What causes flank pain in appendicitis due to fecalith?

In general, flank pain caused by fecalith-induced appendicitis may result from special anatomical position of the appendix, chronic constipation, worsening impaction of appendiceal fecaliths, periappendicitis, or perforated appendicitis complicated by peritonitis. Depending on the specific situation, patients can improve symptoms through conservative management, medication, surgical intervention, and other treatments. Detailed analysis is as follows:

1. Special Position of the Appendix

In some individuals, the appendix is located in a retroperitoneal position. When inflammation is triggered by a fecalith, the pain may radiate to the flank area, causing a sensation of heaviness or dragging pain. Patients should rest in bed, avoid strenuous activity, maintain a comfortable posture to relieve pain, and closely monitor changes in pain, seeking medical attention promptly if needed.

2. Chronic Constipation

Chronic constipation leads to accumulation of feces in the intestines, increasing the likelihood of fecalith formation. Abnormal intestinal motility associated with constipation may further aggravate irritation of the appendix by fecaliths, resulting in flank discomfort. Dietary adjustments are recommended, including increased intake of fiber-rich foods such as celery and bananas, drinking plenty of water, establishing regular bowel habits, and, when necessary, using abdominal massage to promote intestinal motility.

3. Worsening Fecalith Impaction in the Appendix

Complete obstruction of the appendiceal lumen by a fecalith increases intraluminal pressure and exacerbates inflammation, leading to persistent and intensifying pain that radiates to the flank. Under medical guidance, anti-inflammatory medications such as cefuroxime axetil tablets, metronidazole tablets, or levofloxacin hydrochloride capsules may be prescribed. Fasting and fluid restriction are required to prepare for further treatment.

4. Periappendicitis

Inflammation from fecalith-induced appendicitis may spread to surrounding tissues, causing periappendicitis. Inflammatory stimuli can affect nearby nerves in the flank region, resulting in a sensation of heaviness or dull pain. Treatment involves administration of intravenous antibiotics such as ceftriaxone sodium for injection, metronidazole for injection, or piperacillin sodium and tazobactam sodium for injection under medical supervision. If an abscess forms, ultrasound-guided percutaneous drainage may be required.

5. Appendiceal Perforation Complicated by Peritonitis

Fecaliths may cause appendiceal perforation, allowing pus to leak into the abdominal cavity and trigger peritonitis. Inflammation stimulates the peritoneum near the flank, causing significant discomfort or dragging pain. Immediate medical attention is essential. Laparoscopic appendectomy is typically performed. Postoperatively, broad-spectrum intravenous antibiotics such as cefoperazone sodium and sulbactam sodium for injection, imipenem cilastatin sodium for injection, or meropenem for injection should be administered as directed. The surgical wound must be kept clean and dry.

Routine preventive measures include maintaining a balanced diet, reducing intake of spicy and greasy foods to prevent constipation, developing regular bowel habits, and avoiding prolonged suppression of defecation. Prompt medical evaluation is crucial upon onset of symptoms such as abdominal pain or nausea to avoid disease progression. After surgery, patients should follow medical advice regarding dietary resumption and physical activity, and attend regular follow-up visits to ensure proper wound healing.