Definition of the disease
Appendicitis is an acute inflammation of the appendix, a small tube-shaped organ located in the colon. This condition usually occurs when the appendix is obstructed by fecal matter, bacteria, or foreign bodies, leading to infection and inflammation. Appendicitis is a medical emergency that requires prompt evaluation to avoid serious complications.
Symptoms
Common symptoms:
- Abdominal pain: Usually located in the lower right quadrant.
- Fever: Elevated temperature due to inflammation.
- Nausea and vomiting: Often accompanied by abdominal pain.
- Loss of appetite: A frequent symptom associated with appendicitis.
- Increased abdominal pain: The pain may intensify over time and spread.
If appendicitis is not treated quickly, it can lead to peritonitis, a serious infection of the abdominal cavity, which can be fatal without surgical intervention.
Causes
Appendicitis is primarily caused by the obstruction of the inside of the appendix. Possible causes include:
- Fecal matter: Blockage of the appendix by solid matter.
- Infection: Bacterial invasion that causes inflammation.
- Foreign elements: Foreign bodies that obstruct the appendix.
This obstruction leads to bacterial proliferation, inflammation, and potentially, perforation of the appendix if not treated.
Treatment of appendicitis
The treatment of appendicitis depends on the severity of the situation:
Non-perforated appendicitis:
- Non-operative treatment: Use of antibiotics to reduce inflammation. This treatment can offer benefits such as faster recovery, but carries a risk of recurrence or progression of the disease.
- Appendectomy: Surgery to remove the appendix, performed within 24 hours of diagnosis. It can be done openly or laparoscopically.
Perforated appendicitis:
- Unstable patients: Require emergency appendectomy, irrigation, and drainage of the peritoneal cavity.
- Stable patients: Initial non-operative management with intravenous antibiotics and, if necessary, percutaneous abscess drainage is preferred.
Elderly and immunocompromised patients: In these patients, appendicitis is more likely to perforate due to an attenuated inflammatory response. An appendectomy is often recommended without delay.
Use of medical imaging
Medical imaging plays a crucial role in the diagnosis of appendicitis, particularly to differentiate between non-perforated and perforated appendicitis, as well as to assess the presence of abscesses or other complications.
- Computed Tomography (CT) Scan: Abdominal and pelvic CT without contrast is the examination of choice to confirm the diagnosis, due to its high accuracy. It allows visualization of the size and location of the appendix as well as signs of obstruction or abscess.
- Ultrasound: Ultrasound is particularly useful in pregnant women and patients who have undergone multiple CT exams. It reduces radiation exposure while providing good visualization of the appendix and potential complications.
Medical imaging thus guides treatment based on the severity of appendicitis and present complications, while minimizing risks to the patient.
Source: UpToDate