Should the appendix be removed?

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Should the appendix be removed?
Should the appendix be removed?

Appendicitis is one of the most common diseases of the abdominal area requiring emergency surgery. But if before the need for emergency surgical intervention in this disease was out of the question, in recent years scientists have been actively studying the possibility of treating appendicitis conservatively with antibiotics

In cases of acute appendicitis, the appendix must be removed. The disease and its complications develop very quickly, and doctors and patients do not have time to try to treat appendicitis with drugs.

Today in Bulgaria, conservative treatment of appendicitis is prescribed only when an appendicular infiltrate is diagnosed and only if there are no signs of an abscess. This process is one of the complications of acute appendicitis. It is characterized by dense adhesions, inflamed tissues, including the appendix itself and nearby organs. In this situation, surgery is impossible due to the fact that surgeons will not be able to isolate the appendix from the compact inflamed mass.

For several years, Western scientists have been trying to find evidence that surgery is not the only treatment option for patients with appendicitis. This theory is supported by several studies. Thus, in 2018, doctors from six hospitals in Finland published data from observations of 273 patients after surgery to remove the appendix and 257 patients treated with antibiotics. Conservative treatment was offered only to patients with uncomplicated appendicitis, which was confirmed by computed tomography. The study showed that 60% of the patients in the second group were able to avoid not only the operation, but also the recurrence of appendicitis in the next five years. However, 40% of patients were still forced to lie down on the operating table, of which 15 patients underwent surgical treatment in the first days after the start of the course of antibiotics.

What causes the development of acute appendicitis?

In most cases, acute appendicitis develops due to blockage of the opening of the appendix in the rectum with fecal stones, parasites, food masses, neoplasms, etc. The contents of the appendix, including pathogenic flora, contribute to the development of the disease. The presence of enterococci, streptococci, staphylococci and pathogenic Escherichia coli is most often associated with the development of appendicitis.

What is chronic appendicitis?

In medicine, there is no such thing as chronic appendicitis. This concept is used to explain intestinal inflammation in the region of the appendix. But this is not an emergency situation, as in acute appendicitis, and the disease does not require emergency surgery. It is necessary to remove the appendix only if it is inflamed or has pus in it. There is no reason to remove the appendix if there is no evidence of acute appendicitis. Usually, inflammations in the intestines are treated with pills. However, inflammation is a much more common problem than acute appendicitis.

What are the symptoms of appendicitis?

The most common symptom of appendicitis - inflammation of the appendix of the cecum, is pain in the lower, right side of the abdomen. Initially, the pain can be of different intensity (strong, weak) and nature (constant, periodic), and after 6-7 hours it intensifies and is felt mainly in the lower, right part of the abdomen, the place of the projection of the appendix. It is easy to determine this place if you imagine the intersection of two imaginary lines: horizontally, from the navel and around the abdomen, and vertically, from the right nipple down.

Appendicitis pain is usually aggravated by movement and tension of the abdominal muscles, such as coughing, as well as lying down with the legs outstretched, as the pressure on the peritoneum increases.

Can appendicitis pain not be on the right side?

Yes, it can. In some people, the appendix is located in the middle of the abdomen or in the lower left part of the abdomen. But in 90% of diagnosed cases, pain during inflammation of the appendix occurs in the lower right part of the abdomen. In pregnant women, the pain may be felt a little higher, due to the fact that the fetus affects the localization of the appendix.

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