All You (N)ever Wanted to Know about Appendectomies

WARNING:  This Post was Written by an Extremely Sleep Deprived Woman and is Rated PG-13 for medical gore and mild potty humor.    (consider yourself warned)

According WebMD  the main symptoms of acute appendicitis are:

• You have pain in your belly. The pain may begin around your belly button.
• The pain in your belly gets stronger and moves below your belly button on your right side (the lower right quadrant). This is the most common place to feel pain when you have appendicitis.
• The pain does not go away and gets worse when you move, walk, or cough.
• You have pain in any part of your belly or on your side.
• You feel nauseated or throw up a few times. You also may not feel like eating.
• You have constipation, back pain, slight fever, or a swollen abdomen. 

Spencer had been having mild abdominal pain and nausea that came and went for the last few days, but it never seemed like anything  to worry about, because it never lasted more than a few minutes at a time.  Then, starting at about 1:30 this morning, Spencer had the nausea, slight fever, lack of appetite, and the severe stabbing pain in his lower right abdomen that got worse every time he moved even slightly.    The pain did not let up over time and he was given morphine to combat the pain. 

After it was apparent that the pain was not a  fleeting thing, the doctors decided to perform tests to determine the cause.  To diagnose, they always start with the cheapest, least harmful tests first.  Spencer started with an abdominal x-ray which was brought right to the room (this was about 3:00am), which showed nothing.    Next was an abdominal ultrasound which was done at about 6:00am in the ultrasound section of the hospital.  This test also showed nothing, because they couldn't even find his appendix during the test.  We were told that this is a common thing to happen with teenagers because of their anatomy, their appendices are notoriously hard to find via ultrasound. 

Finally, when the pain was still not letting up and the doctors were starting to get increasingly worried about the typhlitis,  so it was determined that a ct scan needed to be performed.  A ct scan is a very accurate diagnostic tool for both appendicitis and typhlitis.   Around 9:30 am he was given a contrast solution mixed with a Powerade to drink.  Finally at around 11:30 or so transport came and wheeled him down to the radiology department for the scan. 

Although the ct scans are a more definitive diagnostic tool than the x-rays and ultrasounds, because the ct scans emit a lot of radiation,  they tend to use them as a last-ditch diagnostic tool.  With all of the pain he was enduring, I was surprised when Spencer started talking about how nervous he was about getting the scan.  He had even talked the nurse into giving him something to help him relax for it, but fortunately someone finally realized that he had his heavy duty hospital machines mixed up.  While he was envisioning being stuck in the closed-in tube of an MRI machine for 45 minutes,  as you can see in this picture the ct scanner is much more open (only a couple feet deep) and only takes a minute or two.   He did not need to take any medication for his nerves. 

After the scan was done it was quickly realized (within 10 minutes) that it was for sure his appendix that was causing issues and not his bowels being inflamed which are indicative of the typhlitis. 

Thank goodness! 

As soon as the appendicitis diagnosis was made, he was immediately squeezed into the surgery schedule as soon as possible ( a couple hours later).  In the meantime, we were back in his room and he was writhing in pain.  The morphine did take the edge off, but his pain was still significant, especially with movement. 

At about 2:00 we went down to our favorite dungeon of the hospital, the pediatric sedation suite.  I was happy when we found out his surgeon was going to be Dr. Soutter, the same pediatric surgeon who  placed his central line.    He and his partner do over 400 appendectomies per year and we felt very comfortable putting Spencer into his hands.  We had a strong respect for him when he placed his line and like him even better now.

According to our understanding, a laparoscopic appendectomy is done by making three small incisions in the following places (NOTE:  after a glimpse at Spencer's belly, we noticed that he actually has the belly button incision plus two lower incisions, rather than one high and one low incision as shown in this diagram): 

image from laparoscopy . net

I'm not sure which is done through which incision, but carbon dioxide is blown in through one of the incisions, to inflate the abdomen enough to be able to see everything they need clearly.  A tiny camera is inserted through another of the incisions to help guide the surgeon to the proper place.  And the instruments are inserted in the other to remove the diseased appendix. 

Here's a glimpse at Spencer's appendix:  (Sorry, but I did warn you)

The whole procedure took about an hour and if he weren't already a patient at the hospital, he'd likely be able to go home tomorrow.   Normal eating and drinking can resume as he feels up to it. 

He was still in a considerable amount of pain tonight, but the morphine was helping him relax and get some much needed rest.  Too bad no one got the memo that mom needed some rest too, because I've still got kids up doing homework at almost 11:00pm.    That 5:00am alarm clock is going to go off way too soon! 

Apparently one of the biggest causes of post-appendectomy pain is caused by the extra air left in his system after having it blown into his abdomen for the surgery.  The doctor says the best thing he can do in the next few days is get up, move his body,  and pass lots of gas. 

Based on familial history, he shouldn't have any trouble with that last one.

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A couple more tidbits:

The doctors do not think the appendicitis and the leukemia were related and that the timing was just happenstance.  I am not sure about that. 

Speaking of timing,  his appendicitis attack was timed relatively well in that his chemo was already finished, thereby not interrupting the cycle, but it occurred early enough that his blood counts hadn't dropped yet.    Being neutropenic would have made surgery a much riskier procedure. 

His ANC was 9000 today.  Normal is 1500-8000.  Being elevated was actually a good sign in that it meant that his body had mounted a response to the appendicitis. 

Spence is the first one in our family to have his appendix out.