Early complications of appendectomy. Possible early postoperative complications in appendicitis

In the postoperative period special treatment not performed on patients. Only physical therapy and painkillers at night (if necessary) are prescribed. For special indications, cardiovascular and other medications are given. Essential has physical therapy, which should be carried out for all patients. The next day after surgery, patients can walk. Permission to get up and walk should be taken into account the individual characteristics and condition of the patient.

As noted, an indispensable condition is the use of methyluracil in the postoperative period: the postoperative period in patients is easier, the number of complications becomes insignificant. Sutures are removed 4-5 days after surgery. Over the past 8 years, there have been no deaths due to acute appendicitis in our clinic.

Postoperative complications

After appendectomy, complications most often develop in the wound and in abdominal cavity. However, complications from the respiratory, cardiovascular and genitourinary systems may occur.

The incidence of complications ranges from 2 to 19-20%. According to V.P. Radushkevich et al. (1969), complications are 4.6%. The greatest number of complications arise from destructive forms of appendicitis. G.G. Karavanov et al. (1969) reported that after appendectomy for catarrhal appendicitis, complications developed in 0.74% of patients, for phlegmonous - in 3.02%, for gangrenous - in 9.37%, for perforated - in 25.66% ; the most common complications are wound suppuration (6.72%), peritonitis (1.99%) and pneumonia (1.9%) - Appendectomy can be complicated by intestinal fistulas, which form in 0.05-0.02% of patients. B.A. Vitsin (1969) notes an increase in the number of intestinal fistulas in recent years.
M.I. Kolomiychenko et al. (1971) provide a detailed analysis of the causes of the formation of intestinal fistulas after appendectomy.

The most important measure in the treatment of intestinal fistula is the suction of intestinal contents using a vacuum device until the fistula forms. Abscesses of the wall of the cecum in the area of ​​the stump of the appendix are rare (0.1% - according to A. G. Sutyagin, 1973), they require relaparotomy. Untimely intervention can lead to the formation of phlegmon, breakthrough of an abscess into the abdominal cavity, or the formation of an infiltrate.

Complications of the wound process

The most common complication is the formation of an inflammatory infiltrate and wound suppuration. In the first two days, the patient’s condition does not cause concern, but on the third day, after a short subsidence of postoperative pain in the wound, they reappear and soon acquire a pulsating character. By this time, the temperature, which has dropped after the operation, rises again to 38-38.5°. The activity of patients is reduced, they spare the stomach when moving and prefer to lie down. Upon removal of the bandage, swelling of the tissues in the wound area, threads cut into the skin and hyperemia of the skin are detected. Skin is hot. Even a light touch causes severe pain. On palpation, a dense painful infiltrate is determined, located in subcutaneous tissue, in depth. abdominal wall or capturing its entire thickness.

Infiltrates vary in prevalence.

If appropriate measures are not taken, then with increasing pain, persistence of high temperature, increased toxic changes in the blood and urine for several days, signs of abscess formation of the infiltrate appear (decreased density, clearer boundaries, ripples). Subsequently, the abscess becomes chronic course, and along with the stable general condition of the patient or its gradual deterioration (emaciation, pallor, bad dream, loss of appetite, stool retention) the inflammatory process involves the skin in the process and opens up on its own. With subcutaneous abscesses, the process resolves in a shorter time.

Recognition of infiltrates and abscesses of the abdominal wall in the wound area is clear from the above clinical picture.

An alarming moment, definitely indicating an unfavorable course of the wound process, is the appearance or intensification of pain on the 3-4th day after surgery and an increase in temperature. Pain in the wound area and determination of infiltrate during palpation complete the diagnosis. Of undoubted importance in diagnosis is the study of blood and, in later stages, urine. The earliest recognition of inflammatory complications is very important. It was previously noted that if treatment is started at a time when the inflammatory process is in the infiltration stage, it is possible to reverse its development with timely targeted treatment.

Treatment should begin with the immediate implementation of a bilateral lumbar novocaine blockade. The therapy is complemented by antibiotics, cold on the abdomen, UHF, and other physiotherapeutic procedures, the nature of which is determined by the attending physician together with a physiotherapy specialist. Timely accepted therapeutic measures in 2-3 days the acute inflammatory process is eliminated, and the patient recovers.

If carried out conservative treatment does not have an effect and signs of abscess formation appear, you should turn to surgical treatment. In case of subcutaneous suppuration, the sutures are removed, the edges of the wound are spread wide, the purulent-necrotic masses are removed and the cavity is tamponed with tampons moistened with a 0.5% solution of chloramine or a solution of furatsiln 1:5000. In cases where the abscess is localized in the thickness of the abdominal wall, especially when abscess formation is recognized 8-9 days after surgery, it is necessary to local anesthesia or under anesthesia, dissect the tissue layer by layer and open the purulent cavity. After surgery, the wounds heal, gradually filling with granulations. After cleansing the wounds from purulent-necrotic masses, ointment dressings are used, then secondary sutures are applied.

In the vast majority of patients, the described complications end without a trace, however, with significant destruction of the muscles and aponeurosis, hernias may subsequently develop. Postoperative hernias in the area of ​​the scar after appendectomy are not very rare.

Hematoma. Insufficient hemostasis can lead to hematoma formation. Most often, hematomas are localized in the subcutaneous fatty tissue, less often in the muscles. The next day the patient complains of a feeling of pressure or dull pain in the wound area. There is noticeable swelling in the right iliac region, moderate uniform pain.

Sometimes swaying is detected.

Treatment consists of partial removal of sutures and removal of hematoma (blood, blood clots). After this, the wound is sutured, a pressure bandage and cold are applied. If the hematoma is represented by uncoagulated blood, then it can be evacuated by puncture with a thick needle (after skin anesthesia). Treatment should begin immediately after recognition of the hematoma. Otherwise, the hematoma may fester or cause extensive scarring of the abdominal wall.

Dehiscence of wound edges. The apparently smooth course of the postoperative period is sometimes complicated by divergence of wound edges without visible signs inflammation. Dehiscence of the wound edges occurs immediately after the sutures are removed. The occurrence of this complication is associated with a decrease in regenerative processes, vitamin deficiencies, general decline protective reactions of the body. Often there is a divergence of the edges of the wound when the sutures are removed (with the usual management of the postoperative period) in early dates- 4-5 days after surgery. It should be noted that without the use of regeneration stimulants, sutures can be removed after 7 days, because only by this time a scar begins to form (the maturation of connective tissue is microscopically detected). With the use of methyluracil and inert suture material, we remove the sutures after 4-5 days and never* get dehiscence of the wound edges. Morphological and physical research methods performed in our laboratory and in many other institutions show that maturation of connective tissue during treatment with methyluracil occurs 2-3 days earlier than in control observations.

Bleeding. A rare but serious complication is bleeding from the stump of the mesentery of the appendix when the ligature slips. In the first hours, bleeding is asymptomatic, and only with significant blood loss do signs appear acute blood loss and very mild pain all over the belly. If the bleeding is moderate, then the general condition of the patient is satisfactory. Pain in the abdomen, initially weak or moderate, gradually increases in strength, and when the blood is infected, it becomes severe, accompanied by nausea, repeated vomiting, bloating, retention of stool and gases, i.e. symptoms of increasing diffuse peritonitis appear.

At objective research The patient's anxiety, pallor, rapid pulse, and coated tongue are noticeable. At first, the abdomen has the correct shape, moderately painful, with signs of peritoneal irritation. In sloping areas of the abdomen, it is sometimes possible to determine the presence of free fluid. Intestinal peristalsis sounds are reduced. When examining with a finger through the rectum, tenderness of the pelvic peritoneum is noted. In case of blood infection, symptoms characteristic of peritonitis appear.

Careful observation of the patient after surgery and a thoughtful explanation of each symptom of trouble will allow a timely diagnosis of intra-abdominal bleeding. Diagnosis is often hampered by the doctor’s attempts to explain abdominal pain, signs of anemia, peritoneal irritation and other symptoms by the surgical intervention performed and the patient’s hypersensitivity. It should be emphasized that irritation of the peritoneum in the presence of blood in the abdominal cavity in the first days is weak and may be completely absent. In doubtful cases, the issue must be resolved in favor of relaparotomy - re-opening the abdomen. An important role in diagnosis is hourly observation of the patient with the indispensable recording of the following indicators:

1) the patient’s condition (better, worse), 2) pulse, 3) the condition of the abdomen, including the severity of the Shchetkin-Blumberg symptom. Such observation will allow doubts in the diagnosis to be resolved in the shortest possible time.

It is clear that the only method of treatment is relaparotomy, during which a revision is performed, the bleeding is stopped and the blood and its clots are removed. Before suturing, it is advisable to inject a solution of methyluracil with antibiotics into the abdominal cavity.

Infiltrates and abscesses. Most often, infiltrates form in the right iliac region, near the cecum, after operations for destructive appendicitis in the presence of effusion, fibrinous-purulent deposits and involvement in the process nearby organs. The formation of infiltrates is facilitated by remaining pieces of dead tissue, contents that have fallen out of the appendix, and thick silk or catgut ligatures. Sometimes infiltrates form without visible reasons. In such cases, one must think about the high virulence of the infection and the decrease in the body’s defenses.

Postoperative infiltrates appear 5-6 days after surgery. From the first days, patients have noticeably more severe course postoperative period: they are pale, the pain almost does not disappear, and after three days it becomes quite severe, the temperature rises to 38-39°, the pulse is frequent, stool is retained. By the 5-6th day, a dense painful formation. Treatment tactics are the same as for appendiceal infiltrates formed before surgery: bilateral lumbar novocaine blockade, antibiotics, cold on the stomach, rest. Subsequently - thermal procedures.

Infiltrates and abscesses can be localized in other parts of the abdominal cavity: in the pelvis, between the loops small intestine, under the diaphragm, under the liver. Quite often, infiltrates form in the pouch of Douglas, in women, and between the rectum and bladder in men. This pocket of the pelvic peritoneum is quite deep and narrow, overlapped from above by loops of the small intestine and partially by the cecum and sigmoid colon, which contributes to the accumulation and retention of effusion and pus here, and, consequently, the formation of infiltrates and abscesses. Most often, infiltrates and abscesses of the pouch of Douglas are formed with destructive appendicitis and a low position of the cecum. In such cases, exudate accumulates in the pelvic recess of the peritoneum and becomes the cause of an abscess if it is not completely removed during surgery. In the pouch of Douglas, purulent exudate, formed during diffuse or limited peritonitis, can be delimited.

An infiltrate forms in the pelvic cavity, involving adjacent organs in the inflammatory process: loops of the small intestine, rectum, cecum, uterus, etc. appendages in women, bladder, pelvic walls. When abscess formation occurs, a cavity is formed here containing varying amounts of pus: from 100-150 to 1000 or more milliliters.

The clinical picture of abscesses in the pouch of Douglas in many patients is quite expressive. 4-6 days after the operation, sometimes against the background of a fairly favorable course, the patient develops or intensifies pain in the lower abdomen, a feeling of discomfort in the anus, an increase in temperature to high numbers, which subsequently acquires a hectic character. Soon a frequent urge to nag follows. defecation, tenesmus, mucus discharge from the rectum, as well as frequent painful urination. .These disorders are explained by the involvement in the inflammatory process of the nerve elements that innervate pelvic organs, and mechanical pressure of the formed infiltrate.

The patient's general condition worsens, pallor and weakness increase, the patient noticeably loses weight and refuses food. The abdomen is somewhat protruded above the pubis or above the Pupart's ligament, and is painful. Large infiltrates are determined by palpation of the abdomen. Infiltrates located deep in the pelvis are inaccessible to palpation from the abdominal wall, which in such cases has regular form and may be involved in respiration. Great importance in recognition inflammatory infiltrates The pouch of Douglas is examined with a finger through the rectum in men and children and through the vagina in women.

The spelling of the anterior wall of the rectum or back wall vagina ( posterior arch) and a dense painful infiltrate, which sometimes sharply deforms the hollow pelvic organs (compresses them). When the infiltrate abscesses, an area of ​​softening is detected - ripple (fluctuation) (Fig. 91).

We must remember the need for digital examination of the rectum in all patients in the postoperative period with an unexplained increase in temperature, abdominal pain and other symptoms indicating trouble in the abdominal cavity.

As in all patients with suppurative complications in the postoperative period, with infiltrates and abscesses of the pouch of Douglas there are changes in the blood: leukocytosis, a shift in the white blood count to the left, accelerated ROE, etc.

If you do not intervene in a timely manner during the infiltration, it will abscess, the suppurative process will progress and can break into the abdominal cavity - a general purulent peritonitis occurs at lightning speed, ending in the death of the patient. Long purulent process, accompanied by hectic temperature and severe intoxication, causes dystrophic changes in vital important organs, violates metabolic processes, which sharply reduces defensive reactions body. Therefore, the breakthrough of the abscess and the occurrence of severe peritonitis is the last link in this tragic situation. Even immediate recognition of an abscess breaking into the abdominal cavity and the operation undertaken are useless in such cases - the patient dies in the next few hours.

Less commonly, ulcers break out through the abdominal wall, into the small or large intestine, and then recovery can occur. A case of emptying of a huge abscess (about two liters of pus) of the pouch of Douglas through fallopian tube, uterus and vagina, which ended with the patient’s recovery. But one cannot count on such outcomes. It is necessary to intervene during the inflammatory process, first conservatively, and then, when indications appear, operational methods treatment.

Treatment of infiltrates of the pouch of Douglas is the same as for infiltrates of other localizations. Additional measures include: warm enemas with furatsilin, enemas with novocaine, hot douching in women.

Unfortunately, infiltrates of the pouch of Douglas rarely resolve. They abscess and require surgical intervention. The operation is performed on the rectal side in men, and on the vaginal side in women. It is best to operate under anesthesia. The rectum is opened wide with hooks and thoroughly treated with a 2% solution of chloramine and iodine. In the midline of the rectum, at the site of the greatest protrusion (where softening is determined), a puncture is made with a thick needle and, having obtained pus, the tissues are bluntly separated through the needle and the abscess is emptied. The cavity is treated with a 2% chloramine solution and drained with a rubber or polyethylene tube, the end of which is removed through anus out. It is even better to insert two tubes, which will allow you to rinse the cavity 2-3 times a day with an antiseptic liquid or antibiotics, to which the flora in this patient is sensitive. A similar operation is performed in women, but the hyoid is opened from the vaginal side, cutting its posterior fornix. Purulent cavity, freed from purulent masses, decreases in size and gradually heals. Immediately after the operation, the temperature drops to normal levels, and literally before our eyes the patient recovers, quickly freeing himself from all the symptoms of his former purulent process.

The clinical picture, diagnosis and treatment of infiltrates and abscesses in other areas of the abdomen are similar to those described.

The only difference is the localization of the process, which affects the clinical course and the choice of surgical treatment method (approach). So, subphrenic abscesses are accompanied by pain when breathing, dry cough (Troyanov's symptom), expansion, protrusion and sharp pain of the lower intercostal spaces (Kryukov's symptom) and require special approaches during surgery, of which extrapleural and extraperitoneal ones should be considered the best. Each infiltrate and abscess of the abdominal cavity must be studied in depth and a treatment method must be thoughtfully chosen, taking into account topographic and anatomical data and the individual characteristics of the patient.

Peritonitis

The most serious complication after appendectomy is peritonitis- inflammation of the peritoneum. Peritonitis after surgery for appendicitis occurs rarely and, as a rule, in patients with destructive forms of the disease. Peritonitis after appendectomy is especially alarming. This danger, this anxiety is due to the fact that symptoms of peritonitis appear in a patient in the postoperative period. The doctor, to a certain extent, has reason to associate the patient’s pain, anxiety and deterioration in condition with the characteristics of the postoperative period, with the instability of the patient’s neuropsychic status.

How does peritonitis manifest in patients after appendectomy? The leading symptom of peritonitis is pain, which gradually intensifies, instead of disappearing 1-2 days after surgery. The pain is constant, severe, causing the patient to moan and behave restlessly. Nausea and repeated vomiting, which does not provide relief, soon follow.

Postoperative peritonitis is often accompanied by hiccups, which indicates the spread of inflammation to the diaphragmatic peritoneum. The patient's condition worsens, the pulse becomes frequent (does not correspond to the temperature), facial features sharpen, the tongue becomes dry and coated with a brownish coating, stool is retained, gases do not pass away, the abdomen is initially tense and then becomes swollen. During auscultation, rare weak peristaltic sounds are detected, then disappearing altogether. Symptoms of peritoneal irritation are clearly expressed. The blood picture worsens and changes dramatically biochemical parameters. The daily amount of urine decreases.

The above symptoms, even if they are mild, dictate the need for immediate surgical intervention.

It is necessary to do a relaparotomy. There can be no explanation for refusing surgical intervention in the presence of symptoms of peritonitis, and if this rule is well remembered and felt, then errors in the surgeon’s tactics in the treatment of peritonitis, both preoperative and postoperative, will be extremely rare.

The operation consists of opening the abdominal cavity, revision, eliminating the cause of peritonitis and drainage. With limited peritonitis in the right iliac region, the abdominal cavity can be opened by removing the sutures from the wound and spreading its edges. Generalized peritonitis requires midline laparotomy. The operation is best performed under general anesthesia. More detailed information about peritonitis will be given in the corresponding chapter.

Other complications

In the postoperative period, complications from other organs and systems are possible. In spring and autumn, bronchitis and pneumonia often occur. The most important preventative measure for these complications is therapeutic exercises, which should be started from the first day after surgery. In the first hours after the operation, the patient is recommended to bend and straighten his legs, do breathing exercises, turn on your side. In the following days, the methodologist conducts gymnastics according to a special scheme and gives tasks to the patients for the whole day. If there is no methodologist in the department, physical therapy classes are assigned to a nurse. Therapeutic exercise for the vast majority of patients, even the elderly and weakened, ensuring good ventilation of the lungs and maintaining normal tone of cardio-vascular system, prevents lung complications.

In our time pulmonary complications are rare. When they appear, antibiotics, sulfa drugs, cupping, cardiovascular and expectorant medications, and inhalations are prescribed. Pulmonary complications are of greatest concern in the elderly. Treatment is best done together with a therapist.

After appendectomy, urinary retention may occur, which is caused by reflex effects from the surgical wound or the patient’s inability to urinate in a supine position. Timid, shy people sometimes do not talk about urinary retention and suffer seriously. They complain of pain in the lower abdomen and behave restlessly. An objective examination can reveal bloating, sharp pain on palpation, muscle tension, and even the Shchetkin-Blumberg symptom. After urine evacuation, all alarming symptoms disappear, the patient calms down. Hence the conclusion should be drawn: it is imperative that every patient in the postoperative period inquire about urination. When urinary retention occurs, the simplest methods are used first: warm heating pad on the lower abdomen, gentle diuretics, methenamine (0.25), irrigation of the external genitalia with warm water. Good effect gives a conditioned reflex effect: the patient is taken on a gurney to the dressing room and the water tap is turned on, or in the ward a thin stream of water is poured from a jug into a basin. The babbling stream of water renders reflex influence per function Bladder. Sometimes, to eliminate urinary retention, it is enough to raise the patient to his feet. If listed. the measures do not have an effect, then they resort to catheterization of the bladder. This procedure must be carried out under strictly aseptic conditions.

Because the risk of missing a perforated appendix is ​​higher than the risk of unnecessary surgery, surgeons remove the appendix even if there is doubt about its inflammation. However, the patient may be prescribed bed rest for further observation. If he does not get better, doctors will perform an excision of the appendix, i.e. appendix will be removed.

Removing the appendix is ​​very simple operation, taking no more than half an hour and produced under general anesthesia. Modern medications and antibiotics have significantly reduced the likelihood of complications.

After removal of the appendix, the patient feels much better and after a few days is ready to be discharged from the hospital. In a week they will remove him postoperative sutures. After the sutures are removed, the operated patient can already carry out ordinary life, excluding, at least for several weeks, such active species sports like boxing or football. This is the so-called rehabilitation period after appendicitis.

Chronic appendicitis

Primary chronic appendicitis can be very dangerous. The formation of gangrene at the tip of the appendix leads to perforation. Pus entering the abdominal cavity can lead in just a few hours to an acute inflammation called peritonitis, which often develops into generalized peritonitis. With this disease, after removing the appendix, a special plastic drain is inserted into the abdominal cavity, through which all the products of inflammation come out. Intravenous administration will help overcome the infection. medicinal solutions and antibiotics.

Aftereffects of surgery to remove appendicitis (appendix)

After removal of the appendix during the healing stage, you may feel periodic pain, which will stop in a month or two. However, soon after surgery, many experience an accumulation of gases in the intestines.

In addition, after any abdominal surgery, the intestines stop functioning for some time, so temporary bloating is a good sign, meaning that digestive system returns to normal functioning and that soon it will be possible to eat and drink as usual. The patient should be explained that escaping gases are the best indication of a speedy and complete recovery.

Consequences of appendectomy (removal of the appendix)

During the healing stage, the patient sometimes experiences attacks of appendicitis pain, but after a month they will pass. However, other effects may occur soon after surgery, such as severe gas buildup. This may be the result of the stomach being open during surgery, allowing air to enter. Another common type of consequence is temporary cessation of bowel function. This effect is observed after any abdominal surgery. The accumulation of gases indicates that the digestive system is returning to normal functioning, which means that the patient is on the way to full recovery and will soon be able to eat regular food.

In our other reviews, read about how you can determine the presence of appendicitis, as well as the importance of the appendix in the human body.

Appendicitis is an inflammation of the appendix of the cecum. It can develop in women and men, regardless of their age. The only category of patients in whom this inflammation is never diagnosed is infants(age up to 1 year).

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Appendicitis: causes and factors provoking development

The absolutely exact causes of the occurrence and development of the inflammatory process in the appendix have not yet been established. There is an opinion that the disease can be triggered by eating sunflower seeds and watermelon with peel, eating grapes with seeds, and poor chewing of food.

In fact, this version is not confirmed by anything or anyone, but doctors and scientists have identified certain factors that can still provoke an inflammatory process in the appendix of the cecum:

1. Changes in the immune system that occur for no apparent reason. With this condition, the walls of the appendix become more susceptible to irritation and infection.
2. Blockage of the lumen of the appendix of the cecum. The cause of blockage may be:
   • formation of fecal stones;
   • helminthic infestations;
   • tumor diseases (benign and malignant).
3. Inflammatory processes in the walls of blood vessels - vasculitis.
4. Infectious diseases general– for example, tuberculosis, typhoid fever.

note: no one will ever be able to predict in advance the development of the inflammatory process in the vermiform appendix of the cecum. Even if a person undergoes regular examinations, it is possible to prevent the development acute inflammation impossible.

Classification of appendicitis

The forms are divided into acute appendicitis and chronic appendicitis. In the first case, the symptoms will be pronounced, the patient’s condition is very serious, and emergency medical care is required. Chronic appendicitis is a condition after suffering an acute inflammatory process with no symptoms.

Doctors distinguish three types of the disease in question:

• catarrhal appendicitis - penetration of leukocytes into the mucous membrane of the appendix occurs;
• phlegmonous - leukocytes are found not only in the mucous membrane, but also in the deeper layers of the tissue of the appendix;
• gangrenous - the wall of the appendix affected by leukocytes becomes dead, inflammation of the peritoneum develops (peritonitis);
• perforated - the walls of the inflamed appendix rupture.

Clinical picture and symptoms of appendicitis

The symptoms of the pathological condition in question are quite pronounced; doctors can make a diagnosis quickly and accurately, which reduces the risk of complications. The main symptoms of appendicitis include:

1. Pain syndrome. Localization of pain in appendicitis - top part abdomen, closer to the navel, but in some cases the patient cannot indicate exact concentration pain. After an acute attack of pain, the syndrome “moves” to right side belly - this is considered very characteristic feature inflammation of the appendix of the cecum. Description of the pain: dull, constant, intensifies only when turning the body.

note : after a severe attack of pain, this syndrome may disappear completely - patients mistake this condition for recovery. In fact, this sign is very dangerous and means that a certain part of the appendix has died and nerve endings It just doesn't respond to stimulation. Such imaginary sedation always leads to peritonitis.

note : with chronic appendicitis, of all the above symptoms, only pain will be present. And it will never be acute and constant - rather, the syndrome can be described as periodically occurring. The doctor talks about the symptoms of appendicitis:

Diagnostic measures

To diagnose appendicitis, you will need to conduct a number of examinations:

1. General examination with identification of syndromes:
   • Kochera - intermittent pain from the upper abdomen to the right side;
   • Mendel - when tapping the anterior wall of the abdomen, the patient complains of pain in the right iliac region;
   • Shchetkin-Blumberg - the right hand is inserted into the right iliac region and then abruptly removed - the patient experiences severe pain;
   • Sitkovsky - when the patient tries to turn on his left side, the pain syndrome becomes as intense as possible.
2. Laboratory research:
   • Clinical blood test;
   • biochemical blood test;
   • coprogram;
   • stool test for the presence of occult blood;
   • general urine test;
   • examination of stool for the presence of worm eggs;
   • Ultrasound (ultrasound examination) of the abdominal organs;
   • electrocardiogram (ECG).

Note: interviewing the patient, collecting anamnesis of life and illness is carried out only in initial stage development of inflammation in the appendix of the cecum.

In an acute attack, it is indicated to carry out emergency surgery when confirming the diagnosis using the above-described syndromes. Detailed information about the causes, signs of acute appendicitis, as well as treatment methods is in the video review:

Surgery to remove appendicitis

Treatment of an acute attack of the inflammatory process of the appendix of the cecum can only be carried out surgically– none therapeutic activities not worth doing. The patient is prepared for surgery to remove an inflamed appendix as follows:

1. The patient is partially sanitized, but it is advisable to take a full shower.
2. If diffuse disease was previously diagnosed varicose veins veins, then the patient should bandage lower limbs elastic bandage. Please note: if there is a risk of thromboembolism, heparin drugs must be administered before surgery.
3. If emotional background If the patient is labile (he is very excited, irritated, panicking), then doctors prescribe sedative (calming) medications.
4. If you eat food 6 hours before an attack of acute appendicitis, you will need to empty your stomach - vomiting is artificially induced.
5. Before surgery, the bladder is completely emptied.
6. The patient is given a cleansing enema, but if there is a suspicion of perforation of the appendix wall, then forced bowel cleansing is strictly prohibited.

The above activities must end two hours before surgical intervention. The surgeon’s work can be carried out in several ways:

1. The classic method of performing the operation is to cut the abdominal wall (anterior) and cut out the inflamed appendix.
2. The laparoscopic method is a more gentle method of surgery; all manipulations are performed through a small hole in the abdominal wall. The reason for the popularity of the laparoscopic method of surgical intervention is the short recovery period and the virtual absence of scars on the body.

Note: if symptoms of inflammation of the appendix of the cecum occur (or similar signs appendicitis) you should immediately seek medical help. It is strictly forbidden to take any painkillers, apply a heating pad to the site of pain, give an enema, or use drugs with a laxative effect. This may provide short-term relief, but subsequently such measures will hide the true clinical picture from the specialist.

Postoperative period and diet after appendicitis

After surgery to remove appendicitis recovery period involves following diet No. 5. It includes:

• soups with vegetable broth;
• compotes;
• lean boiled beef;
• fruits (non-acidic and soft);
• legumes;
• crumbly porridge.

Lard, baked goods, fatty meat and fish, black coffee, chocolate, hot spices and sauces, milk and fermented milk products are excluded from the diet.

note : in the first 2 days after surgery, the diet can only include chicken broths, still water with the addition of lemon, weak tea. From day 3 you can gradually introduce permitted foods. TO normal menu You can return only 10 days after removal of the inflamed appendix of the cecum. To maintain immunity during the postoperative period, you need to consume vitamin complexes, as well as preparations containing iron and folic acid.

ABOUT proper nutrition After removal of appendicitis, the surgeon says:

Possible complications and consequences of appendicitis

Most serious complication appendicitis is peritonitis. It can be limited or unlimited (spilled). In the first case, the patient’s life is not in danger if assistance is provided at a professional level.

With diffuse peritonitis, rapid inflammation of the peritoneum develops - in this case, delay leads to death. Doctors also identify other complications/consequences of the inflammatory process in question:

• suppuration of the wound left after surgery;
• intra-abdominal bleeding;
• formation of adhesions between the peritoneum and abdominal organs;
• sepsis - develops only with peritonitis or unsuccessful surgery. When the appendix ruptures under the surgeon’s hands and its contents spill out through the peritoneum;
• pylephlebitis of purulent type - inflammation develops large vessel liver ( portal vein).

Preventive actions

There is no specific prevention of appendicitis, but to reduce the risk of developing an inflammatory process in the appendix of the cecum, you can adhere to the following recommendations:

1. Correction of diet. This concept includes limiting the consumption of greens, hard vegetables and fruits, seeds, smoked and too fatty foods.
2. Timely treatment of chronic inflammatory diseases– there were cases when inflammation of the appendix of the cecum began due to penetration pathogenic microorganisms of the sick palatine tonsils(for decompensated tonsillitis).
3. Detection and treatment of helminthic infestations.

Appendicitis is not considered dangerous disease– even the probability of developing complications after surgery does not exceed 5% of the total number of operations performed. But such a statement is appropriate only if medical care was provided to the patient in a timely manner and at a professional level.

Tsygankova Yana Aleksandrovna, medical observer, therapist of the highest qualification category.

The inflammatory process in the appendix leads to a common disease of the abdominal cavity - appendicitis. Its symptoms: pain in abdominal area, fever and digestive disorders.

The only one proper treatment in case of an attack of acute appendicitis, appendectomy is the surgical removal of the appendix. If this is not done, they may develop severe complications, leading to death. What are the dangers of untreated appendicitis - our article is just about this.

Preoperative consequences

The inflammatory process develops with at different speeds and symptoms.

In some cases, it goes into and may not manifest itself for a long time.

Sometimes between the first signs of the disease and the onset critical condition It takes 6-8 hours, so you should not hesitate under any circumstances.

For any pain of unknown origin, especially against the background of fever, nausea and vomiting, you should definitely seek medical help. medical assistance, otherwise the consequences may be the most unpredictable.

Common complications of appendicitis:

• Perforation of the walls of the appendix. Most common complication. In this case, ruptures in the walls of the appendix are observed, and its contents enter the abdominal cavity and lead to the development of sepsis of the internal organs. Depending on the duration and type of pathology, severe infection may occur, up to fatal outcome. Such conditions account for approximately 8–10% of total number patients diagnosed with appendicitis. With purulent peritonitis, the risk of death, as well as exacerbation, increases accompanying symptoms. Purulent peritonitis statistically occurs in approximately 1% of patients.
• Appendicular infiltrate. Occurs when the walls of nearby organs adhesion. The incidence is approximately 3 – 5% of cases clinical practice. It develops approximately on the third to fifth day after the onset of the disease. The onset of the acute period is characterized pain syndrome fuzzy localization. Over time, the intensity of pain decreases, and the contours of the inflamed area can be felt in the abdominal cavity. The inflamed infiltrate acquires more pronounced boundaries and a dense structure, the tone of the muscles located nearby increases slightly. After about 1.5 - 2 weeks, the tumor resolves, abdominal pain subsides, and general pain decreases. inflammatory symptoms(high temperature and biochemical blood parameters return to normal). In some cases, the inflammatory area can cause an abscess to develop.
• . Develops against the background of suppuration of the appendiceal infiltrate or after surgery with previously diagnosed peritonitis. Typically, the development of the disease occurs on days 8–12. All abscesses must be opened and debrided. To improve the drainage of pus from the wound, drainage is performed. Antibacterial therapy is widely used in the treatment of abscess.

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

Complications after appendectomy

Surgery, even if performed before the onset of severe symptoms, can also cause complications. Most of them cause deaths in patients, so any alarming symptoms should alert you.

Common complications after surgery:

• . Very often occur after removal of the appendix. Characterized by the appearance of nagging pain and noticeable discomfort. Adhesions are very difficult to diagnose, because they are not visible with modern ultrasound and x-ray devices. Treatment usually consists of absorbable medications and laparoscopic removal.
• . It appears quite often after surgery. It manifests itself as prolapse of a fragment of the intestine into the lumen between the muscle fibers. Usually appears when the recommendations of the attending physician are not followed, or after physical activity. Visually manifested as swelling in the area surgical suture, which can increase significantly in size over time. Treatment is usually surgical, consisting of suturing, trimming, or complete removal section of the intestine and omentum.

Photo of a hernia after appendicitis

• Postoperative abscess. Most often it appears after peritonitis and can lead to infection of the entire body. Treatment uses antibiotics and physiotherapeutic procedures.
• . Luckily it's pretty rare consequences appendicitis removal surgery. The inflammatory process spreads to the area of ​​the portal vein, mesenteric process and mesenteric vein. Accompanied high temperature, sharp pains in the abdominal cavity and severe liver damage. After the acute stage, it arises, and, as a consequence, death. Treatment of this disease is very difficult and usually involves administration antibacterial agents directly into the portal vein system.
• . IN in rare cases(in approximately 0.2 - 0.8% of patients) removal of the appendix provokes the appearance of intestinal fistulas. They form a kind of “tunnel” between the intestinal cavity and the surface of the skin, in other cases - the walls of internal organs. The causes of fistulas are poor sanitation purulent appendicitis, gross errors by the doctor during surgery, as well as inflammation of surrounding tissues during drainage of internal wounds and abscess areas. Intestinal fistulas very difficult to treat, sometimes requiring resection of the affected area or removal of the upper layer of the epithelium.

The occurrence of one or another complication is also facilitated by ignoring the doctor’s recommendations, non-compliance with hygiene rules after surgery and violation of the regime. If the condition worsened on the fifth or sixth day after removal of the appendix, most likely we're talking about about pathological processes of internal organs.

In addition, other conditions may arise during the postoperative period that require consultation with a doctor. They can be evidence of various ailments, and also have nothing to do with the surgery, but serve as a sign of a completely different disease.

Temperature

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

Most often, inflammation of the appendages is observed, which can make it difficult to determine exact reason. Often the symptoms of acute appendicitis can be confused with precisely such ailments, therefore, before the operation (if it is not urgent), an examination by a gynecologist is necessary and ultrasound examination pelvic organs.

Fever can also be a symptom of an abscess or other internal diseases. If the temperature rises after an appendectomy, it is necessary additional examination and laboratory tests.

Diarrhea and constipation

Digestive disorders can be considered as the main symptoms and consequences of appendicitis. Often, the functions of the gastrointestinal tract are disrupted after surgery.

During this period, constipation is worst tolerated, because the patient is forbidden to push and strain. This can lead to suture divergence, hernia protrusion and other consequences. To prevent digestive disorders, it is necessary to adhere to strict rules and not allow stool to become fixed.

Stomach ache

This symptom may also have different origins. Typically, pain continues for some time after surgery, but disappears completely within three to four weeks. Usually this is how much tissue will need to regenerate.

In some cases, abdominal pain may indicate the formation of adhesions, hernia and other consequences of appendicitis. In any case, the best solution would be to consult a doctor rather than try to get rid of discomfort with painkillers.

Appendicitis is a common pathology requiring surgical intervention. The inflammatory process occurring in the appendix of the cecum can easily spread to other organs, lead to the formation of adhesions and abscesses, and also give many other serious consequences.

To prevent this from happening, it is important to seek help from the hospital in a timely manner, and not to ignore warning signs that may indicate the development of the disease. How appendicitis is dangerous and what complications it can lead to is described in this article.