If cholecystectomy is the most common elective general surgical procedure then what is the most common emergency general surgical procedure?

Well, this time it was Tamara’s turn to find out!

One night, Tamara could not sleep. She tells her mom, Susan, that she is having tummy ache. In the morning, Tamara has no desire for breakfast and reluctantly goes to school

Before lunch, Susan gets a phone call from Tamara’s school. Tamara has fever, tummy ache and vomiting. Susan takes Tamara to the Emergency Department. The physician on duty finds that Tamara is very tender in the right lower quadrant of the abdomen. In fact, slight pressure on the area causes Tamara to jump.

The ER physician makes a provisional diagnosis of acute appendicitis and consults the general surgeon on call. The surgeon confirms the clinical impression of the ER physician and explains to Tamara and her mom that the best treatment for this condition is emergency removal of the appendix.

“Doctor, what about tests to confirm the diagnosis?” asks anxious Susan.

Although most patients with this kind of clinical picture end up having blood and urine tests and plain abdominal x-rays, the diagnosis of acute appendicitis remains a clinical one. These tests are valuable when the diagnosis is not clear. That happens in about 20 percent of cases.

“Doctor, can the surgery wait till tomorrow?”

No. Once the diagnosis of acute appendicitis is made then the appendix should be removed within the next few hours, depending on the condition of the patient. If ruptured appendix or abscess is suspected then the procedure should be undertaken within couple of hours. If the patient is not “toxic”, then 4 to 6 hours’ wait is reasonable. But the surgeon makes the call on the timing of the procedure. With his experience, he will be right most of the time.

“Doctor, what is the risk of delaying surgery?”

Perforation (ruptured appendix), peritonitis and death from “toxic shock”. From time to time, people have died from ruptured appendix. The reasons are: delay in presentation to a doctor (quite often people think it is flu and stay home and self-medicate), and unusual presentation leading to delay in diagnosis.

Once the diagnosis of acute appendicitis is made then it is better to remove a normal one then risk perforation and subsequent complications. About 10 to 20 percent normal appendectomies are acceptable in a surgeon’s carrier.

“Doctor, don’t we need an appendix? What happens after it is removed? Is Tamara going to feel anything different?”

No, we do not need the appendix. Its function in the immune system is not clear. It does not serve any useful purpose as a digestive organ in humans. It is believed to be gradually disappearing in the human species. Absence of appendix causes no adverse effects.

About 110 appendectomies are done at Medicine Hat Regional Hospital each year. Historically, appendectomies have been done since 1880. Leonardo da Vinci was the first to describe and illustrate the appendix in 1492.

Tamara has a successful uncomplicated appendectomy. Couple of days in the hospital and one week at home should get her back to school feeling happy and healthy. Most patients have uncomplicated recovery. Hopefully, Tamara will not be an exception.

This series of articles explore the health problems of Dave and his family. They are composite characters of a typical family with health problems.

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