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Abstract: Acute appendicitis is a common type of appendicitis, and recently a 24 woman was deeply troubled by this disease. More than 20 days after a cesarean section, she suddenly developed pain in the right lower abdomen, which continued to worsen and was accompanied by nausea and vomiting. After coming to our hospital, we perfected the blood routine, ultrasound and other related examinations to clarify the diagnosis of acute appendicitis. After 10 days of combined treatment with ampicillin for injection, gentamicin sulfate injection and metronidazole injection intravenously, the patient’s symptoms improved and her condition was stable.
Basic information】Female, 24 years old
Disease Type】Appendicitis (acute appendicitis)
Hospital】The First Hospital of China Medical University
Date of consultation】May 2022
Treatment plan】Medication (ampicillin for injection, gentamicin sulfate injection, metronidazole injection)
Treatment period】10 days of inpatient treatment, 1 month of outpatient follow-up
Treatment effect] Symptoms improved, stable condition
I. Initial consultation
The patient, a female, complained that she had a previous cesarean section for more than 20 days. 10 hours ago, she developed abdominal pain with no obvious cause, mainly in the right lower abdomen, accompanied by nausea, vomiting and gradually increasing abdominal pain, without diarrhea or chest discomfort, and came to our hospital urgently. Physical examination: abdominal bulge, about 20 cm surgical scar in the lower abdomen, healing is possible, no gastrointestinal type and peristaltic wave, slight tension in the abdominal muscles, positive pressure pain and rebound pain in the right lower abdomen, most obvious at the Mai’s point, no enlargement of the liver and spleen, no mobile turbid sounds, no percussion pain in the liver area, no percussion pain in both kidney areas, normal bowel sounds. The initial diagnosis was acute appendicitis, and the patient was admitted to the hospital for treatment. The patient’s consciousness was clear since the onset, and he ate poorly.
Treatment history
After the patient was admitted to the hospital, routine blood tests showed elevated leukocytes and a swollen appendix in the right lower abdomen was seen on ultrasound, which clarified the diagnosis of acute appendicitis. After communicating with the patient, it was decided to give anti-inflammatory drugs for conservative treatment, and to closely observe the changes of the condition during the period. The patient was given a combination of ampicillin for injection, gentamicin sulfate injection, and metronidazole injection intravenously to control local inflammation. After 3 days of medication, the patient’s symptoms were reduced and the routine blood tests showed that the white blood cell values decreased but were still higher than normal, suggesting that the medication was effective. After 10 days of drug treatment, the patient’s symptoms improved and the condition was stable.
III. Treatment effect
Before treatment, the patient had obvious pain in the right lower abdomen, which continued to worsen, accompanied by nausea and vomiting, and the examination showed elevated leukocytes and swelling of the appendix. After 10 days of intravenous treatment with ampicillin, gentamicin sulfate injection and metronidazole injection, the patient’s symptoms of abdominal pain disappeared, and the results of routine blood tests and ultrasound examination showed that the white blood cell values returned to normal levels, and the swollen appendix was not seen under the ultrasound. The patient’s inflammation was controlled and she recovered well.
IV. Notes
The patient was in a very happy mood after her condition improved. In order to prevent recurrence of the disease and better recovery of the patient, I carefully emphasized to the patient that the following points should be noted in life.
1. patients should strengthen dietary management during the recovery period, choose light and easily digestible food, eat less and more meals, limit the intake of high-fat and spicy stimulating food, and avoid drinking alcohol.
2, patients should seek medical attention promptly to prevent disease recurrence if they experience abdominal pain, nausea, vomiting and other uncomfortable symptoms again after discharge from the hospital.
3. Patients should rest more during the recovery period, ensure enough sleep, and avoid overwork and staying up late to avoid affecting the recovery process of the disease.
V. Personal insight
The patient in this case has aggravated right lower abdominal pain with nausea and vomiting as the main symptom, which is also a common symptom of many digestive system diseases, and should be differentiated from the following diseases in diagnosis to avoid omission and misdiagnosis.
1, acute pelvic inflammatory disease, acute adnexitis: the patient is a female patient, physical examination: right lower abdominal pressure pain, rebound pain, but the site is high, gynecological examination did not see obvious abnormalities, so consider this diagnosis basically can be excluded.
2, urinary stones: Patients with urinary stones usually have no obvious positive signs in the right lower abdomen, and the urine routine shows occult blood and red blood cells, and the ultrasound shows dilatation of the right renal pelvis, but this patient does not have the above-mentioned manifestations, so the diagnosis can be basically excluded.
3, upper gastrointestinal perforation: patients often have a history of previous gastric disease, sudden onset of epigastric pain, physical examination suggests total peritonitis, the upper abdomen is heavy, abdominal plain film can be seen under the diaphragm free gas gas gas. In this patient, the physical signs were not consistent with the signs of upper gastrointestinal perforation, and no subdiaphragmatic free gas was seen in the abdominal plain film, so the diagnosis was basically excluded.
Therefore, patients with right lower abdominal pain should, like the patient hospital in this case, be seen in a timely manner to avoid blind medication that could delay the condition and aggravate the discomfort.