Avascular necrosis of appendix wall

Introduction The so-called ischemic necrosis of the appendix wall is the continuous increase of intracavitary pressure, the wall of the appendix is also compressed, the venous return is blocked, the wall of the appendix is edema and ischemia, and the bacteria can penetrate into the abdominal cavity. In severe cases, the arteries are also blocked, causing necrosis of the appendix. The location of the luminal obstruction is mostly at the base of the appendix, but also in the middle and distal segments of the appendix.

Cause

(1) Obstruction of the appendix lumen: The lumen of the appendix is narrow and slender, and the distal end is closed to form a leading end. Blockage of the lumen is the basis for inducing acute appendicitis.

(2) Bacterial infection: There are a large number of bacteria in the appendix cavity, including aerobic bacteria and anaerobic bacteria. The bacteria are consistent with the bacteria in the colon, mainly Escherichia coli, Enterococcus and Bacteroides.

(C) nerve reflex: various causes of gastric and intestinal dysfunction, can be reflective caused by the contraction of the appendix ring muscle and the appendix artery.

an examination

Related inspection

White blood cell count (WBC) blood routine

1, blood routine examination: the majority of patients with acute appendicitis, white blood cell count and neutrophil ratio increased, such as inflammation has invaded the abdominal cavity, white blood cell count often rises above 18X109 / L; but the increase is not obvious can not be denied diagnosis, should be repeated Examination, if gradually increased, has diagnostic value.

2, urine routine examination: urine test generally no positive findings, but appendicitis after cecal can stimulate the adjacent right ureter, a small amount of red blood cells and white blood cells can appear in the urine.

3, regular stool examination: pelvic appendicitis and perforated appendicitis with pelvic abscess, blood cells can also be found in the stool.

4, X-ray examination: chest and abdomen perspective as a routine. Acute appendicitis can also have a positive result on the plain plain film: about 5-6% of patients have one or several stone shadows in the right lower abdomen appendix, and 1.4% have gas accumulation in the appendix cavity. In acute appendicitis with diffuse peritonitis, in order to exclude ulcer perforation, acute strangulated intestinal obstruction, etc., standing abdominal plain film is necessary, such as the presence of free gas under the armpit, appendicitis can basically be ruled out.

5, abdominal B-ultrasound examination: the longer course of the disease to take the right lower abdomen B-ultrasound to see if there is an inflammatory mass. In the decision to cut and drain the appendix abscess, B-ultrasound can provide the specific location, depth and size of the abscess, easy to choose the incision.

Diagnosis and treatment can be performed based on the above findings.

Differential diagnosis

Ischemic hyperemia of the appendix: The appendix artery is the terminal branch of the ileo-arterial artery. It is a terminal artery. Therefore, it is often caused by ischemia or congestion of the appendix due to stimulation changes.

Perforation of appendix: At present, if you have acute appendicitis and have had surgery early, the risk is very small, and the consequences are quite good; but once the "end perforation" occurs, the light form a local abscess, and the severe one is diffuse. Peritonitis, abdominal suppuration, septic shock, and even life-threatening, that is, timely surgery after perforation, often cause a series of complications such as wound infection, residual abdominal abscess, intestinal fistula, intestinal adhesion, adhesive intestinal obstruction, etc. In the case of intestine adhesion patients who have been suffering from surgery, the initial source of the disease is often "perforation of the appendix." Therefore, beware of appendix perforation is the key to the treatment of appendicitis, and this key is the close cooperation of patients, families and doctors, and work together to complete. Appendicitis refers to an inflammatory change in the appendix due to a variety of factors. It is a common disease whose prognosis depends on timely diagnosis and treatment. Early diagnosis and treatment, patients can recover in a short period of time, the mortality rate is extremely low (o.1% - 0.2%); if the diagnosis and treatment delay can cause serious complications, and even cause death. Appendicitis is a common disease. Clinically, there are often lower right abdominal pain, elevated body temperature, vomiting and neutrophilia. Appendicitis is inflammation of the appendix, the most common abdominal surgical disease.

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