A dangerous complication of acute appendicitis is an appendicular abscess. It can occur both before surgical procedures and in the postoperative period. According to statistics, a serious complication appears in 3% of patients and requires immediate intervention by surgeons.
Causes
An abscess is an inflammation of tissues characterized by the formation of a limited purulent cavity. Often the causative agent of this complication is E. coli. Also, the human factor is the cause of the appearance of an appendicular abscess:
- Illiterate diagnostics: numerous mistakes made during the course of research, contributing to the development of complications of appendicitis.
- A long waiting period due to erased symptoms. This situation may arise due to the presence of other diseases with pronounced symptoms, as well as the use of pain medications. As a rule, attrition of symptoms is noted in elderly patients.
- Ineffective treatment regimen.
- Untimely appeal to a medical institution.
Development mechanisms
At the initial stage of the development of the disease, an infiltrate is formed - the inflamed cells accumulate and tightly connect with each other. If, despite the conservative treatment, the seal does not resolve, but, on the contrary, abscesses, emergency surgery is indicated. Otherwise, the abscess can break into the abdominal cavity, provoking its inflammation. The transition of the pathological process into the lumen of the intestine or retroperitoneal space is possible . Further, the purulent process quickly spreads to nearby tissues.
Symptoms
The formation of infiltrate has symptoms that usually occur in acute appendicitis:
- general malaise;
- chills;
- rise in body temperature;
- increased sweating;
- pain in the right iliac region.
As the appendicular abscess develops, the following symptoms appear:
- It becomes impossible to make body movements due to bouts of cramping pain.
- An intestinal abscess is accompanied by moderate bloating and partial bowel obstruction.
- Along with throbbing pain, redness and swelling of the skin appear.
- With a pelvic abscess of appendicular origin, pain and bloating in the lower abdomen are disturbing. When defecating, the patient also experiences unpleasant sensations, and the process of exit of feces is accompanied by mucous secretions. Frequent urination is noted.
When making a diagnosis, body temperature is of fundamental importance. If with appendicitis it rises slightly (up to 37.5 ° C), then with an appendicular abscess, the thermometer shows 39-40 ° C.
Diagnostics
The clinical manifestations of the complication are similar to the signs of some diseases, therefore, it is first necessary to differentiate it.
In addition, the diagnosis of appendicular abscess includes the following measures:
- Inspection and medical history. The doctor probes the right iliac region to detect infiltrate. With deep palpation, fluid accumulation in most cases is not detected. As a rule, the infiltrate is dense and motionless. Rectal or vaginal palpation is often performed to detect painful compaction, which is the lower pole of the abscess. The doctor draws attention to the patient’s tongue - in case of illness, it is moist and covered with a dense coating. In the process of breathing, you can notice a lag in the abdomen in the right iliac region.
- Blood analysis. It is important for determining the level of white blood cells in the blood. With an appendicular abscess, a sharp increase is observed.
- Ultrasound and radiography of the abdominal cavity. Using these types of diagnostics, the fluid level in the right side of the abdomen, the exact location and size of purulent inflammation are determined.
Treatment
Surgery is not possible at the stage of infiltrate formation.
Treatment is carried out in an inpatient setting and includes:
- compliance with bed rest;
- applying to the stomach in the first three days of cold, in the following days - heat;
- the introduction of a solution of novocaine for pain relief (taking drugs to reduce the severity of pain is excluded);
- special diet.
In case of successful resorption of the infiltrate after 2 months, a planned operation is performed to remove the appendix (appendectomy). This is due to the fact that after some time, bouts of pain and the process of the formation of infiltrate can recur, increasing the risk of complications.
With an established appendicular abscess, treatment involves an emergency operation. In the process, an abscess is opened and drained. The scope of access depends on its location. As a rule, use extraperitoneal access. The wound is washed with an antiseptic solution, after which drainage tubes are installed.
Autopsy of the appendicular abscess is carried out under general anesthesia. By decision of the doctor, the appendix can be removed, which is preferable.
Postoperative period
The patient who underwent surgery is shown strict bed rest. Drainage requires special care - regular washing of the wound. Tubes are removed only after pus stops from the cavity. After removing them, the wound is not sutured, it is healed on its own. The use of antibiotics and drugs that eliminate the symptoms of intoxication is indicated. At the same time, therapy is carried out aimed at the overall strengthening of the body.
If during the operation the appendix has not been removed, an appendectomy is performed 2 months after the inflammatory process is completely eliminated.
Effects
In case of untimely seeking qualified help, spontaneous opening of the appendicular abscess may occur, after which there is a high probability of the development of the following complications:
- purulent peritonitis - inflammation of the peritoneum;
- urinary tract infections;
- phlegmon - a purulent process that quickly spreads to neighboring tissues;
- paracolitis - inflammatory changes in the fiber of the retroperitoneal space;
- liver abscess - the destruction of healthy tissues and the formation of a purulent cavity;
- adhesive intestinal obstruction;
- purulent thrombophlebitis - the formation in the veins of blood clots and small foci of an abscess;
- fistulas of the abdominal wall - channels connecting the internal organs to the surface of the body.
As for the prognosis, it is determined by the degree of promptness of diagnosis and surgical intervention.
Prevention
In order to prevent the development of a dangerous complication, the patient at the first sign of acute appendicitis should call an ambulance team. Prompt diagnosis and timely intervention will help to avoid an abscess. Ignoring signs of the disease can be fatal.
An appendicular abscess is a serious complication, characterized by the development of an inflammatory process of a purulent nature. At the initial stage, symptoms similar to signs of acute appendicitis are manifested. As the inflammatory process develops, the patient's body temperature rises to high marks, it becomes impossible to perform body movements due to bouts of cramping pain. It is important to call an ambulance team immediately to avoid dangerous consequences.