Appendicitis can occur at any age, but the peak incidence is in young people between the ages of 20 and 30. Acute appendicitis is one of the most common diseases in abdominal surgery, and most patients are able to seek timely medical attention and obtain good results. However, sometimes the diagnosis is quite difficult and some serious complications can occur when it is not managed properly. To date, acute appendicitis still has a mortality rate of 0.1-0.5%, so it is still worth paying attention to how to improve the efficacy and reduce misdiagnosis.
Where is the appendix]
The appendix is located in the lower right part of the abdomen, between the cecum and the ileum, and looks like a worm-like protrusion. The appendix sometimes becomes inflamed and is called appendicitis, or “appendicitis” as some people used to call it, which is not quite accurate.
Why does it get inflamed easily?
The appendix is a long, thin, blind tube. Because it is long, it is easily twisted or compressed by surrounding things; because it is thin, the lumen is as narrow as a sheep’s intestine, and it is easily blocked by fecal matter, foreign bodies and parasites in the intestine, which can cause obstruction of the appendix lumen. Because the appendix is a blind tube, once it is blocked, it is blocked on all sides, and at this time, the appendix still keeps secreting mucus into the closed cavity, which increases the pressure in the appendix cavity and obstructs the blood supply on the appendix wall, thus destroying the mucous membrane layer and opening the door for the invasion of bacteria.
Because there are many bacteria in the appendix cavity, such as Escherichia coli, enterococci, anaerobic streptococci and so on. Some patients may have had upper whistle infection or other bacterial infections prior to appendicitis, thus giving bacteria the opportunity to invade the bloodstream and constitute a bloodstream infection; due to the reflexes of the nervous system, when the functional activity of the stomach and intestines is impaired, it is often accompanied by spasm of the muscles or blood vessels of the appendix. Vascular spasm can cause local necrosis of the appendix, and muscle spasm can cause appendiceal obstruction, which are both opportunities for appendiceal inflammation.
What are the signs]
Once an organ becomes inflamed there will be congestion, redness, swelling and pain, and so does the appendix. The main symptom of appendicitis is abdominal pain, typically in the early stages of acute appendicitis there is pain in the middle and upper abdomen or around the umbilicus, after a few hours the abdominal pain shifts and is fixed in the right lower abdomen.
The pain in the early stage is actually a visceral nerve reflex pain, so the pain in the mid-upper abdomen and around the umbilicus is more diffuse and often cannot be located exactly. Moreover, due to reflex gastric cramps, patients often have a combination of nausea and vomiting, which many people would think is stomach pain during this period.
When the inflammation of the appendix reaches the plasma membrane layer and the wall peritoneum, the pain is fixed in the right lower abdomen where the appendix is located. Simple appendicitis often presents with paroxysmal or persistent swelling and dull pain, and persistent severe pain is often indicative of septic or gangrenous appendicitis. Persistent severe pain extending to the mid-lower abdomen or both lower abdomens is often a sign of perforated gangrene of the appendix.
Sometimes the patient feels instantaneous relief of abdominal pain with perforated appendiceal gangrene, but this pain relief is temporary and other accompanying signs and symptoms do not improve or even increase.
The surgeon usually confirms the diagnosis of appendicitis based on the fixed pressure pain in the right lower abdomen at the Mai’s point combined with medical history and laboratory tests, and the presence of rebound pain and muscle tension in the abdomen to determine whether the patient has combined peritonitis.
About treatment
Surgical treatment
At the present medical level, if the patient can seek early medical treatment, early diagnosis and early surgery, good treatment effect can be received. Early surgery refers to the surgical removal of appendicitis when the lumen is still obstructed or when there is only congestion and edema, which is a simple operation and has few postoperative complications. If the surgery is performed after suppuration and gangrene or perforation, the operation is difficult and the postoperative complications will increase significantly.
The advantages of laparoscopic appendectomy are obvious].
Laparoscopic appendectomy is a major breakthrough in appendectomy, which involves making 2-3 small holes of 0.5-1.0 cm in the abdomen, placing laparoscopic instruments, and removing the appendix without suturing the incision.
Compared with traditional appendectomy, it has obvious advantages.
①Small trauma, fast recovery, good cosmetic effect and short hospital stay. The length of the abdominal incision in traditional surgery is 3-6cm and the healing time of the incision is 7-8 days, while the incision of laparoscopic appendectomy does not require suturing and the postoperative hospital stay is 2-3 days.
②Laparoscopy also has diagnostic functions, and the whole abdominal cavity can be explored during the operation, so ectopic appendix, pelvic diseases and gynecological diseases can be clearly diagnosed and treated symptomatically.
③Low complications, because the incision of laparoscopic appendectomy does not exceed 1 cm, so there are no complications such as incisional dehiscence and incisional hernia, and the incisional infection rate is low; the intraoperative interference with other organs of the abdominal cavity is small, and the incidence of adhesive intestinal obstruction is low; at the same time, the pus can be completely removed under direct vision, and no abdominal residual abscess occurs after the operation.
For non-surgical treatment, the medication should be thorough
Most acute appendicitis can be relieved by antibiotic treatment if the conditions do not allow it or if you are not willing to operate. However, acute appendicitis can easily turn into chronic appendicitis if the antibiotic treatment is not complete, and the change to chronic appendicitis is prone to recurrence. Therefore, patients who are treated non-operatively should still apply the medication for 1 week after the disease disappears to consolidate the effect and reduce recurrence.
After acute appendicitis is treated or cured non-operatively, the appendiceal wall is left with fibrous tissue hyperplasia and thickening, luminal narrowing and surrounding adhesions, which is called chronic appendicitis and can easily lead to another acute attack. Surgical removal is the only way to cure chronic appendicitis.
Appendicitis in children, pregnant women and the elderly requires more attention].
Appendicitis in children is very prone to perforation: In children, appendicitis is often poorly expressed and is often overlooked. Therefore, parents should keep an extra eye out for sudden abdominal pain or unexplained crying, vomiting, or diarrhea in children, and be alert to whether it could be acute appendicitis and take the child to the doctor sooner.
Children with abdominal pain, especially pain lasting more than 3 hours without relief or even gradually worsening, accompanied by vomiting, fever and other symptoms, need to be alert to the possibility of appendicitis, which is prone to perforation in children, so once diagnosed, pediatric appendicitis advocates surgery.
Appendicitis in the elderly is also not easy to recognize and can easily worsen: elderly people often do not have a pattern of metastatic right lower abdominal pain after appendiceal obstruction and inflammation due to poor responsiveness. When the elderly suffer from acute appendicitis, the appendiceal cavity is highly susceptible to perforation, which in turn can easily develop into diffuse peritonitis and become life-threatening. Therefore, any mild complaints of abdominal pain and other abdominal symptoms and manifestations such as chills and fever in the elderly should be carefully examined and observed, not forgetting the possibility of acute appendicitis.
Appendicitis during pregnancy: It is also not easy to determine when a pregnant woman has appendicitis, and it can easily perforate and develop into peritonitis, which can also lead to miscarriage and preterm delivery. Therefore, abdominal pain and gastrointestinal symptoms in pregnant women should not be taken lightly as well.