Appendectomy (removal of the appendix)

The condition

The appendix is a small pouch that hangs from the large intestine where the small and large intestine join. Appendectomy is the surgical removal of the appendix. The operation is done to remove an infected appendix. An infected appendix, called appendicitis, can burst and release stool and bacteria into the abdomen.

Symptoms

• Abdominal pain that starts around the navel  and then shifts to the right lower abdomen
• Not wanting to eat
• Low fever
• Nausea and sometimes vomiting
• Diarrhea or constipation

The procedure

The procedure can be done open or laparoscopically.  For the open surgery a 2-3 inch incision is made in the right lower abdomen.  For the laparoscopic approach the surgeon will make about 3 small incisions in the abdomen. A port (nozzle) is inserted into one of the slits, and carbon dioxide gas inflates the abdomen. This process allows the surgeon to see the appendix more easily. A laparoscope is inserted through another port. The laparoscope looks like a telescope with a light and camera on the end so the surgeon can see inside the abdomen. Surgical instruments are placed in the other small openings and used to remove the appendix. This is done with a surgical stapler. The diseased appendix then is placed into a plastic bag, and removed from the abdomen through one of the small incisions. After the appendix has been removed, the carbon dioxide is released out of the abdomen through the slits, and then these sites are closed with sutures or staples, or covered with glue-like bandage and steri-strips.

Nonsurgical Treatment

If the patient only has mild signs of appendicitis, the surgeon may elect to monitor the patient to see if the symptoms get any worse. If there is development of an appendicial abscess (a collection of pus), the surgeon may treat the patient with antibiotics first and have him/her come back for elective surgery in 4 to 6 weeks. In some cases, a small (pencil-thin) tube may be inserted into the abscess by a radiologist to allow for the drainage of pus. Such a tube may remain in place for several weeks.

Risks

• Infection of the skin at the incision site
• Collection of pus inside the abdomen (intraabdominal abscess)
• Postoperative ileus (the intestines slow down/stop working for several days)
• Leakage from the stump of the appendix
• Sepsis

Medical negligence

The above mentioned risks and complications are known to happen with appendectomy and such complications do not necessarily constitute deviation from the medical standard of care.  The following examples however may be considered as medical negligence.

• Failure to diagnose and treat appendicitis when clinical signs and symptoms as well as radiologic and laboratory testing indicate appendicitis.
• Injury to the female reproductive system
• Failure to diagnose and treat appendiceal stump leak or inadvertent colon or small intestinal perforation