Chronic appendicitis
On the diagnosis of chronic appendicitis, the current understanding is not complete reunification of clinical its ability as an independent disease, the difference between views. Practical work, the pathology of chronic appendicitis and chronic appendicitis clinically between the two, is not always consistent. For example, in the attached appendix removal usually asymptomatic submitted, a considerable portion appendectomy in the pathology of chronic inflammation in there. A typical clinical presentation and after resection of the seizure appendectomy Although the chronic appendicitis, but not satisfied with the effect of postoperative patients and the appendectomy did not confirm the seizure of chronic inflammation, but symptoms after surgery complete remission. Of course, the majority of patients with chronic appendicitis clinical manifestations, pathology and surgical effect of the three completely identical and should therefore be recognized chronic appendicitis clinically is an independent disease.
Second, classification
Clinical General chronic appendicitis roughly divided into two types.
(A) The primary chronic appendicitis
Its characteristics for the onset occult, the slow development of symptoms, the disease continued longer, a few months to several years. No acute attack of the early history, nor in the course of repeated acute phenomenon.
(B) Secondary chronic appendicitis
Features for the first time after onset of acute appendicitis, and the non-surgical treatment to alleviate or more, then left with clinical symptoms, in the course can be repeated again or acute exacerbation.
Third, pathology
Chronic appendicitis visual inspection can have various manifestations, under layers are visible appendectomy lymphocyte infiltration.
(1) was curling appendectomy slender, folding and correct take-shaped so that the emptying appendectomy blocked. Mesangial appendectomy and its surrounding tissues and organs with a varying degree of adhesion.
(B) appendectomy wall thickening, the diameter size uneven, with some narrow-lumen, sometimes for a considerable period of occlusion and distal lumen was completely cord-like.
(C) a bezoar appendectomy cavity, foreign body obstruction, vascular appendectomy serosa markedly increased and clear.
IV, clinical performance
(A) Abdominal Pain
Mainly located in the right lower abdomen, characterized by intermittent pain or pain, heavy, light, and relatively fixed positions. Most of the patients in a meal, exercise and long-term stand, induced abdominal pain occurred. Of course there may be acute appendicitis attack.
(B) gastrointestinal reaction
Patients often feel ranging from the severity of indigestion, Longer course may arise suffering from weight loss, weight loss. General without nausea and vomiting, abdominal distension no, but elderly patients may be associated with constipation.
(C) abdominal tenderness
Tenderness is the only signs, mainly located in the right lower abdomen, and general scope of smaller, location constant pressure can be when there. generally without abdominal mass, but sometimes can be touched Flatulence the cecum.
(D) Indirect signs
Various specific tenderness such as the Markov, Portland’s point lumbar muscle levy, Rose Levy, in the diagnosis of chronic appendicitis meaningless.
(E) Supplementary examination
Permeability and gastrointestinal barium examination fiber node to a certain extent help. Barium thoroughly ileocecal as shown in appendix there is tenderness, a sub-section-shaped appendectomy, the appendix barium cavity emptying time and not appendectomy developer, and so on, are the characteristics of chronic appendicitis. Fiber colonoscopy can be directly observed appendectomy and around the orifice of the change and mucosal biopsy, can still appendectomy cavity contrast to the differential diagnosis of a certain significance.
5, diagnosis
Chronic appendicitis diagnosis sometimes quite difficult, domestic statistics chronic appendicitis after surgery to relieve symptoms not as high as 35 percent, mainly because of the wrong diagnosis. Should a high degree of chronic appendicitis diagnosis seriously, in a “rule out” except for one by one and it is easy to confuse the disease. The major ones are blind to the Department of tuberculosis, chronic colitis, chronic inflammation annex, gastrointestinal malignancies, such as colon and Neurosis.
6, treatment
Surgical treatment is the only effective way, but in line appendectomy decision should be taken seriously.
(1) diagnosed with chronic appendicitis after, in principle, be treated surgically with pathological appendectomy, especially those with a history of acute patients and more timely surgery. The diagnosis of suspected patients or patients with serious coexist elderly patients, non-surgical treatment should be temporary, in the follow-up observation.
(B) if found appendectomy surgery appearance basically normal, we can not only easily Commissioner abdominal resection after appendectomy, the appendix should carefully check nearby tissues and organs such as the ileocecal, terminal ileum 1 m, and small mesenteric lymph nodes. Female patients should be careful exploration pelvic and Annex to prevent misdiagnosis and missed diagnosis.
(C) respond to each and every post-operative patients were followed up for a period of time to find out after appendectomy with the actual results. The final diagnosis of chronic appendicitis is not pathological, but after surgery the symptoms completely disarm. Postoperative patients still have symptoms, should conduct a comprehensive examination to find out the real cause, not easily after intestinal adhesion by symptomatic treatment.
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