appendicitis(redirected from gangrenous appendicitis)
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appendicitis:see under appendixappendix,
small, worm-shaped blind tube, about 3 in. (7.6 cm) long and 1-4 in. to 1 in. (.64–2.54 cm) thick, projecting from the cecum (part of the large intestine) on the right side of the lower abdominal cavity.
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inflammation of the vermiform extension of the cecum—the appendix. Appendicitis afflicts persons of all ages (except infants). The reasons for the occurrence of appendicitis are not always clear. Microbes that are always present in the vermiform appendix may become pathogenic as a result of prolonged holding of fecal masses in the cecum and in the appendix (with certain peculiarities of location of the appendix or of its folding, etc.), of accumulation of small intestinal worms in the appendix, of obstruction of the lumen of the appendix by a foreign body swallowed with food or by a small lump of hardened feces. Sluggishness of the large intestine—that is, a tendency to constipation—fosters the development of appendicitis. The neurovascular theory explains the occurrence of appendicitis by disruption of blood circulation in the appendix resulting from irritation of the nervous system. Morbidity from appendicitis increases with abundant use of meat products, especially canned meats. Appendicitis may occur in acute or chronic form.
Acute appendicitis. The principal obligatory symptom is abdominal pain on the lower right (in the iliac area, the location of the appendix), sometimes occurring suddenly (like a stab), sometimes coming on by degrees but still very quickly. Often the pain is first felt mainly in the area of the navel and in the pit of the stomach, and only after some time does the pain move into the iliac area. Nausea is almost always present and, later, vomiting occurs. The temperature rises to 37.5°-38.5°C or remains normal, especially in persons of advanced age. Blood counts reveal moderate increases in leucocytes. In favorable cases, attacks last no more than 24 hours, then all symptoms subside. More frequently, if timely measures are not taken, the inflammation spreads to the abdominal cavity and peritonitis develops. In that case, rapid adhesion of the intestinal loops to each other and to the omentum takes place, which may halt further spread of the infection beyond the cecum (localized peritonitis). However, sharp movement by the patient and especially ingestion of a laxative threaten disruption of the formed adhesions and the development of diffuse peritonitis (sharp intensification of pain, resumption of vomiting). In the most serious cases of acute appendicitis, the appendix necrotizes (gangrenous appendicitis) or ruptures (perforative appendicitis); an enormous number of microbes enter the abdominal cavity and diffuse peritonitis immediately develops.
The treatment for acute appendicitis is immediate surgery (appendectomy). The only first aid before the arrival of a physician is complete rest. Hot water bottles, enemas, and laxatives are forbidden. Analgesics (preparations of belladonna, opium, Pantopon, morphine, etc.) are also not to be given because they obscure the picture of the disease and hinder its diagnosis. Surgery is performed in the first day of the disease. If the attack has passed without surgery, complete recovery does not occur. In the majority of cases the attack repeats itself sooner or later (relapsing appendicitis), often more severely each time. When the operation is not performed in time, an obvious delimitation of the inflammatory process occurs, and the operation is post-poned until the infiltrate formed in the abdominal cavity is reabsorbed (fixation). When the infiltrate festers (abscess in the abdominal cavity), treatment is limited to lancing it; an operation is indicated for later. In the absence of symptoms of delimitation and growing indications of peritonitis, emergency surgery is performed any time after onset of the attack.
Chronic appendicitis. The chronic form of the disease usually develops after the person has suffered an acute attack; however, primary chronic appendicitis develops gradually. Chronic appendicitis is manifested by more or less constant pain on the right side of the abdomen or in the epigastrium, sometimes spasmodically intensifying, by functional disruptions of the intestines (constipation or diarrhea), and by nausea. Short attacks (one to two hours or less) are also possible; this known as appendiceal colic. Chronic appendicitis may become acute at any moment. The treatment for chronic appendicitis is removal of the vermiform appendix.