Appendectomy; for ruptured appendix with abscess or generalized peritonitis
CPT4 code
Name of the Procedure:
Appendectomy
Common name(s): Surgical removal of the appendix
Medical term: Laparoscopic appendectomy, Open appendectomy
Summary
An appendectomy is a surgical procedure to remove the appendix. It's typically performed to treat appendicitis, which is an inflammation of the appendix. This description focuses on cases where the appendix has ruptured, causing an abscess or generalized peritonitis (infection of the abdominal lining).
Purpose
Medical Condition Addressed:
- Ruptured appendix with abscess formation or generalized peritonitis.
Goals/Expected Outcomes:
- Removal of the inflamed or ruptured appendix.
- Clearance of any infection or abscess.
- Prevention of further infection and complications.
Indications
- Severe abdominal pain, usually in the lower right quadrant.
- Fever and elevated white blood cell count.
- Symptoms of generalized peritonitis, such as severe, diffuse abdominal pain, bloating, and tenderness.
- Radiological evidence (e.g., ultrasound, CT scan) showing a ruptured appendix and abscess formation.
Preparation
- Patients are typically required to fast for at least 8 hours before the surgery.
- Preoperative blood tests and imaging studies (CT scan or ultrasound) are usually conducted.
- Antibiotics may be administered before the procedure to manage infection.
- Patients might need to adjust or cease certain medications as directed by their healthcare provider.
Procedure Description
- Anesthesia: Administered general anesthesia.
- Incision: A small incision is made in the abdomen.
- Laparoscopic: Several small incisions for inserting a camera and instruments.
- Open Surgery: A single larger incision may be required if infection is widespread.
- Exploration and Removal: Visualization of the abdominal cavity to locate the ruptured appendix and any abscess.
- The appendix is isolated and removed.
- Abscesses are drained and the area is thoroughly cleaned to prevent further infection.
- Closure: Incisions are closed with sutures or staples.
- Post-procedure: The surgical site is dressed.
Tools/Equipment: Laparoscope, surgical instruments, suction devices for abscess drainage.
Duration
The procedure typically takes 1 to 2 hours, but may vary depending on the complexity due to the rupture and presence of abscesses.
Setting
- Hospital operating room.
Personnel
- General surgeon or specialized abdominal surgeon.
- Anesthesiologist.
- Surgical nurses and assistants.
Risks and Complications
Common Risks:
- Infection at the incision site.
- Bleeding.
- Post-operative pain.
Rare Risks:
- Damage to surrounding organs or tissues.
- Persistent abscesses requiring further treatment.
- Anesthesia-related complications.
Benefits
- Relief from symptoms of appendicitis and infection.
- Prevention of further complications such as widespread infection or sepsis.
- Most patients experience significant improvement within a few days post-surgery.
Recovery
- Initial hospital stay of 1-3 days for monitoring.
- Pain management with prescribed medications.
- Avoid strenuous activities for at least 2-4 weeks.
- Follow-up appointments for wound check and recovery assessment.
Alternatives
Non-surgical:
- Antibiotic treatment (less preferred for ruptured cases).
Comparison:
- Non-surgical treatment may be used in non-ruptured cases but is often not effective for ruptured appendicitis with abscess or peritonitis.
Patient Experience
During the Procedure:
- Patient is under general anesthesia, so they will be unconscious and not feel pain.
After the Procedure:
- Some pain and discomfort managed with medications.
- Instructions on wound care, activity limitations, and diet.
- Possible feelings of fatigue and mild discomfort for a few days post-surgery.
- Pain management with oral medications as needed.
Patients should follow all post-operative care instructions carefully to ensure proper healing and report any unusual symptoms to their healthcare provider promptly.