How appendicitis occurs is not entirely understood. In some people, a piece of hardened stool becomes lodged in the appendix and the muscular wall of the appendix cannot dislodge the stool. So the appendix swells, becomes red and starts to cause symptoms. In typical cases, pain is felt around the navel and then later settles on the right side at about the belt line. Appendix pain can be very different, however and appendicitis can be very difficult to diagnose. As time goes by, the obstructed appendix fills with pus and may burst, spilling its infected contents into the abdominal cavity, producing the potentially lethal complication of peritonitis. The pain may be associated with a feeling of sickness and actual vomiting. The bowels may either be constipated or in some the stools are loose. Fever occurs but not in everybody with appendicitis. The symptoms above can be caused by a wide variety of conditions, some serious, other trivial; this is particularly the case in children and the elderly and in young women.

The doctor will take the history into account and will examine you. In typical cases the area on the right side of the tummy just below the navel is very painful to touch. The doctor may examine the back passage with a finger as sometimes, the appendix pops down into the pelvic cavity and can be felt when the rectum is examined. X-rays are not necessary to diagnose appendicitis unless certain other conditions such as kidney stones cannot be ruled out. Blood tests may help the doctor but they must be interpreted carefully and they can be misleading. In some instances, especially when there is doubt about the diagnosis, an abdominal scan may be helpful as it may pick up other problems such as cysts on the right ovary and infections in the pelvic cavity in women.

We now know that some, probably many cases of appendicitis settle without an operation. In early cases, or where there is doubt about the diagnosis, the doctor will choose to treat you without an operation. You will be given painkillers, fluids into your veins and paracetamol to bring your temperature down. Sometimes antibiotics are used. If, despite the above measures your symptoms do not subside, the doctor will advise that you have your appendix removed. The operation, referred to appendicectomy, is performed under general anaesthetic and the cut is on the right side of the tummy. Nowadays, many operations to remove the appendix are performed using the laparoscopic or ‘keyhole’ technique.

Most people recover quickly after an appendicectomy. Apart from soreness and stiffness at the site of the operation, there are no major side effects if the inflammation is caught early. Water is allowed the day after the operation and food within 48 hours. If the appendix had burst and produced peritonitis, however, recovery takes much longer. The patient will be put on a drip and a tube passed into the stomach to suck out its contents and stop vomiting. Antibiotics and painkillers are given. Water and food are withheld for longer while the operation site heals.

• If there was a lot of infection in the tummy cavity, the bowels may become paralysed for a few days. This complication is referred to as paralytic ileus and needs time to clear. The bowels will be rested and this means no food or drinks and a tube down in the stomach for some days.
• There is a chance of the wound becoming infected especially if the appendix had burst. In these cases some stitches may be removed to allow the infection to drain and the wound packed with antiseptic dressings.
• Bleeding can occur from the wound but this is uncommon.
• On rare occasions, tight bands of scar tissue, known as adhesions, can occur and these stick bowels together. It is rare to get adhesions in the few days after the operation but they can occur. If they occur, adhesions are more common months or years later. When they obstruct the bowels, an operation may be necessary to free them.

ENDOSCOPIC REMOVAL OF SCREW IN A CHILD

LAPAROSCOPY APPENDIX OPERATION