Appendicitis

What it is

Appendicitis is the inflammation of the appendix, a small outgrowth of the large intestine, usually caused by an obstruction of its opening. It is the most common cause of emergency abdominal surgery. The pain usually starts around the navel and, within a few hours, shifts to the lower right abdomen, worsening with walking, coughing or pressing on the area; it comes together with loss of appetite, nausea, vomiting and low-grade fever. In women, it must be distinguished from gynecological causes, such as ovarian cysts, pelvic inflammatory disease and ectopic pregnancy. Diagnosis is clinical, supported by blood tests, ultrasound or CT scan. Treatment is appendectomy, preferably by laparoscopy, and delay increases the risk of perforation and peritonitis.

Most common symptoms

• Pain that starts around the navel and moves to the right side
• Pain that worsens with walking, coughing or pressing the area
• Loss of appetite
• Nausea and vomiting
• Low-grade fever
• Tender, rigid abdomen in advanced cases
• Diarrhea or constipation, in some cases

Causes and risk factors

• Blockage of the appendix opening by hardened stool (fecalith)
• Enlarged lymphoid tissue in the appendix wall after infections
• Age between 10 and 30, though it can occur at any age
• Family history of appendicitis
• More rarely, parasites, foreign bodies or tumors

How it is diagnosed

Diagnosis is essentially clinical: the history of the pain, the sequence of symptoms and the abdominal exam — with tenderness and rebound tenderness in the lower right area — point to the diagnosis. Blood tests show signs of inflammation, and ultrasound or CT scans confirm the condition and assess complications such as perforation and abscess. In women, a gynecological exam, a pregnancy test and transvaginal ultrasound help distinguish appendicitis from ovarian cysts, pelvic inflammatory disease and ectopic pregnancy.

How we treat it at Femi Saúde

Treatment for appendicitis is appendectomy — removal of the inflamed appendix — performed on an urgent basis, with antibiotics and intravenous fluids beforehand. The general surgery team at Femi Saúde prefers laparoscopy, which allows the entire abdominal cavity and pelvic organs to be examined through the same small incisions — especially useful in women, when it is unclear whether the cause is appendiceal or gynecological. In cases with perforation or abscess, drainage and a longer course of antibiotics may be necessary. The recovery plan is individualized, with guidance on diet, physical activity and return to work, according to each patient's progress.

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