Ruptured appendix

A Ruptured appendix is an inflammation-related perforation of the appendix. This appendix on the appendix can break through if the inflammation is untreated, so that the intestinal contents can penetrate into the abdominal cavity. There, inflammation can lead to serious complications.

What is a ruptured appendix?

Having a ruptured appendix, too Appendix rupture called, one understands the most serious complication of appendicitis. Because this creates a portal for germs to enter the abdominal cavity, there is an acute risk of death if the appendix ruptures. A ruptured appendix occurs particularly frequently in adolescents and young adults, who, however, also have the best healing prognosis.

Overall, the mortality rate from this disease is around 1%. In general, older patients who already suffer from other pre-existing conditions are more likely to have complications in healing. With timely diagnosis and treatment by surgery, patients with a ruptured appendix will be completely healthy with only a small scar on the right lower abdomen.

causes

The cause of a ruptured appendix is ​​always a previous appendicitis, which is not recognized and treated in time. Such inflammations, in turn, can have a variety of causes, but mostly they result from the penetration of a foreign body into the appendix, to which the immune system reacts with increased activity. This then results in local inflammation that spreads over the entire appendix.

Due to the shape of the appendix, the pressure of the growing inflammation cannot be dissipated, so that at some point the skin will tear and purulent secretion can penetrate outwards into the abdominal cavity. Corresponding causative foreign bodies can be, for example, undigested food, excrement stones, grape seeds or small, swallowed bone fragments. Other causes of appendicitis are bacterial infections that travel through the lymphatic system to the lymph nodes in the appendix.

In many cases, no clear cause of appendicitis can be determined afterwards. Risk groups are patients with autoimmune diseases or inflammatory bowel diseases such as ulcerative colitis or Crohn's disease. Very obese people are also at increased risk of having a ruptured appendix.

Symptoms, ailments & signs

Even before a ruptured appendix, there is persistent pain in the right lower abdomen, which is a sign of appendicitis or even appendicitis. The abdominal wall is tense because more and more pus accumulates in the appendix. If left untreated, the appendix can burst. This is a life-threatening complication of appendicitis.

After the appendix has ruptured, the pain initially subsides because the appendix, which is bulging with pus, is relieved by the emptying. However, there is only short-term pain relief. Because the pus as well as stool residues and bacteria then get from the intestine into the abdominal cavity. There the bacteria multiply and cause life-threatening inflammation of the peritoneum (peritonitis).

Peritonitis manifests itself as increasing abdominal pain in the right lower abdomen. The stomach becomes hard as a board. A typical symptom is the so-called letting go pain that occurs after touching the abdominal wall. In addition to the pain, the patient often suffers from a high fever, cold sweat, racing heart, as well as nausea and vomiting. Without treatment, you will quickly lose consciousness.

At the same time, intestinal paralysis can occur, which under certain circumstances leads to an intestinal obstruction. If left untreated, the rupture of the appendix is ​​fatal. Only emergency surgery and intensive antibiotic treatment can avert this danger. After treatment, the symptoms usually subside very quickly and there is usually complete healing.

Diagnosis & course

A ruptured appendix can be diagnosed using imaging techniques, such as computed tomography or ultrasound, or based on the symptoms. The classic picture corresponds to appendicitis where the pain subsides for a short time, the so-called lazy peace, and then occurs again much more strongly when the breakthrough has occurred and the abdominal cavity begins to inflame.

A rupture of the appendix can also theoretically be determined via increased laboratory values ​​for leukocytes. As a rule, however, this is not done because if there is justified suspicion of a rupture, an operation must be performed immediately. Without surgery, the disease is quickly fatal. The penetration of intestinal contents into the abdominal cavity leads to inflammation, extreme pain and a high, high fever. The abdominal wall hardens in a so-called immune tension until the patient's circulation breaks down.

Complications

The rupture of the appendix is ​​a dreaded complication of appendicitis. Its consequences can be life-threatening for those affected. Thanks to modern antibiotics, most patients survive this high-risk situation and recover completely.

However, the risk of complications and long-term effects is greater with a ruptured appendix than with an early removal of the inflamed appendix. When scarring, loops of the intestine can grow together or become narrowed, which sometimes leads to an intestinal obstruction (ileus). Symptoms may reappear after the operation, which necessitates further surgical interventions.

If the appendix ruptures, bacteria, pus and intestinal contents enter the abdominal cavity. The result is an extensive inflammation of the peritoneum (peritonitis) that requires immediate surgery. The severe clinical picture can take on a life-threatening course in individual cases.

The surgeon mechanically flushes the entire abdominal cavity and places thin drainage tubes on the outside. With a ruptured appendix there is always the risk of abscesses forming in the abdomen. These pus deposits can lead to chronic inflammation that affects bowel function. In the worst case, it leads to complete intestinal paralysis.

The risks of surgery and anesthesia are usually low. Complications include injuries to other abdominal organs, infections, bleeding, and poor wound healing. Chronic pain and sensitivity disorders can also occur.

When should you go to the doctor?

A ruptured appendix is ​​the most serious complication of appendicitis and a medical emergency that is not always immediately recognized as such because of its paradoxical symptoms. When the appendix ruptures, the appendix filled with pus bursts open, which immediately leads to a decrease in pain.

For the person concerned, it may initially appear as if their condition has improved significantly. In fact, when the appendix bursts open, stool and bacteria from the inside of the intestine enter the abdominal cavity, which leads to a severe infection of the peritoneum (peritonitis). After a while, the pain returns and is worse than before.

The abdomen stiffens and becomes hard like a board, the patient develops a high fever and becomes apathetic or unconscious. In this situation there is an acute danger to life. The person concerned must be taken to the nearest hospital immediately.Immediate action is critical to the patient's chances of survival.

Appropriate countermeasures are sensibly taken much earlier and a doctor is consulted at the first signs of appendicitis. Appendicitis is characterized by pain in the right lower abdomen combined with tenderness and fever. Anyone who observes such symptoms in themselves or their child should consult a doctor or the nearest hospital as soon as possible.

Doctors & therapists in your area

Treatment & Therapy

A ruptured appendix can only be treated surgically. The greatest urgency is required during treatment. During the operation, the abdominal cavity is opened and the torn appendix is ​​exposed. Depending on the severity of the breakthrough, there is the possibility of a minimally invasive procedure with the so-called keyhole method.

The appendix must be completely removed in any case. In addition, the abdominal cavity is rinsed to prevent inflammation from any germs that may have penetrated. After the operation, the patient is given antibiotics to prevent inflammation of the peritoneum, known as peritonitis.

Painkillers are also given to relieve pain through the surgical wound. Anatomically, the appendix no longer fulfills any function in humans. This means that after the surgical scar has healed, the patient should not have any complaints or restrictions.

If the appendix is ​​about to break through, there is the option of conservative, wait-and-see treatment with bed rest, high-dose antibiotics, painkillers and food abstinence. It is important here to closely monitor the patient and to be ready for an immediate operation should a breakthrough begin. Without surgery, a perforated appendix has a very high death rate.

This is why an operation is also indicated in patients with a high risk of surgery, for example due to cardiovascular diseases. The procedure is always performed under general anesthesia and can take several hours. Depending on the severity and physical constitution of the patient, the recovery takes several days to weeks, whereby bed rest is necessary at the beginning. Lifting heavy objects should be avoided in the first few weeks after an appendix operation so that the wound cannot tear open again.

Outlook & forecast

The prognosis for a ruptured appendix is ​​very good, provided that the operation is carried out quickly. If there is a ruptured appendix that is not surgically treated and treated with antibiotics, however, in most cases it leads to death by spreading the inflammation to the peritoneum, inducing sepsis, etc.

The operation itself has an excellent prognosis: the mortality rate for a simple operation is a fraction of a percent, while that for a more difficult operation due to an abdominal perforation is around one percent.

Almost all of the risks of surgery are its possible consequences. Life-threatening complications occur in around one percent of those who have been operated on, including, for example, renewed inflammation, bleeding and intestinal paralysis. The prognosis for the absence of these complications is more favorable, the cleaner the operation and the better the aftercare in the form of medication, wound cleaning and the follow-up examination.

Bed rest and general restraint for several weeks also have an influence. Occasionally, severe pain, bleeding, and general discomfort may occur. The bowel function is often disturbed for some time after the procedure.

The prognosis with regard to possible complications worsens if the person affected by the ruptured appendix is ​​frail, ill or has some other form of health impairment.

prevention

The only effective prevention against a ruptured appendix is ​​early diagnosis and treatment of appendicitis. A doctor must be consulted immediately if symptoms occur. Then the inflammation is either fought with medication or the inflamed appendix is ​​surgically removed before it can break through.

Appendicitis itself is also difficult to prevent. Basically, however, care should be taken not to swallow any foreign bodies and to chew food thoroughly. If the appendix has already been completely removed from a patient, there is no risk of recurrence.

Aftercare

The rupture of the appendix requires surgical treatment and consistent follow-up care for optimal regeneration. Aftercare includes the care of the scar by the patient, which means above all protection from contamination in order to avert the risk of infection. Do not do heavy lifting or exercise for a few weeks after the operation.

The reason for this is that the abdominal press, which is required as tension for many loads, can prevent the tissue from regenerating. The scar can also be spared by avoiding the abdominal press. The doctor determines the duration of the protective measures.

Pressing on the toilet slope can also delay the healing process and cause pain. Hard stools are therefore best avoided. This can be achieved by drinking a sufficient amount of water, eating a diet rich in fiber and avoiding gas and stuffy foods. If constipation has nevertheless occurred, preparations such as psyllium husks can be used to support stool regulation in consultation with the treating doctor.

A ruptured appendix is ​​often associated with an infection in the abdomen and the administration of antibiotics. In these cases, it is advisable to restore any intestinal flora that may have been disturbed by the antibiosis and to strengthen the immune system as part of the aftercare. Here, too, the attending physician should be asked if the patient would like to take supplements.

You can do that yourself

A ruptured appendix is ​​a life-threatening condition that requires immediate medical attention. There are clear limits to self-treatment here. Little can be done preventively either. If you have appendicitis, it is important that it is closely monitored. If in doubt, an internist should be consulted.

In the case of a ruptured appendix, early diagnosis can save lives. The treatment itself takes place exclusively through an operation. The self-treatment measures can therefore only be used postoperatively. Depending on the severity of the disease, the recovery phase can take days or weeks. Strict bed rest must be observed for the first few days.

Those affected should ensure they are drinking enough fluids and only eat light foods. It is also important to chew the food thoroughly. Anything that could irritate the gastrointestinal tract should be avoided. Homeopathically prepared arnica can help to support the healing process. This plant extract relieves inflammation in the body and improves wound healing. The micronutrient selenium also has an anti-inflammatory effect in the body.

As a follow-up therapy, the patient is prescribed antibiotics for several days. In order to support the intestines - since antibiotics also kill healthy intestinal bacteria - probiotics from the pharmacy can help. With good healing progress, sufferers should move around gently to stimulate the digestive tract. Do not lift heavy weights in the first few months.