Normal anatomy

The appendix is a small, finger-shaped pouch of intestinal tissue located between the small intestine (cecum) and large intestine (colon).

Indications

If the appendix becomes infected (appendicitis), the infected appendix must be surgically removed (emergency appendectomy) before a hole develops in the appendix (perforation) and spreads the infection to the entire abdominal space (peritonitis).

Symptoms of acute appendicitis include:

• pain: abdominal pain (located in the lower right side)
• fever (elevated temperature)
• reduced appetite (anorexia)
• nausea; vomiting

The doctor will:

• check your abdomen for tenderness and tightness
• check your rectum for tenderness and an enlarged appendix
• check your blood for an increase in white blood cells (WBC)
• perform a pelvic exam in women, to exclude pain caused by the ovaries or uterus

There is no test to confirm appendicitis and the symptoms may be caused by other illnesses. The doctor must diagnose from the information you report and what he sees. Even if the surgeon finds that the appendix is not infected (which can happen up to 25% of the time), he will thoroughly check the other abdominal organs and remove the appendix anyway.

Incision

While the patient is deep asleep and pain free, a small incision is made in the lower right side of the abdomen and the appendix is removed.

Procedure

If a pocket of infection (abscess) has formed or the appendix has ruptured (perforated), the abdomen will be thoroughly washed out during surgery. The surgeon may then leave the skin open and allow it to heal together on its own (secondary intention), to allow the infection to drain, or less frequently, put in a small drainage tube.

In unusual cases, appendectomy can be performed laparoscopically. This is most frequently done in women, in which the cause of the abdominal pain is uncertain.

Aftercare

Recovery from a simple appendectomy is usually complete and rapid. Most patients can go home the day after the operation, and resume normal diet and activities within one to two weeks. If the appendix has developed an abscess or has ruptured, the recovery may be slower and more complicated, requiring use of medications to treat the infection (antibiotics).

Living without an appendix causes no known health problems.