Appendicitis is an inflammation of the appendix of the cecum. Despite the ongoing development of modern surgery, a large number of complications of this pathology are still noted. This is due both to the low awareness of the population and the reluctance to seek medical help, as well as to the insufficient qualifications of some doctors. Therefore, let's understand how this disease manifests itself and what complications after appendicitis can occur.
What is appendicitis?
Appendicitis is a disease that is characterized by inflammation of the wall of the appendix (vermiform appendix of the cecum). It is located in the lower right side of the abdomen, which is also called the iliac region. In the adult body, the appendix has no function, so its removal (appendectomy) does not harm human health.
Most often, the appendix is inflamed in people aged 10 to 30 years.
Main symptoms
Before directly proceeding to what complications after acute appendicitis may occur, we will analyze what symptoms will help to suspect the presence of inflammation for timely access to medical care.
If chronic inflammation of the appendix can not manifest itself for a long time and not cause inconvenience to the patient, then acute appendicitis has vivid symptoms:
- sharp severe pain in the upper abdomen (epigastrium), which gradually descends down and to the right (in the iliac region);
- increased pain when turning to the right side, with coughing, walking;
- muscle tension of the anterior abdominal wall, which is due to pain that occurs in a patient when moving with abdominal muscles;
- possible accumulation of gases in the intestines, constipation;
- low-grade temperature (up to 37.5 ° C).
Classification of appendicitis
Perhaps for the inhabitants it does not matter much what kind of inflammation of the vermiform appendix is observed in his case. However, it is very important for the surgeon to know the type of appendicitis, because depending on this, one can determine the prognosis of the further course of the disease and the likelihood of complications. And it also defines surgical tactics.
The following types of appendicitis are distinguished:
- catarrhal or simple - the most common form;
- surface;
- phlegmonous - purulent inflammation of the appendix;
- gangrenous - with the development of necrosis of the appendix;
- perforated - with the destruction of the appendix and the penetration of intestinal contents into the abdominal cavity.
It is the phlegmonous and gangrenous species that are the most unfavorable in terms of the development of complications. These varieties of appendicitis require the greatest attention of the surgeon and immediate surgical intervention. A perforated view, in fact, is a complication after gangrenous appendicitis.
Types of Complications
Complications after appendicitis can be divided into two large groups.
The first includes complications of the inflammation itself, which often leads to untimely seeking medical help. These are complications such as:
- appendicular infiltrate - the formation of conglomerate from the loops of the intestine, mesentery and other organs of the abdominal cavity around the appendix;
- abscesses in the abdominal cavity (in the pelvis, between the loops of the intestine, under the diaphragm);
- peritonitis - inflammation of the peritoneum;
- pylephlebitis is an inflammation of the portal vein (a vessel that carries blood to the liver), as well as its branches.
Complications after appendicitis surgery most often develop in the wound and abdominal cavity. However, there may be complications in the respiratory organs, organs of the genitourinary and cardiovascular systems.
Appendicular infiltrate
When answering the question, what can be the complications after appendicitis, first of all, it is necessary to highlight the formation of appendicular infiltrate. It is a group of organs and tissues of the abdominal cavity welded together that limit the appendix from the rest of the abdominal cavity. As a rule, this complication develops several days after the onset of the disease.
Symptoms of complications after appendicitis, specifically appendicular infiltrate, are characterized by a decrease in the intensity of pain in the lower abdomen. It becomes not so sharp, but more stupid, does not have a clear localization, increases slightly only when walking.
On palpation of the abdominal cavity, you can feel a fuzzy formation, characterized by pain. Further, the infiltrate becomes denser, the contours become more blurred, the pain disappears.
Infiltrate can resolve within one and a half to two weeks, however, it can also fester with the formation of an abscess. With suppuration, the patient's condition deteriorates sharply, temperature appears, the abdomen becomes painful on palpation, the muscles of the anterior abdominal wall are tense.
Appendicular abscess
A purulent, prognostically unfavorable complication after appendicitis is the formation of an abscess of the appendix. But abscesses can form not only directly in the appendix, but also in other places of the abdominal cavity. This occurs when an effusion in the abdominal cavity is clotted and prevents the development of common peritonitis. Often this picture occurs as a complication after phlegmonous appendicitis.
To diagnose this complication and search for abscesses in the abdominal cavity, it is recommended to use ultrasound and computed tomography. If an abscess formed as a complication after appendicitis in women, its pelvic localization is characteristic. Then its presence can be determined using a vaginal examination.
CT is presented above with the formation of an abscess of the anterior abdominal wall.
Purulent peritonitis and pylephlebitis
These two types of complications occur least often, but are most unfavorable for the patient. Peritonitis as a complication after appendicitis occurs in only 1% of cases. But it is this pathology that is the main cause of death in patients with appendicitis.
The rarest condition for inflammation of the appendix is pylephlebitis (septic inflammation of the portal vein). As a rule, it is a complication after an appendectomy operation, however, it can develop even before surgery. It is characterized by a sharp deterioration in the general condition of the patient, high temperature, sharply swollen abdomen. If veins that pass directly to the liver tissue are damaged, jaundice, enlargement of the liver occur, and liver failure develops. The most likely outcome of this condition is the death of the patient.
Complications arising in the surgical wound
And now we will talk about the complications after appendicitis surgery. The first group of complications are those that are limited to an operational wound. Most often, inflammatory infiltrates and suppurations develop. As a rule, they occur 2-3 days after the removal of the appendix, while the already abated pain in the wound returns again, the body temperature rises, and the general condition worsens.
On the wound, when removing the bandage, redness and swelling of the skin are visualized, the threads of the postoperative sutures cut into the skin. On palpation, sharp pain is observed and a dense infiltration is felt.
After a few days, if you do not intervene in time and prescribe treatment, the infiltrate may fester. Then its boundaries become less clear, with palpation you can find a symptom of fluctuation, which characterizes the presence of purulent fluid. If you do not open and drain the abscess, it can acquire a chronic course. Then the patient’s condition becomes worse and worse. He loses weight, is exhausted, his appetite is reduced, constipation occurs. After a certain time, the purulent process from the subcutaneous tissues spreads to the skin and is independently opened. This is accompanied by leakage of pus and relief of the patient's condition.
In addition to the most common complications listed above after the removal of appendicitis, such pathological conditions may occur in a postoperative wound:
- hematoma;
- bleeding;
- divergence of edges.
Hematoma
Incomplete hemorrhage during surgery may cause hematoma formation. The most frequent localization is in subcutaneous fat, less often there is an accumulation of blood between muscle fibers. The day after the operation, the patient is concerned about dull pain in the wound area, a feeling of pressure. The surgeon upon examination determines the swelling in the lower right abdomen, pain on palpation.
To eliminate the process, it is necessary to partially remove the surgical sutures and remove blood clots. Next, the seams are applied again, fixed on top with a bandage. Something cold is applied to the wound. In cases where the blood has not yet coagulated, you can make a puncture and remove the hematoma with a puncture. The main thing in the treatment of hematoma is not to postpone it, since the wound can suppurate, which will worsen the patient's condition and prognosis of the disease.
Bleeding
The photo in the article presents one of the types of surgical elimination of the source of bleeding - vessel clipping.
A terrible complication may be bleeding from the stump of the appendix. At first, it may not manifest itself in any way, but later on there are general and local signs of blood loss.
Among the common signs, the following symptoms are distinguished:
- headache and dizziness;
- general weakness;
- pallor of the skin;
- cold sweat;
- decrease in pressure and decrease in heart rate with severe bleeding.
Among the local manifestations of this complication after the removal of appendicitis, the most characteristic symptom is a gradually increasing pain in the abdomen. At first, moderate and not very disturbing to the patient, it indicates irritation of the peritoneum. But if bleeding does not stop in time, the pain becomes stronger, which can indicate the development of diffuse peritonitis.
With a significant accumulation of blood in the abdominal cavity on examination, the surgeon determines the irregular shape of the abdomen. With percussion (tapping on the anterior abdominal wall), a dull sound is detected in places of blood accumulation, peristaltic noise of the intestine is muffled.
In order not to miss this complication and to provide timely assistance to the patient, it is necessary to regularly check these indicators:
- general condition of the patient;
- blood pressure and pulse;
- the state of the abdomen, including symptoms of peritoneal irritation (the most common and informative is the Shchetkin-Blumberg symptom).
The only possible treatment in this situation is relaparotomy, that is, re-opening the abdominal wall, determining the source of bleeding and stopping it surgically.
Infiltrate and abscess: treatment
How to treat the most common complications after appendectomy?
Treatment of infiltrate begins with novocaine blockade. Antibiotics are also prescribed, cold in the place of this formation. In addition, the surgeon, together with the physiotherapist, can prescribe a number of procedures, for example, UHF. If you apply all of these therapeutic measures on time, recovery is expected in a few days.
If drug treatment does not help, the patient's condition worsens, and signs of an abscess appear, it is necessary to consult a surgical procedure.
If the abscess is not deep, but subcutaneous, it is necessary to remove the sutures, expand the edges of the wound and remove pus. Next, the wound is filled with tampons moistened with a solution of chloramine or furatsilina. If the abscess is deeper in the abdominal cavity, which often occurs when the abscess is recognized a week after the operation, it is necessary to perform a repeated laparotomy and remove suppuration. After the operation, daily dressings should be done with cleansing the wound with a solution of hydrogen peroxide, after the formation of granulation on the wound, dressings with ointments are used that contribute to speedy healing.
Usually these complications do not leave any trace, however, with a strong stratification of the muscles, the formation of hernias is possible.
After appendectomy, women may develop infiltration of the Douglas space, which is a depression between the uterus and the rectum. The approach to the treatment of this complication is the same as with the infiltration of another localization. However, here you can add the implementation of procedures such as warm enemas with furatsilin and novocaine, douching.
Complications from other organs and systems
In the recovery period after surgery, not only complications in the postoperative wound can occur, but also pathologies of other organs.
So, in the spring, the appearance of bronchitis and pneumonia is quite common. The main preventive method is therapeutic gymnastics. It should be started as soon as possible after surgery. It is necessary to prevent the patient’s passive lying in bed, as this contributes to the occurrence of congestion in the respiratory tract. The patient should bend and unbend his legs, turn from side to side, perform breathing exercises. To control the regularity and correctness of the exercises in the hospital, there must be a methodologist. If not, exercise control falls on the nurse of the department.
If pulmonary complications nevertheless developed, antibiotic therapy is prescribed, expectorant and sputum-thinning agents (mucolytics).
One of the complications after laparoscopy of appendicitis is acute urinary retention. Its cause can be both the reflex effect on the nerve plexuses from the side of the surgical wound, and the elementary inability of the patient to go to the toilet while lying down. Although surgeons are regularly interested in the patient's urination, some patients are embarrassed to talk about such a problem. In such cases, the surgeon can observe tension and bloating in the suprapubic region, the patient develops pains in the lower abdomen.
After catheterization and removal of the contents of the bladder, all complaints disappear, the patient's condition improves. However, before resorting to catheterization, simpler methods can be used. Sometimes, even after the patient is placed on his feet, an act of urination occurs. It is also possible to use heating pads on the lower abdomen, diuretics.
Postoperative complications in children
Unfortunately, at this time, a high percentage of complications after appendectomy in children under three years of age is determined - from 10 to 30%. This is due to the more severe course of the disease and the frequent development of destructive forms of appendicitis.
Among the complications after appendicitis in children, the following pathological conditions most often occur:
- infiltrate and abscess;
- postoperative bowel obstruction due to the formation of adhesions;
- intestinal fistula;
- protracted course of peritonitis.
Unfortunately, children more often than adults experience a fatal outcome after surgery.
And although complications after appendicitis are increasingly less common in our time, it is important to know their symptoms to prevent dangerous consequences.