Appendicitis Treatment in Delhi, India

Appendicitis refers to an inflamed appendix. The appendix is a small, tubular pouch located at the lower right section of the large intestine. Sometimes, faecal matter, viral and bacterial infections can block or infect this pouch, causing it to swell and burst. A raptured appendix is a serious medical emergency as the bacteria can spread from inside the bowels into the abdominal cavity. Bacteria can enter the bloodstream, leading to life-threatening complications such as sepsis, an extreme inflammatory response to infection).

There are two types of appendicitis:

• Acute: Acute appendicitis, as the name suggests, occurs suddenly and typically worsens within a few hours. 
• Chronic: Chronic appendicitis is a rare condition that develops gradually over time. Symptoms such as pain and bloating are usually mild and may resolve on their own. However, these symptoms may recur after a week, a few months, or even years. 

The primary cause of appendicitis is an obstruction in the lumen, a small space inside the appendix that connects to the large intestine. In addition to the obstructions in the appendix’s lumen, several conditions may contribute to development of appendicitis, such as:

• Lymphoid hyperplasia: This conditions occurs when lymph nodes produce excess cells in response to a virus or infection. Because the appendix contains lymphatic tissue, it may react by swelling, even if it is not the source of the infection. That swelling can cause a blockage, resulting in an infection.
• Colitis: Inflammation of the lining of the colon (colitis) can also affect the appendix through the spread of infection or because of inflammation.
• Parasitic infection: A parasitic infection in the digestive tract can cause secondary inflammation to the appendix resulting in appendicitis.
• Tumour: A tumour growth inside the appendix can cause appendicitis.

Appendicitis is associated with several risk factors that can lead to the development of the disease:

• Age: Children and adults between the ages of 10-30 are more prone to developing appendicitis and is most commonly seen in this age range.
• Sex: Appendicitis is more common in men than women.
• Colorectal Cancer: People who have had colorectal cancer are at an increased risk of appendicitis and vise versa.
• Taking antibiotics before 6 months: Infants who have had to take antibiotics early on in life in the first 6 months are at an increased risk of developing appendicitis later on.
• Smoking: Studies suggest that people who smoke are more prone to appendix perforation. 

Common symptoms associated with appendicitis include:

• Lower belly pain
• Pain that worsens with coughing or jarring movements
• Nausea and vomiting
• Loss of appetite
• Constipation or diarrhoea
• Fever that can go up to 39℃ (102℉)
• Bloating and Gas

Less common symptoms include:

• Painful urination
• Pelvic pain
• Severe cramps
• Acid reflux
• Pain under the rib cage

Diagnosis of appendicitis is tricky as the symptoms associated with this condition can be mistaken for other diseases such as inflammatory bowel disease, kidney stones or even urinary tract infections.

• Physical Exam: A physical exam will be done by checking any physical signs of a swollen appendix such as stiffening in the lower belly area or pain in response to pressure. 
• Blood Test: Any type of infection increases the amount of white blood cells in our body. A blood test is used to confirm the infection.
• Urine Test: A urinalysis may be done to rule out urinary tract infections or kidney stones.
• Imaging Test: Imaging tests like an ultrasound or a CT scan can confirm the presence or absence of inflammation in the appendix.

Medications

Antibiotics are generally prescribed as a preventive measure before the surgery. Even if the cause of appendicitis is not a bacterial infection, it will eventually lead to one.

Pain relief medications are also given before and after surgery.

Appendectomy

Generally, appendicitis is treated via a surgery called the appendectomy. The appendix can be removed either by laparoscopy or through open surgery. 

• Laparoscopy: During the procedure, the surgeon inflates the abdomen with carbon dioxide using a tube. This helps in better visualisation of the appendix. Following the inflation, the surgeon removes the appendix by making a 2-4 inch long cut. Once the appendix is removed, the cut is closed either with dissolvable or regular stitches. Hospital stay is usually for a day.
• Open Surgery: An open surgery involves making a larger cut in the lower side of the belly. This is followed by tying off the appendix with stitches and removing it. Sutures are made to close up the cut. In case the appendix has burst open, the abdominal cavity will be washed out with salt water. A hospital stay is up to a week in case of open surgery.

Common complications associated with appendicitis include:

• Peritonitis: Appendicitis if not treated in time, can lead to infection of the abdominal cavity (peritonitis) which can be life-threatening. It needs to be treated quickly with strong antibiotics.
• Abscess: A collection of pus is known as an abscess. Bursting of the appendix causes abscess. 
• Ileus: Ileus is a condition where the intestines cannot contract normally, causing food to move slowly or not at all through the digestive system. Symptoms of ileus include constipation, bloating and gas.

There is no sure shot way of preventing appendicitis. But, maintaining a healthy diet, exercising regularly, avoiding alcohol and tobacco consumption may help reduce triggers of appendicitis.

1. What are the four Stages of appendicitis?

• Early Stage: At the early stages of appendicitis, milder pain and discomfort can be felt. The appendix is enlarged, but there is no serious threat of rupture.
• Suppurative Stage: In the suppurative stage, pus forms Inside the appendix as the inflammation becomes worse.
• Gangrenous Stage: Tissue death (gangrene) occurs due to the blockage of blood supply to the appendix. There is an increased tendency towards rupture of the appendix.
• Perforation Stage: A potentially lethal disease known as peritonitis results from appendix rupture; the infectious contents spill into the abdominal cavity.

2. Can appendicitis cure on its own, without any need for medical treatment?

No, appendicitis is not commonly resolved without medical aid. The condition might result in rupture of the appendix and several other serious complications without treatment. 

3. How long does it take to recover from an appendectomy?

This depends upon what type of surgery has been done. Generally, recovery after laparoscopic surgery usually occurs between 1 to 3 weeks, and these patients can return to normal activity sooner compared to open surgery. Open surgery patients take about 4-6 weeks to recover because of a bigger incision. Full recovery depends upon age, health, and occurrence of complications.

4. Is laparoscopic surgery always preferable over open surgery for appendicitis?

Laparoscopic surgery is generally preferred over open surgery due its advantages like minimal scarring and less recovery time. Open surgery is done in cases of complications or when the appendix has burst open.

5. Are there any long-term side effects after appendectomy surgery?

Most people do not experience any long term effects of appendectomy, however in rare cases, side effects like bowel obstructions can be a long term problem. Talk to your doctor if you experience any long term side effects of the surgery.

Reviewed by Dr Arun NC Peters, Senior Director - Bariatric Surgery / Metabolic, Minimal Access & Laparoscopic Surgery, Department of General Surgery and Robotics on 9 Dec 2024.

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