perforated appendix
Introduction
Introduction If you have acute appendicitis and have had surgery early, the risk is already very small, and the consequences are quite good; but once the "appendix perforation" occurs, the light form a local abscess, and in severe cases, diffuse peritonitis, abdominal suppuration, Infectious shock, even life-threatening, that is, timely surgery after perforation, often cause a series of complications such as wound infection, residual abscess in the abdominal cavity, intestinal fistula, intestinal adhesion, adhesive intestinal obstruction, and many intestines suffering from repeated abdominal surgery. Adhesive patients, traced back to their initial source of disease is often "ends perforation." Therefore, beware of appendix perforation is the key to the treatment of appendicitis, and this key is the close cooperation of patients, families and doctors, and work together to complete.
Cause
Cause
The causes of appendicitis are:
1 The poor emptying of the appendix is one of the main causes of appendicitis. Mainly due to the curved blind tube, the opening is small, the lumen is narrow, and the peristalsis is extremely slow, so that the appendix lumen is easily blocked, often due to obstruction of feces (stone), food fragments, mites or foreign bodies.
2 adhesions outside the appendix, fibrous cords, tumor compression can also cause obstruction.
3 In addition, the appendix is short, the appendix is twisted, and the opening is small. When the gastrointestinal motility is disordered, the appendix creep will be weaker and slower, which will also cause obstruction. At this time, bacteria invade the lumen, causing inflammation.
Examine
an examination
Related inspection
Abdominal plain film abdominal CT
Illness performance
At the onset of acute inflammation, the appendix showed hyperemia and swelling, edema in the wall and infiltration of neutral polymorphonuclear leukocytes, small ulcers and bleeding spots in the mucosa, and a small amount of exudation of the serosa. The turbid exudate accumulated in the cavity, called simple appendicitis, because the location of visceral pain is unknown, the patient feels pain in the upper abdomen or around the umbilicus, often accompanied by nausea and vomiting, general malaise, and abdominal pain gradually shifts to the lower right abdomen. Local and obvious tenderness, the clinically used McBney's point indicates the tender part. In the right lower abdomen, there is a finite local tenderness point in the lateral 1/3 of the anterior superior iliac spine. This pain point was first discovered and described by American C. McBeeney in 1889, so it is called McBee. Nie's point (Mc's point). If the condition continues to develop, the swelling and congestion of the appendix are more obvious after a few hours. There is often a small abscess in the wall of the appendix. The mucosa is ulcerated and necrotic. The serosal surface is fibrously exuded. The cavity is filled with purulent liquid, called suppuration. Cellulitis inflammatory appendicitis. At this time, the systemic symptoms were severe, and the right lower quadrant was painful. Finally, it can develop into tissue necrosis of the appendix wall. If there is obstruction, the distal necrosis of the appendix is more serious, purple-black, often perforated here, called gangrenous appendicitis, usually combined with localized peritonitis. In addition, it is accompanied by obvious muscle tension and rebound tenderness. The body temperature is more than 38.5 ° C, and the peripheral blood white blood cell count is also increased. Because the proximal end of the appendix cavity is swollen and closed, the perforated spill is only the pus accumulated in the cavity, no intestinal contents, and there is a large omentum wrap, rarely secondary diffuse peritonitis, and form around the appendix. Abscess.
Diagnosis
Differential diagnosis
Appendicitis in the following three special groups should be given special attention and identification:
1, acute appendicitis in children: children with acute appendicitis develop fast, serious condition, high perforation rate, and many complications. Almost 100% of acute appendicitis in infants under one year of age is perforated, 70%-80% within two years of age and 50% at five years of age. The mortality rate of acute appendicitis in children is 2%-3%, which is 10 times higher than that of adults. Moreover, pediatric examinations often do not cooperate, and the extent of tenderness in the abdomen is not easy to determine. Immediately after diagnosis, the appendix should be surgically removed to enhance preoperative preparation and postoperative comprehensive treatment to reduce complications.
2, elderly acute appendicitis: With the aging of China's population, the incidence of acute appendicitis in the elderly over 60 years of age has increased. Older people often suffer from a variety of major organ diseases such as coronary heart disease, and the mortality rate of acute appendicitis is higher, and it increases with age. Older people have low resistance, thin appendix wall, and hardened arteries. About one-third of patients have pierced the appendix at the time of treatment. In addition, the elderly have low response, abdominal tenderness is not obvious, clinical manifestations are not typical, because the abdominal muscles have shrunk, even if appendicitis has been perforated, abdominal tenderness is not obvious, it is easy to misdiagnose.
3, acute appendicitis during pregnancy: due to physiological changes in pregnant women, once appendicitis occurs, the risk is greater than the average adult. According to statistics, the mortality rate of acute appendicitis during pregnancy is 2%, 10 times higher than the average person, and the fetal mortality rate is about 20%.
In the treatment of acute appendicitis in pregnancy, in principle, it should be safe from the pregnant woman, the disease within three months of pregnancy, the principle of treatment is the same as that of non-pregnant patients, emergency appendectomy is best; acute appendicitis in the second trimester, the symptoms are still severe Treatment is good; late pregnancy appendicitis, about 50% of pregnant women may be premature, fetal mortality is higher, surgery should minimize the stimulation of the uterus.
The clinical misdiagnosis rate of acute appendicitis is quite high. Domestic statistics are 4-5%. Foreign reports are up to 30%. There are many diseases that need to be identified with acute appendicitis. The most important ones are the following ten diseases.
