Appendicitis (cont.)
Why can it be difficult to diagnose appendicitis?
It can be difficult to diagnose appendicitis. The position of the appendix in
the abdomen may vary. Most of the time the appendix is in the right lower
abdomen, but the appendix, like other parts of the intestine,
has a mesentery.
This mesentery is a sheet-like membrane that attaches the appendix to other
structures within the abdomen. If the mesentery is large, it allows the appendix
to move around. In addition, the appendix may be longer than normal. The
combination of a large mesentery and a long appendix allows the appendix to dip
down into the pelvis (among the pelvic organs in women). It also may allow the
appendix to move behind the colon (called a retro-colic appendix). In either
case, inflammation of the appendix may act more like the inflammation of other
organs, for example, a woman's pelvic organs.
The diagnosis of appendicitis also can be difficult because other
inflammatory problems may mimic appendicitis. Therefore, it is common to observe
patients with suspected appendicitis for a period of time to see if the problem
will resolve on its own or develop characteristics that more strongly suggest
appendicitis or, perhaps, another condition.
What other conditions can mimic appendicitis?
The surgeon faced with a patient suspected of having appendicitis always must
consider and look for other conditions that can mimic appendicitis. Among the
conditions that mimic appendicitis are:
- Meckel's diverticulitis. A
Meckel's diverticulum is a small outpouching of the small intestine which
usually is located in the right lower abdomen near the appendix. The
diverticulum may become inflamed or even perforate (break open or rupture). If
inflamed and/or perforated, it usually is removed surgically.
- Pelvic inflammatory disease. The right
fallopian tube
and ovary lie near the
appendix. Sexually active women may contract infectious diseases that involve
the tube and ovary. Usually, antibiotic therapy is sufficient treatment, and
surgical removal of the tube and ovary are not necessary.
- Inflammatory diseases of the right upper abdomen.
Fluids from the right upper abdomen may drain into the lower abdomen where they
stimulate inflammation and mimic appendicitis. Such fluids may come from a
perforated duodenal ulcer, gallbladder disease, or inflammatory diseases
of the liver, e.g., a liver
abscess.
- Right-sided diverticulitis.
Although most diverticuli are located on the left side of the colon, they
occasionally occur on the right side. When a right-sided diverticulum ruptures
it can provoke inflammation they mimics appendicitis.
- Kidney diseases. The right kidney is close enough to the appendix that
inflammatory problems in the kidney-for example, an abscess-can mimic
appendicitis.
Next: How is appendicitis treated? »
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