appendicitis

Quick Overview

• symptomsStinging or pulling abdominal pain – usually in the right lower abdomen, loss of appetite, nausea, vomiting, diarrhea or constipation, documented tongue, fever, sometimes increased pulse and night sweats.
• causesClosure of the appendix due to hardened faeces (feces) or an unfavorable position (kinking), more rarely due to foreign bodies or intestinal worms. Other inflammatory bowel diseases such as enterococci, Crohn’s disease or ulcerative colitis.
• treatment: Complete removal of the inflamed appendix (appendix) by classical surgery or laparoscopy (keyhole method).
• complications: If left untreated it can lead to intestinal perforation (perforation) followed by life-threatening peritonitis (peritonitis). Intestinal paralysis, intestinal obstruction. In addition, the inflammation can spread to other areas of the intestine. Fistula formation in Crohn’s disease patients possible.
• Forecast: With rapid treatment, appendicitis usually heals completely and leaves no lasting damage.

Appendicitis: symptoms

Physicians divide appendicitis according to severity in two forms – simple and destructive appendicitis:

In the simple appendicitis (Appendicitis simplex) the tissue is inflamed but not destroyed. There are two stages of the disease here:

• in the catarrhal stage the inflamed appendix is ​​swollen and red, but no pus is formed. The inflammation can spontaneously regress.
• in the seropurulent stage the appendix is ​​inflamed and pus accumulates. Within 24 to 48 hours it can develop a destructive appendicitis:

In the destructive (destructive) appendicitis (Appendicitis destructiva) the inflamed tissue gradually decays. The vermiform appendage may burst (Intestinal perforation, Perforation). Inflammatory contents (bacteria) get into the abdominal cavity, which also causes the Ignite the peritoneum can (peritonitis or peritonitis).

Peritonitis can be life threatening! The risk of this complication increases significantly in appendicitis after about 48 hours. If you suspect appendicitis, you should therefore go to the doctor immediately!

Appendicitis: symptoms in the initial stages

At the beginning of an appendicitis usually unspecific complaints appear, which could also point to other illnesses. This is how many patients initially feel stinging or pulling pain in the upper abdomen or at navel level, which may initially be misinterpreted as stomach discomfort. Within hours, more symptoms will be added.

Appendicitis: Symptoms in the acute phase

In the acute phase, the walk Pain in the right lower abdomen and reinforce themselves there. They may also radiate to the left lower abdomen or affect the entire abdominal area. Where exactly it hurts depends on the position of the appendix, which can vary from person to person. In addition, the appendix may change its position, such as during pregnancy.

Typical of the acute phase of appendicitis is that the pain suddenly becomes stronger, especially when running. Patients also can not lift their right leg painlessly, so they attract it like a stork while walking (already limping). For the medical routine suspected appendicitis, it is therefore necessary to check whether the patients can bounce painless.

Other symptoms in appendicitis in the acute phase are:

• Fever up to 39 degrees, rarely very high fever
• anorexia
• nausea
• Vomit
• Diarrhea or constipation
• occupied tongue
• sometimes increased heart rate and night sweats

Appendicitis in children, pregnant women and seniors

In children, pregnant women and the elderly, appendicitis often deviates, which can make the diagnosis more difficult:

children usually suffer from stronger syndromes than older people. In addition, the pain in small patients often extends over the entire abdominal area and are accompanied by severe nausea.

at older people appendicitis symptoms such as pain and vomiting are usually less intense. Even fever rarely occurs.

at pregnant The appendix is ​​displaced from the lower abdomen into the right upper and middle abdomen by the growing unborn child. The characteristic of appendicitis pain then occur in atypical places, often even in the back.

Chronic appendicitis: symptoms

Chronic appendicitis is not limited to a specific period, but occurs again and again. The typical symptoms only appear briefly over several years and then disappear again after a few hours. Doctors also refer to this as chronic recurrent appendicitis.

Appendicitis: treatment

An appendicitis usually involves surgery: The surgeon removes the inflamed appendix (appendectomy).

Appendicitis is rarely treated non-operatively (conservatively) today (abstinence from food, bed rest, antibiotics). It can lead to complications relatively untreated relatively quickly.

For the appendectomy, two methods are available: classic appendectomy with a large abdominal incision (laparotomy) and the minimally invasive (laparoscopic) method. Both are performed under general anesthesia and take about 20 minutes.

Classic appendectomy

In the classic, open surgery, the surgeon opens the right lower abdomen with a cut of about five centimeters (laparotomy). He cuts out the inflamed appendix and then sutures the wound edges. This method can leave a scar on the lower abdomen.

Laparoscopic appendectomy

Laparoscopy is also called operative laparoscopy or Keyhole method known. In this procedure, three very small abdominal incisions are made. Through one of the cuts, the surgeon inserts a rod-like device (the laparoscope) into the abdomen. A light source and a camera are connected to the laparoscope. The camera transmits the image of the abdominal area live on a monitor so that the surgeon sees what he is doing. About the other two sections of the physician introduces the necessary instruments. As a result, he removes the appendix, as in the classic operation, and subsequently sutures the wound.

For a better view, the abdominal area is filled with gas (carbon dioxide).

The laparoscopic method has several advantages: For example, the small abdominal incisions usually leave no visible scars. The pain after laparoscopic surgery is generally less than after an open procedure. In addition, wound infections are less common. However, any internal bleeding can not be as well as an open surgery. In addition, the operation time is slightly longer than the open procedure.

The keyhole method is suitable especially in the early stages of appendicitis, If the inflammation is more advanced, doctors prefer the classic surgical method.

After the operation

After removal of the appendix, you usually have to stay in the hospital for a few days. During this time, the doctors monitor the bowel function: they look to see if the intestine resumes its normal activity quickly. Sometimes you get infusions to make sure your body is getting enough nutrients and fluids.

As a rule, you are allowed to drink something in the evening after the operation. However, you should not eat solid food until the following day.

After the procedure, walking may initially be painful and you should spare a few days. For this you will usually be on sick leave for two to three weeks.

Many clinics today use self-dissolving threads to suture the abdominal wall. Threads that do not self-dissolve are usually pulled in the week after surgery. This can also be done on an outpatient basis.

Sometimes the surgeon drains the appendix, which is a thin tube that delivers any wound fluid or pus from the abdominal cavity to the outside. This tube will be removed a few days after the procedure.

Possible complications

As with any other surgery, it may also be after cecal surgery Bleeding or infections come. The risk is relatively low, however, because the procedure is very frequent and therefore routine for many surgeons.

Some days after the operation, pus can accumulate under the abdominal wall, which must be drained. Doctors then speak of one Abdominal abscess.

If there is a sudden fever and pain in the intestinal area about a week after the operation, this can be due to a so-called Peritoneal abscess clues. Then pus accumulated in the deepest place of an abdominal cavity. The abdominal cavity abscess is treated by another operation.

Rare but serious complications are after an appendectomy Scarring (adhesions) in the abdomen. They stick the abdominal organs, such as the intestinal loops, so that the chair can not be transported further unhindered. This complication manifests itself in the first three weeks after surgery. Usually a new operation is necessary.

Appendicitis: causes and risk factors

The term appendicitis is common, but medically incorrect. In fact, it is an inflammation of the appendix (appendix), which hangs on the cecum. He is about the size of a little finger and has no function for the digestion.

An inflammation of the appendix (appendicitis) is usually caused by the fact that the connection between the cecum and the appendix clogged. This closure can be through faecal stones (hardened faeces), rarely also by foreign body like cherry or melon seeds are made. Then secretions accumulate in the appendix, which causes large intestinal bacteria to multiply well and cause inflammation. Even if the worm appendage is unfavorable and, for example bends, secretions can accumulate in them and cause inflammation.

Only very rare Tumors or intestinal worms responsible for appendicitis.

The appendicitis can also inflammatory-bowel disease (Crohn’s disease, ulcerative colitis). The inflammation can spread from the place of origin (primary site of inflammation) to the appendix.

Also bacterial infections come as a cause of appendicitis in question. They can affect various sections of the intestine, including the appendix.

Appendicitis: examinations and diagnosis

In the beginning is the Survey of the medical history (Anamnesis): The doctor gives the patient a detailed description of his symptoms and asks for any underlying or previous illnesses. Possible questions for the medical professional include:

• Where exactly do you feel abdominal pain?
• Can you describe the nature of the pain (colicky, stabbing, etc.)?
• Do you have any other complaints, such as nausea, vomiting or lack of appetite?
• Since when do you have complaints?
• Do you have any pre-existing conditions?
• Have you ever been operated on the abdomen?
• In women: Are you pregnant?

Physical examination

After the anamnesis interview follows a physical examination: First, the doctor gropes the lower abdomen with a view pain points typical of appendicitis:

1. McBurny point: It is in the middle of the connecting line between the belly button and the right projection of the hip bone.
2. Lanz Point: It lies between the right and middle thirds of the connecting line between the two protrusions of the hip bones.

If the doctor easily presses on these two points, a healthy person feels no particular pain. In appendicitis, on the other hand, the pressure causes severe pain, so that the patient tenses the abdominal wall reflexively – an almost certain indication of appendicitis.

In addition, other types of pain may indicate appendicitis:

• Rovsing symptom: severe pain when the colon is smeared in the direction of the right lower abdomen with light pressure
• Blumberg sign: Release pain when the doctor presses on the lower abdomen and then suddenly lets go
• Sitkowski characters: Stretching pain in the right lower abdomen when the patient lies on the left side.
• Psoas sign: severe pain if the affected person should lift his right leg against resistance

Since appendicitis is often with fever The temperature is usually measured once under the armpit and once in the rectum (rectally). Typical of appendicitis is the temperature difference – the temperature measured in the rectum is at least one degree higher than that measured under the armpit.

blood test

If there is a suspicion of appendicitis, then a blood test follows. If certain levels are increased, such as the number of white blood cells (leukocytes), this may indicate inflammation in the body. The same applies to an increased blood cell lowering rate (ESR) and an elevated CRP value (C-reactive protein).

However, the blood test does not show exactly where the inflammation is in the body. This question can only answer a physical examination.

Further investigations

In children, pregnant women and the elderly, appendicitis is often more difficult as the symptoms are not always clear. Then one can Urinalysis be useful to exclude diseases of the kidneys and urinary tract as the cause of the complaints.

Imaging procedures can also help with unclear diagnosis: Im Ultrasonic appendicitis is a shadow in the picture. In complicated cases in which the symptoms can not be clearly assigned and, in addition, complications must be expected Computed tomography be displayed.

Gynecological diseases such as ovarian or oviduct can cause symptoms similar to appendicitis. Therefore, in patients with suspected appendicitis one gynecological check advisable.

The last certainty with unsafe appendicitis diagnosis brings only one laparoscopy (Laparoscopy): A look inside the abdominal cavity lets the doctor clearly identify whether appendicitis is present or not. If so, he can remove the inflamed tissue as part of the laparoscopy (laparoscopic appendectomy).

Appendicitis: history and prognosis

Basically, appendicitis can occur at any age. Mostly, however, adolescents between the ages of 10 and 19 are affected. Infants and the elderly are less likely to have appendicitis. Every year, an average of 110 out of 100,000 inhabitants contract appendicitis. Overall, about seven percent of the population in Germany get appendicitis once in their lives.

The forecast appendicitis depends on how early it is recognized and treated. If you remove the inflamed appendix prematurely and completely, the prognosis is usually good – the appendicitis usually heals without consequential damage.

However, if appendicitis is recognized and treated late, it can be life-threatening. Due to the increasing pressure in the appendix, it can lead to Intestinal perforation (perforation) come. This creates a hole in the intestinal wall through which faeces and bacteria enter the surrounding abdominal cavity. This can be a life threatening one Peritonitis (peritonitis) lead, which must be operated on immediately.

Untreated appendicitis can also spread to surrounding intestinal tissue. As a rule, a larger and more difficult operation is necessary. Seldom can an appendicitis as well Intestinal paralysis or one Intestinal obstruction (ileus) entail. In Crohn’s disease patients may also be fistulas form. These are tubular connections between organs, in this case between appendix and other intestinal sections.

Such complications one appendicitis but occur only very rarely.