Acute Appendicitis Complicated with Acquired Immunodeficiency Syndrome (AIDS)

　　First, etiology

　　The incidence of abdominal surgery in AIDS patients is not high (4.2%), but appendicitis is prone to occur, and it is believed that this is related to its blood supply being terminal vessels without collateral branches, and infections and edema in the blood vessels cause thrombosis, making the appendix prone to gangrene and perforation.

　　Second, pathogenesis

　　AIDS patients have a high incidence and mortality rate due to severe suppression of the immune function, and even minor injuries often cause significant systemic and local reactions, leading to many serious conditions. Once appendicitis occurs, its pathological development is different from that of normal appendicitis, and it also needs to be distinguished from the special gastrointestinal inflammation in AIDS patients (such as cytomegalovirus colitis, acute ileitis), which can often be cured without surgery, while the delay in appendicitis can bring much more serious consequences to AIDS patients than to normal people.

　　About 1/3 of patients may delay diagnosis for up to 3-21 days, all forming perforative appendicitis. The incidence of perforation is about 44%. Before the onset of abdominal pain, there may be a history of irregular vaginal bleeding, sudden and severe abdominal pain, often accompanied by pale complexion, decreased blood pressure, and other signs of shock; the tone of the abdominal muscles is slight, with mobile dullness; gynecological examination shows blood in the vagina, cervical erosion, swelling of one adnexa, and unfixed blood in abdominal puncture or lumbar puncture.

　　The pain of acute salpingitis begins in the lower abdomen, lower than that of appendicitis, mostly bilateral, and high fever may appear early, with a history of increased leukorrhea; vaginal examination shows increased leukorrhea and uterine tenderness.

　　Symptoms mainly include abdominal pain, which later becomes localized to the lower right abdomen, with less than 50% also having nausea and vomiting, and all have low fever. Signs include tenderness in the lower right abdomen, abdominal muscle tension, and positive rebound pain. Abdominal pain and signs are similar to gastrointestinal manifestations of opportunistic pathogens in AIDS, making diagnosis more difficult.

　　The incidence of abdominal surgery in AIDS patients is not high (4.2%), but appendicitis is prone to occur, and it is believed that this is related to its blood supply being terminal vessels without collateral branches, and infections and edema in the blood vessels cause thrombosis, making the appendix prone to gangrene and perforation.

　　After meals, avoid rushing and walking abruptly, during the sweltering summer heat, avoid excessive cooling, especially not to overindulge in ice beer and other cold drinks. Pay attention to not eat too greasy food in daily life, avoid overeating刺激性 food, and actively participate in physical exercise to enhance physical fitness and improve immune ability. If there is a history of chronic appendicitis, extra attention should be paid to avoid recurrence, and keep the bowels smooth in daily life.

　　Blood routine examination found that 1/3 of the patients had only slightly elevated white blood cell count, and the rest were within the normal range or below normal (average 3.9×109/L). When there is effusion around the appendix, ultrasound examination and CT examination can often provide assistance. Some people recommend laparoscopy as a diagnostic basis with a high rate of diagnosis, but this examination is traumatic and should not be used unnecessarily, otherwise it may cause unnecessary injury.

　　I. Diet formula:

　　1, Formula One

　　Rhubarb 10 grams, natrii sulfas 9 grams, forsythia 12 grams, lonicera 12 grams, sappan wood 15 grams, magnolia officinalis 10 grams, costus 9 grams, persica 9 grams, and moutan bark 12 grams. Decocted and taken in one dose per day.

　　This formula clears heat and promotes bowel movement, regulates qi and nourishes blood, suitable for appendicitis caused by damp-heat and blood stasis, with main symptoms such as: hidden pain in the lower right abdomen that resists palpation, persistent or intermittent, or pain initially in the upper abdomen, or pain around the navel first, then shifting to the vicinity of the right tianshu point, possibly with tense abdominal skin, epigastric stuffiness, nausea and belching, slight fever, normal stool or constipation. Thin white coating or yellow and white mixed coating, wiry and slippery pulse, wiry and rapid pulse, or thin and涩 pulse.

　　2, Formula Two

　　Lonicera 12 grams, dandelion 15 grams, viola yedoensis 15 grams, oldenlandia 10 grams, rhubarb 10 grams, pericarpium citri reticulatae 9 grams, moutan bark 10 grams, and rhizoma corydalis 15 grams. Decocted and taken in one dose per day.

　　This formula clears heat and detoxifies, resolves blood stasis and relieves pain, suitable for appendicitis caused by heat retention, with main symptoms such as: abdominal pain that resists palpation, marked tenderness in the lower right abdomen, with rebound pain, tense abdominal skin, possibly palpable mass, accompanied by fever, thirst, decreased appetite, epigastric stuffiness, nausea and vomiting, constipation or loose stools, short and red urine, yellow and thin coating or thick and greasy coating, wiry and rapid pulse or slippery and rapid pulse.

　　3, Formula Three

　　Lonicera 10 grams, forsythia 12 grams, scutellaria 9 grams, raw rehmannia 9 grams, and radix scutellaria 6 grams, rhubarb 10 grams, viola yedoensis 12 grams, chrysanthemum 9 grams, and melon seed 30 grams. Decocted and taken in one dose per day.

　　This formula clears heat and detoxifies, promotes bowel movement and expels pus, suitable for appendicitis caused by pus-toxin ulceration, with main symptoms such as: abdominal pain starting from the lower right abdomen and spreading to the entire abdomen, severe pain, tense abdominal skin, generalized tenderness, rebound pain, persistent fever or alternating chills and fever, flushed face and red eyes, dry lips and foul breath, nausea and vomiting, abdominal distension and constipation, or loose stools with foul smell, frequent urination resembling dripping, red and dry tongue with yellow rough and prickly coating or yellow and greasy coating, wiry and slippery pulse or thin and rapid pulse.

　　4, Formula Four

　　Fresh wild chrysanthemum 60 grams, patrinia 15-60 grams, and viola yedoensis 30 grams. Choose one of them, decocted; taken in 3-4 doses, one dose per day.

　　This formula can be used for acute appendicitis.

　　5, Formula Five

　　White peony 18-45 grams, licorice and bupleurum each 6-12 grams, acacia and moutan bark, and phellodendron each 10-15 grams. Decocted and taken in three doses, one dose per day, with double dosage for severe cases.

　　This formula is applicable to acute and chronic appendicitis.

　　6, Recipe Six

　　Sanguisorba officinalis, Sophora japonica flower each 30 grams, Scutellaria baicalensis 15 grams, licorice 3 grams, fresh Rehmannia glutinosa 30 grams, scallions with roots 20 roots.

　　Boil and take in three doses, one dose per day.

　　This recipe is suitable for acute appendicitis.

　　7, Recipe Seven

　　Garlic 60 grams, mirabilite and rhubarb each 30 grams. First, grind garlic and mirabilite into a paste and apply it to the most painful part of the abdomen (apply a layer of Vaseline to the skin first to prevent skin damage). After 2 hours, remove the medicine, and then apply rhubarb powder mixed with vinegar externally, leave it on for 6-8 hours, and this is one dose. It can be repeated every few hours if necessary.

　　This recipe is used for acute appendicitis.

　　8, Recipe Eight

　　Fresh Portulaca oleracea 120 grams (dried 30 grams), mung bean 30-60 grams. Boil the soup and take it in 2-3 doses.

　　This recipe is effective for acute appendicitis.

　　9, Recipe Nine

　　Coix seed 50-100 grams. Boil in water until soft, make it into porridge with moderate consistency, take 1-2 times a day, one dose per day.

　　This recipe is used for the convalescent period of acute appendicitis and chronic appendicitis.

　　10, Recipe Ten

　　Sweet melon seeds 30 grams, sugar to taste. Grind and refine them, and take them with boiling water.

　　This recipe is suitable for acute appendicitis.

　　Second, Diet Principles:

　　Fluid diet should be given, such as milk, soy milk, rice porridge, meat soup, etc., or semi-liquid diet, such as congee, thin soft noodles, etc. If you are preparing for hospital surgery, you should fast and not drink water.

　　The information is for reference only, please consult a doctor for specifics.

　　Acute Appendicitis in AIDS Patients Western Medical Treatment After the diagnosis of acute appendicitis is clear, early surgery should be performed to remove the lesion. At the same time, effective broad-spectrum antibiotics should be administered for 5 to 7 days. Even so, about 80% of patients have persistent fever for more than a week without other systemic symptoms of sepsis. During the fever period, the white blood cell count in the blood does not increase (average 3.5×109/L), and the average hospital stay is 11 days. The patient can recover to the preoperative level, and the cause of postoperative fever, although it is often not found through physical examination, blood culture, X-ray examination, etc., may be due to low-grade local inflammation lasting for a long time. Therefore, effective broad-spectrum antibiotic treatment is used as a countermeasure. Since laparoscopy can be used to make a clear diagnosis, some people advocate using laparoscopic appendectomy as a treatment method, which is convenient for completing it in one go.