Published on 11/04/2015 by admin

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Last modified 11/04/2015

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CHAPTER 15 Appendectomy


The appendix is a blind-ended tubular structure arising from the cecum approximately 2 cm below the ileocecal valve (Fig. 15-2). Obstruction of the lumen of the appendix by fecal material (i.e., fecalith), a tumor, or lymphoid hyperplasia may result in elevated intraluminal pressures, vascular congestion, stasis, bacterial overgrowth, and inflammation. Without intervention, the resulting appendicitis may progress to wall necrosis and appendiceal perforation. Prompt diagnosis and management are critical to the successful treatment of appendicitis. Despite the high incidence of appendicitis, however, its diagnosis is not always straightforward. The differential diagnosis of appendicitis is broad and may include gastroenteritis, Meckel’s diverticulitis, colonic diverticulitis, inflammatory bowel disease, urinary tract infection, epididymitis, and gastrointestinal and reproductive tract malignancies. Women of childbearing age who present with abdominal pain pose a particular diagnostic challenge because pelvic inflammatory disease, ovarian cysts, and ovarian torsion can also mimic appendicitis.

This chapter focuses on the perioperative and operative management of diseases of the appendix. Both laparoscopic and open approaches to appendectomy are frequently in use and are discussed.