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How to confirm appendicitis?

  • If typical symptoms and signs are present no need of other confirmatory tests

  • In doubtful cases or suspicion of complications imaging such as USG or CT may be necessary

  • Blood test - CBC may show leukocytosis

What is appendicitis?

  • Appendicits is inflammation of the appendix usually caused by obstruction of the lumen of the appendix by a small fecolith/appendicolith.

How to suspect appendicitis ?

  • Patient with appendicitis usually have the one or more of the following symptoms.

  • More the symptoms higher the probability of appendicitis

    • Pain in the right lower quadrant of the abdomen

    • Fever

    • Nausea/Vomiting

    • Anorexia (Loss of appetite)

colo-rectal surgery

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  • ​​Large intestine (colon) extends from ileocecal junction to recto-sigmoid junction and the rectum extends from recto-sigmoid junction to ano-rectal junction

  • The terminal ileum empties into the cecum through a thickened, nipple-shaped invagination, the ileo-cecal valve

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  • The appendix extends from the cecum approximately 3 cm below the ileocecal valve as a blind-ending elongated tube, 8 to 10 cm in length

  • The colon and rectum constitute a tube of variable diameter approximately 150 cm in length

  • Parts of colon 

    • Cecum​ - 7.5 - 10 cm

    • Ascending colon - 15 cm

    • Transverse colon - 45 cm

    • Descending colon - 25 cm

    • Sigmoid colon - 15 - 50 cm

  • Rectum - 12 to 15 cm​

  • The main function of colon is to absorb water, electrolytes and nutrients which escape from small intestine and the main function of rectum is elimination of stool

  • Approximately, 1 - 1.5 litres of fluid enters the colon daily, most of which is absorbed (upto 10 times) and only 100 to 150 mL/day is eliminated in stool

  • Tenia coli ( 3 longitudinal bands), appendices epiploicae, haustra and sacculations are present in colon not in small intestine / rectum

Photo Gallery 

Discussion 

What are the common colo-rectal disorders?

  • Colitis

  • Proctitis

  • Inflammatory bowel disease (IBD) - Ulcerative colitis, Crohn's disease

  • Stricture

  • Bleeding

  • Perforation

  • Cancers

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What are the common colo-rectal symptoms?

  • Pain abdomen

  • Constipation

  • Abdominal distension

  • Bleeding per rectum etc.

What are the common investigations?

  • Serum CEA level- tumor marker of colorectal cancer

  • X ray abdomen for bowel obstruction, perforation etc.

  • Sigmoidoscopy

  • Colonoscopy

  • Barium enema

  • CT scan / MRI scan

What are the commonly done colo-rectal surgeries ?

  • Resection & anastomosis - a segment of the intestine which is abnormal is resected and ends are joined together

  • Closure of peroration - Simply, perorated site is closed by sutures

  • Colostomy - Intestine is opened & brought out through the abdominal wall & anchored to skin. The faecal matter gets collected in the stoma bag, which is emptied frequently

  • Rectopexy for rectal prolapse

  • Cancer surgeries

    • Right hemicolectomy for right colon cancer​

    • Left hemicolectomy for left colon cancer

    • Total colectomy

    • Total proctocolectomy

    • Anterior resection for sigmoid/rectal cancer

    • Low anterior resection for rectal cancer

    • Ultra low anterior resection for rectal cancer

    • APR (Abdomino Perineal Resection) for rectal cancer

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