Where is the Appendix
Appendix is a vestigial organ situated at the junction of small and large intestine. The base of the appendix can be marked on the surface as the McBurney’s point, which is situated at the junction of the lateral 1/3rd and medial 2/3rd of the line joining the anterior superior iliac spine and the umbilicus. McBurney’s point is the classical site of tenderness in appendicitis. Appendix varies in length, but the average length is about 10cm in adult. It is present only in human beings and certain anthropoid apes.
Types of Appendicitis
There are four type of appendicitis
- Acute appendicitis
- Sub-acute appendicitis
- Recurrent appendicitis
- Chronic appendicitis
- Acute appendicitis is the most common surgical condition of the abdomen. Acute appendicitis may occur at all ages, but is most commonly seen in the second and third decades of life. There is hardly any difference of gender incidence, but this condition seems to be more commonly seen in teenage girls.
- The sequence given in acute appendicitis is not inevitable. Some episodes of acute appendicitis apparently subside spontaneously before they reach the acute stage. This is called as sub-acute appendicitis. This condition may recur again. Presumably obstruction of the lumen due to lymphoid hypertrophy or soft fecolith may spontaneously be relieved allowing subsidence of appendicular inflammation and its attendant symptoms.
- If a full-blown appendicitis does not ensue, the appendix may turn into a ‘grumbler’ precipitating recurrent attacks. This is known as recurrent appendicitis. These attacks are usually milder. The patients remain symptom-free between attacks and physical examination is normal. Barium enema X-ray often shows normal filling of the appendix due to disappearance of obstruction.
- Sometimes pathological examination of the appendix may reveal thickening and scarring suggesting old, healed acute inflammation. This is called as chronic appendicitis. Patients with such appendicitis often complain of persistent right lower abdominal pain. The resected appendix shows fibrosis of the appendicular wall, evidence of old mucosal ulceration and scarring and infiltration by chronic inflammatory cells to be designated as chronic appendicitis.
Sub-acute, recurrent and chronic appendicitis are usually due to obstructive causes.
Non-obstructive appendicitis is a less dangerous condition as there is no obstruction there is not much distension but when the serous membrane is involved localized peritonitis develops and the patient complains of pain in right iliac fosse. Such inflammation terminates either by suppuration, gangrene, fibrosis or resolution. Many of the sub-acute, recurrent appendicitis and chronic appendicitis develop from this variety.