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Background Appendicitis is defined as an inflammation of the inner lining of the vermiform appendix that spreads to its other parts.

This condition is a common and urgent surgical illness with protean manifestations, generous overlap with other clinical syndromes, and significant morbidity, which increases with diagnostic delay (see Clinical Presentation). In fact, despite diagnostic and therapeutic advancement in medicine, appendicitis remains a clinical emergency and is one of the more common causes of acute abdominal pain. No single sign, symptom, or diagnostic test accurately confirms the diagnosis of appendiceal inflammation in all cases, and the classic history of anorexia and periumbilical pain followed by nausea, right lower quadrant (RLQ) pain, and vomiting occurs in only 50% of cases (see Clinical Presentation). Appendicitis may occur for several reasons, such as an infection of the appendix, but the most important factor is the obstruction of the appendiceal lumen (see Pathogenesis and Etiology). Left untreated, appendicitis has the potential for severe complications, including perforation or sepsis, and may even cause death (see Prognosis and Complications). However, the differential diagnosis of appendicitis is often a clinical challenge because appendicitis can mimic several abdominal conditions (see Diagnostic Considerations and Differentials). [1] Appendectomy remains the only curative treatment of appendicitis (see Treatment and Management). The surgeon's goals are to evaluate a relatively small population of patients referred for suspected appendicitis and to minimize the negative appendectomy rate without increasing the incidence of perforation. The emergency department (ED) clinician must evaluate the larger group of patients who present to the ED with abdominal pain of all etiologies with the goal of approaching 100% sensitivity for the diagnosis in a time-, cost-, and consultation-efficient manner. Go to Pediatric Appendicitis for more information on this topic. Anatomy The appendix is a wormlike extension of the cecum and, for this reason, has been called the vermiform appendix. The average length of the appendix is 8-10 cm (ranging from 2-20 cm). The appendix appears during the fifth month of gestation, and several lymphoid follicles are scattered in its mucosa. Such follicles increase in number when individuals are aged 8-20 years. A normal appendix is seen below.

Normal appendix; barium enema radiographic examination. A complete contrast-filled appendix is observed (arrows), which effectively excludes the diagnosis of appendicitis. The appendix is contained within the visceral peritoneum that forms the serosa, and its exterior layer is longitudinal and derived from the taenia coli; the deeper, interior muscle layer is circular. Beneath these layers lies the submucosal layer, which contains lymphoepithelial tissue. The mucosa consists of columnar epithelium with few glandular elements and neuroendocrine argentaffin cells. Taenia coli converge on the posteromedial area of the cecum, which is the site of the appendiceal base. The appendix runs into a serosal sheet of the peritoneum called the mesoappendix, within which courses the

appendicular artery, which is derived from the ileocolic artery. Sometimes, an accessory appendicular artery (deriving from the posterior cecal artery) may be found. Appendiceal vasculature The vasculature of the appendix must be addressed to avoid intraoperative hemorrhages. The appendicular artery is contained within the mesenteric fold that arises from a peritoneal extension from the terminal ileum to the medial aspect of the cecum and appendix; it is a terminal branch of the ileocolic artery and runs adjacent to the appendicular wall. Venous drainage is via the ileocolic veins and the right colic vein into the portal vein; lymphatic drainage occurs via the ileocolic nodes along the course of the superior mesenteric artery to the celiac nodes and cisterna chyli. Appendiceal location The appendix has no fixed position. It originates 1.7-2.5 cm below the terminal ileum, either in a dorsomedial location (most common) from the cecal fundus, directly beside the ileal orifice, or as a funnel-shaped opening (2-3% of patients). The appendix has a retroperitoneal location in 65% of patients and may descend into the iliac fossa in 31%. In fact, many individuals may have an appendix located in the retroperitoneal space; in the pelvis; or behind the terminal ileum, cecum, ascending colon, or liver. Thus, the course of the appendix, the position of its tip, and the difference in appendiceal position considerably changes clinical findings, accounting for the nonspecific signs and symptoms of appendicitis. Congenital appendiceal disorders Appendiceal congenital disorders are extremely rare but occasionally reported (eg, agenesis, duplication, triplication). Pathophysiology Reportedly, appendicitis is caused by obstruction of the appendiceal lumen from a variety of causes (see Etiology). Independent of the etiology, obstruction is believed to cause an increase in pressure within the lumen. Such an increase is related to continuous secretion of fluids and mucus from the mucosa and the stagnation of this material. At the same time, intestinal bacteria within the appendix multiply, leading to the recruitment of white blood cells (see the image below) and the formation of pus and subsequent higher intraluminal pressure.

Technetium-99m radionuclide scan of the abdomen shows focal uptake of labeled WBCs in the right lower quadrant consistent with acute appendicitis. If appendiceal obstruction persists, intraluminal pressure rises ultimately above that of the appendiceal veins, leading to venous outflow obstruction. As a consequence, appendiceal wall ischemia begins, resulting in a loss of epithelial integrity and allowing bacterial invasion of the appendiceal wall.

Within a few hours, this localized condition may worsen because of thrombosis of the appendicular artery and veins, leading to perforation and gangrene of the appendix. As this process continues, a periappendicular abscess or peritonitis may occur. Etiology Appendicitis is caused by obstruction of the appendiceal lumen. The most common causes of luminal obstruction include lymphoid hyperplasia secondary to inflammatory bowel disease (IBD) or infections (more common during childhood and in young adults), fecal stasis and fecaliths (more common in elderly patients), parasites (especially in Eastern countries), or, more rarely, foreign bodies and neoplasms. Fecaliths form when calcium salts and fecal debris become layered around a nidus of inspissated fecal material located within the appendix. Lymphoid hyperplasia is associated with various inflammatory and infectious disorders including Crohn disease, gastroenteritis, amebiasis, respiratory infections, measles, and mononucleosis. Obstruction of the appendiceal lumen has less commonly been associated with bacteria (Yersinia species, adenovirus, cytomegalovirus, actinomycosis, Mycobacteria species, Histoplasma species), parasites (eg, Schistosomes species, pinworms, Strongyloides stercoralis), foreign material (eg, shotgun pellet, intrauterine device, tongue stud, activated charcoal), tuberculosis, and tumors. Epidemiology Appendicitis is one of the more common surgical emergencies, and it is one of the most common causes of abdominal pain. In the United States, 250,000 cases of appendicitis are reported annually, representing 1 million patient-days of admission. The incidence of acute appendicitis has been declining steadily since the late 1940s, and the current annual incidence is 10 cases per 100,000 population. Appendicitis occurs in 7% of the US population, with an incidence of 1.1 cases per 1000 people per year. Some familial predisposition exists. In Asian and African countries, the incidence of acute appendicitis is probably lower because of the dietary habits of the inhabitants of these geographic areas. The incidence of appendicitis is lower in cultures with a higher intake of dietary fiber. Dietary fiber is thought to decrease the viscosity of feces, decrease bowel transit time, and discourage formation of fecaliths, which predispose individuals to obstructions of the appendiceal lumen. In the last few years, a decrease in frequency of appendicitis in Western countries has been reported, which may be related to changes in dietary fiber intake. In fact, the higher incidence of appendicitis is believed to be related to poor fiber intake in such countries. There is a slight male preponderance of 3:2 in teenagers and young adults; in adults, the incidence of appendicitis is approximately 1.4 times greater in men than in women. The incidence of primary appendectomy is approximately equal in both sexes. The incidence of appendicitis gradually rises from birth, peaks in the late teen years, and gradually declines in the geriatric years. The mean age when appendicitis occurs in the pediatric population is 6-10 years. Lymphoid hyperplasia is observed more often among infants and adults and is responsible for the increased incidence of appendicitis in these age groups. Younger children have a higher rate of perforation, with reported rates of 5085%. The median age at appendectomy is 22 years. Although rare, neonatal and even prenatal appendicitis have been reported. Clinicians must maintain a high index of suspicion in all age groups. Go to Pediatric Appendicitis for more information on this topic.

Prognosis Acute appendicitis is the most common reason for emergency abdominal surgery. Appendectomy carries a complication rate of 4-15%, as well as associated costs and the discomfort of hospitalization and surgery. Therefore, the goal of the surgeon is to make an accurate diagnosis as early as possible. Delayed diagnosis and treatment account for much of the mortality and morbidity associated with appendicitis. The overall mortality rate of 0.2-0.8% is attributable to complications of the disease rather than to surgical intervention. The mortality rate in children ranges from 0.1% to 1%; in patients older than 70 years, the rate rises above 20%, primarily because of diagnostic and therapeutic delay. Appendiceal perforation is associated with increased morbidity and mortality compared with nonperforating appendicitis. The mortality risk of acute but not gangrenous appendicitis is less than 0.1%, but the risk rises to 0.6% in gangrenous appendicitis. The rate of perforation varies from 16% to 40%, with a higher frequency occurring in younger age groups (40-57%) and in patients older than 50 years (55-70%), in whom misdiagnosis and delayed diagnosis are common. Complications occur in 1-5% of patients with appendicitis, and postoperative wound infections account for almost one third of the associated morbidity. Patient Education For patient education information, see eMedicine's Esophagus, Stomach, and Intestine Center, as well as Appendicitis and Abdominal Pain in Adults

Appendicitis

Appendicitis is an inflammation of the appendix, a 3 1/2-inch-long tube of tissue that extends from the large intestine. No one is absolutely certain what the function of the appendix is. One thing we do know: We can live without it, without apparent consequences. Appendicitis is a medical emergency that requires prompt surgery to remove the appendix. Left untreated, an inflamed appendix will eventually burst, or perforate, spilling infectious materials into the abdominal cavity. This can lead to peritonitis, a serious inflammation of the abdominal cavity's lining (the peritoneum) that can be fatal unless it is treated quickly with strong antibiotics.

Sometimes a pus-filled abscess (infection that is walled off from the rest of the body) forms outside the inflamed appendix. Scar tissue then "walls off" the appendix from the rest of the abdomen, preventing infection from spreading. An abscessed appendix is a less urgent situation, but unfortunately, it can't be identified without surgery. For this reason, all cases of appendicitis are treated as emergencies, requiring surgery. In the U.S., 1 in 15 people will get appendicitis. Although it can strike at any age, appendicitis is rare under age 2 and most common between ages 10 and 30. What Causes Appendicitis? Appendicitis occurs when the appendix becomes blocked, often by stool, a foreign body, or cancer. Blockage may also occur from infection, since the appendix swells in response to any infection in the body. What Are the Symptoms of Appendicitis? The classic symptoms of appendicitis include: Dull pain near the navel or the upper abdomen that becomes sharp as it moves to the lower right abdomen. This is usually the first sign. Loss of appetite Nausea and/or vomiting soon after abdominal pain begins Abdominal swelling

Fever of 99 F to 102 F Inability to pass gas

Almost half the time, other symptoms of appendicitis appear, including: Dull or sharp pain anywhere in the upper or lower abdomen, back, or rectum Painful urination Vomiting that precedes the abdominal pain Severe cramps Constipation or diarrhea with gas

Call your doctor if: You have pain that matches these symptoms. Do not eat, drink, or use any pain remedies, antacids, laxatives, or heating pads, which can cause an inflamed appendix to rupture. If you have any of the mentioned symptoms seek medical attention immediately since timely diagnosis and treatment is very important.

If you have any of the mentioned symptoms, seek medical attention immediately since timely diagnosis and treatment is very important.

How Is Appendicitis Diagnosed? Diagnosing appendicitis can be tricky. Symptoms of appendicitis are frequently vague or extremely similar to other ailments, including gallbladder problems, bladder or urinary tract infection, Crohn's disease, gastritis, intestinal infection, and ovary problems. The following tests are usually used to make the diagnosis. Abdominal exam to detect inflammation Urine test to rule out a urinary tract infection Rectal exam Blood test to see if your body is fighting infection CT scans and/or ultrasound

How Is Appendicitis Treated? Surgery to remove the appendix, which is called an appendectomy, is the standard treatment for appendicitis. If appendicitis is even suspected, doctors tend to err on the side of safety and quickly remove the appendix to avoid its rupture. If the appendix has formed an abscess, you may have two procedures: one to drain the abscess of pus and fluid, and a later one to remove the appendix.

Antibiotics are given before an appendectomy to fight possible peritonitis. General anesthesia is usually given, and the appendix is removed through a 4-inch incision or by laparoscopy. If you have peritonitis, the abdomen is also irrigated and drained of pus. Within 12 hours of surgery you may get up and move around. You can usually return to normal activities in 2 to 3 weeks. If surgery is done with a laparoscope (a thin telescope-like instrument for viewing inside the abdomen), the incision is smaller and recovery is faster. After an appendectomy, call your doctor if you have: Uncontrolled vomiting. Increased pain in your abdomen. Dizziness/feelings of faintness. Blood in your vomit or urine. Increased pain and redness in your incision. Fever. Pus in the wound.

Can Appendicitis Be Prevented? There is no way to prevent appendicitis. However, appendicitis is less common in people who eat foods high in fiber, such as fresh fruits and vegetables. Reviewed by The Cleveland Clinic Department of Gastroenterology.

Apendisitis Akut Apendisitis Akut adalah inflamasi pada dari vermiform appendiks dan ini merupakan kasus operasi intraabdominal tersering yang memerlukan tindakan bedah.1 Penyebab pasti dari appendisitis belum diketahui pasti. Beberapa studi menyampaikan bahwa ada tendensi keturunan. Belakangan diketahui itu disebabkan oleh kesamaan kebiasaan makan, resistensi genetik dari flora bakteri. Kebiasaan makan rendah serat, tinggi gula dan lemak juga merupakan predisposisi terjadi buang air besar yang tidak banyak, waktu transit makanan di usus jauh lebih lama, dan peningkatan tekanan di dalam lumen usus. 2,3

Gambar 4. Perjalanan Penyakit Apendisitis4

Penegakkan Diagnosis Karakter klinis dari appendisitis dapat bervariasi, namun umumnya ditampikan dengan riwayat sakit perut yang samar-samar, dimana dirasakan pertama kali di ulu hati. Mungkin diikuti mual dan muntah, demam ringan. Nyeri biasanya berpindah dari fossa ilaka kanan setelah beberapa jam, sampai dengan 24 jam. Titik maksimal nyeri adalah pada sepertiga dari umblikus ke fossa ilaka kanan, itu disebut titik Mc Burney. Nyeri biasanya tajam dan diperburuk dengan gerakan (seperti batuk dan berjalan). Nyeri pada titik Mc Burney juga dirasakan pada penekanan iliaka kiri, yang biasa disebut tanda Rovsing. Posisi pasien dipengaruhi oleh posisi dari apendiks. Jika apendiks ditemukan di posisi retrosekal (terpapar antara sekum dan otot psoas) nyeri tidak terasa di titik Mc Burney, namun ditemukan lebih ke lateral pinggang. Jika apendiks terletak retrosekal nyeri jika ilaka kiri ditekan tidak terasa. Ketika apendiks dekat dengan otot psoas, pasien datang dengan pinggul tertekuk dan jika kita coba meluruskan maka akan terjadi nyeri pada lokasi apendiks ( tanda psoas). Ketika apendiks terletak retrosekal maka bisa menyebabkan iritasi pada ureter sehingga darah dan protein dapat ditemukan dalam urinalisis. Jika apendiks terletak di pelvis, maka tanda klinik sangat sedikit, sehingga harus dilakukan pemeriksaan rektal, menemukan nyeri dan bengkak pada kanan pemeriksaan. Jika apendiks terletak di dekat otot obturator internus, rotasi dari pinggang meningkatkan nyeri pada pasien ( tanda obturator). Hiperestesia kutaneus pada daerah yang dipersarafi oleh saraf spinal kanan T10,T11 dan T12 biasanya juga mengikuti kejadian appendisitis akut. Jika apendiks terletak di depan ileum terminal dekat dengan dinding abdominal, maka nyeri sangat jelas. Jika apendiks terletak di belakang ileum terminal maka diagnosa sangat sulit, tandatanda yang ada samar dan nyeri terletak tinggi di abdomen.5-6 Rovsings sign Psoas sign atau Obraztsovas sign Obturator sign Positif jika dilakukan palpasi dengan tekanan pada kuadran kiri bawah dan timbul nyeri pada sisi kanan. Pasien dibaringkan pada sisi kiri, kemudian dilakukan ekstensi dari panggul kanan. Positif jika timbul nyeri pada kanan bawah. Pada pasien dilakukan fleksi panggul dan dilakukan rotasi internal pada panggul. Positif jika timbul nyeri pada hipogastrium atau vagina.

Dunphys sign Ten Horn sign

Pertambahan nyeri pada tertis kanan bawah dengan batuk Nyeri yang timbul saat dilakukan traksi lembut pada korda spermatic kanan Kocher (Kosher)s sign Nyeri pada awalnya pada daerah epigastrium atau sekitar pusat, kemudian berpindah ke kuadran kanan bawah. Sitkovskiy (Rosenstein)s Nyeri yang semakin bertambah pada perut kuadran kanan sign bawah saat pasien dibaringkan pada sisi kiri Bartomier-Michelsons Nyeri yang semakin bertambah pada kuadran kanan bawah sign pada pasien dibaringkan pada sisi kiri dibandingkan dengan posisi terlentang Aure-Rozanovas sign Bertambahnya nyeri dengan jari pada petit triangle kanan (akan positif Shchetkin-Bloombergs sign) Blumberg sign Disebut juga dengan nyeri lepas. Palpasi pada kuadran kanan bawah kemudian dilepaskan tiba-tiba Tabel 1. Sign of Appendicitis6-7

Kemungkinan apendisitis dapat diyakinkan dengan menggunakan skor Alvarado. Sistem skor dibuat untuk meningkatkan cara mendiagnosis apendisitis.6 The Modified Alvarado Score Perpindahan nyeri dari ulu hati ke perut kanan bawah Mual-Muntah Anoreksia Tanda Nyeri di perut kanan bawah Nyeri lepas Demam diatas 37,5 C Pemeriksaan Leukositosis Lab Hitung jenis leukosit shift to the left Total Interpretasi dari Modified Alvarado Score: 1-4 : sangat mungkin bukan apendisitis akut 5-7 : sangat mungkin apendisitis akut 8-10 : pasti apendisitis akut Gejala Skor 1 1 1 2 1 1 2 1 10

Tabel 2. The Modified Alvarado score6 Pemeriksaan laboratorium didapati peningkatan sel darah putih. Pemeriksaan kehamilan harus di kerjakan pada pasien wanita untuk menyingkirkan kasus-kasus kebidanan. Pemeriksaan USG dikerjakan jika tanda-tanda klinik tidak jelas, pemeriksaan USG mempunyai sensitivitas 80% dan spesifitas 100%. 8

Tabel 3. Diagnosa banding pada Appendisitis5 Tatalaksana Appendisitis Tatalaksana apendisitis pada kebanyakan kasus adalah apendektomi. Keterlambatan dalam tatalaksana dapat meningkatkan kejadian perforasi. 9 Penggunaan ligasi ganda pada setelah appendektomi terbuka dilakukan dengan jahitan yang mudah diserap tubuh. Ligasi yang biasa dilakukan pada apendektomi adalah dengan purse string (z-stich atau tobacco sac) dan ligasi ganda. Pada keadaan normal, digunakan jahitan purse string. Ligasi ganda digunakan pada saat pembalikkan tunggul tidak dapat dicapai dengan aman, sehingga yang dilakukan adalah meligasi ganda tunggul dengan dua baris jahitan. Dengan peningkatan penggunaan laparoskopi dan peningkatan teknik laparoskopik, apendektomi laparoskopik menjadi lebih sering. Prosedur ini sudah terbukti menghasilkan nyeri pasca bedah yang lebih sedikit, pemulihan yang lebih cepat dan angka kejadian infeksi luka yang lebih rendah, akan tetapi terdapat peningkatan kejadian abses intra abdomen dan pemanjangan waktu operasi. Laparoskopi itu dikerjakan untuk diagnosa dan terapi pada pasien dengan akut abdomen, terutama pada wanita. Beberapa studi mengatakan bahwa laparoskopi meningkatkan kemampuan dokter bedah untuk operasi. 10

Insisi Grid Iron (McBurney Incision)11 Insisi Gridiron pada titik McBurney. Garis insisi parallel dengan otot oblikus eksternal, melewati titik McBurney yaitu 1/3 lateral garis yang menghubungkan spina liaka anterior superior kanan dan umbilikus.

Lanz transverse incision12 Insisi dilakukan pada 2 cm di bawah pusat, insisi transversal pada garis miklavikula-midinguinal. Mempunyai keuntungan kosmetik yang lebih baik dari pada insisi grid iron.

Rutherford Morissons incision (insisi suprainguinal)13 Merupakan insisi perluasan dari insisi McBurney. Dilakukan jika apendiks terletak di parasekal atau retrosekal dan terfiksir.

Low Midline Incision13 Dilakukan jika apendisitis sudah terjadi perforasi dan terjadi peritonitis umum.

Insisi paramedian kanan bawah13 Insisi vertikal paralel dengan midline, 2,5 cm di bawah umbilikus sampai di atas pubis.

Tabel 4. Macam-macam Insisi untuk apendektomi PEMBAHASAN Pasien dengan keluhan nyeri perut kanan bawah pada laki-laki mempunyai diagnosis banding apendisitis, kolik saluran kemih, kelainan pada saluran pencernaan seperti divertikulitis, ileokolitis, typhoid, serta keganasan. Demam pada pasien ini didahului oleh nyeri sehingga kemungkinan typhoid dapat disingkirkan. Gejala buang air kecil dan besar tidak ada kelainan maka kolik saluran kemih, divertikulitis, ileokolitis, maupun keganasan dapat disingkirkan. Pada pemeriksaan fisik didapatkan defans muskular pada region abdomen kanan bawah, dengan tanda psoas dan rovsing yang positif, maka kemungkinan letak apendiks di daerah retrosekal. Nilai Modified Alvarado Scoring System adalah 9 dari 10 sehingga pasien pasti didiagnosis apendisitis dan dilakukan apendektomi. Diagnosis kerja pada pasien adalah apendisitis kronis eksaserbasi akut melihat adanya riwayat nyeri perut kanan bawah sejak dua tahun yang lalu. Pada saat operasi ditemukan apendiks yang terletak retrosekal retroperitoneal sesuai dengan tanda yang didapatkan pada pemeriksaan fisik. Didapatkan pula appendiks yang gangrenosa sehingga diagnosis post operasi adalah apendisitis gangrenosa. Apendisitis gangrenosa merupakan stadium akhir dari apendisitis dimana terjadi nekrosis jaringan akibat adanya gangguan aliran darah pada apendiks sehingga dapat terjadi perforasi. Terapi antibiotic spektrum luas pada apendisitis sederhana dan supuratif hanya dilakukan profilaksis preoperatif. GLOSSARY Appendektomi (atau apendisektomi)14 : Operasi pengangkatan usus buntu Apendiks 15 : Usus buntu, umbai cacing, kantong berbentuk cacing yang melekat pada sekum, awal dari usus besar. Peritonitis16 : Radang pada peritoneum, selaput lapisan dinding perut dan panggul. DAFTAR PUSTAKA Williams B A, Schizas A M P, Management of Complex Appendicitis. Elsevier. 2010. Surgery 28:11. p544048. Andersson N, Griffiths H, Murphy J, et al. Is appendicitis familial? Br Med J 1979 Sep 22; 2: 697e8. Heaton KW. In: Br Med J, Res Clin, eds. Aetiology of acute appendicitis 1987 Jun 27; 294:1632e3. Bewes P. Appendicitis. [Internet] April 2003. [cited April 2011] E-Talc Issue 3. Available from: http://web.squ.edu.om/med-Lib/MED_CD/E_CDs/health %2520development/html/clients/beweshtml/bewes_01.htm Soybel D. Appendix. In: Norton JA, Barie PS, Bollinger RR, et al. Surgery Basic Science and Clinical Evidence. 2nd Ed. New York: Springer. 2008. Brunicardi FC, Andersen DK, Billiar TR, et al. Shwartzs Principles of Surgery. 9th Ed. USA: McGrawHill Companies. 2010. Appendicitis [Internet] [updated September 2010; cited April 2011]. Available from: http://en.wikipedia.org/wiki/Appendicitis Puylaert JB, Rutgers PH, Lalisang RI, et al. A prospective study ofultrasonography in the diagnosis of appendicitis. N Engl J Med 1987 Sep 10; 317: 666e9.

1. 2. 3. 4.

5. 6. 7. 8.

9. 10. 11. 12. 13. 14. 15. 16.

Temple CL, Huchcroft SA, Temple WJ. The natural history of appendicitis in adults. A prospective study. Ann Surg 1995 Mar; 221: 278-81. Birnbaum BA, Wilson SR. Appendicitis at the millennium. Radiology 2000 May; 215: 337e48. Skandalakis JE, Colborn GL, Weidman TA, et al. Editors. Skandalakis Surgical Anatomy. USA: McGrawHill. 2004. Russell RCG, Williams NS, Bulstrode CJK. Editors. Bailey and Loves Short Practice of Surgery. 24 th Ed. London: Arnold. 2004. Patnalk VG, Singla RK, Bansal VK. Surgical Incisions-Their Anatomical Basis. J Anat. Soc. India 50(2) 170178 (2001) Appendectomy. [Internet] [cited April 2011] Available from: http://en.wikipedia.org/wiki/Appendectomy Vermiform Appendix. [Internet] [cited April 2011] Available from: http://en.wikipedia.org/wiki/vermiform_appendix Peritonitis. [Internet] [cited April 2011] Available from: http://en.wikipedia.org/wiki/peritonitis

Apendisitis (radang usus buntu) adalah peradangan pada apendiks vermiformis (umbai cacing/ usus buntu). Umumnya apendisitis disebabkan oleh infeksi bakteri, namun faktor pencetusnya ada beberapa kemungkinan yang sampai sekarang belum dapat diketahui secara pasti. Di antaranya faktor penyumbatan (obstruksi) pada lapisan saluran (lumen) apendiks oleh timbunan tinja/feces yang keras (fekalit), hiperplasia (pembesaran) jaringan limfoid, penyakit cacing, parasit, benda asing dalam tubuh, kanker dan pelisutan. Faktor kebiasaan makan makanan rendah serat dan konstipasi /susah buang air besar (BAB) menunjukkan peran terhadap timbulnya apendisitis. Konstipasi akan meningkatkan tekanan lumen usus yang berakibat sumbatan fungsional apendiks dan meningkatnya pertumbuhan flora normal usus. Tipe apendisitis: 1. Apendisitis akut (mendadak). Gejala apendisitis akut adalah demam, mual-muntah, penurunan nafsu makan, nyeri sekitar pusar yang kemudian terlokalisasi di perut kanan bawah, nyeri bertambah untuk berjalan, namun tidak semua orang akan menunjukkan gejala seperti ini, bisa juga hanya bersifat meriang, atau mual-muntah saja. 2. Apendisitis kronik. Gejala apendisitis kronis sedikit mirip dengan sakit asam lambung dimana terjadi nyeri samar (tumpul) di daerah sekitar pusar dan terkadang demam yang hilang timbul. Seringkali disertai dengan rasa mual, bahkan kadang muntah, kemudian nyeri itu akan berpindah ke perut kanan bawah dengan tanda-tanda yang khas pada apendisitis akut. Penyebaran rasa nyeri akan bergantung pada arah posisi/letak apendiks itu sendiri terhadap usus besar, Apabila ujung apendiks menyentuh saluran kemih, nyerinya akan sama dengan sensasi nyeri kolik saluran kemih, dan mungkin ada gangguan berkemih. Bila posisi apendiks ke belakang, rasa nyeri muncul pada pemeriksaan tusuk dubur atau tusuk vagina. Pada posisi usus buntu yang lain, rasa nyeri mungkin tidak spesifik. Perjalanan penyakit apendisitis:

Apendisitis akut fokal (peradangan lokal)

Apendisitis supuratif (pembentukan nanah) Apendisitis Gangrenosa (kematian jaringan apendiks) Perforasi (bocornya dinding apendiks ) Peritonitis (peradangan lapisan rongga perut); sangat berbahaya, dan mengancam jiwa Ada beberapa pemeriksaan yang dapat dilakukan oleh Tim Kesehatan untuk menentukan dan mendiagnosis adanya Apendisitis, diantaranya adalah pemeriksaan fisik, pemeriksaan laboratorium dan pemeriksaan radiologi : 1. Pemeriksaan fisik. Pada apendisitis akut, dengan pengamatan akan tampak adanya pembengkakan (swelling) rongga perut dimana dinding perut tampak mengencang (distensi). Pada perabaan (palpasi) didaerah perut kanan bawah, seringkali bila ditekan akan terasa nyeri dan bila tekanan dilepas juga akan terasa nyeri (Blumberg sign) Dengan tindakan tungkai kanan dan paha ditekuk kuat / tungkai di angkat tinggi-tinggi, maka rasa nyeri di perut semakin parah. Kecurigaan adanya peradangan apendiks semakin bertambah bila pemeriksaan dubur dan atau vagina menimbulkan rasa nyeri juga. Suhu dubur yang lebih tinggi dari suhu ketiak, lebih menunjang lagi adanya radang usus buntu. 2. Pemeriksaan Laboratorium. Pada pemeriksaan laboratorium darah, yang dapat ditemukan adalah kenaikan dari sel darah putih (leukosit) . 3. Pemeriksaan radiologi. Foto polos perut dapat memperlihatkan adanya fekalit. Namun pemeriksaan ini jarang membantu dalam menegakkan diagnosis apendisitis. Ultrasonografi (USG) cukup membantu dalam penegakkan diagnosis apendisitis (71 ?97 %), terutama untuk wanita hamil dan anak-anak. Tingkat keakuratan yang paling tinggi adalah dengan pemeriksaan CT scan (93-98 %). Dengan CT scan dapat terlihat jelas gambaran apendiks. Bila diagnosis sudah pasti, maka penatalaksanaan standar untuk penyakit apendisitis (radang usus buntu)adalah operasi. Pada kondisi dini apabila sudah dapat langsung terdiagnosis kemungkinan pemberian antibiotika dapat saja dilakukan, namun demikian tingkat kekambuhannya mencapai 35%. Pembedahan dapat dilakukan secara terbuka atau semi-tertutup (laparoskopi). Setelah dilakukan pembedahan, harus diberikan antibiotika selama 7 -10 hari. Selanjutnya adalah perawatan luka operasi yang harus terhindar dari kemungkinan infeksi sekunder dari alat yang terkontaminasi dll. Kamus Nyeri Kolik : Nyeri perut akut, khas ditandai dengan nyeri organ dalam tidak terus menerus dengan fluktuasi sesuai gerakan otot polos. Biasanya khas nyeri pada organ berongga/ mempunyai saluran. Referensi

Ferri FF. Appendicitis Acute. In: Ferri FF. Ferri's Clinical Advisor 2009: Instant Diagnosis and Treatment. Philadelphia, Pa.: Mosby Elsevier; 2009. http://www.mdconsult.com/das/book/body/1470024272/0/1701/0.html. Accessed July 1, 2009.

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