Appendicitis: The Difference Between Men, Women and Children

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In men, appendicitis usually begins with a cramping wave-like mid-abdominal pain, that after number of hours, usually within a day, the pain is then localized in the right lower side of the abdomen.

The cramping pain is because the appendix is being blocked by a concretion, a solid mass of feces, and that cramping pain is caused by the contractions of the appendix trying to push it out.

But once the block remains, the protein mucus (germ food) in the appendix allows the bacterial germs proliferate. This causes the appendix to become inflamed from acute infection. And that infected appendix touching the inside of the abdominal cavity, its peritoneal lining’s thousands of tiny nerves, causes the localized pain.

In a woman, it is the exact same situation with appendicitis. However, making the correct diagnosis is complicated by the possibility of the infection being caused instead by pelvic inflammatory disease, usually caused by the bacterial germ gonorrhea, infecting the fallopian tubes. Here instead of a low-grade fever of approximately 100°, it’s usually between 102° to 103°. During a pelvic examination, by pushing on the mouth of the womb, the cervix, this causes severe pain. That helps distinguish between appendicitis versus infected fallopian tube‘s.

In children, the sequence of events is much faster, usually within 12 hours to one day until the rupturing of the appendix occurs. And unlike in adults, the omentum, the fat pad that hangs down from the stomach and large intestine is much less developed, and therefore infection can spread throughout the abdominal cavity, which is called peritonitis. In adults, it’s more likely that this fat pad will wall off and then localize the infection causing an abscess, rather than a widespread and potentially deadly infection, peritonitis.

 

Large Intestine (colon) and Rectal Cancer Negligence

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Large intestine (colon) and rectal cancers are two of the most common cancers affecting men and women, and particularly as they age.

This cancer begins in the lining of the large intestine or rectum, the mucosa. If it is discovered while it is still in the lining before eroding into the muscular wall of the intestinal tract, then there is a 95 percent cure rate. But once it penetrates the muscular wall, the survival diminishes to approximately 70 percent, and if it spreads into the lymph nodes, the drainage sites where the inter-cellular fluid will be filtered, then the cure rate drops into the 30 percent range, but once it is in the liver, there is really no cure that point.

As the cancer grows, it encircles the intestinal track from within, which is referred to as an “apple core lesion.” Eventually, the cancer would block the fecal flow completely.

Before surgery it is critical that the intestinal tract be cleansed. The patient is put on a liquid diet and has laxatives. Enemas are also given. A clean intestinal tract is important because fecal matter are mostly germs, which would increase the risk of any infection.

At surgery it is important not to manipulate the cancer itself, to prevent the spread of cancer cells into the veins and lymphatic vessels (which transport the fluid from between the cells). This avoidance of handling the cancer itself is called the “no touch technique.”

When surgery is performed on the large intestine, the area involving the cancer and healthy large intestine a few inches above and below the cancer are removed (resected). Then the continuity of the intestinal tract is restored with either sutures or staples. When using the stapling device it is negligent to obstruct the passage way, the lumen, for the fecal matter to pass through.

When the cancer has caused a total blockage of the large intestine, then the cancer is removed but the upstream end of the large intestine is brought out through the abdominal wall as a colostomy. Then, after a few months, an operation then will take place by suturing the two ends together, but this occurs after the few days in which the intestinal tract is thoroughly cleaned.

More than 1/3 of rectal cancer‘s are able to be felt by the rectal examination. If the cancer is higher up, above a few inches, then it would be possible to remove the cancer and sew the large intestine back to the remaining area of the rectum.

If the cancer is too close to the anus, there is not enough healthy flesh between this cancer and the large intestine for suturing together. Therefore, the entire lower rectum is removed. This is called the of abdominal-perineal resection. The surgeon operates through the abdominal cavity to reach the cancer from above and to perform a colostomy, and at the same time the operation occurs surrounding the anus and removing the rectum with the cancer from below. Drains are inserted.

If the surgeon literally scrapes the inside of the sacrum, the lower most portion of the spine, that would sever multiple blood vessels and create a severe hemorrhage which can cause the death of the patient. There is a natural cleavage plane, layers of separation between areas of flesh, and is imperative that the surgeon not scrape the sacral bone. To do so would be negligence.