When Appendix causes trouble
IT’S A WORM LIKE structure in the body. People commonly call it “Par-andrum”. We, the surgeons call it Appendix. Functionally, it is alien to the body but structurally an important part of the body. It is one of the common organs in the body that gets infected and a commonly performed surgery is done for its removal. It is rare before 2 years of age. The incidence of its infection increases in pre-school, school age and adolescence and rises in teens. One of the common causes of its infection (Appendicitis) is worms in the gut that find an access in its lumen. So beware of pain in the abdomen, it could be appendicitis, especially in children. The children have a habit of putting everything in the mouth (hand to mouth phase), and their poor defence mechanism makes them more vulnerable to infection. It is a blind muscular tube with an average length of 7.5 to 10 cms. The patient is usually a child presenting with pain in the abdomen, vomiting, fever, and listlessness. However symptoms like loose stools, blood with urine may sometimes be associated. The blood analysis may show increase in cell count and urine examination may show RBC.
X. ray of abdomen is also helpful in diagnosis. Ultrasound is supportive in diagnosis. It is a fact that Focussed Occussed Appendiceal Computerised Tomography, that is almost 99% sensitive and specific for its diagnosis. Since it is costly, we routinely do not advise it. We always respect the age old surgical dictum: whenever in doubt, operate the patient. On top of all these investigations, it is the surgeon who decides which patient to operate on. The surgery called Appendicectomy is performed prophylactically in astronauts. If the surgeon makes the diagnosis of appendicitis, the surgery should be routinely performed within 24hrs. If the patient is not fit for the surgery, turns up late to the doctor, a conservative line of management is used and patient is put on drugs. The interval Appendicectomy is performed in such patients after a period of 8 weeks to 3 months. Currently laparoscopic approach is gaining importance for its removal and is quite safe too. The importance of this technique is that the unnecessary surgery can be avoided and associated problems can also be tackled in the same sitting. It is a scar-less surgery, cost effective, less hospital stay and patient friendly. The child can join the school on 3rd to 4th day only. Prevention is better than cure. So it is important to give our children safe and boiled water for drinking not only at their homes but also in school. Avoid uncovered and unripe and hard seedy fruits. Take antihelminthetics routinely after every three monthly and always consult a surgeon whenever there is pain in the abdomen.
(Dr. Mushtaq Chalkoo is Consultant Laparoscopic and minimal access surgeon in GMC, SMHS and associated hospitals. Mail at firstname.lastname@example.org)