Appendix Chapter, Sabiston Textbook of Surgery

Appendix
Huang,Shuo
Specialist Surgeon
Section of General Surgery
Department of Surgery
Jiamusi university hospital
Telephone Email:
+86-136 045 402 35 shuo.huang@hotmail.com
Telephone Email:
• Appendicitis
• History
• Although appendicitis has been a
common problem for centuries, it was
not until the early 19th century that the
appendix was recognized as an organ
capable of causing disease.
Telephone Email:
• In 1827, Melier described several autopsy
cases of appendicitis and clearly stated the
opinion that the appendix was the likely cause,
including the presumed pathophysiology that
is accepted today.
• By 1880, both Matterstock in Germany and
with in Norway published papers that clearly
suggest the appendix as a significant cause of
iliac fossa inflammation.
Telephone Email:
• In 1886, Reginald Fitz of Boston made a
landmark contribution by discussing the
appendix as the primary cause of right
lower quadrant inflammation.
• He coined the term appendicitis and,
importantly, recommended early surgical
treatment of the disease.
Telephone Email:
• In 1889, Chester McBurney described the migratory pain as
well as the finger point localization of pain between 1.5 and 2
inches from the anterior iliac spine on an oblique line to the
umbilicus.
• He incorrectly stated that this was an almost constant finding in
patients with appendicitis.
• McBurney in New York and McArthur in Chicago described a
right lower quadrant muscle splitting incision for surgical
treatment in 1894.
• It is interesting to note that McBurney kept his patients on bed
rest for at least 4 weeks after surgery.
• In 1905, Murphy clearly described the appropriate sequence of
symptoms of pain followed by nauseas and vomiting with fever
and exaggerated local tenderness in the position occupied by
the appendix.
• Currently, the mortality rate is 0.25% if all ages are considered
Telephone Email:
• Pathophysiology
• It is widely accepted that the inciting event in
most instances of appendicitis is obstruction
of the appendiceal lumen.
• Given the correlation with the incidence of
appendicitis by age and the size and
distribution of the lymphoid tissue, it is likely
that lymphoid obstruction or partial obstruction
of the lumen is a common cause.
Telephone Email:
• Necrosis of the appendiceal wall subsequently
occurs along with translocation of bacteria through
the ischemic wall.
• This is gangrenous appendicitis.
• Without intervention, the gangrenous appendix will
perforate, with spillage of the appendiceal contents
into the peritoneal cavity.
• If this sequence of events occurs slowly, the
appendix is contained by the inflammatory response
and the omentum, leading to localized peritonitis and
eventually an appendiceal abscess.
• If the body does not wall off the process, the patient
may develop diffuse peritonitis.
Telephone Email:
• Clinical
• history
• physical findings, laboratory and radiographic
examinations.
• Vomiting
• anorexia and nausea.
• The pain
• in the epigastrium and gradually moves towards
the umbilicus, finally localizing in the right lower
quadrant.
Telephone Email:
• diminished bowel sounds
• direct tenderness
• muscle spasm
• rebound tenderness.
• The temperature
• The appendix is often situated at or around
McBurney’s point.
Telephone Email:
Rovsing’s sign
The psoas sign

.
• The obturator sign
• Rectal examination
Telephone Email:
• Radiographic
• flat and upright abdominal radiograph
• useful in patients with atypical symptoms and

physical signs.
Telephone Email:
• Ultrasound
• the initial diagnostic imaging
• Noninvasive
• rapidly available
• avoids radiation exposure.
• Sensitivity more than 85%
Telephone Email:
• Computed tomography
• atypical for appendicitis
• appears as a thin tubular structure in the
right lower quadrant
• Abnormal (distended or thickened)
• Sensitive
• 48-72 hours
Telephone Email:
Telephone Email:
• Nuclear medicine
• Noninvasive
• not promptly available.
• Accuracy (unknown)
Telephone Email:
• Laboratory
• complete blood count

• left shift
• C-reactive protein
• Urinalysis
Telephone Email:
• Diagnoses
• a thorough history
• physical examination
• laboratory tests.
• Diagnostic laparoscopy
• Female,15 and 45
• whether to remove a normal appearing

appendix at laparoscopy.
Telephone Email:
• Differential diagnoses
• Preschool children
• Intussusception
• Meckel’s diverticulitis
• Acute gastroenteritis
• School-age children
• Gastroenteritis
• Functional pain
Telephone Email:
• Adolescent boys and young adult men
• Crohn’s disease
• ulcerative colitis
• epidihymitis.
Telephone Email:
• Adolescent girls and young adult women
• gynaecologic conditions.
• Pelvic inflammatory disease
• Ovarian cysts (ruptured cyst, ovarian torsion)
• Urinary tract infections
Telephone Email:
• Elderly age group
• gastrointestinal tract
• reproductive system.
• Diverticulitis
• perforated ulcers
• cholecystitis.
Telephone Email:
Telephone Email:
• Types of treatment
• fluid resuscitation before surgery.
• nonperforated disease
• perforated appendicitis.
Telephone Email:
Telephone Email:
• acute, nonperforated appendicitis
• antibiotic therapy alone for appendicitis.

• rare situations such as with sailors on
long submarine tours
Telephone Email:
Telephone Email:
• Incision
• transverse right lower quadrant skin incision

• oblique version
• paramedian incision
Telephone Email:
Telephone Email:
• Handle removal of the appendix.
• suture ligate
• purse string
• Z-stitch
Telephone Email:
Telephone Email:
• Laparoscopy
•
• superior to an open approach?
• adult,
• operative costs are higher
• longer procedure
• more equipment
• Pain less
• return to work sooner.
• To children?
Telephone Email:
Telephone Email:
Telephone Email:
Telephone Email:
Telephone Email:
• Perforated appendicitis
• require several hours or more of fluid resuscitation before

operative intervention.
• Management of appendiceal mass
• Percutaneous drainage
Telephone Email:
• Appendicitis during pregnancy
• the location of point tenderness varies during gestation.
• The white blood cell count
• Common symptoms
• Ultrasound
Telephone Email:
Telephone Email:
• Crohn’s disease
• Meckel’s diverticulum
Telephone Email:
• Postoperative complications
• Infection
• Bowel obstruction
• Infertility
• Miscellaneous
• Urinary tract infections, pneumonia, and other

complications of hospitalization
Telephone Email:
Telephone Email:
During an appendectomy for acute appendicitis, a
4 cm mass is found in the midportion of the
appendix. Frozen section reveals this lesion to be
a carcinoid tumor. Which of the following
statements is true?
A Ni further surgery is indicated

B A right hemicolectomy should be performed
C There is about a 50% chance that this patient
will develop the carcinoid syndrome
D Carcinoid tumors arise from islet cells
E Carcinoid syndrome can occur only in the
presence of liver metastases
Telephone Email:

Appendix Chapter, Sabiston Textbook of Surgery

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Appendix Chapter, Sabiston Textbook of Surgery

Uploaded by

Copyright:

Available Formats

Appendix

The psoas sign

• flat and upright abdominal radiograph

• useful in patients with atypical symptoms and

• the initial diagnostic imaging

• complete blood count

• whether to remove a normal appearing

• Pelvic inflammatory disease

• Ovarian cysts (ruptured cyst, ovarian torsion)

• Urinary tract infections

• fluid resuscitation before surgery.

• antibiotic therapy alone for appendicitis.

• transverse right lower quadrant skin incision

• require several hours or more of fluid resuscitation before

• Management of appendiceal mass

• the location of point tenderness varies during gestation.

• The white blood cell count

• Urinary tract infections, pneumonia, and other

A Ni further surgery is indicated

You might also like