Last week, as my clinic was coming to an end, a 19-year-old young man entered the clinic, clutching his stomach tightly and groaning. His name was Tharindu. Tharindu was having trouble even standing up straight.
"Doctor Priya, last night I had a mild pain around my navel. But since this morning, the pain has shifted to the right side of my lower abdomen, and it's unbearable. I'm also vomiting and have a fever," Tharindu explained with difficulty.
As soon as I laid Tharindu down on the examination table and gently pressed the right side of his abdomen (McBurney's Point), he screamed in pain.
I immediately said, "Taridu, you're not having a normal stomach ache. This is acute appendicitis . This is because the appendix , a small finger-like tube at the beginning of our large intestine, has become infected and swollen. We need to get you ready for surgery right away. Because if this isn't removed quickly, the appendix could burst inside the abdomen."
๐จ Red Flags that require immediate hospitalization
Appendicitis is a medical emergency that requires immediate medical attention. If you experience the following symptoms, you should go to the emergency department of your nearest major hospital without delay, as the appendix may have ruptured:
- Pain in the right lower abdomen suddenly spreads to the entire abdomen (a key sign that the appendix has burst).
- High fever with shivering and incessant vomiting.
- The abdomen feels tight, swollen, and painful, making it impossible to even touch it.
- Rapid heartbeat, difficulty breathing, and feeling faint.
Why does appendicitis occur?
The appendix is โโa small tube that is closed at one end and located in the lower right part of our digestive system.
If this tube becomes blocked by a fecal mass (fecalith), a viral or bacterial infection, or swollen lymph nodes, the opening of the appendix tube becomes completely blocked.
Bacteria grow rapidly in the blocked appendix, causing a severe swelling filled with pus. This cuts off blood flow to the area, eventually causing the appendix to rupture and burst. The pus and bacteria then spread throughout the abdominal cavity, causing a life-threatening bacterial infection called peritonitis .
The specific pattern in which symptoms appear
Appendicitis pain shows a different pattern than a typical stomach ache:
1. Onset: The pain first appears as a mild ache in the middle of the abdomen, around the belly button.
2. Spreading: Within a few hours, this pain moves to the right lower quadrant of the abdomen.
3. Escalation:The pain increases sharply when coughing, walking, hitting the ground, or when pressing on the right side of the abdomen and removing the hand (rebound tenderness).
4. Additional symptoms: Complete loss of appetite, nausea, vomiting, and mild fever.
Appendicitis surgery (Appendicectomy)
The only permanent cure for appendicitis is to surgically remove the infected appendix. This surgery is called an appendicectomy .
Currently, two main surgical methods are used for this:
- Laparoscopic Surgery / Keyhole Surgery: A modern surgery performed through about 3 small incisions in the abdomen using a camera and delicate instruments. The pain is minimal and there are no scars. The patient can recover quickly and go home.
- Open Surgery: In severe cases where the appendix has ruptured and spread infection throughout the abdomen, this is a traditional surgery performed through a 5-10 cm incision on the side of the abdomen. This requires a few days of hospitalization to recover.
Do's & Don'ts
| โ๏ธ Things to do (Do) | โ Don'ts |
|---|---|
| If appendicitis is suspected, stop eating and drinking immediately (Nil by mouth). This is essential for anesthesia for emergency surgery. | Do not take painkillers without a doctor's prescription to relieve stomach pain. This can mask symptoms and delay diagnosis. |
| Immediately take the patient to the emergency department of the nearest major hospital if there is any suspicious abdominal pain. | Never give an enema, laxatives, or hot water bottles to warm your stomach because you think it's indigestion. These can greatly increase the risk of your appendix bursting. |
| Take the full dose of antibiotics prescribed by your doctor after surgery. | Avoid lifting weights, running, or engaging in strenuous exercise for the first two weeks after surgery. |
โ Some other questions you may have (FAQ)
Are there any health problems after removing the appendix? โผ
No, the appendix is โโa vestigial organ that is not essential to our body. Removing it from the body will not have any effect on digestion or any other long-term health functions.
Can appendicitis be cured with antibiotics alone? โผ
Doctors may sometimes decide to use antibiotics alone for cases of uncomplicated or uncomplicated appendicitis. However, since the risk of recurrence is very high, surgery is the most definitive and safest treatment accepted worldwide.
What happens if the appendix bursts? โผ
If the appendix bursts, the pus and bacteria inside it can spread throughout the abdominal cavity, causing peritonitis. This can progress to sepsis, a condition in which bacteria enter the bloodstream and can even be fatal.
How to differentiate between abdominal pain caused by PCOS or urinary tract infection? โผ
Lower abdominal pain can also occur in women with ovarian pain (PCOS/Cyst rupture) and urinary tract infections. However, the pattern of pain starting from the navel and spreading to the right side and the characteristics of rebound tenderness do not occur there, as in appendicitis. This is differentiated through blood tests and scans.
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