What causes appendicitis what complications. The most frequent complications in patients with acute appendicitis

Ministry of Health of Russia

Voronezh State Medical Academy

named after N.N.Burdenko

Department of Faculty Surgery

Complications of acute appendicitis

abstract lecture for students

4 course of therapeutic faculty and international faculty

medical education

4k. Lecture4

Voronezh, 2001

Complications of acute appendicitis (at the stages of flow)

Early period (The first two days) is characterized by the lack of complications, the process is usually not beyond the limits of the process, although destructive forms and even perforation can be observed, especially in children and old people.

IN interstitial period (3-5 days) Completions are usually arise: 1) Perforation of the process, 2) Local peritonitis, 3) thrombophlebitis veins mesenychychka processed, 4) Appendico-Larny infiltrate.

IN late The period (after 5 days) is observed: 1) the spilled peritonitis, 2) appendi-chular abscesses (due to the abscess of infiltrate or as a result of peritonitis), 3) thrombophlebitis of the portal vein-pilephlebit, 4) liver abscesses, 5) sepsis.

It should be noted several conditional nature of the separation of complications in the flow stages.

Perforation- develops usually for 2-3 days from the beginning of the attack when destructive forms Appendicitis is characterized by a sudden enhancement of pain, the appearance of pronounced peritoneal symptoms, a picture of local peritonitis, an increase in leukocytosis. In some cases, in the presence of unwitting pain in the early period, the moment of perforation is indicated by patients as the beginning of the disease. Mortality during perforations by cousin reaches 9%. Perforated appendicitis was observed in 2.7% of patients received in early terms, among those enrolled in the later dates - in 6.3%.

Apandicular Infiltrate - This is a conglomerate of inflammatoryly modified internal organs - the glands, thin and blind intestines around the black-shaped proof of inflammatoryly modified internal organs, forms various statistical data from 0.3-4.6 to 12.5%. It is rarely diagnosed in the pre-hospital stage, sometimes only during the operation. Developed by 3-4 days after the start of the attack, sometimes as a result of perforation. It is characterized by the presence of dense tumor-like formation in the right-hand horizontal region, moderately painful during palpation. Peritoneal symptoms at the same time as a result of the separation of the process, the stomach becomes soft, which allows palpate infiltrate. The temperature is usually held at level to 38º, leukocytosis is noted, the chair is detained, with an atypical arrangement of an infiltrate process can be palpable in accordance with the location of the process, with a low location, it can be palpable through the rectum or vagina. Diagnostics helps ultrasound examination. In doubtful cases, laparoscopy is produced.

The presence of infiltrate is the only contraindication to operations (as long as it is not absced), because Attempting to allocate the proof from the conglomerate of the bodies soldered to it entails the risk of intestinal damage, mesenter, the gland, which is fraught with heavy complications.

Treatment of infiltrate must be conservative (in the hospital): I / cold locally, 2 / wide spectrum antibiotics, 3 / double-sided panefral blockade every other day or blockade for schoolchildren, 4 / aufok or laser irradiation, 5 / methylurapil, 6 / disaggigraigans Blood, 7) proteolytic enzymes, 8) diet - rubbed soups, liquid porridges, kisins, fruver juices, white crops. Infiltrate is absorbed in 85% of cases, it usually occurs on time from 7-19 days to 1.5 months. Slow absorption of infiltrates suspiciously for the presence of a tumor. Before discharge, irrigoscopy is required - to eliminate the tumor of the blind intestine.

After the disappearance of all clinical signs, the patient is discharged of a mandatory indication of the need for an operation - appendectomy after 2 - 2.5 months after the resorption of infiltrate.

If the infiltrate was not diagnosed before the operation and came the find on the operating table, removing the process is inappropriate - the operation ends with the introduction of drainage and antibiotics into the abdominal cavity.

Appendicular abscesses - develop in the late period more often as a consequence of the suppuration of appendicular infiltrate (before surgery) or the separation of the process during peritonitis (more often after operations). It develops for 8-12 days after the start of the disease. In 2% consequence of complicated forms. Localization is distinguished: I / Ileocecal (parapperdnkulinary), 2 / pelvic (abscess Douglas Space), 3 / SUNNY, 4 / Padiaphragmal, 5 / intercircuit. All of them are subject to operation - opening, rehabilitation and drainage according to the general rules of surgery (UBI PUS IBI EVACUO)

General features of the abscessant / degradation of the general condition, b / increase the body temperature and its hectic nature, sometimes with chills, the increase in leukocytosis and the shear of the leukocyte formula to the left, the leukocyte intoxication index.

I. . Ileocecal abscess - It develops in most cases with a unlucky process as a result of the abscess of appendicular infiltrate. Signs of abscess, in addition to general phenomena, is an increase in the sizes of infiltrate or no reduction in it, it is impossible to count on the appearance of fluctuations, as recommended by a number of authors!

Outside short-term anesthesia Outstretchinously by the section of Pirogov: the duck from the point of Mac-Burnea is almost at the ridge of the iliac bone, the cavity of the abscess is part of the side wall side, the cavity is dried, examine the finger (possibly with a cash stones that need to be removed) and drain. The wound heals the secondary tension. The process is removed after 2-3 months. With a retrocecal arrangement of the ability abscess localitonealo stop - psas-abscess.

All other abscess localizations are usually observed after appendectomium with destructive forms with peritonitis phenomena.

2. Pelvic abscess - There is 0.2-3.2% of the cousin, according to the materials of our clinic - by 3.5% with a gangremenous appendicitis. In addition to the general phenomena, it is characterized by a rapid liquid chair with mucus, teensions, gaping anus or urination, sometimes with thumbs (due to engagement in the process of the octopry-blur or olocus fiber).

The difference in the temperature between the axillary depression and the rectal 1-1.5 at 0.2-0.5 is normal), a daily rectal or vaginal study is necessary, in which the housing of the arches and dense infiltrate is determined, then softening, sprinkling.

Treatment. Initially, in the stage of infiltration - antibiotics, warm enemas 41-50º, douching; In abscessive - the appearance of ripples is an autopsy. Previously, the bladder emptying catheter !! Anesthesia total. Position on the table as a gynecological chair. A straight intestine or vagina is revealed by mirrors, the softening section is determined by a finger - on the front wall of the intestine or the rear edge of the vagina. Here it is a thick needle puncture and when receiving a pus, without removing the needles, the abscess is opened on a slight incision, which stupidly expands, after which the cavity is washed and drained. Drainage is muted to the skin of anus or a small sexual lip.

3. SUNNYAKH abscess - revealed in the area of \u200b\u200bthe right hypochondrium, the existing infiltrate is pre-soldered from abdominal cavity Napkins, after which they open and drain.

4. Subiaphragmal abscess - (It is relatively rare - in 0.2% of cases) - the accumulation of pus between the right dome of the diaphragm and the liver. The infection here falls on the lymph paths of the retroperitoneal space. The most severe form of abscesses, mortality at which is reaches 30-40%.

Clinic: shortness of breath, pain when breathing in the right half chestDry cough (symptom of Trojanova). In case of inspection - the lag of the right half of the chest in respiration, soreness during phableing; At percussion - the high standing of the upper boundary of the liver and lowering the lower boundary, the liver becomes an affordable palpation, the emission of intercostal gaps, the FRINICS-symptom on the right. General condition Heavy, high temperatures with chills, sweat, sometimes jaggility skin Pokrov.

With radioscopy- High standing and restriction in the mobility of the right dome of the diaphragm, the effusion in sinus is a "excreasing exdut pleurisy". When forming an abscess horizontal level of fluid with a gas bubble (due to the presence of gas-forming forms of flora).

Treatment- Surgical. Access is difficult, due to the danger of infection of the pleura or abdominal cavity.

1. Outleptural access (in Melnikov) - In the course of the eleventh edge with a rescue, the rear leaflet of the periosteum dishes, the transitional fold of the pleura (sinus) is found, which stupidly peckles from upper The surface of the diaphragm up, the diaphragm is dissected and an ulcer is revealed, which is drained.

2. Outstretch (Clermont)- along the edge of the rib arc through all the layers reach the transverse fascia, which, together with the peritoneum, peeling from the lower surface of the diaphragm, after which the umnot is revealed. Both of these methods are dangerous for the possibility of infection of the pleura or abdominal cavity due to the presence of infiltrate and adhesions that make it difficult.

3. Transabdomomominal- An opening of the abdominal cavity in the right hypochondrium, the separation of it with napkins followed by penetration into the cavity of the abscess on the outer edge of the liver.

4. Transstorocal- through the chest wall in the region of 10-11 intercostal or with resection 10-11 ribs a) somnationIf when the pleura is reached, it turns out to be opaque, the lung tours is not visible, the sinus is smeared; Puncture is performed by a thick needle and an autopsy on the needle, b) double-met- If the pleura is transparent - the light excursions are visible - the sine is not smeared, the pleura is smeared with alcohol and iodine, - / chemical irritation and tightly tamponed - (mechanical irritation) (1st stage) after 2-3 days the swamp is removed and, making sure that the sinus is smeared , puncture and vectors with the drainage of abscess (2nd stage) are produced. In some cases, with the undesirability of a delay, the opening of the abscess of the sine is muffled to the diaphragm around the circle with a diameter of about 3 cm with a sabling seam of an atraumatic needle and in the center of the suspended abscess section is revealed.

5. By Littmanna (see Monograph),

Pilyfelbit - The thrombophlebitis of the portal vein is a consequence of the distribution of the process from the veins of the mesenzheki outcrow for mesenteric veins. It is found at 0.015-1.35% (by cousin). It is an extremely severe complication, accompanied by a high, hectic temperature, repeated chills, cyanosis, and skin care. There are sharp pains around Zheeot. Subsequently - multiple liver abscesses. Usually ends with death in a few days, sometimes sepsis. (There were 2 cases of pylephlebit on 3000 observations in the clinic). Treatment: Anticoagulants in combination with antibiotics wide spectrum Actions, preferably with direct introduction to the system of a gorgeous vein by catheterization of the umbilical vein or puncture of the spleen.

Chronic appendicitis

As a rule, it is a consequence of acute, less often develops without prior attack.

Distinguish: I) residual or residual Chronic appendicitis in the presence of one attack as an anamnesis; 2) recurrent- in the presence of several attacks in history; 3) primary-chronic or the nestless, arising gradually in absence acute attack. Some authors exclude such an opportunity. Patanatomy - cell infiltration, scarring, sclerosis of the walls, sometimes losing lumen; If the lumen in the free end remains fluid (watering), the mucus (mucocele) of the process, the mesenter is shortened, deformed. Macroscopically notes deformation of the process, spikes with neighboring organs.

Clinicpoor Symptoms, Nepipical: Pains in the right iliac region are sometimes constant, sometimes parotid, nausea, constipation, sometimes diarrhea at normal temperature and blood pattern.

For objective study - Local pain in the right iliac region at the points of Mac-Burnea and Lanz without protective tension of muscles and peritoneal symptoms. Sometimes symptoms of Sitkovsky, roving, exemplary can be positive.

When diagnosis is very important (the presence of sharp attacks) is very important. In primary-chronic appendicitis, the diagnosis is made on the basis of the exclusion of other possible causes of pain. Recently, the data of irrigoscopy and colors of the large intestine are attached great importance - the presence of deformation draw-shaped process Or the absence of its fill. This is regarded as direct and indirect signs of chronic appendicitis.

Differentiate Chronic appendicitis is necessary from gynecological diseases, diseases of the right urinary tract, ulcerative duodenal disease, chronic cholecystitis, spastic colitis, melted invasion (in children-append. oxyuria), tuberculosis and blind gut cancer.

With the diagnosis of chronic appendicitis, treatment is only operational, but remote results after operations on chronic appendicitis worse than after acute appendicitis (spikes after removal of the unchanged process are noted in 25% of patients, after destructive forms with the suppuration of the abdominal cavity - 5.5% of observations ).

With an acute inflammatory process, a quick change of stages occurs in a dark-shaped outflow of a blind intestine. Already 36 hours after the start of inflammation, there may be serious complications that threaten the life of the patient. In pathology, a simple or catarrhal uncompandicitis occurs first, when the inflammation only affects the mucous membranes.

When the inflammatory process spreads deep into and captures the underlying layers in which lymphatic and blood vessels, they are already talking about the destructive stage of appendicitis. It is at this stage that pathology is most often diagnosed (in 70% of cases). If not spent operational interventionThe inflammation applies to the entire wall and the pus accumulates inside the process, the phlegmonous stage begins.

The wall of the draft-like process is destroyed, erosion appears through which the inflammatory exudate penetrates into the abdominal cavity, and the organ cells die away, that is, a gangrene appendicitis develops. Last stage - Perforated, at which the appendix filled with pus appendix and infection penetrates into the abdominal cavity.

What complications are possible in acute appendicitis

The amount and severity of complications directly depends on which stage there is a disease. So, B. early period (The first 2 days) complications of appendicitis usually do not occur, since the pathological process does not turn out beyond the heart-shaped process. In rare cases, more often in children and old people can occur destructive forms of the disease and even the gap of the appendix.

For $ 3-5, after the onset of the disease, such complications may develop such as perforation of the process, local inflammation of the peritoneum, thrombophlebitis of a mesentery, appendicular infiltrate. On the fifth day of the disease, the risk of developing spilled peritonitis, appendicular abscesses, thrombophlebitis of the carrier vein, liver abscesses, sepsis is increased. This separation of complications in flow stages is conditional.

Cause complications in acute appendicitis are capable of:

• later, surgery, which happens with the late treatment of the patient, the rapid progression of the disease, long-term diagnosis;
• defects of surgical equipment;
• unforeseen factors.

Possible complications are divided into preoperative and postoperative. The first are especially dangerous because they are able to lead to death.

Preoperative pathology

To preoperative complications acute appendicitis Believe:

• peritonitis;
• perforation;
• pilefelbit;
• appendicular abscesses;
• apandicular infiltrate.

With destructive forms of the disease, perforation is usually happening by 2-3 days after the disease manifestation. When the organ breaks, the pain is suddenly enhanced, expressed peritoneal symptoms arise, clinical manifestations Local peritonitis is growing leukocytosis.

If on early stages The pain syndrome was not very pronounced, then perforation is perceived by patients as the beginning of the disease. Mortality for perforation reaches 9%. The gap of appendicitis occurs in 2.7% of patients who applied in the early stages of pathology and in 6.3% of the diseased, who seemed to the doctor in the later timing.

In acute appendicitis, complications are developing due to the destruction of the process and the spread of the pus

Peritonitis is a sharp or chronic inflammation of the peritoneum, which is accompanied by local or common symptoms Diseases. Secondary peritonites occur when penetrating bacterial microflora from the inflamed organ into the abdominal cavity.

The clinic distinguishes 3 stages:

• reactive (expressed by pain syndrome, nausea, gas delay and chair, the abdominal wall is tense, the body temperature rises);
• toxic (shortness of breath appears, coffee vomiting, general state The abdomen will deteriorate, the abdominal wall is tense, the intestinal peristalsis disappears, the gas and chair is delayed);
• terminal (in the treatment of 3-6 Disease Disease, the inflammatory process manages to degrade and reduce intoxication syndrome, due to which the state of the patient is improved. In the absence of therapy for 4-5 days, imaginary improvement occurs, the abdominal pain is reduced, the eyes are wetted, vomiting with greenish or brown liquid continues, breathing superficial. The deadly outcome usually occurs on 4-7 days.).

In the treatment of peritonitis, it is necessary to eliminate the source of the infection, carry out the abdominal cavity, drainage, adequate antibacterial, detecting and infusion therapy. Appendicular infiltrate is called those who have grown around appendix changed by inflammation of internal organs (glad, intestine). According to various statistical data, pathology is found at 0.3-4.6 to 12.5 cases.

Rarely, such changes are detected at the initial stages of the disease, sometimes they are found only during surgery. The complication of 3-4 day of the disease is developing, sometimes after perforation. It is distinguished by the presence in the iliac region of the dense formation of a similar tumor, which is moderately painful in tackling.

Peritonial symptomatics subsides, since the pathological process is limited, the stomach becomes soft, and this makes it possible to try to try infiltrate. Temperature of the body is usually in a patient subfebrile, leukocytosis and a stool delay is noted. With an uncharacteristic arrangement of the process, infiltrate is palpable in a place where it is located if it is located low, it can be forgotten through the rectum or vagina.

Study using ultrasound allows you to confirm the diagnosis. In difficult cases, a diagnostic operation is made (laparoscopy).

The presence of infiltrate is the only circumstance in which the operation is not performed. It is impossible to carry out surgical intervention until the infiltrate abscessed, since the risk is a great risk that when trying to separate appendix from the conglomerate, the resulting organs (mesenter, intestines, oil seal) will be damaged, and this may lead to difficult consequences.

The therapy of infiltrate conservative and is carried out in the hospital. The cold on the stomach, the course of antibiotics, a double-sided panefral blockade, reception of enzymes, diet and therapy and other measures that contribute to the reduction of inflammation are shown. Infiltrate is absorbed in the overwhelming majority, it usually occurs in 7-19 or 45 days.

If the infiltrate does not disappear, then the tumor is suspected. Before the discharge patient, it is necessary to pass irrigoscopy to exclude the tumor process in the blind intestine. If the infiltrate was found only on the operating table, the process is not deleted. Drainage is done, and antibiotics are introduced into the abdominal cavity.

Pylephlebit is a thrombosis of the carrier vein with inflammation of its wall and the formation of a thrombus closing the clearance of the vessel. The complication develops as a result of the distribution of the pathological process from the veins of the mesenzheshki appendix for mesenteric veins. Complication is extremely difficult and usually ends with death after a few days.

It leads to high temperatures with large daily oscillations (in 3-4 s), cyanosis appears, jaundice. The patient has strongest sharp pains all over the stomach. Multiple liver abscesses are developing. Treatment involves the technique of anticoagulants, a wide range of action antibiotics that are introduced through an umbilical vein or spleen.

Appendicular abscesses appear in the late period, before the operation, mainly as a consequence of the suppuration of infiltrate, and after surgical intervention as a result of peritonitis. There is a complication of 8-12 days after the start of the disease. By location, distinguish:

• ileocecal (parappendicular) abscess;
• pelvic abscess;
• sUNNY abscess;
• subiaphragmal abscess;
• intercircuit abscess.

Early complications of appendicitis can be within 12-14 days later, may arise in a couple of weeks

Ileocecal abscess occurs with the unfortunate appendix due to the abscess of infiltrate (other types of abscesses appear after the removal of appendicitis during destructive forms of illness and peritonitis). It is possible to suspect the pathology if the infiltration increases in size or does not decrease.

It is revealed under anesthesia, the cavity is dried and tested for the presence of roaming stones, then drain. The process is removed in 60-90 days. With phlegmonous-ulcerative appendicitis, the wall perforation occurs, which leads to the development of a limited or spilled peritonitis.

If a proximal process of the process is closed with a phlegmonous appendicitis, the distal department expands and the pus (empya) is accumulated. The spread of the purulent process on the tissue surrounding the process and the blind intestine (peritiflite, periapsendicitis) leads to the formation of accusable jets, there is inflammation of the retroperitoneal fiber.

Postoperative states

Complications after removal of appendicitis are rare. Usually they arise in older and weakened patients, patients who have been diagnosed late pathology. The classification of complications in the postoperative period distinguishes:

• complications arising with operational wounds (suppuration, ligatural fistula, infiltrate, stern, euentraration);
• complications that manifested in the abdominal cavity (peritonitis, abscesses, uluses, intestinal fistula, bleeding, acute postoperative obstruction intestines);
• complications from other organs and systems (urinary, respiratory, cardiovascular).

The pelvic abscess causes a rapid liquid stool with mucus, painful false beings for defecation, the gaping of anus or frequent urination. Characteristic to complicate the difference between the body temperature measured in the axillary depression and rectally (the difference in 0.2-0.5 s is normal, it is 1-1.5 s complicated).

At the stage of infiltration, the treatment diagram includes the reception of antibiotics, warm enemas, douching. When the abscess softens, it is opened under general anesthesia, then washed and drained. SUNTING Abscess is opened in the region of the right hypochondrium, if there is infiltrate, it is cut off from the abdominal cavity, then cut purulent inflammation And drain.

Padiaphragmal abscess appears between the right dome of the diaphragm and the liver. It is rare enough. The infection penetrates here on the lymphatic vessels of the retroperitoneal space. Mortality for this complication is 30-40%. The complication of the breath is manifested, pain with breathing on the right side of the chest, dry cough.

The general condition is heavy, heat and chills appears, increased sweating, sometimes marked the jaggility of the skin. Treatment only surgical, access is difficult because there is a danger of pleura or abdominal cavity. Surgery knows several ways to open the abdominal cavity applicable in this case.

Prevention of complications lies in the early diagnosis of the inflammatory process and comply with the recommendations of the doctor in the postoperative period

Complications with operating wounds are most often occurring, but they are relatively safe. Infiltrate, suppuration and discrepancy of the seam are most often manifested, and they are connected with how deeply the incision had to do, and the sewing technique. In addition to compliance with aseptics, the method of operation, tissue spares, the general condition of the patient is also important.

Acute appendicitis - a dangerous disease that is capable of absence surgical treatment lead to death. Most complications occur if after the appearance of the clinic passed 2-5 days. Preoperative complications are most dangerous, because in the abdominal cavity there is an infectious hearth, which can be burst at any time.

Postoperative complications After appendectomy less dangerous, but more common. They may arise, including the fault of the most patient, for example, if he does not comply with the bed or, on the contrary, it does not fall after the operation for a long time if dietary prescriptions do not comply with the wound or makes exercises to the press.

Inflammatory process In the appendix process leads to a common abdominal disease - appendicitis. His symptoms: pain in the abdominal region, an increase in temperature and disorder of the digestive function.

The only one right treatment In the case of an attack of acute appendicitis is Appendectomy - removal of the process surgically. If this is not done, severe complications may develop, leading to death. What threatens the unbearable appendicitis - our article is just about it.

Preoperative consequences

The inflammatory process in develops at different speeds and symptoms.

In some cases, it goes into and may not show a long time.

Sometimes between the first signs of the disease before the occurrence of a critical state takes place 6 - 8 hours, so it is impossible to slow down in any way.

With any pain of incomprehensible origin, especially against the background of increasing temperature, nausea and vomiting, it is necessary to apply for medical helpotherwise the consequences may be the most unpredictable.

Common complications of appendicitis:

• Perforation of the walls of Appendix. The most frequent complication. At the same time, there are gaps of the walls of the appendix, and its contents fall into the abdominal cavity and leads to the development of sepsis of internal organs. Depending on the duration of the flow and the type of pathology, severe infection may occur, right up to death. Such states are approximately 8 - 10% of the total number of patients with a diagnosis of appendicitis. With purulent peritonitis, the risk of death, as well as exacerbation increases related symptoms. Purulent peritonitis according to statistics occurs approximately 1% of patients.
• Apandicular infiltrate. It occurs when the walls are spike nearby organs. The frequency of occurrence is approximately 3 - 5% of cases of clinical practice. It develops about the third to the fifth day after the occurrence of the disease. The beginning of the sharp period is characterized by pain syndrome fuzzy localization. Over time intensity pain sensations Reduced, contours of the inflamed area are told in the abdominal cavity. Inflamed infiltrate acquires more pronounced borders and a dense structure, the tone of the muscles located near the muscles rises. After about 1.5 - 2 weeks, the tumor is absorbed, the abdominal pain is sweeping, total inflammatory symptoms decrease ( increased temperature and biochemical indicators blood comes back to normal). In some cases, the inflammatory area may cause abscesses.
• . Develops against the background of the suppuration of appendicular infiltrate or after the operation at a previously diagnosed peritonitis. Typically, the development of the disease occurs on 8 - 12 days. All abscesses must be opened and sanitized. To improve pus outflow from the wound, drainage is performed. Antibacterial therapy is widely used in the treatment of abscesses.

The presence of such complications is an indication for urgent surgical operation. The rehabilitation period also takes a lot of time and an additional course of medication treatment.

Complications after removal of appendicitis

Operation, even spent before the onset heavy symptomscan also give complications. Most of them are the cause of deaths of patients, so any disturbing symptoms should alert.

Common complications after surgery:

• . Very often arise after the removal of appendix. Characterized by the appearance of pulling pain and tangible discomfort. Spikes are very difficult to diagnose, because they do not see modern ultrasound and x-ray devices. Treatment usually consists of receiving resorption preparations and a laparoscopic removal method.
• . It often appears after the operation. It is manifested as a fragment of the intestinal fragment into the lumen between muscle fibers. Usually appears when not fulfilling the recommendations of the attending physician, or after physical Loads. Visually manifests itself as swelling in the area of \u200b\u200boperational seam, which can significantly increase significantly in size. Treatment is usually surgical, lies in liner, truncation or full removal The sector of the intestine and the gland.

Photo of hernia after appendicitis

• Postoperative abscess. Most often manifest after peritonitis, can lead to infection of the whole organism. Antibiotics are used in the treatment, as well as physiotherapeutic procedures.
• . Fortunately, this is quite rare consequences of the removal operation of appendicitis. The inflammatory process extends to the region of the portal vein, a mesenteric process and mesenteric vein. Accompanied by high temperatures, sharp pain In the abdominal cavity and severe liver damage. After the sharp stage arises, and, as a result, death. Treatment of this disease is very difficult and typically involves the introduction of antibacterial agents directly into the portal vein system.
• . In rare cases (approximately 0.2 - 0.8% of patients), the removal of the appendix provokes the appearance of intestinal fistulas. They form a kind of "tunnel" between the cavity of the intestine and the surface of the skin, in other cases - the walls of the internal organs. The reasons for the appearance of fistula is the poor sanitation of purulent appendicitis, the coarse mistakes of the doctor during surgery, as well as inflammation of the surrounding tissues during the drainage of the internal wounds and lesions of the abscess. Intestinal fistula is very difficult to treat, sometimes resection of the affected place or removal of the upper layer of the epithelium.

The emergence of a complication also contributes to ignoring the recommendations of the doctor, non-compliance with the rules of hygiene after the operation and the violation of the regime. If the deterioration of the state happened to the fifth - the sixth day after the removal of appendix, most likely, we are talking about the pathological processes of internal organs.

In addition, in the postoperative period there may be other states that require advice of the doctor. They may be evidence of various ailments, as well as not to have a relation to the transferred operation, and serve as a sign of a completely different disease.

Temperature

Increased body temperature after surgery can be an indicator of different complications. The inflammatory process, the source of which was in the appendix, can easily spread to other organs, which causes additional problems.

In most often there is inflammation of the appendages, which may make it difficult to determine the exact cause. Often, the symptoms of acute appendicitis can be confused with such ailments, so before the operation (if it is not urgent), it is necessary to inspect the gynecologist and ultrasound examination A small pelvis organs.

Increased temperature may also be a symptom of abscess or other diseases of the internal organs. If the temperature rose after appendectomy, additional examination and delivery of laboratory tests is necessary.

Diarrhea and constipation

Digestion disorders can be considered as the main symptoms and as the consequences of appendicitis. Often the functions of the gastrointestinal tract are violated after the operation.

During this period, constipation is worse all the worst, because the patient is forbidden to stand and strain. This can lead to discrepancies of the seams, to protrude hernia and other consequences. For the prevention of digestion disorders, it is necessary to stick to strict and prevent the fixation of the chair.

Stomach ache

This symptom can also have different origins. Usually, the pains manifest themselves for some time after the operation, but completely pass for three to four weeks. Usually we need so much to the tissues for regeneration.

In some cases, abdominal pain may indicate the formation of adhesions, hernia and other consequences of the transferred appendicitis. In any case, the most successful decision will appeal to the doctor, and not try to get rid of uncomfortable sensations with the help of painkillers.

Appendicitis is a common pathology requiring surgical intervention. The inflammatory process occurring in a blind intestine can easily spread to other organs, lead to the formation of adhesions and abscesses, as well as give a lot of heavy consequences.

That this does not happen, it is important to apply to the hospital in a timely manner, as well as not to ignore the alarms that may indicate the development of the disease. What is dangerous appendicitis, and to what complications it can lead, told in this article.

Inflammation of appendicitis is acute or chronic. Forms of pathology are distinguished by the severity of symptomatic signs of manifestation. Depending on the degree of damage to the mucous membrane of the colon process, the number of leukocytes in the epithelium is isolated, phlegmonous, perforated, type of disease.

Pronounced symptoms of the inflammatory process or exacerbation of chronic appendicitis are:

• strong spasms of acute character on the right side of the abdominal cavity;
• temperature increase;
• vomiting, nausea;
• selection of frequent liquid stool;
• dryness in the oral cavity;
• dyspnea.

The main feature is pain syndrome, the intensity of which depends on the position of the body. Sudden termination of the sensation of spasms indicates the lack of functioning of nerve cells due to the death of the tissue of the intestinal mucosa.

Emergency surgery after the diagnosis of acute appendicitis is the main method of treating inflammation.

Possible complications

The progression of inflammation of the colon has several stages of development. The first stage of exacerbation of appendicitis lasts a few days. During this period, structural changes in the tissue of the mucous membrane are observed.

The development of appendicitis is associated with the entry of leukocytes in the deep layers of a draft-like process, which leads to a violation of the functioning of the colon, accompanied by strong pain. Non-turning of medical care in the first 5 days after observation of spasms in the field of the right groin fold leads to complications that are of serious health hazard.

Preoperative period

The progression of the disease depends on the individual characteristics of the body. The inflammatory process can go into a chronic form, which is distinguished by the absence of symptomatic signs, and may exacerbate to a critical state.

Hazardous complications of appendicitis in the preoperative period are:

• peritonitis;
• abdominal abscess.

Complications of acute appendicitis occur in late treatment for medical care, chronic nature of pathology, as well as improper treatment of the disease.

Structural change in internal cells, the gap of the fat intestine mucous membrane is observed 3 days after the appearance of symptomatic signs of exacerbation of appendicitis. Damage to the epithelium leads to the spread of pathogenic bacteria, pus from a heart-shaped process to the abdominal cavity region.

The main symptoms of complications of acute appendicitis are:

• abdominal pain, pelvis depth;
• high body temperature;
• fevering condition;
• heart palpitations;
• incixation of the body: headache, weakness, change in the natural color of the face;
• constipation.

When identifying symptoms of complication of appendicitis, a visual inspection is carried out, palpation. Gas isolation, detection of a sign of the Sprinka-Blumberg syndrome ( strong pain During a sharp pressure and release), when pressed on the right side of the abdominal cavity indicates the occurrence of peritonitis of appendicular origin. The late suspension of the process leads to the death of the patient.

The inflammatory process of appendix leads to the propagation of pathogenic microorganisms at a nearby gear, rectaging processes, which are interconnected by forming infiltrate with pronounced structural boundaries.

The dense bump arising in the right-hand side of the abdominal cavity causes disturbing symptomatic signs:

• the temperature rises;
• strong spasms are observed at the point of formation of the appendicular infiltration during palpation;
• rapid pulse;
• elevated muscle tone of the abdominal wall;
• deterioration of general well-being.

The occurrence of a dense tumor after 3-4 days prevents emergency appendectomy. The reason for postponing surgical intervention - possible removal connected blind and rectal loops, which leads to serious complications after the operation. For the treatment of infiltrate is assigned medical therapyAfter the end of which the procedure is carried out to remove the inflamed acute appendicitis.

The main drugs are:

• antibiotics;
• spasmolytics;
• anticoagulants.

Antibacterial agents remove the inflammatory process, antispasmodics eliminate pain syndromes in the abdomen, anticoagulants dilute blood, preventing the formation of thrombosis.

Additional methods of treatment - diet and therapy, including products rich in rough tissue, cold compresses, conducting physiological procedures for dissolving dense neoplasms. Complication of acute appendicitis in children requires the selection of methods of therapy, taking into account age characteristics.

The disappearance of infiltrate is observed 1.5-2 months after the start of reception medicines. After successful treatment Surgical intervention is appointed. As a result of the individual characteristics of the body, the tumor can start highlighting the pus, contributing to the development of abdominal abscesses. The inflammatory process, accompanied by hyperthermia, a feverish state, painful palpation, develops into peritonitis.

The purulent abscess is formed when bacteria from the colon proceeds from the structural damage to the mucous membrane. Complication of appendicitis in the period before the operation is observed in 1-1.5 weeks after exacerbation.

Signs of the Lopanery of the Pointeer are:

• hyperthermia;
• the state of chills, fever;
• weakness, increased fatigue;
• headache;
• increase the number of leukocytes.

The complication of acute appendicitis can be observed in the todium area on the right side of the bone, under the diaphragm, in space for abdominal wall. In the event of an abscess in the recess between the rectum and bubble The belly inflates, the urge is raised to the release of a liquid chair, there are pain in the perineum, the area of \u200b\u200bthe small pelvis. When pusing under the right diaphragm, difficulties with breathing, cough, chest spasms, intoxication are noted.

Postoperative period

Complications after removal of appendicitis occur as a result:

• untimely assistance in exacerbation;
• lack of diagnosing the nature of the inflammation of the appendix;
• improper technology of surgical intervention;
• non-compliance with the rules during the rehabilitation period;
• acute forms of pathologies of the abdominal organs.

The classification of complications after surgery is based on the site of inflammation, the time of manifestation of symptoms of exacerbation. Dangerous consequences Surgical intervention can be observed in the structural damage zone of the drawing process, the abdominal cavity, near the arranged organs.

Postoperative complications of acute appendicitis are manifested 10-14 days after the removal procedure or more than a few weeks.

The dangerous consequences of surgical intervention are:

• discrepancies of seams after sewing wounds;
• internal bleeding;
• pilefelbit;
• damage near the arranged organs, fabrics;
• development of intestinal fistulas;
• selection of pus from the wound;
• purchase of intestinal lumen;
• adhesion formation, hernia;
• abscesses of the respiratory system, abdominal cavity;
• nephritis, cystitis of acute form.

The removal of appendicitis can lead to pathologies of the functioning of the respiratory, circulatory, urinary system, the gastrointestinal tract, the region of the abdominal cavity, the small pelvis. The main symptoms of the complication of the acute form of the disease are hyperthermia, indicating the spread of the purulent process, diarrhea and constipation due to the violation of the normal functioning of the digestive organs, pain and bloating after surgery.

Pilyfelbit

The spread of the purulent process on the liver leads to the development of a dangerous complication in appendicitis - pylephlebit.

The main symptomatic features that are manifested in a few days are:

• sharp hyperthermia;
• feverish condition, trembling in the body;
• belly spasms in the field of right hypochondrium with painful sensations in the spinal departments;
• increase liver, gallbladder;
• sepsis;
• the appearance of a yellow face - a symptom of the Couvia.

Timely detection of late complications, the correct technique of operational intervention, reception antibacterial drugs and dilution blood bumps Allow the patient's life to preserve. The risk of the consequences of appendicitis is a sharp, rapid deterioration state leading to death.

Development of fistula

The pathologies of the gastrointestinal tract arise due to the spread of inflammation in case of incorrect equipment for conducting interference, the formation of laying out due to the tight medical devices used during the surgical procedure during the drainage of the wound.

In pronounced signs of development of fistulas after removal of appendix include:

• pain syndrome observed in the eagleproof area on the right side;
• selection of the intestinal content of the operating room;
• the formation of infiltrate as a result of hushing in the abdominal cavity.

The manifestation of signs of complication of the removal of appendicitis after the operation occurs 7 days after surgery. Cutting the intestinal fistula by carrying out the operation by hiding, clearing, drainage neoplasms.

Education adhesions, hernia

The identification of the weaving of the transfers of the blind and rectum is diagnosed after the method of minimally invasive therapy, which implies the introduction of the device with an optical chamber through a small hole in the abdominal cavity. Signs of adhesions are the pain of a pulling nature in the abdomen. After removal of appendicitis, the occurrence of a tumor is occurring at the place of the operating room as a result of the loss of the intestinal proof in the deepening between the abdominal muscles.

Prevention of complications

Complicated appendicitis is observed in non-compliance with the rules in the preoperative and rehabilitation period.

• appeal for medical care when the symptoms of acute appendicitis are found;
• compliance with dietary power rules:
• regular use of fiber-rich foods: fruits, vegetables in baked form;
• rejection of greens, semi-finished, fat, salt, smoked food;
• bed regime during the period established by the doctor;
• you can not sleep on the stomach;
• lack of physical activity after surgery for 90 days;
• compliance with hygienic procedures, avoiding the fall of water and soap to the wound;
• abstinence from sexual intercourse for 7 days.

Complication of appendicitis occurs when not paid due attention to symptomatic signs of the disease. Intimoiled assistance provided during deformation of the draft-like process leads to a fatal outcome.

Information on our website is provided by qualified doctors and is exceptionally introductory character. Do not self-medicate! Be sure to contact a specialist!

Gastroenterologist, Professor, Doctor of Medical Sciences. Assigns diagnostics and conducts treatment. Expert study group inflammatory diseases. Author of more than 300 scientific papers.

One of the most common diseases in people who need surgical interventionIs inflammation of appendicitis.

The atrophied part of the colon is the appendix, it looks like a worm-shaped outflow of a blind intestine. Appendixes is formed between the thick and small intestine.

Doctors note that it is quite difficult to predict and warn. Experts do not recommend drinking painkiller in the case of appendicitis.

The reception will interfere with the doctor to put the correct diagnosis to the patient. This should be engaged exclusively by a specialist who will appoint the ultrasound.

Thanks to him, it will be possible to understand what a form of the inflamed appendix. It may be clogged or swollen. It can be removed solely surgically.

Forms of appendicitis

To date, the disease is divided into acute and chronic form. In the first case clinical picture is bright.

The patient is very bad, and therefore without emergency hospitalization can not do. In chronic form, the patient feels a state that is caused by transferred acute inflammation With the absence of symptoms.

Types of appendicitis

Today is known 4 types of appendicitis. This is a catarrhal, phlegmonous, perforated; gangrenous.

The diagnosis of catarrhal appendicitis is placed in the event of a doctor if the penetration of leukocytes in the sheath of the mucous membrane was noted.

FLEGMONOS is accompanied by the presence of leukocytes in the mucous membranes, as well as other deep layers of the appendix fabric.

The perforated is observed if the walls of the inflamed transformation of the blind intestine were broken, but the gangrenous appendicitis is affected by leukocytes the wall of the appendix, which completely donated.

Symptomatics

The symptoms of the disease should include:

• acute pain in the abdomen, or rather in the right half in the region of the Pakhova Fold;
• increasing body temperature;
• vomiting;
• nausea.

The pain will be constant and stupid, if you try to turn the body, it will become even stronger.

It should be noted that the case is not excluded when after strong attack Pain syndrome disappears.

Patients will accept this condition for what it has become better, but in fact, the feeding of pain carries a greater danger, indicating that the fragment of the body is death, not just so nervous endings ceased to react to irritation.

Ends such reassuring pain peritonitis, which is a dangerous complication after appendicitis.

Also observe the symptoms of the problem with the gastrointestinal tract. A person will feel a feeling of dryness in his mouth, he can disturb the diarrhea, a liquid chair.

Pressure can jump, heartbeat increase to 100 shots per minute. A person is tortured shortness of breath, which will be provoked to disturbed heart work.

If the patient has a chronic form of appendicitis, then all the above symptoms are not manifested, with the exception of pain.

The most common complications after appendicitis

Of course, the doctors set themselves the task of excluding all complications after removing appendicitis, but sometimes they are simply not avoided.

Below will be presented the most common consequences of appendicitis.

Perforation of the walls of Appendix

In this case, the breaks on the walls of the draft-shaped process are observed. Its content will be in the abdominal cavity, and this provokes sepsis of other organs.

Infection can be quite heavy. The lethal end is not excluded. Such perforation of the walls of appendicitis is observed in 8-10% of patients.

In the event that it is purulent peritonitis, the risk of death is high, and the exacerbations of symptoms are not excluded. Such a complication after appendicitis is observed in 1% of patients.

Apandicular infiltrate

These complications after the operation to remove appendicitis are observed in the case of spikes of organs. The percentage of such cases is 3-5.

The development of complications for 3-5 days after the formation of the disease begins. Accompanied by pain syndrome fuzzy localization.

Over time, the pain subsides, and in the region of the abdominal cavity, contours of the inflamed area appear.

Infiltrate with inflammation acquires pronounced borders and a dense structure, and there will also be a voltage alongside the muscles.

About 2 weeks old tumor will depart, and pain will stop. The temperature also subsides, and blood indicators will rate.

In many cases, it is possible that the inflamed part after appendicitis will cause the development of an abscess. He will be talked below.

Abscess

The disease is developing against the background of the suppuration of appendicular infiltrate or the operation in the event of diagnosing peritonitis.

As a rule, the development of the disease takes 8-12 days. All abscesses need to be hide and sanitia.

In order to improve pus outflow, doctors put drainage. During the treatment of complications after appendicitis, it is customary to use antibacterial agents Medical therapy.

If there is a similar complication after appendicitis, it is necessary to conduct urgent surgery.

After that, the patient will wait for a long rehabilitation period, accompanied by drug treatment.

Complications after appendectomy

Even if the operation to remove appendicitis was carried out until the onset of severe symptoms, it does not give warranty that there will be no complications.

Many cases of death after appendicitis make people pay more close attention to any disturbing symptoms.

The most common complications that may arise after the removal of the inflamed appendix will be indicated.

Spikes

One of the most frequent pathologies that appears after the removal of appendix is. Accompanied by pulling pain and discomfort.

Diagnostics are difficult, because ultrasound and x-ray do not see them. It is necessary to carry out a course of treatment with absorbing drugs and resort to the laparoscopic adhesion removal method.

Hernia

The phenomenon is really frequent after appendicitis. There is a fallout of the intestine in the area of \u200b\u200bthe lumen between the muscle fibers.

It looks like hernia, like a tumor in the seam area, increasing in size. Provided operational intervention. The surgeon climbs it, truncates or removes part of the intestine and the gland.

Abscess

It occurs in most cases after appendicitis with peritonitis. It is able to infect organs.

We need a course of antibiotics and special physiotherapy procedures.

Pilyfelbit

Very rare complication after an operation to remove appendicitis. Inflammation is observed, which extends to the region of the portal vein, the mesenteric vein and the process.

It is accompanied by an increase in temperature, severe liver damage, sharp pain in the abdominal cavity region.

If that acute Stage pathology, then everything can lead to death. Treatment is complex, it is necessary to introduce antibiotics in the system of the portal vein.

Intestinal fistulas

It occurs after appendicitis in 0.2-0.8%. Intestinal fistulas form a tunnel in the intestinal area and skin, sometimes in the walls of the internal organs.

The reasons of their appearance may be bad rehabilitation of purulent appendicitis, the error of the surgeon, the inflammation of the tissues during the drainage of the inner wounds and the foci of the development of an abscess.

Treat pathology is difficult. Sometimes, doctors prescribe resection of the affected place, as well as the removal of the top layer of the epithelium.

It should be noted that the appearance of complications contributes to ignoring the advice of the doctor, the lack of no compliance with the rules of hygiene, the violation of the regime.

The deterioration of the condition may be observed for 5-6 days after the operational intervention.

This will talk about the development of pathological processes in internal organs. During the postoperative period, cases are not excluded when it is necessary to consult with the attending physician.

Do not avoid it, on the contrary, your body gives signals that other ailments are developing, they may even have no relation to appendectomy.

It is important to pay due attention to your health and do not be shy to seek help to the doctor.

Increase body temperature

The inflammatory process may affect other organs, and therefore the emergence of additional health problems is not excluded.

Women often suffer from inflammation of appendages, which makes it difficult to diagnose and the exact cause of the disease.

Often, the symptoms of the acute form of appendicitis can be confused with such pathologies, and therefore doctors prescribe an examination of the gynecologist and ultrasound of the small pelvis organs if the operation is not an emergency.

Also, the increase in body temperature indicates that abscess or other diseases of the internal organs is possible.

If the temperatures rise after the operation, you need to go through an additional inspection and pass the tests again.

Digestion disorders

Ponos and constipation can talk about the failure of the functions of the gastrointestinal tract after appendicitis. At this time, the patient is hard with constipation, it is impossible to strain and straighten, because it is fraught with the penetration of hernia, the breaks of seams and other problems.

So that there is no digestive disorder, you need to stick to the diet, following the stools to be fixed.

Pain bouts in the stomach

As a rule, on 3-4 weeks of pain after surgery should not be. So much time is required to pass the process of tissue regeneration.

In some cases, pain speaks about hernias, spikes, and therefore it is not necessary to drink painkillers, it is worth consulting a doctor.

It is worth noting that appendicitis is often found in medical practice doctors. Pathology needs urgent hospitalization and operations.

The thing is that inflammation can quickly go to other organs, which will entail a lot of heavy consequences.

So that this was not, it is important to come to the doctor in a timely manner, call an ambulance. Do not ignore those signals of the body that talk about the development of illness.

Appendicitis is dangerous, never even when the operation was carried out successfully, deaths were observed, which is already talking about when patients are negligiously related to their health.

Prevention

Special preventive Mer Appendicitis does not exist, but there are some rules that should be observed to reduce the risk of developing inflammation in the field of a worm-like transformation of a blind intestine.

1. Adjust the diet. Mail consumption in the diet of fresh greenery (parsley, green onions, dill, sorrel, salad), solid vegetables and ripe fruits, seeds, fatty and smoked treats.
2. Watch for health. It is worth paying for all signals about failure in your body. We have never been in medical practice, there are cases when the inflammation of the appendix was provoked by pathogenic microorganisms into it.
3. Conduct the detection of glisted invasions, as well as timely treatment.

Summing up

Let appendicitis do not belong to dangerous diseasesBut the pathology has a great risk of developing complications after the operational removal of the transformation of the blind intestine. As a rule, they manifest themselves in 5% of people after appendicitis.

The patient can count on a qualified medical careBut it is important not to miss the moment and consult a doctor in a timely manner.

You need to wear a bandage, women can wear pulling panties. This measure will facilitate not only the exclusion of complications after appendicitis, but also to preserve the seam carefully, without causing its defectiveness.

Pay attention to your health, and if the appendicitis was identified, try to do everything that the doctor indicates to avoid problems in the future.

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