Dr. Maria Kapoor Suri & Dr. Rishabh Gupta
The Appendix has long been thought of as a vestige of our evolutionary history, but a new study cast doubt on this concept by indicating that it may have an impact on gut and immunological function. The appendix may operate as a storehouse for immune cells and good bacteria, assisting in the preservation of a balanced population of microorganisms in the gastrointestinal tract, as suggested by the existence of lymphatic tissue. Thus, especially in the early stages of life when the immune system is still growing, the appendix may aid in immunological monitoring and response.
Moreover, the complex population of bacteria that live in the digestive system, known as the gut microbiome, may be developed and maintained in part by the appendix, according to new research.Even with these new understandings of the appendix’s possible uses, there is still controversy and clinical curiosity about it.
The medical illness known as appendicitis is defined by inflammation of the appendix, which is a tiny finger-like projection around 8-10cm long, that is situated at the start of the large intestine. Although the exact causes of appendicitis are frequently unknown, a confluence of genetic, environmental, and behavioural variables is thought to be the cause. The common cause of appendicitis is a blockage of the appendix’s opening, which allows mucus, germs, and faecesto build up inside the organ.There are several potential causes of this obstruction, includingFecolith (solidified clump of excrement obstructing the appendix’s opening),Expanded lymphoid tissue, Tumours (gastrointestinal tract tumours can obstruct the appendix’s opening) and round worms.
A variety of symptoms, varying in intensity and onset from person to person, are associated with appendicitis. Classic appendicitis symptoms include Abdominal Painwhichbegins near the navel and moves to the lower right side of the abdomen, Loss of Appetite, Vomiting and Nausea, Fever and chills, and Change in Bowel Habitsincluding but not limited to constipation, diarrhoea, or difficulties in passing gas, Abdominal Tenderness, Rebound tenderness (pressing and then rapidly releasing pressure from the abdomen causing pain),Localized Swelling may be seen if the appendix has developed an abscess or has become extremely inflamed and there may be Low-Grade Fever.It’s crucial to remember that not everyone with appendicitis will have every symptom listed and that symptoms can differ in intensity. Additionally, the diagnosis of appendicitis can be more difficult in certain individuals, such as small children, pregnant women, and older adults, as they may show unusual symptoms. It is imperative to seek medical assistance as soon as appendicitis is suspected in order to avoid complications including appendiceal rupture and peritonitis.
A physical examination, diagnostic tests, and medical history are usually used to diagnose appendicitis. A thoroughMedical History about the patient’s symptoms, including the location, duration, and start of any abdominal discomfort, along with any concomitant symptoms like fever, vomiting, nausea, or changes in bowel habits is taken first. A Physical Exam is performed to look for localized pain, especially the lower right quadrant, which is home to the appendix. Urinalysis is doneto rule out any urinary tract infections.Imaging Tests like CT scans or ultrasounds may be ordered. Due to its low radiation exposure, ultrasound was frequently chosen as the first line of investigation, initially a gold standard, whereas CT scan has shown better accuracy, thereby reducing thenumber of admissions and negative appendectomies. CT scan is also employed in situations where the diagnosis is unclear.
The Conservative or Non-Surgical Approach to treating appendicitis, commonly referred to as non-operative management, is treating mild cases of the illness with supportive care and antibiotics rather than removing the appendix surgically right away. If appendix gets adherent to other organs forming a lump, conservative management is usually advised. Surgical intervention may be required if patients do not respond well to antibiotics or if they experience recurring episodes of appendicitis, perforation, or the formation of an abscess not responding to conservative management. To treat the inflamed appendix and stop additional complications in such circumstances, an appendectomy may be done.
An appendectomy, or surgical excision of the inflamed appendix, is one of the commonest performed emergency surgeries in the world. It is a technique used to treat appendicitis in patients with severe or acute cases.Additionally, patients who are not suitable candidates for non-operative management or who have failed conservative treatment may undergo surgery.In Open Appendectomy a lower right abdominal incision is madeto reach and remove the appendix. With this method, the surgeon may see the appendix and surrounding organs directly, which is advantageous in complex cases or patients with different anatomy. In Laparoscopic Appendectomy,a minimally invasive procedure, a thintube with a camera is inserted into the abdomen along with surgical instruments to perform an appendectomy.
Compared to open surgery, laparoscopic appendectomy has a number of benefits, such as a quicker recovery period, less pain following the procedure, and a lower chance of problems like hernias and wound infections. In many healthcare settings, it is the recommended course of action for simple cases of appendicitis.While appendectomy is generally safe and effective, complications can occur, including bleeding, infection, wound complications, and injury to surrounding organs or structures. Prompt recognition and management of complications are essential for ensuring optimal outcomes for patients undergoing surgical treatment for appendicitis. After surgery, patients are monitored in the recovery room before being transferred to a hospital ward or discharged home, depending on their condition and the surgical approach used. Pain medication is provided to manage postoperative discomfort, and patients are encouraged to gradually resume normal activities as tolerated. In uncomplicated cases, most patients can expect to be discharged within 24 to 48 hours after surgery.
Life after surgery: One may return back to work in 1 to 3 weeks after laparoscopic surgery and 2 to 4 weeks after open surgery. One should avoid high-fat, processed meat, spicy and acidic food, and sugary snacks. Day-to-day activity should be normal. Development of constipation should be avoided by incorporating fiber-rich fruits, vegetables, whole grains, lean protein, and lots of fluids into the diet.
(The writers Dr. Maria Kapoor Suri is Additional Professor, Department of General Surgery, AIIMS Vijaypur, Jammu and Dr. Rishabh Gupta is Senior Resident, Department of General Surgery, AIIMS Vijaypur, Jammu).
