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Abstract: Appendiceal stone refers to the clinical appendiceal fecal stone. In this case, an 18-year-old young man came to the doctor with sudden onset of epigastric pain with fever, and was diagnosed with appendiceal fecal stone and acute appendicitis after abdominal CT examination. After the CT examination, he was diagnosed with appendiceal fecal stone and acute appendicitis. He underwent a minimally invasive appendectomy in the emergency general surgery department, and the abdominal pain disappeared after the operation.
Basic information】Male, 18 years old
Disease Type】Appendiceal fecal stone, acute appendicitis
Hospital】Zhengzhou People’s Hospital
Date of consultation】March 2022
Treatment plan】Surgical treatment (single-port laparoscopic appendectomy) + drug treatment (tramadol hydrochloride injection, cefoperazone sodium sulbactam sodium for injection)
[Treatment period] 1 week of hospitalization and regular review
Treatment effect】Postoperative pain disappeared, and all indicators were normal in the 1-week review
I. Initial consultation
The patient was a police student, usually in good health. Last night, he suddenly developed upper abdominal pain after dinner and thought it was gastritis, so he took some stomach medicine at home. When the patient came to our hospital, the pain in the abdomen was unbearable, and he had to cover his stomach when walking and could not stand up straight, and he was sweating profusely. Physical examination: pressure pain and rebound pain in the lower abdomen and right lower abdomen were obvious; routine blood and C-reactive protein tests showed that leukocytes, C-reactive protein, neutrophils and neutrophil ratio were significantly elevated; CT examination of the lower abdomen showed that the appendix was thickened and swollen, and a fecal stone was seen at the appendiceal opening, and the surrounding fatty space was blurred. Combining the patient’s symptoms and examination results, the patient was diagnosed with acute appendicitis caused by an embedded fecal stone in the root of the appendix.
II. Treatment history
After the patient was admitted to the hospital, he was immediately given tramadol hydrochloride injection for pain relief, and the pain could not be relieved after a short period of observation. The patient was informed that the appendix needed to be removed for complete treatment because there was a stone at the root of the appendix. The patient indicated that he accepted the surgical solution, so a single-port laparoscopic appendectomy was performed under general anesthesia, and the patient’s condition gradually improved after the operation.
III. Treatment effect
After one week of anti-inflammatory treatment, the white blood cell, C-reactive protein, neutrophil and neutrophil ratio all returned to normal on reexamination, and the abdominal ultrasound indicated that there was no accumulation of fluid in the abdominal cavity, so the patient was discharged from the hospital. The patient was very satisfied with the surgical effect.
IV. Notes
The patient was found to be recovering well at the time of review and was truly happy for him. The patient was advised to pay attention to the protection of the surgical incision after discharge, to avoid water and sweat at the incision, and to come to the hospital for review and change of medication if there is any obvious redness and swelling of the wound afterwards. The diet can be slowly changed from semi-liquid to normal, but avoid spicy, greasy, raw and cold food, do not smoke and drink. Take proper rest and reduce strenuous activities to prevent wound dehiscence. When the skin heals well, you can take a normal bath.
V. Personal insight
Appendiceal fecal stone is a common cause of acute appendicitis, which can develop into appendiceal root gangrene and perforation, complicated by limited or diffuse peritonitis if not treated early. In acute appendicitis, the abdominal pain starts in the upper abdomen, under the glabella or around the navel, and after about 6-8 hours, the abdominal pain gradually moves down and finally fixes in the right lower abdomen, so it is easy to misdiagnose it as gastritis or enteritis in the early stage. Therefore, it is also recommended that once intolerable abdominal pain occurs, it is important to go to the hospital in a timely manner to clarify the cause and then standardize the treatment to avoid delaying the condition.