Appendix
Under Supervision Of
Prof Dr / MOHAMED ABO ALSAAD
BY
- Ahmed Elsayed Fathy Meslhy 231011225
- Abdelshafi Gad Elkareim Abdelshafi
231011412
- Mohamed Medhat Mohamed Mahmoud
231011509
- Hamza Ashraf Mohamed Mohamed
231011335
-Mohamed Ramadan Ahmed 231011482
Contents
01 02
Surgical
Acute Appendicitis
Anatomy
03 04
Chronic
Neoplasm
Appendicitis
Surgical
01
Anatomy
01 Surgical Anatomy
• The appendix is a blind-ended hollow muscular Tube
that arises from the caecum .
• It averages 7.5 to 10 cm in length .
• position :-
1)The commonest position of the appendix is retrocaecal
(74%).
2) pelvic position(21%).
3) paracaecal (2%) , subcaecal (1.5%) , pre-ileal (1%).
4) post-ileal (0.5%)
01
Surgical
Anatomy
blood supply:-
Arterial supply
one or two appendicular arteries --> ileocolic artery.
Venous drainage
the organ is drained by tributaries of the ileocolic vein , to
the superior mesenteric , and then the portal vein.
Acute
02
Appendicitis
02 Acute Appendicitis
• Acute appendicitis is the most common acute
abdominal surgical emergency.
• It is most prevalent in the 2nd and 3rd decades of life
• Appendicitis in the two extremes of life is relatively
rare
Acute
02
Appendicitis
Gross types :-
1) Obstructive type:- in about two thirds ofcases , Obstruction is
usually caused by a faecolith , or by swelling of the lymphoid
tissue in
response to viral infection
2) Non-obstructive type represent one third of cases.
Course:-
in untreated cases, it may :-
1) Resolve with recurrent attacks
2) Gangrene and perforation especially if obstructed and
cause either generalized or localized peritonitis.
History and examination is the corner stone of diagnosis
(A) Symptoms :-
1) Shifting right iliac fossa pain.
2) Anorexia and nausea are nearly present ( vomiting in 3/4 of the
patient )
3) Constipation is usual
(B)physical examination:-
1) Cough tenderness
2) Localized tenderness
4) Rigidity indicates perforation
5) Restricted abdominal wall movement with respiration indicates
peritonitis
6) in third or fourth attack a tender appendicular mass may be felt
in the RT iliac fossa
8) Special signs ( Rovsing sign, Psoas sign, Obturator sign)
Atypical presentations:
1) Tenesmus and dysuria in pelvic appendicitis
2) pain and tenderness in subhepatic appendicitis
3) Pain in right loin in long retrocecal appendicitis
4) Diarrhea in retroileal appendicitis
5) Appendicitis in infants and children are serious
6) Appendicitis in elderly diagnosed lately.
7) Appendicitis with pregnancy displaced upward
02
Acute
Investigations :-
Appendicitis
A) Lab:-
1)moderate leukocytosis (10000-16000/uL). Normal count not exclude acute
appendicitis
2) Urine analysis may show few RBCs
3) Pregnancy test
B) Radiological :-
1) Ultrasound (more than 6mm diameter and non-compressible)
2) CT (diameter ore than 6mm, thick wall &mesoappendix)
3) Laparoscopy (especially in females in childbearing period)
Treatment Of Acute
02 Appendicitis
A) Uncomplicated appendicitis:
Urgent appendectomy (open, laparoscopic)
B) Appendicular mass:
Ochsner-sherren regimen then interval appendectomy after 3 months
C) Appendicular abscess:
Ultrasound guided aspiration. If failed, open extra-peritoneal drainage.
Interval
appendectomy after 3-6 months.
D) Generalized peritonitis:
Urgent surgery with removal of the appendix.
Chronic
03 Appendicitis
Is a cause of recurrent attacks of abdominal pain and
dyspepsia
appendicitis is the cause of pain , Even when pain and
tenderness are centered around the right lower abdomen.
It is advisable to exclude other causes of chronic pain before
removing the appendix ( Amoebic colitis , irritable bowel
syndrome , chronic calcular cholecystitis , and Crohn's
disease)
The treatment of chronic appendicitis is appendicectomy.
04 Neoplasm
1) Carcinoid tumor (argentaffinoma):
• The commonest tumor of the appendix and the appendix
is The commonest site in the gut (65%) to be affected by
carcinoid tumor the ileum affected in 25%.
Clinical picture:
1) Asymptomatic (common)
2) Carcinoid tumor:
May be accidental finding on doing histopathology of a
spicemen of acute or chronic appendicitis. Cut section
has a bright yellow color due to lipoid
3) Carcinoid syndrome:
Rare , Occurs due to malignant carcinoid tumor
metastasized to the liver.
Investigations:
High urinary serotonin metabolite 5-hydroxyindoleacetic
acid (5-HIPA).
Treatment:
A) Tumor < 2 cm and confined to the appendix
appendectomy is the treatment.
B) Tumors > 2cm , right hemicolectomy is the treatment.
2) Adenocarcinoma:
Rare , May present as acute appendicitis , Behaves as
cancer
colon
If confined to appendix and regional LN, right
hemicolectomy
Thank
you