Demographic Data:

Name: Jamelyn Gomez

Age: 10 years old
Gender: Female
Address: San Agustin East, Agoo, La Union
Diagnosis: Emergency Appendicitis
Obstruction
Risk
Increase
Risk
Inflammatory
Modifiable for
by
Acute
for
deficient
the
inInfection
pain
pressure
Appendix
Response Appendectom
related
fluid
Impaired due
– bodyin
volume
venous
Signs by
to
theprescence
inadequate
(fecalith
appendix
response
and related
return
Non- to (hardened
of
toprimary
causing
the
Symptoms: surgical
lumen
postoperative
bacterialthat
stool),
hyperemia result
invasion lymph
in to
(improper node,
distention
theO2, oftumor,
walland the of foreign
nutrient
appendix.
supply)
objects)
Diet – appendix
Increased Immuned
people who’s Normal
complex defenses.
yrestriction.
low incision.
diet isbacteria
(disease
in found
plus
in antibody)
appendix
Modifiable
fiber and
Abdominal pain rich in causes
begin
refined to
swelling
invade
carbohydrates. of
(infect)
tissue the
resulting
lining to
of inflammation
the of
appendix wall.
Infection – Gastrointestinal infections such as Amaebiasis, Bacterial Gastroenteritis,
Age
Fever
mumps IncreasedGender
swelling of
Hereditary
Appendix

Pathophysiology:

Appendectomy:
➢ sometimes called appendisectomy or appendicectomy
➢ surgical removal of the vermiform appendix.
 ➢ This procedure is normally performed as an emergency procedure, when the patient is
suffering from acute appendicitis.
Step-by-Step Procedure of Appendectomy:
1. Skin incision is made with a knife.
2. Bovie electrocautery is used to dissect through subcutaneous tissue and control small skin
bleeding.
3. The aponeurosis (muscle sheath) of the outer layer of the external oblique muscle is visualized
and split by a small incision with a knife and then further opened along the direction of the fibers
with a scissors or the Bovie.
4. The muscle belly of the external oblique is then bluntly retracted (but not cut) using the classic
muscle splitting technique via a hemostat or Kelly clamp until the aponeurosis of the internal
oblique is visualized.
5. The aponeurosis of the internal oblique is split in a similar manner as the external oblique.
6. The muscle belly of the internal oblique is bluntly retracted in a similar manner as the external
oblique until the peritoneum is visualized.
7. The peritoneum is grasped on either side by two forceps, pulled up and into the wound, and
palpated to insure there is no bowel caught in the fold of the peritoneum.
8. The peritoneum is opened with a small incision using either a knife or scissors.
9. The peritoneal fluid is immediately inspected for amount and prurulence and cultures are
taken.
10. The opening in the peritoneum is widened and two hand-held retractors are placed to expose
the cecal area.
11. Manual and visual exploration for the appendix is performed by locating the convergence of
the cecum and the terminal ileum.
12. The appendix is delivered up into the wound either by digitally “flipping it up” or be
grasping the base with a Alice or Babcock and applying traction to allow dissection of any
adhesions holding it in the abdominal cavity.
13. The entire appendix is inspected with close attention to the base to insure that the area of
rupture is sufficiently distant from the base to allow a margin of healthy tissue.
14. If the base of the appendix is involved in the rupture a limited right hemicolectomy is done
15. If the base of the appendix is not involved, the mesoappendix or mesentery of the appendix is
divided, cross-clamped with Kelly clamps or hemostats and tied with 2-0 or 3-0 silk usually.
16. When the appendix has been isolated from the mesoappendix, the appendix proximal to the
rupture is crushed with a straight clamp.
17. Two chromic ties are then placed on the area of crushed appendix.
18. The appendix is then resected off the stump distal to the ties using a knife.
19. The exposed mucosa is then ablated by the Bovie cautery.
20. Some surgeons then prefer to “dunk” the tied-off appendiceal stump by placing a running
pursestring suture around the stump.
21. The intraabdominal area is inspected for bleeding and pockets of remaining infection.
22. Most surgeons will irrigate the abdominal cavity with saline solution or antibiotic-containing
saline solution.
23. The edges of the peritoeum are reapproximated using a running 3-0 or 4-0 Vicryl suture.
24. The edges of the internal oblique aponeurosis are reapproximated using a 1-0 or 2-0 Vicryl
suture.
25. The edges of the external oblique aponeurosis are likewise reapproximated.
26. The superficial wound is irrigated.
27. If the appendix has ruptured and there was frank pus, many surgeons will leave the
subcutaneous tissue and skin open to heal by secondary intention.
28. If the appendicitis was in the early stages or was normal the subcutaneous tissue can be
closed at the level of Scarpa’s fascia with interrupted or running 2-0 Vicryl suture.
29. The skin is closed with staples, interrupted Nylon sutures, or a subcuticular absorbably suture
such as Monocryl.