【正文】 the skin over the area of the appendix in the right lower abdomen (McBurney incision). 2022/10/23 90 2022/10/23 91 2. The muscles are split and the abdomen is entered 3. The large bowel or cecum is located and followed to its end where the appendix is found 2022/10/23 92 4. The appendix is pulled up through the incision 2022/10/23 93 5. The mesoappendix is separated off of the appendix, clamped and tied off 2022/10/23 94 6. The appendix is then tied off at its base next to the cecum 7. The remainder of the appendix is lamped, cut and removed 2022/10/23 95 8. Care is taken to prevent spillage of bacteria from the cut end. 9. If the appendix has ruptured, a drainage is placed in the region of the appendix to allow bacteria to drain out . The drainage are removed when the infection is cleared. 2022/10/23 96 plications Complications of appendicitis abdomen abscess fecal fistula pylephlebitisChills,high fever,lowgrade jaundice,and later,hepatic abscess. Complications of appendectomy bleeding wound infection Intestinal obstruction Fecal fistula 2022/10/23 97 APPENDICITIS IN INFANTS AND YOUNG CHILDREN 2022/10/23 98 The establishment of a diagnosis of acute appendicitis in the young is even more difficult than in the adult. All contributing factors are the inability of young children to give an accurate history, diagnostic delays by both parents and physicians, and the frequency of gastrointestinal upset in children 2022/10/23 99 The more rapid progression to rupture and the inability of the underdeveloped greater omentum to contain a rupture lead to significant morbidity rates in children. In a study of 1336 specimens from pediatric patients undergoing appendectomies, histologic analysis revealed 12% normal appendices, 68% nonperforated appendices and 20% perforated appendices. 2022/10/23 100 Children under 8 y had a twofold increase in the rate of perforation as pared to older children. The incidence of major plications was related to rupture, with an incidence of % in simple appendicitis pared to % in perforated appendicitis. 2022/10/23 101 The treatment regimen for perforated appendicitis generally includes immediate appendectomy antibiotic irrigation of the peritoneal cavity, transperitoneal drainage through the wound, and a 10day antibiotic treatment regimen. Laparoscopic appendectomy had also been shown to be safe and effective in children 2022/10/23 102 APPENDICITIS IN THE ELDERLY 2022/10/23 103 Although the incidence of appendicitis in the elderly is lower than in younger patients, the morbidity and mortality are significantly in creased in this patient population. Delays in diagnosis, a more rapid progression to perforation, and conitant disease are all contributing factors. 2022/10/23 104 The diagnosis of appendicitis may be more subtle and less typical than in younger individuals, and a high index of suspicion needs to be maintained. In patients over 80 Y, perforation rates of 49% and mortality rates of 21% have been cited. 2022/10/23 105 APPENDICITIS DURING PREGNANCY 2022/10/23 106 Appendicitis is the most frequently encoun tered extrauterine disease requiring surgical treatment during pregnancy. The incidence is approximately 1 in 2022 pregnancies. 2022/10/23 107 Changes in position and direction of appendix during pregnancy. pp=postparum Rise of appendix during pregnancy Acute appendicitis can occur at any time during pregnancy but is more frequent during the first trimesters. As fetal gestation progresses, the diagnosis of appendicitis bees more difficult as the appendix is displaced laterally and superiorly. 2022/10/23 108 Nausea and vomiting after the first trimester or newonset nausea and vomiting should raise the consideration of appendicitis. Abdominal pain and tenderness will be present,although rebound and guarding are less frequent due to laxity of the abdominal wall. 2022/10/23 109 Elevation of the white blood cell count above the normal pregnancy levels of 15,000 to 20,000/m3 with a predominance of polymorphonuclear cells of usually present 2022/10/23 110 when the diagnosis is in doubt, abdominal ultrasound may be beneficial. Laparoscopy may be indicated in equivocal cases, especially early in pregnancy. 2022/10/23 111 The performance of any operation during pregnancy carries a risk of premature labor of 10 to 15%, and the risk is similar for both negative laparotomy and appendectomy for simple appendicitis. 2022/10/23 112 The most significant factor associated with both fetal and maternal death is appendiceal perforation. Fetal mortality increases from 3 to 5% with early appendicitis to 20% with perforation. 2022/10/23 113 The suspicion of appendicitis during pregnancy should prompt rapid diagnosis and surgical intervention. 2022/10/23 114 Appedictis in patients with AIDS or HIV infection ?Oppertunistic infection ?The leukocytosis may not be present ?Diagnostic laparoscopy 2022/10/23 115 Thank you!