The document provides an overview of appendicitis, detailing its anatomy, causes, clinical features, and types, along with risk factors and differential diagnoses. It discusses the Alvarado score for diagnosing acute appendicitis, various investigation methods like ultrasound and CT scans, and treatment options including surgical interventions. Complications such as appendicular mass and abscess are also addressed, including their clinical features and management approaches.

1. Appendicitis and its
complications

2. Contents

3. Anatomy
• Located at the terminal end of the caecum.
• Size: 5 to 10 cm
• Diameter: 3-8 mm
• Mesoappendix: Extention of the mesentery containing
appendicular artery, branch of ileocolic artery.
• Positions of appendix:
• Retrocaecal (74%) – most common
• Pelvic
• Paracaecal
• Preileal
• Subcaecal
• Post ileal (0.5%) – least common

4. Appendicitis
• Appendicitis is an inflammation of the appendix that develops most
common in adolescents.
• It refers to the acute inflammation of the appendix, and is the most
common cause for acute severe abdominal pain
• The abdomen is most tender at McBurny’s point – 1/3rd
of the
distance from R ASIS to umbilicus, corresponds to the location of the
appendix

5. Risk Factors
• Faecolith – most common cause
• Infection
• White races
• Lack of fibre rich diet
• Family history: 30%
• Obstuction
• Extremes of age
• Previous abdominal surgery

6. Causes
• Organism:
• E.Coli (85%)
• enterococci, (30%),
• streptococci,
• Anaerobic
• streptococci,
• Cl. welchii, bacteroides

7. Pathogenesis
• Acute inflammation of the mucus membrane with secondary infection
without obstruction causes acute nonobstructive appendicitis.
• Luminal obstruction by faecolith, lymphoid hyperplasia, pinworm
(oxyuris vermicularis), other worms, foreign body, carcinoma/Crohn‘s
disease

8. Types
• Acute nonobstructive appendicitis (catarrhal) (mucosal appendicitis)
• Acute obstructive appendicitis.
• Recurrent appendicitis.
• Subacute appendicitis.
• Stump appendicitis

9. Clinical Features
• Pain: earliest symptom. Visceral
pain starts around the umbilicus ->
right iliac fossa
• Vomiting: due to reflex
pylorospasm.
• Murphy’s triad
• Pain
• Vomiting
• Febrile
• Constipation is the usual feature
but diarrhoea can occur
• Fever, tachycardia.
• Urinary frequency: bladder
irritation.
• Tenderness and rebound
tenderness at McBurney’s point.
• Rovsing’s sign: On pressing left iliac
fossa, pain occurs in right iliac fossa
• Baldwing’s test is positive in
retrocaecal appendix.

10. Alvarado Score
• Several clinical and laboratory-based
scoring systems have been devised to
assist diagnosis.
• The most widely used is the Alvarado
score. A score of 7 or more is strongly
predictive of acute appendicitis.
• In patients with an equivocal score (5
or 6), abdominal ultrasonography or
contrast-enhanced CT examination is
recommended.

11. Differential Diagnosis for Acute Appendicitis
• Perforated duodenal ulcer.
• Acute cholecystitis
• Acute pancreatitis
• Right ureteric calculi
• Acute typhlitis
• Bacterial enterocloltis
• PID
• Testicular torsion

12. Investigations
• USG:
• Noncompressible appendix of size > 6 mm AP diameter, hyperechoic
thickened appendix wall > 2 mm—target sign.
• Appendicolith.
• Interruption of submucosal continuity.
• Periappendicular fluid.
• CBC (WBC) to correlate clinically.
• CECT: usually in old people
• MRI: useful in pregnancy

13. Surgery
• Open appendectomy-
• Grid iron incision, Lans incision, Rutherford Morrison’s incision
• Appendix identified and the base of mesoappendix clamped, divided and
ligated.
• Base of the appendix is ligated close to the base, and amputated between
artery forceps and the ligature.
• Appendicualr vessels are then ligated.

14. Open appendectomy

15. • Laparoscopic appendicectomy:
• Penumoperitoenum established using infra umbilical approach.
• Umbilical port + 2 working ports.
• The appendix is found using caecel taeniae.
• Appendix elevated and mesoappendix is displayed and is dissected.
• Appendicular vessels are ligated.
• Appendix is free at its base and is ligated.
• The specimen is removed through one of the operating ports.

16. Laparoscopic appendectomy

17. Complications

18. APPENDICULAR MASS
• It is the localisation of infection occurring 3 to 5 days after an attack of
acute appendicitis.
• Inflamed appendix, greater omentum, oedematous caecum, parietal
peritoneum and dilated ileum (ileus) forms a mass in the right iliac
fossa.
• Investigations
• TC is increased.
• Ultrasound confirms the mass.
• Treatment - Ochsner-Sherren Regimen

19. • Contraindications for
Ochsner-Sherren regimen
• 1. When diagnosis is in
doubt.
• 2. In acute appendicitis in
children and elderly.
• 3. In burst, gangrenous
appendicitis.
• 4. In patients in whom
diffuse peritonitis sets in.

20. APPENDICULAR ABSCESS
• Suppuration in an acute appendicitis or suppuration in an already formed
appendicular mass.
• commonly occurs in retrocaecal region
• Clinical features
• High fever, tender abdomen, smooth, dull (to percuss),
• soft swelling in right iliac fossa.
• Investigations: Ultrasound confirms the diagnosis.
• Treatment
• Antibiotics are started.
• CT-guided aspiration or catheter drainage is done often as initial
• Drainage of abscess.

22. Treatment
• Surgery:
• Open appendicectomy
• Laparoscopic appendicectomy

23. Thank You