Appendicitis

WHAT IS APPENDICITIS?
The appendix (appendix vermiformis) is a thin, finger-shaped organ located in the lower right quadrant of the abdomen, at the beginning of the large intestine, at the end of the caecum. Its length is usually between 6-9 cm. Although its function in the body is not fully elucidated, it is known to secrete some substances related to the immune system. There is no loss of function if taken. Appendicitis means inflammation of the appendix. Most often, this occurs due to blockage at the root of the finger organ. Although it can be seen at all ages, it is most common between the ages of 10-30.
WHAT ARE THE SYMPTOMS OF APPENDICITIS?
ABDOMINAL PAIN is the most important complaint. The complaints occurred within the last day or several days. The pain usually starts gradually around the navel. Then it disappears around the navel. It is located in the lower right side of the abdomen. The pain increases with movement, coughing, laughing and shaking. It is a constant and constant pain.

The characteristics of the pain may differ from the typical form described here in those taking painkillers/antibiotics, diabetics, children and the elderly. It is more difficult to diagnose appendicitis, especially in young children, as they cannot localize the pain. It is necessary to perform very careful repeated physical examinations. Some patients who delay in consulting a doctor may have a burst appendicitis. In this case, the pain may be relieved for a few hours. But later it returns more commonly along with FEVER.
LOSS OF APPETITE (Seen in more than 90% of patients. Patients do not even want to eat their favorite food even though they are hungry.)
NAUSE, sometimes vomiting (Usually occurs hours after the pain begins)
In the presence of such complaints, you can apply to Göztepe Pediatric Surgery Clinic.
WHAT IN CASE OF SUSPICION OF APENDICITIS? SHOULD?

If the child has severe and persistent pain, especially in the lower right quadrant of the abdomen, it is necessary to apply to the nearest PEDIATRIC SURGERY center. The patient should not be fed orally and medications such as painkillers/antibiotics should not be given without a definitive diagnosis. These medications may suppress existing findings, leading to delayed diagnosis and undesirable consequences, including appendix rupture.
WHAT ARE THE EXAMINATION FINDINGS?

Patients prefer to lie still, pulling their legs towards their abdomen. Severe pain (SENSITIVITY) occurs when pressing lightly on the lower right part of the abdomen. During the examination, “an imaginary line extending from the belly button to the right lateral anterior prominence of the pelvis” is considered. The most sensitive area in appendicitis is usually the area around the outer half of this line. Apart from sensitivity, stiffness is also felt in this area. This is called defense. If the hand is suddenly withdrawn after pressing deeply on this area for at least 4-5 seconds, a sharp, severe pain as if an electric shock may be felt in the abdomen. This is called rebound. This pain can sometimes be so severe that it makes the patient jump from the bed. The presence of this finding in the right lower quadrant of the abdomen is very important for the diagnosis of appendicitis. Examination findings may be different, especially in young children under the age of five. It is important to relax the child as much as possible before the examination and ensure compliance with the examination. Young children tend to tense their entire abdomen due to severe pain. It may not be possible to identify the main painful area. If necessary, young children can be examined again by giving mild sedatives. The experienced team of Göztepe Pediatric Surgery clinic makes the appropriate diagnosis and applies the necessary treatment to patients presenting with abdominal pain.

WHAT ANALYSIS AND EXAMINATIONS ARE PERFORMED IN APPENDICITIS?
The diagnosis of appendicitis is made mainly based on the history of the disease and the examination findings of the patient. Some of the diagnostic aids are: High white blood cell count (WBC), high C-reactive protein (CRP) level in blood tests, and signs specific to appendicitis were detected on ultrasound and standing abdominal radiography. However, these are not always valid. The fact that these criteria are normal does not exclude us from the possibility of appendicitis. Elimination of causes similar to appendicitis that may be confused with appendicitis brings us closer to the diagnosis of appendicitis. These; These are situations such as normal urinalysis
and no problems with gynecological diseases. Even if ultrasound findings are normal, surgery may be decided if examination findings are present. The opposite may also happen.
If there are findings compatible with appendicitis on ultrasound, but the patient's complaints regress and the examination findings disappear, the doctor may decide not to perform surgery and follow up.
IS DELAY DANGEROUS? APPENDICIST BURST

Patients who consult a surgeon and undergo surgery within the first 24-48 hours usually undergo surgery in less than half an hour
and can regain their health by staying in the hospital for two days. However, the situation of patients whose surgery is delayed for some reason may become difficult and dangerous. Surgeries for such patients
are more troublesome. After the surgery, they may experience a more difficult period, such as placing a tube (drain) in the abdomen and keeping it for a while, and additional medication and serum treatments for at least five
days.
The appendix, whose root is blocked and becomes infected with bacteria, first swells. Then circulatory disorder develops
and a perforation occurs as a result of decay in a certain area. This is called burst appendix (perforated
appendicitis). Once the appendix is ruptured, the dirty infected contents spread freely into the environment. Pus accumulates in the surrounding area (periapendicular abscess) develops. If the patient is not operated on as soon as possible, a severe condition in the form of widespread intra-abdominal
inflammation will develop.
WHAT PREPARATIONS SHOULD BE MADE BEFORE THE SURGERY?

All patients who are decided to undergo surgery are examined by the anesthesiologist before being taken into surgery.
If the patient takes aspirin, coraspin, coumadin, etc. If one is using blood thinners, the risk of bleeding will be high if one undergoes surgery under the influence of these drugs. However, appendicitis is an emergency and it is not possible to stop these medications and wait for their effects to wear off over time. The patient is taken to emergency surgery by taking some precautions. Before the surgery, the patient is given preventive antibiotic treatment. Patients should stop eating and drinking as soon as the possibility of appendicitis is mentioned. If possible, it is preferred that patients be hungry as if they have been fasting for at least 5-6 hours before the surgery. All patients must read and sign the surgery-specific informed consent forms presented to them regarding the planned surgery.
They must also be informed about the risks of the surgery and document that they have given informed consent for the surgery in writing.
HOW IS APENDICITIS SURGERY PERFORMED?

The surgery is performed under general anesthesia. Surgery time is usually between 30-60 minutes. Hospitalization
requires two days of hospitalization. Often, a 2-3 centimeter incision in the right lower quadrant of the abdomen is sufficient. In very rare cases where the diagnosis is not clear
a midline incision in the lower part of the umbilicus can also be used. During surgery, the appendix is located in the lower right quadrant of the abdomen, extending in the shape of a finger at the end of the cecum at the beginning of the large intestine. The appendix is removed by ligating its vein and root. The appendix may be normal in 10-15% of patients who undergo surgery with the diagnosis of appendicitis. This situation is caused by diseases that mimic appendicitis and the difficulty in diagnosing appendicitis. In fact, in an emergency situation, it is also necessary to act cautiously for the benefit of the patient in the face of a risky situation. It is not considered as an error, complication or malpractice. This rate
is considered normal by medical and scientific references.
Some of the diseases that mimic appendicitis are; inflammatory bowel diseases, diverticulitis, some bowel diseases

tumors, gastrointestinal perforations, ovarian cysts in girls, etc. For these reasons
If an additional intervention is required during the surgery, the additional intervention is performed in the same session by the surgeon himself or the specialist of the relevant department.
The surgery can also be performed by a closed (laparoscopic) method. In this method, the same procedure is performed
by making a 1cm incision on the navel and a 0.5cm incision on the left side and mid-abdominal area, and using instruments inserted through these holes. Your surgeon will decide which method will be appropriate
according to the condition of the patient and the operating room. Appendicitis surgeries are successfully performed with open or closed methods at Göztepe Pediatric Surgery Clinic.
WHAT IS THE FOLLOW-UP LIKE AFTER THE SURGERY?
After standard appendicitis surgery, patients can stand up, walk and take food orally on the same day.
There is no significant pain problem. Most patients are discharged within two days. Explosion (perforation),

Patients who develop abscess and wrapped appendicitis (plastron) may need to be hospitalized for longer periods (at least 5 days)
and receive intravenous antibiotic treatment.
The dressing is removed 24 hours after the surgery and it is not necessary to close it again. Bathing can be done on the fifth day.
The wound can be left open. Redness, discharge etc. If there is no problem, no re-dressing is required. If the wound is closed with self-dissolving hidden stitches, it is not necessary to remove stitches. If visible stitches
are placed, the stitches should be removed one week after the surgery. There is no special diet or nutritional restriction.
Lifting excessive weights should be avoided for about a month. It is recommended to avoid heavy sports and physical exercises. After the surgery, there will be no disorder or deficiency in physical urination due to the loss of the appendix from the body. There is no need for long-term follow-up and controls. The appendix tissue removed during surgery will be sent for pathological examination. You need to follow this result and show it to your
surgeon.

WHAT ARE THE PROBLEMS AFTER SURGERY?
Infection may develop in the wound after surgery. Pain, redness, swelling, and inflammatory discharge may occur in the wound. Periodic dressings and antibiotic treatment may be required. If the patient
has undergone surgery in case of ruptured appendicitis, the risk of developing an abscess in the appendix area increases. In this
case, he places a drain (small plastic tube) extending from that area to the outside of the abdomen. The drain can be removed after being kept for a few days
. In a very small group of patients, an abscess may develop days after surgery. In this case, the patient may need to be hospitalized again and start intravenous antibiotic treatment. Re-operation is rarely necessary.
It can usually be treated by placing a drain along with imaging methods.
There is a risk of adhesion and obstruction of the intestines with decreasing frequency after surgery. If you have complaints of abdominal pain,
abdominal swelling, vomiting (especially with green bile), you should immediately consult your surgeon.

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