Acute appendicitis is a common disease in surgery, ranking first among all kinds of acute abdomen. Fitz was first named in 1886, and McBurney put forward the idea of surgical treatment of this disease in 1889. Over the past century, due to the improvement of surgical techniques, anesthesia, antibacterial treatment and nursing, most patients have been cured, and the mortality rate has dropped to about 0.65438 0%. Metastatic right lower abdominal pain, tenderness at appendix point and rebound pain are common clinical manifestations, but the condition of acute appendicitis is varied, so we should pay attention to each specific case, ask the medical history in detail and check it carefully, so as to accurately diagnose, operate early, prevent complications and improve the cure rate.

diagnose

1. Symptoms: Metastatic right lower abdominal pain is a typical clinical manifestation of acute appendicitis. When the cecum and appendix are located in the lower left abdomen, the possibility of left appendicitis should also be considered because of metastatic lower left abdominal pain. The location of the initial pain and the time required for the transfer process vary from person to person. However, it should be noted that about 65,438+0/3 patients begin with pain in the right lower abdomen, especially in the acute attack of chronic appendicitis. Therefore, there is no metastatic right lower abdominal pain, and the existence of acute appendicitis cannot be completely ruled out. We must combine other symptoms and signs to make a comprehensive judgment. Others may have gastrointestinal symptoms such as nausea and vomiting. There may be no fever in the early stage, and there will be obvious symptoms of systemic poisoning such as fever when the appendix is suppurated, necrotic or perforated.

2. Physical examination: tenderness of the right lower abdomen and different degrees of peritoneal stimulation are its main signs, especially when the early conscious abdominal pain of acute appendicitis is not fixed, there is tenderness in the right lower abdomen. When appendiceal perforation complicated with diffuse peritonitis, although abdominal tenderness is extensive, it is still most obvious in the right lower abdomen. Sometimes in order to know the exact location of tenderness, the whole abdomen should be carefully and repeatedly examined. The tenderness of acute appendicitis is always in the right lower abdomen, which may be accompanied by abdominal muscle tension and rebound pain in different degrees.

3. Auxiliary examination: The total number of white blood cells and neutrophils in blood can be slightly or moderately increased, and stool and urine routine can be basically normal. Chest fluoroscopy can exclude the right chest diseases and reduce the misdiagnosis of appendicitis. Standing on the abdominal plain film to observe whether there is free gas under the diaphragm can rule out the existence of other surgical acute abdomen, and B-ultrasound examination of the right lower abdomen to know whether there is inflammatory mass is helpful to judge the course of disease and decide the operation.

4. Young women and married women with a history of menopause, when in doubt about the diagnosis of acute appendicitis, should ask for gynecological consultation to rule out ectopic pregnancy, ovarian follicular rupture and other diseases.

Treatment measures

A, non-surgical treatment:

It is mainly suitable for simple appendicitis, appendiceal abscess, appendicitis in early and late pregnancy and appendicitis in the elderly with major organ diseases.

Basic treatment: bed rest, diet control, proper rehydration and symptomatic treatment.

2. Antibacterial treatment: broad-spectrum antibiotics (such as ampicillin) and anti-anaerobic drugs (such as metronidazole) can be used for intravenous drip.

3. Acupuncture treatment: You can choose Zusanli and Appendices for strong stimulation, and keep the needle for 30 minutes, twice a day for 3 consecutive days.

4. Chinese medicine treatment: external application is suitable for appendiceal abscess, and "Sihuang Powder" can be selected; Oral administration mainly focuses on clearing away heat and toxic materials, activating qi and promoting blood circulation, dredging interior and attacking toxin, and can add or subtract "Dahuang Mudan Pi Decoction".

Second, the surgical treatment:

1, operation principle: after the diagnosis of acute appendicitis is confirmed, early operation should be performed, which is safe and can prevent complications. Early operation refers to the removal of the appendix when the lumen is still blocked or there is only congestion and edema. At this time, the operation is simple. If it is difficult to operate again after suppuration or gangrene, the postoperative complications will increase obviously.

2. Surgical choice: Different clinical types of acute appendicitis have different surgical methods.

1) acute simple appendicitis, appendectomy, primary suture of incision. In recent years, laparoscopic appendectomy has been used for this type, but it requires skilled technology.

2) Acute suppurative or gangrenous appendicitis, appendectomy; If there is pus in the abdominal cavity, the peritoneum can be closed after the pus is discharged, and latex sheets can be placed in the incision for drainage.

3) Periappendiceal abscess, if there is no limited trend, should be cut and drained, and whether the appendix can be removed can be decided according to the specific situation during the operation; If the appendix has fallen off, try to take it out and close the cecum wall to prevent intestinal fistula. If the abscess is confined to the right lower abdomen and the condition is stable, do not force appendectomy, give antibiotics and strengthen the whole body support treatment to promote the absorption of pus and the disappearance of abscess.

3, surgical methods:

Epidural anesthesia is generally used for (1) anesthesia.

(2) The incision should be located at the most obvious tenderness of the right lower abdomen. Generally, right lower abdomen oblique incision (McBurney incision) or right lower abdomen transverse oblique incision is adopted. The skin is cut along the direction of dermatoglyphics, which has little damage to blood vessels and nerves. This kind of oblique incision, because the fiber direction of the three layers of abdominal muscles is different, the incision heals firmly after operation, and incision hernia is not easy to occur. However, because this kind of incision is not convenient to explore other parts of abdominal cavity, the right lower rectus abdominis incision should be chosen for the exploration operation with unknown diagnosis, and the incision should not be too small.

(3) Find the appendix, push the small intestine inward with gauze pad, find the cecum first, and then trace it to the top of the cecum along the three colon bands to find the appendix. If you still can't find it, you should consider the possibility that the appendix is at the back of the cecum, then cut the lateral retroperitoneum and turn the cecum out to find the appendix. After finding the appendix, clamp the appendix with an appendix forceps or clamp mesoappendix with a hemostatic forceps, and take out the appendix from the incision. If it can't be put forward, it is also necessary to strictly protect all layers of tissue in the incision before appendectomy.

(4) mesoappendix's treatment The appendix artery is generally located at the free edge of mesoappendix. When infection and inflammation get worse, the mesentery is fragile and easy to clip. The appendix artery should be cut and ligated at the root of the appendix as much as possible. If the mesentery is wide and thick, it should be removed and ligated step by step.

(5) Treat the appendix root, gently clamp it at the appendix root 0.5cm away from the cecum, then tie a knot with silk thread, cut off the appendix at the far end of the silk thread, clean the stump with iodine and alcohol, and wrap it in the cecum wall with purse-string suture. Pouch suture should not be too large to prevent residual dead space in the intestinal wall. Finally, cover and reinforce with mesoappendix or adjacent adipose connective tissue (Figure 1).

1. Remove the appendix.

2. The seromuscular layer on the cecum wall.

3. Remove the appendix at the root of the appendix

4. Tighten the purse-string suture and bury the stump in the cecum wall.

Figure 1 appendectomy

(6) Appendectomy under special circumstances

1) The appendix is attached and fixed behind the peritoneum, which cannot be removed by conventional methods. Instead, it is suggested to perform retrograde resection, that is, cut off the appendix at the root, embed the stump, and then cut off the mesoappendix in sections to remove the whole appendix.

2) The inflammatory edema of cecum wall is serious, and the appendix stump can't be buried by purse-string suture as usual. The appendix can be cut off at the root of the appendix, and buried in the appendix stump by the method of inverted suture of discontinuous silk seromuscular layer. If it still can't be buried, cover the stump with adipose connective tissue from mesoappendix or nearby.

3) Appendicitis is very edema, fragile and easy to tear, and the root can't be clamped. Pouch suture can be used on the cecum wall, and the appendix stump that can't be ligated is buried in the cecum cavity, and the discontinuous silk pulp muscle layer is added to flip suture.

I hope it works for you.