The appendix is a tube like structure at the junction of the small and large bowel .it is a vestigial organ for the human beings.Its base remains constant at the above junction but the position of its tip varies resulting in different types of clinical presentation.
The appendix is vestigial organ in the human body i.e.. during evolution to our prurient human state , this organ has become non functional.
Obstruction of the opening of the appendix ( where it is joined to the caecum or the initial part of the large bowel ) can sometimes occur.This may occur because of a ball of faeces (facecolith) blocking the opening or a swelling of lymphoid tissue at the opening blocking it. Secretions inside the blocked appendix cause it to get swollen and this causes discomfort and pain in central abdomen.
Later the appendix gets inflammed and infected irritating the inner layer of abdomen locally in right lower abdomen causing a shift in pain to that region. In addition patient may have nausea / vomiting , difficulty in passing urine and loose stools.The pain tends to be severe and acute.
On examination of the patient ; classically there will be severe tenderness and guarding of muscles in the right lower abdomen .
Since the clinical presentation may vary due to different positions the appendix can occupy ; Investigations are carried for confirmation.These are :
Complete Blod Count (CBC ) :more specifically , the TLC (Total Leukocyte Count).This indicates the white cell count in blood .This gets raised in cases of inflammation / infection inside the body and acts as a corroborative evidence.
Ultrasound scan of abdomen : This can confirm appendicitis in upto 90 % cases in expert hands .There is no radiation in this investigation and is the preferred first modality in children and pregnant women.
CT Scan of abdomen : has a very high diagnostic accuracy of 95 % to 98 %. It is the preferred method of diagnosis.However it carries radiation.
MRI scan of abdomen : may be used sometimes in case of pregnant women with suspected appendicitis.
Treatment : The treatment of choice for acute appendicitis is surgical removal of appendix or appendicectomy . This is so because there is danger of rupture (perforation) of appendix and resultant sepsis .
Surgery is carried out using both open and laparoscopic techniques .Increasingly ; the laparoscopic method has gained prominence due to less pain , early recovery and better cosmetic outcome.