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For over a century, laparotomy (open appendectomy) was the standard treatment for acute appendicitis. [93] This procedure consists of the removal of the infected appendix through a single large incision in the lower right area of the abdomen. [94] The incision in a laparotomy is usually 2 to 3 inches (51 to 76 mm) long.
The symptoms may mimic those of acute appendicitis, diverticulitis, or cholecystitis. The pain is characteristically intense during/after defecation or micturition (espec. in the sigmoid type) due to the effect of traction on the pedicle of the lesion caused by straining and emptying of the bowel and bladder. Initial lab studies are usually normal.
Currently, conservative management and surgery are the only treatment options for omental infarction with no consensus as to the best treatment modality. Having both acute appendicitis and omental infarction is extremely rare with only two cases reported in the literature: one in an adult female and the other in a 7-year-old girl. [2]
Appendicitis develops most commonly in the second trimester. [2] If appendicitis develops in a pregnant woman, an appendectomy is usually performed and should not harm the fetus. [16] The risk of premature delivery is about 10%. [17] The risk of fetal death in the perioperative period after an appendectomy for early acute appendicitis is 3 to 5%.
In cases of acute appendicitis, antegrade appendicectomy is the preferred option, but in cases where the base of the appendix is accessible but is difficult to identify or deliver its more distal portion, a retrograde appendicectomy becomes necessary.
In the clinical context, it is performed when acute appendicitis is suspected. In this condition, the appendix becomes inflamed and enlarged. The appendix may come into physical contact with the obturator internus muscle, which will be stretched when this maneuver is performed on the right leg.
Prior to surgery, the bowels are typically cleared with a routine called bowel prep. [20] Bowel prep can be performed at home the 1–2 days before surgery or in some instances, occurs in a hospital before the operation. [20] Bowel prep may require magnesium citrate drink to empty the colon. [21] Bowel prep is done to reduce infection risk. [22]
The AIR score was developed to overcome some of the drawbacks of the Alvarado score, another diagnostic scoring system for identifying appendicitis. [2] The AIR score is one of the two scores (the other being the Adult Appendicitis Score , AAS) recommended by the 2020 World Society of Emergency Surgery clinical practice guidelines for the ...