Repeated surgery after removal of appendicitis. Appendicitis

Developing acute appendicitis almost always requires emergency surgical intervention, during which the inflamed appendix is ​​removed. Surgeons resort to surgery even if the diagnosis is in doubt. This treatment is explained by the fact that complications acute appendicitis Sometimes they are so serious that they can lead to death. Operation - appendectomy reduces the risk of some of the dangerous consequences of appendicitis to a person.

When complications may occur with appendicitis

Acute inflammation of the appendix in humans occurs in several stages. First, catarrhal changes occur in the walls of the processes, usually lasting for 48 hours. At this time, there are almost never serious complications. After the catarrhal stage, destructive changes follow; appendicitis from catarrhal can become phlegmonous, and then gangrenous. This stage lasts from two to five days. During this time, purulent melting of the walls of the appendix occurs and a number of dangerous complications may develop, such as perforation followed by peritonitis, infiltration and a number of other pathologies. If there is no surgical treatment during this period, then other complications of appendicitis arise, which can cause death. IN late period appendicitis, which occurs on the fifth day from the onset of inflammation of the appendix, diffuse peritonitis develops, and an appendicular abscess and pylephlebitis are often detected.

Possible various complications and after surgery. The causes of postoperative complications are associated with untimely operation, late diagnosis of acute appendicitis, and surgeon errors. More often pathological disorders after surgery develop in older people with a history of chronic diseases. Some complications may also be caused by patients’ failure to comply with doctor’s recommendations in the postoperative period.

Thus, complications in patients with acute appendicitis can be divided into two groups. These are those that develop in the preoperative period and those that develop after surgery. Treatment of complications depends on their type, the patient’s condition and always requires a very careful attitude of the surgeon.

Complications of appendicitis in the preoperative period

The development of complications before surgery in most cases is associated with untimely application person in medical institution. Less commonly, pathological changes in the appendix itself and the structures surrounding it develop as a result of incorrectly selected tactics for the management and treatment of the patient by the doctor. The most dangerous complications that develop before surgery include diffuse peritonitis and appendiceal infiltrate. inflammation of the portal vein - pylephlebitis, abscess in different parts abdominal cavity.

Appendiceal infiltrate

Appendiceal infiltration occurs due to the spread developing inflammation on the organs and tissues located next to the appendix, these are the omentum, loops of the small intestine and cecum. As a result of inflammation, all these structures are welded together, and an infiltrate is formed, which is a dense formation with moderate pain in the lower, right part of the abdomen. This complication usually occurs 3-4 days after the onset of the attack; its main symptoms depend on the stage of development. On early stage the infiltrate is similar in characteristics to destructive forms of appendicitis. that is, the patient has pain, symptoms of intoxication, signs of peritoneal irritation. After the early stage comes the late stage, it is manifested by moderate pain, slight leukocytosis, and an increase in temperature to 37-38 degrees. On palpation, a dense tumor is determined in the lower abdomen, not very painful.

If the patient has an appendiceal infiltrate, then appendectomy is postponed. This approach to treatment is explained by the fact that when removing the inflamed appendix, the intestinal loops, omentum, and mesentery soldered to it may be damaged. And this, in turn, leads to the development of life-threatening postoperative complications for the patient. Appendiceal infiltration is treated in hospital conservative methods, these include:

• Antibacterial drugs. Antibiotics are necessary to eliminate inflammation.
• Using cold helps limit the spread of inflammation.
• Painkillers or bilateral blockade with novocaine.
• Anticoagulants are drugs that thin the blood and prevent the formation of blood clots.
• Physiotherapy with a resolving effect.

Throughout treatment, patients must adhere to strict bed rest and diet. It is recommended to consume less foods with coarse fiber.

Appendiceal infiltration may further manifest itself in different ways. If its course is favorable, it will resolve within a month and a half; if unfavorable, it will fester and be complicated by an abscess. In this case, the patient exhibits the following symptoms:

• Increase in body temperature to 38 degrees or above.
• Increasing symptoms of intoxication.
• Tachycardia, chills.
• The infiltrate becomes painful on palpation of the abdomen.

The abscess can break into the abdominal cavity with the development of peritonitis. In almost 80% of cases, the appendiceal infiltrate resolves under the influence of therapy, and then planned removal of the appendix is ​​indicated after about two months. It also happens that the infiltrate is detected even when surgery is performed for acute appendicitis. In this case, the appendix is ​​not removed, but drained and the wound is sutured.

Abscess

Appendiceal abscesses arise due to suppuration of an already formed infiltrate or when limited pathological process with peritonitis. In the latter case, the abscess most often occurs after surgery. A preoperative abscess forms approximately 10 days after the onset inflammatory reaction in the appendix. Without treatment, the abscess may rupture and release purulent contents into the abdominal cavity. The following symptoms indicate the opening of an abscess:

• Rapid deterioration in general health.
• Feverish syndrome – fever, periodic chills.
• Signs of intoxication.
• Increase in leukocytes in the blood.

An appendicular abscess can be found in the right iliac fossa, between intestinal loops, retroperitoneally, in the pouch of Douglas (rectovesical recess), in the subphrenic space. If the abscess is located in the pouch of Douglas, then common features Symptoms such as painful, frequent stools, irradiation of pain into the rectum and perineum are added. To clarify the diagnosis, rectal and vaginal examinations are also carried out in women, as a result of which an abscess can be detected - an infiltrate with beginning softening.

Abscess is treated surgically, it is opened, drained and antibiotics are subsequently used.

Perforation

On the 3-4th day from the onset of inflammation in the appendix, its destructive forms develop, leading to melting of the walls or perforation. As a result, purulent contents, along with a huge amount of bacteria, enter the abdominal cavity and peritonitis develops. Symptoms of this complication include:

• Spread of pain throughout all parts of the abdomen.
• Temperature rises to 39 degrees.
• Tachycardia over 120 beats per minute.
• External signs are sharpening of facial features, sallow skin tone, anxiety.
• Retention of gases and stool.

Palpation reveals swelling, the Shchetkin-Blumberg symptom is positive in all parts. In case of peritonitis, emergency surgery is indicated; before surgery, the patient is prepared by administering antibacterial agents and antishock drugs.

Postoperative complications in patients with acute appendicitis

Postoperative complicated appendicitis leads to the development of pathologies from the wound and internal organs. It is customary to divide complications after surgery into several groups, these include:

• Complications identified from the sutured wound. These are hematoma, infiltration, suppuration, divergence of wound edges, bleeding, fistula.
• Acute inflammatory reactions in the abdominal cavity. Most often these are infiltrates and abscesses formed in different parts abdominal cavity. Also, after surgery, local or general peritonitis may develop.
• Complications affecting the gastrointestinal tract. Appendectomy can lead to intestinal obstruction, bleeding, and the formation of fistulas in different parts of the intestine.
• Complications from the heart, blood vessels and respiratory system. IN postoperative period Some patients experience thrombophlebitis, pylephlebitis, embolism pulmonary artery, pneumonia, abscesses in the lungs.
• Complications from the urinary system - acute cystitis and nephritis, urinary retention.

Most complications of the postoperative period are prevented by following the doctor's recommendations. For example, intestinal obstruction can occur due to non-compliance with the diet and under the influence of insufficient physical activity. Thrombophlebitis is prevented by using compression garments before and after surgery, administration of anticoagulants.

Complications of acute appendicitis from the wound are considered the most common, but also the safest. The development of pathology is judged by the appearance of compaction in the wound area, an increase in general and local temperature, and the release of pus from the suture. Treatment consists of re-treating the wound, introducing drainage, and using antibiotics.

The most severe complications after surgery include pylephlebitis and intestinal fistulas.

Pylephlebitis

Pylephlebitis is one of the most severe complications of acute appendicitis. With pylephlebitis purulent process from the vermiform appendix it spreads to the portal vein of the liver and its branches, resulting in the formation of numerous abscesses in the organ. The disease develops rapidly; it may be a consequence of untreated acute appendicitis. But in most patients it is a complication of appendectomy. Symptoms of the disease can appear either 3-4 days after surgery or after a month and a half. The most obvious signs of pylephlebitis include:

• A sharp jump in body temperature, chills.
• The pulse is frequent and weak.
• Pain in the right hypochondrium. They can radiate to the scapula and lower back.
• Enlarged liver and spleen.
• The skin is pale, the face is haggard and jaundiced.

With pylephlebitis there is a very high mortality rate; rarely the patient can be saved. The outcome depends on how quickly this complication is detected and the operation is performed. During surgery, abscesses are opened, drained, and antibiotics and anticoagulants are administered.

Intestinal fistulas

Intestinal fistulas in patients with appendectomy occur for several reasons. This is most often:

• Inflammation spreading to the intestinal loops and their destruction.
• Failure to comply with the surgical technique.
• Bedsores that develop under the pressure of tight tampons and drains used during surgery.

The development of intestinal fistulas can be judged by increased pain in the right iliac region about a week after removal of the inflamed appendix. Signs of intestinal obstruction may be observed. If the wound is not completely sutured, then intestinal contents are released through the suture. Patients suffer much more severely from the formation of a fistula when the wound is sutured - the contents of the intestine penetrate into the abdominal cavity, where it develops purulent inflammation. The resulting fistulas are eliminated surgically.

Complicated appendicitis requires careful diagnosis, identification pathological changes And quick treatment. Sometimes the patient’s life depends only on timely emergency surgery. Experienced surgeons can already assume the risk of complications after appendectomy based on the patient’s age and history of chronic diseases, such as for example diabetes. Undesirable changes often occur in patients prone to obesity. All these factors are taken into account both in the preoperative and postoperative periods.

Minimize possible quantity complications are only possible through timely appeal to the doctor. Early surgery prevents the most serious complications and shortens recovery period.

http://appendicit.net

Complications of appendicitis vary depending on the time that has passed since the onset of the disease. The early period (the first two days) is characterized by the absence of complications; the process usually does not extend beyond the process, although altered forms and even perforation may be observed, especially often in children and the elderly.

After operation

The most common complications after appendicitis are from the wound. It may develop an inflammatory infiltrate or suppuration in the subcutaneous tissue. With inflammation of the cecum, an intestinal fistula is formed as a result of cutting sutures or necrosis of the wall.

The postoperative period may be complicated by diffuse peritonitis, retroperitoneal phlegmon, periappendicular, subhepatic, interintestinal, subphrenic abscess, pyelophlebitis, sepsis, pulmonary embolism. These complications are observed during late surgery for destructive appendicitis.

A severe complication of appendicitis is pylephlebitis - purulent inflammation of the portal vein with the formation of small metastatic abscesses in the liver.

Acute

• Appendicular infiltrate. If the operation is not performed on time, then around the 3rd day, due to inflammation, the appendix sticks together with the surrounding intestinal loops, and together they turn into a dense conglomerate. In this case, the person is bothered by slight pain and an increase in body temperature to 37⁰C. Over time, the infiltrate resolves or turns into an abscess. The patient is prescribed bed rest, diet, cold on the stomach, and antibiotics. Operations are not performed for infiltration.
• Abscess in the abdominal cavity. It is a cavity filled with pus, which is formed due to the melting of the infiltrate. Worried severe pain, heat body, lethargy, weakness, bad feeling. Surgical treatment: the abscess must be opened.
• Peritonitis. This serious condition, caused by the entry of pus from the appendix into the stomach. In the absence of adequate treatment, the patient may die. An emergency operation is performed and antibiotics are prescribed.
• Pylephlebitis. This is very rare and extremely dangerous complication acute appendicitis. Pus enters the veins, causing their walls to become inflamed and blood clots to form. Treatment involves the use of powerful antibiotics.

After removal

If the operation to remove acute appendicitis was performed incorrectly or malfunctions occurred on the part of the body during the healing period, a number of postoperative complications are possible:

• On the fifth to seventh day, compaction may appear in the area of ​​the sutures, body temperature rises to 37-38 degrees and higher. This may indicate the presence of purulent inflammation.
• Increased adhesion formation, which in turn can cause even more formidable complication– adhesive intestinal obstruction, which is manifested by nausea, vomiting, bloating, lack of gas and stool, cramping pain in the abdomen.
• The presence of an abdominal abscess is indicated by symptoms such as: an increase in temperature on the eighth - twelfth day to thirty-eight - forty degrees, the occurrence of abdominal pain, changes in blood tests, chills.
• The discharge of intestinal contents (liquid feces) from the wound indicates such a formidable complication as an intestinal fistula.
• One of the most severe complications after removal of acute appendicitis is purulent thrombophlebitis of the portal vein - pylephlebitis. It usually appears in the early stages, two to three days and up to two to three weeks after the operation. The development of complications occurs rapidly: the patient’s condition becomes serious due to pain in the right hypochondrium, tremendous chills, weakness, increased body temperature to thirty-nine - forty degrees, heavy sweating. Jaundice is noted skin and sclera, enlarged liver, spleen.

Unlike appendicitis, there is a disease that is very difficult to diagnose - severe pneumatosis intestinalis.

http://progastroenterology.ru

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 are infants (under 1 year of age).

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, poor chewing food.

In fact, this version is not confirmed by anything or anyone, but certain factors, which may still provoke inflammatory process V vermiform appendix cecum, doctors and scientists have identified:

1. Changes immune system that occurred without visible reasons. 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 of a general nature - 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. The localization of pain in appendicitis is the upper abdomen, closer to the navel, but in some cases the patient cannot indicate the exact concentration of pain. After acute attack 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 fragment of the appendix has died and the nerve endings simply do not respond to irritation. 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 - right hand 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 ( ultrasonography) abdominal organs;
   • electrocardiogram (ECG).

Please 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 case of an acute attack, emergency surgery is indicated when the diagnosis is confirmed using the syndromes described above. detailed information about the causes, signs of acute appendicitis, as well as treatment methods - in the 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 - no therapeutic measures should be taken. 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 the patient’s emotional background 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.

Please note: if you experience symptoms of inflammation of the appendix of the cecum (or similar signs of appendicitis), you should immediately seek help from a doctor. 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, the 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 dairy products.

note. in the first 2 days after surgery, the diet can only include chicken broths, still water with lemon, and weak tea. From day 3 you can gradually introduce permitted foods. You can return to the normal menu 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.

A surgeon talks about proper nutrition after appendicitis removal:

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 through the peritoneum;
• pylephlebitis of purulent type – inflammation of a large liver vessel (portal vein) develops.

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 from diseased tonsils (with 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.

http://okeydoc.ru

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 are infants (under 1 year of age).

We recommend reading:

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 of a general nature - 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 impossible to prevent the development of acute inflammation.

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. The localization of pain in appendicitis is the upper abdomen, closer to the navel, but in some cases the patient cannot indicate the exact concentration of pain. After an acute attack of pain, the syndrome “moves” to the right side of the abdomen - this is considered a very characteristic sign of 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 fragment of the appendix has died and the nerve endings simply do not respond to irritation. 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 sharply 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 the initial stage of development of inflammation in the appendix of the cecum.

In case of an acute attack, emergency surgery is indicated when the diagnosis is confirmed using the syndromes described above. 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 - no therapeutic measures should be taken. 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 varicose veins were previously diagnosed, the patient should bandage the lower limbs with an elastic bandage. Please note: if there is a risk of thromboembolism, heparin drugs must be administered before surgery.
3. If the patient’s emotional background 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 should end two hours before surgery. 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 (or similar signs of appendicitis) occur, you should immediately seek help from a doctor. 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, the 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 lemon, and weak tea. From day 3 you can gradually introduce permitted foods. You can return to the normal menu only 10 days after removal of the inflamed appendix of the cecum. To maintain immunity in the postoperative period, you need to take vitamin complexes, as well as preparations containing iron and folic acid.

A surgeon talks about proper nutrition after appendicitis removal:

Possible complications and consequences of appendicitis

The most serious complication of 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 through the peritoneum;
• pylephlebitis of purulent type – inflammation of a large liver vessel (portal vein) develops.

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 have been cases when inflammation of the appendix of the cecum began due to the penetration of pathogenic microorganisms from diseased tonsils (with decompensated tonsillitis).
3. Detection and treatment of helminthic infestations.

Appendicitis is considered not a dangerous disease - even the probability of 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.

Appendectomy is a common surgery. Compliance with recovery rules is an important component of a speedy recovery. How do stress affect the body after appendicitis? What to do to reduce the risk of complications to zero?

The appendix is ​​an organ that is not filled with any tissue (hollow), has the appearance of a vermiform appendix, and can reach from 7 to 11 cm in length.
Appendicitis is inflammation of the appendix.
Appendectomy is an operation to remove appendicitis.
The absence of an appendix in a person is not critical. For our ancestors, the organ played an important role - it helped in the digestion of roughage, but today it is considered rudimentary, i.e. having lost their original function in the process of evolution.
But it is not completely useless; it performs an immune function (it acts as a barrier when bacteria enter the body, as their storage facility).
The appendix contains lymphatic tissue, so the organ performs protective functions. There is no need to delete without reason, because... surgery can significantly weaken the immune system and lead to hormonal imbalance.

What complications can occur after appendicitis removal?

Acute pain in the lower part of the right side, fever, and abnormal bowel movements are reasons to immediately consult a doctor. Removal of appendicitis is carried out using 2 methods:

• Laparotomy (the abdominal wall is cut to access internal organs, long period of rehabilitation, visible stitches);
• Laparoscopy (allows you to shorten the postoperative period after removal of appendicitis, the operation is performed through holes up to 1.5 cm in the abdominal wall. The sutures heal faster and do not leave a cosmetic defect).

The following complications may arise when presenting late: medical care, non-compliance with the rules of recovery after surgery or unprofessional assistance provided:

1. Peritonitis.
2. Bleeding.
3. Hyperthermia.
4. Adhesive disease.
5. Suppuration or suture dehiscence.
6. The threads may not take root.
7. Blood poisoning.
8. Development of chronic appendicitis (in case of untreated acute).

Proper recovery is the path to a speedy recovery

Surgery and anesthesia cause stress and hormonal disbalance body, which is displayed on digestive system and the general well-being of the patient, after an appendectomy it is necessary to follow several rules, then the rehabilitation will go faster.

Nutrition

Because after removal of appendicitis, the integrity of the intestinal walls is compromised, the patient needs a temporary refusal to eat or a strict diet in compliance with the proportions. Thirst may occur after surgery; the patient is allowed to drink warm sweet tea or water, but not large quantities so as not to induce vomiting.
12 hours after surgery, you can include easily digestible foods in your diet:

• thin porridge (preferably rice);
• vegetable or chicken broth;
• vegetable puree (potato, pumpkin, squash, etc.);
• low-fat dairy products;
• jelly, compote;
• non-acidic fruits.

It is necessary to gradually include new foods in the diet, because... The body needs nutritious food for a quick recovery.
The food temperature should not be high or low.
It is forbidden to eat in large quantities, it is necessary frequent meals, but in small portions.
In the first week it is not recommended to consume: flour products, citrus fruit, spicy, smoked, pickles, legumes, alcohol, coffee, sparkling water, fatty foods.
The restrictions are tolerable and the diet after recovery will be beneficial.

Physical exercise

Recovery after appendicitis removal may take longer, because... After the operation, the patient's immunity is weakened. The patient feels a loss of strength, so it is important to remain in bed for at least a day. Low physical mobility is allowed on the second day after surgery. On the third day, you are allowed to get out of bed; before, it is not recommended, because... the load on the fragile abdominal cavity can provoke complications.
Over the next month and a half, muscle fusion processes will take place in the body. Therefore, doctors categorically prohibit sudden movements and heavy lifting. Physical exercise should be moderate - to maintain tone, i.e. walking, physiotherapy, doctors also recommend wearing a bandage so as not to provoke the formation of adhesions or hernia.
Favorable conditions for rehabilitation after appendicitis removal will help the body cope with the postoperative period faster. And prevention in the form of balanced and rational nutrition, timely treatment inflammatory processes in the body will help not provoke inflammation of the appendix.

Is bleeding. More often, bleeding is observed from the stump of the mesentery of the process, which occurs as a result of insufficiently strong ligation of the vessel feeding the process. Bleeding from this small-diameter vessel can quickly lead to massive blood loss. Often the picture internal bleeding is detected in the patient while still on the operating table.

No matter how insignificant bleeding into the abdominal cavity may seem, it requires urgent surgical intervention. You should never hope to stop bleeding on your own. It is necessary to immediately remove all stitches from the surgical wound, if necessary, widen it, find the bleeding vessel and bandage it. If the bleeding has already stopped and the bleeding vessel cannot be detected, you need to grab the stump of the mesentery of the appendix with a hemostatic clamp and re-bandage it at the very root with a strong ligature. Blood that has spilled into the abdominal cavity must always be removed, since it is a breeding ground for microbes and thus can contribute to the development of peritonitis.

Vessels can also be a source of bleeding abdominal wall. When opening the rectus sheath, the inferior epigastric artery may be damaged. This damage may not be immediately noticeable, since when the wound is opened with hooks, the artery is compressed and does not bleed. After surgery, blood can infiltrate the tissues of the abdominal wall and enter the abdominal cavity between the peritoneal sutures.

It is understandable that in some patients the bleeding may stop on its own. All existing hemodynamic disturbances gradually subside. However, the skin and visible mucous membranes remain pale, the hemoglobin content and the number of red blood cells in the blood are significantly reduced. When examining the abdomen, painful phenomena may not exceed normal postoperative sensations; for percussion determination, the amount of liquid blood must be significant.

In some patients, blood spilled into the abdominal cavity can be absorbed without a trace. Then only the presence of anemia and the appearance of jaundice as a result of the resorption of extensive hemorrhage make it possible to correctly assess the existing phenomena. However, such a favorable outcome even with minor hemorrhage is observed quite rarely. If the blood accumulated in the abdominal cavity becomes infected, peritonitis develops, which is usually limited in nature.

With more significant hemorrhage, in the absence of its delimitation and with delayed intervention, the outcome may be unfavorable.

As a complication in the postoperative course, the formation of infiltrate in the thickness of the abdominal wall should be noted. Such infiltrates, if they occur without a pronounced inflammatory reaction, are usually the result of soaking subcutaneous tissue blood (with insufficiently thorough hemostasis during surgery) or serous fluid. If such an infiltrate is not large, then it will resolve in the coming days under the influence of thermal procedures. If, in addition to infiltration, there is ripple along the suture line, indicating an accumulation of fluid between the edges of the wound, you need to remove the fluid using a puncture or pass a button probe between the edges of the wound. The last method is more effective.

If the formation of infiltrate occurs with a temperature reaction and an increase in pain in the wound, suppuration should be assumed. In order to promptly diagnose this complication, every patient whose temperature does not decrease during the first two days after surgery, and even more so if it increases, must be bandaged to control the wound. The sooner 2-3 stitches are removed to drain the pus, the more favorable the course will be. In case of severe infection of the abdominal wall, the wound must be opened wide and drained, removing all sutures from the skin, from the aponeurosis and from the muscles, if there is an accumulation of pus under them. Subsequently, wound healing occurs by secondary intention.

Sometimes after the wound heals, ligature fistulas form. They are characterized by small size, purulent discharge and the growth of granulation tissue around the fistula opening. After removing the ligature using anatomical tweezers or a crochet hook, the fistulas heal. It’s even better to use a large fish hook bent over a flame, the tip of which is bent so that a second barb is formed.

In patients, especially with a severe process in the appendix and cecum, operated on in the presence of peritonitis, an intestinal fistula may form after surgery. Fistulas can form when damage from the base of the process extends to the adjacent part of the cecum. If this is detected during surgery, then the affected area of ​​the intestine is immersed with sutures, closing it over the required length with the unchanged part of the wall of the cecum. If, when removing the appendix, the lesion of the intestinal wall remains undetected, with further progression of the process, perforation may occur, which will lead to the release of feces into the free abdominal cavity or into its area limited by adhesions or tampons.

In addition, the cause of the development of intestinal fistulas may be either damage to the intestine during surgery, or a bedsore as a result of long-term pressure drainages and tampons, or injury to the intestinal wall due to insufficiently delicate manipulations during dressing of wounds in which intestinal loops lie open. It is unacceptable to remove pus from the surface of the intestines with gauze balls and tampons, since this can very easily cause severe damage to the intestinal wall and its perforation.

In the formation of fistulas, a certain role can also be played. toxic effect some antibiotics, such as tetracyclines, which can lead to severe damage to the intestinal wall, including complete necrosis of the mucous membrane. The above applies to both the large and small intestines.

The formation of an intestinal fistula with a tightly sutured abdominal wound leads to the development of peritonitis, requiring immediate intervention, consisting of wide opening of the wound and placing drainage and delimiting tampons to the fistula. Attempts to sew up an existing hole are justified only at the earliest possible date. If the abdominal cavity was already drained before the formation of the fistula, diffuse peritonitis may not occur due to the formation of adhesions around the tampons. With a favorable course, peritoneal phenomena are increasingly limited and gradually subside completely. The wound is filled with granulations surrounding the fistula, through which intestinal contents are released.

Fistulas small intestine, transverse colon and sigmoid, the wall of which can be flush with the skin, usually labiform and require surgical closure. Fistulas of the cecum, as a rule, are tubular and can close on their own with careful washing of the fistula tract with an indifferent liquid. Surgical closure of the fistula is indicated only if it is unsuccessful conservative treatment within 6-7 months.

Long-term non-healing tubular fistulas of the cecum should suggest the presence of foreign body, tuberculosis or cancer, since removal of the appendix in these diseases can lead to the formation of fistulas.

Postoperative peritonitis may develop gradually. Patients do not always complain about increased pain, considering it a self-evident phenomenon after surgery. However, the pain continues to intensify; in the right iliac region, upon palpation, increasingly sharp pain, muscle tension and other symptoms characteristic of peritoneal irritation are noted. The pulse quickens and the tongue begins to dry out. Sometimes the first and initially seemingly only sign of peritonitis may be vomiting or regurgitation, sometimes - increasing intestinal paresis. The abdomen gradually begins to swell, gases do not pass away, peristaltic sounds are not heard, and in the future the picture develops in exactly the same way as with appendiceal peritonitis in non-operated patients. In some patients, at first there is only an increase in heart rate that does not correspond to the temperature.

Signs of peritonitis may gradually appear during the first days after surgery, increasing very slowly. But sometimes they appear quickly, and in the next few hours a picture of diffuse peritonitis develops. The development of postoperative peritonitis is always an indication for urgent relaparotomy and elimination of the source of infection. The last one is either the stump of the process, which opened due to the failure of the sutures, or the perforation hole in the intestinal wall. If the intervention is performed early, it is possible to close the stump or perforation hole with sutures. IN late dates this fails due to the fact that the sutures placed on the inflamed tissues are cut, then we have to limit ourselves to supplying drainage and tampons.

When no local cause is identified, we have to consider the development of peritonitis as the result of progression of the diffuse inflammation of the peritoneum that existed before the first operation and proceed in the same way as was described in the section on the treatment of peritonitis that developed before the operation.

For peritonitis that develops after surgery, the source of infection should be in the area former operation. Therefore, relaparotomy must be performed by removing all sutures from the surgical wound and opening it wide. If the source of infection is located elsewhere and the development of peritonitis is not associated with the operation, but is caused by some other disease, the choice of access should be determined by the localization of the painful focus. Antibiotic therapy and other measures to combat peritonitis should be more active.

With postoperative peritonitis, as well as with peritonitis that developed before surgery, the formation of limited abscesses may be observed in the abdominal cavity. Most often, the accumulation of pus occurs in the pouch of Douglas. The formation of such an abscess is usually accompanied by a temperature reaction and other general manifestations septic in nature. Symptoms characteristic of this complication are frequent urge to bowel movements, loose, loose stools with a large admixture of mucus, tenesmus and gaping anus, which is due to the involvement of the rectal wall in the inflammatory process and infiltration of the sphincters. When examining the rectum, a finger marks the varying degrees pronounced protrusion of the anterior wall, where a clear swell is often detected.

It should be remembered that such phenomena of irritation of the rectum can develop very late, when the abscess has already reached a significant size. Therefore, if the course of the postoperative period is not smooth, it is necessary to systematically perform a digital examination of the rectum, bearing in mind that Douglas abscess is the most common of all severe intra-abdominal complications observed after surgery for appendicitis. It is opened through the rectum or (in women) through the vagina, emptying the purulent accumulation through the posterior fornix.

The formation of abscesses in other parts of the abdominal cavity is less common. At first, interintestinal abscesses can manifest themselves only as increasing septic phenomena. Sometimes it is possible to detect an infiltrate in the abdomen if the abscess is parietal. If it is not adjacent to the abdominal wall, then it can be palpated only when intestinal bloating and abdominal muscle tension decrease. Abscesses must be opened with an incision appropriate to its location.

Subphrenic abscesses after appendectomy are extremely rare. The subphrenic abscess should be opened extraperitoneally. To do this, when the abscess is located in posterior section The patient's subdiaphragmatic space is placed on a cushion, as for kidney surgery. The incision is made along the XII rib, which is resected without damaging the pleura. The latter is carefully pushed upward. Next, parallel to the course of the ribs, all tissues are dissected to the preperitoneal tissue. Gradually separating it together with the peritoneum from the lower surface of the diaphragm, they penetrate with their hand between the posterolateral surface of the liver and the diaphragm into the subphrenic space and, moving their fingers to the level of the abscess, open it, breaking through the diaphragmatic peritoneum, which does not offer much resistance. Purulent cavity drained with a rubber tube.

Pylephlebitis (thrombophlebitis of the branches of the portal vein) is a very severe septic complication. Pylephlebitis is manifested by chills with an increase in body temperature to 40-41 ° C and with sharp drops, heavy sweat, vomiting, and sometimes diarrhea. Characteristic is the appearance of jaundice, which is less pronounced and appears later than jaundice with cholangitis. When examining the abdomen, mild peritoneal phenomena and some tension in the abdominal wall muscles are noted. The liver is enlarged and painful.

When treating pylephlebitis, first of all, it is necessary to take all measures to eliminate the source of infection - emptying possible accumulations of pus in the abdominal cavity and retroperitoneal space, ensuring good outflow through extensive drainage. Vigorous treatment with antibiotics. When abscesses form in the liver, open them.

One more thing should be noted rare complication postoperative period - acute obstruction intestines. Except dynamic obstruction intestines as a result of their paresis during peritonitis.

In addition, in the coming days after appendectomy, mechanical obstruction may develop as a result of compression of the intestinal loops in the inflammatory infiltrate, bending them with adhesions, pinching them with cords formed during fusion with each other abdominal organs etc. Obstruction can develop soon after surgery, when inflammation in the abdominal cavity has not yet subsided, or at a later date, when it already seemed that complete recovery had occurred.

Clinically, the development of obstruction is manifested by all its characteristic symptoms. The diagnosis of this complication can be very difficult, especially when the obstruction develops early, in the first days after surgery. Then the existing phenomena are regarded as the result of postoperative intestinal paresis, and correct diagnosis Because of this, it may be delayed. In later stages, obstruction develops more typically. Sudden Appearance"among full health» cramping pain in the abdomen, local bloating, vomiting and other signs of intestinal obstruction greatly facilitate diagnosis.

If conservative measures are ineffective, treatment of mechanical obstruction should be surgical.

In case of obstructive obstruction caused by bending of the intestines as a result of their contraction by adhesions, or when they are compressed in the infiltrate, the adhesions are separated if this is easily feasible. If this is difficult and if it is associated with injury to inflamed and easily vulnerable intestinal loops, a bypass interintestinal anastomosis is performed or limited to the position of the fistula.

After an appendectomy, other complications, generally characteristic of the postoperative period, can sometimes develop, both from respiratory organs, and from other organs and systems. This especially applies to elderly patients.

Long-term results of surgical treatment of acute appendicitis in the vast majority of patients are good. Rarely observed poor results are mostly due to the presence of some other disease that the patient had before the attack of appendicitis or that arose after the operation. Much less often bad condition patients is explained by the development of postoperative adhesions in the abdominal cavity.

The appendectomy operation is considered easy and harmless for the patient and the surgeon. Maybe! But how many cases of peritonitis or late complications after a successful intervention.
And most often this happens through the fault of the patient. Appendectomy is a wide-ranging intervention on. And behavior after surgery also affects the healing process, as does the skill of the surgeon.

Surgery to remove the appendix is ​​considered a non-hazardous procedure.

The rehabilitation period after appendectomy is 2 months. Young patients who led a healthy and active lifestyle before the intervention recover faster. It is more difficult for children and overweight people to recover.

On the first day after the intervention, only drinking regime. No solid foods. Non-carbonated is allowed mineral water or low-fat kefir.

On the second day you should start eating. This will allow you to quickly restore intestinal motility. Meals are fractional, in small portions - from 5 to 6 times a day. What to bring to the patient for lunch:

1. liquid porridge;
2. vegetable purees from non-fermentable vegetables;
3. fruit purees;
4. fermented milk products except sour cream;
5. pureed meat;
6. compotes.

On the fourth day, the diet expands. You can add dried bread, gradually introduce solid foods, herbs, baked apples, meat and fish. Fermented milk products in any form and quantity are indicated to normalize the microflora.

Subsequently, the patient returns to his usual routine. But any changes in diet should be agreed with your doctor.

Drinks allowed include rosehip decoction without restrictions, juices, weak tea, still mineral water and herbal infusions.

It is important to adhere to the standard drinking regime.

What should you exclude from your diet?

After appendix removal, alcohol is strictly prohibited.

This diet is aimed at reducing the risk of rupture of internal sutures and post-operative bleeding in rehabilitation period. Prohibited for consumption following products and drinks:

• alcohol in any form. Use of alcohol-containing medicines should be agreed with your doctor;
• reduce the amount of salt consumed, do not use seasonings and spices;
• , peas, other legumes;
• exclude certain types of vegetables - tomatoes, raw green and onions, cabbage in any form, hot peppers;
• smoked meats and semi-finished products;
• conservation;
• strong coffee;
• carbonated sweet and mineral waters;
• grape juice and wine.

This video will tell you how to eat properly after appendicitis removal:

Water procedures

Surgery, blood, a surge of adrenaline, vomiting and the patient realizes that after the operation he smells unpleasant. Nose water treatments will have to wait.

Until the stitches are removed, bathing and showering are prohibited. It is allowed to wipe the body with water, wash your face, and wash your feet.

After the stitches and bandage are removed, the restrictions are removed, but you should not rush to the bath or sauna. Doctors recommend short-term bathing in the shower.

The suture area should not be rubbed or massaged. It is not advisable to use while swimming, as they dry out the skin.

After bathing, the suture area is treated with antiseptics prescribed by the attending physician.

Seam and care

After removing the appendix, you need to monitor the condition of the suture.

The patient sees only the outer seam on the skin. But fabrics are cut and sewn in layers, so internal seams require the same attention as external ones.

For several days or weeks, the patient will experience pain and a feeling of tissue tension.

This is fine. But there are a number of conditions in which pain is a symptom of a complication. Pathological conditions surgical suture:

1. hyperemia, swelling;
2. bloating and swelling appeared;
3. the seam began to get wet;
4. discharge of pus, blood from the suture;
5. pain in the suture area lasting more than 10 days after the intervention;
6. pain in the lower abdomen of any location.

Why do complications develop in the area of ​​the surgical suture? The reasons are varied and their occurrence equally depends on behavior and medical personnel, and the patient:

• wound infection during surgery and during the rehabilitation period;
• violation of the rules for caring for surgical sutures;
• abdominal tension – heavy lifting, not using a postoperative bandage;
• impaired immunity;
• elevated .

Although pain in the suture area after appendectomy is normal, any discomfort not worth it. Self-medication is prohibited and in case of any unpleasant phenomena you should contact a medical facility.

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