What are the symptoms of appendicitis?

Appendicitis is the most common problem, which can be divided into acute appendicitis and chronic appendicitis. Acute appendicitis, in particular, develops rapidly and causes greater harm. The most obvious symptoms are abdominal pain and muscle tension, especially in the right upper abdomen. Therefore, it is important to pay attention to the diagnosis through B-ultrasound, so as to adopt scientific and effective treatment methods and avoid misdiagnosis.

(I) Low-position (pelvic) acute appendicitis: When the cecum descends too much or the right colon is free and lacks fixation, the appendix may be located below the iliac spine line or even completely enter the pelvic cavity. The clinical estimated incidence of pelvic acute appendicitis is about 4.8% to 7.4%, which manifests as migratory abdominal pain, but the location of the abdominal pain and the tenderness area are both lower, and the muscle tension is also lighter. During the course of the disease, there may be symptoms of rectal irritation such as increased bowel movements and anal distension; or bladder irritation symptoms such as frequent urination and urgency. The treatment of low-position appendicitis is the same as that of general appendicitis. Emergency surgery is required to remove the appendix. During the operation, the location of the cecum and appendix should be carefully explored, and the inflammatory adhesions should be separated. The appendix should be completely freed before being removed.

(ii) High-level (subhepatic) acute appendicitis: When the intestine is congenitally rotated and descended incompletely, the cecum and appendix may remain under the liver; when the acquired appendix is ​​too long, the tip may also extend outside the liver. In subhepatic appendicitis, abdominal pain, tenderness and muscle tension are all limited to the right upper abdomen. Clinically, it is often mistaken for acute cholecystitis. If necessary, an abdominal B-ultrasound examination should be performed. If it is confirmed that the gallbladder is of normal size, with a clear outline and no foreign body echo in the gallbladder cavity, high-level appendicitis should be considered. Once the diagnosis is confirmed, the appendix should be removed as a last resort.

(III) Left-sided acute appendicitis: Due to congenital heterotopy of abdominal viscera, the cecum may be located in the left lower abdomen. The acquired free cecum may also move and adhere to and fix in the left lower abdomen, and the appendix is ​​also fixed in the left iliac fossa. Left-sided acute appendicitis is extremely rare. Its pathological type and course of disease are the same as those of right-sided acute appendicitis. There is metastasis to the left lower abdominal pain, tenderness and muscle tension, which are also limited to the left medullary fossa. When considering the possibility of left-sided acute appendicitis, a careful physical examination and X-ray examination of the chest and abdomen should be performed. After the diagnosis is confirmed, the appendix can be removed through an oblique incision in the left lower abdomen.