Two cups of fever grass tea, one cup each of ginger, green, regular Lipton and a cup of peppermint tea — Jameel Lightbourne consumed all of it in the course of a day, as he sought relief from a “bloated, gassy” feeling. As the day progressed, he was not relieved, and the pain got progressively worse, going from a feeling of pressure, to excruciating pain that forced him to seek medical attention in the middle of the night. Lightbourne had to have emergency surgery on Independence morning. His appendix had ruptured.

Appendicitis is an inflammation of the appendix, a finger-shaped pouch that projects from the colon on the lower right side of the abdomen. The appendix doesn’t seem to have a specific purpose. Although anyone can develop appendicitis, most often it occurs in people between the ages of 10 and 30. Standard treatment is surgical removal of the appendix.

Appendicitis diagnosis is very common, according to General Surgeon Dr. Ross Downes.

“Typically in one month, if 100 people present, 80 percent of those people that present with abdominal pain, would either have appendicitis or something going on with their gall bladder,” said the surgeon who practices out of Centreville Medical Center at #68 Collins Avenue in the surgical suite. “It’s one of the most common surgeries that is performed by a general surgeon, and certainly one of the most common surgeries that I do.”

According to Downes, the common story is that patients don’t go to hospital when they initially feel the pain because, like Lightbourne, they think they are having gas pains.

Patients usually start having the pains around the belly button and then they realize they’ve having pain in the lower quadrant of the abdomen, which is known as the classic way for patients to present. The doctor said when patients have that kind of pain pattern, the diagnosis is usually appendicitis, until proven otherwise.

“Overwhelmingly, the majority of appendicitis [incidents] that present are usually [found in] patients with simple appendicitis — it’s inflamed, not ruptured. There is no gross infection, so by the time they present, we’re able to take out that appendix and send them home in one day.”

In about 20 percent of the people, there is a ruptured appendix, and by the time they get to the hospital, the appendix is rotten, gangrenous, ruptured and there is some form of abscess. Lightbourne, who was operated on by Downes was in that 20 percent.

“The good news to those patients is the abscess is usually localized to the right lower quadrant. The body normally does a very good job of walling it off and keeping it down into one spot so the rest of the belly is pretty OK. And for that reason, a lot of patients would have the pain, they would feel sick and ill, but the rest of the belly relatively is OK, so they continue to eat, they continue to think it’s gas until they have other symptoms like fever, they’re vomiting excessively or feel weak or something along those lines,” he said.

Single port laparoscopy

Lightbourne’s appendix was removed through a minimally invasive technique — a single cut at the base of his belly button in a single port laparoscopy. The technique allows for the patient to avoid having the multiple small incisions that are done with traditional surgery. They have less pain and recover faster. Their bowel functions return faster, so they’re able to eat and have normal diets sooner. In about a week after the single port laparoscopy, about 50 percent of patients want to go back to work and have resumed their normal activities, according to the doctor.

Traditional open appendectomy requires the doctor to make an approximate three-inch incision in the lower right section of the abdomen. In laparoscopic appendectomy, four incisions, each about one inch in length are made on the abdomen. In single port laparoscopy one tiny cut is made in the base of the belly button. Through that one tiny incision, the surgery is performed.

Downes has been doing the single port laparoscopy surgery for the past two years.

In a research article published in KEI Journals, a hybrid open-access journal for the field of medicine and related subspecialties, a contribution by Downes concludes that single-port laparoscopic appendectomy (SILA) is a safe and feasible procedure. His preliminary analysis showed that 30 cases were sufficient to achieve an equivalent operative duration compared with conventional three-port laparoscopic appendectomy.

His results showed that demographics were similar between the single-port and three-port groups. In the SILA series, operative duration was unchanged after the first 10 cases. An operative duration less than that of the conventional three-port method could be achieved after 30 cases.

The aim of Dr. Downe’s study was to examine the inauguration of single-port laparoscopic appendectomy for uncomplicated appendicitis and demonstrate its efficacy and safety.

His study was done on 32 patients who underwent single-port laparoscopic appendectomies between January 2014 and December 2014. Their results were compared retrospectively with 20 prior consecutive patients who underwent surgery in the three-port manner. Length of hospital stay, operative time, conversion rate and complications were used as the indicators of effective implementation.

“Single port laparoscopy is the wave of the future,” said Downes. “You have better cosmesis. There are no scars on your belly, because we hide that scar in the base of your belly button so you can keep your bikini body. You’re faster on your feet — faster recovery, faster return of your bowel function. After they’ve healed, most patients even forget they’ve had a surgery, so I have to give them the pathology report for them to remember that their appendix was taken out at some point in time,” he said.

Symptoms

Pain characteristics can give you all the answers as to whether your appendix is inflamed, says the doctor.

“Usually when you have appendicitis, it’s not a sudden pain. It’s a gradual pain that over 24 hours doesn’t go away. And it gets gradually worse and worse and worse. The traditional way for appendicitis to present is that the patient will first complain of a pain in the periumbilical area and that pain migrates and goes into the right lower quadrant, and it’s usually a crampy-type dull pain at first, then becomes a sticking, sharp, localized pain by the time it’s gone to the right lower quadrant.”

The mortality rate for appendicitis is quite low at around one percent according to Dr. Downes. He reminded that the problem with appendicitis is that it may range from a simple appendicitis to a ruptured appendix with gangrene.

“Even if you have a good surgery and we’re able to wash all the puss out, what happens is that a small

percentage of those patients continue to have small pockets of puss in the belly. The problem with puss in your belly, and even if it’s washed out completely, is that your bowels don’t work well, you’re quite distended, you can’t eat properly, you vomit, and it takes about three or four days before your bowel function returns and before you can eat again and go home.”

In the worst-case appendicitis scenario, he said sometimes patients aren’t able to ward off the puss, and they get peritonitis, which is puss throughout the entire belly. This condition can make patients very sick, causing them to be admitted to the intensive care unit. Some of them may end up dying.

Keeping your appendix healthy

The general surgeon says appendicitis usually results from one or two conditions — a small piece of stool that becomes hardened and gets stuck in the base of the appendix. When that “pebbled stool” gets stuck, it cuts off the blood supply and the appendix becomes inflamed.

The abdomen is the location of a significant amount of lymphatic tissue — tissue that fights off infections, particularly viruses. When some people pick up viruses, they have an abnormal reaction to it and the lymphatic tissue becomes inflamed and engorged and can block off the base of the appendix and give the person a similar appendicitis. If that persists, then a person can have infection, eruption and rotting of the appendix.

To try to ensure that you keep your appendix healthy, Downes says properly chewing hard food, like nuts, is essential, because food particles can form a center for stool to collect on. He also encouraged the consumption of vegetables to keep the roughage content high in the intestines to allow feces to pass without becoming hard.

Your immune health is important to appendix health as well.

“If you have good immune health when these viruses and stuff come along that can cause all the inflammation to happen in the belly, your body is able to fight it off quite easily without having to have such a drastic inflammatory response to take care of it. So really, keeping your immunity up to scratch is one of the things that you have to do,” said Downes.

While Lightbourne said he never in his wildest dreams thought the pain he endured was an inflamed appendix, he says he’s happy the inflammation occurred while he was at home, as the weekend prior he had been on a Family Island with his family.

“If that [eruption] had happened while I was on the Family Island only God knows what would have happened,” said Lightbourne.