Stage of Disease 3 (Appendicitis)

Figure abdo_4a_n.jpg and abdo_4b_n.jpg: Operative findings and incised appendix in a 13.10-year-old boy. abdo_4a_n.jpg: Advanced ileocecum. Visible is a deep red, finger-like structure of 6 to 7 cm length with a diameter of 3 to 4 cm; on the left side there is a black zone with a yellow coat. abdo_4b_n.jpg: Incised appendix of the same patient. In the region of the already mentioned black zone a probe can be pushed to the outside through a wall defect. Proximal to the defect a calculus appearing like a cherry stone can be seen. abdo_4a_n.jpg and abdo_4b_n.jpg: The diagnosis is a perforated appendicitis. Following the inflammatory process a necrosis of the appendical wall has occurred (black zone in abdo_4a_n.jpg and course of the probe in abdo_4b_n.jpg). Alvine calculi which form around a small and not-absorbable foreign body play an important role in the pathogenesis of appendicitis; they hinder the drainage of the distally situated appendix ($$abdo_6??££alternate figure§§ ). Because they may be x-ray positive they can be recognized on abdominal x-ray performed in 'surgical abdomen' and are an indication of a complicated appendicitis as cause of the abdominal emergency.