Appendicitis is called the acute or chronic inflammation of the Appendix (vermiform Appendix) cecum. The last stage of development of this pathological process is the destruction of authority, it can proceed according to the type of cellulitis or gangrene. The form of phlegmonous appendicitis, its peculiarities and characteristics, and surgical treatment is the focus of this article.
Appendicitis abscess is a purulent inflammation of the Appendix, in which the quantity of pus is rapidly increasing, which can lead to rupture of an inflamed vermiform Appendix inside its contents into the abdominal cavity. This can develop life-threatening complications – peritonitis and sepsis.
Signs of phlegmonous appendicitis
The main symptom of appendicitis is pain in the right abdomen. At the transition of the pathological process in the abscess stage, the patient usually feels an increase in pain, and the doctors noted a significant deterioration of the patient. He has to take a posture to reduce pain, walking, sitting, coughing becomes impossible because of strengthening of the abdominal discomfort.
Localization of pain pointed by patient, the transition of appendicitis in abscess stage, as a rule, becomes more definite is the lower right quadrant of the abdomen. In this area it is noted the muscle tension and the absence of a characteristic for the act of breathing ascents and descents of the anterior abdominal wall (a protective reaction of the organism to pain).
In addition to pain in phlegmonous appendicitis, there are other signs:
Some people have symptoms of phlegmonous appendicitis can be atypical. In this group are young children, expectant mothers in the last months of the child’s expectations and those with abnormal location of the Appendix. So, pregnant women may be unexpressed painful reaction to the doctor test. For young children characterized by the predominance of General symptoms over pain syndrome. Kids lose their appetite, be cranky, sleepy but can not sleep. They have quite often there is a diarrhea, vomiting and severe fever.
In people with localization of the Appendix in a non-standard location with the inflammation of the Appendix pain appears not quite where it should be, for example, on the left, under the liver, with the navel in the pelvis or lower back. In this regard, to consult a doctor is necessary when any pain in the abdomen or back, acute appendicitis can masquerade as a variety of diseases.
What is the danger of phlegmonous appendicitis
If the patient is not timely medical assistance (when phlegmonous appendicitis is just surgical intervention) may develop dangerous complications:
- Peritonitis – inflammation of the serous membranes covering the organs and inner abdominal wall. This disease occurs due to the fact that the pus from the burst Appendix freely out into the abdominal cavity.
- Appendicular abscess – formation conglomerate suppurative (abscess) around the inflamed vermiform Appendix.
- Sepsis – infection in the bloodstream very fast and spread it throughout the body with the strongest toxicity and the formation of almost all organs of many purulent foci.
- Purulent inflammation and thrombosis of the portal vein branches. On these vessels the blood moves from the intestines to the liver, so the inflammation can quickly spread to them.
- Obstruction of the intestine.
It is important
Any of these conditions exist in the case of ineffectiveness or lack of treatment can lead to death of the patient.
Diagnosis phlegmonous appendicitis
Diagnosis of the disease under consideration is based on the following methods:
- The survey and inspection. Particular attention doctors pay palpation of the anterior abdominal wall of the patient and verifying symptoms of “acute abdomen”.
- The General analysis of blood. In acute appendicitis there has been an increasing number of leukocytes.
- Ultrasound scanning of the abdomen and pelvis. To explore the intestine with the help of this study it is impossible, but to exclude other acute pathology (e.g., ectopic pregnancy or rupture of the ovary in women, pancreatitis or cholecystitis representatives of any gender).
- Gynecological examination in women. Surgeons must ensure that the cause of pain is not gynecological pathology, namely, appendicitis.
It is a small amount of research enables experienced doctor make the diagnosis and choose appropriate treatment plan. Subsequently the patient may have to undergo other investigations (blood biochemistry, urinalysis, etc.), but they needed more doctors not to diagnose this pathology and to assess the General condition of the patient.
First aid for phlegmonous appendicitis
With the appearance of severe abdominal pain you need to call an ambulance or, in extreme cases, alone (always accompanied by someone) to go to the hospital. Expect the pain subsides, it is impossible. Appendicitis progresses very rapidly, so after a few hours of feeling bad can come irreversible consequences – rupture of the Appendix, etc.
It is important
It should be noted that the reduction of pain in appendicitis in most cases does not indicate a recovery, and the development of complications, so this picture should not appease, but rather to alert.
While waiting for the doctor:
- Not to take painkillers and laxatives. Such curative action can lubricate the clinical picture and the doctors will simply waste valuable time.
- Can’t eat or drinkbecause you may need surgery and it is best done when the stomach is nothing.
- Cannot be applied to the stomach warm. It accelerates the formation and accumulation of pus in the Appendix. But it is safe to reduce pain by using cold compress.
Treatment of phlegmonous appendicitis
The only treatment of this form of appendicitis is emergency surgery. The inflamed Appendix must be removed and to audit its surrounding organs and tissues. The sooner will be carried out surgical treatment, the smaller will be the risk of complications and a shorter recovery period.
Operation on appendicitis
Surgery for phlegmonous appendicitis is performed under General anesthesia, endotracheal anesthesia. Itself surgery called appendectomy. It is carried out in two ways: traditional and laparoscopic. Laparoscopic treatment is less traumatic. However, if there is a suspicion that the Appendix already formed inflammatory infiltrate, surgeons still choose the second option, to be able to more thoroughly conduct an audit of the abdominal and pelvic cavities.
Is this type of surgery under the control of the optical device (laparoscope) and special instruments. They are introduced into the abdominal cavity of the patient through three small puncture wounds: first – for laparoscopy, the second and third are for surgical instruments (scissors, electrodes, scalpels, etc.). All manipulations in the abdomen of the patient are performed by these devices. After surgery, puncture wounds (incisions) are closed with stitches.
The advantages of laparoscopic appendectomy:
- Moderate pain intensity in the postoperative period.
- Faster recovery of bowel function.
- Good cosmetic effect (and so small postoperative scars become almost invisible).
- A shorter period of hospital stay (if all goes well, 3-4 days operated go home).
A barrier to the implementation of laparoscopic appendectomy may be:
- The spread of inflammation in the cecum.
- Rupture of the Appendix.
- The formation of an inflammatory infiltrate around the process.
- Multiple adhesions between the intestinal loops.
- Obesity is an extreme degree.
- Atypical location of the inflamed cecum.
- The last trimester of pregnancy.
In this type of surgery involves an oblique incision with a length of 10-12 cm in the right lower abdomen (iliac fossa). After skin incision, the surgeon cuts through the layers of fat and the aponeurosis of the abdominal muscles, then breeds the muscle fibers, exposing the peritoneum, which lifts and also cuts. After access into the abdominal cavity, the doctor carefully dried the wound and inspection of the intestine.
Inflamed Appendix is neatly displayed together with the caecum in the operating field. Through a series of manipulations, the surgeon cuts the bone and sutured to the dome cecum. Next, the abdomen should be carefully cleaned of exudate, tissue remnants, and wash out the operative field with saline. The final stage of the operation – establishment of drainage (a special tube to cleanse the abdominal cavity and antibiotics if necessary) and layer-by-layer wound closure.
During the surgery the doctor must pay attention to the fluid that has accumulated around the intestinal loops. If it is cloudy, it is sent for bacteriological examination. Subsequently such patients lavage of the abdominal cavity solutions with a high concentration of antibiotics.
When running phlegmonous appendicitis and suspected perforation surgeons perform an appendectomy with a wide access to the abdominal cavity (incision is made the letter “T” – the so-called Nizhneserginsky laparotomy). In addition, it is sure draining.
Features of the postoperative period
If appendicitis was uncomplicated and the operation went without incident, getting up and walking to the patient is recommended after 6-8 hours. Next, the patient should be observed sparing regimen for at least 30 days to return to normal physical activity can be no earlier than 3 months.
To reduce pain patients can be prescribed painkillers. In addition, the operated shown antibiotic therapy and daily dressing with the inspection of surgical wounds. If the process of wound healing is normally 7-8 days, the doctor removes the stitches.
Important components of the recovery period after appendectomy are physiotherapy, therapeutic exercise, and, of course, diet. In the first days after surgery the patient can eat liquid porridge, low-fat dairy products, vegetables, pureed soups, or something else, what do you recommend doctor. Further, the diet can be expanded, however, the transition to a normal diet is recommended not earlier than in 2-3 weeks.
Zubkova Olga, medical observer, medical epidemiologist