Uno de los mayores miedos de los padres cuando se presenta un posible cuadro de apendicitis es que tarden demasiado en diagnosticarlo y termine provocando una peritonitis. La técnica que suele confirmarla es un TAC, pero antes, el tacto y la opresión de la parte derecha del abdomen ayudan al médico a hacer una primera aproximación, que en muchos casos es definitiva.
El apéndice: qué es y para qué sirve
El apéndice es un pequeño trozo de tejido con forma de gusano o de dedo que sale de la parte inicial del colon, en la zona inferior derecha del abdomen. Antiguamente se pensaba que el apéndice era un órgano vestigial, es decir, un órgano que permanece pese a que su función original se haya perdido durante el proceso de evolución humana. Hoy en día se sabe que el apéndice participa en las defensas inmunitarias y sirve de reservorio de bacterias beneficiosas para combatir algunos cuadros como la diarrea. En cualquier caso, su inflamación debe tratarse de manera urgente, por las consecuencias que puede llegar a tener.
La apendicitis es relativamente frecuente y se estima que aproximadamente una de cada 10 personas la acabará padeciendo en algún momento de su vida. Pero, ¿quién no conoce algún caso de apendicitis que casi termina de manera trágica con una peritonitis? Son los casos que han tardado demasiado en diagnosticarse, de manera que la inflamación propia de la apendicitis ha terminado provocando una peritonitis.
¿Qué es la peritonitis y por qué es una emergencia?
La peritonitis es una inflamación del peritoneo, que es la membrana que recubre el interior del abdomen y protege órganos como el intestino, el hígado o el estómago. Normalmente aparece cuando bacterias o sustancias irritantes entran en esa zona estéril. Esto provoca una reacción inflamatoria muy intensa. Una de las causas más habituales es la ruptura del apéndice, que origina esa perforación e infección de la cavidad abdominal, que puede ser muy peligrosa. Por lo tanto, el diagnóstico a tiempo es fundamental.
Causas más comunes de una peritonitis
- Apendicitis perforada.
- Úlcera gástrica perforada.
- Diverticulitis.
- Infecciones abdominales.
- Traumatismos o cirugía reciente.
- En pacientes con ascitis (líquido en el abdomen), puede aparecer sin perforación (peritonitis espontánea).
De apendicitis a peritonitis: de aquellos polvos, estos lodos
- La mayoría de las veces, la apendicitis se origina al taponarse el apéndice con algún fragmento de heces e incluso a veces por la presencia de gusanos, lo que desencadena su inflamación e infección. El tratamiento en estos casos es quirúrgico (extirpación del apéndice o apendicectomía), y posteriormente también se usan antibióticos para prevenir en lo posible infecciones abdominales.
- Si la inflamación continúa sin tratamiento el apéndice puede romperse, originando una perforación que, a su vez, puede provocar la formación de una bolsa infectada llena de pus (absceso) y desencadenar como resultado una peritonitis (inflamación y habitualmente infección de la cavidad abdominal que puede conducir a una infección potencialmente mortal). Si el apéndice se ha perforado la operación es más compleja y existe más riesgo de complicaciones, por lo que la recuperación es más lenta y precisa más días de ingreso en el hospital.
- En la mujer, cuando se produce esta perforación, pueden infectarse los ovarios y las trompas de Falopio y la cicatrización resultante puede obstruir las trompas de Falopio ocasionando infertilidad.
- La perforación del apéndice también permite que las bacterias infecten el torrente sanguíneo, una situación potencialmente mortal que recibe el nombre de septicemia.
Síntomas principales de peritonitis: ¿cómo reconocerla a tiempo?
- Dolor repentino que comienza en el lado derecho de la parte inferior del abdomen. A veces comienza alrededor del ombligo y se desplaza hacia la parte inferior derecha del abdomen.
- Dolor que empeora al toser, caminar o hacer algún movimiento brusco.
- Náuseas.
- Vómitos.
- Pérdida de apetito.
- Fiebre ligera que puede progresar.
- Estreñimiento o diarrea.
- Hinchazón abdominal.
- Flatulencia.
Diagnóstico y tratamiento: el tiempo es vital
La clave para diagnosticar una apendicitis es la palpación del abdomen por el médico. Para confirmar el diagnóstico es frecuente la realización de pruebas de imagen, como la tomografía computarizada (TAC) o una ecografía. La ecografía es especialmente útil en niños, en los que es importante limitar la exposición a la radiación para reducir el riesgo de cáncer en el futuro. Un análisis de sangre suele revelar un aumento moderado del número de glóbulos blancos (leucocitos) en respuesta a la infección, aunque no existe un análisis de sangre definitivo para diagnosticar una apendicitis.
Consejo del farmacéutico
La peritonitis es una afección grave que requiere atención médica inmediata. Si presentas dolor abdominal intenso que empeora con cualquier movimiento, no tomes analgésicos ni laxantes; acude al servicio de urgencias más cercano. El diagnóstico precoz salva vidas.
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