Acute Appendicitis -
The appendix is a blind tubular structure that is connected to the first part of the large bowel (caecum) and has little physiological significance. It has a variable position that might affect the presentation if it becomes infected. Inflammation of the appendix (Acute Appendicitis) occurs when the neck of the appendix gets blocked with stool or similar stuff leading to flare up of the bacterial content within the blind tube and development of the clinical features. It usually involves young age group of patients, but may occur at any age.
Acute appendicitis could mimic a urinary tract infection or different gynaecological problems where the need for further investigations (above) are used to confirm. In elderly patients, occasionally a tumour at the caecum may present with acute appendicitis. It may also mimic infection of a pouch in the bowel (either diverticular disease or Meckel’s diverticulum). Also, in severe cases the appendix may perforate locally forming an abscess (collection of infected fluid within the abdomen) or generally forming acute peritonitis (disseminated spread of infected abdomen all over the abdomen).
Clinically (from your symptoms) and examination are the usual methods for diagnosis of acute appendicitis but can be supported by:
Urinary tests (dip stick and pregnancy test)
Diagnostic Laparoscopy (key hole surgery)
Acute appendicitis could mimic urinary tract infection or different gynaecological problems where the need for further investigations (above) to confirm. Rarely in elderly patients, tumour at the caecum may present with acute appendicitis. It may also mimic infection of a pouch in the bowel (either diverticular disease or Meckel’s diverticulum). Also, in severe cases the appendix may perforate locally forming an abscess (collection of infected fluid within the abdomen) or generally forming acute peritonitis (disseminated spread of infected abdomen all over the abdomen).
Benefit of Surgery
Removal of infected appendix that could lead to serious complications if untreated. There is a possibility I may have to remove part of the unhealthy bowel in relation to infected Meckel’s diverticulum. If there is normal appendix and a gynaecological cause identified, I shall deal with the problem myself with / without the help of Gynaecologist.
Potential complications of Surgery
Infection and bleeding/haematoma formation as any other surgery, visceral injury (injury to intra-abdominal organs), urinary retention (unable to pass urine leading to insertion of catheter temporarily, likely related to local pain or the Anaesthetics), conversion to open (conventional) surgery and anaesthetic risks that include: DVT/PE (development of clot in the leg which might migrate to the lung) and cardiorespiratory complications (risks on the heart and chest). I may have to leave the drain (tube to drain infected fluid out of the abdomen, through skin in to a bag) and resect bowel segment with primary anastomosis (join the two ends of bowel together).
I may start you on intravenous antibiotics, keep you on nil by mouth and provide you with intravenous fluids to keep you hydrated. Just before the surgery time, you need to pass urine and empty your bladder otherwise I may have to insert a catheter to drain your bladder. You don’t need to shave the area, as we will do that in theatres.
The operation will be a key hole surgery performed under General
Anaesthesia (you will be completely asleep) and takes an average of
40 minutes (may take between 30-90 minutes) and needs 1-2 days
to recover from, during which you may need further antibiotics.
The operation will include three cuts as shown in the diagrams,
unless converted to open (an extra right lower quadrant incision
shown by the dotted line in the diagram). The appendix will
be removed through the umbilical wound. The base of the
appendix will be closed using special ties, the surrounding area
will be washed-out with normal saline. The rest of abdominal
and pelvic viscera will be examined during the operation.
The larger umbilical wound fascia/muscle will be closed with
delayed dissolvable sutures, while the skin of all wounds will be
closed with dissolvable sutures and covered with special glue
that is both water- and air-proof. No dressing is usually applied.
As mentioned above, most of patients aim to be home within 1-2 days of surgery provided you meet the following five conditions:
1. Feeling well and mobilising
2. Eating and drinking without being sick (vomit)
3. Your observations (blood pressure, pulse, temperature…etc) are normal
4. Manage to pass urine
5. Someone will stay with you at home overnight
You can have a shower from next morning but avoid baths until day 5 after surgery at which point you can try to peel the glue off the wound and you can have a bath.
You will have generalised ache and wound pain that usually lasts for 2-3 days, during which, you are advised to take your pain killers regularly and then taper them down when you need to. You can walk, but be careful with stairs, always protect your larger wounds when coughing, sneezing or straining. You should avoid driving the first 10 days, and after that if you are able to control your vehicle and press emergency brake, then you can drive. Gradually increase activity back to normal over the three weeks following surgery.
Ideally, you should avoid flights, especially long distance ones in the first four weeks after surgery and better to check with your flight insurer before booking.
We can give you a sick note for two weeks and if you need an extra week, your doctor (GP) can provide you with this.
Aim to be reviewed in clinic in 4-6 weeks. If you have any problems before then, you could contact the ward at the Spire Hospital or contact my secretary for an advice and I will be in touch or advice accordingly.