Watch video about laparoscopic appendectomy surgery here for FREE! You'll see how doctors do with our appendix!.Appendicitis Updated Review
Review all aspect of appendicitis including symptoms, sign, investigation,treatment and surgery
Watch video about laparoscopic appendectomy surgery here for FREE! You'll see how doctors do with our appendix!.Perforation of Appendicitis
It is a commonly held belief that if left untreated, appendiceal inflammation will progress inevitably to necrosis, and ultimately to perforation. The time course of this progression varies among patients. In one study of the natural history of appendicitis, the authors questioned patients undergoing appendectomy for suspected appendicitis about their duration of symptoms. Patients with nonperforated appendicitis reported an average of 22 hours of symptoms prior to presentation to the hospital, while patients with perforated appendicitis reported an average of 57 hours. However, 20% of cases of perforated appendicitis presented within 24 hours of the onset of symptoms; one of those patients had symptoms for only 11 hours. Although concern for perforation should be present when evaluating a patient with more than 24 hours of symptoms, the clinician must remember that perforation can develop more rapidly.
Appendiceal abscess, Appendiceal mass, Phlegmon
Localized perforation occurs when the periappendiceal infection of appendix becomes walled off by omentum and adjacent viscera. The clinical presentation consists of the usual findings in appendicitis plus a right lower quadrant mass. An ultrasound or CT scan should be performed; if an abscess is found, it is best treated by percutaneous ultrasound-guided aspiration. Opinion differs about how small abscesses and phlegmons should be handled. Some surgeons prefer a regimen consisting of antibiotics and expectant management followed by elective appendectomy 6 weeks later. The purpose is to avoid spreading the localized infection, which usually resolves in response to the antibiotics. Other surgeons recommend immediate appendectomy, which some believe shortens the duration of the illness. However, the immediate surgery approach has significant complications in a higher percentage of patients. There is not currently a consensus.
Perforation from Appendicitis
Delay in seeking medical care appears to be the principal reason for perforations; the appendicitis has just been allowed to progress according to its natural history. Perforation is accompanied by more severe pain and higher fever (average, 38.3 °C) than in appendicitis. It is unusual for the acutely inflamed appendix to perforate within the first 12 hours. The appendicitis has progressed to perforation by the time of appendectomy in about 50% of patients under age 10 or over age 50. Nearly all deaths occur in the latter group.
The acute consequences of perforation vary from generalized peritonitis to formation of a tiny abscess that may not appreciably alter the symptoms and signs of appendicitis. Perforation in young women increases the subsequent risk of tubal infertility about fourfold.
