Preprocedural Planning
Analgesics and antipyretics may mask the underlying disease and therefore should not be administered patients with suspected appendicitis who have not been evaluated by the surgeon.
Venous access must be obtained in all patients diagnosed with appendicitis. Venous access allows administration of isotonic fluids and broad-spectrum intravenous antibiotics before the operation
Patient Preparation
Appendectomy requires general anesthesia. Before the start of the surgical procedure, the anesthesiologist performs endotracheal intubation to administer volatile anesthetics and to assist respiration.
Monitoring and Follow-up
After hospital discharge following surgery, patients must have a light diet and limit their physical activity for a period of 2-6 weeks, depending on the surgical approach to appendectomy (ie, laparoscopic or open). The patient should be evaluated by the surgeon in the clinic to determine improvement and to detect any possible complications.
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Laparoscopic appendectomy. Procedure perfomed by Spencer Armory, MD, and James Lee, MD, ColumbiaDoctors, New York, NY. Video courtesy of ColumbiaDoctors (https://www.columbiadoctors.org).
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Normal appendix; barium enema radiographic examination. Complete contrast-filled appendix is observed (arrows), which effectively excludes diagnosis of appendicitis.
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Computed tomography scan reveals enlarged appendix with thickened walls, which do not fill with colonic contrast agent, lying adjacent to right psoas muscle.
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Computed tomography (CT) study of appendicitis. Intravenous (IV) contrast was administered to patient, who had gram-negative sepsis but no abdominal pain on examination. Left, inconclusive CT scan after administration of oral contrast but no IV contrast. Right, repeat CT scan study following administration of IV contrast demonstrates thickened, enhanced appendiceal wall and periappendiceal changes. Retrocecal location of appendix may have attenuated abdominal symptoms.
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Suppurative appendicitis; transverse view, color Doppler ultrasound image. Circumferential colors are observed in wall of inflamed appendix (arrows), strong indicator of acute appendicitis.
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Technetium-99m radionuclide scan of abdomen shows focal uptake of labeled white blood cells in right lower quadrant, consistent with acute appendicitis.
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Sagittal graded compression transabdominal ultrasonogram shows acutely inflamed appendix. Tubular structure is noncompressible, lacks peristalsis, and measures greater than 6 mm in diameter. Thin rim of periappendiceal fluid is present.
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Transverse graded compression transabdominal ultrasonogram of acutely inflamed appendix. Note targetlike appearance due to thickened wall and surrounding loculated fluid collection.
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Perforated appendicitis.
