A more complex question is whether a person who plans to be
away from civilization for a period of time should have his appendix removed as
a prophylactic precaution. With modern means of communication and travel, this
is probably not necessary unless the person will be extremely isolated (as on a
Pacific island or in an unexplored jungle area).
The best secondary preventive
measure is prompt diagnosis and treatment of an inflamed but still un-ruptured
appendix. The problem here is that the initial symptoms of appendicitis may be
mimicked by so many other conditions-pneumonia with abdominal pain, gallbladderdisease, ruptured ovarian follicle, tubal pregnancy, or just plain
gastroenteritis-that the diagnosis of appendicitis can tax the most astute
physician. The symptoms usually are nausea, abdominal pain, and loss of
appetite, and sometimes fever, constipation or diarrhea.
Typically, the pain of
appendicitis will become most severe in the lower right side of the abdomen
where the appendix is usually located. Since the appendix in some individuals
may be located in an unusual position, pain may localize elsewhere. Careful
history-taking and physical examination with close attention to where the pain
is located are the most useful diagnostic measures. As noted, the pain of
appendicitis is typically much localized; to pinpoint it further, a rectal orvaginal examination is of value. Suggestive clues such as in- creased white
blood cell count, fever, and failure of symptoms to subside help confirm the
diagnosis.
Treatment is surgical removal, and with good anesthesia and
modern surgical techniques, the risk of surgery is virtually zero, while
problems encountered after an appendix ruptures are formidable. After removal
of an intact inflamed appendix, the patient is usually out of bed next day and
home from the hospital in five to seven days.
Further convalescence is
ordinarily uneventful. Even those suffering from other ailments such as heart
disease usually come through the surgery and anesthesia very well. In contrast,
a ruptured appendix calls for intravenous feeding, antibiotics, strict bed rest
sometimes for several days before surgery can even be performed. Recovery from
surgery may involve several weeks of hospitalization because, even with
antibiotics, peritonitis is still a difficult and dangerous medical problem.
