UPDATED TOPICS IN MINIMALLY INVASIVE ABDOMINAL SURGERY

Appendicitis and Appendicectomy
It is suggestive that there is irritation at the peritoneum where it comes into contact with the
appendix. Rovsing’s sign can be demonstrated by palpating the left iliac area which results
in stretching of the underlying peritoneum. This induces pain in the right iliac fossa due to
irritation of the inflamed peritoneum. Digital rectal examination can elicit tenderness on the
ipsilateral side to the appendix.
Fig. 1. Diagramatic illustration of McBurneys point (1) with regards to the umbilicus (2) and
the anterior superior iliac spine (3).
Fig. 2. Various positions of the vermiform appendix.
In females of child bearing age it is important to consider the possibility of pregnancy
particularly if the patient was sexually active. An ectopic pregnancy should be considered in
the potential differential diagnosis which can often present with pain in the lower
quadrants. The pain associated with ectopic pregnancies often radiates to the shoulder. A
history of the patient’s menstrual cycle and sexual activity and contraception can help in
elimination of this differential. It is important to assess beta HCG levels on admission as this
would determine further management. Ultasonography and CT scanning are the best noninvasive
means of investigating appendicitis. The scan may show an abnormal appendix or
an appendicolith with a diameter of over 6mm. The blood results will often have a rise in
the inflammatory markers including white cell count and C-Reactive protein (CRP).
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