Appendiceal abscess incision and drainage

The appendix is an intraperitoneal organ with a length of about 5 to 7 cm, a few less than 2 cm or as long as 20 cm, and a diameter of about 0.5 to 0.8 cm. The appendix is a blind tube whose root is located in the end of the cecum and where the three colonic confluences meet and communicate with the cecum. The tip is free and can be extended in any direction. Common sites include anterior or posterior ileum, lower cecum, posterior cecum, and lateral cecum. Therefore, in the appendectomy, the cecum should be found first, and the colon should be looked down. At the confluence of the three colonic bands, the root of the appendix can be found. There are appendix arteries and veins in the appendix. The appendix artery originates from the ileal artery and is a terminal branch. Once the blood circulation is blocked, the appendix gangrene is very likely to occur; the appendix vein passes through the ileal vein to the superior mesenteric vein. Therefore, in the appendicitis, it may lead to portal inflammation or liver abscess. Treatment of diseases: appendicitis, acute appendicitis Indication Appendectomy or abscess is generally curable with non-surgical treatment. When the pain is obvious, the boundary of the tumor is clear, and the actual sound is diagnosed, indicating that it has formed adhesion with the local abdomen, or the infection is rapidly spread to the surrounding area, and the drainage should be performed. Surgical procedure 1. Incision is made in the obvious part of the right lower abdomen mass bulge or the most obvious part of tenderness. The incision is usually located inside the iliac crest, which is a short incision. Generally 3 to 5 cm long, depending on the thickness of the abdominal wall. 2. Cut the skin, fascia and muscle layers. Pay special attention to the adhesion of the peritoneum and abdominal viscera when cutting the peritoneum. Generally, the wall of the abscess is mostly surrounded by the peritoneal, cecal, small intestine and ascending colon of the lateral abdominal wall. The peritoneum often forms the anterior wall of the abscess, so the peritoneum can be cut into the abscess. 3. Before cutting the abscess, be sure to do a trial puncture. After withdrawing the pus, use the curved vascular clamp or finger to separate the abscess wall along the puncture needle, drain and absorb the pus, then enlarge the incision and remove the necrotic tissue and fecal stone. Then repeatedly rinse the abscess with warm saline and absorb. 4. According to the size of the abscess, place 1 or 2 cigarettes for drainage or double catheter suction, which is led out by the incision. 5. Regarding the timing of appendectomy, it is generally chosen to be 2 to 3 months after the appendectomy is cured. At this time, the inflammation around the appendix has subsided, the adhesion is loose, and it is safer to remove the appendix. If the appendix is immediately seen in the abscess, the resection can be performed without destroying the wall of the abscess. 6. Some appendix abscesses are deep in the pelvic floor. When they are very mature, a longitudinal incision can be made through the rectum or vagina (married) wall. However, special care must be taken not to damage the intestinal fistula and bladder. Therefore, the patient must be urinated or catheterized before surgery, and an empty needle must be used to determine the position of the abscess before the incision is made. After the pus is withdrawn, the puncture needle is not pulled out temporarily, and is cut with a sharp knife in the direction of the puncture needle, and then inserted into the abscess with a straight vascular clamp, the hemostat is opened, the drainage port is enlarged, and the pus is released. After draining the pus, take a soft rubber tube into the abscess and take it out of the anus. Cut 2 or 3 side holes at the top of the rubber tube to facilitate drainage of the pus. Finally, the anal dilator is removed and the drainage tube is fixed with a tape. complication If the intestine and bladder are not damaged during the operation, the postoperative drainage is smooth, and there is generally no special complications.

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