Appendicitis is the most common abdominal surgical emergency. Yet when it strikes at a mature age, it always surprises. This is the mishap that has just happened to singer and former tennis player Yannick Noah.
Lying on his medical bed, the French sports icon shared this moment with a grimace and disconcerted emojis. What is appendicitis? Why is increased vigilance necessary after middle age? Dr Samy Chaibi, digestive and obesity surgeon, head of department at the Groupe Hospitalier Public du Sud de l’Oise (GHPSO), deciphers the subject for True Medical.
What is appendicitis and what are its typical symptoms?
Appendicitis is the inflammation of the vermicular appendix, a small “glove-finger” structure measuring 6 to 20 cm in adults, attached to the right colon. “Usually the appendix is ventilated, which is why it does not tend to become inflamed. When it is blocked by different mechanisms, it will have a tendency to become infected and therefore inflamed. begins our expert. Over a lifetime, the risk of developing acute appendicitis is 8%.
Dr Chaibi distinguishes two main clinical pictures:
- Catarrhal appendicitis (uncomplicated). It evolves quietly over 2 to 3 days. The pain is initially periumbilical (around the navel) then described as “migratory” because it moves towards the right iliac fossa (lower right of the abdomen). Vomiting and a slight fever may occur, but this is not systematic;
- The aggressive form (called ischemic or necrotic): More brutal and noisy, the pain immediately sets in on the right and is intense. The presence of fever almost systematically indicates a picture of abscess, perforation or peritonitis, requiring immediate treatment.
Faced with such pain, self-medication should be avoided, particularly anti-inflammatories.
“Anti-inflammatories are typically the drug class that aggravates any digestive condition. Apart from painful periods, self-medication with anti-inflammatory should really be banned“insists the surgeon.
In addition, don’t waste time waiting for an appointment with your doctor: in the event of an acute attack, go directly to the emergency room to avoid complications.
Why does appendicitis after age 50 require further examinations?
Although appendicitis mainly affects children and young adults, it can occur at any time in life. However, in patients over 50, like Yannick Noah, surgeons are extra vigilant.
“Appendicitis after age 50 challenges us, as surgeons. The peculiarity of age is to ask yourself: isn’t there cancer of the right colon underneath?” explains the specialist.
It is not a question of panicking, but of applying an essential precautionary principle. This is why, between 1 and 2 months after the procedure, a control colonoscopy is systematically scheduled remotely. It ensures the absence of underlying lesions (polyps or tumors) in the right colon. The examination is never performed immediately after surgery to allow time for the internal sutures to heal completely.
© Instagram Yannick Noah
What is the standard treatment and how is the operation carried out?
In France, surgical treatment — appendectomy — remains the “gold standard” (the absolute reference). Unlike certain countries which sometimes try purely medical treatment with antibiotics (generally Augmentin), surgery offers two major advantages:
- It prevents recurrences (which occur in 25% of cases after medical treatment, often in the complicated form of abscesses);
- And allows an anatomopathological analysis of the part.
In 1 to 2% of cases (and up to 10% in complicated forms), this analysis makes it possible to diagnose cancer of the appendix that has been ignored.
The operation, for its part, is almost always carried out laparoscopically via three small plastic tunnels called trocars.
- The surgeon identifies the vessel that nourishes the appendix and electrocoagulates it;
- It isolates the base of the appendix, surrounds it and strangulates it using a specific thread (a lasso called endoloop);
- The severed appendix is placed in a small waterproof bag (endobag) to be removed from the stomach without contaminating the wall;
- If pus is present (peritonitis), the surgeon’s first reflex is to aspirate the fluid and take a bacteriological sample before removing the organ.
Aftermath of surgery: what should you expect during convalescence?
The speed of recovery depends on the severity of the attack.
“Today, uncomplicated acute appendicitis can be perfectly managed on an outpatient basis: the patient can be operated on in the early afternoon and return home the same evening around 10 p.m., provided they are accompanied home for the first night.” assures our expert.
In other cases, hospitalization generally lasts 2 to 3 days.
Concerning the resumption of activities, a work stoppage of 15 days is prescribed on average (up to 3 weeks in the event of forceful work involving the carrying of heavy loads). Sports activities can be resumed after a period of one month, following the control consultation.
Complications remain rare but must be monitored. The main risk is post-operative abscess (around 5% of cases). In this case, you must consult the surgical department directly again. The rarest complication (less than 1%) is stump fistula (the remainder of the cut appendix which reopens), which then requires more extensive reoperation.