Appendix

Acute Appendicitis is the inflammation of the appendix with a resultant bacterial infection. Acute appendicitis is a surgical emergency as the infection can progress rapidly and the appendix can potentially give way and perforate. This will lead to the infection and pus spreading throughout the abdomen.

Acute appendicitis usually starts as discomfort over the central abdomen. This can then progress to severe pain in the right lower quadrant of the abdomen. The progression of the pain can occur over a few hours or a few days. Acute appendicitis can occur together with fever, nausea, vomiting, diarrhoea or painful urination. The wide variety of symptoms often leads to the delayed diagnosis of acute appendicitis as it can often be mistaken with other acute conditions. The conditions that can mimic acute appendicitis include urinary tract infection and food poisoning.

The mainstay of treatment of acute appendicitis is the removal of the appendix through a keyhole surgery known as Laparoscopic Appendicectomy. This procedure usually requires only an overnight stay if the diagnosis is recognised early.

 

Appendiceal Cancers are relatively uncommon cancers arising from the appendix. There are different subtypes of Appendiceal cancers but its treatment is similar to that of colonic tumours.

Appendiceal Cancers are often diagnosed in two different circumstances.

The first circumstance is an incidental diagnosis after the appendix had been removed for acute appendicitis. The patient’s symptoms will be that of the initial acute appendicitis. Appendiceal cancers discovered in such circumstances are often early-stage tumours and with no further surgery required.

The second circumstance usually occurs with appendiceal cancer at a more advanced stage. The symptoms include chronic pain at the right lower quadrant for weeks to months and symptoms of anaemia such as breathlessness and decreased exercise tolerance. In advanced stages of the disease, weight loss and generalised abdominal pain and abdominal distension due to accumulated fluid in the abdomen are all possible symptoms.

Advanced appendiceal cancers will require the removal of the right colon to ensure sufficient cancer clearance. This can often be performed as a keyhole/laparoscopic approach. In cancers that have spread widely, there may still be a chance for cure depending on the cancer subtype. This will entail a surgery known as Cytoreductive Surgery (CRS) with intraoperative chemotherapy (HIPEC).

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