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Apendicitis, reminiscencias del “cólico miserere”
Escrito por Francisco Galindo / EFE-Reportajes    Miércoles, 22 de Julio de 2009 13:35    Imprimir E-mail

El apéndice es una pequeña porción del intestino ciego que debe extirparse en el quirófano cuando se inflama. Para la apendicitis aguda no hay otra solución más que la quirúrgica porque la inflamación se localiza en una zona de la masa intestinal –la derecha- que no tiene salida y, por tanto, las complicaciones derivadas resultarían fatales.

Por Francisco Galindo / EFE-Reportajes

Hasta el primer tercio del siglo XX, la peritonitis ocasionada por la inflamación del apéndice suponía el preludio de una muerte inevitable. El ataque de apendicitis era conocido entre el vulgo y en la literatura como el “cólico miserere”. De esta forma se significaba la fatalidad de una enfermedad que no fue descrita clínicamente hasta finales del siglo XIX, como síntomatología principal del dolor abdominal agudo.
Sin embargo, desde el año 1970 el índice de mortalidad por esta enfermedad es de menos de 1 por 100.000 casos, según datos recientes de la Asociación Médica Mundial (AMM), que considera asimismo a la apendicectomía como una forma de cirugía menor.
La intervención quirúrgica es la única manera de resolver este problema, aunque en los casos en que la inflamación sea extremadamente aguda es conveniente rebajarla antes de que el paciente sea llevado al quirófano, con antibióticos por vía intravenosa, que también se suelen aplicar en la zona intervenida, una vez que el cirujano ha extirpado el apéndice, con el fin de lograr una sepsis segura.

TAMBIÉN POR LAPAROSCOPIA
Aparte de la cirugía convencional, el apéndice se puede extirpar por medio de técnicas de laparoscopia por vía vaginal, sobre todo en las mujeres en edad no fértil.
Se puede decir que la apendicitis es, hoy en día, una patología simple y grave a la vez, ya que sin operación las complicaciones posteriores son muy peligrosas.
Un ejemplo ilustrativo de la prevención de este problema lo tenemos en los astronautas de la NASA, quienes antes de ser enviados a misiones espaciales son apendicectomizados de forma preventiva, para evitar dificultades irresolubles en caso de que se le presentara un ataque abdominal cuando están en órbita. 
Una convalecencia normal posterior a una operación de apendicitis no debe superar los diez días, aunque pueden presentarse complicaciones que alarguen el proceso hasta las tres semanas o incluso más.
Heces y residuos digestivos, infecciones intestinales o, muy raramente tumores, figuran entre las causas de principales de la inflamación de apendicitis, que suele afectar al doble de mujeres que de hombres, de edades comprendidas entre los 20 y los 30 años, de acuerdo con las estadísticas de la AMM.

ORIGEN POCO CONOCIDO
Sin embargo, el origen de los ataques de apendicitis no se conoce aún muy bien y éstos se pueden presentar a cualquier edad, tanto en un niño de pocas semanas como en un octogenario, si bien se ha comprobado que en los países del Tercer Mundo la incidencia es bastante inferior a las naciones desarrolladas.

Los estudiosos consideran que las razones estriben probablemente en el régimen de vida que impera en estos últimos países y en sus sistemas de alimentación, a veces nada saludables. 
Aunque los síntomas suelen ser evidentes y aparentemente fáciles de identificar, los errores de diagnóstico suelen darse hasta en un 30 por ciento de los casos, sobre todo en niños y adolescentes, de acuerdo con datos del sistema de salud de Estados Unidos, el país que registra las cifras más elevadas de apendicectomías, en términos absolutos.
Los datos agregan que, entre un 30 y un 45 por ciento de los diagnosticados, lo son tardíamente cuando ya se ha producido un principio de peritonitis que puede derivar en complicaciones severas.
Un dolor abdominal agudo, localizado principalmente en el lado derecho, inapetencia, escalofríos, alternancia de diarrea y estreñimiento, vómitos y unas décimas de fiebre son los síntomas principales de un ataque de apendicitis, pero en ocasiones estos signos llevan al médico al error. 

UN SIMPLE ANÁLISIS DE ORINA
La preocupación por las dificultades de diagnóstico en esta patología en Estados Unidos ha llevado a científicos del hospital de Boston a trabajar en un sencillo análisis de orina que podría permitir llegar a la conclusión clínica acertada, con un margen de error muy escaso, de una forma rápida y con un costo mínimo.
Los investigadores del citado centro médico han identificado una proteína en la orina que es un indicador fiable para la inflamación del apéndice, según afirman en un estudio publicado en la revista Annals of Emergency Medicine.
El estudio, que se centró en la orina de 67 niños, permitió descubrir a través de una varilla medidora de los desechos líquidos investigados, que los niveles de glicoproteína alfa-2 rica en leucina (LRG) eran muy elevados cuando el apéndice estaba inflamado.
Richard Bachur, uno de los responsables del servicio de urgencias del hospital, advirtió no obstante a periodistas de que las técnicas avanzadas de radiodiagnóstico, como el escáner y los ultrasonidos, permitirían un diagnóstico rápido y bastante aproximado de una inflamación del apéndice, pero reconoce que éstas no son accesibles a todo el mundo, lo cual suponen una rémora.
El especialista también valoró otros riesgos de este tipo de pruebas al dejar claro que “las tomografías computerizadas exponen, principalmente a los niños, a radiaciones que pueden incrementar el riesgo de contraer cáncer a lo largo de su vida”.

 

Foto: El dolor abdominal agudo puede ser el síntoma más evidente de una paendicitis.

 

Actualizado ( Miércoles, 29 de Julio de 2009 10:33 )
 

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