Appendicitis

What is appendicitis?

Appendicitis is an inflammatory disease affecting a small diverticulum, called the vermiform appendix, which starts from the initial tract of the large intestine. This slender intestinal extension, about ten centimeters long with an average diameter of 6 mm, does not seem to have any function in humans; despite this, when it is hit by an inflammatory process, the appendix can endanger the health of the whole organism, as all those who have had to have it removed with an urgency will know.

Appendicitis has a clear prevalence in childhood, adolescence and early adulthood, although this does not exempt it from creating major problems at all ages.

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Generality

Acute appendicitis is a fairly common disease, affecting approximately 0.2% of the population annually and one in seven throughout life. Of rare occurrence below the age of two and in the geriatric age, it mainly affects young people between the ages of ten and thirty.

More widespread in western and industrialized countries, probably due to the terrible combination of a sedentary lifestyle and an unbalanced diet, appendicitis mainly affects young male subjects, while before puberty and after thirty years the risk between the two sexes is equivalent to .

Symptoms

To learn more: Appendicitis symptoms

The initial symptoms, typical of acute appendicitis, are represented by a sense of general malaise, accompanied by mild fever and abdominal pain localized around the navel.

In the following 12-24 hours, the pain, which is the cardinal symptom of appendicitis, moves downwards, undermining the right iliac fossa (between the navel and the hip bone) at the anatomical site of the 'Appendix. Sometimes the pain is so intense that it pushes the subject to adopt analgesic positions (thighs flexed on the pelvis, lying position).

Not infrequently, the symptomatology also includes gastrointestinal disorders, which however suffer from a greater degree of individual variability (vomiting and, above all in the child, diarrheal discharges that precede a phase of stopping the emission of gas and feces).

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Causes

The causes : the inflammation is generally caused by an obstruction internal to the appendix, consequent to the stagnation of undigested material, or to the hypertrophy of the appendicular lymphatic follicles, which can increase in number and size in response to a local or systemic infection (mononucleosis, measles, typhoid, Crohn's disease, gastroenteritis, respiratory infections etc.). This second etiopathogenic hypothesis is mostly reserved for the juvenile period, since from the thirty years onwards the appendicular lymphatic follicles are significantly reduced, until they disappear around the sixth decade of life. For this reason, in adulthood the occlusion of the appendix is ​​often correlated to the stagnation of a solidified cluster of fecal material and inorganic salts (coprolite) or, more rarely, by the presence of a foreign body (gallstones, neoplasms or parasites intestinal, such as Taenia, Ascaris and Enterobius vermicularis).

Whatever the origin of the obstruction, the accumulation of mucus, which continues to be produced and poured into the intra-appendicular site without finding an outlet, increases the pressure inside the appendix. The consequent mechanical stimulation of pain receptors is responsible for the onset of early symptoms associated with appendicitis, such as nausea, anorexia (understood as reduction or loss of appetite) and visceral pains of medium size and poorly localized.

The increase in blood pressure hinders the perfusion of the appendix, to the point of determining lymphovenous stasis, arteriolar impairment and consequent tissue ischemia. The reduced blood supply and the lymphatic stasis favor the virulentation of the bacteria that normally populate the appendix without causing any damage (acute catarral appendicitis). If the obstruction is resolved the process regresses; on the contrary, if the inflammation persists, the bacterial ulceration of the mucosa, associated with the reduced vascularization, determines the formation of purulent material (suppurative appendicitis).

If the process continues the severe impairment of lymphovasal drainage is associated with the appearance of real gangrenosis foci (acute gangrenous appendicitis). The next stage is the perforation of the bowel, with possible extension of the inflammatory process to the parietal peritoneum (a sort of sheet folded in two that surrounds the walls of the abdominal cavity); from here the inflammation is potentially able to extend to all the adjacent structures (acute perforated appendicitis), even if often the organism succeeds in circumscribing the infectious focus. It is precisely during these latter stages that patients show the traditional exacerbation and migration of pain, which moves from areas close to the navel to those situated lower down, towards the hip bone.

Generalized peritonitis is the most serious complication of appendicitis and, if not treated in time, can even be lethal.