- WHAT IS APPENDICITIS?
Appendix (appendix vermiformis) in the lower right quadrant of the abdomen, at the beginning of the large intestine, blind It is a thin, finger-shaped organ at the end of the intestine. Its length is usually between 6-9 cm. Although its function in the body is not fully elucidated, it is known to secrete some substances related to the immune system. There is no loss of function if taken. Appendicitis means inflammation of the appendix. Most often, this occurs due to blockage at the root of the finger organ. Although it can be seen at all ages, it is most common between the ages of 10-30.
- WHAT ARE THE SYMPTOMS OF APENDICITIS?
ABDOMINAL PAIN. It is the most important complaint. The complaints occurred within the last day or several days. The pain usually starts gradually around the navel. Then it disappears from around the navel. It is located in the lower right side of the abdomen. The pain increases with movement, coughing, laughing and shaking. It is a constant and constant pain.
The characteristics of the pain may differ from the typical form described here in those taking painkillers/antibiotics, diabetics, children and the elderly. It is more difficult to diagnose appendicitis, especially in young children, as they cannot localize the pain. It is necessary to perform very careful repeated physical examinations. Some patients who delay in consulting a doctor may have a burst appendicitis. In this case, the pain may be relieved for a few hours. But later it returns more commonly with FEVER.
NO APPETITE (Seen in more than 90% of patients. Patients do not even want to eat their favorite food even though they are hungry. .)
NAUSE,sometimes vomiting (Generally (occurs hours after the onset of pain) If there is severe and persistent pain in the quadrant, it is necessary to apply to the nearest pediatric surgery center. The patient should not be fed orally and medications such as painkillers/antibiotics should not be given without a definitive diagnosis. These drugs suppress existing findings and may lead to delayed diagnosis and undesirable consequences, including burst appendicitis.
- WHAT ARE THE EXAMINATION FINDINGS?
Patients They prefer to lie still, pulling their legs towards their abdomen. Severe pain (SENSITIVITY) occurs when you press lightly on the lower right part of the abdomen. During the examination, «an imaginary line extending from the belly button to the right lateral anterior protrusion of the pelvis» is considered.
The most sensitive area in appendicitis is usually the area around the outer half of this line. Apart from sensitivity, stiffness is also felt in this area. This is called defense. If the hand is suddenly withdrawn after pressing deeply on this area for at least 4-5 seconds, a sharp, severe pain as if an electric shock may be felt in the abdomen. This is called rebound. This pain can sometimes be so severe that it makes the patient jump from the bed. The presence of this finding in the right lower quadrant of the abdomen is very important for the diagnosis of appendicitis. Examination findings may be different, especially in young children under the age of five. It is important to relax the child as much as possible before the examination and ensure compliance with the examination. Young children tend to tense their entire abdomen due to severe pain. It may not be possible to identify the main painful area. If necessary, young children can be re-examined with mild sedatives.
- WHAT ANALYSIS AND EXAMINATIONS ARE DONE IN APPENDICITIS?
The diagnosis of appendicitis is made mainly based on the history of the disease and the examination findings of the patient. Some of the diagnostic aids are: In blood tests, white blood cell (WBC) elevation, C-reactive protein (CRP) elevation and ultrasound and standing abdominal X-ray showed signs specific to appendicitis. However, these are not always valid. The fact that these criteria are normal does not exclude us from the possibility of appendicitis. Elimination of causes similar to appendicitis that may be confused with appendicitis brings us closer to the diagnosis of appendicitis.
These are; These are situations such as normal urinalysis and no problems with gynecological diseases.
Even if ultrasound findings are normal, if examination findings are present, a decision for surgery may be made. The opposite may also happen, if the patient's complaints regress and the examination findings disappear while there are findings compatible with appendicitis on ultrasound, the doctor may decide not to perform surgery and follow up.
- IS DELAY DANGEROUS? BURST APPENDICITIS
Patients who consult a surgeon and undergo surgery within the first 24-48 hours usually undergo surgery in less than half an hour and can regain their health by staying in the hospital for two days. However, the situation of patients whose surgery is delayed for some reason may become difficult and dangerous. Surgeries for such patients are more troublesome. After the surgery, they may experience a more difficult period such as placing a tube (drain) in the abdomen and keeping it for a while and additional medication and serum treatments for at least five days.
The root is clogged and filled with bacteria. The appendix that develops infection first swells. Then, circulatory disorder develops and a perforation occurs as a result of decay in a certain area. This is called appendicitis burst(p It is called perforated appendicitis). Once the appendix is ruptured, the dirty infected contents spread freely into the environment. Pus accumulates in the surrounding area and a periapendicular abscess develops. If the patient is not operated on in a short time, a severe condition in the form of widespread intra-abdominal inflammation develops.
- WHAT PREPARATIONS SHOULD BE MADE BEFORE THE SURGERY?
Surgery. All patients whose decision is made are examined by an anesthesiologist before being taken into surgery. If the patient is on aspirin, coraspin, coumadin, etc. If one is using blood thinners, the risk of bleeding will be high if one undergoes surgery under the influence of these drugs. However, appendicitis is an emergency and it is not possible to stop these medications and wait for their effects to wear off over time. The patient is taken into emergency surgery by taking some precautions. Preoperatively, the patient is given preventive antibiotic treatment. Patients should stop eating and drinking as soon as the possibility of appendicitis is mentioned. If possible, it is preferred that patients be hungry as if they have been fasting for at least 5-6 hours before the surgery. All patients must read and sign the surgery-specific informed consent forms presented to them regarding the planned surgery.
They must also be informed about the risks of the surgery and must document that they have given informed consent to the surgery.
- HOW IS APENDICITIS SURGERY PERFORMED?
The surgery is performed under general anesthesia. Surgery time is usually between 30-60 minutes. Two days of hospitalization is required. Often, a 2-3 centimeter incision in the lower right quadrant of the abdomen is sufficient. In very rare cases where the diagnosis is not clear, a midline incision in the lower part of the umbilicus can also be used. During surgery, the appendix is located in the lower right quadrant of the abdomen, extending in the shape of a finger at the end of the caecum at the beginning of the large intestine. appendix by connecting its vein and root is removed. The appendix may be normal in 10-15% of patients who undergo surgery with the diagnosis of appendicitis. This situation is caused by diseases that mimic appendicitis and the difficulty in diagnosing appendicitis. In fact, in an emergency situation, it is also necessary to act cautiously for the benefit of the patient in the face of a risky situation. It is not considered as an error, complication or malpractice. This rate is considered normal by medical scientific references.
Some of the diseases that mimic appendicitis are; inflammatory bowel diseases, diverticulitis, some intestinal tumors, gastrointestinal perforations, as well as ovarian cysts in girls, etc. If an additional intervention is required during the surgery for these reasons, the additional intervention is performed in the same session by the surgeon himself or the specialist of the relevant department. The surgery can also be performed with a closed (laparoscopic) method.
In this method, the same procedure is performed by making a 1cm incision in the navel and a 0.5cm incision in the left side and middle abdomen, and with instruments inserted through these holes. Depending on the condition of the patient and the operating room, your surgeon will decide which method will be appropriate.
- WHAT IS THE FOLLOW-UP LIKE AFTER THE OPERATION?
After standard appendicitis surgery Patients can stand up, walk and take food orally on the same day.
There is no significant pain problem. Most patients are discharged within two days. Patients who develop burst (perforation), abscess and wrapped appendicitis (plastron) should be hospitalized for longer periods (at least 5 days) and receive intravenous antibiotic treatment. They may need to be removed.
- POST-SURGERY PROBLEMS WHAT ARE THEY?
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