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volume 4, issue 6, 2025
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ACUTE APPENDICITIS: DIAGNOSIS AND SURGICAL TREATMENT
Turg'unova D.Z.¹, Ezozkhanova S.I.²
¹ Department of Medical and Natural Sciences, Kokand University, Andijan Branch
² Student of the Faculty of Medicine, Kokand University, Andijan Branch
Abstract:
Acute appendicitis is one of the most common surgical diseases, requiring prompt
diagnosis and treatment. This article discusses the etiopathogenesis, clinical manifestations,
diagnostic methods, and modern surgical treatment options for acute appendicitis. A comparative
analysis of laparoscopic appendectomy and open surgery is provided. The article also highlights
possible complications and preventive measures.
Keywords
: acute appendicitis, appendectomy, laparoscopy, diagnosis, surgical treatment
INTRODUCTION
Acute appendicitis is an acute inflammation of the vermiform appendix and is one of the most
frequent abdominal surgical emergencies. It occurs in all age groups, with the highest incidence
between the ages of 10 and 30. The prevalence is nearly equal between males and females.
Delayed
diagnosis
and
treatment
may
lead
to
serious
complications.
The incidence of appendicitis is approximately 100–200 cases per 100,000 people annually. The
mortality rate in modern medical conditions is 0.1–0.5%, but this rate can increase significantly
with delayed intervention.
ETIOPATHOGENESIS
Several factors contribute to the development of acute appendicitis.
Main causes include:
- Obstructive factors: luminal obstruction due to fecaliths, parasites, tumors, or lymphoid
hyperplasia
- Infectious factors: bacterial or viral infections
- Immunologic factors: local immune suppression
- Genetic predisposition: positive family history of appendicitis
Pathogenesis stages:
1. Luminal obstruction of the appendix
2. Continued secretion leading to increased intraluminal pressure
3. Impaired blood circulation – ischemia
4. Bacterial infection – inflammation intensifies
5. Necrosis and perforation – development of severe complications
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CLINICAL PRESENTATION
Classic symptoms:
- Pain: begins in the epigastric region and shifts to the right lower quadrant
- Fever: 37.5–38.5°C
- Loss of appetite: anorexia
- Nausea and vomiting: in 60–70% of cases
- Muscle tension: in the right lower quadrant
Specific signs:
- Rovsing's sign: pain in the right lower quadrant upon palpation of the left side
- Sitkovsky's sign: increased pain when the patient lies on the left side
- Blumberg's sign: rebound tenderness
- Cope’s sign: pain with passive extension of the right thigh
Clinical presentation may vary depending on age and disease stage. Classical signs may be less
evident in children and the elderly.
DIAGNOSTIC METHODS
Laboratory tests:
- Complete blood count: leukocytosis (>10,000/mcl), left shift
- Urinalysis: to exclude urinary pathology
- Biochemical tests: CRP, procalcitonin
- Coagulation profile: preoperative evaluation
Imaging and procedures:
- Ultrasound: thickened appendix, presence of fluid
- CT scan: gold standard for accurate diagnosis
- MRI: preferred in pregnant women
- Diagnostic laparoscopy: in uncertain cases
Differential diagnosis is crucial to rule out other conditions such as acute pancreatitis,
cholecystitis, urolithiasis, or gynecological diseases.
SURGICAL TREATMENT
Appendectomy remains the mainstay of treatment for acute appendicitis. There are two principal
approaches:
Open appendectomy:
- Traditional method
- Performed through McBurney-Volkovich-Dyachenko incisions
- Effective in uncomplicated cases
- Used where limited resources are available
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Laparoscopic appendectomy:
- Minimally invasive
- Faster recovery
- Less postoperative pain
- Better cosmetic outcomes
Advantages of laparoscopic appendectomy:
- Minimally invasive
- Shorter hospital stay
- Fewer adhesions
- Improved cosmetic results
POSTOPERATIVE MANAGEMENT
Standard postoperative care includes:
- Pain management
- Antibiotic therapy (as indicated)
- Gradual resumption of activity
- Dietary and lifestyle guidance
- Wound care
Patients are typically discharged within 1–3 days, with complete recovery in 2–4 weeks.
COMPLICATIONS AND PREVENTION
Preoperative complications:
- Perforation
- Peritonitis
- Appendiceal mass
- Abscess formation
Postoperative complications:
- Wound infection
- Bleeding
- Bowel obstruction
- Adhesions
Preventive measures:
- Early diagnosis and timely surgery
- Aseptic surgical technique
- Prophylactic antibiotics
- Proper surgical procedure
CONCLUSION
Acute appendicitis is a serious condition requiring urgent diagnosis and treatment. Advances in
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diagnostic techniques and surgical methods have significantly improved the prognosis.
Laparoscopic appendectomy is currently the preferred approach due to its lower complication
rate and faster recovery. Early diagnosis, correct surgical technique, and proper postoperative
care are essential for successful outcomes.
REFERENCES
1. Textbook of Surgical Diseases, Tashkent, 2020.
2. Emergency Abdominal Surgery, Moscow, 2019.
3. Laparoscopic Surgery, Saint Petersburg, 2021.
4. Appendicitis: Modern Approaches to Diagnosis and Treatment, Surgery Journal, 2020.
5. Minimally Invasive Surgery, Tashkent, 2021.
