(Disclaimer: This article is for general use only, and the information in the following content has been processed to protect patient privacy)
Abstract: The patient in this case is a young male. The patient was admitted to the hospital one day before with no obvious cause of abdominal pain, the pain was characterized by persistent periumbilical colic, which was tolerable, accompanied by nausea and vomiting symptoms, and the relevant examination was completed, and the final diagnosis was acute appendicitis with fecal stone obstruction.
Basic information】Male, 26 years old
Disease Type】Acute appendicitis with fecal stone obstruction
Hospital】Tianjin Fifth Central Hospital
Date of consultation】March 2022
Treatment plan】Surgical treatment (laparoscopic appendectomy) + medication (sodium chloride glucose injection, sodium pantoprazole for injection, ceftriaxone sodium for injection)
Treatment period】6 days in hospital
Treatment effect] Postoperative symptoms disappeared, wound healing, good recovery
I. Initial consultation
The patient, male, 26 years old, presented with abdominal pain without obvious cause 1 day before admission, mainly as persistent periumbilical colic, tolerable, accompanied by nausea, vomiting, vomiting of gastric contents, no vomiting of blood, accompanied by chills, fever, consulted in the emergency room, no significant relief after symptomatic treatment. 6 hours later the pain gradually shifted and fixed in the right lower abdomen. On examination: temperature 38.2℃, pressure pain and rebound pain in the right lower abdomen, combined with symptoms and signs, the diagnosis of acute appendicitis was considered. Among them, appendiceal fecal stone obstruction, usually refers to appendiceal stone obstruction.
II. Treatment history
Combining the patient’s symptoms, physical examination and CT findings, the diagnosis of acute appendicitis with fecal stone obstruction was made clearly.
Since the patient was a young male with no underlying disease, laparoscopic minimally invasive surgery was considered as a priority. A pelvic drain was placed during the operation to facilitate postoperative recovery. Postoperatively, the patient was given ceftriaxone sodium for injection for anti-inflammatory treatment, regular wound dressing changes, sodium chloride glucose injection for basic nutritional support, and pantoprazole sodium for injection for acid suppression treatment. When the patient gradually resumed diet, acid suppression therapy was withdrawn and the amount of intravenous fluids was gradually reduced. The pelvic ultrasound was reviewed and no abnormality was found, and the drainage tube was removed.
III. Treatment effect
After the operation, the patient had no further fever and the infection was controlled. After 6 days of hospitalization, the patient’s abdominal pain, nausea and vomiting symptoms were significantly relieved, and the patient gradually returned to normal diet from liquid and semi-liquid diet, and the laparoscopic incision recovered quickly and healed initially without any blood leakage or infection.
IV. Notes
I am truly happy for the patient that her symptoms disappeared and her disease recovered after active treatment. However, the patient should be advised to maintain a good diet after discharge, avoid overeating, focus on high fiber and low fat foods, and pay attention to good bowel habits. In addition, avoid strenuous exercise and heavy physical labor until the incision is completely healed, which may lead to wound lacerations. In addition, pay attention to reasonable rest, avoid staying up late and straining, and maintain a good state of mind to help the condition recover smoothly.
V. Personal insight
Fortunately, this patient was treated promptly and his condition was effectively controlled after taking standard treatment. Appendiceal fecal stone itself is not terrible, but diseases with fecal stone obstruction are more serious, such as acute appendicitis due to appendiceal obstruction, high lumen pressure, accelerated disease progression, if not timely diagnosis and treatment, it can develop into acute appendiceal gangrene, perforation, formation of periappendiceal abscess, which not only misses the time of surgery, but also makes the treatment period significantly longer.