What to do if your appendix hurts? Beware of appendicitis

If you experience appendicitis pain in your life, it must be appendicitis. The most obvious symptom of appendicitis is appendicitis pain. The pain caused by appendicitis is very serious, especially acute appendicitis. It is sometimes easy to misdiagnose, so a correct diagnosis must be made in time.

1. Treatment of appendicitis

Ectopic acute appendicitis is difficult to diagnose and is often misdiagnosed as an inflammatory disease of the organ in the ectopic location. For example, subhepatic or high-positioned acute appendicitis is often misdiagnosed as acute cholecystitis, and acute appendicitis deep in the female pelvis is misdiagnosed as an inflammatory disease of the pelvic organs. When ectopic location is in the left lower abdomen, it is generally difficult to diagnose preoperatively unless the midgut is known to have non-rotational deformity or is accompanied by dextrocardia. Therefore, for patients with pain and fixed tenderness located outside the right lower abdomen, a careful medical history and a comprehensive physical examination must be conducted to consider the possibility of ectopic appendicitis.

2. Disease Diagnosis

Ectopic acute appendicitis is difficult to diagnose and is often misdiagnosed as an inflammatory disease of the organ in the ectopic location. For example, subhepatic or high acute appendicitis is often misdiagnosed as acute cholecystitis, and acute appendicitis deep in the female pelvis is misdiagnosed as an inflammatory disease of the pelvic organs. When the appendix is ​​ectopic in the left lower abdomen, it is generally difficult to make a clear diagnosis before surgery, unless the midgut is known to have a nonrotational deformity or is accompanied by dextrocardia. Therefore, for patients with pain and fixed tenderness outside the right lower abdomen, a careful medical history and a comprehensive physical examination must be conducted to consider the possibility of ectopic appendicitis.

3. Symptoms and Signs

(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 an emergency.

(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 the possibility of left-sided acute appendicitis is considered, 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.