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குடல்வால் அறுவை சிகிச்சை என்றால் என்ன?

அப்பெண்டிக்ஸ் என்று சொல்லப்படும் குடல்வால் பகுதியில் தொற்று ஏற்பட்டாலோ, அதில் வீக்கம் ஏற்பட்டாலோ (அழற்சி), குடல்வாலை முழுமையாக அகற்றிவிடுவதே குடல்வால் அகற்று அறுவை சிகிச்சை ஆகும். இந்த அறுவை சிகிச்சை முறையை அப்பென்டக்டமி (Appendectomy) என்று மருத்துவத்தில் அழைக்கிறார்கள். இந்த அறுவை சிகிச்சை முறையும், லேபரோஸ்கோபி முறையில் துளையிட்டே செய்துவிடுகிறார்கள். வயிற்றின் அடிப்பகுதியை கீறி திறந்த நிலையில் அறுவை சிகிச்சை செய்த காலம் எல்லாம் மலையேறிவிட்டது.

குடல்வாலில் ஏன் அழற்சி ஏற்படுகிறது?

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Peritonitis due to a ruptured appendix

Peritonitis is the inflammation or infection in the peritoneum. This is a thin layer that covers all the abdominal organs and is an inner lining of the abdomen wall. An inflammation to the peritoneum can be caused mainly when the fluid in the gastro intestinal tract comes in contact with the peritoneum. This can happen due to a ruptured appendix, ulcer perforation, gallbladder infection, intestinal perforations, trauma to the abdomen (accidents where the abdomen suffers from rupture and injuries) . Let us know more.

What actually is Peritonitis?

Simply put, it is the inflammation or infection that affects the peritoneum. Most infections in our body are due to bacteria, virus, fungus and other pathogens that enter the body system. Peritoneal infection is also similar. Because pathogens have entered the peritoneum region, this infection occurs. The infection inflames the abdominal organs. The peritoneum actually functions to contain the infection locally and protects the other organs while the body actually responds and fights the infection to ward off the pathogens.

How Peritonitis can occur?

If the peritoneal tissue is compromised and breached then they get exposed to an array of pathogens. The compromise can occur because of rupturing of appendix, any underlying medical condition, or abdominal injury.

Peritonitis due to a ruptured appendix

An inflamed appendix gives enough warning by the typical pain it manifests. The pain actually will be unbearable if the appendix has reached a point of rupturing. The pain can be felt in the lower right abdomen below the navel region. When all these symptoms are ignored, then the appendix ruptures. A ruptured appendix spills its entire content into the peritoneum. The content of the appendix is generally faeces which we all know is replete with bacteria and other pathogens. The contents may also contain undigested food particle, the corrosive digetsive juices including bile and acid. When this content spills to the peritoneum, infection manifests.

Significant Symptoms of Peritonitis

The patient will look really sick. Abdomen wall which is supposed to be soft to touch becomes a rigid like a cardboard. The abdomen which is supposed to move will remain rigid, severe pain, trachypnea (shallow breathing and so increased breathing). The patient will be still because of the pain that manifests in the abdomen.

When the doctor examines the abdomen they will have severe pain, high grade fever, trachycardia. When the surgeon examines with a stethoscope, there will be absence of any movement inside the abdomen (silent abdomen).

Some of the other common symptoms of peritonitis include nausea, vomiting, dehydration, not enough urine output, etc.

Radiologically (In X-rays) there will be air under the diaphragm. This is because the intestinal air ecaped into the abdomen cavity.

Treatment of Peritonitis due to ruptured appendix

Peritonitis is generally treated as critical. They need to be treated as an emergency procedure. It is infact common to observe many patients voluntarily saying that a ruptured appendix has to be operated in six hours. The abdomen region has to be washed and removed of all the content of the ruptured appendix first. This is done surgically only. In the same surgery, the appendix removal is also done simultaneously. After the surgical procedure is over, the patient is generally given dosage of antibiotics to help the body fight the infection.

Failure to treat Peritonitis

Any delay or failure to treat peritonitis can lead to sepsis. The infection can spread to the blood and thereby the infection begins to reach other organs of the body. As the infection spreads unabated, multiple organ failure (heart, kidney, and brain) is the result. This can be life threatening and can lead to death.

Dr. Maran M’s opinion of ruptured appendix and peritonitis

Dr Maran is of the opinion that most appendicitis condition can be diagnosed by modern methods and only very rarely the patients can ignore all the symptoms. He however cautions that peritonitis occurring due to ruptured appendix still happen due to ignorance and neglect. So Dr Maran advises to take pain in the stomach seriously and consult a good gastro surgeon who can easily diagnose if appendicitis is present.

Image showing a ruptured appendix that is removed and that region is cleaned during a appendix surgery in Chennai to prevent infection.

What happens if appendix ruptures?

Some may wonder if an internal organ like appendix can burst. We tend to assume that if there is acute stomach pain, the physician would do physical examination to doubt appendicitis. A diagnosis would lead to finding appendicitis in you. You would get an appendix removal surgery done and remove the appendix. This is what most of you would think. But according to Dr Maran M, a gastro surgeon who regularly performs many appendix surgery in Chennai, it is not an easy sequence of events many times. Let us look at the challenges.

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Dr Maran, the surgeon, talks about diagnostic challenges of Appendicitis in Children and appendix removal surgery in Chennai.

Appendicitis in Children – Diagnostic Challenges and Treatment

The occurrence of Appendicitis in Children is common nowadays. But what happens if appendicitis may have occurred in children as young as four or five years old? Children that young may not exactly tell what the pain is all about and it becomes the duty of the paediatrician or physician to observe the symptoms carefully and report.

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