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Abstract: Appendiceal stone is usually referred to as appendiceal fecal stone. In this paper, a 21-year-old female, in her youth, came to our emergency department with sudden lower abdominal pain for 6 hours, accompanied by nausea and vomiting, and had obvious positive signs of acute appendicitis on abdominal examination. She was discharged from the hospital without any obvious abdominal pain and discomfort, and was advised to take precautions after discharge.
Basic information】Female, 21 years old
Type of disease】Appendiceal fecal stone with acute appendicitis
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of consultation】March 2022
Treatment plan】Surgical treatment (laparoscopic appendectomy) + medication (ceftriaxone sodium)
Treatment period】4 days in hospital
Effectiveness of treatment] Abdominal pain was relieved after surgery, no significant pain and discharged successfully.
I. Initial consultation
One day in March 2022, I was sitting in the emergency surgery clinic when a 21-year-old girl came to our emergency clinic. The patient reported that she had been in good health before, and 6 hours ago, she developed pain and discomfort in the right lower abdomen without any obvious cause, accompanied by nausea and vomiting, without chills and high fever. Subsequently, the patient’s abdomen was examined. The patient’s abdomen was flat, with pressure and rebound pain in the right lower abdomen, no muscle tension, and normal bowel sounds. At that time, I considered acute appendicitis, and prescribed routine blood tests, abdominopelvic CT and other related tests. The routine blood test indicated mild elevation of leukocytes and neutrophils, and the CT results of the abdominopelvic cavity showed that the diameter of the right lower abdomen was about 7 mm, the surrounding fatty space was clear, and the density in the lumen was slightly high, which was considered as appendiceal fecal stone. He was admitted to the hospital as an emergency patient with acute appendicitis and appendicitis.
II. Treatment process
After the patient was admitted, I explained the patient’s condition and treatment plan to the patient and his family. Due to severe abdominal pain and abdominopelvic CT showing appendiceal fecal stone, the patient was recommended to undergo direct surgery, and the patient and his family agreed to the surgery. The patient and family agreed to the surgery. Next, we improved the preoperative related tests, including coagulation tetralogy, infectious tetralogy, chest X-ray and electrocardiogram, etc. None of the above tests showed any significant abnormality, so we immediately arranged the emergency surgery, and the main procedure was laparoscopic appendectomy. After 30 minutes of emergency surgery, the procedure went smoothly and the patient returned to the ward safely. After returning to the ward, cardiac monitoring, oxygenation, rehydration and other related supportive treatments were given, and ceftriaxone sodium was given for postoperative anti-infection treatment.
III. Treatment effect
On the first day after surgery, the patient could move to the ground, fasting water, and abdominal pain was relieved; on the second day after surgery, there was no obvious discomfort in the abdomen, and there was defecation in the anus, and a liquid diet was given, and gradually transitioned to a normal diet; on the third day after surgery, the patient recovered well, the abdominal incision healed well, there was no obvious redness, swelling and exudation, no abdominal pain, no fever, and the routine blood test showed that the white blood cells and neutrophils were normal, and the patient was discharged successfully. Before discharge, the patient was informed about appendicitis and postoperative precautions to enhance the patient’s health awareness.
IV. Precautions
We are glad that the patient’s surgery was successful, but we should not take it lightly after discharge and should pay attention to daily care. After discharge from the hospital, we can move to the ground appropriately to reduce the occurrence of intestinal adhesions and intestinal obstruction. Diet is recommended to be light and nutritious, and we also need to pay attention to eat some easily digestible food. In addition to diet, good bowel habits are also important, otherwise it is easy to form appendiceal fecal stones, which can lead to the recurrence of acute appendicitis. In addition, it is necessary to keep the abdominal incision dry and to inform the medical staff by phone promptly if there is any redness and oozing to confirm if a follow-up visit is needed. If abdominal pain, abdominal distension and fever occur, promptly go to the hospital for a follow-up examination.
V. Personal insight
Acute appendicitis induced by appendicular fecal stone is one of the common acute abdominal diseases in surgery, which is easily complicated by appendicular perforation, gangrene and diffuse peritonitis, etc. In clinical practice, patients with the above-mentioned diseases should be actively treated surgically. Appendiceal fecal stone refers to the continuous accumulation of intestinal contents into the appendiceal cavity, forming a material similar to a stone. In this paper, the patient had appendiceal fecal stone with acute appendicitis, which was promptly seen and treated surgically with good therapeutic results. Therefore, if there is sudden onset of lower abdominal pain with nausea and vomiting, it should be detected and treated as early as possible to avoid systemic adverse effects.