Ectopic acute appendicitis
Introduction
Introduction to ectopic acute appendicitis Most people are born when the appendix has fallen to the right armpit. If the embryo is abnormal, the appendix can stay in any part of the abdominal cavity. When acute inflammation occurs in the appendix of the abnormal position, there is a certain difficulty in diagnosis. The clinically more common ectopic appendix is the pelvic position, the lower liver and the left side. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: abdominal abscess, intestinal obstruction, jaundice, septic shock, sepsis, liver abscess
Cause
Etiology of ectopic acute appendicitis
There are several types of ectopic tails:
1 non-transposition malformation: the small intestine is on the right side, the colon is on the left side, and the cecum and appendix are ectopic in the left lower abdomen.
2 Incomplete rotation: The cecum and appendix are located in a certain part of the rotation, such as the left upper abdomen or the liver, and the latter is also called the high appendix.
3 liters of colonic insufficiency: blind, incomplete colonic insufficiency caused the position of the appendix to change.
4 reverse transposition: very rare, the midgut rotates clockwise, so that the small intestine is located on the left side, the ascending colon is on the right side, in a few cases, the cecum and appendix are in the median position.
Prevention
Ectopic acute appendicitis prevention
1, after the meal should not rush, the summer heat should not be too cold, especially not to drink cold beer, and other cold drinks.
2, usually take care not to be too fatty, avoid eating too irritating food.
3, should actively participate in physical exercise, enhance physical fitness and improve immunity.
4, if there is a history of chronic appendicitis, should pay attention to avoid recurrence, usually keep the stool smooth.
Complication
Ectopic acute appendicitis complications Complications abdominal abscess intestinal obstruction jaundice infectious shock sepsis liver abscess
(1) Abdominal abscess: The abscess formed around the appendix is an abscess around the appendix, but it can also form abscesses in other parts of the abdominal cavity. Common parts include pelvic cavity, infraorbital and intestinal space, and clinical manifestations of bloating symptoms of paralytic ileus , signs of peritoneal irritation, tenderness mass and symptoms of systemic infection, etc., B-mode ultrasound can assist in diagnosis and localization, and should be surgically opened and drained as soon as it is diagnosed.
(2) internal and external fistula formation: if the abscess around the appendix is not drained in time, part of the abscess can be broken into the small intestine or large intestine, or can be worn to the bladder, vagina or abdominal wall to form various internal or external hemorrhoids; The fluid can be expelled from the fistula, and X-ray tincture examination can help to understand the extent and extent of the fistula, and help to choose the treatment to expand drainage or remove the fistula.
(3) phlebitis (pylephlebitis): Infectious thrombus in the appendix vein in acute appendicitis, along the superior mesenteric vein to the portal vein, leading to inflammation of the portal vein, clinical manifestations of hepatomegaly and tenderness, jaundice, chills, high fever, etc., such as worsening It can produce septic shock and sepsis, and treatment delay can develop into a bacterial liver abscess.
Symptom
Ectopic acute appendicitis symptoms Common symptoms Lower abdominal pain Bladder stimulation urinary frequency Iris infection Inflammatory abdominal pain Anal bulge tension
(1) Low (pelvic) acute appendicitis: Due to excessive cecal drop or lack of fixation of the right colon, the appendix can be located below the sacral spine, or even completely into the pelvic cavity. The clinical incidence of acute appendicitis is estimated to be approximately 4.8 ~ 7.4%, manifested as metastatic abdominal pain, but the abdominal pain and tenderness area are lower, muscle tension is also lighter, rectal irritation may occur in the course of the disease such as increased stool, anal bulge; or bladder Stimulating symptoms such as urinary frequency and urgency, etc., the treatment of low appendicitis is the same as general appendicitis, emergency surgery to remove the appendix, the location of the cecum and appendix should be carefully examined during the operation, the inflammatory adhesions should be separated, and the appendix should be completely freed and removed.
(B) high (lower liver) acute appendicitis: when the congenital intestinal rotation declines, the cecum and appendix can stay under the liver; acquired appendix is too long, the tip can also extend outside the liver, subcutaneous appendicitis, abdominal pain , tenderness and muscle tension are confined to the right upper abdomen, clinically often mistaken for acute cholecystitis, if necessary, abdominal B-ultrasound examination, such as the normal size of the gallbladder, clear outline, no foreign body echo in the gallbladder cavity, high appendicitis should be considered Once diagnosed, emergency diagnosis and removal of the appendix.
(3) Acute appendicitis on the left side: Due to congenital abdominal visceral ectopic, the cecum can be located in the left lower abdomen; the acquired cecum can also be moved and adhered to the left lower abdomen, and the appendix is also fixed in the left axilla. Acute appendicitis is rare, and its pathological type and pathogenesis are the same as acute appendicitis on the right side. There is a shift of left lower abdominal pain, tenderness and muscle tension are also confined to the left medullary fossa. Considering the possibility of acute appendicitis on the left side, the chest should be carefully performed. The abdominal examination and X-ray examination, after diagnosis, can be removed through the oblique incision of the left lower abdomen.
Examine
Examination of ectopic acute appendicitis
1, blood routine examination : the total number of white blood cells is more than 10 × 109 / L, neutrophils are often more than 80%, if perforation occurs peritonitis, often can be raised to 20 × 109 / L or more, young infants due to strong reaction, The total number of early white blood cells can be as high as 15 × 109 / L, if the posterior appendicitis affects the ureter or bladder, white blood cells, red blood cells and even pus cells can appear in the urine, at this time should exclude urinary tract infection.
2, abdominal X-ray examination : cecal and external colon inflation, local inflammation is obvious, the right side of the psoas muscle is unclear, the right lower abdomen abdominal fat line edge blur widened or even disappeared, if the pelvic appendix, it can be seen The basin line disappeared.
3, B-mode ultrasound examination : there is a certain significance in the limitation of appendicitis abscess.
Diagnosis
Diagnosis and diagnosis of ectopic acute appendicitis
Ectopic acute appendicitis is not easy to diagnose, often misdiagnosed as an inflammatory disease of the ectopic site, such as acute or high acute appendicitis is often misdiagnosed as acute cholecystitis, acute appendicitis in the female pelvic cavity is misdiagnosed as pelvic organ inflammation When the disease is located in the left lower abdomen, except that the midgut is known to have a non-rotating malformation or a right heart, it is generally difficult to diagnose before surgery. Therefore, the pain and fixed tenderness outside the right lower abdomen must be carefully inquired. A full medical examination of the medical history requires the possibility of ectopic appendicitis.
