What are the main symptoms of appendicitis. How long does it take for an appendix to rupture. What happens if appendicitis is left untreated. Can appendicitis be mistaken for other conditions. How is a ruptured appendix diagnosed and treated.

Understanding Appendicitis: Causes and Risk Factors

Appendicitis is a condition characterized by inflammation of the appendix, a small, finger-shaped sac located in the lower right side of the abdomen where the small and large intestines connect. While the exact cause of appendicitis remains unknown, medical experts believe that an infection triggers inflammation inside the appendix.

The primary mechanism behind appendicitis involves a blockage of the appendix opening. This obstruction can be caused by various factors, including:

• Bacteria
• Viruses
• Parasites
• Stool buildup
• Inflammatory bowel disease (IBD)

Once blocked, bacteria can become trapped inside the appendix and multiply rapidly, leading to inflammation and the onset of appendicitis symptoms.

Who is at risk for appendicitis?

Appendicitis can affect individuals of any age, but certain groups are more susceptible:

• Children and teenagers between 10 and 20 years old
• People assigned male at birth
• Individuals with a family history of appendicitis
• Children with cystic fibrosis

Understanding these risk factors can help in early detection and timely treatment of appendicitis, reducing the risk of complications such as a ruptured appendix.

Recognizing the Symptoms of Appendicitis

Identifying appendicitis can be challenging, as its symptoms often mimic other abdominal conditions. However, being aware of the classic signs can help in seeking prompt medical attention.

What are the primary symptoms of appendicitis?

The most common symptoms of appendicitis include:

• Abdominal pain, typically starting around the navel and moving to the lower right abdomen
• Pain that intensifies with movement, coughing, or sneezing
• Nausea and vomiting
• Loss of appetite
• Low-grade fever
• Abdominal bloating or swelling
• Constipation or diarrhea
• Inability to pass gas

It’s important to note that symptoms can vary among different age groups. For instance, infants and young children may experience more generalized abdominal pain, while older adults might have less severe pain and tenderness.

How quickly do appendicitis symptoms progress?

The progression of appendicitis symptoms can be rapid. Typically, the pain begins around the navel and then shifts to the lower right abdomen within a few hours. As the condition worsens, the pain intensifies, and additional symptoms like fever and nausea may develop.

Given the potential for rapid progression, it’s crucial to seek medical attention as soon as you suspect appendicitis. Early diagnosis and treatment can prevent complications such as a ruptured appendix.

The Dangers of a Ruptured Appendix

A ruptured appendix, also known as a perforated appendix, is a serious complication of untreated appendicitis. When the appendix bursts, bacteria and infected material are released into the abdominal cavity, leading to a potentially life-threatening situation.

How long does it take for an appendix to rupture?

The time it takes for an appendix to rupture can vary, but it typically occurs within 48 to 72 hours after the onset of symptoms. The risk of rupture increases significantly the longer treatment is delayed:

• At 36 hours after symptom onset, the risk is about 2%
• After 36 hours, the risk increases by approximately 5% every 12 hours

This underscores the importance of seeking medical attention promptly when experiencing symptoms of appendicitis.

What are the symptoms of a ruptured appendix?

The symptoms of a ruptured appendix can be severe and may include:

• Intense abdominal pain that spreads throughout the abdomen
• High fever
• Chills
• Weakness
• Nausea and vomiting
• Abdominal swelling

Interestingly, some individuals may experience temporary relief from pain immediately after the appendix ruptures due to the release of pressure. However, this relief is short-lived, and more severe symptoms soon follow.

Complications of a Ruptured Appendix: Peritonitis

One of the most serious complications of a ruptured appendix is peritonitis, an inflammation of the abdominal cavity lining caused by the spread of bacteria from the burst appendix.

What is peritonitis and how does it develop?

Peritonitis occurs when bacteria from the ruptured appendix enter the abdominal cavity, causing inflammation of the peritoneum (the membrane lining the abdominal cavity). This condition can rapidly become life-threatening if not treated promptly.

What are the symptoms of peritonitis?

The symptoms of peritonitis are similar to those of appendicitis but often more severe:

• Constant, severe abdominal pain throughout the entire abdomen
• High fever
• Rapid heart rate
• Shortness of breath
• Nausea and vomiting
• Abdominal swelling
• Decreased urine output

Peritonitis requires immediate medical attention and often necessitates emergency surgery to clean the abdominal cavity and treat the infection.

Diagnosing Appendicitis and Ruptured Appendix

Accurate and timely diagnosis of appendicitis is crucial to prevent complications such as a ruptured appendix. However, the diagnosis can be challenging due to the similarity of symptoms with other abdominal conditions.

How is appendicitis diagnosed?

Diagnosing appendicitis typically involves a combination of methods:

1. Medical history and physical examination
2. Blood tests to check for signs of infection
3. Urine tests to rule out urinary tract infections
4. Imaging tests such as ultrasound, CT scan, or MRI

During the physical examination, the doctor may perform specific tests to assess abdominal pain and tenderness, such as the Rovsing’s sign or the psoas sign.

Can appendicitis be mistaken for other conditions?

Yes, appendicitis can be mistaken for other abdominal conditions due to the similarity of symptoms. Some conditions that may mimic appendicitis include:

• Gastroenteritis (stomach flu)
• Urinary tract infections
• Ovarian cysts or ectopic pregnancy in women
• Crohn’s disease
• Kidney stones

This potential for misdiagnosis underscores the importance of comprehensive medical evaluation when experiencing abdominal pain.

Treatment Options for Appendicitis and Ruptured Appendix

The treatment approach for appendicitis depends on the severity of the condition and whether the appendix has ruptured.

How is uncomplicated appendicitis treated?

For uncomplicated appendicitis, the standard treatment is a surgical procedure called an appendectomy. This involves removing the inflamed appendix before it ruptures. The surgery can be performed in two ways:

1. Laparoscopic appendectomy: A minimally invasive procedure using small incisions and a camera
2. Open appendectomy: A traditional surgery involving a larger incision in the lower right abdomen

In some cases, antibiotics alone may be used to treat mild appendicitis, although this approach is still being studied and is not universally accepted.

What is the treatment for a ruptured appendix?

When dealing with a ruptured appendix, the treatment is more complex and may involve:

• Emergency surgery to remove the appendix and clean the abdominal cavity
• Intravenous antibiotics to combat infection
• Drainage of any abscesses that may have formed
• Supportive care to manage pain and other symptoms

In some cases, if an abscess has formed, the doctor may drain it first and perform the appendectomy later when the infection is under control.

Recovery and Prognosis After Appendicitis Treatment

The recovery process and long-term outlook for individuals who have undergone treatment for appendicitis or a ruptured appendix can vary depending on the severity of the condition and the type of treatment received.

What is the typical recovery time after an appendectomy?

Recovery time after an appendectomy depends on the surgical approach and whether complications occurred:

• Laparoscopic appendectomy: Most patients can return home within 24 hours and resume normal activities within 1-3 weeks
• Open appendectomy: Recovery may take 2-4 weeks
• Ruptured appendix: Recovery can take several weeks to months, depending on the extent of infection and complications

During recovery, it’s important to follow the doctor’s instructions regarding wound care, physical activity, and follow-up appointments.

What is the long-term outlook for patients who have had appendicitis?

The long-term prognosis for patients who have undergone treatment for appendicitis is generally excellent. Most people recover fully without any lasting effects. However, those who experienced a ruptured appendix may face a slightly higher risk of complications such as:

• Abdominal adhesions
• Bowel obstruction
• Fertility issues (rare)

Regular follow-up with a healthcare provider can help monitor for any potential long-term effects and address them promptly if they arise.

Preventing Appendicitis and Its Complications

While appendicitis itself may not be entirely preventable, there are steps individuals can take to reduce their risk and prevent complications such as a ruptured appendix.

Can appendicitis be prevented?

There is no guaranteed way to prevent appendicitis, as its exact cause remains unknown. However, some lifestyle factors may help reduce the risk:

• Maintaining a healthy diet rich in fiber
• Staying hydrated
• Practicing good hygiene to prevent infections
• Managing underlying conditions like inflammatory bowel disease

While these measures may not completely prevent appendicitis, they contribute to overall digestive health.

How can the risk of a ruptured appendix be minimized?

The key to preventing a ruptured appendix is early detection and prompt treatment of appendicitis. To minimize the risk:

1. Be aware of the symptoms of appendicitis
2. Seek medical attention immediately if you suspect appendicitis
3. Don’t ignore persistent abdominal pain, especially if it’s accompanied by fever or vomiting
4. Avoid self-diagnosis or attempting to treat suspected appendicitis at home

Remember, the risk of rupture increases significantly with delayed treatment, so timely medical intervention is crucial.

Understanding appendicitis, its symptoms, and potential complications like a ruptured appendix is essential for early detection and treatment. By recognizing the signs and seeking prompt medical attention, individuals can significantly reduce their risk of serious complications and ensure better outcomes. While appendicitis may not be entirely preventable, awareness and quick action can make a substantial difference in managing this common yet potentially serious condition.

Causes, Symptoms, Recovery, and Survival

Untreated appendicitis may cause your appendix to rupture (burst), resulting in an infection. Symptoms associated with a ruptured appendix include severe abdominal pain, fever, chills, and weakness.

Appendicitis is inflammation of the appendix. This small, thin, finger-shaped sac is located on the lower right side of your abdomen, where your small and large intestines connect. Most doctors think the appendix doesn’t have an important function and can be removed without causing harmful effects.

If your appendicitis is left untreated, your appendix can rupture (burst). When this happens, bacteria get released into your abdomen and can cause a serious infection.

A ruptured appendix, also known as a perforated appendix, can make you very sick and is sometimes hard to treat.

The risk of rupture increases the longer that appendicitis treatment is delayed. The risk is about 2% 36 hours after symptoms start. After that, the risk increases by about 5% every 12 hours.

The biggest risk factor for a ruptured appendix is delaying treatment for appendicitis. The longer you wait to address your symptoms, the higher your risk.

According to a 2018 literature review, younger children are more likely to have a ruptured appendix than older children. This is because they have more trouble explaining their appendicitis symptoms to others.

The exact cause of appendicitis is unknown, but experts think an infection triggers inflammation inside the appendix.

For instance, If something blocks the opening of the appendix, an infection can follow. Bacteria can get trapped inside the appendix and multiply quickly, causing appendicitis. Viruses, parasites, and stool buildup may cause the blockages and infections that result in appendicitis. Inflammatory bowel disease (IBD) is another possible cause of appendicitis.

When appendicitis isn’t treated promptly and correctly, bacteria or pus build up. As this happens, pressure increases and the appendix swells. Eventually, it swells so much that the blood supply to part of the appendix gets cut off. That part of the appendix wall dies, and a hole or tear develops in the dead wall. The high pressure pushes the bacteria and pus into the abdominal cavity.

A ruptured appendix usually oozes or leaks into the abdomen instead of bursting like a balloon.

Risk factors for appendicitis

Appendicitis can happen at any age, but it often affects children and teens between the ages of 10 and 20 years. It’s more common in people who were assigned male at birth.

Having other family members with appendicitis can increase your risk too. Children with cystic fibrosis are also more likely to have appendicitis.

Was this helpful?

Appendicitis symptoms can be similar to those of other conditions that affect the abdomen, such as a stomach virus or an ovarian cyst. For this reason, it can be hard to tell if you have appendicitis.

The classic symptoms of appendicitis are pain starting around the belly button and then vomiting. Several hours later, the pain moves to the lower right abdomen.

If you have these symptoms and think it might be appendicitis, seek medical attention as soon as possible. Quick treatment is essential to avoid a rupture.

Other symptoms of appendicitis include:

• abdominal pain that may start in the upper or middle abdomen but usually settles in the lower right abdomen
• abdominal pain that increases when you walk, stand, jump, cough, or sneeze
• a bloated or swollen abdomen
• tenderness when you push on your abdomen, which may get worse when you quickly stop pressing on it
• an inability to pass gas
• fever
• nausea along with vomiting
• decreased appetite
• constipation or diarrhea

Keep in mind that not everyone who gets appendicitis has these classic symptoms. It’s common for kids and older adults to have more unusual symptoms.

In babies and children, the pain is often spread out all over the abdomen. Caregivers should look for pain that starts around the child’s belly button and moves to the right side, along with appetite loss and fever.

In older people, the abdomen may be less tender, and pain may be less severe.

Appendicitis inflames the appendix and causes it to swell. Without treatment, the pressure eventually reaches the point where the appendix bursts. This can happen as quickly as 48 to 72 hours after your symptoms start.

Once your appendix ruptures, you may have a variety of symptoms. At first, you may feel better for a few hours because the high pressure in your appendix is gone, along with your original symptoms.

Peritonitis

When bacteria leave the intestine and enter the abdominal cavity, the lining of your abdominal cavity becomes inflamed. This condition is called peritonitis.

Peritonitis can be very serious and very painful. It requires immediate treatment.

The symptoms of peritonitis are similar to those of appendicitis, except:

• the pain is in your whole abdomen
• the pain is constant and more severe
• your fever is often higher
• your breathing and heart rate may be fast because of fever, infection, or severe pain
• you may have other symptoms, including chills, weakness, and confusion

Abscess

When you have an infection in your abdomen, the surrounding tissues sometimes try to wall off the infection from the rest of your abdomen. The wall forms an abscess, a closed-off collection of bacteria and pus.

Symptoms of an abscess are also similar to those of appendicitis, except:

• the pain may be in one area (but not always the lower right abdomen), or it may be in your entire abdomen
• the pain can be either a dull ache or sharp and stabbing
• the fever doesn’t go away, even when you take antibiotics
• you may have other symptoms, such as chills and weakness

Sepsis

When left untreated, the bacteria from a ruptured appendix can enter your bloodstream, causing a serious condition called sepsis. Sepsis is inflammation throughout your entire body.

Symptoms of sepsis include:

• fever or a low temperature
• fast heartbeat and breathing
• chills
• weakness
• confusion
• low blood pressure

The treatment for a ruptured appendix is to remove your appendix with surgery.

Doctors sometimes wait to perform surgery on a child who isn’t in any immediate danger. The surgeon will drain infected fluid from the abdomen, have the child take antibiotics, and remove the appendix later. The name for delayed surgery is interval appendectomy.

Peritonitis

The treatment for peritonitis is to clean bacteria out of the abdomen during surgery.

You’ll usually get antibiotics through a vein, at least for the first few days. You may need to receive hospital treatment for 10 to 14 days to ensure the infection is gone.

Abscess

Often, your appendix will be removed right away. If there’s a large abscess, your doctor might want to drain it before surgery. A tube inserted into the abscess lets the bacteria- and pus-filled fluid drain out.

This process can take several weeks. You might go home with the drain in place, and you’ll need to take antibiotics while the drain stays in place.

Once the abscess is drained and the infection and inflammation are controlled, your doctor will perform your surgery.

Sepsis

Antibiotics are the main treatment for sepsis. It’s important to start taking these medications as soon as possible, because the infection is life threatening if left untreated.

Duration of treatment may vary, but shorter treatment courses are generally preferred, according to a 2020 study.

You’ll need to take antibiotics once your ruptured appendix is removed or a drain is put into an abscess. You’ll typically take antibiotics before, during, and after surgery.

The length of antibiotic treatment will vary. Your surgeon will analyze your case to determine the best plan for you.

One 2021 study recommended that postsurgical antibiotic treatment be limited to 3 to 6 days.

Open surgery (instead of minimally invasive laparoscopic surgery) is typically used for a ruptured appendix. It helps your doctor ensure all of the infection is cleaned out.

After surgery, you’ll need to keep the incision clean and dry. Avoid taking a bath or shower until your doctor says it’s fine to do so.

It can take up to 6 weeks to fully recover from open surgery. Try not to lift anything heavy or participate in sports or other strenuous activities during this time. Your recovery will take longer if you have a drain inserted and shorter if you have a laparoscopic procedure.

You may take strong prescription pain medication for a few days after surgery or after a drain is placed. After that, you can usually manage the pain with over-the-counter (OTC) medications such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol).

Your doctor may encourage you to get up and walk as soon as possible after surgery. You may have to adjust your diet and eat smaller meals while you heal.

You should be able to return to work or school around 1 week after surgery, depending on how you feel.

Considerations for children

A child whose appendix has ruptured may need to stay in the hospital for 1 week or so.

A 2022 study recommended that children who’d undergone laparoscopic surgery and had a normal white blood cell count discontinue antibiotics at the time of their hospital discharge.

Others may come home with a special tube called a peripherally inserted central catheter (PICC line) so they can get antibiotics through a vein at home.

Kids should stay on a liquid diet for a couple of days after surgery. They should wait until they have their follow-up visit with the surgeon, and get the surgeon’s approval, before going back to their regular activities. This could take up to 3 weeks.

Without quick treatment, a ruptured appendix is a life threatening condition.

When the appendix hasn’t perforated, the risk of death is under 1% according to a 2020 literature review. The risk can be as high as 5% if the appendix has perforated.

Treating a ruptured appendix increases the odds of survival.

If you get medical attention right away for appendicitis, you have a better chance of fully recovering if your appendix ruptures. That’s why it’s important to see a doctor if you have any symptoms of appendicitis.

There’s no way of knowing when or if appendicitis will happen, so you can’t prevent it. However, you can avoid a rupture if you get immediate treatment.

The key is to know the symptoms of appendicitis. If you have any abdominal pain combined with nausea or other symptoms, get medical help immediately.

See a healthcare professional even if you’re unsure if your symptoms are appendicitis. It’s better to find out that you don’t have appendicitis than to wait and have your appendix rupture.

Appendicitis | Johns Hopkins Medicine

What is appendicitis?

The appendix is a thin tube that is joined to the large intestine. It sits in the lower right part of your belly (abdomen). When you are a young child, your appendix is a working part of your immune system, which helps your body to fight disease. When you are older, your appendix stops doing this and other parts of your body keep helping to fight infection.

The appendix can get infected. If not treated it can burst (rupture). This can happen as soon as 48 to 72 hours after you have symptoms. Because of this, appendicitis is a medical emergency. If you have symptoms, see a doctor right away to avoid more infection, which can be life-threatening.

What causes appendicitis?

Appendicitis happens when the inside of your appendix is blocked. Appendicitis may be caused by various infections such as virus, bacteria, or parasites, in your digestive tract. Or it may happen when the tube that joins your large intestine and appendix is blocked or trapped by stool. Sometimes tumors can cause appendicitis.

The appendix then becomes sore and swollen. The blood supply to the appendix stops as the swelling and soreness get worse. Without enough blood flow, the appendix starts to die. The appendix can burst or develop holes or tears in its walls, which allow stool, mucus, and infection to leak through and get inside the belly. The result can be peritonitis, a serious infection.

Who is at risk for appendicitis?

Appendicitis affects 1 in 1,000 people living in the U. S. Most cases of appendicitis happen to people between the ages of 10 and 30 years. Having a family history of appendicitis may raise your risk, especially if you are a man. For a child, having cystic fibrosis also seems to raise the risk of getting appendicitis.

What are the symptoms of appendicitis?

The following are common symptoms of appendicitis. Your own symptoms may vary.

Pain in the abdomen is the most common symptom. This pain:

• May start in the area around your belly button and move to the lower right-hand side of your belly. It may also start in the lower right-hand side of your belly.
• Often gets worse as time goes on.
• May feel worse when you are moving, taking deep breaths, being touched, and coughing or sneezing.
• May be felt all over your belly if your appendix bursts.

Other common symptoms include:

• Upset stomach and vomiting
• Loss of appetite
• Fever and chills
• Trouble having a bowel movement (constipation)
• Loose stool (diarrhea)
• Trouble passing gas
• Swollen belly

Do not take pain medicines. They may hide other symptoms your healthcare provider needs to know about.

Appendicitis symptoms may look like other health problems. Always see your healthcare provider to be sure.

How is appendicitis diagnosed?

Your healthcare provider will ask about your past health and do a physical exam. He or she may also have you take the following tests:

• Blood tests: To check for signs of infection, such as having a high white blood cell count.
• Urine tests: To see if you have a urinary tract infection.

You may also have some imaging tests, including:

• Abdominal ultrasound: Lets the doctor see internal organs as they work and checks how blood is flowing through different blood vessels.
• CT scan: Shows detailed images of any part of the body, such as the bones, muscles, fat, and organs.
• MRI: Sometimes used to diagnose appendicitis, especially in a pregnant woman, instead of CT scan.

How is appendicitis treated?

Appendicitis is a medical emergency. It is likely the appendix will burst and cause a serious, deadly infection. For this reason, in almost all situations, your healthcare provider will advise that you have surgery to remove your appendix.

The appendix may be removed in an open procedure or using laparoscopy:

• Open (traditional) surgery method. You are given anesthesia. A cut (incision) is made in the lower right-hand side of your belly. The surgeon finds the appendix and takes it out. If the appendix has burst, a small tube (shunt) may be placed to drain out pus and other fluids in the belly. The shunt will be taken out in a few days, when your surgeon feels the infection has gone away.
• Laparoscopic method. You are given anesthesia. This surgery uses several small cuts (incisions) and a camera (laparoscope) to look inside your belly. The surgical tools are placed through a few small incisions. The laparoscope is placed through another incision. A laparoscopy can often be done even if the appendix has burst.

If your appendix has not burst then your recovery from an appendectomy will only take a few days. If your appendix has burst, your recovery time will be longer and you will  need antibiotic medicine.

You can live a normal life without your appendix. Changes in diet or exercise are usually not needed.

Complications of Appendicitis

The main problem with appendicitis is the risk of a burst appendix. This may happen if the appendix is not removed quickly. A burst appendix can lead to infection in the belly, called peritonitis. Peritonitis can be very serious and even cause death if not treated right away.

Can appendicitis be prevented?

At this time, there is no known way to stop appendicitis from happening.

When should I call my healthcare provider?

If you have any of the symptoms of appendicitis listed above, call your healthcare provider right away. Or go to an emergency department. Appendicitis is a serious medical emergency. It should be treated as quickly as possible.

Key Points About Appendicitis

Appendicitis is when your appendix becomes sore, swollen, and diseased.

• It is a medical emergency. You must seek care right away.
• It happens when the inside of your appendix gets filled with something that causes it to swell, such as mucus, stool, or parasites.
• Most cases of appendicitis happen between the ages of 10 and 30 years.
• It causes pain in the belly, but each person may have different symptoms.
• Your health care provider will advise that you have surgery to remove your appendix.
• You can live a normal life without your appendix.

Next Steps

Tips to help you get the most from a visit to your healthcare provider:

• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.

Acute appendicitis

Acute appendicitis is an acute inflammation of the appendix (vermiform appendix of the caecum), requiring urgent surgical treatment, one of the most common inflammatory diseases of the abdominal organs.

What is the “appendix” and why does it become inflamed?

The appendix arises from the lower end of the caecum (the beginning of the large intestine). It is believed that the appendix is ​​one of the links of the immune system, since the mucous membrane of the appendix is ​​rich in lymphoid tissue. It is generally accepted that inflammation of the appendix may occur due to blockage of the appendix lumen by enlarged lymphoid tissue, fecal stones (hard stools resulting from chronic constipation), a foreign body, and sometimes helminths. Blockage leads to expansion of the appendix cavity, the rapid development of infection and inflammation. However, the exact cause of this common disease is not clear.

Symptoms of acute appendicitis

Manifestations of acute appendicitis depend on the location of the appendix, the time elapsed from the onset of the disease, the severity of the inflammatory process in the appendix and the involvement of nearby organs and peritoneum, as well as the age of the patient and the presence of concomitant diseases.

Since the appendix is ​​a mobile organ, its inflammation can mimic almost any disease. In some cases, doctors have difficulty in making a diagnosis, since the main symptom of appendicitis – pain – can occur not only in the right lower abdomen, where it should be located according to the anatomy of the caecum, but also in the navel, in the groin, above the pubis , in the lower back, in the right hypochondrium and disguised as diseases of the liver, kidneys, female genital organs.

As a rule, the disease begins with the appearance of pain in the upper abdomen, which gradually increases, moves to the right iliac region (right lower quadrant of the abdomen). The pain is aggravated by coughing and movement. Usually there is a subfebrile body temperature of 37.2-37.5 ° C. Examination of the abdomen reveals involuntary tension of the muscles of the anterior abdominal wall and pain in the right iliac region. The pain is constant and may be accompanied by nausea and sometimes vomiting. There is often loss of appetite and refusal to eat, as well as stool retention caused by restriction of intestinal motility due to inflammation spreading through the peritoneum.

Unfortunately, these classic signs of appendicitis are observed in just over half of patients with acute appendicitis. The pain may not have a clear localization, especially in children under 3 years of age. In elderly and senile patients, reduced reactivity of the body, connective tissue replacement of all layers of the appendix wall and its blood vessels contribute to poor symptoms of acute appendicitis and a large number of complicated forms. In pregnant women in the second and third trimesters, a uterine appendix may cause an atypical clinical picture. Therefore, so often patients with acute appendicitis come to the emergency surgery department already with complications (perforation of the appendix, peritonitis).

What is “phlegmonous” and “gangrenous” appendicitis?

If the patient’s symptoms of appendicitis are mild, but, nevertheless, the inflammatory process develops (the pain is not very strong, there is no nausea and vomiting), he is in no hurry to seek medical help, and then catarrhal appendicitis turns into a phlegmonous form. The appendix fills with pus and ulcerates. Inflammation begins to spread to the surrounding tissues: the walls of the intestine, the peritoneum. The pain becomes more pronounced, aggravated by the tension of the abdominal muscles; in thin people, the inflamed process can be felt as a dense roller.

Phlegmonous appendicitis can turn into a gangrenous form, when the inflammatory process develops already in the abdominal cavity. With gangrenous appendicitis, there is a decrease or complete absence of pain associated with the death of the nerve endings of the appendix, but signs of general intoxication, deterioration of the general condition: weakness , pallor, bloating. If at this stage the patient is not helped, the patient’s life is at risk due to the development of peritonitis.

How is appendicitis diagnosed?

If acute appendicitis is suspected, the patient must be urgently admitted to a surgical hospital. In the EMC Surgical Clinic, emergency operations are performed around the clock for acute appendicitis and its complications.

At the stage before hospitalization, even in the presence of a pronounced pain syndrome, one should not take painkillers, as this may complicate the diagnosis of the disease. You should also not use antibiotics, as this can blur the picture with the further development of complications (perforation of the process, diffuse peritonitis).

Diagnosis begins with a thorough questioning and examination, as well as taking a blood test (a complete blood count usually reflects inflammation – an increase in the number of leukocytes, leukocytosis occurs). In the classic course of acute appendicitis (high temperature and pain in the right iliac region from tolerable to very strong), the diagnosis is not difficult. For patients with questionable or unclear symptoms, doctors may order an abdominal and pelvic ultrasound and/or computed tomography when admitted to the hospital.

In some cases, a diagnostic Laparoscopy can be performed, a diagnostic procedure in which a thin fiber optic tube with a camera is inserted into the abdominal cavity through a small opening in the abdominal wall. Laparoscopy allows you to see the appendix and other organs of the abdominal cavity and pelvis and assess their condition.

Acute Appendicitis Emergency

Surgery to remove an appendix (inflamed appendix) is called an “appendectomy” in which the inflamed appendix is ​​removed.

In the presence of perforation (rupture) of the appendix, the surgical intervention becomes technically more difficult to perform. There is a need for a thorough “washing” of the abdominal cavity from pus. Consequently, both the operation itself and recovery can be delayed.

Removal of the appendix is ​​preceded by intravenous antibiotics to prevent complications. If there is a perforation of the appendix, antibiotic treatment continues until the blood tests normalize (approximately 5-7 days). The question of the abolition of antibiotics is decided by the attending physician.

Laparoscopic Appendectomy

As a general rule, in EMC, most of the surgical interventions for acute appendicitis, even in the case of severe forms of the disease, are performed laparoscopically, which guarantees a minimum of pain and a shorter recovery period. In uncomplicated appendicitis, if the appendix has not been perforated, the patient is usually discharged the next day. Patients with a perforated appendix may stay in the clinic longer (up to 7 days), especially if peritonitis has developed.

However, there are some cases where traditional open surgery (open appendectomy) is preferred.

With timely surgical intervention, recovery occurs quickly.

Wisdom teeth – malocclusion and eruption

Alexander Spesivtsev
orthodontist, clinical director Star Smile

Do we need wisdom teeth?

I use a single compound word. In biology, there is such a concept0062 RUDIMENT – a part of the human body that has lost its function in the process of evolution. The most famous rudiment is the vermiform appendix of the intestine or appendix. So – a large number of doctors and people believe that there is nothing superfluous in the body and wisdom teeth can serve a person at an older age, when the main teeth are lost and the doctor can use figure eights to install, for example, a bridge prosthesis.

Unfortunately, in most cases this is impossible and even wrong!

Most people simply don’t have room for their eighth teeth in their jaws, and mother nature will start mocking them (and, of course, our doctors) in every possible way: painful eruption, irregular shape, incorrect size of the tooth itself, poorly developed root system – all of the above leaves no chance for the correct use of “eights”.

How wisdom teeth are formed

Unlike other teeth, the rudiments of wisdom teeth are not formed in the process of prenatal development, but at the age of 3-5 years, when the child’s body is preparing to change milk teeth to a permanent dentition. At this age, you can determine the number of future eights (and there can actually be from one to four). But at this age, it is not yet possible to detect any possible developmental pathologies.

It becomes more or less clear a little later, the crown part of the wisdom teeth begins to form. The process of formation starts in a child at about 12 years old, but at the same time, the development of the root part of the figure eight takes several more years and can continue even after teething. Considering that the most common age for the appearance of wisdom teeth is 18 – 25 years, the eruption of eights occurs already in quite an adult age. It was not in vain that I said earlier the phrase “actually from one to four”, since approximately 10 – 15% of the eight are absent in principle. That is why it is normal to consider the number of teeth in an adult from 28 to 32. These are wisdom teeth, right? How unwisely they treat us and make puzzles!

Fix it
bite or defect of the dentition with the help of invisible
aligners
Find out what it is

Teething of wisdom – a continuous “headache”

“Born into the world” a wisdom tooth in the oral cavity is always painful. The main causes of the pain effect are thick walls of the dental sac, thickened mucous membrane and reduced growth factors. In addition to the pain of the process itself, the eruption of eights can cause many other complications. What? Let’s talk about this in a little more detail.

The wisdom tooth sometimes does not erupt completely, restricting the surrounding teeth. This situation, as a rule, entails local inflammation and pain.

The time during which a wisdom tooth is cut can be quite long, and inflammation can constantly bother you, manifesting itself as an increased temperature of the whole body and sensitive pains, which sometimes make it difficult even just to open your mouth! This condition is fraught with inflammation of the tissues surrounding the problematic tooth, up to the bone, and therefore requires the immediate intervention of a qualified dentist.

The first problem of teething eights – caries

Often, at the time when the wisdom tooth is growing, its effective cleaning is difficult (due to the location of the wisdom teeth in the depth of the jaw). This is how caries occurs. Incorrect position during the eruption of the wisdom tooth also increases the risk of caries on the adjacent tooth due to difficult access to the spaces between these teeth. If symptoms of caries appear, you should consult a dentist and carry out appropriate treatment. Very often, in this case, the removal of a wisdom tooth is recommended, especially if all other teeth are developed normally.

In practice, it happens that a wisdom tooth erupts already … sick, that is, it becomes infected with caries while still in the gum. In such cases, the figure eight should be removed immediately so that the diseased wisdom tooth does not negatively affect the rest of the teeth.

Second problem – cyst

In rare cases, in the tissues surrounding the erupting wisdom tooth, a cyst and swelling may occur, which requires immediate surgical intervention by a dental surgeon.

Need help?

Need help?

Sign up for a free consultation

By clicking on the “Waiting for a call” button, you confirm your

consent to the processing of user data

Thank you for your application, our manager will contact you

Third problem – malocclusion

In the case of an incorrect position of the wisdom tooth during eruption, it is highly likely that such a tooth will significantly affect the position of the remaining teeth, which causes a change in bite. And the appearance of aesthetic problems – the teeth begin to stand crooked in the mouth. And this entails orthodontic treatment, bringing the dentition in order.

The fourth problem is language dysfunction

In addition to aesthetic problems, this can also cause functional problems. For example, if the wisdom tooth is displaced towards the vestibule of the oral cavity, serious injury to the mucous membrane of the cheeks, lips or tongue can occur, causing erosions and ulcers.

Fifth problem – the wisdom tooth wanted to, but could not erupt

Rarely, but there is a situation when, with a lack of space in the dentition or in the case of an incorrect inclination of the wisdom tooth itself, an anomaly develops, called “submerged wisdom tooth”. Such “submerged” teeth are usually removed.

It is possible that the wisdom tooth does not erupt at all. Despite its absence, such a tooth is dangerous for its complications. It can damage the roots of neighboring teeth or provoke neuralgic pain. In this case, you need to contact the surgeon and, most likely, the figure eight will have to be removed.

Sixth problem – pericoronitis

At the moment of eruption of the lower (!) wisdom teeth, when only part of the tooth appeared, acute inflammation and even accumulation of pus in the formed hood between the gum and the tooth can occur. This causes such a serious disease as pericoronitis (pericoronitis).

The main symptoms of the inflammatory process in pericoronitis are pain and swelling of the gums surrounding the wisdom tooth, bad breath and an unpleasant aftertaste.

In case of the appearance of the listed symptoms during the period of wisdom teeth cutting, you need to urgently consult a dentist

The seventh problem of wisdom teeth – periodontitis

When the figure eight erupts quite smoothly, due to its inconvenient location when cleaning, the wisdom tooth is not properly cleaned of plaque. It is also problematic to remove tartar and plaque on this tooth in dentistry. Because of this, bacteria begin to accumulate around the wisdom tooth, causing inflammation of the gums – periodontitis, which can then turn into osteoperiostitis. In this case, the tooth must be removed.

Total – seven problems of wisdom teeth. What conclusions do we draw?

Dentists have such a saying that if the patient did not notice how his wisdom teeth erupted, then he was very lucky. In many ways, this statement is true, because according to statistics, for most of us, the appearance of “eights” does not pass without complications.

You can get a quality consultation on wisdom teeth in your city

I want to check my “eights”!

Treat or remove eights?

Now with regard to orthodontic treatment and wisdom teeth. Believe me, it is very unpleasant for us doctors, as well as for patients, to make radical decisions. But there are good reasons! These are your stories. The stories of patients who underwent treatment with braces in adolescence achieved excellent results and….

All the beauty of even teeth, especially the lower incisors (they just started to enjoy a beautiful smile) – it disappears in 20 years and beyond. It is when most of us fully have these very “eights”. Two, three and even four years of medical “torment” to correct crooked teeth, turning them into a beautiful / sweet / courageous smile, as they say, down the drain . .. Yes, yes – the only option to become the owner of beautiful teeth again is repeated orthodontic treatment. Whether it will be aligners or braces again, it doesn’t matter anymore, the important thing is that there is a good saying: forewarned is forearmed! No one is immune from mistakes and relapse.

Our body is beautiful and magical in that it almost always adapts and compensates for almost any pathology. Therefore, the “eights” with difficulty, but cut through and after themselves deform very important teeth in front!

So what do we do with the eights?

The moral of this fable is this – trust qualified and educated doctors, and not kind and humane “neighborly” advice. Be wise. Especially at such crucial moments in life, when wisdom teeth make themselves felt. And in general, I wonder who was the first to call them “wisdom teeth”?

Moreover, an interesting point from medical practice: if you (what if?) Decided to remove the eights, it’s not a fact that they will be removed for you. The reason is banal – the removal of wisdom teeth should be carried out exactly according to the indications. A normal doctor will never remove a healthy tooth just because you feel like it.

You have decided to have your wisdom teeth removed. How traumatic is it?

If the wisdom tooth has grown normally, its roots are not intertwined, the extraction usually takes place, without any complications. The edges of the tooth socket after extraction are often not even sutured.

What is most important after removing the figure eight is to let the hole of the newly removed wisdom tooth heal. Quite a big wound.

What to do is absolutely impossible? Do not rinse vigorously, even with such seemingly useful solutions as chamomile or calendula.

What to do. To get rid of food debris, you need to gently take water into your mouth and do short mouth baths without intensive rinsing. Instead of water, you can use a solution of chlorhexidine, miramistin or analogues, which is specially sold in pharmacies, – they disinfect the oral cavity. And so – at least three days. If this recommendation is neglected, the hole may become inflamed. Then the dentist prescribes treatment with drugs, up to antibiotics.

What if the roots of the insidious wisdom tooth are intertwined or fused?

Alas, in this case, complications are not excluded – soft tissues can be damaged. If an inflamed tooth is removed, in rare cases, the neurovascular bundle (!) of the lower jaw is injured. In this case, separate treatment may be required.

When is it advisable not to remove wisdom teeth?

There are situations when the “seventh” or “sixth” chewing teeth are to be removed. And in this situation, a wisdom tooth that has grown correctly can still come in handy. It will become one of the two supports for the future bridge prosthesis. However, in this case, a healthy sixth (or fifth) tooth will suffer, because it will have to be processed under the supporting crown.

A little now about the sad . It will take 10-15 years, the bridge will “work out” the prescribed time of operation. And sometimes it will not work to insert an implant – the jawbone atrophied under the bridge will not allow: in the absence of teeth, any person develops adentia of bone tissue. So, on the horizon of life, removable removable dentures of the jaws and newfangled gels appear, making them easier to wear.

Now a little about the positive . In such situations, you can initially consider dental implantation in specialized medical centers, where they will help restore bone volume and take control of the situation with the teeth.

What do we do after removing the eights?

We evaluate the possible damage that eights could cause to neighboring teeth. If the adjacent teeth are deformed, then the pathology can spread according to the domino principle, and here it is already necessary to carry out systemic orthodontic treatment aimed at correcting the malocclusion.

Aligners are the most sparing and aesthetic type of teeth correction today. The site contains a lot of information on aligners, but I would like to say about one indisputable advantage, namely, the patient can see the result of his treatment on aligners without even starting it! How so, you ask? The answer is simple – all future treatment of the patient is calculated using modern computer technology. The example below shows a real clinical case, a patient with crowding of teeth, caused just by the pathological effect of “eights” on adjacent teeth.

See how wisdom teeth lead to crowded teeth

And how crowded teeth are eliminated with Star Smile aligners

The video shows how the 3D setup is done. I am commenting on the video, orthodontist Alexander Spesivtsev, clinical director of Star Smile, a doctor with many years of experience in the successful use of aligners in orthodontic practice. To restore even dentition, the wisdom teeth themselves – figure eights – had to be removed.

At Star Smile – more precisely, at the clinics of its partners (and this is more than 70 cities in Russia), any treatment begins with a diagnosis and a virtual setup. The doctor takes photographs of the patient’s face, dentition, as well as x-rays and dental casts. With the help of special software, the obtained data is processed and a three-dimensional model of the patient’s dentoalveolar system is obtained. And already this allows you to calculate the trajectory of tooth movement, the duration of treatment, the required number of sets of caps. Also, the final result of the treatment will be visualized – the patient will be able to evaluate the aesthetics of the smile after the treatment. Patients really like this approach – to see their future smile, their straight teeth. The prediction of a 3D setup when teeth are aligned with aligners comes true in almost 100% of cases. You see, this is completely different from the “blind” bite correction, as is usually the case with braces. Everything is clear here, without any guesswork and assumptions.

Gevorkyan Oscar Vladimirovich

Candidate of Medical Sciences, Maxillofacial Surgeon, ZNIIS, Scientific Consultant Star Smile

” awn”?

feel free to contact the doctors of Star Smile company, they will help you understand this sometimes difficult, but very important life problem for many. Do not delay the decision in order to avoid possible complications in the future”

in your city, where you can discuss the problem of wisdom teeth and determine the best solution for you.To do this, you need to fill out the form below, a Star Smile medical specialist will contact you and help by scheduling a consultation at a convenient time or providing the doctor’s contacts.