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Surgery and Health

Abdominal pain, acute appendicitis

Appendicitis Strikes More Than Kids

By Dr. W. Gifford Jones

December 16, 2001

I'll never forget one Christmas. I had been in training at The Harvard Medical School only a few months and arrived home to find my father desperately ill. During a trip to Scotland he had developed abdominal pain and the doctor had mistakenly diagnosed "an intestinal cold". The decision to fly home nearly ended my father's life. An acute appendicitis had ruptured causing .

The diagnosis of acute appendicitis is sometimes as easy as falling off a log. Pain starts in the mid©abdomen and gradually shifts to the lower right side. Often the pain is worse on moving, coughing or when the abdomen is prodded. And frequently abdominal discomfort is accompanied by low grade fever, nausea or vomiting.

But this textbook account of appendicitis is all too often clouded, particularly in older patients. For this reason elderly patients are often seen only after the appendix ruptures.

In 1902, Frederick Treves must have wished he was anywhere but in London, England. With great reluctance older doctors had asked this young "whipper©snapper" surgeon him to examine a future King. Prince Edward was scheduled to be crowned King of England in two days.

Court physicians had diagnosed Edward's abdominal pain as inflammation of the bowels. But there was a problem, the patient's condition was rapidly deteriorating.

Treves diagnosed a ruptured appendix and advised surgery, much to the consternation of the other doctors. The coronation was postponed, Treves organized the operating theatre and others made plans for Edward's funeral, for good reason.

Queen Victoria had reigned so long that Edward had ample time to enjoy the pleasures of the flesh. He was obese, old, flatulent and a terrible operative risk.

But the young surgeon made a wise decision. Treves simply made an incision, drained the abscess and left the appendix alone. No doubt he then prayed while the courts of Europe awaited the royal funeral. Luckily Edward rallied and was later crowned King Edward VII. Treves was knighted for his efforts. What nearly ended Edward's reign before it began often terminates the lives of people who delay seeking medical attention when abdominal pain strikes.

Older people are more likely to fall into this trap. The pain is often mild, with little fever. Hence the tendency for the elderly to write off these symptoms as a mild intestinal upset or take the attitude "I'll feel better in the morning".

¡ But delaying medical attention is just one of the pitfalls. If you develop abdominal pain never, never take a laxative. Or assume that an enema will relieve the discomfort. Rather, it may cause an inflamed appendix to rupture.

¡ Don't take food or drink until you've consulted a doctor. In the event surgery is required it's best to have an empty stomach. And delay taking painkillers. This will make the diagnosis more difficult once you see the doctor.

¡ To make the diagnosis abdominal and rectal examinations must be done. In addition, blood examination may show an elevation of the white blood cell count and imaging techniques such as ultrasound or a CT (computerized tomography) scan may help to pinpoint the problem. ¡ But sometimes, only by removing the appendix can one become sure of the diagnosis.

¡ How the appendix is removed depends on individual circumstances. The traditional incision has been used for years. Today surgeons have developed great expertise in using laparoscopic surgery. In these cases an optical instrument is inserted into the abdomen and the diseased appendix removed through a small hole.

¡ Now it seems so logical to remove the entire appendix when surgeons discover an acutely inflamed organ. But how doctors finally arrived at this conclusion is one of the most interesting chapters in the history of surgery.

¡ Claudius Amyand of St. George's hospital in London, England, removed the first appendix in 1736. But for the next 150 years confusion reigned about how to treat appendicitis. The great French surgeon, Dupuytren ridiculed the suggestion that the appendix was the source of infection. He declared it was impossible for such a small organ to produce such disastrous effects.

¡ Other surgeons disagreed with him. One surgeon in 1885, Henry Sands of New York, merely stitched up the hole in the perforated appendix! Another straightened out its kinks. If these patients survived it was the Almighty who saved them.

¡ Fortunately my Father survived, in part because penicillin had just become available.

¡ My best wishes to all for a happy and healthy holiday.


W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com

My book, �90 + How I Got There� can be obtained by sending $19.95 to:

Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1

Pre-2008 articles by Gifford Jones
Canada Free Press, CFP Editor Judi McLeod