ACUTE APPENDICITIS

Inflammation of the appendix.

Causes

  • Blockage of the appendix duct with stool or particles, followed by infection by intestinal bacteria

Clinical features

  • Constipation (common)
  • Pain situated around the umbilicus
    • Crampy, keeps on increasing in severity
  • After some hours, the pain is localised in the right iliac fossa and becomes continuous
  • There may be nausea and vomiting
  • Fever (low grade in initial stages)
  • Tenderness and rigidity (guarding) in right iliac fossa
  • Generalized abdominal pain and signs of peritonitis follows rupture when the contents are poured into the
    abdominal cavity

Differential diagnosis

  • Salpingitis (in females), ovarian cyst
  • Ectopic pregnancy
  • Pyelonephritis, ureteritis (inflammation of the ureter)
  • Intestinal obstruction

Investigations

  • No special investigations – good history and physical examination are essential for diagnosis
  • Complete blood count: look for leucocytosis
  • Transabdominal ultrasound
  • Abdominal X ray (to assess for perforation and intestinal occlusion)

Management

  • Emergency surgery
  • If surgery is delayed, start antibiotic treatment while referring
    • ceftriaxone 2 g IV once daily
      Child: 80 mg/kg IV once daily
    • plus metronidazole 500 mg IV every 8 hours
      child 10 mg/kg IV every 8 hours
  • Start antibiotic prophylaxis before the surgery and continue for a duration depending on the
    findings (< 24 hours for unperforated appendix, at least 5 days for perforated appendix)