Dr. Anthony Tannous

    Appendicitis

    7/24/2018 12:00:00 AM

    Healthy Living – July 24, 2018
    Anthony Tannous, MD – Eastern Maine Medical Center
     
    Tannous.jpgAppendicitis is one of the most common problems that require surgery in the United States. Most all of us have someone we know who has had their appendix removed. It’s a problem that can occur at any age and it presents in a wide spectrum of severity. In the great majority of cases the answer is surgery, but not in all cases.

    The most common symptom of appendicitis is abdominal pain. The appendix is a small outpouching of the beginning of the colon and it usually sits in the right lower abdomen. But the pain is not necessarily located in that area, at least at first. Most of the time, the discomfort initially occurs in the area around the umbilicus. It then migrates to the right lower abdomen over the course of the day as the appendix gets more and more inflamed. At some point, the appendix gets so inflamed that it “bursts” or perforates. The relief in pressure actually results in a temporary relief in symptoms and the pain is slightly improved. Over the next hours though, infection overcomes the abdomen and peritonitis sets resulting in even more pain.

    The pain is usually accompanied by other symptoms such as nausea, vomiting, lack of appetite, and fever. Most patients present to the emergency department or their primary care provider’s office a day or two into the process. In most cases, your doctor will suspect appendicitis and order some tests. The tests may include a blood count which will in most cases show an elevated white blood cell count, and an imaging study such as a CT scan of the abdomen. The CT scan is the best way to show the appendix. But in some younger children and pregnant women, some doctors may resort to an ultrasound or an MRI to prevent radiation.

    Once the diagnosis of appendicitis is made, a surgeon is usually called. In most cases, surgery is the answer, and in the great majority of cases, the appendix is removed laparoscopically with small incisions under general anesthesia. If it is not perforated and everything goes smoothly, most patients can go home to recover without the need for antibiotics, but your surgeon may choose to keep you if they are concerned about anything and want to watch you further or give you more antibiotics. When the appendix has burst, there is usually a fair amount of contamination in the abdomen, and you may need to stay in the hospital for a day or two while receiving intravenous antibiotics.

    Not all patients require immediate surgery, however. If there are signs on the CT scan that the appendix has burst and resulted in a large abscess, it may not be prudent to operate right away. The infection and inflammation in that area may increase the risk in injury to the surrounding organs such as the colon and the small bowel. In most of these cases, patients require a course of antibiotics and a drain into the abscess that is most of the time placed by a radiologist under image guidance. A few weeks down the line, once the inflammation has calmed down sufficiently, the surgeon may revisit the option of an appendectomy.  

    Recovery from a simple appendectomy is usually swift. The great majority of patients have slight discomfort around the incision sites that can be treated with over the counter pain medications. You may need to take a couple of days off from work or school especially if you are on your feet a lot. It’s important to follow up on the pathology of the appendix as in some rare cases, the pathologist may find unusual findings that may need follow up.

    We don’t know what causes appendicitis but we certainly know how to fix it. Make sure to be diligent about seeing your doctor when symptoms arise because the earliest we get to it, the earliest you can go back on your feet.
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