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Abstract: Acute abdominal disease is a group of abdominal emergencies with acute abdominal pain as the main manifestation. The patient presented in this article, Mr. Wang, came to the clinic mainly with pain in the right lower abdomen, which gradually worsened. Considering that it might be acute appendicitis, the patient was asked to do abdominal CT and blood tests, and the diagnosis of acute appendicitis was finally clarified. After communicating with the patient and his family about his condition, he was given laparoscopic appendectomy in time and recovered well after the operation.
Basic information】Male, 41 years old
Type of disease】Acute appendicitis
Hospital】The Second Hospital of Fuzhou, Xiamen University
Date of consultation】May 2022
Treatment plan] Fasting + medication (sodium chloride glucose injection, sodium lactate ringer injection, glucose injection, cefoperazone sodium for injection, sulbactam sodium for injection) + surgery (laparoscopic appendectomy) + oxygen therapy
[Treatment period] 5 days of inpatient treatment, 1 month of outpatient follow-up
Treatment effect】After treatment, the abdominal pain disappeared, the wound healed, and the patient resumed normal life.
I. Initial consultation
The patient Mr. Wang came to our hospital with “metastatic right lower abdominal pain for 12 hours”. The patient reported that he felt nausea this morning after eating barbecue last night, but did not vomit, and felt discomfort in the upper abdomen, with reduced appetite and diet. The patient was then asked to check the blood routine, and it was found that the white blood cells were significantly increased, and the proportion of neutrophils was increased; physical examination revealed that the right lower abdomen had pressure pain at the point of McDonald’s, and rebound pain was obvious; CT of the lower abdomen revealed that the appendix was thickened, and strong echogenic fecal stone shadow was seen inside. The diagnosis of acute appendicitis was clear. After communicating with the patient’s family, we suggested emergency surgery, to which the patient agreed and went through the admission procedure.
II. Treatment process
We communicated with the patient that nowadays appendectomy is divided into conventional open surgery and laparoscopic appendectomy, and the latter has faster wound recovery, less trauma, and a wide field of view, which makes it easy to detect other diseases, and suggested the patient to undergo laparoscopic surgery.
After admission, the patient was asked to fast, given gastrointestinal decompression, and given intravenous glucose sodium chloride injection to replenish energy and await surgery. The appendix was removed during surgery, the wound was sutured, and oxygen was administered upon return to the ward, and sodium lactate Ringer injection and glucose injection were supplemented, and cefoperazone sodium for injection and sulbactam sodium for injection were used to treat the infection.
III. Treatment effect
After the operation, the patient’s abdominal pain disappeared, and he could get out of bed on the 2nd day, and he could eat some thin rice and noodles after exhaustion, etc. The patient’s blood routine recheck has returned to normal. The stitches were removed 5 days after the operation, and the wound was basically healed without redness, swelling, pain, and infection such as no running water, with good recovery, and the patient did not complain of special discomfort, and was discharged with it. 1 month later, the patient’s wound was well healed, his diet was normal, and he recovered well, and the patient expressed his gratitude to the medical staff.
IV. Notes
The patient’s symptoms improved after treatment, as a doctor truly happy, but in daily life, still need to remind the patient to pay attention to some matters to promote physical recovery:.
1. Patients should pay attention to rest at home, do not stay up late, and pay attention to clean diet to avoid the formation of fecal stone blockage and other conditions again.
2. attention to a nutritious diet, but not greasy, and attention to vitamin C-rich foods.
3, pay attention to avoid strenuous activities of the abdomen, such as playing football, soccer, climbing. Because although the wound is small, it needs time to heal completely, and it takes several months for the elastic fiber to return to normal.
V. Personal insight
Acute appendicitis in the acute abdomen is a common emergency that can occur at all ages, in both sexes and in all ages. It is more common in adults, such as this patient. Therefore, in patients with metastatic abdominal pain, abdominal ultrasound and abdominal CT should be done actively to clarify the diagnosis and need to be differentiated from other relatively more dangerous acute abdominal conditions, especially in female patients of childbearing age, who need to exclude the possibility of ectopic pregnancy and ruptured bleeding, and require checking pregnancy indicators to prevent hemorrhagic shock.