Hello, i am from Romania, a poor country in Eastern Europe with a rather inefficient health care system. Several days ago, my girlfriend had an appendectomy. She had had some abdominal pain for the last six months in the right side of her belly. As there are no diagnosis tools such as a ct scan or ultrasound in romania, the surgeon used the following method to diagnose: "does in hurt here?" "no" "here?" "no". "here?" "yes!" "then it's appendicitis", he said. The blood analysis performed before the surgery revealed only a level of fibrinogen of 615 mg/dl instead of the normal values of 200-400 and a deficit of calcium (3,72 instead of 4). All other values were normalBefore the appendectomy she had to have an enema inside the hospital, performed by a nurse. The enema was not for diagnosis purposes, just so... I googled on the use of such preoperative procedure, but I found only three links, one recommending it for children, during the last day before the appendectomy, and the other two saying it's dangerous when acute appendicitis is suspected. Then, as my girlfriend was terrified for various reasons by the idea of a regional anaesthesia (spinal anaesthesia), she told the anaesthetist she wanted a general anaesthesia. The anaesthesist said "fine, we'll make a spinal anaesthesia, which is a general anaesthesia". That was outrageous. However, after some talks with the anaesthetist, she had a general anaesthesia. Finally, after the surgery, the surgeon told my girlfriend's parents that the appendix was small (half the length of a finger) and a little swollen. So, I would really be happy if you could answer me the following: - is an enema usual before an appendectomy? - is there a possibility for a wrong diagnosis and the appendix was healthy? The problem is that doctors in Romania are not trustworthy and I do not know where to turn for reliable information and counselling. Thank you very much!
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Enema before appendectomy
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You didn't say anything about her white blood cell (WBC) count, or anything else that would indicate infection. Once he opens someone up, it should be pretty clear to the surgeon whether the appendix is infected. The enema, though, sounds extremely dangerous. It could cause an "on the edge" appendix to burst, with bad results. Ideally, it's good to have the lower bowel cleaned out, but the surgeon can contain the contents of bowel if there's not already a leak.Is there any possible way you can track down a really good abdominal surgeon in Romania for a consultation?25 years ago, there were no CT machines in the U.S. either. It's hard to imagine how anything got done...most large hospitals have several of them, and they're busy all the time.
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Thank you very much for your reply.
The WBC count was normal, that's why I'm puzzled. I will ckech it once again, but anyway the surgeon said that the appendicitis was not "seen" on the blood analysis.
As regards the enema thing, it looks like it's routinely performed in my country also before childbirth whether or not the future mothers desire it. It is so medieval, bleah...
I will try to track down a good surgeon after my girlfriend recovers. I forgot to say that other doctors suspected giardiasis or some liver problems.
I just talked to her and she's fine and she told me that the procedure was laparoscopic: that's what they wrote down in the paper, and the cut on her belly is only 1-2 inches long (2-3 centimeters, actually).
Thanks again! -
While an appendectomy is not very complex surgery, laproscopic surgery is pretty advanced. I wonder where the surgeon was trained. It's good stuff...it reduces trauma in a big way, and really speeds up healing versus open surgery.
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I had my appendix removed many moons ago at the age of 15. All I remember is them shaving me with a lethal looking NHS razor and I have a little scar about 3 inches long which has faded so is hardly noticable. I did not have an enema and although my parents dealt with the results of tests etc the docs told them after I had had it removed that it was only slightly inflamed and was more likely to a urine infection!Crazy.
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Well, probably the surgeon was trained somewhere in Europe.Regarding the enema issue, I managed to establish contact with an old high school friend, currently a physician in the U.S. and she said that usually the patient is required to drink around 4 liters of polyethylene glycol solution before the appendectomy, and no enema.Now, I think the surgeon was quite fine (well, I hope it was appendicitis, and not something else). However, the supporting personnel (nurses etc.) was very crappy and the preoperative procedures quite anacronic. Anyway, we were lucky because we knew the surgeon, otherwise he would have asked for money (although in theory the Romanian health care system is universal and free - we pay taxes for it -, the bribe is widespread; we had to bribe the nurses anyway to increse the chances of a humane treatment from their side).Currently, my girl is fine, but when lying down in bed, she gets some fever - 37,3 Celsius... Hope it's ok.Thank you all for your support!
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According to another physician, the appendectomy was open, not laparoscopic (supposedly the surgeon wrote "laparoscopic" in the papers for reasons such as promotion, maybe...), as there is only one incision (3-5 cm long).Anyway, now I'm concerned that the skin around the incision is red/violet and it feels like there's a lump under the skin. I'm not sure whether it is the healing ridge or not, because it's not only under the incision, but also the surrouding area.The surgeon seems reassuring, but I would really appreciate a second opinion. Thank you again!
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Hmm well I had an appendectomy alittle over 2 years ago (I was about 22 years old) and they did not give me an enema nor did I have to drink any liquid before hand. I went into the hospital early that morning with sharp pains in my side and that night, 9:30pm I was in surgery.
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The lump might be scar tissue; you are probably concerned that it might be an abscess.It's hard to tell from your description how well the wound is healing. But the important thing is whether there are signs of infection, such as ischarge from the wound or fever. If there are signs of infection, then antibiotics are in order.
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Thank you, SteveA!There are no signs of infection, such as fever or discharge. She also went to the doctor and he said it's fine.Thank you again, you all were very helpful See, weird things happen in Romanian hospitals (see the link below) and I badly needed a second opinion...http://www.smh.com.au/articles/2004/07/16/1089694566537.html?from=storylhs&oneclick=true
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That's great news! Your girlfriend is very lucky to have an adovcate like you.