What should I do about acute appendicitis?

Written by Ren Zheng Xin
Gastroenterology
Updated on December 02, 2024
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Once acute appendicitis is diagnosed and surgical contraindications are ruled out, appendectomy is usually performed. Currently, the most common method is laparoscopic appendectomy, which results in less intraoperative bleeding and quicker postoperative recovery. After the surgery, depending on the severity of the appendicitis, the use of antibiotics may be considered. Additionally, fasting is required on the day of the surgery, and a semi-liquid diet may be chosen for the first one or two days post-surgery. Three to four days after the surgery, foods like egg custard, vegetable soup, and rice can be eaten, before gradually transitioning back to a normal diet.

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Written by Ren Zheng Xin
Gastroenterology
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Is appendicitis prone to recurrence?

Appendicitis, if treated by surgically removing the appendix, generally does not recur and can be cured. However, if one only uses medication to control the symptoms during an attack of appendicitis, it can easily recur. For appendicitis, laparoscopic appendectomy is currently the preferred surgical treatment. This method involves less bleeding during surgery and quicker recovery post-surgery. For elderly or frail patients who cannot tolerate general anesthesia, the traditional surgical method involving an incision at McBurney's point can be chosen. With this method, it is important to rest more. Patients can usually be discharged about a week after surgery. Postoperative care should be strengthened, dietary adjustments should be made, and more vegetables should be eaten to prevent constipation.

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Written by Li Jin Quan
General Surgery
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Where does chronic appendicitis hurt?

Chronic appendicitis, unlike acute appendicitis, does not begin with upper abdominal pain followed by pain in the lower right abdomen, which we refer to as migratory lower right abdominal pain; migratory lower right abdominal pain is a characteristic symptom of acute appendicitis. Chronic appendicitis typically presents with chronic recurrent pain, discomfort, dull pain, or bloating in the lower right abdomen. During a physical examination, chronic appendicitis generally manifests as fixed tenderness in the lower right abdomen, with less evident rebound pain. Rebound pain in the lower right abdomen during a physical exam only occurs when chronic appendicitis acutely flares up and signs of peritonitis are present.

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Written by Huang Gang
Gastroenterology
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Acute appendicitis clinical features

Acute appendicitis generally presents primarily as abdominal pain, specifically migratory pain to the lower right abdomen. Initially, the patient may experience stomach pain, which gradually shifts to pain in the lower right abdomen. Whether it is appendicitis needs to be diagnosed by a physical examination by a doctor, or an ultrasound of the appendix during the acute phase can be performed. If the appendix appears significantly swollen on the ultrasound, it can also confirm the diagnosis of acute appendicitis. Typically, the best treatment for acute appendicitis is surgery, especially if the condition is very severe and critical, as it may lead to perforation of the appendix and result in purulent peritonitis, which is very serious and life-threatening. Therefore, once diagnosed with acute appendicitis, it is best to be hospitalized for surgery.

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Written by Zhang Peng
General Surgery
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Characteristics of Appendicitis Pain

The most typical pain manifestation of appendicitis is migratory pain, which generally starts in the upper abdomen or around the navel, and in most cases moves to the lower right abdomen and becomes fixed within a few hours. During physical examination, the pain usually localizes to a fixed point in the lower right abdomen, typically at McBurney's point, although this can vary with the position of the appendix. However, as the condition of the appendix progresses, such as when it becomes purulent or even gangrenous, the inflammation worsens and the area of tenderness can expand. This is mostly manifested by symptoms of peritoneal irritation, which are generally indicative of the timing for surgery. In most cases of appendicitis where the diagnosis is clear, early surgical intervention is recommended, as surgery is the only cure. Most patients who improve with conservative treatment are likely to experience recurrence later on.

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Written by Li Jin Quan
General Surgery
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Is chronic appendicitis serious?

Chronic appendicitis can achieve good treatment outcomes through active surgical treatment or conservative treatment, and the cases of appendicitis here are not severe. However, a very small portion of patients with chronic appendicitis, especially those with underlying diseases such as diabetes, are at risk of developing a purulent infection of the appendix, which can lead to perforation of the appendix and result in diffuse peritonitis, sepsis, septic shock, and multiple organ failure. Thus, it can be said that there are indeed a few severe cases among patients with chronic appendicitis.