APPENDICITIS

PROF E. C. OHANAKA
CONSULTANT SURGEON
 APPENDICITIS
COMMONEST SURGICAL ABDOMINAL
EMERGENCY
APPENDICECTOMY: COMMONEST ABDOMINAL
EMERGENCY SURGERY
RISING INCIDENCE PARTICULARLY IN THE
DEVELOPING WORLD
KNOWLEDGE IS IMPORTANT
 ANATOMY OF APPENDIX
• PART OF LARGE INTESTINE
• RETROCAECAL: 75%
• PELVIC: 21%
• OTHERS: RETROILEAL, PREILEAL, SUBILEAL
(4%)
• A LUMINAL STRUCTURE
 PATHOLOGY OF APPENDICITIS
• INTRALUMINAL OBSTRUCTION
- LYMPHOID HYPERPLASIA, FAECOLITHS
- PARASITIC WORMS: OXYURIA VERMICULARIS
- TUMOURS OF APPENDIX, CAECUM AND
ASCENDING COLON
- FAMILIAL
- OBSTRUCTION/DISTENSION/VENOUS
CONGESTION/ ISCHEMIC
NECROSIS/PERFORATION/PERITONITIS
CLINICAL FORMS OF APPENDICITIS
• RECURRENT APPENDICITIS

* ACUTE APPENDICITIS

* PERFORATED APPENDICITIS

• APPENDIX MASS

• APPENDIX ABSCESS
 CLINICAL: ALVARADO SCORE
MIGRATORY RIF PAIN 1
ANOREXIA 1
NAUSEA/VOMITING 1
TENDERNESS 2
REBOUND TENDERNESS 1
ELEVATED TEMP 1
LEUCOCYTOSIS 2
SHIFT TO THE LEFT 1
TOTAL 10
 ALVARADO SCORE (CONTD)
• 0 – 4 : LOW PROBABILITY (OBSERVATION)

• 5 – 8: PROBABLE APPENDICITIS (IMAGING:

USS, CT SCAN)

• 9 – 10: HIGHLY PROBABLE (APPENDICECTOMY)

 DIFFERENTIAL DIAGNOSIS
• ANY ACUTE ABDOMINAL EMERGENCY

• FEMALE PELVIC CONDITIONS

• CHILDHOOD CONDITIONS

• MEDICAL CONDITIONS
 INVESTIGATIONS
• FULL BLOOD COUNT
• ELECTROLYTES/UREA/CREATININE
• URINALYSIS
• ABDOMINAL USS
• CT SCAN
• DIAGNOSTIC LAPAROSCOPY
• HCG ASSAY
 MANAGEMENT OF ACUTE APPENDICITIS

• NIL ORALLY
• IV INFUSION AND BLOOD INVESTIGATIONS
• ? NASOGASTRIC ASPIRATION
• INTRAVENOUS ANTIBIOTICS
• ANALGESIA
• SURGERY: EMERGENCY APPENDICECTOMY
(OPEN OR LAPAROSCOPIC)
 PERFORATED APPENDICITIS
• CLINICAL FEATURES
• PREPARATION FOR SURGERY
• INVESTIGATIONS
• SURGERY: EXPLORATORY LAPAROTOMY,
APPENDICECTOMY, PERITONEAL LAVAGE
• POSTOPERATIVE MANAGEMENT
 APPENDIX MASS
• DEFINITION
• CLINICAL FEATURES
• DIFFERENTIAL DIAGNOSIS: INTRA-
ABDOMINAL, RETROPERITONEAL
• INVESTIGATIONS/MANAGEMENT
• OCHNER – SHERREN’S REGIMEN
• SURGICAL INTERVENTION
• FOLLOW - UP
 APPENDIX ABSCESS
• PATHOGENESIS

• DIAGNOSIS

• TREATMENT

• INTERVAL APPENDICECTOMY
 TYPES OF APPENDICECTOMY
• ELECTIVE

• EMERGENCY

• INTERVAL

• INCIDENTAL
COMPLICATIONS OF APPENDICECTOMY

• HAEMORRHAGE: WOUND, INTRAPERITONEAL

• INFECTION: WOUND, INTRA-ABDOMINAL

(PELVIC, SUBPHRENIC), PORTAL PYAEMIA

• ENTEROCUTANEOUS FISTULA

• DAMAGE TO OTHER STRUCTURES

 CONCLUSION
• KNOWLEDGE OF APPENDICITIS VERY
IMPORTANT

- EXAMINATONS

- CLINICAL PRACTICE
• THANKS FOR LISTENING