Ectopic acute appendicitis

　　Ectopic appendicitis has the following types

　　1, Non-rotation deformity

　　The small intestine is located on the right, the colon on the left, and the cecum and appendix are ectopic in the lower left quadrant;

　　2, Incomplete rotation

　　The cecum and appendix are ectopic at a certain position during rotation, such as the upper left quadrant or under the liver, the latter also known as a high-position appendix;

　　3, Ascending colon is not fully fixed

　　The cecum and ascending colon are not fully fixed, leading to a variable position of the appendix;

　　3, Reverse position

　　Extremely rare. The midgut rotates clockwise, placing the entire small intestine on the left side, the ascending colon on the right, and in a few cases, the cecum and appendix are in the middle position.

　　1, Abdominal abscess

　　An abscess formed around the appendix is called a per appendiceal abscess. However, abscesses can also form in other parts of the abdominal cavity, commonly in the pelvis, subphrenic space, and interloop spaces, etc. Clinical manifestations include symptoms of paralytic ileus, peritoneal irritation signs, tender masses, and systemic infection and intoxication symptoms. B-ultrasound examination can assist in diagnosis and localization. Once diagnosed, timely surgical incision and drainage should be performed.

　　2. Formation of internal and external fistulas

　　If the perianal abscess is not drained in time, part of the cases may perforate into the small intestine or large intestine, or into the bladder, vagina, or abdominal wall, forming various internal and external fistulas; pus can be discharged from the fistula. X-ray barium examination can assist in understanding the course and extent of the fistula, which is helpful in choosing the treatment method of expanding drainage or excising the fistula.

　　3. Portal vein inflammation

　　During acute appendicitis, the infectious thrombus in the appendiceal vein can extend along the superior mesenteric vein to the portal vein, leading to portal vein inflammation. Clinical manifestations include liver enlargement and tenderness, jaundice, chills, and high fever. If the condition worsens, it can produce septic shock and sepsis. Delayed treatment can develop into bacterial liver abscess.

　　1. Low-positioned acute appendicitis

　　When the cecum descends too much or the right half of the colon is free and lacks fixation, the vermiform appendix can be located below the iliac crest, or even completely enter the pelvic cavity. The clinical estimate of the incidence of pelvic acute appendicitis is about 4.8-7.4%. It is manifested as referred pain, but the site of pain and the area of tenderness are both lower, and the muscle tension is also lighter. During the course of the disease, symptoms such as increased defecation and anal distension may occur, or symptoms such as frequent urination and urgency may occur. The treatment of low-positioned appendicitis is the same as that of general appendicitis. Appendectomy should be performed urgently, and the position of the cecum and vermiform appendix should be carefully explored during the operation. Inflammatory adhesions should be separated, and the vermiform appendix should be completely freed before resection.

　　2. High-positioned acute appendicitis

　　When the cecum descends too much or the right half of the colon is free and lacks fixation, the vermiform appendix can be located below the iliac crest, or even completely enter the pelvic cavity. The clinical estimate of the incidence of pelvic acute appendicitis is about 4.8-7.4%. It is manifested as referred pain, but the site of pain and the area of tenderness are both lower, and the muscle tension is also lighter. During the course of the disease, symptoms such as increased defecation and anal distension may occur, or symptoms such as frequent urination and urgency may occur. The treatment of low-positioned appendicitis is the same as that of general appendicitis. Appendectomy should be performed urgently, and the position of the cecum and vermiform appendix should be carefully explored during the operation. Inflammatory adhesions should be separated, and the vermiform appendix should be completely freed before resection.

　　3. Left-sided acute appendicitis

　　Due to congenital visceral ectopia, the cecum can be located in the lower left abdomen; in the case of acquired wandering cecum, it can also move and adhere to the lower left abdomen, and the vermiform appendix follows to adhere to the left iliac fossa. Left-sided acute appendicitis is very rare, and its pathological type and pathogenesis are the same as those of right-sided acute appendicitis. The pain, tenderness, and muscle tension are all localized to the left iliac fossa. When considering the possibility of left-sided acute appendicitis, a careful physical examination of the chest and abdomen and X-ray examination should be performed. After diagnosis, the appendix can be removed through a lower abdominal oblique incision.

　　Avoid sudden running after meals, and avoid excessive cooling in the sweltering summer heat. It is especially not advisable to drink excessive amounts of ice beer and other cold drinks. Pay attention to not eating too greasy food in daily life and avoid overeating刺激性 food. Take an active part in physical exercise to enhance physical fitness and improve immune function. If there is a history of chronic appendicitis, it is even more important to avoid recurrence and maintain smooth defecation in daily life.

　　1. Blood routine examination

　　The total white blood cell count is usually above 10×109/L, and the neutrophils are often above 80%. If perforation occurs and peritonitis develops, it can usually rise above 20×109/L. In small infants with strong reactions, the total white blood cell count can reach as high as 15×109/L in the early stage. If posterior appendicitis involves the ureter or bladder, white blood cells, red blood cells, or even pus cells may appear in the urine. At this time, urinary tract infection should be excluded.

　　2. Abdominal X-ray examination

　　When the cecum and external colon are inflated and expanded, and local inflammation is obvious, the right lumbar muscle edge is unclear, the right lower abdominal adipose line edge is blurred and widened, or even disappears. If it is a pelvic appendicitis, the pelvic adipose line may disappear.

　　3. B-ultrasound examination

　　It has a certain significance in limited appendiceal abscess.

　　First, blood stasis type food therapy and medicine

　　1. Peach Kernel and Coix Seed Porridge: 10 grams of peach kernel (with skin and tip removed), 30 grams of coix seed, 50 grams of glutinous rice, cooked into porridge until extremely soft for consumption.

　　2. Celery and Winter Melon Seed Soup: 30 grams of celery, 20 grams of winter melon seed, 20 grams of lotus node, 30 grams of wild chrysanthemum. Decocted, taken twice a day.

　　Second, food therapy and medicine for damp-heat type

　　1. Winter melon seed and Sophora flavescens Decoction: 15 grams of winter melon seed, 30 grams of Sophora flavescens, 10 grams of licorice, decocted, mixed with appropriate honey for drinking.

　　2. Patrinia scabiosa Decoction: 30 grams of Patrinia scabiosa, 20 grams of honeysuckle vine, 10 grams of peach kernel, 30 grams of coix seed, decocted, taken twice or three times a day.

　　3. Snake mouth grass and Patrinia scabiosa Decoction: 30 grams of white flower snake mouth grass, 20 grams of Patrinia scabiosa, decocted in water, mixed with appropriate honey for drinking.

　　Ectopic acute appendicitis is not easy to diagnose and is often misdiagnosed as organ inflammatory diseases at the site of ectopia, such as subhepatic or high-positioned acute appendicitis often misdiagnosed as acute cholecystitis, and acute appendicitis deep in the female pelvic cavity often misdiagnosed as pelvic organ inflammatory diseases, etc. When located in the lower left abdomen, it is generally difficult to diagnose before surgery, except for known midgut non-rotation deformity or associated with dextrocardia. Therefore, for patients with pain and fixed tenderness located outside the lower right abdomen, it is necessary to carefully inquire about the medical history and perform a comprehensive physical examination, considering the possibility of ectopic appendicitis.

　　The treatment principles for ectopic appendicitis are the same as those for general appendicitis.