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Appendix death: What Can Happen If Your Appendix Bursts?

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What Can Happen If Your Appendix Bursts?

Appendicitis: Understanding a Common Condition and its Life-Threatening Risks

Introduction:

If you have ever heard someone say they have had appendicitis, you may think of it as a common ailment. However, appendicitis is a serious condition that, if left untreated, can lead to life-threatening complications. This blog will discuss appendicitis, its symptoms, and the importance of prompt medical attention. We will also explore the risks of untreated appendicitis, including what can happen if your appendix bursts.

What is appendicitis?

The appendix is a thin, pouch-like tube that lies near the meeting point of the small and large intestines. Appendicitis is a common condition that involves inflammation and/or infection of the appendix. The precise cause of appendicitis is not well understood, and it can affect anyone at any time, although it is more frequently seen in children. Because appendicitis can lead to widespread infection, a ruptured appendix, and other severe or life-threatening complications, almost immediate diagnosis and treatment are necessary.

Symptoms of appendicitis:

The signs and symptoms of appendicitis can mimic those of other conditions, making it a difficult ailment to self-diagnose. Some of the most common symptoms include:

  • Sudden onset of abdominal pain
  • Abdominal pain that migrates and settles in the lower right side
  • Fever
  • Chills
  • Fatigue
  • Loss of appetite
  • Nausea and vomiting
  • Abdominal bloating or swelling
  • Pain with physical activity

What happens when your appendix bursts?

When appendicitis is left untreated, bacteria and pus begin to build up in the appendix and cause it to swell. Ultimately, the wall of the appendix is compromised, allowing the pus and other bacteria to ooze out into the abdominal cavity. Though it is not an explosive event, this is referred to as bursting or rupturing of the appendix. As the infection spreads throughout the abdomen, patients often experience worsening symptoms, including high fever and severe pain.

Most cases of a ruptured appendix occur about 48 – 72 hours after the onset of symptoms. A ruptured appendix is always considered an emergency and requires immediate treatment. If left untreated, a ruptured appendix can lead to widespread infection, abscess, sepsis (an infection in the bloodstream), and even death.

Why seek immediate medical attention?

To ensure your health and safety, signs and symptoms of appendicitis should be evaluated immediately by a medical professional. The award-winning team of board-certified emergency room physicians at iCare ER & Urgent Care is highly experienced in the early detection and treatment of appendicitis in Frisco and Fort Worth, TX. During your visit, you will be evaluated promptly and may undergo lab work, imaging studies, and other tests to determine with certainty whether your symptoms are related to appendicitis.

Conclusion:

Appendicitis is a serious condition that requires immediate medical attention. If you suspect that you or someone you know has appendicitis, seek prompt medical attention to prevent life-threatening complications.  At iCare ER & Urgent Care in Frisco or Fort Worth, TX we are committed to providing almost immediate appendicitis treatment in Frisco and Fort Worth, TX. Our expert team of board-certified ER physicians and medical professionals is available 24/7 to evaluate and treat all of your emergency medical needs.

Appendicitis – Digestive Disorders – Merck Manuals Consumer Version




By

Parswa Ansari

, MD, Hofstra Northwell-Lenox Hill Hospital, New York


Reviewed/Revised Apr 2023

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Appendicitis is inflammation and infection of the appendix.

  • Often a blockage inside the appendix causes the appendix to become inflamed and infected.

  • Abdominal pain, nausea, and fever are common.

  • Exploratory surgery or an imaging test, such as computed tomography or ultrasonography, is done.

  • Treatment involves surgery to remove the appendix and antibiotics to treat the infection.

(See also Acute Abdominal Pain Overview of Gastrointestinal Emergencies Certain gastrointestinal disorders can be life threatening and require emergency treatment. For many people, emergency treatment involves surgery. Abdominal pain, often severe, usually accompanies… read more .)

The appendix is a small finger-shaped tube projecting from the large intestine near the point where it joins the small intestine. The appendix may have some immune function, but it is not an essential organ.

The Digestive System

Appendicitis is the most common cause of sudden, severe abdominal pain and abdominal surgery in the United States. Over 5% of the population develops appendicitis at some point. Appendicitis most commonly occurs during adolescence and in the 20s but may occur at any age.

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Appendicitis (https://www.youtube.com/watch?v=r9amif1DQMc) by Osmosis (https://open.osmosis.org/) is licensed under CC-BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0/).

The cause of appendicitis is not fully understood. However, in most cases, a blockage inside the appendix probably starts a process. The blockage may be from a small, hard piece of stool (fecalith), a foreign body, tumor, or, rarely, even worms. As a result of the blockage, the appendix becomes inflamed and infected. If inflammation continues without treatment, the appendix can rupture.

A ruptured appendix may cause a pus-filled pocket of infection (abscess Abdominal Abscesses An abscess is a pocket of pus, usually caused by a bacterial infection. Most people have constant abdominal pain and a fever. Computed tomography or another imaging test can distinguish an abscess… read more ) to form. As a result, peritonitis Peritonitis Abdominal pain is common and often minor. Severe abdominal pain that comes on quickly, however, almost always indicates a significant problem. The pain may be the only sign of the need for surgery… read more (inflammation and usually infection of the abdominal cavity, which may result in a life-threatening infection) may develop. In a woman, the ovaries and fallopian tubes may become infected, and the resulting scarring may block the fallopian tubes and cause infertility. A ruptured appendix also may allow bacteria to infect the bloodstream—a life-threatening condition called sepsis Sepsis and Septic Shock Sepsis is a serious bodywide response to bacteremia or another infection plus malfunction or failure of an essential system in the body. Septic shock is life-threatening low blood pressure … read more .

Pain begins in the upper abdomen or around the navel, then nausea and vomiting develop, and then, after a few hours, the nausea passes, and the pain shifts to the right lower portion of the abdomen. Although these symptoms are the most traditionally described, fewer than 50% of people with appendicitis have them.

When a doctor presses on the right lower portion of the abdomen, it is tender, and when the pressure is released, the pain may increase sharply (rebound tenderness).

A fever of 100° to 101° F (37.7° to 38.3° C) is common. Moving and coughing increase the pain.

In many people, particularly infants and children, the pain may be widespread rather than confined to the right lower portion of the abdomen. In older people and in pregnant women, the pain may be less severe, and the area is less tender.

If the appendix ruptures, pain may lessen for several hours. Then, peritonitis occurs, and pain and fever may become severe. Worsening infection can lead to shock Shock Shock is a life-threatening condition in which blood flow to the organs is low, decreasing delivery of oxygen and thus causing organ damage and sometimes death. Blood pressure is usually low. .. read more .

Did You Know…

A doctor may suspect appendicitis after reviewing the person’s symptoms and examining the abdomen. Typically, surgery is done immediately if the doctor strongly suspects appendicitis.

If the diagnosis of appendicitis is not clear, doctors usually do an imaging test such as computed tomography Computed Tomography and Magnetic Resonance Imaging of the Digestive Tract Computed tomography (CT) and magnetic resonance imaging (MRI) scans are good tests for assessing the size and location of abdominal organs. Additionally, cancerous (malignant) or noncancerous… read more (CT) or ultrasonography Ultrasound Scanning (Ultrasonography) of the Abdomen Ultrasound scanning uses sound waves to produce pictures of internal organs (see also Ultrasonography). An ultrasound scan can show the size and shape of many organs, such as the liver and pancreas… read more . Ultrasonography is particularly useful in children, in whom it is important to limit radiation exposure to reduce the risk of future cancers.

Surgeons can also do laparoscopy Laparoscopy Laparoscopy is an examination of the abdominal cavity using a fiberoptic instrument inserted through the abdominal wall. This is a surgical procedure done in an operating room. People are given… read more to explore the abdominal cavity and help determine the diagnosis.

A blood test often shows a moderate increase in the white blood cell count because of the infection, but there is no definitive blood test for appendicitis.

Surgery is the main treatment of appendicitis. Delaying surgery until the cause of the abdominal pain is certain can be fatal: An infected appendix can rupture less than 36 hours after symptoms begin.

VIDEO

If appendicitis is found, fluids and antibiotics are given by vein and the appendix is removed (appendectomy). If the doctor does an operation and appendicitis is not found, the appendix is usually removed anyway to prevent any future risk of appendicitis.

There has been recent interest in treating appendicitis only with antibiotics, so that surgery can be postponed or avoided. Although this treatment may be successful in some people, many of them eventually need surgery. Surgical removal of the appendix is still considered the most effective and thus usually the recommended treatment for appendicitis.

With an early operation, the chance of death from appendicitis is very low. The person can usually leave the hospital in 1 to 3 days, and recovery is normally quick and complete. However, older people often take longer to recover.

Without surgery or antibiotics (as might occur in a person in a remote location without access to modern medical care), more than 50% of people with appendicitis die.

The prognosis is worse for people who have a ruptured appendix, an abscess, or peritonitis.




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Why appendicitis is dangerous and how to deal with it

In the right iliac region of a person there is an appendix – a worm-like appendage of the caecum up to 1 cm thick and up to 23 cm long (usually 7-9 cm). It performs a protective function of the body due to the accumulation of lymphoid tissue in it. In addition, it plays an important role in maintaining the intestinal microflora.

Inflammation of this process is called appendicitis. Until now, the most common method of treating appendicitis is the removal of the appendix, however, in recent decades, the prevalence of antibiotic therapy has gradually increased.

One of the first known operations to remove the appendix was performed in 1735 in London by the royal surgeon Clodis Amiand. He operated on an 11-year-old child who soon recovered. By 1839, the clinical picture of acute appendicitis was described in detail, it was also established that it is an independent disease, and not a complication of inflammation of the caecum, as previously thought.

The term “appendicitis” appeared in 1886, it was introduced by the American physiologist Reginald Gerber Fitz. Then it was found that the optimal method of treatment is the removal of the appendix. In Russia, the first operation to remove the appendix was performed in 1890 year. However, they began to be carried out regularly only after the IX Congress of Russian Surgeons in 1909 – before that, doctors adhered to a wait-and-see approach, resorting to surgical intervention only in extreme cases.

The first doctor to operate on himself was the American surgeon Evan Kane in 1921. He successfully removed his own appendix as part of a study of patient tolerance to local anesthesia.

And in 1961, the Soviet surgeon Leonid Rogozov, a member of the 6th Soviet Antarctic Expedition, operated on himself.

During the expedition, he discovered a clinical picture of acute appendicitis, conservative treatment – rest, hunger, local cold and antibiotics – did not help. It was impossible to get to the hospital.

With the help of other members of the expedition, who gave instruments and monitored Rogozov’s condition, the surgeon operated on himself for almost two hours. Because of the weakness that appeared during the operation, he now and then had to pause. But he successfully completed the operation, and a week later he removed the stitches.

“At the most difficult stage of the appendix removal, I lost heart: my heart stopped and noticeably slowed down, and my hands became like rubber,” Rogozov recalled. Well, I thought, this will end badly. But all that remained was to actually remove the appendix! But then I realized that I was actually already saved!”

Appendicitis manifests itself at any age, but mostly at 15-35 years. Women experience it 2-3 times more often than men, but men are more likely to experience complications. The removal of the appendix accounts for up to 80% of all emergency operations. The incidence of acute appendicitis is 4-5 cases per 1000 people per year.

The main symptoms of appendicitis are pain in the right side, fever, nausea and vomiting. On palpation of the right iliac region, appendicitis is characterized by increased pain with a sharp decrease in pressure.

In clinical practice, there are two forms of appendicitis – acute and chronic. When acute appendicitis occurs, urgent treatment is necessary, the main cause of death is a delay of more than two days between the onset of symptoms and the start of treatment.

Delay threatens the development of complications, for example, the formation of appendicular infiltrate – an accumulation of densely fused altered tissues. In this case, it is no longer possible to remove the appendix – it turns out to be inseparable from the surrounding tissues. The infiltrate can resolve on its own, which most often happens, or lead to suppuration with the formation of an abscess.

Another common complication is diffuse purulent peritonitis, inflammation of the peritoneum, complicated by the appearance of purulent foci.

Peritonitis directly threatens the patient’s life and in this case, an early operation is simply necessary.

Chronic appendicitis is rare. It occurs after acute appendicitis and is characterized by atrophic changes in the tissues of the appendix.

There are many theories for the development of acute appendicitis. According to the mechanical theory, it occurs due to blockage of the lumen of the appendix, mainly by fecal stones. When the lumen is filled with mucous secretion, the diameter of the process increases several times. This compresses the vessels inside the appendix itself, which leads to acute inflammation and necrosis.

Another cause of inflammation of the appendix can be an infection – the causative agents of infectious diseases, penetrating into the mucous membrane of the organ, lead to the development of appendicitis. It is also assumed that appendicitis may occur due to vascular spasms and circulatory disorders in the intestinal tissues.

At risk are people who regularly suffer from constipation. It is also assumed that the incidence of acute appendicitis is associated with a low content of vegetable fiber in the diet.

In the past 20 years, research has shown that appendicitis can be successfully treated with antibiotics, and the number of surgeries performed in the US has halved.

However, analysis of almost half a million registered cases of appendicitis showed that those patients who were operated on the first or second day after going to the hospital died from possible complications 2.4 times less than those who were treated with non-surgical methods.

It turned out that older people were more likely to undergo conservative treatment, which further worried the researchers.

“U.S. surgeons choose older patients for non-surgical treatment because they may not be the best candidates for surgery,” explains study lead author Dr. Isaiah Turnbull. —

However, these patients are at increased risk of poor outcomes because if treatment fails, their body does not have the resources to fight the disease. ”

However, antibiotic treatment of appendicitis is good suitable for children. An analysis of 404 cases of acute appendicitis in childhood showed that with an uncomplicated course of the disease, treatment with antibiotics is successful in 90% of cases. However, if appendicolitis occurs (exit of a stone from the appendix into the abdominal cavity) or other complications, it is still recommended to resort to surgical treatment.

In Volgograd, a 23-year-old guy died after a simple operation – February 10, 2023

Ivan managed to write to the girl that he was being taken for an operation

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On Sunday, February 12, in the village of Dub New Ravine 23-year-old Ivan Tronev will be buried near Volgograd. Until recently, he was hospitalized with suspected appendicitis, but after a seemingly simple operation, he never got out of anesthesia and fell into a coma. Three weeks later he died. What caused the tragedy and who is guilty of it is now being investigated by the investigation and the inspectors of the regional health department. A resuscitation professor with many years of experience, in turn, believes that this was the result of the so-called post-resuscitation disease – a terrible complication that can occur even with the simplest surgical intervention.

Ivan Tronev became ill on January 17th. My stomach hurt and it became clear that I couldn’t do without the help of doctors. Relatives took him to hospital No. 15 of the Krasnoarmeysky district of Volgograd, from where the guy was sent to hospital No. 22 on duty. The young man spent the night in the hospital ward, and in the morning he wrote to his girlfriend that he was being taken for an operation.

The operation was about to end, when suddenly Ivan’s heart stopped. The resuscitator managed to “launch” the young man, but he never regained consciousness.

“He was admitted to the hospital with acute appendicitis,” said the young man’s mother, Elena Troneva. – The next day, towards evening, we were informed that he did not come to his senses. The doctors said that during the operation there was a cardiac arrest and after that Vanya was on a ventilator.

Ivan did not live up to his birthday only 16 days

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The young man’s friends managed to restore the chronology of events. They say that at 23:50 on January 17 he was taken to the hospital. The operation began the next morning at 08:20. At 09:25 Ivan’s heart stopped. They launched it at 09:32 – after 7 minutes. After another 8 minutes, the operation ended. Since then, the guy has not regained consciousness.

“For two weeks we were told that he was stabilized, his pressure was equalized, his temperature was brought down, he was under a ventilator in an artificial coma,” said Elena Troneva. – They explained to me that they were waiting for a signal from the brain to restore breathing, after which Ivan would be taken for an MRI. And then the doctor let slip that the coma was not drug-induced and that he fell into it during an operation, after a cardiac arrest. I signed a consent to the installation of a tracheostomy. It was the best decision for him at that time. And then he suddenly began to lose weight. All that was left of him was bones. I ask: why did this happen? They answer: cardiac arrest caused multiple organ failure, due to which, among other things, the cerebral cortex suffered, and in general he is not a tenant. He was injected with some kind of medicine, put on drips to raise the pressure that had collapsed a few days ago. But doctors say: everything, the state is critical, an irreversible reaction of the brain has begun.

Ivan died in the intensive care unit of hospital No. 22

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On February 9 at 02:40 Ivan’s heart finally stopped. Resuscitation measures were unsuccessful, the duty team of doctors pronounced him dead.

“A couple of days before his death, his blood pressure began to drop,” says Elena Troneva. “We were on the phone that night, constantly calling the hospital. Some man took the phone, said that the doctor could not come up, that he did not leave Vanka, he was trying to increase his pressure. And at 02:40 they called us and said that he was no more.

In the intensive care unit of hospital No. 22, they refused to communicate with journalists, saying that all questions should be addressed to the management of the medical institution. Avoided communication with the correspondent and the head physician of the hospital.

Ivan did not live up to his birthday only 16 days

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— A man was taken to the hospital with suspected acute surgical pathology. From the moment of hospitalization, an examination was scheduled and carried out, including ultrasound diagnostics, ECG and biochemical blood tests, – explained the death of a man in the health committee of the administration of the Volgograd region. — Based on the results of the examination and based on the patient’s condition, it was decided to perform surgery. During the operation, the patient’s condition deteriorated sharply, after the completion of the operation, the patient was in intensive care, where he consulted daily with the main freelance specialists of the region. Unfortunately, despite the efforts of doctors to save the life of the patient, the patient died on 9February. Upon the fact of the complication, verification activities are carried out.

The Investigative Committee also announced that the check had begun.

“A pre-investigation check has been launched into the death of a man after an operation to remove the appendix,” the Investigative Committee of the Investigative Committee of Russia for the Volgograd Region said in a statement. – The actions of medical workers will be given a legal assessment under the article “Causing death by negligence due to improper performance by a person of his professional duties. ”

Doctor of Medical Sciences, Professor Mikhail Statsenko suggested that a complex of problems arose during the operation, called post-resuscitation disease. And a protracted period of clinical death led to a fatal outcome, after which problems in the body began to grow like a snowball.

— As for coma, as a person who has worked in cardio intensive care for 18 years, I can say that such moments do happen. The so-called post-resuscitation disease manifests itself, – Professor Statsenko reflects. – It can occur even after successful resuscitation. The heart has stopped beating, the blood is not flowing anywhere. There is a total hypoxia, first of all – the largest consumer, the brain. Therefore a coma follows. If a person is in a state of hypoxia for a long time, then all organs suffer, multiple organ failure develops. In addition, cells are destroyed. And when the heart starts up again, toxic substances enter the bloodstream again, further damaging organs and systems. This is called post-resuscitation illness.

Seven minutes that Ivan’s heart did not work during the operation, according to Professor Statsenko, became catastrophic for the body.

– Not all patients manage to restart the heart. This guy succeeded in 7 minutes. But irreversible changes in the brain begin in 3-5 minutes, complains Mikhail Statsenko. – It is believed that resuscitation is effective and passes without consequences for the person, if performed during this particular time. Of course, cases of longer times are described, for example, when a person drowned in cold water. In this case, the brain cools down, and doctors have a better chance of saving the person. Seven minutes is a lot. Specific complications associated with tissue ischemia are possible. Then there is a syndrome of restoring blood flow, DIC, multiple organ failure, tissue hypoperfusion, an increase in the concentration of enzymes in the blood that damage organs and tissues. A well-known thing in medicine, it is described, but its consequences, unfortunately, are very serious.