Quirúrgicas — Apéndice (Apendicitis)
Aquí una guía esencial para entender en qué consiste la apendicitis y su tratamiento, con la honestidad y transparencia que su salud requiere.
Información importante que debe saber
Appendix (Appendicitis)
Appendix (Appendicitis)
1. What is it?
The vermiform appendix It is a small, tubular structure, 6–10 cm long, located in the cecum (the first part of the colon). It contains lymphoid tissue and is part of the intestinal immune system, especially during childhood. Although not vital, it plays a role in the early regulation of the gut microbiota.
2. What is it for?
Although for decades it was considered a “vestigial” organ, today we know that the appendix acts as:
- Reservoir of beneficial microbiotahelping to restore intestinal balance after severe infections.
- Local immune center, with a high concentration of lymphoid follicles that contribute to defense against enteric pathogens.
Its function is most important in childhood, gradually decreasing in adulthood.
3. Can we live without it?
When the appendix is removed (appendectomy), otros tejidos linfoides del intestino compensan su función inmunológica.
The body maintains its bacterial balance and the intestinal immune system continues to function without relevant limitations.
There is no evidence that appendectomy affects long-term life expectancy, digestion, or immunity.
1. Causes of appendicitis
Appendicitis occurs due to a obstruction of the appendiceal lumen, which triggers progressive inflammation. The most frequent causes are:
- Lymphoid hyperplasia (the number one cause in young people).
- Fecaliths or plugs of fecal matter.
- Intestinal parasites (Enterobius, Ascaris).
- foreign bodies (very rare).
- Tumors of the appendix (carcinoid, mucinous; more common in older adults).
The obstruction causes increased pressure, bacterial infection, ischemia, and, if left untreated, perforation.
2. Stages of appendicitis
Appendicitis progresses rapidly. The stages are:
- Edematous appendicitis (0–12h): initial inflammation of the appendix.
- Suppurative appendicitis (12–24h): bacterial infection, migratory pain to the right iliac fossa.
- Gangrenous appendicitis (24–48h): necrosis due to lack of irrigation.
- Perforated appendicitis (>48h): rupture of the appendix — peritonitis or intra-abdominal abscess.
The progression is variable, but in most patients it happens in hours, not days.
3. Complications if not treated in time
- Perforation of the appendix.
- Appendiceal abscess.
- Generalized peritonitis.
- Sepsis.
- Intestinal obstruction due to inflammation.
- Fistulas (rare).
- Prolonged hospital stay and a higher post-perforation surgical risk.
Every hour matters: early surgery reduces complications and improves recovery.
The global standard treatment is appendectomy, preferably laparoscopic, due to its advantages:
- Small incisions.
- Less pain.
- Faster recovery.
- Lower risk of infection.
- Best assessment of the entire abdomen.
Antibiotic treatment alone may be considered in highly selected cases, but most guidelines recommend it only in uncomplicated appendicitis, with a high risk of relapse and need for subsequent surgery.
The surgery is safe and the average time for full recovery is 7–10 days depending on the patient's progress.
- Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132(5):910–925.
- Andersson RE. The natural history and traditional management of appendicitis revisited. Ann Surg. 2007;245(6):986–995.
- Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet. 2015;386(10000):1278–1287.
- Rhee SJ, Spencer AU, Cohen J, et al. The appendix and immunity: a review. Clin Exp Immunol. 2016;186(1):20–27.
- Salminen P, Tuominen R, Paajanen H, et al. Antibiotic therapy vs appendectomy for treatment of uncomplicated acute appendicitis. JAMA. 2015;313(23):2340–2348.
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