Acute appendicitis is an inflammation of the appendix of the rectum. This is one of the most common surgical conditions. About 10% of the population in Europe develops the pathology during life. Appendicitis is most often diagnosed in patients aged 10-30 years. The treatment for most patients is a surgical intervention. Less commonly, conservative antibiotic therapy or appendicular abscess puncture under computed tomography guidance is performed.

Content

1. Diagnostics of appendicitis
2. Conservative therapy
3. CT-guided puncture
4. Surgical treatment
5. How is the surgery performed
6. Where to undergo treatment

Diagnostics of appendicitis 

Timely diagnostics is very important for appendicitis. This disease must be treated as early as possible. Otherwise, this condition can cause serious complications that require more traumatic surgical interventions and prolonged treatment.

The main patient complaints are as follows: 

• Abdominal pain, which firstly has an unspecified site, and then manifests itself in the lower abdomen on the right.   
• Loss of appetite. 
• Nausea. 
• Single vomiting at the onset of the disease. 

The main task of the doctor is not to miss appendicitis. Therefore, the patient must be examined within 1 hour after admission to the hospital. To exclude appendicitis, AIR or AAS scales are used.

The main method of instrumental diagnostics is ultrasound scanning. In case of questionable results and persisting suspicion of appendicitis, computed tomography is performed. Pregnant women undergo MRI instead of CT scanning. However, it is less informative, since this diagnostic test does not always allow distinguishing a simple appendicitis from a complicated one.

Conservative therapy 

With appendicular infiltrate detected, the treatment tactics may be conservative. Nonetheless, there are two exceptions:

• The presence of a fecal stone in the lumen of the appendix.
• The development of appendicitis in a pregnant woman. 

The patient is prescribed two antibiotics, and the infiltrate gradually resolves. 

CT-guided puncture

With the presence of an appendicular abscess (cavity with pus) without signs of peritonitis (inflammation of the peritoneum), puncture is performed instead of surgery. The doctor inserts a thick needle into the abscess to remove the inflammatory fluid from the abscess. To avoid damage to the adjacent organs, doctors abroad carry out the procedure under computed tomography guidance. Sometimes ultrasound can be used to visually control the procedure.

Surgical treatment 

Appendectomy (removal of appendicitis) is considered the standard treatment for the disease. The surgeon can perform it using one of two techniques:

• Open surgery. 
• Laparoscopic appendectomy (laparoscopy of appendicitis). 

Whenever possible, the surgery is performed within the shortest possible time. With uncomplicated appendicitis, it is performed within a day, but with a complicated form of the disease, the surgery must be carried out immediately.

If the patient is admitted in a serious condition, doctors conduct a preparation for the surgery using medication. It helps reduce the risk of complications. 2 or more hours prior to surgery, doctors prescribe antibiotics. If necessary, infusion therapy, as well as correction of fluid and electrolyte disturbances are provided.

Some patients require prevention of thromboembolic complications before surgery. The drugs are administered with the presence of risk factors such as obesity, age over 50, varicose veins of the lower extremities, taking oral contraceptives, severe heart disease or cancer.

How is the surgery performed

The surgery to remove appendicitis abroad is mainly performed using the laparoscopic technique. The doctor makes short incisions in the abdomen and inserts a video camera with lighting and thin long instruments into the abdominal cavity. The advantages of this approach are as follows:

• Less trauma. 
• Less pain. 
• Lower risk of complications.
• Shorter hospitalization period.
• Better aesthetic result. 
• Quick return to work. 

Laparoscopic appendectomy is especially recommended for patients with obesity, concomitant diseases and the elderly, as they have a higher risk of complications in the case of open surgery.

Whichever way the surgery is performed, its essence consists in removing the inflamed vermiform appendix. Doctors abroad use an ultrasonic scalpel to transect the mesentery. In this case, the least thermal tissue damage is achieved. Sometimes other options can also be used. These may be clipping, endoloop, bipolar coagulation, LigaSure transection.

With a severe course of the disease or untimely treatment for appendicitis, perforation (through hole) of the appendix may occur. In this case, pus enters the surrounding tissues and their inflammation develops.

In case of perforation of the appendix, revealed during the surgical intervention, the doctor leaves the drains – thin tubes through which fluid flows. To reduce the risk of complications, postoperative antibiotic therapy is carried out.

Where to undergo treatment 

If you suffer from acute appendicitis, you can go abroad. The Booking Health specialists will find the most suitable hospital for you. We will arrange your urgent treatment and emergency surgery in one of the developed countries.

There are several reasons for you to undergo appendicitis treatment in Europe:

• In some patients, appendicitis can be treated without surgery: with the help of antibiotics or appendicular abscess puncture.
• The vast majority of operations are performed using laparoscopic access. Minimally invasive interventions allow patients to quickly recover and reduce the length of hospital stay.
• There is no over-treatment, because doctors do not use antibiotics after surgery for uncomplicated appendicitis.
• Accurate diagnostics: there is no risk of having your appendix removed if you do not actually have appendicitis.
• Sparing treatment of complicated appendicitis – even if peritonitis develops, doctors do not flush the abdominal cavity with saline, as research has shown that this procedure does not improve treatment outcomes, but increases the risk of complications.
• Doctors do not switch from laparoscopic surgery to open surgery, even if they find signs of peritonitis. As a result, the treatment remains minimally traumatic and safe for health.
• Foreign specialists successfully treat even the most severe cases of appendicitis complicated by widespread peritonitis, intestinal paresis, and septic shock.

Please leave your request on the Booking Health website. Our specialist will contact you within just a few hours. If you book a medical care program through our service, the cost of treatment will be lower due to the lack of additional coefficients for foreign patients. You can compare prices in different hospitals in order to book your treatment at the best price.

Authors: Dr. Nadezhda Ivanisova, Dr. Farrukh Ahmed