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!.Immunocompromise and Appendicitis
The immunocompromised state alters the normal response to acute infection and wound healing. Appendicitis affects all types of patients and must be considered in those who have undergone organ transplantation, are receiving chemotherapy, have hematological malignancy, or are infected with the human immunodeficiency virus. The differential diagnosis of abdominal pain in this population is broad and includes hepatitis, pancreatitis (from medications or cytomegalovirus infection), acalculous cholecystitis, intra-abdominal opportunistic infections (cytomegalovirus colitis or mycobacterial ileitis), secondary malignancies (lymphoma or Kaposi’s sarcoma), graft-versus-host disease, and typhlitis. This broad differential diagnosis often results in delay in diagnosis and late presentation to surgical evaluation, at which time perforation may be more likely.
Summary of Appendicitis Disease
Summary of Appendicitis Disease
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.
Malignant of Appendix, Carcinoid, CA appendix
Primary malignant tumors were found in 1.4% of appendices in the same large series. Carcinoid and argentaffin tumors comprise the majority of appendiceal cancers, and the appendix is the commonest location of carcinoid tumors of the gastrointestinal tract. Carcinoid tumors of the appendix are usually benign, but the uncommon tumor that is over 2 cm in diameter may exhibit malignant behavior. Most appendiceal carcinoids are found in the tip of the organ, while a few are at the base. About half of these tumors are discovered during an appendectomy for acute appendicitis, and the remainder are identified incidentally. Lesions less than 2 cm in diameter invade the appendiceal wall in 25% of cases, but only 3% metastasize to lymph nodes, and hepatic metastases and the carcinoid syndrome are truly rare. Appendectomy alone is adequate treatment unless the lymph nodes are visibly involved, the tumor is more than 2 cm in diameter, mucinous elements are present in the tumor (adenocarcinoid), or the mesoappendix or base of the cecum is invaded. Right hemicolectomy is recommended for these more aggressive lesions.
