Appendicitis occurs when the appendix becomes inflamed. It’s the most common major surgical emergency. More precisely, this disorder is an inflammation of the vermiform appendix, a small, fingerlike projection attached to the cecum just below the ileocecal valve. The appendix may harbor good bacteria that protect the gut and play a role in the immune system.
Causes of appendicitis include:
• mucosal ulceration
• fecal mass (fecalith)
• barium ingestion
• viral infection.
Mucosal ulceration triggers inflammation, which temporarily obstructs the appendix. The obstruction blocks mucus outflow. Pressure in the now-distended appendix increases, and the appendix contracts. Bacteria multiply, and inflammation and pressure continue to increase, restricting blood flow to the organ and causing severe abdominal pain. Inflammation can lead to infection, clotting, tissue decay, and perforation of the appendix.
If the appendix ruptures or perforates, the infected contents spill into the abdominal cavity, causing peritonitis, the most common and dangerous complication.
What to look for
Initially, the patient may manifest these signs and symptoms:
• abdominal pain, generalized or localized in the right upper abdomen, eventually localizing in the right lower abdomen.
• nausea and vomiting
• boardlike abdominal rigidity
• retractive respirations
• increasingly severe abdominal spasms and rebound spasms. (Rebound tenderness on the opposite side of the abdomen suggests peritoneal inflammation.)
Later symptoms include:
• constipation (although diarrhea is also possible)
• fever of 99º to 102º F (37.2º to 38.9º C)
How it’s treated
An appendectomy is the only effective treatment for appendicitis. If peritonitis develops, treatment involves GI intubation, parenteral replacement of fluids and electrolytes, and administration of antibiotics.