Acute appendicitis is one of the most common abdominal surgical emergency. This condition commonly occurs in people between 9 and 30 years, but its onset can be possible at any age, there are known cases of individual manifestations in elderly patients like pseudotumoral apendicitis.
Acute appendicitis is a disease characterized by inflammation of the appendix. Once started, the inflammatory process can not be stopped using medication, the only working treatment of this condition is the surgical one. If the surgical intervention is delayed, the disease may become complicated: from catarrhal stage (early stage) to phlegmon stage, gangrenous later (necrosis of apendix), with perforation and peritonitis which is initially localized then generalized, resulting in patient’s death.
Appendicitis is a vermiform tubular structure attached to the first portion of the large intestine (colon), named cecum. The structure is lymphatic (hollow body organ with abundant lymphatic tissue). Its function is not well known, and it is considered primarily a remnant of the embryo. Its removal by appendectomy (appendicitis operation in which the appendix is extracted when it gets inflamed) does not alter the digestive function.
Causes of apendicitis
The cause of appendicitis can be, in many cases, obstruction of the lumen and body cavity, or due to lymphatic proliferation stimulated by bacterial proliferation or the presence of small foreign bodies.
This obstruction of the lumen causes an increase in intraluminal pressure (inside the appendix body) causing blood circulation disorders resulting in inflammation that can evolve without treatment, to gangrene and perforation (rupture). We can also talk about a genetic predisposition to obstruction as a cause of appendicitis.
Symptoms are varied but they do have certain characteristics:
- Pain which is initially located in the epigastric region (or lower chest) and periombilical (around belly button), then in right iliac fossa, often radiating to the right lower limb. Pain intensity is different and can be variable from one stage to another. If a slight discomfort is present initially, later may transform into unbearable pain leading even to muscle contraction (abdomen becomes hard to palpation).
- Loss of appetite, nausea and vomiting, constipation or diarrhea.
- Subfebrility (mild fever)
In some cases it can evolve very quickly without the representative symptoms in patients with immunosuppressive therapy used for organ transplants and in patients with certain diseases like HIV patients, patients with diabetes mellitus, patients under cancer treatment with chemotherapy or obese patients.
Also pregnant women, small children and the elderly may have a particular forms of manifestation. Women during pregnancy often have symptoms such as pain, nausea and vomiting, but when they present unusual properties and intensities, the patient must present to the emergency surgeon for special examination.
In small children
The appearance of this disease in small children raises special problems because of their inability to communicate pain to the doctor. They may have atypical symptoms like just vomiting, drowsiness, difficulty in feeding, constipation. Specialized medical consultation should requested quickly, especially in small children where the disease can often evolve without intermediate stages.
In elderly patients
Different manifestations can be present therefore diagnosis is more difficult. Pseud-occlusive form may be present with mimicking symptoms of intestinal obstruction or pseudotumoral form with mimicking symptoms of a cecum tumor.