c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Appendectomy: 1

A D V E R T I S E M E N T

   
 

Appendicitis can be a life-threatening condition because of systemic sepsis (systemic inflammatory response syndrome/SIRS leading to multiple organ failure) following rupture and abscess formation. It is therefore important to operate before rupture occurs. While the following presentation focuses on the technique of appendectomy, it is worthwhile to note a few points about the diagnosis. Appendicitis can mimic a variety of other conditions and vice versa. The young, elderly, diabetics and immuno-compromised patients are prone to rupture earlier than normal adults. While the appendix can be highly mobile, the most reliable indication for operation is localized right lower quadrant tenderness. Guarding and rebound may be absent because the majority of appendices are partially or totally retro-cecal.    

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Appendectomy: 2

A D V E R T I S E M E N T

   
 

The classic McBurney incision is made at a point two-thirds the distance (McBurney's point) between umbilicus and anterior superior spine of the ilium. The incision is perpendicular to the connecting line, and is made one third above and two thirds below the line. It is often adjusted to coincide with the point of maximal tenderness.      

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Appendectomy: 3

A D V E R T I S E M E N T

   
 

The distance between the lateral edge of the rectus abdominis and the anterior superior iliac spine is only a few centimeters, so it is beneficial to move the line of a McBurney incision even more lateral than the two thirds point in order to have maximal working room.      

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This page was last modified on 12/5/1999.