Appendicitis is an inflammation of the appendix in the intestine. More common in children and young adults, its symptoms can be subtle.
Appendicitis scares every parent. A pain that persists in the child’s stomach and we want to know which side is the appendicitis? Left or right? What are the warning symptoms of appendicitis? What to do? Explanations from Professor Philippe Wind, visceral and digestive surgeon at the Avicenne hospital in Bobigny.
The term “appendicitis” refers to sudden and acute inflammation of the appendix. “The appendix is an atrophied part of the beginning of the large intestineexplains Professor Wind. It is a lymphoid organ which means that, like the lymph nodes, the appendix is part of the body’s immune defenses. There are many lymphoid organs located around the digestive system.” The appendix looks like a sort of “dead end” between the small and large intestine, 6 to 12 cm in length and 5 mm in diameter on average and is hollow. Appendicitis occurs as a result an obstruction of the appendix by fecal matter It affects one person in fifteen, mainly between 10 and 30 years old. It is rare before the age of 5, and exceptional before 3 years old. Acute appendicitis is distinguished from chronic appendicitis.
► Acute appendicitis
It can affect people of all ages, but particularly occurs before the age of 30, with a peak in prevalence generally between 10 and 14 years and another between 25 and 34 years. Acute appendicitis is a sudden inflammation of the appendix. This inflammation is sudden and is accompanied by severe abdominal pain.
►Chronic appendicitis
Chronic appendicitis is a long-standing inflammation or fibrosis of the
Above all, do not take laxatives which could increase the risk of bursting the appendix.
A typical attack of appendicitis begins with abdominal pain, most often located in the right iliac fossa, that is, just above the groin fold. This is in fact where the appendix is located in most people. Note that in approximately a third of cases, the appendix is not located in the right iliac fossa. It can, for example, be lodged under the liver, we then speak of a subhepatic appendix (but it is always on the right). Other times, it is in the middle of the abdomen, under the large intestine, and it is then retrocecal appendicitis.
- Sharp and persistent abdominal pain in the lower abdomen, near the navel or a little further to the right above the groin,
- A moderate fever, around 38.5°C
- Nausea
- Vomiting
- Headaches
- Constipation
On the x-ray, the inflamed appendix is more swollen and more opaque. If these symptoms appear, it is advisable not to give anything to eat or drink and to urgently call the doctor or call 15. Above all, do not take laxatives which could increase the risk of bursting of the appendix.
This inflammation can occur for various and, most often, undetermined reasons. “The initial mechanism is not well understood. We only know that sometimes germs or parasites are the cause of the outbreak.“, continues the doctor. It is therefore impossible to predict if and when the crisis will occur, or even to try to escape it. On the other hand, the only certain fact is that it affects children and young adults much more often. “Again, there is no definitive explanation, but it may have something to do with the fact that children’s immune systems are often more active than adults’.“.
► The complete blood count (CBC): this is the quantity of leukocytes (a category of white blood cells) that we will measure. Leukocytes are produced by the lymphoid organs (of which the appendix is a part) to fight infections. Generally, in the event of an appendicitis attack, the leukocyte level is much higher than normal. That said, the CBC is not sufficient to make a diagnosis of appendicitis, since leukocytes can be elevated for countless reasons.
► CRP, or C-reactive proteins, are other markers of inflammation. A bit like white blood cells, they mainly have a negative predictive value: if the CRP is high, it is consistent with an attack of appendicitis. If they are low during two measurements more than 24 hours apart: it is not appendicitis.
► The scanner is “without a doubt the best reviewcomments Professor Wind. It makes it much easier to identify a thickening of the appendix and fatty infiltration all around, a typical sign of an appendicitis attack..” Although the result is not 100% guaranteed, it is still, by far, the most reliable diagnostic tool.
► Ultrasound has the same properties as CT, but it is less reliable: depending on where the appendix is placed, the amount of abdominal fat, etc. it can be difficult to spot. This is still the recommended examination for pregnant women and children, who cannot be too exposed to the scanner’s rays.
In a few rare cases, the crisis resolves on its own. But most of the time, to treat an attack of appendicitis, it is necessary to carry out an appendectomy, in other words a removal of the appendix by surgery. However, surgical intervention is no longer systematic and we now favor removal by laparoscopy. The laparoscope consists of making three small holes in the abdomen under general anesthesia, inserting a mini-camera to incise and remove the appendix with as little damage as possible. Carbon dioxide is introduced into the abdomen to lift the abdomen, so that the viscera is easily accessible. Using large needles (trocars), the surgeon can insert the surgical instruments into the abdomen and carry out the ablation. After the operation, in the case of a “simple” appendicitis attack, the patient receives antibiotic therapy for approximately two days, to ensure that the infection is well contained.
In the case of a laparoscopic operation, the three small holes become almost invisible a few weeks later. For a classic operation, the very fine incision of a few centimeters becomes barely perceptible over time.
If appendicitis is not treated, there is a high risk that it will degenerate into peritonitis.
If appendicitis, treated in time, is benign, peritonitis, on the other hand, can leave after-effects. “We speak of peritonitis as soon as there is inflammation of the peritoneum.explains Professor Wind. Peritonitis is not necessarily the result of an attack of appendicitis. On the other hand, if appendicitis is not treated, there is a strong risk that it will degenerate into peritonitis.“The peritoneum is the membrane that covers the interior walls of the abdomen. In 10% to 15% of cases, the infection of the appendix will contaminate it. “This is the scenario doctors fear, which is why they tend to be overly cautious with abdominal pain. The signs are much more telling. They are approximately the same as for appendicitis but are expressed with much more intensity. This time, both doctor and patient generally have much less hesitation. In industrialized countries, for healthy people, cases of appendicitis with peritonitis are perfectly treatable.“, reassures Philippe Wind. The aftermath of the operation can be a little more painful.
Peritonitis can be fatal. Indeed, if it is not detected in time, it causes septicemia, that is to say a generalized infection, from which it is almost impossible to escape alive. Apart from the time factor between the start of the appendicitis attack and the moment of diagnosis, we do not know how to explain why approximately 1 in 10 people will develop peritonitis and not the others.
On the health forum: discussions about appendicitis
To remember
► The appendix measures 6 to 12 cm in length and 5 mm in diameter on average.
► Acute appendicitis occurs mainly before the age of 30 with 2 peaks: between 10 and 14 years and between 25 and 34 years.
► Sharp and persistent abdominal pain in the lower abdomen, near the navel or a little further to the right may suggest appendicitis,
► In the event of an operation, the laparoscopy technique is preferred in 90% of cases.
► We speak of peritonitis as soon as there is inflammation of the peritoneum.
Thanks to Professor Philippe Wind, specialist in visceral and digestive surgery at the Avicenne Hospital (AP-HP) in Bobigny.
