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Appendicitis: When hours count
Appendicitis: When hours count

 Don't hesitate to seek medical help if you have certain signs and symptoms
If you suspect you have appendicitis, first call your family doctor to describe your symptoms.

Appendicitis"If it's after hours, your best bet is to go to a hospital emergency room," says George V. Cristescu, MD, a general surgeon at Kent Hospital.

Appendicitis is characterized by a sharp pain that begins in the belly button area and moves to the lower right abdomen, where it becomes even sharper. Additionally, "You may have a poor appetite, and possibly experience vomiting, diarrhea, or a fever. Pain will worsen with movement," Dr. Cristescu says.

Seven percent of the population will have appendicitis in their lifetime, with the most common instances occurring between the ages of 10 and 30 years.

To determine if you indeed have appendicitis, you will probably be given a blood test, including a white blood cell count to check for infection. If the diagnosis is unclear, your doctor may order a CT scan or ultrasound.

Dr. Cristescu estimates that more than 50 percent of people who come to the emergency room thinking that they have appendicitis actually do not. In these cases, the culprit is often a pelvic infection, ruptured ovarian cyst, or viral gastroenteritis.

Surgery: What it entails

The appendix is a small, finger-shaped organ attached to the large intestine. Appendicitis is caused by an obstruction or blockage of the inside of the appendix, called the appendiceal lumen.

Most patients with acute appendicitis have surgery within 12 hours of arriving at the hospital.

"If there is a lot of inflammation around the appendix, which occurs occasionally, we will only treat the infection with antibiotics because surgery would be very difficult," Dr. Cristescu explains. "If a patient's appendix ruptures, then emergency surgery is needed."

There are two types of surgery to remove the appendix, called an appendectomy. An open method appendectomy entails making a four- to six-inch incision in the right lower abdomen and pulling out the appendix. The laparoscopic method involves using a camera and long, thin instruments to remove the appendix through a one-inch belly button incision. The patient would also have two additional tiny one-third inch incisions to get the medical instruments in.

"Most surgeons today prefer the laparoscopic method because it causes less patient discomfort and enables a slightly quicker recovery," Dr. Cristescu says. The risk of complications is also lower at about 2 percent.

He adds that it's important to operate right away because the appendix could rupture, which can spread infection, called peritonitis, throughout the abdomen.

"Trying to treat appendicitis with antibiotics alone works in some patients, but generally increases the amount of time spent in the hospital and can lead to recurrent attacks after discharge," Dr. Cristescu says.

Recovery: What to expect

Patients with non-ruptured appendicitis generally go home the day of surgery or the next day. Patients with ruptured appendicitis usually stay in the hospital on antibiotics for three to five days.

"We prescribe mild narcotics for pain or Motrin and Tylenol," Dr. Cristescu says. Antibiotics are not usually needed at home. Patients typically need two to four weeks to fully recover.

Dr. Cristescu says humans can live normally without an appendix. "In the first few years of life, the appendix plays a role in immune system function. However, after that it has no importance," he says.

 

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