Acute appendicitis

Introduction to acute appendicitis Acute appendicitis is commonly known as "cebiitis", which is a misunderstanding on the anatomical site. The actual appendix is a disused organ at the end of the cecum. If an infection occurs, it is prone to inflammation and causes disease. The cause may be caused by fecal stone obstruction, lymphoid hyperplasia, parasitic invasion and the like. According to the severity and severity of the disease, the disease can be divided into acute, subacute and chronic diseases, such as abscess, gangrene and perforation leading to peritonitis. General diagnosis and treatment is not difficult and is good afterwards. But because the end of the appendix can be located almost anywhere on the abdomen. Therefore, the signs may vary greatly. Therefore, it must be carefully identified with other acute abdomen to avoid misdiagnosis. basic knowledge The proportion of illness: 0.85% Susceptible people: no specific population Mode of infection: non-infectious Complications: peritonitis sepsis

Cause of acute appendicitis

The pathogenesis of acute appendicitis is not yet certain, but most of the opinions suggest that several factors occur in combination. The recognized factors are as follows:

Obstruction (30%):

The appendix is a slender tube, and only one end is connected to the cecum. Once obstructed, the endocrine secretions can be accumulated, the internal pressure is increased, and the appendix wall is pressed to block the distal blood supply. On this basis, the bacteria in the lumen invade the damaged mucosa. It is easy to cause infection. Some people have found that gangrenous appendicitis has almost obstruction. The common causes of obstruction are: 1 blocked fecal stone in the appendix cavity, dried fecal mass, food debris, foreign body, aphid, etc. 2 The wall of the appendix was destroyed The stenosis or adhesion of the lumen is caused; 3 the appendix formed by the shortness of the appendix is too short, which hinders the patency of the tube; 4 the lymphatic tissue hyperplasia or edema in the wall of the appendix causes the lumen to narrow; 5 the opening of the appendix near the cecum is lesioned. Such as inflammation, polyps, tuberculosis, tumors, etc., so that the opening of the appendix is compressed, and the emptying is blocked. Among them, fecal stone obstruction is the most common, accounting for about 1/3.

Obstruction is a common basic factor in the pathogenesis of acute appendicitis. Therefore, the early stage of acute appendicitis often has xiphoid or umbilical colic, which is caused by obstruction of the appendix lumen and increased internal pressure. In addition, the specimens of the appendix are often seen. The fecal stone obstructs the lumen, and the distal end is obviously inflammatory and even gangrenous.

Infection (30%):

There are also cases of obstruction and the main cause of the direct infection caused by bacteria in the appendix cavity. The appendix cavity is connected with the cecum, so it has the same strain and quantity of Escherichia coli and anaerobic bacteria. If the appendix mucosa is slightly damaged, bacteria invade the wall, causing different degrees of infection. A small number of patients occur after the upper respiratory tract infection, so it is considered that the infection can be transmitted from the blood to the appendix, and some infections occur from the adjacent organs. Sexual infection, invading the appendix.

Other (10%):

Among other factors that are thought to be associated with the disease, visceral nerve reflexes due to gastrointestinal dysfunction (diarrhea, constipation, etc.) cause the appendix muscles and vasospasm. Once the normal strength is exceeded, the appendix lumen stenosis and blood supply disorders may occur. Impaired mucous membranes and acute inflammation caused by bacterial invasion. In addition, some people believe that the incidence of acute appendicitis is related to eating habits and heredity. The incidence of polycellular diet is low, which may be related to the rapid emptying of the colon and constipation, due to constipation. Habitual application of laxatives may cause intestinal mucosal congestion, but also affect the appendix. Some people believe that genetic factors are associated with congenital malformations of the appendix, excessive distortion, small lumens, long length, poor blood supply, etc. are prone to acute inflammation. conditions of.

Pathogenesis

1, pathological type

The basic pathological changes of acute appendicitis are tube wall congestion and edema, massive inflammatory cell infiltration, and tissue destruction. Therefore, it is divided into three types: simple, suppurative and gangrenous. The three are usually three different stages of inflammation development. However, it may also be three different direct consequences due to different factors of the disease. Due to concurrent perforation, combined with limited or diffuse peritonitis, the pathology of acute appendicitis is more complicated and variable.

(1) simple appendicitis: slight inflammatory changes in the appendix, edema congestion is not serious; or serosal hyperemia, inflammatory cell infiltration in all layers of the appendix wall, with a thick mucosa, superficial small bleeding point Or ulcers (Figure 3), such appendicitis is an early mild infection, clinical symptoms and body reactions are also light, if it can be treated in time, can achieve inflammation absorption, infection subsides, the appendix can return to normal.

(2) Suppurative appendicitis: caused by early inflammation, or due to obstruction of the appendix, internal pressure is increased, distal blood supply is severely blocked, infection is formed and spreads rapidly, resulting in suppurative or even cellulitis within a few hours. Sexual infection, swelling of the appendix is significant, the serosa surface is highly congested and there are more purulent exudates, some or all of which are covered by the omentum, a large number of inflammatory cells infiltrate in the wall of the appendix, and some have formed tiny abscesses. Or has been occupied by a large number of tiny abscesses of different sizes, there are purulent secretions in the appendix cavity, and there are obvious cases of Escherichia coli and anaerobic infection. Suppurative appendicitis can cause localized peritonitis around the appendix, but also because Perforation leads to diffuse peritonitis. The appendix of this appendicitis has different degrees of tissue destruction. Even if it is conservatively restored, the scar of the appendix wall shrinks, which can narrow the lumen and cause repeated inflammation (Figure 4).

(3) gangrenous appendicitis: due to aggravation of suppurative infection of the appendix, or due to severe obstruction of the appendix lumen, the appendix blood supply is completely blocked in a short period of time and causes appendix gangrene, reaching the most serious degree of acute inflammation of the appendix, according to The part of the appendix was blocked, and the appendix showed partial or complete necrosis. The necrotic part was purple-black. The mucosa was almost completely eroded and shed. There was bloody pus in the appendix cavity (Fig. 5). Most of them had perforation and were omentum. Covered, surrounded by limited pus accumulation or has become diffuse peritonitis, such appendicitis can occur in specific conditions of the disease, can also occur after clinical misdiagnosis and delay in treatment, once it appears, not only have serious local signs At the same time, there are severe peripheral reactions such as toxic shock, which may have fatal consequences. Therefore, some people have combined gangrenous and perforated appendicitis as advanced appendicitis, which should be prevented as much as possible during the development of acute appendicitis.

If the above three types of acute appendicitis are still limited to the appendix and do not involve the surrounding area, the infection has a lighter effect on the body, and the treatment is easy and the effect is good. However, when the appendix inflammation is serious, it involves surrounding, especially the perforation, and the infection invades the abdominal cavity. The inflammation spreads locally from the appendix to some or all of the abdominal cavity, and the pathology is complicated, which also causes difficulty in handling.

Appendicitis with localized peritonitis refers to the spread of acute appendicitis to the surrounding abdominal cavity. It can occur in the early or no perforation of the appendix. It is only formed by the suppuration of the serosal exudate. The peritoneal inflammation often occurs due to the omentum or Peripheral intestinal fistula is surrounded and limited. The localized peritonitis caused by accumulated purulent exudate can also be transformed into abscess around the appendix because it is not treated in time. Localized peritonitis may be absorbed and disappeared. Once abscess is formed, the amount of abscess is small. Surgical drainage is required, and the abscess may be due to multiple pus, high internal pressure, diffuse peritoneal inflammation due to ulceration of the abscess wall; or formation of multiple abscesses in the abdominal cavity; or ulceration to nearby organs (intestine, bladder, vagina) Forming internal hemorrhoids; or breaking the abdominal wall to form the sinus; or due to the increased fibrosis of the abscess wall, forming a localized inflammatory mass and mistaken for the tumor.

Perforation of the appendix complicated with diffuse peritonitis is the most serious pathological change in acute appendicitis. The inflammation of the appendix is severe and progresses rapidly. The local area is too late to have the omentum or intestinal adhesion adhesion protection. Once perforated, the infection quickly spreads to the entire abdominal cavity, so it is common in Gangrene appendicitis, when the infection involves all abdominal cavity, because of the large abdominal area and large amount of exudate, it quickly leads to insufficient blood volume of the patient, and the bacteria and toxins in the abdominal cavity are absorbed in large quantities, so that the patient is fully systemic in a short time. In sepsis and shock, it is often critical and the mortality rate is high. Acute appendicitis complicated with diffuse peritonitis is associated with perforation of appendix. Perforation occurs in gangrenous appendicitis but can also occur in the late course of suppurative appendicitis. In the appendix or distal side of the appendix, there are 1000 cases of acute appendicitis. The perforation accounts for 21% and only 7% is complicated with diffuse peritonitis. The key is that the body has certain defense ability. The omentum, the nearby mesentery and the small intestine can be quickly Adhere to the perforation to limit it, only when the patient lacks this ability, the perforation of the appendix The spread of infection can spread to the whole abdomen, the omentum of infants is too short, the uterus during pregnancy hinders the decline of the greater omentum, the elderly and the patients with acquired immunodeficiency, lack of limited infection ability, are Easy to cause diffuse peritonitis after perforation of the appendix, must pay attention to, acute appendicitis complicated with sepsis can also be seen in severe infection through the appendix vein into the portal vein to become purulent portal phlebitis or multiple liver abscess, although rare, but There is a very high case fatality rate.

2, the disease outcome

The above different pathological types can be based on the strength of the random body defense mechanism, whether the treatment is timely, correct and have different transformations.

(1) Inflammation subsides: simple appendicitis before the mucosa has not formed ulcers, timely anti-inflammatory may cause inflammation to subside without leaving pathological changes. Early suppurative appendicitis, if treated, even if the inflammation subsides, it will be scar healing, causing the appendix cavity It narrows, the wall thickens, the appendix is distorted, and it is easy to relapse.

(2) Localization of inflammation: suppuration or gangrene. After perforation, the appendix is covered by the omentum to form an abscess around the appendix, or adhere to an inflammatory mass. This is a kind of outcome in which inflammation is limited, such as less pus. Can be completely absorbed.

(3) Inflammation spread: If the body's defense mechanism is poor, or it is not treated in time, the inflammation is aggravated and the appendix is suppurated, the gangrene perforation is even diffuse peritonitis, and purulent portal phlebitis.

Acute appendicitis prevention

Do not rush after the meal, summer heat should not be too cold, especially should not drink cold beer, and other cold drinks, usually pay attention not to be too fatty, avoid excessive irritating, should actively participate in physical exercise, enhance physical fitness, improve immunity If you have a history of chronic appendicitis, you should pay attention to avoid recurrence, and usually keep the stool smooth.

1. Enhance physical fitness and pay attention to hygiene.

2, be careful not to suffer from cold and diet.

3, timely treatment of constipation and intestinal parasites.

Acute appendicitis complications Complications peritonitis sepsis

1. Peritonitis

Localized or diffuse peritonitis is a common complication of acute appendicitis, and its occurrence and development are closely related to perforation of appendix. Perforation occurs in gangrenous appendicitis, but can also occur in the later stages of suppurative appendicitis.

2, abscess formation

It is the consequence of appendicitis without timely treatment. The appendix abscess formed around the appendix is the most common. It can also form abscesses in other parts of the abdominal cavity. There are pelvic, infraorbital or intestinal spaces.

3, internal and external formation

If the abscess around the appendix is not drained in time, it can break through the intestine, bladder or abdominal wall to form various internal or external hemorrhoids.

4, suppurative portal phlebitis

Infectious thrombosis in the appendix vein can follow the superior mesenteric vein to the portal vein, leading to portal venous inflammation, which can form a liver abscess.

Acute appendicitis symptoms Common symptoms Abdominal pain Ischemic necrosis of the appendix wall Iris ischemic congestion Dull pain Abdominal muscles Abdominal bloating Lower abdominal pain Nausea lower abdominal pain Low fever

Clinical manifestations are closely related to pathological types.

1. Abdominal pain: Typical acute appendicitis begins with pain in the middle and upper abdomen or umbilical cord. After a few hours, abdominal pain is transferred and fixed in the right lower abdomen. In the early stage, it is a kind of visceral nerve reflex pain, so the upper abdomen and umbilical pain range is higher. Dispersion, often can not be accurately located, when inflammation affects the serosal layer and parietal peritoneum, due to the latter receptor innervation, pain sensitivity, accurate positioning, pain is fixed in the right lower abdomen, the original upper abdomen or umbilical pain is relieved Or disappeared, according to statistics, 70% to 80% of patients have a history of typical metastatic right lower quadrant pain, a small number of patients develop rapidly, pain can be limited to the right lower abdomen at the beginning, therefore, there is no typical metastatic right lower abdominal pain history and Acute appendicitis cannot be excluded.

Simple appendicitis often presents with paroxysmal or persistent pain and dull pain. Sustained severe pain often suggests suppurative or gangrenous appendicitis. Continuous severe pain affects the lower abdomen or the lower abdomen. It is often a sign of perforation of the appendix gangrene. Sometimes the gangrene of the appendix is perforated, the nerve endings lose their sense and conduction function, or the abdominal pain is relieved due to the sudden decrease of pressure in the cavity, but the pain relief phenomenon is temporary, and other accompanying symptoms and signs have not improved, even It has intensified, and for this reason, it must be analyzed in combination with clinical phenomena so as not to be misled by illusions.

2, gastrointestinal symptoms: simple appendicitis gastrointestinal symptoms are not prominent, in the early stage may be due to reflex stomach cramps and nausea, vomiting, pelvic appendicitis or appendicitis gangrene perforation may increase the number of bowel movements due to inflammation around the rectum, Concurrent peritonitis, abdominal distension and persistent vomiting.

3, fever: generally only low fever, no chills, suppurative appendicitis generally does not exceed 38 ° C, high fever is more common in the appendix gangrene, perforation or has complicated peritonitis, accompanied by chills and jaundice, suggesting that may be complicated by purulent portal phlebitis.

4, tenderness and rebound tenderness: abdominal tenderness is the performance of the parietal peritoneum by inflammatory stimulation, the appendix tenderness is usually located at the McBurney point, that is, the right anterior superior iliac spine and the umbilical cord, the outer 1/3 junction At this point, the anatomical landmark of the appendix is not fixed. It can also be located in the anterior superior iliac spine line on both sides, and the Lanz point at the right 1/3 junction, with the variation of the anatomical position of the appendix, the tender point can be changed accordingly. However, the key is that there is a fixed tenderness point in the right lower abdomen. The degree and extent of tenderness are often related to the severity of inflammation.

The rebound tenderness, also known as the Blumberg sign, may be milder in patients with obesity or appendicitis of the cecum, but with significant rebound tenderness.

5, abdominal muscle tension: appendicitis suppuration has this sign, sputum perforation and peritonitis is particularly significant abdominal muscle tension, but elderly or obese patients with weak abdominal muscles, must also check the contralateral abdominal muscles, for comparison, in order to determine whether there is a belly Muscle tension.

6, colon inflation test: also known as Rovsing sign, first with a hand to press the left lower abdomen descending colon area, and then repeatedly press the upper end with the other hand, the patient complained of right lower abdominal pain is positive (Figure 6), only the positive results have diagnostic value .

7, psoas muscle test: the patient's left lateral position, the right lower extremity is extended backwards, causing a positive right lower abdominal pain, which is helpful for the diagnosis of appendicitis after cecum.

8, obturator muscle test: supine position, right leg flexion 90 °, causing right lower abdominal pain is positive, contributing to the diagnosis of pelvic appendicitis.

9, rectal examination: in the pelvic appendix inflammation when the abdomen can be no obvious tenderness, but there is tenderness in the right anterior wall of the rectum, such as gangrene perforation around the rectum, not only tender, but also fullness around the rectum, Rectal examination also helps to exclude inflammatory lesions in the pelvic and uterine attachments.

10, skin hypersensitivity: in the early stage, especially in the appendix cavity obstruction, there may be a right lower abdomen skin hypersensitivity phenomenon, the scope is equivalent to the 10th to 12th thoracic segmental nerve innervation area, located at the highest point of the right iliac crest, right pubic bone The triangular area formed by the iliac crest and the umbilicus, also called the Sherren triangle, does not change due to the different position of the appendix. For example, the perforation of the gangrene of the appendix disappears.

Acute appendicitis examination

1, blood routine

The number of white blood cells in patients with acute appendicitis is increased, accounting for about 90% of the patients. It is an important basis for clinical diagnosis. It is usually at (10-15)×109/L. As the inflammation increases, the number of white blood cells increases, even more than 20×109. /L, but in elderly patients with weak or immune function, the number of white blood cells does not necessarily increase. As the number of white blood cells increases, the number of neutral polymorphonuclear cells also increases (about 80%), and both tend to appear at the same time. However, there is also a significant increase in the number of neutral polymorphonuclear cells (>80%), which is equally important. When the disease is developing, the symptoms are worsening, and the number of white blood cells that have increased is suddenly reduced, often as a manifestation of sepsis. It belongs to the crisis and should be taken seriously.

2, urine routine

Urine examination in patients with acute appendicitis is not special, but in order to rule out urinary system diseases like appendicitis, such as ureteral stones, routine examination of urine is still necessary, occasionally inflammation of the distal appendix and adhesion to the ureter or bladder, urine A small amount of red, white blood cells may also appear and should not be confused with stones.

3, abdominal X-ray film

Uncomplicated acute appendicitis, the X-ray film may be completely normal, no diagnostic significance, in the case of concomitant or diffuse peritonitis, you can find:

(1) Intestinal gas accumulation and liquid-gas plane in the right lower abdomen cecum and the terminal part of the ileum;

(2) lumbar scoliosis and right lumbar muscles with blurred shadows;

(3) Sometimes the tail stone is visible;

(4) The right lower abdomen soft tissue block shadow, set off by the surrounding inflatable bowel, the edge can be relatively clear;

(5) pneumoperitoneum caused by perforation is extremely rare;

(6) transverse colon expansion can help diagnose and exclude ureteral stones, intestinal obstruction and other possibilities, but the specificity is very poor.

4, CT examination

Normal appendix is only occasionally seen on CT examination. The inflammation appendix can show the symmetry thickening of the periorbital wall, the lumen is occluded or filled with pus and dilated. Sometimes the fat around the cecum is blurred, the density is increased, and the right lumbar muscle is swollen. It is especially easy to find. Abscess around the appendix, there are multiple abscesses in the abdominal cavity for patients with complications, but the CT findings are only 13% to 60%, so only when used to find appendicitis with inflammatory masses or abscesses around, although the sensitivity is as high as 94%, The specificity is only 79%, which can be used as an auxiliary diagnosis when necessary and to exclude abdominal lesions that are confused with appendicitis.

5, ultrasound examination

It has been recognized as a valuable method in the diagnosis of acute appendicitis. This test was applied to the diagnosis of acute appendicitis in the 1980s. The pressure detection method was used to drive the gas around the intestines and the shape of the appendix was unchanged. The appendix congestion and edema exudation showed a low echo tubular structure in the ultrasound display, which was stiffer, and its cross-section was concentrically developed as a target, with a diameter of 7 mm, which is a typical image of acute appendicitis with an accuracy rate of 90% to 96%. Sensitivity and specificity are also about 90%, but gangrenous appendicitis or inflammation has spread to peritonitis, a large number of abdominal exudate and intestinal paralysis affect the rate of ultrasound, ultrasound examination can show appendicitis after cecum, because of the cecal sputum As a translucent window to display the appendix, ultrasonography can also play an important role in differential diagnosis, because it can show ureteral stones, ovarian cysts, ectopic pregnancy, mesenteric lymphadenopathy, etc., so the diagnosis and identification of acute appendicitis in women The diagnosis is particularly useful. It has been reported that typical clinical patients should consider surgery even if the ultrasound is negative, if both If it is not certain, it should be observed. Ultrasound is a non-invasive examination. It has the advantages of convenience, painlessness, repeatability, bedside application and popularization.

6, laparoscopy

It should be considered as a method that can obtain the most positive results in the diagnosis of acute appendicitis, because the insertion of laparoscopy through the lower abdomen can directly observe the presence or absence of inflammation in the appendix, and can also distinguish adjacent diseases with similar symptoms from appendicitis, not only for the diagnosis. It can play a decisive role and can be treated at the same time, but this method has the following disadvantages:

(1) Must have expensive laparoscopy;

(2) A small incision must be made in the lower abdomen under anesthesia, although the incision is not large, but it is also surgery;

(3) The surgeon must be skilled to achieve the purpose of diagnosis without causing complications, which may not be completed by the general practitioner;

(4) cannot be carried out at the bedside;

(5) Inconvenient and painful, so this method is only used when it is necessary. When AIDS patients (including AIDS/HIV, anticancer chemotherapy, application of a large number of hormone therapy, and patients with immunosuppressive agents after organ transplantation) appear The clinical manifestations of typical acute appendicitis can not wait for observation to aggravate the condition, and can not blindly operate or even miscut the normal appendix. Laparoscopy is definitely a preferred method. In general, unless laparoscopic surgery is performed, it is not necessary. .

Diagnosis and diagnosis of acute appendicitis

diagnosis

The diagnosis of most acute appendicitis is still based on metastatic right lower abdominal pain or right lower quadrant pain, tenderness at the appendix and increased white blood cell count. Typical acute appendicitis (about 80%) has the above-mentioned very clear symptoms and Signs, easy to make a diagnosis based on this, for patients with clinical atypical, other auxiliary examination means to assist diagnosis.

Diagnose based on

1, acute onset, metastatic right lower abdominal pain or the beginning of the right lower abdominal pain. Gastrointestinal symptoms such as nausea and vomiting.

2, the right lower abdomen fixed tenderness rebound tenderness, muscle tension.

3, rectal right front tenderness or colonic inflatable sign or lumbar muscle sign or obturator muscle sign or cough and tenderness test positive.

4, the total number of white blood cells and neutrophils increased to varying degrees.

5, B-ultrasound found swelling of the appendix, effusion or effusion (pus).

Differential diagnosis

The clinical misdiagnosis rate of acute appendicitis is quite high. The domestic statistics are 4-5%. The foreign reports are as high as 30%. There are many diseases that need to be identified with acute appendicitis. The most important ones are the following ten diseases.

First, the identification of acute abdomen with internal medicine:

1. Right lower pneumonia and pleurisy: inflammatory lesions in the right lower lung and thoracic cavity, which can cause right lower abdominal pain, and can be misdiagnosed as acute appendicitis, but pneumonia and pleurisy often have obvious respiratory tract such as cough, cough and chest pain. Symptoms, chest signs such as breath sound changes and wet rales, abdominal signs are not obvious, right lower abdomen tenderness does not exist, chest X-ray, can be clearly diagnosed.

2, acute mesenteric lymphadenitis: more common in children, often secondary to upper respiratory tract infection, due to extensive enlargement of small mesenteric lymph nodes, ileal end is particularly obvious, clinically can be expressed as lower right abdominal pain and tenderness, similar to acute appendicitis, However, this disease is associated with high fever, abdominal pain and tenderness is widespread, and there are fashions that can reach swollen lymph nodes.

3. Localized ileitis: The lesion mainly occurs at the end of the ileum. It is a non-specific inflammation. Young people aged 20-30 are more common. In the acute phase of the disease, the intestinal tube of the lesion is congested, edema and exudation. Stimulate the peritoneum of the right lower abdominal layer, abdominal pain and tenderness, similar to acute appendicitis, the location is limited to the ileum, no metastatic abdominal pain, abdominal signs are also extensive, sometimes can be swollen intestinal tube, in addition, patients may be accompanied by diarrhea The stool examination has obvious abnormal components.

Second, the identification of acute abdomen with obstetrics and gynecology:

1. Right fallopian tube pregnancy: After the right ectopic pregnancy rupture, intra-abdominal hemorrhage stimulates the right lower abdominal wall peritoneum, which may have clinical features of acute appendicitis, but ectopic pregnancy often has a history of menopause and early pregnancy, and there may be vaginal bleeding before the onset, patients with abdominal pain After the perineal and anal swelling, there are internal bleeding and hemorrhagic shock, gynecological examination shows that there is blood in the vagina, the uterus is slightly larger with tenderness, the right side of the annex is swollen and the posterior malleolar puncture has blood and other positive signs.

2, ovarian cyst torsion: right ovarian cyst pedicle torsion, cyst circulation disorder, necrosis, bloody exudation, causing inflammation of the right abdomen, similar to appendicitis, but this disease often has a history of pelvic mass, and the onset is sudden, for the array Colic cramps, may be associated with mild shock symptoms, gynecological examination can reach the cystic mass, and tenderness, abdominal B-ultrasound confirmed the presence of cystic mass in the lower right abdomen.

3, ovarian follicular rupture: more common in unmarried young women, often two weeks after menstruation, due to intra-abdominal hemorrhage, causing lower right abdominal pain, the lower part of the right lower abdomen of this disease is mild, diagnostic abdominal puncture can draw hemorrhagic exudation.

4, acute attachment inflammation: acute inflammation of the right fallopian tube can cause symptoms and signs similar to acute appendicitis, but salpingitis occurs in married women, there is a history of excessive vaginal discharge, the incidence of more than before the menstrual cramps, although there is right lower quadrant pain However, there is no typical metastasis, and the abdominal tenderness is lower, almost close to the pubic bone. The gynecological examination shows that there is purulent discharge in the vagina, the tenderness on both sides of the uterus is obvious, and the right side attachment has a tender mass.

Third, the identification of surgical acute abdomen:

1. Acute perforation of ulcer disease: After perforation of ulcer disease, part of the stomach contents flow into the right axilla along the right colonic sulcus, causing acute inflammation of the right lower quadrant, which may be mistaken for acute appendicitis, but this disease has a history of chronic ulcers before the onset. There are many causes of overeating, sudden onset and severe abdominal pain. When the body is examined, the abdominal wall is plate-shaped. The peritoneal irritation is most obvious under the xiphoid process. Abdominal fluoroscopy can see free gas. Diagnostic abdominal puncture can extract the upper digestive tract. liquid.

2, acute cholecystitis, cholelithiasis: acute cholecystitis sometimes needs to be distinguished from high appendicitis, the former often has a history of biliary colic, with pain in the right shoulder and back; and the latter is characterized by metastatic abdominal pain, acute cholecystitis at the time of examination Morphy's sign may be positive, and even the enlarged gallbladder may be touched. The emergency abdominal B-ultrasound may show gallbladder enlargement and calculus.

3, acute Meckel diverticulitis: Meckel diverticulum is a congenital malformation, mainly located at the end of the ileum, its location is very close to the appendix, acute inflammation of the diverticulum, clinical symptoms like acute appendicitis, difficult to identify before surgery Therefore, when the clinical diagnosis of appendicitis and the appearance of the appendix in the operation is basically normal, the end ileum should be carefully examined to 1 meter to avoid missing the inflamed diverticulum.

4, right ureteral calculi: ureteral stones can cause pain in the lower right abdomen when moving downwards, sometimes confused with appendicitis, but violent colic in the onset of ureteral stones, unbearable, pain along the ureter to the external genitals, the inside of the thighs Abdominal examination, tenderness and muscle tension in the right lower abdomen are not obvious. Abdominal plain films sometimes have positive stones in the urinary system, while urine has a large number of red blood cells.

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