Acute Appendicitis Treatment, Diagnosis, Pre-Operation Preparation

Treatment for Acute Appendicitis

Immediate appendicectomy is the treatment of choice in acute appendicitis without rupture.
Immediate appendicectomy should be performed to obviate possibility of rupture of appendix and spreading peritonitis.

Preoperative Preparation

  • No patient with acute appendicitis is taken directly to operation theatre on admission. All patients require a preoperative preparation which rarely requires more than 3 or 4 hours or at least 1hr before the patient is taken to operation theatre. This is more important in case of patients in whom perforation and peritonitis are suspected.
  • Naso-gastric aspiration is helpful in all patients with appendicitis, particularly in those with peritonitis.
  • Intravenous fluid replacement should be started immediately. Although prophylactic administration of antibiotics is a matter of controversy, the evidence in various reports in the past decade is clearly in favor on antibiotic administration. Antibiotics are of minor benefit unless the appendix is gangrenous or has perforated. But in cases of gangrenous appendix or perforated appendix antibiotics play a major role in reducing the incidence of wound infection if started preoperative.

Acute Appendicitis Operation

  • When the diagnosis is confirmed McBurney’s grid-iron incision (junction between lateral 1/3rd and medial 2/3rd of iliac spine crest and umbilicus respectively) is made and appendix is removed.
  • Now-a-days laparoscopic appendicectomy is done at McBurney’s point.
  • Other methods are Lanz’s transverse incision (at a level 2-3cm below the umbilicus).
  • Para-median incision is made from 2.5cm below the umbilicus 1.25-2.5cm to right of midline and ends just above the pubis.