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You're three days into into a backpacking trip in Denali National Park when you notice dull, low abdominal pain that gradually localizes to the right side of the belt line. The tenderness slowly worsens over about eight hours, aggravated by every bump or movement.  Congratulations -- you need emergency surgery!  You have turned out to be one of the 7% of people who will develop appendicitis -- caused by inflammation of a 3-inch worm-like projection located at the beginning of your large bowel.

Bad as your situation is, be grateful you were born after 1900.  Prior to that, most patients with appendicitis could look forward to rupture of the appendix, peritonitis, abscess formation, and eventual agonizing death.  Following the invention of general anesthetic, surgeons routinely operated on all right lower quadrant pain, and a 60% correct diagnosis was considered pretty good.  Today, the CT scanner seldom misses a hot appendix -- although because they are ordered for every twinge of pain that prompts an emergency room visit, only one out of 20 scans may be positive.  Since about 100 million CT-scans are preformed annually in the US, some estimate an estimated 35,000 additional cases of cancer might result from this radiation exposure.

The introduction of the laparoscope in the 1980's allowed surgeons to easily remove the appendix through a pipe stuck through your abdominal wall in a procedure that is euphemistically referred to as "band-aid surgery."  However, if you have had prior abdominal surgery, or have a retrocecal appendix you may be eligible for the older abdomen-splitting procedure.

Fortunately, even patients in the Denali Alaskan wilderness are likely to have a good outcome since appendectomies are routinely performed in almost every hospital in the world as the most common emergency surgery.  Nowadays, the only people likely to suffer from untreated appendicitis are devout Christian Scientists, patients who are hopelessly afraid of doctors, and die-hard independents who prefer self-diagnosis by reading web pages like this one.  And, of course -- physicians, most of whom would rather die than consult a doctor themselves.

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