix gets infected and inflamed. Often the cause is a small blockage to the small opening of the appendix. The appendix becomes inflamed due to natural bacteria in the colon and appendix becoming trapped. The appendix swells and in some cases can burst. A burst appendix is dangerous as it can cause widespread abdominal infection. This infection can make you very sick. Although appendicitis is more common in children, it can happen in any age group.

Common symptoms

If you have any of these symptoms, you should seek medical attention.

• 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 moves to the lower right side.)
• Loss of appetite
• Nausea and vomiting
• Fever

Less common symptoms include:

• Upset stomach
• Gas pains or abdominal bloating
• Irregular bowel movements, can be diarrhea or constipation
• Feeling ill (flu-like symptoms)

It is important to remember these symptoms can be caused by other conditions in the abdomen. Regardless, you should seek medical attention if you have the above symptoms.

Testing

We preform various tests to determine if you have appendicitis or another condition that can mimick the symptoms of appendicitis.

• Blood tests to look for signs of infection or inflammation in the body
• Physical examination of your body and particularly your abdomen to help determine the origin of your symptoms.
• Ultrasound to create an image of the organs on the inside of your abdominal cavity.
• A CT scan or sometimes called a CAT scan which is a special X-ray of the inside of the body.

Appendicitis can also occur during pregnancy. If you are pregnant and have symptoms of appendicitis, you should seek medical attention. We can perform different tests to determine if you have appendicitis. You may still need surgery to remove your appendix so your doctor will discuss the risks and benefits with you.

Appendectomy

The main treatment for appendicitis is surgery which removes the appendix. We do appendectomies 2 different ways.

• Open surgery — During open surgery, your doctor makes an incision near the appendix, on the right lower part of your abdomen. The incisoion will be large enough to pull the appendix through, about 3 - 4 inches. We cut your appendix from its attachment to the colon and removed it from your body.
• Laparoscopic surgery— Laparoscopic surgery is a minimally invasive surgery. We do the surgery using a camera and long tools through the wall of the abdomen. We view the inside of your abdomen on a television screen using the camera. During this surgery, your doctor makes a few smaller cuts. Usually one cut will be around the belly button with another 2-3 smaller incisions on other areas of your abdomin. Then he or she 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, cutting the appendix of its attachment to the colon. He or she removes it through the hole around your belly button.
  The doctor will discuss surgery options, risks, and benefits with you.

Risks

The major risks of appendectomy may include, but not limited to:

• Bleeding
• Injury to surrounding organs, including the intestines, the bladder, female reproductive organs
• Infection in the belly or in the wounds especially if your appendix has burst
• The need for further surgery or other procedures

Burst (ruptured) appendicitis

If your appendix has burst, your surgery will be more complicated. Your doctor will need to cleanse the infection that spilled out when your appendix bursts. As a result, your cuts may be larger or you may spend more time in surgery. You will likely need to stay in the hospital for at least 3-5 days. While there you will receive IV antibiotics for the infection in your abdomen.

If it has been a few days since your appendix burst, your doctor might decide not to do surgery at all. The body can form a wall inside the abdomen, called an abscess, to block off the area that became infected. In cases like that, your doctor will give you antibiotics and watch you in the hospital. Sometimes we need to remove the infection using a drain.

Your doctor might try to avoid surgery altogether because it can be more dangerous for you. After a burst appendicitis your surgery might be longer and more complex as we try to remove your appendix. In fact, sometimes we will recommend waiting 6 - 8 week for you to get surgery. This wait allows the infection and inflammation to resolve as you use antibiotics. This then makes the surgery less risky.

Recovery

If your appendix is not ruptured, we will likely hospitalize you overnight. You might be able to go home the same day depending on your specific condition. You will be sore at the incision sites for several days. You may need to be off work (or school for 1-2 weeks). You will want to take it easy and should not do any strenuous activity for a few weeks.

If your appendix has ruptured, we may hospitalize you for 3 - 5 days or more. This allows us to give you IV (intravenous) antibiotics to treat the infection. We track your diet to make sure you are able to digest the food you eat. It is important that your intestines are working as expected before you leave our care.