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Abstract: A 14-year-old girl, Lele, presented with pain in the right lower abdomen with paroxysmal colic and no other discomfort six months ago with no obvious cause. She was diagnosed with acute appendicitis at a local hospital and given anti-infective treatment with poor results with unknown specific medication. She came to the hospital for further treatment and was diagnosed with chronic appendicitis and was treated with laparoscopic appendectomy on the same day of hospitalization, and was discharged in good condition 3 days after surgery.
Basic information】Female, 14 years old
Disease Type】Chronic appendicitis
Hospital】The First Affiliated Hospital of Xi’an Jiaotong University
Date of consultation】January 2022
Treatment plan】Surgical treatment (laparoscopic appendectomy) + medication (injectable cefuroxime sodium, vitamin C injection, poppy bergamotine hydrochloride injection)
[Treatment period] Hospitalization for 4 days, followed by discomfort
Treatment effect] Abdominal pain symptoms improved, good wound healing
I. Initial consultation
When we first saw Lele, she was in poor mental condition and was not talkative. She was told by her mother that six months ago, Lele developed pain in her right lower abdomen with no obvious cause, which was paroxysmal colic and recurrent, without symptoms of anorexia, nausea, vomiting, diarrhea, urinary frequency and urgency, abdominal distention, and cessation of anal defecation. He was diagnosed with acute appendicitis at a local hospital and given anti-infective treatment, the specific medication used was not known, and the effect was poor. In order to seek further treatment, she came to the clinic with a flat and symmetrical abdomen, no abdominal wall veins showing, no gastrointestinal pattern and peristaltic waves, soft abdomen, pressure pain and rebound pain in the right lower abdomen, with McDonald’s point as the main focus, no abdominal mass, normal intestinal sounds, and was initially admitted to the clinic with chronic appendicitis.
II. Treatment history
The ultrasound showed multiple lymphs in the right lower abdomen. Combined with the physical examination and clinical symptoms, chronic appendicitis was considered to be the cause. The family requested appendectomy, which was indicated, and Lele had no contraindication to surgery. After the operation, he was treated with intravenous anti-inflammatory and symptomatic drugs, cefuroxime sodium, vitamin C injection and poppy bases hydrochloride injection, and was monitored. Anti-inflammatory and symptomatic treatment was still given 2 days after the operation, and the patient could be discharged on the third day after changing the medication.
III. Treatment effect
The operation was relatively smooth, and there was accumulation of feces in the appendix in the postoperative examination. Intraoperative anesthesia was satisfactory, bleeding was about 5 ml, 500 ml of fluid was infused, and the resected specimen was sent to pathology. On the first postoperative day, Lele had a body temperature of 37.0℃, clear consciousness, good spirit, and reported no obvious abdominal pain and distension, the anus was exhausted, no stool was relieved, and the pain at the incision was tolerable. Two days after the operation, Lele’s mental state was good, and there was no abdominal pain, the symptoms were improved and the wound healed well.
IV. Precautions
On the first day after surgery, Lele was advised to fast, drink water in moderation, and inform the patient of any uncomfortable symptoms in time. 2 days after surgery, change the fasting diet to a small amount of liquid diet, such as milk, millet porridge and other foods, and encourage Lele to get out of bed, which is more helpful to the recovery of the disease. After the medication change 3 days after surgery, you can resume normal diet, but try to avoid spicy and stimulating, hard food. After going home, pay attention to the clean and dry wound area, and wear loose cotton clothes to avoid infection caused by the wound. After returning home, you can exercise appropriately, but avoid strenuous exercise to avoid pulling the wound and causing pain. If there are uncomfortable symptoms, you should go to the hospital in time.
V. Personal insight
Chronic appendicitis is characterized by pain in the right lower abdomen at the Mai’s point. When pain in the right lower abdomen occurs, you should go to a regular hospital promptly. If left untreated, acute appendicitis can gradually evolve into chronic appendix and even form serious conditions such as abdominal abscess, septic sepsis and diffuse peritonitis. And poor care after surgical treatment can easily lead to complications such as incisional infection, adhesive intestinal obstruction, and bleeding. Like Lele’s recurrent pain in the right lower abdomen for more than six months before she was seen, chronic appendicitis had formed. However, Lele’s postoperative care was relatively good and no corresponding complications occurred.