Emergency Appendectomy and Treatment of Peritonitis

We've been together for 35 years. Even if I don't play a major role in her life, our relationship grew stronger. They say I'm not a vital organ, just a narrow pouch of tissue that resembles like a worm located in the right lower abdominal area.





Day 1: Last April 22, Tuesday morning, I wasn't feeling well. Marj, while experiencing abdominal pain managed to clean the house right after husband Jonel left for blogging work. The pain scale went up from 2 to 5 until it reached 7 (pain scale 0-10) at 6pm. It was getting stronger. Marjorie thought it was just the usual hyperacidity so she took Kremil S and ate sky flakes but render no relief. I believe she never experienced being hospitalized and admitted for the past 35 years.

Tuesday evening, we were at the emergency dept of Chinese General Hospital. She said she probably experiencing some sort of hyperacidity. No physical assessment, no blood tests done but the Omeprazole and Plasil that run through her veins provided immediate but temporary relief. She was discharged after an hour and I was happy she was able to sleep well that evening.




Day 2: April 23: The next morning, Marj experienced body malaise (weakness) and lost of appetite. I know I have to leave Marj very soon. It was a stressful Wednesday morning for all of us! Marj was crying because of severe abdominal pain near the navel growing sharper down the right and left abdomen. I was in deep pain that I ruptured, a more serious medical emergency that caused localized infection affecting Marj's small intestines. They call it peritonitis. Because we're one, Marj felt the same. The pain grew stronger, she was vomiting, hyperventilating, temperature rises to 38C. Her husband had to brought her again to the ER. This time though Marj requested UERM where grandma was also confined.

UERM-Review

We're glad that the staff were very accommodating, immediately they attended to her needs. They checked if she's pregnant so they know what meds to give her. She was hooked to an IV fluid. Blood tests, pregnancy test, urine test were done. Medical, Surgical and even OB-Gyne doctors came to see her. Finally, they suspected it was me, responsible for all these symptoms! She was also sent for abdominal X-ray. Blood tests reveals increase in WBC, an indication of infection. Blood pressure started to rise, from the usual 100/70 it went to 130/90. I feel sorry for her but I have no control with what's happening, I ruptured and needs to be taken out of her system as soon as possible.

Ultrasound-Procedure
Pale, thirsty, hungry Marj at the Ultrasound department
She was admitted later in the afternoon and was advised not to eat or drink. I know the doctors were preparing for possible surgery, Marj was emotionally unprepared. At her room, they assessed her every hour or two, took her vital signs and checked pain scale. That afternoon though, pain decreased from 10 to 2. It was atypical appendicitis. Marj's present condition was somewhat confusing. Later that evening fever persists, she started to pass watery stool almost every hour.

AeroMed to another hospital for abdominal CT Scan
AeroMed to another hospital for abdominal CT Scan
Day 3: April 24, Thursday was spent on other medical examinations. Through ultrasound, they found out dilated small intestines. TransV ultrasound was also performed and found a cyst-like on the left ovary. Marj was not fed nor given drinking water for 48 hours so visualization of the bladder was a bit difficult. The findings lead to other diagnosis apart from appendicitis when they suspected ectopic pregnancy but later on was cleared because of the negative pregnancy test. The OB-Gyne further explained about the findings on her left ovary which is normal during ovulation.

Medic of AeroMed
Friendly Medic of AeroMed on our way to De Los Santos Hospital
Loving and ever supportive husband on her side
In the afternoon, she was sent again to the Ultrasound department. The examination revealed fluid on right lower abdomen. Marj heard the words "surgical abdomen". The doctors advised to do an emergency abdominal CT Scan which is unfortunately not available at the hosp so my dear Marj was brought to De Los Santos Hospital via Aeromed ambulance. We had to wait the next day though for the official result but Dr. Agustin, Marj's surgeon wanted to see the plates so they requested a copy early Friday morning. Her surgeon and radiologist at UERM read the CT scan and confirmed enlarged appendix and inflamed bowel. The family was anxious about the dilated intestines and Marj was afraid of surgery. Dr. Agustin explained two possible surgical procedures, first is the laparoscopic apppendectomy which uses a camera, patient is under general anesthesia and it's more expensive than traditional appendectomy. Second is open appendectomy, a larger cut (infraumbilical midline incision) to see the intestines and other internal organs such as the ovary and uterus.

CT Scan Room of De Los Santos Hospital
Inside the CT Scan, DLS Hospital
CT Scan Room of De Los Santos Hospital
Abdominal CT Scan reveals enlarged appendix and inflamed intestines
CT Scan Room of De Los Santos Hospital

De Los Santos Hospital

April 25, Friday 3pm, we're at the operating room. They cut me and removed me from her body including all the toxins it caused her. Marj was given spinal anesthesia and the surgery was done successfully. I was sad but I have to leave her. Six hours in the OR and recovery room before she was transferred to her room with an NGT in place (nasogastric tube), IV fluids, antibiotics and pain reliever.

At the Operating Room before the operation
At her room, she heard the anesthesiologist giving her only three hours to pass urine. She told them Marj has very little urine output in the RR. With sense of hearing being the last to go, Marj heard the conversation so she immediately asked for bedpan, requested to open the faucet enough for her to hear water flowing and requested to pour a little water on her. It was effective, she was able to urinate. Post-op, the most irritating, painful and tough was having an NGT (nasogastric tube). It serves as decompression, drainage and feeding but it's very painful and irritating when swallowing. Her first 210 cc Nutren was given through NGT. She was able to tolerate the feeding although a bit bloated.


Washing her face and brushing her teeth while on bed.


Nurse Aid Sarah rendering a morning care. 


Four days later, my dear Marj was discharged in the hospital and recuperating at home. Marj and I found the whole experience to be quite an Amazing Journey. We felt the love and support of the entire family and friends. 


Thank you Kristine Cocos for this book!
At the height of feeling bloated, irritable, she met a medical intern that prayed for her, even gave her this book but Marj never saw her again. Friends from GCC and CAFE went to visit her. At home, it was her mom, little brother and husband Jonel taking care of her - from taking a bath, cooking for her to assisting her as she moves around the house. The experience may be challenging and real expensive but we're all thankful it was just a piece of worm-like tissue that caused the surgery. 


Left my gwapong husband, Right my gwapong Surgeon Dr. Gerard Agustin
Left her good-looking husband, Jonel / Right her good-looking and awesome Surgeon Dr. Gerard Agustin
Dra Angela Layusa, Anesthesiologist
Dra Angela Layusa, Anesthesiologist
Dr. Romulo Ramos and the Medical Intern and Residents
(Team Medicine) Dr. Romulo Ramos and the Medical Intern and Residents
Team Surgery
(left: Nurse RJ / right: a young medicine student)

By taking small steps each day, taking aside stress, I know my dear Marj will recover fast. And now that I'm gone, I know it will work out just fine.


Goodbye,
Appendix

P.S. The writer decided to share her story to raise awareness on the complications of Ruptured Appendix. She was diagnosed with Ruptured Appendix and Peritonitis. As a nurse by profession, she advocates wellness and health, not taking for granted medical conditions. I hope you will be inspired. The surgery went well and she's back to her regular daily activities including blogging and wifey duties.

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