Ultrasound Video showing the technique to localize the Inflamed Appendix.

This video shows the technique to localize the Inflamed Appendix.
The Appendix is a small, pouch-like sac of tissue that is located in the first part of the colon (cecum) in the lower- right abdomen. Lymphatic tissue in the appendix aids in immune function. The official name of the appendix is a vermiform appendix, which means "worm-like appendage." The appendix harbors bacteria.
Appendicitis is a condition in which the appendix becomes inflamed, swollen, or infected, causing pain in the lower right side of the lower abdomen.
This video shows the localization of the inflamed Appendix. A small amount of free fluid is also seen in the lower abdomen in this case.
This is a case where the patient is experiencing pain in Rt. iliac fossa. When acute appendicitis is suspected, scan the patient lying supine. I selected a high power ( from 07 to 11 MHz ) transducer. You may put a pillow under both knees to have the abdomen of the patient relaxed. You will search a blind-ending tubular structure arising from the caecum. First of all, we will identify the ascending colon. Then one has to scan inferiorly to localize the caecum, and then one can see the Appendix. The colon will have the haustra which will differentiate it from a small bowl. You can see the haustra in the long-axis view. Now you will scan caudally to reach the inferior end of the caecum. Now you have to sweep the probe to do the examination in the transverse plane or axial plane (also called the horizontal plane or transaxial plane). The position of the appendix is variable from patient to patient so you will have to look around the caecum to localize the Appendix. The localization of Psoas muscle is also important as the appendix is often seen overlying it. You will start by applying the gentle pressure, then apply firmer pressure to displace the bowel to avoid bowel gases. As the bowl loops are inflamed, they are fixed without peristaltic movements. Most often tenderness will help you to localize the appendix. The appendix is seen as on cross-sectional scan as a concentric circle. You can see that the inner lumen is hypoechogenic with hyperechogenic edema surrounding it. Now if you start the scan in the long axis, the appendix will appear in a tube-like structure with the same pattern.
It is not easy to localize the appendix but once you practice it, it looks much easier. Practice makes a man perfect you know
An ultrasound is a painless procedure that uses sound waves to provide images to identify organs within the body. Ultrasound can identify an enlarged appendix or an abscess. Nevertheless, during appendicitis, an enlarged inflamed appendix or abscess can be seen in only 50% of patients.
Applying compression during scanning improves the image quality by reducing the distance between the probe and the bowl.
By using the high-frequency probe i.e. High power linear probe, You can see a tubular structure in the Rt. Iliac fossa surrounded by a hypoechoic rim. This is a transverse view. Now you can see a small amount of fluid is surrounding this tubular structure. Now by sweeping the probe I can see a longitudinal view of this tubular structure. The Bowel wall is thin. Both ends of this tubular structure are blunt. By applying some pressure with the probe you can see this structure is not compressible. It does not collapse. A significant mucus and debris is seen in its interior but no Fecolith is seen in this case. You may find faecolith in some other cases. This area is extremely tender with patients experiencing intense pain.
A study in the Journal of the American College of Surgeons found the risk of rupture was less than 2 percent when appendicitis was treated within 36 hours of the start of symptoms. It increased to 5 percent when it was treated 36 hours or more after the start of symptoms.

What causes a rupture? The exact cause is unknown for sure, but it is thought it’s probably due to an infection that triggers inflammation inside Appendix.
Classical symptoms of appendicitis include:-
-Fever
-Nausea and vomiting
-Abdominal pain that may start in the upper or middle abdomen but usually settles in the lower abdomen on the right side
-Abdominal pain that increases with walking, standing, jumping, coughing, or sneezing
-Decreased appetite
-Constipation or diarrhea
-Inability to pass gas
-Bloated or swollen abdomen
-Abdominal tenderness when you push on it that may worsen when you quickly stop pressing on it.
The haustra (singular haustrum) of the colon are the small pouches caused by sacculation (sac formation), which give the colon its segmented appearance. The teniae coli runs the length of the colon. Haustral contractions are slow segmenting, uncoordinated movements that occur approximately every 25 minutes.