A ruptured appendix is a perforation of the appendix caused by inflammation. This appendix on the appendix can rupture if inflammation is left untreated, allowing intestinal contents to enter the abdominal cavity. There, inflammation can lead to serious complications.
What is a ruptured appendix?
Appendicitis rupture, also called appendix rupture, is the most serious complication of appendicitis. Because this creates a portal of entry for germs into the abdominal cavity, an appendix rupture poses an acute danger to life. The incidence of appendicitis is particularly high in adolescents and young adults, who, however, have the best prognosis for recovery. Overall, the mortality rate for this disease is about 1%. In general, older patients who already suffer from other pre-existing conditions are more likely to experience complications during recovery. With timely diagnosis and treatment by surgery, patients with ruptured appendix recover completely and are left with only a small scar on the lower right abdomen.
Causes
The cause of a ruptured appendix is always a preceding appendicitis that is not recognized and treated in time. Such inflammations, in turn, can have a variety of causes, but most often they stem from the penetration of a foreign body into the appendix, to which the immune system reacts with increased activity. This results in local inflammation, which then spreads to 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 tears and purulent secretions can penetrate outward into the abdominal cavity. Appropriate causative foreign bodies may include undigested food, fecal 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 definite cause for appendicitis can be determined in retrospect. 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 appendicitis.
Symptoms, complaints, and signs
Even before an appendix ruptures, there is persistent pain in the lower right 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 then 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, the pain is relieved only for a short time. This is because the pus as well as stool residue and bacteria then pass from the intestine into the abdominal cavity. There the bacteria multiply and cause a life-threatening peritonitis. Peritonitis is noticeable by increasing abdominal pain in the right lower abdomen. The abdomen becomes hard as a board. A typical symptom is the so-called release pain, which occurs after touching the abdominal wall. In addition to the pain, the patient often suffers from high fever, cold sweat, palpitations, and nausea and vomiting. Without treatment, loss of consciousness occurs quickly. At the same time, intestinal paralysis may occur, possibly leading to intestinal obstruction. If no treatment is given, ruptured 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 a complete recovery.
Diagnosis and course
A ruptured appendix can be diagnosed by imaging, such as computed tomography or ultrasound, or by symptoms. The classic picture corresponds to appendicitis, with pain subsiding for a short period of time, known as rotten peace, and then returning much more severely once the rupture has occurred and the abdominal cavity begins to become inflamed. An appendicitis rupture can also theoretically be detected via elevated laboratory values in leukocytes.As a rule, however, this is not done because surgery must be performed immediately if there is a reasonable suspicion of rupture. Without surgery, the disease quickly becomes fatal. The invasion of intestinal contents into the abdominal cavity leads to inflammation, severe pain and high fever. The abdominal wall hardens in what is called defensive tension until the patient’s circulation collapses.
Complications
Appendicitis rupture is a feared complication of appendicitis. Its consequences can be life-threatening for the affected person. Thanks to modern antibiotics, most patients today survive this high-risk situation and make a full recovery. However, the risk of complications and late effects is greater with a ruptured appendix than with early removal of the inflamed appendix. During scarring, loops of intestine can become fused or constricted, sometimes leading to intestinal obstruction (ileus). After surgery, symptoms may recur, requiring further surgical intervention. When the appendix ruptures, bacteria, pus as well as intestinal contents enter the abdominal cavity. As a result, extensive peritonitis often develops, requiring immediate surgery. The severe clinical picture can take a life-threatening course in individual cases. The surgeon mechanically flushes out the entire abdominal cavity and places thin drainage tubes to the outside. In the case of a ruptured appendix, there is always a risk of abscesses forming in the abdominal cavity. These pus deposits can lead to chronic inflammation that affects bowel function. In the worst case, complete intestinal paralysis occurs. The risks of surgery and anesthesia are usually low. Complications include injury to other abdominal organs, infection, postoperative bleeding, and poor wound healing. Chronic pain and sensory disturbances may also occur.
When should you see a doctor?
A ruptured appendix is the most serious complication of appendicitis and is a medical emergency that is not always immediately recognized as such because of its paradoxical symptoms. In appendicitis rupture, the appendix, which is filled with pus, bursts open, which immediately causes the pain to subside. For the affected person, it may initially appear as if his or her condition has improved significantly. In fact, however, when the appendix bursts, stool and bacteria from inside the intestine enter the abdominal cavity, causing a severe infection of the peritoneum (peritonitis). After some time, the pain returns and is worse than before. The abdomen stiffens and becomes hard as a board, the patient develops high fever and becomes apathetic or loses consciousness. In this situation, there is an acute danger to life. The affected person must be taken to the nearest hospital immediately. Immediate action is critical for the patient’s chances of survival. Reasonably, appropriate countermeasures are taken much earlier and a doctor is consulted at the first signs of appendicitis. Characteristic of appendicitis is pain in the right lower abdomen combined with tenderness and fever. Anyone who observes such symptoms in himself or his child should promptly consult a doctor or the nearest hospital as a precaution.
Treatment and therapy
A ruptured appendix can only be treated surgically. During treatment, utmost urgency is required. During surgery, the abdominal cavity is opened and the ruptured appendix is exposed. Depending on the severity of the rupture, there is the possibility of a minimally invasive procedure using the so-called keyhole method. In any case, the appendix must be completely removed. In addition, the abdominal cavity is rinsed to prevent inflammation caused by any germs that may have penetrated. Following the operation, the patient is given antibiotics to prevent peritonitis. In addition, painkillers are given for the pain caused by the surgical wound. Anatomically, the appendix no longer performs any function in humans. This means that after the surgical scar heals, the patient should not retain any discomfort or limitations. If the appendix is still before rupture, there is the option of conservative, wait-and-see treatment with bed rest, high-dose antibiotics, painkillers, and dietary restriction.It is important to monitor the patient closely and to be ready for immediate surgery if a perforation begins to appear. Without surgery, a perforated appendix has a very high mortality rate. Therefore, surgery is also indicated in patients with a high risk of surgery, for example, due to cardiovascular disease. The operation is always performed under general anesthesia and can take several hours. Depending on the severity and physical constitution of the patient, recovery takes several days to weeks, with bed rest required initially. Lifting heavy objects should be avoided for the first few weeks after an appendectomy to prevent the wound from re-opening.
Outlook and prognosis
The prognosis for a ruptured appendix is very good, provided that the appropriate surgery is performed quickly. On the other hand, if there is a ruptured appendix that is not treated surgically and with antibiotics, it will lead to death in most cases due to a spillover of inflammation into the peritoneum, the initiation of sepsis, etc. The operation itself has an excellent prognosis: the mortality rate for a simple operation is a fraction of one percent, and for a more difficult operation due to an abdominal perforation it is about one percent. Almost all the risks of the operation are the possible consequences. For example, life-threatening complications occur in about one percent of those operated on, including recurrent inflammation, bleeding and intestinal paralysis. The prognosis for the absence of these complications is more favorable the cleaner the operation and the better the follow-up care in the form of medication, wound cleaning and follow-up examination. Bed rest and a general gentle behavior for several weeks also have an influence. There may be occasional severe pain, bleeding and general discomfort. Bowel function is often disturbed for some time after the procedure. The prognosis with regard to possible subsequent 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 of appendicitis rupture is early diagnosis and treatment of appendicitis. Thus, a physician must be consulted immediately if appropriate symptoms are present. Then the inflammation is either combated with medication or the inflamed appendix is surgically removed before it can rupture. It is also difficult to prevent appendicitis itself. In principle, however, care should be taken not to swallow foreign bodies and to chew ingested food well. If the appendix has already been completely removed from a patient, there is no risk of recurrence.
Follow-up
Appendiceal rupture requires surgical treatment and consistent aftercare for optimal recovery. Aftercare includes patient care of the scar, which primarily means protection from contamination to prevent risk of infection. Heavy lifting should be avoided for a few weeks after the operation, as well as sports. The reason for this is that the abdominal press, which is needed as a tension for many loads, can hinder the tissue in its regeneration. The scar should also be spared by avoiding the abdominal press. The duration of the sparing measures is determined by the doctor. Pressing when going to the toilet can also delay the healing process and cause pain. Hard stools are therefore best avoided. This can be achieved by drinking enough fluids, eating a diet rich in fiber and avoiding foods that cause gas and constipation. If constipation has nevertheless occurred, preparations such as psyllium husks can also be used to support stool regulation in consultation with the attending physician. Often a ruptured appendix is also associated with an infection in the abdomen and antibiotic administration. In these cases, it is advisable to restore any intestinal flora that may have been disturbed by the antibiotics and to strengthen the immune system as part of the aftercare. Again, the attending physician should be consulted if the patient wishes to take preparations as a supplement.
What you can do yourself
A ruptured appendix is a life-threatening condition that requires immediate medical attention. There are clear limits to self-treatment in this case. There is also little that can be done preventively. It is important in the case of an existing appendicitis that it is strictly monitored.If in doubt, consult an internist. In the case of a ruptured appendix, a timely diagnosis can save lives. The treatment itself is performed exclusively by surgery. Accordingly, self-treatment measures can only be applied postoperatively. Depending on the severity of the condition, the recovery period may last days or weeks. Strict bed rest must be observed during the first few days. Patients should make sure they drink enough fluids and eat only light food. It is also important to chew food thoroughly. Everything that could irritate the gastrointestinal tract should be avoided. To support the healing process, homeopathically prepared arnica can help. This plant extract relieves inflammation in the body and improves wound healing. Likewise, the micronutrient selenium has an anti-inflammatory effect in the organism. As a follow-up therapy, patients are prescribed several days of antibiotics. To support the intestines – since antibiotics also kill healthy intestinal bacteria – probiotics from the pharmacy can help. When healing is well underway, sufferers should engage in light exercise to stimulate the digestive tract. Lifting heavy weights should be avoided for the first few months.