Appendix Surgery
The appendix is a small, pouch-like sac of tissue that is located in the first part of the colon (cecum) in the lower-right abdomen. Lymphatic tissue in the appendix aids in immune function. The official name of the appendix is vermiform appendix, which means “worm-like appendage.” The appendix harbors bacteria. The suffix “-itis” means inflammation, so appendicitis is inflammation of the appendix. Appendicitis occurs when mucus, stool, or a combination of the two blocks the opening of the appendix that leads to the cecum. Bacteria proliferate in the trapped space and infect the lining of the appendix. If the inflammation and blockage are severe enough, the tissue of the appendix can die and even rupture or burst, leading to a medical emergency.
Anyone can get appendicitis, but it occurs most often in people between the ages of 10 and 30. About 7% of people will experience appendicitis during their lifetime. Very young children and elderly people are at higher risk of complications due to appendicitis. Early recognition and prompt treatment of the condition are necessary, especially in vulnerable populations.
Delaying the diagnosis and treatment of appendicitis increases the risk of complications. One potential complication, the perforation, can lead to an accumulation of pus (abscess) around the appendix or an infection that spreads throughout the abdominal lining and that of the pelvis (peritonitis). Surgery should occur as soon as possible after the diagnosis of appendicitis. Longer delays between diagnosis and treatment (surgery) increase the risk of perforation. For example, the risk of perforation 36 hours after appendicitis symptoms first appear is 15% or more.
Signs and Symptoms
One of the first symptoms of appendicitis is abdominal pain that is hard to localize. People with appendicitis typically experience pain in the central part of the abdomen that eventually moves over to the right lower quadrant. Loss of appetite is another early symptom of appendicitis. Nausea and vomiting may occur early in the course of the illness or even later as the result of an intestinal obstruction.
Doctors diagnose appendicitis clinically, based on the patient’s symptoms and findings during physical examination. A person with appendicitis usually experiences moderate-to-severe pain when the doctor gently pushes down on the lower right abdomen. A potential indication of peritonitis is “rebound tenderness,” which is a worsening of pain when the doctor removes his hand after pressing down on a tender area of the abdomen. The diagnosis could be supported by laboratory tests and imaging studies (Ultrasound, CT- Scan).
Treatment of Acute Appendicitis
Surgical removal of the appendix is called an appendectomy. Antibiotics are given to a patient with suspected or confirmed appendicitis both before and after surgery. Appendectomies can be performed laparoscopically, where special surgical tools are advanced into the abdomen via small incisions.
Appendiceal Carcinoid
Carcinoid tumors are the most common tumor of the appendix, accounting for more than half of all appendiceal malignancies and discovered in seven of every 1,000 appendectomy specimens. They account for 5% of gastrointestinal carcinoids and are more common in women than men. The mean age at presentation is 49 years. This may reflect the common patient age at appendectomy, when the tumors are often incidentally discovered. Approximately two-thirds of appendiceal carcinoid tumors arise in the tip of the appendix, where they are unlikely to cause symptoms of obstruction. Ten percent of appendiceal carcinoids occur in the base where they are more prone to obstruct the appendix and cause acute appendicitis.
Tumor size has been shown to be the best predictor of prognosis in patients with appendiceal carcinoid tumors; as such, the surgical management of appendiceal carcinoids depends largely on the size and location of the primary tumor. According to current guidelines, simple appendectomy is adequate for the treatment of small carcinoid tumors (< l cm). Indications for more extensive surgery than simple appendectomy have been shown to include tumor size >2 cm, lymphatic invasion, lymph node involvement, spread to the mesoappendix, tumor-positive resection margins, and cellular pleomorphism with a high mitotic index.