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Abstract: Confined peritonitis is one of the more common acute abdominal conditions in general surgery, and this case presents a patient with confined peritonitis caused by acute appendicitis. The patient showed signs of limited peritonitis due to acute appendicitis due to some irritation of the peritoneum caused by exudation from the appendix. By treating the patient with emergency surgery (laparoscopic appendectomy) and giving postoperative medication for symptomatic treatment, the patient recovered well and the disease was cured.
Basic information】Female, 52 years old
Disease Type】Confined peritonitis, acute appendicitis
Hospital】Jinzhou Central Hospital
Date of consultation】April 2022
Treatment plan】Surgical treatment (laparoscopic appendectomy) + drug treatment (cefazolin sodium for injection, ornidazole tablets)
Treatment period】5 days of hospitalization
Treatment effect】Good recovery, cured
I. Initial consultation
The patient came to the hospital with metastatic right lower abdominal pain with nausea and vomiting for 1 day. Outpatient ultrasound examination of the appendix was perfected, suggesting a hypoechoic area in the right lower abdomen, and acute appendicitis was suspected and admitted to the hospital for treatment.
Abdominal examination: the patient’s expression was painful, and pressure pain could be detected in the right lower abdomen, accompanied by rebound pain and local muscle tension. Blood count: elevated white blood cells. Appendiceal ultrasonography suggested: right lower abdomen hypoechoic (appendicitis was not excluded), preliminary diagnosis: 1. limited peritonitis, 2. acute appendicitis. I explained the current condition to the patient and family and suggested emergency surgical treatment, which the patient and family agreed to perform after discussion.
(Blood count)
II. Treatment process
After physical examination and preliminary judgment, it was considered that the limited peritonitis was secondary to acute appendicitis, and the primary disease needed to be treated actively. The patient was urgently given routine preoperative tests, including: electrocardiogram, coagulation function, blood type, etc., and the patient was explained to the patient’s condition, and emergency surgery was recommended. Appendicitis surgery can be divided into laparoscopic surgical treatment and traditional open surgical treatment. The patient agreed to the surgical treatment after discussion and agreed to laparoscopic surgical treatment, so the operation notice was given urgently, and laparoscopic exploratory surgery was performed under emergency general anesthesia. After the operation, the patient returned to the ward, and postoperative anti-inflammatory and other symptomatic treatment (cefazolin sodium for injection + ornidazole tablets for anti-inflammatory treatment) was performed. After the operation, the patient recovered well, and the symptoms of limited peritonitis were relieved without discomfort, and he was discharged.
III. Treatment effect
After laparoscopic surgery, the patient was cured of limited peritonitis and the appendix was removed due to the lesion. The patient had no uncomfortable symptoms after surgery, resumed venting and eating on the second postoperative day, and the abdominal pain was resolved without fever. On the 5th day of hospitalization, the patient recovered well and was in good spirits. The surgical incision healed in one stage and the stitches were removed and the patient was discharged. The appearance of the incision is more beautiful than that of traditional open surgery, and the appendix is removed through the extraction bag, avoiding direct contact with the incision and gloves, and the chance of postoperative bleeding and infection is lower, which is satisfactory to the patient.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment, but we still need to remind the patient that he should pay more attention to rest after discharge, and his diet should gradually become more normal, not too hungry and too full, and he can move more appropriately to promote gastrointestinal peristalsis and reduce the occurrence of intra-abdominal adhesions. As the incisions are still not fully healed, it is recommended that the wound be bathed in water after 1 week, and that the condition be promptly seen and treated in the general surgery clinic.
V. Personal insight
By understanding the situation of the patient in this case, it is clear that acute appendicitis causing limited peritonitis is a common disease in general surgery and should be seen early to avoid further progression of the disease, and emergency surgery is the simplest and most effective treatment measure to cure the disease. Currently, laparoscopic surgery is widely performed, which greatly improves the treatment effect of the disease, causes less damage, quicker postoperative recovery, further shortens the treatment period, and the incision is more beautiful, although the cost is slightly higher than traditional surgery, if the condition and conditions allow. In conclusion, for patients with acute appendicitis, laparoscopic surgery is still recommended.