APPENDICITIS

O TJ E H U DAJA
F.K.U.K.M
2007

AN AT O M Y

APPENDIX VERMICULARIS
CAECUM
ILEUM TERMINALE
PLICA ILEOCAECALIS
MESOAPPENDIX / MESENTERIOLUM
A.APPENDICULARIS
M.RECTUS ABDOMINIS
M.ABD.OBLIQUS EXT / INT

ANATOMY
SCHERRENS TRIANGLE
McBURNEYS POINT
LANZS POINT

CAU S E S
OBSTRUCTION IN THE LUMEN OF
APPENDIX EITHER
- BY FAECOLITH
- OR BY THE ENLARGEMENT OF
LYMPHOID FOLLICLES IN ITS WALL

RARER CAUSES

CARCINOMA OF THE CAECUM

CARCINOID TUMOUR
OBSTRUCTION FIBROUS BAND
CRUMPLED APPENDIX
FOREIGN BODY
MUCOCELE

IT MOST OFTEN AFFECTS

CHILDREN
TEENAGERS
YOUNG ADULTS
NOTE :
IN THE INFANT THE LUMEN OF THE
APPENDIX IS WIDE.
THE DIET IS SOFT

PATHOLOGY
APPENDICITIS SIMPLEX
- APPENDICITIS CATARRHALIS
- APPENDICITIS SEROPURULENTA
APPENDICITIS DESTRUCTIVA
- APPENDICITIS PHLEGMONOSA
- APPENDICITIS EMPYEMATOSA
- APPENDICITIS GANGRENOSA

SYMPTOMS
CENTRAL/ EPIGASTRIC ABDOMINAL
CRAMPING OR COLICKY PAIN LASTS
APPROXIMATELY 8 HOURS.
FOLLOWED BY A SHARP, STABING
SOMATIC PAIN IN THE RIF ( RLQ )
NAUSEA ( VOMITING IS UNCOMMON )
LOOSE STOOL ( FRANK DIARRHOEA IS
UNCOMMON )

SYMPTOMS
LOW-GRADE PYREXIA (37.2 37.8C)
WHITE FURRED TOUNGE
CHARACTERISTIC FETOR ( SWEET
FAECAL SMELL TO BREATH )
TACHYCARDIA ( < 100 IN FIRST 24
HOURS )

CAV E
IN INFANT DIARRHOEA AND VOMITING MAY
BE THE ONLY SYMPTOMS
IN ELDERLY PATIENTS THERE MAY BE
CONFUSSION AND LATER SHOCK MAY
DEVELOP, LESS PAIN
APPENDICITIS IN PREGNANCY
- PAIN AND TENDERNESS ARE
HIGHER
- RISK OF ABORTION IN THE FIRST
TRIMESTER, BY PERFORATION HIGHER

SIGNS
TENDER WITH GUARDING IN RIF OVER
McBURNEYS POINT
PER RECTUM : TENDER ANTERIORLY IN
THE RECTOVESICAL OR
RECTOUTERINE POUCH
SITKOWSKIS SIGN
BLUMBERGS SIGN
PSOASS SIGN
ROVSINGS SIGN

OTHER SIGNS

BALDWINS SIGN
COPES SIGN
CHAPMANS SIGN
TEN-HORNS SIGN

INVESTIGATIONS
WHITE CELL COUNT, NEUTROPHIL
LEUKOCYTOSIS
THROMBOCYT ( DD : DENGUE )
ULTRASOUND SCAN
COMPUTERIZED TOMOGRAPHY
LAPAROSCOPIC
COLON IN LOOP

DIFFERENTIAL DIAGNOSIS
ABDOMINAL DISEASE :
MESENTERIC ADENITIS
MECKELS DIVERTICULITIS
CROHNS DISEASE
MESENTERIC EMBOLUS
RIGHT-SIDED COLONIC DIVERTICULITIS
GASTROENTERITIS
PANCREATITIS

DIFFERENTIAL DIAGNOSIS
URINARY TRACT :
- RENAL COLIC
- ACUTE PYELONEPHRITIS
- CYSTITIS
GYNAECOLOGICAL CAUSES :
- SALPINGITIS
- ECTOPIC PREGNANCY
- MITTELSCHMERZ
- OVARIALS CYST
DENGUE

COMPLICATIONS
APPENDIX MASS (APPENDICULAR
INFILTRAT)
APPENDIX ABSCESS (APPENDICULAR
ABCES)
PERFORATION, GENERALIZIED PERITONITIS
PELVIC ABSCESS
PARALYTIC ILEUS
SEPTICAEMIA
PORTAL PYAEMIA

COMPLICATIONS
APPENDICITIS MAY RESOLVE
SPONTANEOUSLY
THE APPENDIX MAY BECOME
SOURROUNDED BY ADJACENT SMALL
BOWEL AND OMENTUM AND GIVE RISE TO
AN APPENDIX MASS (WALLING OFF).THIS
USUALLY HAPPENS 2-5 DAYS AFTER ONSET
OF INITIAL SYMPTOMS
IT MAY PERFORATED GIVING RISE TO
GENERALIZED PERITONITIS

COMPLICATIONS
IT MAY PERFORATE ADMIST LOCAL
ADHESIONS GIVING RISE TO AN
APPENDIX MASS
OFTEN IT IS DIFFICULT TO DIAGNOSE
APPENDICITIS

 48 HOUR RULE
IF THE SYMPTOMS HAVE BEEN
PRESENT FOR 48 HOURS AND THE
DIAGNOSIS TRULY APPENDICITIS,
THEN THE PATIENT SHOULD EITHER
HAVE DEVELOPED AN APPENDIX
MASS OR GENERALIZED PERITONITIS
IF NEITHER OF THESE TWO ARE
PRESENT, THEN THE DIAGNOSIS OF
APPENDICITIS SHOULD BE REVIEWED

TREATMENT
ACUTE APPENDICITIS : APPENDICECTOMY
APPENDIX MASS :
- CONSERVATIVELY, INTERVAL
APPENDICECTOMY AFTER 3 MONTHS
- EARLY SURGERY
APPENDIX ABSCESS
- SURGICAL DRAINAGE AND APPENDICECTOMY (LAPAROTOMY)
- PERCUTANEOUS INSERTION OF A DRAIN,
INTERVAL APPENDICECTOMY

OPERATION
SKINS INCISIONS:
TRANVERSE, OBLIQUE
McBURNEYS INCISION
PARARECTALS INCISION
PURSE SUTURE STRING
(TABAKBEUTELNAHT/JAHITAN
TABAKSACK)
Z-SUTURE (Z-NAHT, JAHITAN Z)

ANTIBIOTIC

PERIOPERATIVE PROPHYLACTIC
THERAPY
CEPHALOSPORINE
METRONIDAZOLE