During appendectomy if it is noticed that base of appendix is inflamed then further line of treatment is

The following steps are usually followed in appendectomy The base of the appendix is crushed with an artery forceps (No longer recommended). The base is then ligated with an absorbable suture. Distal to the ligature the appendix is divided. A purse string suture is applied in the cecal wall around the base of the appendix. The purse string suture is tightened and the appendix stump is invaginated into the cecum. (This step has also lost its popularity and there are surgeons who are in favour of simple ligation and amputation only). Methods adopted in special circumstances When the cecal wall is edematous & inflamed → purse string suture is not applied and the stump is not invaginated. When the base of the appendix is inflamed → the base is not crushed for the fear of the spread of infection by way of lymphatics and bloodstream. It is ligated close to the cecum, after which the appendix is amputated and the stump invaginated. If the base is gangrenous →it is neither crushed nor ligated. Two stitches are placed through the cecal wall close to the base of the appendix, which is amputated flush with the cecal wall after which these stitches are tied. Further closure is effected by means of the second layer of interrupted sutures.