Pathology: Appendectomy

Appendectomy 2

Appendectomy
Pathology:

Appendectomy is the surgical removal of the appendix when an infection has made it inflamed and swollen. This infection, called appendicitis, is considered an emergency because it can be life threatening if untreated. Occasionally, an inflamed appendix burst after a day of symptoms. The appendix is so close to the large intestine, that it could become clogged with stool and bacteria. Other times mucus produced by the appendix can thicken and cause a blockage. In both cases, once the opening to the appendix is congested, it can become inflamed and swollen causing appendicitis. So it’s very important to have it removed as soon as possible. Appendicitis can cause sudden pain in the middle of the
The appendix is a worm-shape hollow pouch attached to the cecum, the beginning of the large intestine. Appendectomies are performed to treat appendicitis, an inflamed and infected appendix. Before the incision, the surgeon would carefully perform a fast physical examination of the abdomen to detect any mass and determine the site of incision. An open appendectomy requires a transverse incision on the right lower quadrant. The incision is called a McBurney, this type of incisions are rarely performed because of the tendency for dehiscene and herniation. The abdominal wall fascia and the underlying muscular layers are sharply split in the direction of their fibers to gain access to the peritoneum. If necessary, the incision may be extended medially, with the surgeon dissecting some fibers of the oblique muscle and retracting the lateral part of the rectus abdominis. The peritoneum is opened transversely and entered. Retractors are gently placed into the peritoneum. The cecum is identified and medially retracted. It is then exteriorized, using a moist gauze sponge or Babcock clamp, and the taeniae coli are followed to their convergence. The convergence of the taeniae coli is detected at the base of the appendix, beneath the Bauhin valve, and the appendix is then viewed. If the appendix is hidden, it can be detected medially by retracting the cecum and laterally by extending the peritoneal
The appendix is clamped proximally about 5 mm above the cecum to avoid contamination of the peritoneal cavity, and the cut is made above the clamp by a scalpel. Fecaliths within the lumen of the appendix may be detected. The appendix must be ligated to prevent bleeding and leakage from the lumen. The residual mucosa of the appendix is gently cauterized to avoid a future mucocele. The appendix may be inverted into the cecum with the use of a purse-string suture. The cecum is placed back into the abdomen, and the abdomen is irrigated. When evidence of free perforation exists, peritoneal lavage with several liters of warm saline is recommended. After the lavage, the irrigation fluid must be completely aspirated to avoid the possibility of spreading infection to other areas of the peritoneal cavity.

Wound closure begins with closing of the peritoneum with a running suture. Then, the fibers of the muscular and fascial layers are reapproximated and closed with a continuous or interrupted absorbable suture. Lastly, the skin is closed with subcutaneous sutures or staples. In some cases of a perforated appendicitis, some surgeons leave the wound open, allowing for secondary closure or a delayed primary closure until the fourth or fifth day after operation.

Most patients feel better immediately after an operation for appendicitis. Many patients are discharged from the hospital