The symptoms of appendicitis are often clear cut. To ignore them can be very serious, even fatal. That’s why it is important to know the signs and to see your doctor without delay.
Appendicitis is the commonest reason for emergency surgery on the abdomen. Each year in the U.S., more than 300,000 people with appendicitis are admitted to the hospital for appendix surgery.
Yet many people are complacent about appendicitis, considering it “nothing to worry about.”
Diagnosed correctly at an early stage, the operation is usually quite routine. But if it is left – symptoms ignored by the patient or a wrong diagnosis made – then the position can rapidly deteriorate. Indeed, the patient may quickly slide into a critical condition that can be fatal.
Fortunately, all doctors are aware of this danger and, in cases of doubt, will frequently recommend surgery.
Of course, wrong diagnoses are made from time to time. The doctor and this includes the specialist surgeon, is sometimes in a dilemma when deciding if the patient is suffering from appendicitis or some other abdominal disorder.
No surgeon likes having a score of “lily-white” appendices on his plate (this is the colloquial term for a normal appendix which could well have stayed intact).
But a lot of other conditions have very similar symptoms. Rather than run an even graver risk of letting an undiagnosed one go undetected, it is more customary to “go in and see.”
The fairly high figure of 22 percent was found to be inaccurate diagnoses. In other words, the appendix was not the cause of the patient’s symptoms. However, this did not indicate that surgery was not needed: 10 percent of all women had gynecological disorders present (either alone or in conjunction with appendix disease); 12 percent of children had an abdominal inflammatory condition called mesenteric adenitis.
Some older patients had acute diverticulitis – that means inflammation of tiny pockets bulging from the bowel.
In only six percent of cases could no abnormality be discovered at operation.
Errors in diagnosis
So, although there was a diagnostic error in about one case in five most patients who came to surgery benefitted – their condition was discovered and dealt with.
It was twice as common to make a diagnostic error with women than men. This is due to the fact that an enormous number of disorders can occur in the female pelvis.
However, according to the British medical magazine Lancet recently, some doctors seem to have a better nose for an appendix than others. “Why does one surgeon make 55 correct diagnoses of acute appendicitis in 58 patients, while some of his colleagues were noticeably less accurate, one making only 28 correct diagnoses in 52 appendectomies?” it asked.
Surgeons at the Aberdeen Children’s Hospital have been taking a long look at their diagnostic prowess. In fact, by very careful observation and spending much more time on their possible appendicitis cases, they managed to haul their incorrect diagnosis figure down to 10 percent.
How does appendicitis strike and how can a person have an idea that he may be heading for trouble in this direction?
There is a typical picture, although there are individual variations of course.
Appendicitis is commonest in people in the 10 to 30 year age group. It is more prevalent in adults.
The first indication that all is not right is pain coming on fairly suddenly in the area just below the breast bone (called the epigastrium) or around the navel. This is often accompanied by one or two episodes of vomiting.
Over the next few hours (from two to 12) the pain tends to shift downward and outward into the right hand lower part of the abdomen. Here it remains, persisting as a steady soreness which is worsened by coughing or even walking or exercising.
The patient feels ill. He loses his interest in food. Constipation is common. In the old days, disaster often followed when a dose of castor oil was administered. This could rapidly lead to rupture of the inflamed appendix and should never be taken for an abdominal pain.
There may be a fever but this is not common and may only be mild. Occasionally there is diarrhea. Often, pressing on the lower right side of the abdomen will cause pain.
There is often a point of maximum tenderness below which is the diseased organ. This is called McBurney’s point.
The best thing to do is to see a doctor without delay. The earlier a diagnosis is made, the sooner treatment is started, and the simpler the operation.
Attending to a gangrenous ruptured appendix in the middle of the night is unsatisfactory – many patients leave it till midnight before deciding it requires action when they should have got moving during daylight hours.
You can help your doctor help you and maybe save your life too.