In medicine, the term "acute appendicitis" refers to the development of the inflammatory process in the vermiform appendix of the cecum. The disease can occur in people of any age and gender. The only method of treatment is surgery. In case of untimely seeking medical help, the appendix in most cases bursts, as a result of which complications can lead to death. If inflammation of the appendix is suspected, an ambulance team must be called immediately.
Development mechanism
In the human body, the appendix is located in the right iliac region. It is a kind of continuation of the cecum, its length is about 8 cm. In the abdominal cavity, it can be located in different ways, and therefore it is necessary to conduct a thorough diagnosis before its removal.
For a long time, doctors were convinced that the appendix did not perform any vital functions in the body, which was explained by the patient's previous level of health remaining after its removal. But in the process of numerous studies, it was found that the vermiform appendix is part of the immune system and is responsible for the production of hormones that improve intestinal motility. Nevertheless, its absence does not affect the patient’s health due to the launch of compensatory processes.
Despite this, inflammation of the appendix can even be fatal. This is explained by the rapid development of the process, in which pronounced morphological changes occur in it, accompanied by the appearance of pronounced symptoms.
In surgery, acute appendicitis is usually divided into several stages:
- Initial. This stage is characterized by the absence of any changes in the appendix. Its other name is appendicular colic.
- Catarrhal. At this stage, redness of the mucous membrane occurs, it swells. In the process of diagnosis, the doctor can detect ulcers. The patient does not feel pronounced symptoms, for many they are completely absent. When you go to the hospital at the catarrhal stage in most cases, you can avoid postoperative complications.
- Phlegmonous. It is characterized by the rapid development of the pathological process, which covers almost the entire process. Acute phlegmonous appendicitis occurs, as a rule, a day after the onset of inflammation. There is a thickening of the walls of the appendix, the vessels expand, the organ itself significantly increases in size. Often, acute phlegmonous appendicitis is accompanied by the formation of pathological foci filled with pus. In such cases, the integrity of the walls of the process is violated, through the holes its contents penetrate into the abdominal cavity. The operation performed at this stage often leads to complications in the form of suppuration of the wound.
- Gangrenous. A feature of this stage is its rapid development. There is a blockage of blood vessels by blood clots, tissues begin to die and decompose, the intestinal walls are covered with purulent plaque. In the absence of qualified medical care at this stage, extensive peritonitis develops, leading to death.
There are cases when acute appendicitis ends in recovery without treatment, but they are single. In this regard, it is necessary to consult a specialist or call an ambulance team when the first alarming signs appear.
In the International Classification of Diseases (ICD), acute appendicitis is assigned the code K35.
Causes
Pathology develops due to the vital activity of infectious agents and provoking factors. Pathogens can enter the appendix as from the intestines, as well as from more distant foci (in this case, they are transported by blood or lymphatic fluid).
In most cases, the development of acute appendicitis is triggered by the following pathogens:
- viruses;
- Salmonella
- E. coli;
- enterococci;
- Klebsiella;
- staphylococci.
The occurrence of inflammation is affected not only by the vital activity of pathogens, but also by many provoking factors. These include:
- intestinal pathologies in the acute stage;
- helminthic infestations;
- violation of the motor process;
- anomalies in the structure of the appendix;
- a large number of fecal stones in the process;
- decrease in the degree of blood circulation;
- narrowing of the lumen by foreign objects;
- blood clots
- vasospasm;
- unbalanced diet;
- defects in the body's defense system;
- prolonged exposure to stress;
- adverse environmental conditions;
- intoxication.
Thus, the launch of the inflammatory process occurs in the presence of common, local and social factors.
Symptoms
Acute appendicitis is always accompanied by pain. At the earliest stage, they are paroxysmal in nature. However, there are no other signs of an inflammatory process. Initially, unpleasant sensations can be localized in the navel or solar plexus. Gradually, they move to the right iliac region. In addition, pain can radiate to the rectum and lower back. Other response sites are also possible.
The nature of the pain in acute appendicitis is constant, it does not stop and intensifies during coughing and sneezing. Sensations become less pronounced if you take a position lying on your back and bend your legs at the knees.
In addition, the following conditions are symptoms of acute appendicitis:
- nausea;
- vomiting
- diarrhea;
- fever;
- bloating;
- belching;
- loss of appetite;
- lethargy, drowsiness;
- tongue coating (first wet, then dry).
It is necessary to consult a doctor if the above symptoms appear. Approximately on the third day, the disease transitions to the late stage, characterized by the spread of the inflammatory process to nearby tissues and organs, as well as a rupture of the appendix. Self-healing is a rarity, in such cases, an acute form of pathology becomes chronic.
Diagnostics
If you suspect an attack of acute appendicitis, you must call an ambulance team or go to the clinic yourself. An accurate diagnosis requires consultation with a physician and surgeon.
In the process of admission, the doctor conducts an initial diagnosis of acute appendicitis, including:
- Interview. The specialist must provide information on all available symptoms, indicate the time of their occurrence and severity.
- Inspection The doctor assesses the surface condition of the tongue, measures body temperature and blood pressure, and palpates.
Then the patient must donate blood and urine for analysis. Studies are performed by express methods. To exclude other possible pathologies, the doctor directs the patient to an x-ray and ultrasound. When confirming the presence of acute appendicitis, surgical intervention is indicated.
Surgical Treatment
In most cases, the removal of the appendix is urgent. Planned appendectomy is carried out if the inflammation is chronic.
The state of agony in the patient is the only contraindication to the operation. In such cases, acute appendicitis is inappropriate to treat. If a patient has a serious illness, doctors use conservative methods of therapy so that his body can undergo surgery.
The duration of the operation is 50-60 minutes, while the preparatory phase takes no more than 2 hours. During this time, an examination is performed, a cleansing enema is placed, a catheter is inserted into the bladder, and the hair is shaved in the desired area. With varicose veins, limbs are bandaged.
After the implementation of the above measures, the patient is taken to the operating room, where he is anesthetized. The choice of anesthesia method depends on the person’s age, the presence of other pathologies, his body weight, and the degree of nervous excitement. As a rule, in children, the elderly and pregnant women, surgery is performed under general anesthesia.
Surgical intervention is carried out in one of the following ways:
- Classic.
- Laparoscopic.
The algorithm for conducting a standard operation in acute appendicitis includes the following steps:
- Providing access to the appendix. A scalpel surgeon makes an incision in the right iliac region. After dissection of the skin and adipose tissue, the doctor enters the abdominal cavity. Then he finds out if there are obstacles in the form of adhesions. Loose joints are separated by fingers, dense ones are dissected with a scalpel.
- Bringing out the necessary section of the cecum. The doctor removes it by gently pulling the organ wall.
- Removal of the appendix. The doctor performs a ligation of blood vessels. Then, a clamp is applied to the base of the vermiform appendix, after which the appendix is sutured and removed. The stump obtained after clipping is immersed in the intestine. The final stage of removal is suturing. These actions can be performed in reverse order. The choice of methodology depends on the localization of the appendix.
- Wound closure. It is carried out in layers. In most cases, the surgeon sutures the wound tightly. Drainage is indicated only in cases where the inflammatory process has spread to nearby tissues or purulent contents have been found in the abdominal cavity.
A more gentle method of appendectomy is laparoscopic. It is less traumatic and easier to tolerate by patients with severe diseases of the internal organs. Laparoscopy is not performed in the late stage of acute appendicitis, with peritonitis and some pathologies. This is due to the fact that with the help of this method it is impossible to fully examine the abdominal cavity and carry out thorough rehabilitation.
Laparoscopic surgery is performed as follows:
- The surgeon makes an incision 2-3 cm long in the navel. Carbon dioxide enters the hole (this is necessary to improve visibility), and a laparoscope is inserted into it. The doctor examines the abdominal cavity. If there is even the slightest suspicion regarding the safety of this method, the specialist removes the instrument and proceeds to the classical appendectomy.
- The doctor makes 2 more incisions - in the right hypochondrium and in the pubic area. Tools are introduced into the resulting holes. With their help, the doctor captures the appendix, bandages the vessels, excises the process and removes it from the abdominal cavity.
- The surgeon conducts rehabilitation, if necessary, establishes a drainage system. The final step is suturing the incisions.
In the absence of complications, the patient is taken to the ward. In other cases, he is transferred to the intensive care unit.
Possible complications
In the first 24 hours after surgery, the patient is concerned about pain, body temperature may increase. These are normal conditions resulting from surgical treatment of acute appendicitis. A feature of pain is its localization exclusively in the area of tissue dissection. If it is felt elsewhere, medical attention is required.
In any case, after an appendectomy, doctors constantly monitor the patient's condition. This is due to the frequent occurrence of various complications. Acute appendicitis is a pathology in which exudate can form in the focus of inflammation, resulting in an increased risk of suppuration in the area of tissue dissection. According to statistics, it occurs in every fifth patient.
In addition, the following complications may develop after appendectomy:
- peritonitis;
- discrepancy of seams;
- bleeding in the abdomen;
- adhesive disease;
- thromboembolism;
- abscess;
- sepsis.
To reduce the risk of negative consequences, it is necessary to follow the doctor’s recommendations and if there are disturbing signs, contact him immediately.
Features of the postoperative period
Patient care is carried out in accordance with a special document - clinical recommendations. Acute appendicitis is a pathology, after surgical treatment of which the patient should be in the hospital for 2 to 4 days. The average length of stay can be increased with complicated forms of the disease.
The recovery period is individual for each person. Young patients return to their usual way of life after about 1.5-2 weeks, for children and the elderly, this period increases to 1 month.
The first day after an appendectomy is considered the most important. During this period, the patient is forbidden to eat food and drink liquid in large quantities. It is allowed to offer him every half hour for 2-3 teaspoons of mineral still water. In the same period, it is necessary to strictly observe bed rest. After 24 hours, the attending physician decides whether the patient can get up and move independently.
While the patient is in the hospital, special treatment is not required, all efforts are aimed at restoring the body after surgery. In the absence of complications, the patient is discharged after a few days.
During the rehabilitation period, each person must comply with the following rules:
- In the first 7 days after the appendectomy, you must wear a bandage. The next few months, you need to wear it during any physical exertion.
- Daily walk in the fresh air.
- Do not lift heavy objects the first 3 months after surgery.
- Do not engage in sports involving high-intensity physical activity, do not swim until a scar forms.
- Avoid sexual contact for the first 2 weeks after surgery.
The fact that high-intensity physical activity is prohibited for several months does not mean that the patient must lead a sedentary lifestyle during the recovery period. Hypodynamia is no less dangerous - against its background, constipation, congestion develop, muscle tissue atrophies. 2-3 days after surgery, you should regularly perform simple exercises.
Power Features
The regimen and diet must be adjusted after treatment of acute appendicitis. In the postoperative period, diet plays a crucial role. After appendectomy, patients are assigned table number 5.
The basic principles of this diet:
- You need to eat 5-6 times a day, but in small portions (no more than 200 g).
- The first 3 days, the consistency of the food should be mashed. In the same period, it is necessary to exclude products that increase gas formation.
- Do not eat too cold or hot dishes.
- The basis of the menu should be boiled foods or steamed. It is necessary to drink enough liquid (water without gas, fruit drinks, fruit drinks, herbal tea).
You can return to the usual regimen and diet 2 months after the operation. The transition process should be gradual.
What to do if you suspect an attack
If certain rules of conduct are not observed, the risk of developing complications of acute appendicitis increases. To reduce the likelihood of their occurrence, you must immediately call an ambulance.
Before her arrival you need:
- To put the patient to bed, he is allowed to take any position in which the severity of pain becomes less.
- Apply a cold heating pad to the affected area. This will help slow down the development of the inflammatory process. Warming the affected area is prohibited, this leads to a rupture of the appendix.
- Every half hour to offer a person a little water.
Simultaneously with the implementation of the above measures, it is necessary to collect things that the patient will need in a hospital. It is not recommended to give a person painkillers - they distort the clinical picture.
Finally
Inflammation of the appendix of the cecum is currently not uncommon. In surgery, acute appendicitis is divided into several forms, each of which has certain symptoms. If inflammation of the appendix is suspected, it is recommended to call an ambulance team. Timely surgery significantly reduces the risk of developing all kinds of complications. In the ICD, acute appendicitis has the code K35.