What is appendix and appendicitis: The appendix is an intestinal protrusion with an average length of 7-12 cm, located in the cecum, which is the starting point of the large intestine, and ends blindly. Inflammation of this tissue is called appendicitis. The appendix is like a continuation of the large intestine but contains dense lymphoid tissue. Therefore, when it becomes inflamed, its narrow duct is blocked and the inflammatory process leading to bursting begins.
Complaints: The most important complaint of the patient with appendicitis is abdominal pain. The pain is continuous and uninterrupted, usually intensely felt in the lower right side of the abdomen, but it can also be widespread. Nausea and loss of appetite often occur. Vomiting occurs several times in the beginning and often does not continue. There may be a not very high fever and malaise. If appendicitis cannot be detected in the acute period and is missed, the patient starts to have liquid poop such as diarrhea and to experience widespread abdominal pain, and in this case, it is more confused with gastroenteritis. If the inflammation has not spread into the abdomen and the ruptured appendix is surrounded by tissues, complaints such as constant pain, fever and loss of appetite in the lower right part of the abdomen are constantly observed.
Diagnosis of appendicitis: Examination findings are very important in the diagnosis of appendicitis. In the examination, tenderness in the lower right part of the abdomen and increased pain when pressing and pulling the hand are important findings. If appendicitis is suspected in the patient, blood analysis, urinalysis, abdominal ultrasound and abdominal X-ray are requested. If the ultrasound did not give a clear result, abdominal computed tomography or MRI may be required for differential diagnosis. With these imaging methods, it is aimed to show the inflamed appendix and abscess foci, if any. Today, there are still difficulties in the diagnosis of appendicitis, since the location of the appendix in the abdomen can vary widely among children and abdominal pain is a very common complaint in children. When the examination finding is very important, these children should definitely be evaluated by a pediatric surgeon.
Acute appendicitis: It is usually the first 24 hours from the onset of appendicitis complaints, that is, the inflammation has not spread into the abdomen, but has remained localized around the appendix. This period may vary, and there may be cases where the appendix bursts and the inflammation spreads into the abdomen or stays localized for a longer period of time after the complaints begin.
Perforated (exploded) appendicitis: If the appendix inflammation progresses and its channel is blocked, the end part is filled with purulent (inflammatory) fluid and swells, then it opens and the inflammation spreads into the abdomen. This is called an appendix perforation or burst. In this case, the severity of the infection increases and if the patient is not treated immediately, septic shock can occur rapidly and may progress to death. Sometimes the appendix is perforated, but the inflammation is surrounded by the surrounding tissues without spreading into the abdomen and the infection is localized. Intense inflammation, adhesions and abscesses can be seen in that area. In perforated appendicitis, postoperative treatment is prolonged and complications are more common.
Treatment: When the diagnosis of appendicitis is made, the treatment is surgery. The inflamed appendix is found, ligated from the entrance to the large intestine, cut and removed, and the surrounding inflammation is washed away. In cases of perforated appendicitis where the infection is severe, there are treatment approaches where the infection is suppressed with strong antibiotic treatment and the surgery is postponed. The surgery can be performed open and laparoscopically (closed):
Open surgery: The appendix is found by entering the abdomen with a horizontal incision of 5 cm on the lower right side of the abdomen, is tied and removed. It is a classical method that has been used for many years. It is an advantage that it can be applied easily and quickly and is a well-known surgery. However, the size of the skin and fascia incision is a significant disadvantage, both healing and aesthetic results are worse.
Laparoscopic (closed) surgery: Laparoscopic surgery is performed with the help of a camera entered through the navel and one or two working channels entered from the lower side of the abdomen. The diameter of the camera and working channels in children is 5 or 3 mm. The appendix is ligated and removed, freeing it from the surrounding tissues. As a result, there is much less scarring and healing is faster. In addition, by examining the intra-abdominal camera, inflammation and abscess foci are better cleaned. Today, appendectomy surgery can be performed laparoscopically in children of all ages.
Postoperative: One day of antibiotic treatment is sufficient in acute appendicitis, while treatment for up to 10 days is required in perforated cases. Nutrition can be started 6 hours after surgery in acute patients, and it can be given one day after perforation or when bowel movements begin. Exercise restriction in patients is sufficient for 3 weeks in laparoscopic surgery, and intense exercise should be avoided for 6 weeks in open surgery.
Complications: Some complications may occur in the early and late period after appendectomy, and these are more common in perforated appendicitis. In the early period, wound infection, intra-abdominal abscess formation, intestinal obstruction (ileus) can be seen. Intestinal obstructions (ileus) can also be seen in the late period. Re-operation may be required for treatment.
