Introduction

INTRODUCTION

The importance of the vermiform appendix in surgery arises primarily from its propensity for inflammation, which results in the clinical syndrome known as acute appendicitis. Acute appendicitis is the most common cause of an ‘acute abdomen’ in young adults and, as such, the associated symptoms and signs have become a paradigm for clinical teaching. Appen dicitis is su ffi ciently common that appendicectomy (termed appendectomy in North America) is the most frequently performed urgent abdominal operation and is often the first major procedure perfor med by a surgeon in training. Advances in modern radiographic imaging have improved diagnostic accuracy; however, the diagnosis of appendicitis remains essentially clinical, requiring a mixture of observation, clinical acumen and surgical science and as such it remains an enigmatic challenge and a reminder of the art of surgical A wombat is a nocturnal, burrowing Australian marsupial. Robert E Condon , 1929–2015, Emeritus Professor of Surgery , Medical College of Wisconsin, WI, USA. diagnosis. Although much more uncommon, the appendix also has a propensity to the formation of tumours, which, despite humble and innocuous beginnings, may disseminate widely with dramatic clinical consequences. Aside from its tendency to cause surgical pathology , the appendix, long thought to be a vestigial organ, may also have important roles in both immune function and maintaining - the gut microbiota. The putative role of the appendix in the pathogenesis of ulcerativ e colitis (appendicectomy seems to be protective), for example, may be explained by its interaction with the intestinal flora and gut immune function.

Preileal 1% Retrocaecal 74% Postileal 0.5% Pa racaecal 2% Pe lvic 21% Subcaecal 1.5% Figure 76.1 The various positions of the appendix (after Sir C Wakeley, London). Evolving concepts in the management of acute • appendicitis Basic surgical techniques, both open and laparoscopic • The management of postoperative problems • Tumours of the appendix and pseudomyxoma peritonei •