Appendicitis is an inflammation of the appendix. It is a three and half inch-long tube of tissue that extends from the large intestine. If it is left untreated, an inflamed appendix will eventually burst or perforate, spilling infectious materials into the abdominal cavity.
Appendicitis is the leading cause of surgical emergency admission in most hospital in Nigeria. It accounts for about 15 to 40 per cent of all emergency surgery done in most hospitals in Nigeria. Removing it is not harmful. The appendix is a small and connected to the large intestine, where faeces (stools) are formed.
All age groups can develop the disease, including children under the age of five, but the incidence is higher in the second and third decade of life.
It has been discovered that majority of patients in Nigeria present late with complicated disease. There are four types of appendicitis: Acute, sub-acute, recurrent and chronic appendicitis.
Acute appendicitis is a medical emergency that almost always requires prompt surgery in order to remove the appendix. This can lead to peritonitis, a serious inflammation of the abdominal cavity’s lining (the peritoneum) that can be fatal unless it is treated quickly with strong antibiotics.
Experts have said that one in 20 people will get appendicitis. Although it can strike at any age, appendicitis is rare under age two and most common between the ages of 10 and 30. No one knows exactly why people have an appendix.
A study done in the United States of America and published in Health Observer, suggests that the appendix may have some role in gut immunity, but nothing is definite. It added that people could live without it, without apparent consequences.
A surgeon at a private hospital in Lagos, Immaculate Tobi, said more cases of appendicitis were being reported for reasons he described as unfathomable.
He said: “I have performed operations on many patients between the ages of five and seven in recent past. Gone were the days when people going to a health facility to complain of appendicitis were mainly adults. Now we receive many children. But generally, the number seems to be increasing. It could also be a matter of increased awareness, unlike in the past when people would be seeking solution where there were none.
“Appendicitis operation is not a difficult one and it is nothing anyone should be afraid of. It could be done in less than an hour, especially when there are no complications. It is the delay that is always dangerous. After a normal surgery, the patient can begin to walk within 24 hours. It takes about three or four days for the patient to be discharged, except on other health grounds. The patient can resume work or school within two or three weeks.
“However patients must be adequately resuscitated before the procedure. Prognosis is excellent. High morbidities and occasional mortalities seen are usually due to late presentation and delay in treatments. In Nigeria, I believe that it is not just the fear of surgery but that of cost of treatment is the main reason for late presentation. Mass education should be done to enlighten the populace on the evil of late presentation. The government can do more in this regard by creating a kind of social support facilities that patients can make use of, at least for broader understanding and in emergency situations.”
Sometimes a pus-filled abscess (infection that is walled off from the rest of the body) forms outside the inflamed appendix. Scar tissue then “walls off” the appendix from the rest of the abdomen, preventing infection from spreading. An abscessed appendix can perforate or explode and cause peritonitis. For this reason, almost all cases of appendicitis are treated as emergencies, requiring surgery.
Studies have shown that the ailment is more common in female than in male. Also, it was hitherto believed that appendicitis was cosmopolitan disease but in the last two decades or so, it has been proven that there is no hospital, large or small, that does not have to deal with this condition in all parts of Nigeria, whether in the urban or in the rural areas.
Though no one knows exactly why people have an appendix, appendicitis occurs when the appendix becomes blocked, often by stool, a foreign body, usually a small piece of seeds, stones faeces (stool) or a swollen lymph node within the wall of the bowel, or cancer. Blockage may also occur from infection, since the appendix can swell in response to any infection in the body. This obstruction leads to the development of inflammation and swelling.
The classic symptoms of appendicitis include: Dull pain near the navel or the upper abdomen that becomes sharp as it moves to the lower right abdomen. This is usually the first sign. There is also loss of appetite; nausea and/or vomiting soon after abdominal pain begins; abdominal swelling; fever of 99-102 degrees; Fahrenheit and inability to pass gas.
Almost half the time, other symptoms of appendicitis appear, including: Dull or sharp pain anywhere in the upper or lower abdomen, back, or rectum; painful urination and difficulty passing urine; vomiting that precedes the abdominal pain; severe cramps and constipation or diarrhoea with gas.
Appendicitis typically starts with a pain in the middle of the abdomen (tummy), pain may come and go. Within hours, the pain travels to the lower right-hand side, where the appendix usually lies, and becomes constant and severe. Other symptoms may consist of anorexia, nausea, low grade fever, pressing on this area, coughing or walking, may all make the pain worse. The patient may lose appetite, feel sick and occasionally experience diarrhoea.
Tobi advised anyone who has any of the mentioned symptoms to seek medical attention immediately. He explained that timely diagnosis and treatment is very important. He kicked against the use of any pain remedies, antacids, laxatives, or heating pads, which can cause an inflamed appendix to rupture.
He also warned against the possibility of mistaking appendicitis for urinary tract infections.
Diagnosing appendicitis can be tricky. Symptoms of appendicitis are frequently vague or extremely similar to other ailments, including gallbladder problems, bladder or urinary tract infection, Crohn’s disease, gastritis, intestinal infection, and ovary problems.
However, the overall diagnostic accuracy achieved by history, physical examination, and laboratory tests has been approximately 80 per cent. In most cases, if the diagnosis of appendicitis is clear from the patient’s history and physical examination, no further testing is needed, and prompt surgical referral is warranted.
The ease and accuracy of diagnosis vary by the patient’s sex and age, and are more difficult in female children, elderly persons and women of childbearing age because acute gynecologic conditions (e.g. pelvic inflammatory disease) may cause symptoms similar to appendicitis.
The following tests are usually used to make the diagnosis: Abdominal examination to detect inflammation; urine test to rule out a urinary tract infection; rectal exam; blood test to see if your body is fighting infection; CT scans and/or ultrasound.
When the diagnosis is not clear, management options for suspected appendicitis include observation in a hospital, diagnostic imaging to clarify the diagnosis and laparoscopy. In atypical cases, ultrasonography and computed tomography (CT) may help lower the rate of false-negative appendicitis diagnoses, reduce morbidity from perforation.
In most cases of appendicitis, the appendix will need to be surgically removed as soon as possible. The removal of the appendix, which is known as an appendectomy or appendectomy, has recorded a high success rate across the globe, including Nigeria. Surgery to remove the appendix, which is called an appendectomy, is the standard treatment for almost all cases of appendicitis. The surgeon removes the appendix through one of the incisions and instils sterile fluid to remove any remaining infectious material. It is also known as laparoscopic surgery.
Most people make a full recovery from an appendectomy in a couple of weeks, although strenuous activities may need to be avoided for up to six weeks after open surgery.
Generally, if appendicitis is suspected, doctors tend to err on the side of safety and quickly remove the appendix to avoid its rupture. If the appendix has formed an abscess, you may have two procedures: one to drain the abscess of pus and fluid, and a later one to remove the appendix. However, there is some research showing that treatment of acute appendicitis with antibiotics may eliminate the need for surgery in certain cases.
What to expect after appendicitis operation
Antibiotics are given before an appendectomy to fight possible peritonitis. Peritonitis is an inflammation of the peritoneum, the tissue that lines the inner wall of the abdomen and covers, supports most of your abdominal organs. Peritonitis is usually caused by infection from bacteria or fungi.
If left untreated, peritonitis can rapidly spread into the blood (sepsis) and to other organs, resulting in multiple organ failure and death. So if you develop any of the symptoms of peritonitis – the most common of which is severe abdominal pain – it is essential to seek prompt medical evaluation and treatment that can prevent potentially fatal complications.
General anaesthesia is usually given, and the appendix is removed through a four-inch incision or by laparoscopy. If the patient has peritonitis, the abdomen is also irrigated and drained of pus.
Within 24 hours of surgery, the patient may get up and move around. He or she can usually return to normal activities in two to three weeks. If surgery is done with a laparoscope (a thin telescope-like instrument for viewing inside the abdomen), the incision is smaller and recovery is faster.
After the operation is carried out, patients are advised to inform their doctors if they experience uncontrolled vomiting; increased pain in the abdomen; dizziness and feelings of faintness; blood in vomit or urine; increased pain and redness in incision; fever and pus in the wound.
On how appendicitis can be prevented, it is worthy to note that as the causes are not fully understood, there’s no guaranteed way of preventing appendicitis. Experts, therefore, have advised the need to increase consumption of high fibre diets such as fresh fruits and vegetables to reduce risk of coming down with the disease. They explained that doing so easily makes bowel movements regular and shorten the digestion transit time.
There have been warnings that the disease may rupture with the escape of faecal material and various bacteria into the abdomen, thus causing more severe disease called peritonitis. An abscess cavity forms around the appendix with the development of severe illness, high-grade fever and considerable discomfort, among others.