TREATMENT OF ACUTE

APPENDICITIS
URGENTAPPENDECTOMY.
SHORT PERIOD OF PREOP.
PREPARATION IS BENEFITIAL.
(iv.fluids,parenteral AB. ,antipyretics)
PALPATE THE RT.ILIAC FOSSA
UNDER G.A. (A mass may be found)??
 INCISIONS OF APPENDECTOMY

 GRID IRON INCISION.

 RUTHERFORD MORRISSON’S INCISION.
 LANZ TRANVERSE INCISION.
 LOW MIDLINE INCISION.
 PARAMEDIAN INCISION.
GRID IRON INCISION
 LANZ TRANVERSE INCISION

Transverse or skin crease incision for appendicitis, 2 cm below

the umbilicus, centred on the midclavicular –midinguinal line
(courtesy of Mr Michael Earley, Dublin, Ireland)
OPEN APPENDECTOMY
OPEN APPENDECTOMY
LAPAROSCOPIC APPENDECTOMY
LAPAROSCOPIC APPENDECTOMY
 VARIATIONS IN TECHNIQUE:

 EDEMATOUS CECAL WALL (do not attempt

invagination).
 INFLAMED BASE OF APPENDIX (do not crush it).
 GANGRENOUS BASE OF APPENDIX (do not crush or
invaginate,but suture the hole in the cecum in 2 layers).
 RETROGRADE APPENDECTOMY (in retrocecal
appendix).
 WHEN TO DRAIN???
 WOUND CLOSURE??
 PROBLEMS FACED IN APPENDECTOMY:

 A NORMAL APPENDIX IS FOUND : EXCLUDE

OTHER PATHOLOGIES (Meckel,s divert.,Crohn’s
dse.& adnexal).
 THE APPENDIX CANNOT BE FOUND ???
 AN APPENDICULAR TUMOR IS FOUND ???
 AN APPENDICULAR ABSCESS IS FOUND (perit.
Toilet,drainage &IV. Antibiotics).
 APPENDICITIS IN CROHN’S DSE.???
 MANAGEMENT OF COMPLICATIONS
 APPENDICULAR MASS.OCHSNER-SHERREN CONSERVATIVE
REGIMEN.(careful observation of vital data & size of the mass,a nasogastric tube
,IV.fluids & parenteral antibiotics).

* IMPROVEMENT USUALLY OCCURES WITHIN 24-48 HOURS.

USING THIS POLICY ABOUT 90% RESOLVE APPENDECTOMY 6-8 WS

*FAILURE TO RESOLVE THINK OF CARC. OR CROHN’S.

* CLINICAL DETERIORATION OR EVIDENCE OF PERITONITIS 
INDICATES EARLY LAPAROTOMY.(rising pulse,spreading & increasing
abd.pain,increasing size of the mass ,vomting or copious gastric aspirate).
 APPENDICULAR ABSCESS
 CLINICAL DETERIORATION DURING CONSERVATIVE
THERAPY OR EVIDENCE OF ABSCESS FROM THE
STARTDRAINAGE IS MANDATORY.
 ULTRASOUND & CT ARE HELPFUL IN THE
DIAGNOSIS AND OF DRAINAGE OF PUS VIA A PER
CUTANEOUS CATHETER.
 MIDLINE LAPAROTOMY IS PERFORMED FOR
DRAINAGE IF TUBE DRAINAGE FAILS. IV
ANTIBIOTICS & IV.FLUIDS. THE APPENDIX IS NOT
REMOVED UNLESS IT IS FOUND LOOSE IN THE
CAVITY.
 PELVIC ABSCESS
 PRESENTATION: SPIKY
FEVER ,PELVIC
PRESSURE OR
DISCOMFORT ,LOOSE
STOOLS OR TENESMUS.
 P R. EXAM. BOGGY
PELVIC MASS ANT.TO
THE RECTUM.
 PELVIC US. OR CT ARE
DIAGNOSTIC.
 TTT BY TRANSRECTAL
DRAINAGE UNDER GA.

Appendix abscess involving the pelvis

 GENERALIZED PERITONITIS

 THIS I STHE MOST SERIOUS OF THE

COMPLICATIONS.
 URGENT EXPLORATION VIA MIDLINE
INCISION.
 PERIT.TOILET IS DONE.
 AMPLE DRAINAGE OF THE PERITONEAL
CAVITY.
 IV ANTIBIOTICS & FLUIDS,NASOGASTRIC
TUBE, ANALGESICS‫ز‬
COMPLICATIONS OF APPENDECTOMY

 WOUND INFECTION.
 INTRA-ABD. ABSCESS.
 ILEUS.
 VENOUS THROMBOSIS & EMBOLISM.
 PORTAL PYAEMIA (PYELEPHLEBITIS).
 FECAL FISTULA.
 ADHESIVE INT.OBST.
 INCISIONAL (paralytic hernia).
 RESP.COMP.
 CAUSES OF ACUTE ABDOMEN
 MEDICAL CAUSES:
1)DIABETIC CRISIS.

2)PORPHYRIA.
3)HYPERLIPEDEMIA.
4)MALARIA.
5)SICKLE CELL ANEMIA.
6)HAEMOPHILIA.
7)HERPES ZOOSTER.
8)HENOCH-SCHONLEIN PURPURA.
9)LOBAR PNEUMONIA & PLEURISY.
 THE SURGICAL ACUTE ABDOMEN
 1)ACUTE APPENDICITIS.
 2)ACUTE CHOLECYSTITIS WITH COMP. (BILIARY
COLICK & EMPEYEMA)
 3) PERFORATED PEPTIC ULCER.
 4)ACUTE PANCREATITIS
 5)RENAL COLICK.
 6)ACUTE DIVERTICULITIS.
 7)MECKEL’S DIVERTICULITIS.
 8)ACUTE INTEST. OBST.
 9)ACUTE GYNECOLOGIC DSE.
 10)COMPLICATED ABD. AORTIC ANEURYSM.
 11)PERFRATED BOWEL :typhoid,carcinoma,P.A.N. ect….