Appendicitis: is surgery always necessary?
The word “appendicitis” we hear quite often. In childhood, parents and teachers tell us about him, doctors check us for his presence or absence. And at times, one of the acquaintances goes to the hospital – “cut the appendicitis.” And then it may turn out that the doctors made a mistake with the diagnosis. One gets the impression that appendicitis is not dangerous …
Moreover, more and more often you can hear that the operation is “superfluous”: they say, surgeons would only have to cut it … But what is true of this, and what is fiction?
Disease of all ages. Appendicitis is an inflammation of a special hollow organ extending from the cecum – the appendix, or appendix. The appendix cavity communicates with the lumen of the intestine, intestinal contents can enter the process – and it should go freely, otherwise stagnation of the contents in the cavity and the development of inflammation are possible. This can happen even because of the anatomical features of the appendix: the fact is that the size of this process, and its location in the abdominal cavity, and the presence of bends can be purely individual – which, we note, in case of inflammation significantly complicates the diagnosis. However, most often, due to the relatively small size of the appendix cavity, only a very small amount of intestinal mass enters it from the intestine.
Typically, in an adult, the appendix reaches a length of 7-9 cm (although there have been cases of underdeveloped processes only 0.5 cm long, and especially long ones up to 23 cm) and a diameter of not more than 1 cm. Moreover, the location of the appendix relative to other organs can be different : it can descend into the pelvic cavity, adjoin the anterior abdominal wall or peritoneum, sit among the loops of the intestine and even grow into the wall of the cecum. How important is this process to humans? On the one hand, this organ is rudimentary, gradually losing importance during evolution, on the other hand, it participates in the work of the immune system, primarily due to lymphoid tissue. It is most important for immunity in children and adolescents under 16 years of age; but also at a later age it is needed – for example, as a reservoir for normal intestinal microflora, from which bacteria (primarily E. coli) are spread throughout the large intestine. However, not only beneficial microorganisms, but also pathogens can settle in such a “reserve”: when studying remote processes, pathogenic microflora, and worm eggs, and helminths themselves were found in them.
Now doctors are inclined to believe that without good reason, this organ is still better not to remove. However, if there is even a suspicion of appendicitis and the doctor insists on surgical intervention, you have to agree: the risk of complications is too high, the possible benefits of the remaining appendix are many times less risk to health and life in case of exacerbation and complication of appendicitis.
Appendicitis is also chronic
There is no age limit for appendicitis either; it can develop in infants and the elderly. Appendicitis is one of the most common surgical diseases: it leads to the need for surgery in about every 20 people. In this case, up to a third of cases may remain undetected – inflammation occurs without pronounced symptoms and goes away by itself, without medical intervention. Almost all other cases are related to acute appendicitis.
If the appendix is not removed during the development of acute appendicitis (for example, due to the development of a special formation – appendicular infiltrate, which is considered a complication of appendicitis and is a dense lump of appendix and tissues of neighboring organs) and the seizures of the disease are repeated, such appendicitis is considered chronic. It is often extremely difficult to distinguish an attack of appendicitis from the symptoms of other diseases: a similar pattern is observed with exacerbation of peptic ulcer of the stomach and duodenum, infringement of a hernia, enterocolitis, renal colic, an attack of acute cholecystitis, some infectious diseases of the gastrointestinal tract (especially in children).
The diagnosis is not always simple.
Therefore, suspicion of appendicitis should occur with any sudden
severe abdominal pain (especially accompanied by fever) that does not go away within 6 hours. Most often, pain occurs at night or in the morning, all over the stomach or near the navel, less often in the hypochondrium, “under the spoon”. At first, the pain is not pronounced, but then its character from the pulling and bursting becomes clearly expressed, intensifying (especially when walking or lying on the left side); at the same time (up to 4 hours from the onset of the attack), the temperature may rise (up to 39-40 ° C, sometimes higher), nausea, vomiting, intestinal upset, dry mouth.
However, all these symptoms (as well as specific diagnostic signs – for example, sharp pain when pressing in the right iliac region) can be expressed clearly, they depend on the degree of inflammation.