Medical experts have described appendicitis as one of the leading causes of surgical emergency admission in most hospitals, warning that delayed appendicectomy, may lead to ruptured appendicitis complications, which can cause infections and even death.
According to Johns Hopkins Medicine, appendicectomy is a medical term used for the surgical removal of an infected appendix – a finger-shaped pouch that sticks out from the colon on the lower right side of the belly, also called the abdomen.
It also defines appendicitis as a condition in which the appendix becomes inflamed, filled with pus and causes pain near the belly button, which then moves to the right side.
This is often accompanied by nausea, vomiting, poor appetite, fever and chills, it noted.
Data from the National Library of Medicine indicates that appendicitis accounts for about 15 to 40 per cent of all emergency surgeries done in many facilities in the country, adding that the condition can affect people of all age groups, though with higher incidence among young adults between 20 and 30 years.
According to a General Surgeon at the Department of Surgery, College of Medicine, University of Lagos, Idi-Araba, Lagos, Dr. Lanre Balogun, appendicitis is always presented late in hospitals due to wrong diagnosis or patients’ decisions to treat it with antibiotics, instead of surgery.
The Consultant Surgeon at the Lagos University Teaching Hospital, Idi-Araba, Lagos, lamented that people try to manage or delay the presentation of appendicitis to the hospital until it ruptures and results in disease complications.
He, however, maintained that surgery is the treatment of choice.
The General Surgeon noted that high morbidities and occasional mortalities recorded in the cases of appendicitis are usually due to late presentation and delay in treatments, saying that surgery is needed immediately after the condition is confirmed.
Balogun, who said that early presentation of appendicitis cases increases positive outcomes, noted that a 72-hour delay after diagnosis is enough for perforation to take place.
He noted that appendicitis may not be treated with antibiotics in all cases, saying that when the condition is suspected in the hospital, instead of booking for immediate surgery, the patient might be placed on antibiotics.
“Even if such a person recovers without surgery at that point, it will still come up later in the future until it is removed. A delay in appendicectomy is dangerous. It is not what should be delayed. Once it is diagnosed and confirmed, there’s no need to keep it. It is capable of taking someone to the intensive care unit if care is not taken.
“Within 72 hours, it will rupture. Appendicitis sac is full of bacteria and when released into the abdomen, will cause a number of complications in the body. This could lead to death. However, the time of presentation of cases determines the outcome and this is a golden rule in medical practice.”
The case of the late 12-year-old Adebola Akin-Bright, the boy with a missing small intestine, who presented with a ruptured appendicitis readily comes to mind.
The late presentation resulted in him undergoing three major surgeries with complications that eventually led to his death at Lagos State University Teaching Hospital, Lagos.
Sequel to this, a Consultant Surgeon at the Badagry General Hospital, Lagos, Dr. Mohammed Sani, said ruptured appendicitis is an issue that is treated as a serious hospital emergency in an intensive care unit.
He warned against late presentation of appendicitis cases.
According to him, ruptured appendicitis is a major emergency that requires state-of-the-art equipment to address.
He warned that the appendix should not be allowed to rupture in the stomach while being managed with antibiotics.
Sani said the fear of surgery and cost of treatment, sometimes are the reasons for late presentation.
He called on mass education to enlighten the populace on the dangers of presenting appendicitis late.
Sani, who is also the Managing Director, Alaba Rago Hospital, Ojo, Lagos, explained that the appendix is a small, finger-shaped organ that comes out of the first part of the large intestine and must be removed when it becomes swollen or infected.
He said, “If the appendix is not removed, it can leak bacteria and infect the entire abdomen, which can be life-threatening. So, what are the signs that you have appendicitis? This condition can be fairly hard to diagnose, especially in children, older people, and women of childbearing age.
“Usually, the first symptom is pain around your belly button. The pain might be mild at first, but then it gets sharp and severe before long. The pain may then move into your right lower abdomen. You may also have diarrhoea, fever, nausea, and reduced appetite.
“Sometimes, people think that they might be having food poisoning. Your doctor will make a diagnosis based on your symptoms. You may also have blood tests, CT scan or ultrasound.
“Once it’s clear that you have appendicitis, your doctor will probably schedule you for emergency surgery. In surgery, you will receive anesthesia for sleep and to make the procedure pain-free. The doctor will make a small cut in the lower right side of your belly and remove the appendix.
“If the surgeon uses the laparoscopic technique, you will have several small cuts in your abdomen for the surgical instruments. If your appendix breaks open, or a pocket of infection has formed, your doctor will wash out your belly during the surgery. A small tube may remain to help drain out fluids or pus.
“Once you’ve had an appendicectomy, you will probably recover quickly. Most patients leave the hospital in one or two days after surgery. The good news is that you will be able to go about your normal duties within a month.”
However, a family physician at the Anambra State Ministry of Health, Dr. Chidumeje Okafor, said appendicitis is one of the most common acute diseases requiring emergency surgery.
He noted that immediately after appendicectomy is suspected, the gold-standard treatment is surgery, saying that delay in diagnosis and treatment significantly contribute to increased incidences of perforated appendicitis, which results in increased patient morbidity.
On whether appendicitis could be managed, he said, “Yes, if it hasn’t ruptured. If you have started with antibiotics to reduce the tension, the appendix mass can be managed and delayed but after 48 hours and nothing changes, you have to remove the appendix.”
On who can perform appendicectomy, Okafor said, “Family physician, who is also known as a general practitioner in the United Kingdom, can perform appendicectomy. A medical officer, who is skilled in surgery, who is not a surgeon and is not a family physician, can still perform an appendicectomy.
“There is no limitation on who can perform the procedure. Appendicectomy is actually regarded as a semi-minor surgery. It’s a surgery that a beginner or first-timer can perform with or without supervision. So, ethically, a general practitioner, who is not a surgeon, can perform appendicectomy.
“However, they can’t perform specialised surgeries. Like a GP is not allowed to perform a craniotomy without the supervision of a neurosurgeon.
“Even if he can perform it, there has to be a neurosurgeon to supervise. It is the name of the neurosurgeon that will be in the operation note, while the general practitioner, who performs the surgery, will now be an assistant.
“Also, a general practitioner can perform a caesarean section, but when it results to things like removal of the uterus, that is a hysterectomy, this is now an extreme case and has to be done by an obstetrician. Even if a general practitioner wants to do it, such has to be under the strict supervision of an obstetrician.
“So, in summary, a general practitioner can perform a number of surgeries but not when it comes to a purely systemic surgery. A GP is limited to the surgeries that are called basic surgeries like appendicectomy, C/S and others.”