Would you know if you had appendicitis?

Appendicitis

What is appendicitis?

The small intestine opens laterally into the large intestine, so that a blind end is created beyond this junction. This is known as the appendix and is usually located in the right lower abdomen. There is an approximately 8 cm long, worm-shaped appendix on the appendix, which doctors refer to as the "appendix". It has an entrance but no exit.
In the case of so-called "appendicitis", it is not the appendix that becomes inflamed, but its appendix. Doctors therefore do not speak of appendicitis, but of "appendicitis". The diagnosis "appendicitis" is most often made in children between the ages of 10 and 15 years. It occurs rather rarely in the first two years of life Men get sick more often than girls and women.
 
At the first signs of appendicitis (abdominal pain, vomiting, diarrhea), the patient should seek medical treatment in good time to minimize the risk of complications. It is important that pain-relieving medication is not administered at first, as the pain relief alleviates the pain symptoms and makes it difficult for the doctor to make an accurate diagnosis.

Appendectomy operations are now a standard procedure in surgery and usually do not take longer than a few minutes.

causes

The appendix contains many lymph nodes and is therefore also known as the "intestinal tonsil", i.e. the "intestinal almond". Since its appendage has an entrance but no exit, it represents a dead end. Therefore, food particles easily accumulate in it, which can cause inflammation. Common causes of appendicitis are

  • a blockage with feces
  • a kinking of the appendix
  • Intestinal infections.

In rare cases, other diseases, such as a worm infestation, but also foreign bodies such as cherry pits or tumors, trigger appendicitis.

Symptoms & clinical picture

The typical symptoms of appendicitis are vomiting and often severe abdominal pain. These mostly cramp-like pains often begin in the area of ​​the navel and then move to the right lower abdomen. They are especially aggravated when walking or hopping on the right leg. In addition, the pain is aggravated by coughing and sneezing. The entire area of ​​the abdominal wall is tense and extremely sensitive to pressure. In addition, those affected usually suffer from nausea and loss of appetite. In addition, a slight fever (approx. 38 ° C) can occur. A difference of more than 1 ° Celsius between the temperature measured in the armpits and in the intestines is typical.

In small children under four years of age, however, the typical symptoms rarely occur, and sometimes the symptoms are not clear. Therefore, appendicitis is sometimes diagnosed late in kindergarten age. Often a completely different disease is hidden behind abdominal pain, such as tonsillitis or headache, because children up to the age of eight to ten cannot tell exactly where something is wrong in the body. The child may have worries or fears and suffer from abdominal pain as a result.

If a child has unexplained abdominal pain for more than three hours, they should always be taken to a pediatrician or immediately to the hospital. When diagnosing "appendicitis", the attending physician will weigh up whether an immediate operation is necessary or whether a surgical procedure can still be awaited.

Complications

If appendicitis is suspected, a doctor should be consulted in any case! If the appendicitis is not treated in time, the appendix can either become brittle or even break through completely. In this case, one speaks of a ruptured appendix or a perforation. Feces and bacteria then get into the abdominal cavity and under certain circumstances lead to life-threatening peritonitis (peritonitis). Such an infection can lead to infertility in girls or young women.

With purulent appendicitis, there is a risk of wound infections or accumulations of pus (abscesses) in the abdominal cavity.
After the operation, the loops of the intestine stick together due to scarring in about 2 to 4% of patients. Then it is not uncommon for a new operation to be necessary.

If the diagnosis is made in good time without any indication of existing complications, the doctor can initially opt for conservative therapy with short-term checks. The advantage consists in avoiding possible operative complications.

diagnosis

Since the symptoms are only present in their typical form in around 50% of all cases, the diagnosis of appendicitis is not always as easy as the medical layperson imagines, even for experienced surgeons. Because of this, paediatricians will often have to work together. The doctor can only diagnose appendicitis with certainty when he has opened the abdomen and sees the appendix in front of him.
Since children up to the age of eight to ten years cannot tell exactly where a disorder is in the body and therefore often complain of abdominal pain even though they have another disease, the pediatrician will not only palpate the stomach, but also look in the throat and listen to the chest and abdomen. He will observe how the child is behaving in order to assess how severely impaired it is. He will also let the child jump, as children with appendicitis tend to avoid vibrations.

The usual examinations also include measuring the body temperature in the armpits and anus as well as examining blood and urine. Elevated leukocytes (white blood cells) and other inflammatory parameters in the blood can reinforce the suspicion of appendicitis. A difference of more than 1 ° Celsius in the measured temperature of the armpits and intestines can also be an indication. Careful palpation of the rectum with the finger (digito-rectal examination) is also part of the diagnosis.

In addition, suspicion of appendicitis can be confirmed by a sonographic examination (ultrasound). Unfortunately, because of the air in the abdomen, the view is not always optimal, but the doctor can see whether fluid has accumulated in the abdomen and in this way estimate how far the disease has progressed. In general, the sooner the doctor is consulted, the faster he can recognize and treat the disease.

In the case of chronic inflammation, an X-ray examination with a contrast agent is indicated in addition to the blood test.

Based on the results of the examination, the doctor makes the decision to operate immediately or to wait with conservative measures such as bed rest or antibiotics.

therapy

In the case of uncomplicated acute inflammation of the appendix, treatment with an antibiotic can be carried out in certain cases. The inflammation often subsides within 48 hours. However, in the following years, appendicitis recurs in many children.
Surgical removal of the inflamed appendix is ​​often the only way to successfully treat appendicitis even after antibiotics have been administered. In order to avoid a rupture of the appendix, the doctor will usually initiate the operation (OP) within 24 hours.

A distinction is made between two surgical methods:

  • The minimally invasive operation with an endoscope under general anesthesia.
  • The conventional operation under general anesthesia, in which the surgeon makes a small, about six centimeter long, horizontal incision on the right side below the navel.

The surgeon decides on the method of choice. After a minimally invasive operation, children can usually leave the hospital faster than after a conventional operation. However, the minimally invasive procedure takes longer. If it turns out during the procedure that there is more extensive inflammation, you can switch from a minimally invasive procedure to the conventional surgical method at any time.

Regular blood tests are carried out if the patient waits to have surgery. On the basis of the inflammation parameters in the blood, the doctor then makes the decision to operate immediately or to wait with conservative measures such as bed rest.

swell

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    doi: 10.1542 / peds.2017-0048.
  • Bublack, R .: Children's emergency. Uncomplicated appendicitis: antibiotics vs. knife. www.springermedizin.de 6.4.2017.
  • Gorter, R.R. et al., Diagnosis and management of acute appendicitis. EAES consensus development conference 2015. Surg Endosc 30, 4668 (2016).
  • Huang, L. et al .: Comparison of antibiotic therapy and appendectomy for acute uncomplicated appendicitis in children. Jama Pedatr. 171 (5), 426 (2017).
  • Kraus, D .: Time window of 24 hours - appendicitis does not require emergency surgery. www.springermedizin.de June 27, 2017.
  • Krohn, K. et al., Acute Childhood Abdominal Pain. These signs give away an emergency. MMW update Med. No. 4 (154th year), 47 (2012).
  • Oberhofer, E .: Clarifying appendicitis in children. From feces to ileus - what the ultrasound reveals. MMW update Med. 157 (13), 20 (2015).
  • Oberhofer, E .: Trend in the USA. Appendicitis in children is increasingly being treated conservatively. www.springermedizin.de June 19, 2017.
  • Serres, S. K. et al .: Time to appendectomy and risk of complicated appendicitis and adverse outcomes in children. JAMA Pediatr. 171 (8), 740 (2017).
    doi: 10.1001 / jamapediatrics.2017.0885.

Author: äin-red

Technical support: Prof. Dr. Hans-Jürgen Nentwich

last change: 06.10.2017