 The
appendix, an ongoing troublemaker
The appendix, which is a
vestigial organ that people seem able to live
normally without, is also one of the most distressing
and costly parts of the human body. With little
or no warning, the appendix can become obstructed
and quickly lead to infection, making appendicitis
the most common cause for emergency surgery
in Western countries.
Appendectomy — surgical
removal of the appendix — is the only
accepted medical treatment for appendicitis.
Treatment with antibiotics follows, especially
if the appendix ruptured prior to surgery.
In 1886, when appendicitis was
first described in medical literature, the death
rate for patients with a ruptured appendix approached
30 percent. Today it is less than 1 percent,
thanks to better surgical techniques, antibiotics
and improved postoperative care.
Although the incidence of appendicitis has declined
significantly since the 1930s, about 250,000
cases do still occur each year in the United
States. Appendicitis can afflict people of all
ages, from infants to the elderly. In Western
countries, 9 percent of men and 7 percent of
women will develop appendicitis.
A non-diagnosis can lead to serious,
even life-threatening complications when an
infected appendix is not removed soon after
manifestation of symptoms. Since the risk of
appendicitis is so common and delays in diagnosis
can result in costly or even deadly outcomes,
surgeons sometimes remove a healthy appendix
whilst doing various type of abdominal surgery.
The appendix is located at the
tip of the cecum, a large blind pouch at the
beginning of the large intestine. It contains
a lot of well-organized lymphoid tissue and
is thought to have evolved with some bearing
on the immune system. Its current function is
unknown, and its surgical removal has not been
linked to an increased risk of any illness,
including colon cancer.
The appendix lies in the lower
right side of the abdomen of most people, and
acute pain in that region prompts many to fear
that they have appendicitis and to quickly seek
medical care. The pain of appendicitis, however,
can sometimes radiate elsewhere throughout the
abdominal region. In infants and small children,
diagnostic delays are common because symptoms
are often mistaken for gastrointestinal (colic)
or urinary tract infections, or a many other
abdominal disorders with symptoms that can mimic
those of appendicitis.
Within 36 hours of the start
of symptoms, the appendix in a child is susceptible
to rupture, spilling its infected contents into
the abdomen and creating a serious medical emergency.
Within 48 hours after abdominal pain begins,
80 percent of children will experience a ruptured
appendix, according to a report in the journal
Contemporary Pediatrics. The appendix ruptures
in 90 percent of children under 2.
In total, one-third of children
with appendicitis, the appendix ruptures before
the ailment is correctly diagnosed and treated.
In the elderly, as well, appendicitis often
results in a delayed diagnosis, because even
when the appendix is severely inflamed, the
pain is often minimal and patients have no fever.
Among pregnant women, in addition
to the unusual location of the pain when the
appendix is displaced by the uterus, patients
often assume their symptoms are somehow related
to pregnancy, not appendicitis. In women who
are not pregnant, the symptoms can be confused
with gallbladder disease, a ruptured ovarian
cyst or pelvic inflammatory disease.
Confusing matters even further,
some people experience recurrent attacks of
appendicitis, without rupture, over a period
of years before the cause of their symptoms
is determined. Experts say that appendicitis
should be suspected in patients with a history
of recurring pain in the lower right abdomen
that goes away on its own.
Appendicitis most often occurs
between the ages of 10 and 30; 80 percent of
cases occur before age 45. Heredity is calculated
in the risk, which is up to 10 times as great
in someone with a parent or sibling who has
had appendicitis.
Diets high in fiber are linked
to a lower risk of appendicitis, probably because
stool is softer and passes more quickly through
the digestive tract.
Appendicitis occurs when the
appendix, a hollow finger-shaped organ, becomes
obstructed, most often by pieces of hardened
stool, sometimes by parasites, stones, tumors
or foreign bodies. Infection and inflammation
and the buildup of fluid follow until the appendix
becomes gangrenous and ruptures.
These symptoms are commonly associated
with appendicitis: pain that starts around the
navel and moves to the lower right side of the
abdomen within a day; low-grade fever, rarely
over 101 on the first day of pain; nausea and
vomiting; a feeling of constipation; and a progressively
severe ache that gets worse while walking or
coughing.
Following a description of symptoms,
the medical work-up starts with a physical exam,
which typically reveals localized tenderness
and signs of muscle inflammation. The white
blood cell count is higher than normal in about
two-thirds of patients.
If the diagnosis is in doubt,
a sonogram, CT scan or both are often needed
to help the doctor zero in on a correct diagnosis.
A refinement of the CT scan, an appendiceal
CT scan that uses a dye inserted in the rectum,
takes only about 15 minutes, involves far less
radiation exposure and is more accurate in pinpointing
appendicitis than a generalized abdominal scan,
according to a report in the October issue of
Emergency Medicine.
|
