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Topic: Clinical anatomy and operative surgery of appendicitis. Localization variability of the appendix.

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Appendicitis is defined as an inflammation of the inner lining of the vermiform appendix that spreads to its other parts. This condition is a common and urgent surgical illness with protean manifestations, generous overlap with other clinical syndromes, and significant morbidity, which increases with diagnostic delay. Appendicitis is defined as an inflammation of the inner lining of the vermiform appendix that spreads to its other parts. This condition is a common and urgent surgical illness with protean manifestations, generous overlap with other clinical syndromes, and significant morbidity, which increases with diagnostic delay.

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The three taeniae coli converge at the junction of the cecum with the appendix and can be a useful landmark to identify the appendix. The three taeniae coli converge at the junction of the cecum with the appendix and can be a useful landmark to identify the appendix. The appendix can vary in length from 30 cm; most appendices are 6 to 9 cm long.

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The lifetime rate of appendectomy is 12% for men and 25% for women, with approximately 7% of all people undergoing appendectomy for acute appendicitis during their lifetim The lifetime rate of appendectomy is 12% for men and 25% for women, with approximately 7% of all people undergoing appendectomy for acute appendicitis during their lifetim Despite the increased use of ultrasonography, computed tomography (CT), and laparoscopy, the rate of misdiagnosis of appendicitis has remained constant (15.3%), as has the rate of appendiceal rupture. The percentage of misdiagnosed cases of appendicitis is significantly higher among women than among men

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Obstruction of the lumen is the dominant etiologic factor in acute appendicitis. Obstruction of the lumen is the dominant etiologic factor in acute appendicitis. – Faecolith / faecal stasis – Submucosal lymphoid hyperplasia – Inspissated barium – Vegetable/fruit seeds – Worms (Entrobius vermicularis – Tumours of caecum/appendix

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Common organisms seen in patients with acute appendicitis Common organisms seen in patients with acute appendicitis

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The sequence of symptom appearance has great significance for the differential diagnosis. In >95% of patients with acute appendicitis, anorexia is the first symptom, followed by abdominal pain, which is followed, in turn, by vomiting (if vomiting occurs). If vomiting precedes the onset of pain, the diagnosis of appendicitis should be questioned.

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Appendetomy : Appendetomy : 1-open appendetomy 2-Laparoscopic appendetomy

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For open appendectomy most surgeons use either a McBurney (oblique) or Rocky-Davis (transverse) right lower quadrant muscle-splitting incision in patients with suspected appendicitis. The incision should be centered over either the point of maximal tenderness or a palpable mass For open appendectomy most surgeons use either a McBurney (oblique) or Rocky-Davis (transverse) right lower quadrant muscle-splitting incision in patients with suspected appendicitis. The incision should be centered over either the point of maximal tenderness or a palpable mass

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Laparoscopic appendectomy usually requires the use of three ports. Four ports may occasionally be necessary to mobilize a retrocecal appendix. The surgeon usually stands to the patient's left. One assistant is required to operate the camera. One trocar is placed in the umbilicus (10 mm), and a second trocar is placed in the suprapubic position. Some surgeons place this second port in the left lower quadrant. The suprapubic trocar is either 10 or 12 mm, depending on whether or not a linear stapler will be used. Laparoscopic appendectomy usually requires the use of three ports. Four ports may occasionally be necessary to mobilize a retrocecal appendix. The surgeon usually stands to the patient's left. One assistant is required to operate the camera. One trocar is placed in the umbilicus (10 mm), and a second trocar is placed in the suprapubic position. Some surgeons place this second port in the left lower quadrant. The suprapubic trocar is either 10 or 12 mm, depending on whether or not a linear stapler will be used. The placement of the third trocar (5 mm) is variable and usually is either in the left lower quadrant, epigastrium, or right upper quadrant.

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The mortality from appendicitis in the United States has steadily decreased from a rate of 9.9 per 100,000 in 1939 to 0.2 per 100,000 today. Among the factors responsible are advances in anesthesia, antibiotics, IV fluids, and blood products. Principal factors influencing mortality are whether rupture occurs before surgical treatment and the age of the patient. The overall mortality rate in acute appendicitis with rupture is approximately 1%. The mortality rate of appendicitis with rupture in the elderly is approximately 5%—a fivefold increase from the overall rate. Death is usually attributable to uncontrolled sepsis peritonitis, intra-abdominal abscesses, or gram-negative septicemia. Pulmonary embolism continues to account for some deaths. The mortality from appendicitis in the United States has steadily decreased from a rate of 9.9 per 100,000 in 1939 to 0.2 per 100,000 today. Among the factors responsible are advances in anesthesia, antibiotics, IV fluids, and blood products. Principal factors influencing mortality are whether rupture occurs before surgical treatment and the age of the patient. The overall mortality rate in acute appendicitis with rupture is approximately 1%. The mortality rate of appendicitis with rupture in the elderly is approximately 5%—a fivefold increase from the overall rate. Death is usually attributable to uncontrolled sepsis peritonitis, intra-abdominal abscesses, or gram-negative septicemia. Pulmonary embolism continues to account for some deaths.