Ruptured appendix
definition
If the appendix ruptures, the appendix breaks the appendix appendix, and the contents enter the abdominal cavity.
The cause is inflammation of the appendix (appendicitis). A ruptured appendix is life-threatening and must be treated immediately. The leakage of the intestinal contents spreads the inflammation and further complications. However, since the ruptured appendix can be treated well, the therapy is usually uncomplicated and the patients experience no long-term effects.
Most often, a ruptured appendix occurs in adolescents or young adults.
causes
Appendicitis leads, if not treated in time, to a rupture of the appendix.
The most common cause of the inflammation is an emptying disorder of the appendix. This can be caused by a kink, scarring, or fecal stones. As a result of the passage disruption, the bacteria can multiply in the appendix, causing inflammation and swelling. Foreign bodies or a worm infestation can also be the cause in rare cases.
Another reason for appendicitis (appendicitis) can be inflammation in the intestines that spreads to the appendix. Therefore, patients with chronic inflammation in the bowel, such as B. more likely to be affected in ulcerative colitis.
Due to the inflammation process and the bacteria in the worm head, its tissue is damaged and dies. This process finally leads to a breakthrough and the bacteria, pus and possible stool remains get into the abdominal cavity. This is where the inflammation can spread, which can lead to very painful peritonitis (Peritonitis).
Read more on this topic at: Causes of appendicitis
Symptoms
In the course of appendicitis to the point of breakthrough, the type and location of the pain changes.
- At the beginning you notice the pain in the middle upper abdomen. They are dull and difficult to localize.
- These migrate to the right sub-usage. Here the pain occurs more intensely under pressure or vibration. They are piercing and easy to localize.
- If the appendix ruptures later, the pain typically disappears. Later they reappear diffusely throughout the abdomen.
With rare variations in the position of the appendix, the pain can also occur in the flanks or in the right upper abdomen. In addition to pain, patients also suffer from fever. In addition, there may be nausea with vomiting. Sufferers have no appetite and are constipated.
Read more on this topic at: Symptoms of appendicitis
What can be the signs of a ruptured appendix?
The main signs of an impending rupture of the appendix are the symptoms of appendicitis:
- severe pain in the right lower abdomen
- nausea
- fever
The more the appendix is inflamed, the more it presses on the peritoneum, which transmits the pain signal. When the appendix bursts, i.e. when the appendix ruptures, this pressure decreases. The most important sign of a ruptured appendix is therefore when there is a sudden decrease in the symptoms of very severe pain in the right lower abdomen. Then at the latest, an emergency doctor must be alerted immediately.
Is there a ruptured appendix without pain?
Since a ruptured appendix is usually the result of pronounced appendicitis, a pain-free progression is extremely unlikely. However, it is typical for the rupture of the appendix that the severe abdominal pain abruptly subside at the onset of this event. The rupture of the appendix itself is not painful.
In addition, elderly people and seriously ill or handicapped patients may have reduced pain perception or the ability to express pain. In such a case, appendicitis with a subsequent rupture of the appendix can proceed with little or no pain.
diagnosis
In most cases, appendicitis or appendix perforation can already be recognized based on the symptoms of the person affected. The main symptom of appendicitis is pain in the right lower abdomen.
On the physical exam, there are several signs and tests that suggest appendicitis, such as: the Blumberg sign. The doctor presses into the left lower abdomen and then suddenly lets go. When you let go, there is pain in the right lower abdomen.
However, if the appendix has already ruptured, the pain may have spread to the entire abdomen. The diagnosis can be confirmed by an ultrasound.
Read more about this under Diagnosis of appendicitis - The physical examination
The operation
To treat the perforation of the appendix, as well as appendicitis, the appendix is removed in an operation. However, not the entire appendix is removed, but only the small, thin appendix (appendix). Because only this is inflamed. One speaks of one Appendectomy.
The appendectomy can be done openly through a 5-10cm abdominal incision in the right lower abdomen or laparoscopically (with a specialized endoscope) through three small abdominal incisions. The method of choice is determined individually according to the location of the appendix, age, risk of complications and progression of the disease. Today the laparoscopic procedure is usually preferred.
In both surgical procedures, the appendix is attached to its base on the actual appendix (Caecum) and severed the vessels supplying the appendix.
In the case of a ruptured appendix, in addition to the appendix removal, the abdominal cavity must be completely freed from the leaked contents so that there is no (again) inflammation in the abdominal cavity after the operation. For this purpose, the abdominal cavity may also be rinsed with germicidal substances or antibiotics.
Under certain circumstances, drains must be placed through which wound fluid can still flow out of the abdominal cavity after the operation.
Read more about this at: Appendicitis surgery and therapy for appendicitis
Complications
If the point where the appendix breaks is covered by another organ, an abscess, a collection of pus, can occur. This is cleared out during the operation and treated with antibiotics.
The complications that can occur after surgery include:
- Secondary bleeding
- Infections
- Wound healing disorders
- Abscesses
Under certain circumstances, it is also possible that the appendix was not sewn up tightly or that the seam is leaking due to further inflammatory processes in the body. This causes inflammation again, and it can also cause bowel movement to stop temporarily, which must be treated as quickly as possible.
Overall, the appendectomy is a relatively small procedure and has few complications, especially if the operation is performed early.
You may also be interested in these topics:
- Abscess in the intestine
- Intestinal obstruction
consequences
Many complications that can arise during surgery lead to a dreaded one Peritonitis , an inflammation in the abdominal cavity if the problem is not identified and treated in time.
The problem with peritonitis is that the inflammation spreads very easily in the abdominal cavity and can attack other organs, which then also become inflamed. Depending on the organ, this can lead to serious consequences. If other parts of the intestine are affected, there is a risk that these will break through and disrupt bowel function.
Peritonitis is life-threatening and is usually treated with surgery and antibiotics. The bowel arrest, which can be the result of the operation or peritonitis, leads to vomiting and pain. It can also lead to shock, a life-threatening circulatory disorder.
Read more about this under Peritonitis after surgery
Can a ruptured appendix be fatal?
A ruptured appendix is a life-threatening disease that must be treated as quickly as possible, otherwise it can be fatal.
The breakthrough creates a direct connection between the inside of the intestine and the free abdominal cavity. Feces and bacteria can penetrate from the intestines into the abdominal cavity and cause peritonitis there. In addition, bacteria can enter the blood and cause sepsis ("blood poisoning") as a result.
Therefore, if an appendix ruptures, an operation must be performed as quickly as possible so that a fatal course can be averted.
In the best case scenario, appendicitis is detected and treated in good time so that an appendix cannot break in the first place.
Adhesions
Adhesions usually occur after every operation. The peritoneum and the serosa, a skin with which the abdominal viscera are coated, grow together. Since the removal of the appendage is only a minor intervention, there is no pronounced formation of adhesions after the operation. If a laparoscopic procedure has been performed, the likelihood of adhesions is less than after an open procedure.
Adhesions usually do not cause any complaints. In some cases they can lead to recurring pain or, in exceptional cases, pinch the bowel.
Duration of the operation
An appendix operation is a very short procedure. Removal of the appendix in appendicitis without a through-book takes about 1 hour.
Since the abdominal cavity is also cleaned of any inflammatory material that has leaked out and the abdominal cavity has to be rinsed afterwards, the operation takes longer.
An appendix that is difficult to access also increases the duration of the operation.
Duration of regeneration
The duration of the illness varies from person to person. It depends on the general state of health in which the person concerned was. Older people and young children generally take longer to recover from illness.
After a ruptured appendix and subsequent complications, the duration of the disease is also longer. The doctor puts you on sick leave for about two to three weeks. In addition, you shouldn't lift heavy objects for several weeks after the operation.
How long is the hospital stay?
After an appendix operation that has not yet resulted in a breakthrough, patients usually have to stay in hospital for another 3-5 days.
After a ruptured appendix or in small children, the length of stay in hospital is longer. It is between 6 and 8 days.
In the case of rare, very serious complications, longer inpatient treatment in the hospital may of course be necessary.
Appendicitis in the child
Appendicitis is very common in children between the ages of 4 and 12. In small children under 2 years of age, however, appendicitis is extremely rare.
In general, children have the same symptoms as adults. However, it can lead to an atypical course in children, in which the symptoms are not clear. For example, young children cannot localize the pain very well or have no abdominal discomfort at all.
Furthermore, fever or diarrhea can occur. This makes the diagnosis more difficult. Since children also tend to progress more quickly, ruptures of the appendix before surgery are relatively common. After a ruptured appendix, the symptoms initially disappear before the pain reappears later. This can additionally delay the therapy, since misinterpretations can occur during this period.
In children, the prognosis is usually good, including a ruptured appendix. The same therapy is used as for adults: the removal of the appendix and antibiotic therapy.
Read more on this topic at: Abdominal pain in children
During pregnancy
Diagnosis of appendicitis and appendectomy is difficult during pregnancy.
From the 2nd trimester or the 4th month, the appendix (the appendix) as the child grows in the uterus from the right lower abdomen to the right upper abdomen. Pain in the right upper abdomen is also caused by inflammation of the renal pelvis or gallbladder. Therefore, the diagnosis is not as simple and clear as with non-pregnant women. In addition, the symptoms caused by appendicitis can initially be dismissed as pregnancy symptoms.
The treatment of appendicitis and rupture of the appendix is also the fastest possible operation during pregnancy, as both are life-threatening for mother and child. As with any operation, there is a certain basic risk for the unborn child, but this is very low and negligible in view of the danger to life from the ruptured appendix.
Depending on the situation, the operation can be carried out openly (via a larger abdominal incision) or laparoscopic (minimally invasive via three small abdominal incisions).When choosing pain relievers and antibiotics, it must of course be ensured that they do not endanger the unborn child.
