1. Diseases of the Appendix
בס"ד
Diseases of the Appendix
יונתן אברהם דמה

2. Appendicitis Disease of the young Incidence
Rare in very young children and elderly
Overall mortality 0.25%
Higher mortality in age extremes

3. Plan Introduction Diagnosis Treatment preop, op and post op
Special consideration
Complication
Neoplasm

4. Introduction
Embryology
Normal anatomy
Pathophysiology
Bacteriology

5. Embryology

6. Embryology

7. Anatomy

8. Anatomy

9. Pathophysiology

10. Diagnosis Clinical History Physical examination Laboratory Imaging
Plain abdominal film US CT

11. History 1889: Chester McBurney Only 55% have classical features.
History hours
Abdominal pain:
(diffuse and periumbilical, localizing to the RLQ)
Anorexia (almost always).
Vomiting (75%).
Low grade fever.
If >38 suspect perforation
Only 55% have classical features.

12. Physical exam

13. Peritoneal inflamation sign
Dunphy's sign
Rovsing's sign
Guarding
Rebound sign
Obturator sign
Psoas sign

14. Dunphy

15. Rovsing

16. Guarding

17. Rebound

18. Obturator

19. Psoas

20. Diffuse Peritonitis
כשהמצב מתקדם

21. Laboratory settings
WBC
Urinalysis

22. אבחנה של דלקת בתוספתן היא קודם כל קלינית

23. Scoring

24. אבל עם אנחנו לא בטוחים....

25. Diagnosis - US Noninvasive Available Operator dependant
Sensitivity 80%
Specificity 90%
Positive Findings
Noncompressible tubular structure
>7 mm
Fluid
appendicolith

26. CT Requires contrast - oral and IV Radiation Sensitivity 90-95%
Specificity 90%
Findings
Nonfilling tubular structure (target)
>7 mm
Pericecal inflammation and Fluid
appendicolith

27. Target

28. >7 מ"מ

29. Fecalith

30. DD Go by organ systems or by category Consider symptoms, Age and Sex
Concomitant conditions

31. Differential diagnosis

32. Diagnostic laparoscopy
If you are not sure…

33. Treatment
Medical
Periappendicular abscess
Surgical

34. Surgical Treatment Appendectomy : Laparoscopic versus open Sex Habitus
Diagnostic uncertain
NOTES, SILS, Lap assisted

35. Lap versus open appendectomy

36. After the surgery

37. Complication In op: Lap converted to open Bowel resection Post op:
Wound infection
Deep space infection/abcess
Small bowel obstruction
Infertility
Enterocutaneous Fistula

38. Special issues Normal appearing appendix Meckels diverticulum
Interval appendectomy
Chronic or recurrent appendicitis
Children
Pregnancy
Crohns dis
FMF

39. Neoplasms Rare Mucocele benign, malignant, pseudomyxoma
Treatment (Rt colectomy vs appendectomy)
Survival rate 55% vs 20%
Adenocarcinoma
Carcinoid
Treatment: size, location
Survival

40. Laparoscopic Appendectomy

41. תודה