Wu Xiang is 21 years old and is a fourth-year student at a prestigious university. Wu Xiang has had frequent stomach pains since he was a child, and has been diagnosed with “chronic appendicitis”. One afternoon, Wu Xiang’s stomach was hurting again, starting with pain around the umbilicus, then the umbilicus didn’t hurt at all, but the pain in the lower right abdomen was getting unbearable, and his classmates quickly took him to the hospital. In the emergency room of the university hospital, the young doctor took a medical history and soon made a diagnosis of “acute attack of chronic appendicitis” after a physical examination. The doctor suggested that it would be better for Wu Xiang to have surgery, because his “chronic appendicitis” often attacks and affects his study and work, and even if he doesn’t have surgery now, he may still need it sooner or later. Wu Xiang thought twice about it, and decided that it was better to have surgery than to have a short term pain. The surgery went well, and after Wu Xiang got off the operating table, he asked to see what his appendix, which had been tormenting him for years, looked like. It turned out to be like a small earthworm, and the post-operative pathology report: it was a normal appendix. Wu Xiang also quickly recovered and was discharged from the hospital. However, more than a month later, Wu Xiang always felt that whenever he was sullen and emotional, the stomach pain still existed. However, repeated examinations did not reveal any abnormalities, and the doctor suggested that Wu Xiang see a psychiatrist. After a thorough examination, the psychiatrist concluded that what Wu Xiang was suffering from was not real appendicitis, but pseudo-appendicitis, or
“psychogenic appendicitis”. After psychological treatment, Wu Xiang’s stomach pains rarely attacked anymore. Wuxiang was confused by this… there are fake appendicitis too? The psychiatrist patiently explained to him …… the so-called “mental appendicitis”, as the name implies, is caused by excessive mental tension. Some people can suffer from psychogenic appendicitis when they encounter loss of love, marital discord, interpersonal tension, busy work, overuse of the brain before exams, sudden accidental shock, etc. Patients may have various symptoms similar to appendicitis, such as metastatic right lower abdominal pain, nausea, vomiting, fever, and rapid pulse, but the appendix and appendiceal tract of such patients are found to be neither congested, swollen, nor septic at the time of surgery. The symptoms of this appendicitis are so realistic that it is often difficult to confirm the diagnosis. Professor Hansen of the University of Southampton, UK, investigated 219 patients diagnosed with acute appendicitis, resulting in surgical evidence that 56 had completely normal appendixes, and 26% had their appendixes wrongly cut, many of which were misdiagnosed as a result of psychogenic appendicitis. The survey also found that patients with psychogenic appendicitis also developed the above-mentioned symptoms of appendicitis after surgery. The pain of “psychogenic appendicitis” is not inflammatory pain, but rather irritable pain. Irritable bowel syndrome, which is very common nowadays, is a systemic disease in which functional motility disorders of the colon predominate, and the onset and exacerbation of the disease is related to psychiatric factors. When spastic bowel motility disorder occurs mainly in the cecum, ascending colon or appendix, there can be pain in the right lower abdomen, which can be easily misdiagnosed as appendicitis, intestinal tuberculosis, right ureteral calculus and right adnexitis. In addition, studies by psychologists have found that when the mind is under high stress or emotional distress, there is an increased secretion of adrenocorticosterone hormone in the body, which can cause an intestinal stress response. “Psychogenic appendicitis” is characterized not only by pain, pressure and rebound pain, but also sometimes by some kind of metastatic pain, which is clearly related to mental factors and intestinal stress. In general, true appendicitis has metastatic pain in the right lower abdomen; marked high fever; significantly elevated white blood cells and neutrophils in routine blood tests; and fixed pressure pain in the right lower abdomen on physical examination, etc. These symptoms and signs help to make a clear diagnosis before surgery. These symptoms and signs can help to make a definite diagnosis before surgery. Although “psychogenic appendicitis” can have these manifestations, they are atypical or very mild. “Psychogenic appendicitis”
The pain symptoms of “psychogenic appendicitis” are closely related to psychological factors, and some people have “pain when they are nervous and pain when they are angry”, which should be taken seriously. These patients are sensitive and suspicious, and the more they think about a little stomach pain, the more it looks like appendicitis. Therefore, doctors should be more observant, let the patient relax, distracted, such as after defecation pain relief or disappear, these are helpful to identify the real appendicitis and false appendicitis. The key to preventing “mental appendicitis” is to maintain a good state of mind, and to be good at harnessing your emotions when you are worried or sad, and to reduce the stimulation of bad emotions as much as possible. This way, the “mental appendicitis” will not “patronize”, you will not “take a knife” for nothing. In the past, the appendix was thought to be a redundant organ, but further research has confirmed that the appendix is also a component of the body’s immune system. Under normal circumstances, it functions as a humoral immune system and is only removed when it becomes truly septic.