Peritonitis in acute appendicitis is caused by –
Correct Answer: Early rupture
Description: Ans. is 'b' i.e.. Early rupture of appendixo Perforation of appendix in acute appendicitis commonly leads to an abscess cavity' walled off by the small bowel loops and the omentum, forming a phlegmon. Rarely the appendix may perforate freely into the peritoneal cavity and cause generalized peritonitis. This usually occurs in cases of early rupture of the appendix as inflammatory process did not get time to be localized by the omentum and bowel loops.o Usually the rupture of appendix is a late sequelae of appendicitis, usually occurring 48 to 72 hours from the onset of symptoms.Also know:o The site of rupture is commonly just beyond the point of obstruction, along the antimesenteric border of appendix,o Fecaliths are the most common cause of appendiceal obstruction.Lets also see the management of appendicitis:Management of appendicitis: o The treatment of appendicitis is appendectomy. (It can be done open or laparoscopically)o Prophylactic antibiotics are indicated preoperatively. Postoperative antibiotic coverage is of no use in simple (uncomplicated) acute appendicitis. If perforated or gangrenous appendicitis is found, antibiotics are continued until the patient is afebrile and has a normal white blood cell count.Perforated Appendicitis (Maingot's 11/e p603)o Rupture is suspected in the presence of fever with a temperature of >39degC (102degF) and a white blood cell count of >18,000 cells/mm3.o The management of perforation depends on the nature of the perforation.o If the perforation is free causing intraperitoneal dissemination of pus and fecal material, urgent laparotomy is done for appendectomy and irrigation and drainage of the peritoneal cavity'.o If the perforation is contained it would result in an appediceal mass or abscess. This is managed as described under.Appendiceal Abscess/ Masso Patients who present late in the course of appendicitis with a palpable or radiographically documented mass (abscess or phlegmon) are treated with-# Conservative therapy and interval appendectomy 6 to 10 weeks later.(conservative management includes intravenous antibiotics and fluids as well as bowel rest.)# Patients with large abscesses, greater than 4 to 6 cm in size, and especially those patients with abscess and high fever, benefit from abscess drainage.
Category:
Surgery
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