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Cecal perforation causes, symptoms and complications
contents
- appendicitis
- Why does the appendix become inflamed??
- symptoms
- The breakthrough
- confusion
- diagnosis
- Healthy worm processes also come under the knife
- Even after the surgery, no clarity
- Antibiotics instead of surgery?
- Diagnosis too expensive?
- treatment
- The operation
- complications
- After the operation
appendicitis
An appendicitis (appendicitis) begins with a small inflammation on the appendix, the appendage to the caecum portion of the colon. This is especially common in children and adolescents. The main symptom is severe abdominal pain in the right lower abdomen. If the treatment starts on time, the inflammation can almost always be controlled. For this purpose, the biologically redundant appendix is removed in one operation.
A so-called appendectomy is the most common complication of inflammation of the appendix. Especially for these are massive pelvic pain on the right side. (Image: sirastock / fotolia.com) Why does the appendix become inflamed??
The appendix is a ten-centimeter-long intestinal tube. It ends blindly, and the opening connects it to the cecum. In appendicitis, not the cecum now ignites, but the appendix, because the connection to the cecum is blocked. Then fluids accumulate in the appendix. Thus, bacteria multiply from the colon and cause the inflammation.
Mostly the opening is blocked by feces, this is hardened feces; A kinking of the appendix in the abdomen can cause inflammation. Occasionally, foreign bodies such as bone fragments or fruit kernels cause constipation. Parasites, viruses and bacteria can also ignite the appendix.
symptoms
If the child falls into the well, the appendix has burst, it is too late to pay attention to symptoms. But this is preceded by a prolonged inflammation. The first signs are acute abdominal pain at the level of the navel or in the stomach area, which migrate into the lower abdomen - on the right side.
Unusual for abdominal pain is now: The abdominal wall is extremely tense and contracts even with gentle touch, causing further pain.
Non-specific symptoms such as fever, nausea and vomiting may be added. However, in the elderly, inflammation of the appendix almost always begins without fever and severe pain, while the pain is highest in toddlers.
If the inflammation increases, the appendix may burst. A dangerous development because it can quickly lead to peritonitis. (Image: bilderzwerg / fotolia.com) The breakthrough
If the inflammation worsens and the appendix breaks through, it becomes critical. Bacteria spread with the intestinal contents in the abdominal cavity, there arise pus and it often causes peritonitis.
The pain increases rapidly and spreads throughout the abdomen, the muscles tense, and the abdominal wall becomes hard. The affected must urgently to surgery - because an inflammation of the peritoneum can be fatal.
Therefore, you should consult a doctor for severe abdominal pain that increase.
confusion
The pains of appendicitis in women are easily confused with menstrual pain, inflammation of the ovaries and ectopic pregnancies.
diagnosis
The doctor presses on certain regions of the abdomen and determines if the pressure causes pain. If the pelvic pain occurs right, appendicitis is the cause.
Physicians are mainly pushing for the "Lanz Point". This is located in the right third of a line between the left and right bony prominences of the ilium. Pain on pressure on the Mc Burney point, which lies in the right third of a line between the navel and the right bony prominence of the iliac bone, may be an indication of appendicitis. Then the doctor measures fever: In appendicitis, the temperature in the anus is at least one degree higher than under the armpit.
In the laboratory, blood tests provide information - so in an inflammation, the white blood cells (the immune system) and the C-reactive protein are increased. An ultrasound scan indicates the inflamed appendix. However, safety is only a microscopic examination - and many doctors consider this too time-consuming.
In women, a gynecological examination shows if there are other causes such as ovarian inflammation.
By applying pressure to certain areas of the abdomen, the doctor can tell if an appendectomy is an option. (Image: Pormezz / fotolia.com) Healthy worm processes also come under the knife
Doctors also accidentally cut out healthy appendages. Up to 40% of the cut out worm shoots are not infected at all.
Is it a botch? It is not that easy. Typical of "appendicitis" are pains that move from the navel into the right lower abdomen. An appendicitis, however, shares its symptoms with other ailments that can have various causes - from an ectopic pregnancy to food poisoning. This means that no doctor can be absolutely sure before surgery that the appendix is inflamed.
Even after the surgery, no clarity
Before the operation, ultrasound, physical examination and blood count are just suspicions. Sometimes even on the out-cut vermiform appendix, it is not possible to detect whether there is inflammation.
Antibiotics instead of surgery?
A 2015 study of 530 adult volunteers found that simple inflammation of the appendix can be cured by up to 70% with antibiotics. A CT had previously proven simple appendicitis.
Diagnosis too expensive?
Skeptical surgeons consider such a diagnosis too time-consuming. A computerized tomography would greatly extend the diagnostics. In addition, you would need to observe the patients who take antibiotics, stationary. This was disproportionate to the fact that every third patient would be operated on despite CT and antibiotics in the end.
treatment
If you have the suspicion that your appendix is inflamed or even breaks through, do not eat anything and go immediately to the doctor or even better to the hospital and be examined.
Almost always an inflamed appendix is removed, so cut out in one operation. Here, the sooner, the better. It makes no sense to "save" a biologically redundant organ, but it makes perfect sense to avoid a dangerous appendectomy.
However, if the appendix has already broken through, an immediate operation is not possible. Now the infection has to be pushed back - with antibiotics and fluids being introduced via a vein. If the condition of the patient improves, the operation is performed.
After the operation you stay in the hospital for several days.
An inflamed "cecum" is almost always treated surgically. The procedure can be open or minimally invasive. (Image: asawinklabma / fotolia.com) The operation
The removal of the appendix is one of the most common operations on the abdomen. Traditionally, the operation is open, so the surgeon cuts open his stomach. Modern is a minimally invasive approach with three small cuts, the so-called keyhole technique. This has the advantage that only three scarcely visible scars remain instead of a longer cut scar.
Both procedures take between 20 and 30 minutes.
In open surgery, the surgeon opens the right lower abdomen with a cut about six centimeters long. Then he separates the appendix from the appendix and takes it out. He sewn the opening with the so-called purse-string stitching from the inside to the outside; the threads dissolve themselves.
If the appendix has broken through, then the doctor mechanically rinses out the opened abdomen and thus removes feces, bacteria and pus. In addition, drains drain the inflammatory fluid from the body.
In laparoscopic appendectomy, the surgeon inserts an endoscope into the abdominal cavity, which blows carbon dioxide gas into the abdomen. A camera shows the entire abdominal area. Two more cuts in the lower abdomen bring more guide sleeves with micro-instruments to the appendix.
The surgeon now inserts two self-knotting slings, separating the worm appendix from the cecum with it, and removing it with a guide sleeve. Then he sews the three small steps from the inside out.
complications
Any surgical procedure in the body carries a risk, but when removing the appendix, complications are extremely rare. It can come as with all operations to rebleeding, the internal wounds can be infected.
After removal of the appendix, there may be an abscess in the abdominal wall. Here pus then accumulates, which the doctor has to remove. However, this is more common because of the size of the incision, in open surgery.
The Douglas abscess is more dramatic. He forms about a week after the operation, accompanied by high fever and pain. Here, the pus at the lowest point of the abdominal cavity collects and a second operation is pending.
After the operation
If no complications occur, then the patient can drink again a few hours after the operation, one day later he may eat again. But this is not a "law", but the doctors observe exactly how the intestinal function regenerates.
After four days, most of the patients are discharged from the hospital, but should be able to spare themselves for several days. Especially walking causes pain and those affected have to take longer breaks. They can usually return to work after two to three weeks. (Dr. Utz Anhalt)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)