- Appendix – a vestigial organ, is a blind ended muscular tube of variable length (average 7 to 10 cm) and variable circumference (1 to 5 mm).
- It is a part of caecum where three taeniae coli merges.
- Its mesoappendix is variable having the appendicular artery (a branch of ileocolic artery) at its margin.
- Lymph drainage is to ileocolic lymph nodes.
- Usually the base of appendix is at constant position (Mc Burney’s point) while its body is at variable positions (retrocaecal, pelvic, paracaecal, subcaecal, pre & postileal) so add in the difficulty of its diagnosis , as is true for abnormal position of caecum e.g. situs inversus viscerum.
Clinical diagnosis of appendicitis
- It is a more clinical diagnosis than laboratory investigations.
- Common history is poorly localised colicky abdominal pain at peri-umbilical region, associated with anorexia, nausea, occasionally vomit than this pain shift to right iliac fossa as somatic pain.
- On examination local abdominal tenderness, rebound tenderness, may or may not muscle guarding are important signs associated with low grade pyrexia and tachycardia.
- Pointing sign, Rovsing’s sign, psoas sign, obturator sign may help in diagnosis of appendix at different location.
- The clinical features of appendicitis varies according to the position of appendix as in retrocaecal , pelvic and at ileum etc and due to mal position of caecum (subhepatic) as well.
- Clinical features also varies in obese, in pregnancy and at different ages as in infants, adult and elderly.
Differential diagnosis of appendicitis These condition must be consider.
- In children
gastroenteritis, tonsil tummy, mesenteric adenitis, meckel’s diverticulitis, intussusception, lobar pneumonia etc,
- In adult
Right ureteric colic, regional enteritis, perforated peptic ulcer, pancreatitis, torsion of testis, regional ileitis etc.
- In adult female
Pelvic inflammatory disease,, ectopic pregnancy (ruptured or un ruptured), torsion or rupture of ovarian cyst, midcyclic bleeding, endometriosis, pyelonephritis, acute cholicystitis etc.
- In elderly
Intestinal obstruction, colonic carcinoma, diverticulitis, mesenteric infarction etc.
- Rare differential diagnosis are:-
Preherpatic pain of right 10th and 11th dorsal nerves, abdominal crises of diabetes mellitus, typhlitis , spinal conditions e.g., tuberculosis, metastatic carcinoma, multiple myeloma, osteoarthritic spine, osteoporotic vertebral collapse etc.
Investigations in appendicitis
-Blood complete picture
-X ray plain abdomen in standing including diaphragm
-Contrast-enhanced CT scan of abdomen and pelvis