User:Medfanas/Perityphlitis

Perityphlitis is the purulent inflammation of the appendage of the caecum. It occurs due to a perforation of the appendix. Without treatment, the disease can be life-threatening.

Symptoms

The symptoms of perityphlitis seem often to be similiar to the ones which occur also with an appendicitis. Typical for perityphlicitis are fever and pain in the groin area and right lower abdomen.

Causes

Perithyplitis is often a consequence of a thyplitis. Rarely perithylitis is caused by an inflammation of the peritoneum. There are also reports that perothyplis can occur together with tuberculosis or congestive abscess.

Diagnosis

The differential diagnosis of perityphlitis has the following pathological processes to be excluded: 1) Partial peritonitis. This exclusion is not always possible. If the artery cruralis, which is normally only separated from the edge of the iliopsoa by connective tissue and the fascia iliaca and lies under the peritoneum, pulses clearly on the tumour, the tumour cannot lie in the cavum peritonei, and inflammation of this serous skin can be completely excluded. The palastion of the crural artery alone is not constant, or it does not give a safe sign if, for example, the tumour lies outwards, the artery inwards. Furthermore, the course of partial peritonitis is usually much more dangerous than that of perityphlitis, and suppuration of the intraperitoneal exudate, which is less easily drained to the outside, is in most cases accompanied by the most unfavourable consequences. 2) The cannulation of the worm-shaped appendix is excluded because it always results in partial peritonitis and therefore the points touched in the previous are also used here. In one case, however, perforation of the venniform process can lead to inflammation of the subperitoneal connective tissue, namely when the appendix is soldered to the peri-toneum, the leaves of the latter are destroyed by suppuration, and pus and coexcrements reach the connective tissue. However, in this case a severe functional disorder is inevitable, and so energetic fever symptoms that the severe peritonitis and its so frequent cause, the perforation of the appendix, should hardly be overlooked. 3) Coprostase (accumulation of faecal matter) in the appendix can sometimes be confused with perityphlitis. Here already the anamnesis gives often information, because with individuals, who lead a sitting way of life, very hard food enjoy, or who suffer from Stenore at any place of the intestinal canal, this condition mainly occurs. If the accumulated manure masses are liquid, which is sometimes the case, one feels a cooing from the air, which is always added to the liquid. If the mass is mushy, then the tumour gives the feeling of mixing a dough; if it is finally solid, the coccrements are present next to, on larger and smaller pieces, the shape of which was produced by the intestinal tract; they do not remain in the same place, can be displaced by pressure, and are released by purgir means, or merely move deeper into the intestinal canal. If coprostase is combined with perityphlitis or peritonitis, the tumour becomes smaller after emptying. 4) To distinguish congestive abscesses from perityphlitis by perceptible fluctuation, by their lanere formation, by the condition of the spine, and other less reliable data. 5) New formations around or on the appendix are finite due to their long duration, and their gradual growth, due to palpation, due to the age and other conditions of the individual, Aneuryem one due to pulsation usually, easily excluded.

Nowadays the diagnosis of Periphylitis is done with ultrasound and Computer Tomography (CT).

Treatment

The therapy consists of an operation with an opening of the abdominal cavity, during which the appendix and abscess as well as already infected adjacent intestinal parts are removed. Postoperatively, additional antibiotics are given to remove any remaining infectious germs and to prevent secondary infections as a result of the operation. Alternatively - for example in patients in very poor general condition - CT- or sonography-controlled drainage can be inserted into the abscess formation and the abscess emptied in this way. In the following days, antibiotics are administered intravenously to ease the inflammation. Only then does the operative restructuring take place. In some cases, adhesions remain in the abdominal cavity, which can lead to bridenileus (intestinal obstruction). Another occasional complication is the formation of an enterocutaneous fistula (connection between intestine and skin surface). This can close spontaneously after some time or is closed surgically.

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