During appendicectomy it was found that base of appendix is inflamed then further line of treatment is:
A. No appendicectomy
B. Crushing of appendicular base is avoided. C. Hemicolectomy
D. Caecal resection
Ans.
is B. Crushing of appendicular base is avoided.
i.e. No burying of stump
‘When base of appendix is inflammed it
should not be crushed but ligated close to the caecal wall’
Steps of appendicectomy
• Incision is made
• Caecum is identified by presence of
taeniae coli
• Appendix is felt, inflammatory
adhesion are broken gently
• Appendix is held by Babcock or Lanes
forceps, base of mesoappendix is clamped, divided and ligated.
• Appendix is now free, base of
appendix is crushed and ligated
• Distal to the ligature appendix is
divided
• A purse string suture is applied in
the caecal wall around base of appendix.
Special situations
Caecal wall is edematous - Purse string
suture is not applied or is applied at a greater distance from base of appendix
- Stump is not invaginated
*Base
is inflamed - It should not be crushed, rather
ligated close to the caecum after which appendix is amputated and base is
invaginated
*Base
is gangrenous - It is neither crushed nor ligated
- Two stitches are placed through
caecal wall close to the base of appendix, which is amputated with a portion of
caecal wall. The sutures are then tied Le. removal from base to tip.
Appendix is retrocaecal - Retrograde
appendicectomy i.e. removal from base to tip.
is performed when appendix is retrocaecal and adherent
