Temperature after gangrenous appendicitis. Purulent peritonitis - symptoms and signs

At the penultimate stage of inflammation of the cecal appendage, gangrenous appendicitis develops. The condition is characterized by the death of the wall of the intestinal appendage with pronounced symptoms and certain features of the course in children and women. The consequences of the disease are extremely dangerous. This includes perforation of the wall, outpouring of pus into the peritoneum. If left untreated, death occurs. Therapy is carried out in a complex - surgically with medication, diet and folk recipes.

Gangrenous appendicitis simultaneously causes necrosis of intestinal tissue.

What does it represent?

Gangrenous appendicitis is accompanied by death (necrosis) of the tissues of the inflamed appendix of the cecum. A clear clinical picture develops, making it possible to distinguish the pathology from other inflammations of the appendix. Necrosis is usually local without affecting the entire surface of the organ. Gangrene is classified as a secondary acute process that occurs on the 2-3rd day of development of the pathology in the absence of medical care. The primary type develops in old people against the background of appendix infarction. The condition is caused by a violation of the blood supply to the organ, followed by tissue death.

If no measures are taken, the acute gangrenous form of inflammation of the appendix appears on the 2-3rd day, and in especially severe cases - after 7-12 hours.

Reasons for appearance

People with the following disorders are primarily at risk for developing gangrenous inflammation of the appendix:

• weakness of the walls of blood vessels (mainly in old people);
• the formation of cholesterol deposits on the walls of intestinal arterial vessels;
• abnormalities in the development of arteries (congenital underdevelopment, which is typical for childhood);
• thrombosis of the arteries and veins of the cecum.

Gangrene may worsen if:

• weakness of the body due to infection;
• increased activity of immune cells;
• problems with blood vessels;
• disruption of the outflow of the contents of the appendix;
• improper treatment of acute appendicitis.

Symptoms and features

The clinical picture of secondary gangrenous inflammation of the appendix is ​​manifested by symptoms:

• indomitable, repeated vomiting without relief;
• symptom complex of “toxic scissors”: temperature 36.6°C with tachycardia up to 100-120 beats/min;
• body temperature remains within normal limits, less often - reduced;
• mild general condition of the patient against the background of severe poisoning of the body with products of tissue decay;
• dry tongue coated with a whitish or yellowish coating of the root.

Primary gangrenous appendicitis is characterized by other symptoms, such as:

• Cutting pain on the right in the iliac zone is an acute stage of infarction of the appendage. The sensations are sudden, quickly subside due to the destruction of nerve endings;
• Tension, pain in the abdomen, even to the point of irritated abdominal muscles;
• Serious condition;
• Body intoxication syndrome with fever and chills.

Features of inflammation in women

Along with the general signs of gangrene, women develop special symptoms:

Appendicitis in women manifests itself with different symptoms due to the peculiarities of physiology.

• Shilovets' symptom, expressed by severe pain when lying on the back. The sensations intensify on the right iliac zone. When changing position to the left side, the pain moves lower.
• Promptov's sign, which manifests itself when palpating the cervix through the vagina - when grasped, the organ vibrates. The absence of pain indicates the development of inflammation of the appendix.
• Zhendrinsky clinic, defined by the absence of pain when pressing a point 2 cm below the navel.

Features of the painless stage of gangrenous appendicitis are mild, diffuse pain, a soft, palpable abdomen, no signs of peritoneal irritation, and normal temperature.

Features of symptoms in children

Diagnosis of primary or secondary gangrene of appendicitis based on the clinical picture in children is difficult. The clinic is blurry, but the development of gangrene of the cecal appendage is extensive. You can suspect appendicitis in children based on the following symptoms:

• increased frequency of bowel movements;
• weakness and lethargy;
• pain when pressing on the stomach;
• restless sleep;
• refusal to eat;
• muscle tension on the right iliac region.

Features of the child's behavior:

• restlessness;
• crying for no reason;
• the desire to press the legs to the stomach for a long time.

Perforation of appendicitis

Gangrenous-perforated appendicitis is the final stage of inflammation of the appendix, following gangrene. The danger of the condition is perforation of the walls of the appendage with the spilling of its contents into the surrounding space of the peritoneum. During a rupture of the wall of the inflamed organ, the patient develops severe pain in the anterolateral peritoneum on the right. Over time, the feeling intensifies and spreads throughout the abdomen.

Along with the pain, repeated, debilitating vomiting appears due to progressive poisoning of the body. The patient has fever, tachycardia, and a dry tongue coated with a brown coating. Gangrene with perforation of appendicitis is characterized by a swollen, tense abdomen with a complete absence of intestinal motility and stool. As a result, there is a risk of developing purulent inflammation of the peritoneum (peritonitis). But more often the process ends with a local purulent abscess.

Examination methods

The following methods are used for diagnosis:

• clinical tests of biofluids (blood, urine);
• physical examination with palpation of the abdomen;
• Ultrasound, CT - to obtain data on the general condition and shape of the diseased organ;
• radiography - to visualize the structure of the process;
• diagnostic laparoscopy is a mini-operation that allows you to simultaneously diagnose (by the thickening, greenish-black tint of the process of dead tissue) pathology and operate on the patient.

Detection of gangrene of the vermiform appendage is complicated due to blurred symptoms against the background of the death of nerve endings along with the tissues of the organ. The absence of pain makes patients think that the disease is receding.

Therapeutic operation

Any form of appendicitis can be treated surgically. The operation to remove the inflamed appendage is called an appendectomy. The following techniques are used:

• Classic with opening of the peritoneum. The diseased organ is removed and sent for analysis. When contents are poured into the cavity, the cavity is washed and drainage is installed.
• Transluminal with excision of the appendage through natural openings in the human body with flexible instruments.
• Laparoscopic with insertion of an instrument into small incisions on the abdominal wall.

Rehabilitation

Light exercises in the form of therapeutic and breathing exercises, massage, medications, diet, and folk remedies are prescribed individually and strictly according to the doctor’s indications. Rules for proper recovery after surgery to remove the appendix with gangrene:

• monitoring the patient's condition;
• carrying out detoxification;
• tracking physiological recovery.

Inflammation occurring in the appendix is ​​called appendicitis. As the disease develops, it goes through several stages from mild, correctable with drug treatment, to complex. Gangrenous appendicitis is a type of lesion of the appendix and the penultimate stage of the disease, dangerous in that it often leads to the death of a person.

In this situation, the use of surgery is not a salvation. As a result of the surgeon's actions, a violation of the integrity of the appendix may occur. The appendage bursts and the pus contained inside ends up on the abdominal organs. Peritonitis develops sharply and tissue necrosis occurs.

This stage of appendicitis does not occur immediately, but 2-3 days after the first signs of the disease appear. During this period, signs of phlegmonous-gangrenous changes in the tissues of the organ appear. Lack of therapy leads to deterioration of the patient's condition and the development of complications. The inflamed organ changes, the outer walls collapse and die. During the operation, the smell of rot comes from the wound. The appearance of the process has characteristic features of the last stage:

• Significant increase in size;
• The color of the appendix has changed to a dirty green hue;
• Areas of blood are observed;
• Tissue necrosis is visible;
• Sources of pus leakage.

The danger of acute damage to the appendix is ​​that it affects internal organs located close to the appendix. In particular, inflammation affects organs located in the abdominal cavity. If medical assistance is not received, gangrenous appendicitis turns into a gangrenous-perforated disease, the wall of the organ becomes perforated, and pus leaks out.

Gangrene of the appendix often develops due to the lack of adequate treatment on the third day. Fulminant development (6-12 hours) of the penultimate stage of appendicitis is extremely rare. It can also be observed in young children, when the immune system is not fully formed and cannot resist the inflammatory process.

Causes leading to the occurrence of the disease:

• Patient age and vascular system. With age, pathological changes occur in the vessels, contributing to a decrease in the quality of supply of oxygen and nutrients to the appendix, and the outflow of venous blood also worsens. Often the development of a primary gangrenous type of disease occurs.
• The appearance of cholesterol plaques in the arteries passing through the intestinal tract (atherosclerosis) leads to an insufficient amount of blood flowing to the intestinal tissues.
• In childhood, gangrene of the appendix can be caused by incomplete development of the vessels passing through the appendix. Hypoplasia in a child is a congenital disease.

• The development of thrombotic disease in the veins and arteries that supply and drain blood in the cecum.

Insufficient blood supply leads to oxygen starvation of organ tissues, they begin to die. The rapid onset of the penultimate stage may be associated with infection or the occurrence of autoimmune processes in the lumen of the intestinal tract.

Symptoms

Acute appendicitis in the gangrenous stage will be characterized by a special clinical picture. The perforated type of the disease increases the intoxication of the body, more and more decay products are released into the blood (the tissue dies and releases toxins). The following symptoms appear:

• Loss of appetite and inability to appreciate the appearance of food.
• The patient is constantly shivering.
• Body temperature increases, the thermometer shows 39 degrees. It is worth noting that this does not always happen.
• State of nausea and vomiting.
• The patient's stool is disturbed. Periods of constipation may be followed by periods of diarrhea.
• In the oral cavity, a white, yellow or brown coating appears on the tongue. The color change is noticeable near the root.
• More gases are produced in the intestines, and the stomach becomes hard.
• The patient feels weakness throughout the body and loss of strength.
• Dry mouth.
• The pulse quickens and reaches 120 beats in one minute.
• Young patients exhibit lethargy, moodiness, and tearfulness.

There comes a period when the patient feels that he is better, but this is only temporary relief, which is a false indicator of recovery. This means that along with the tissues of the appendix, the nerve endings responsible for pain also die.

Perforated disease

The dying tissue leaves behind small holes in the walls of the appendix. Medicine has identified this phenomenon as a separate and dangerous type of gangrenous appendicitis, requiring certain treatment methods, surgery and further care in the period after surgery.

A perforated appendix is ​​painful. When tissue rupture occurs, the patient experiences intense pain on the right side. At first, the pain manifests itself in attacks, but gradually becomes chronic and radiates throughout the entire area of ​​the abdomen.

Consequences

Lack of medical care in the event of gangrene of the appendix leads to a significant deterioration of the patient’s condition and the development of complications:

• Pylephlebitis develops inside. This means that the purulent inflammatory process provokes the formation of blood clots in the portal vein.
• The appearance of purulent sources in the peritoneal cavity. As a rule, the abscess is located between the intestines, in the area of ​​the diaphragm and small pelvis.
• An infiltrate consisting of tissue begins to form around the appendix. Its formation prevents the spread of inflammation to other internal organs.

The most dangerous complication is the gangrenous form of peritonitis. This means that the walls of the appendix have ruptured. This development of the disease is fraught with blood poisoning. Surgeons try to prevent the onset of this stage, since the survival rate of patients is low.

Period after surgery

The chosen method of appendectomy and the severity of the disease determine the duration of the postoperative period. On the first day after gangrenous appendicitis and its removal, a nurse cares for the patient. It does the following:

• Observes the patient and records the appearance of symptoms of internal bleeding.
• Measures temperature, thereby monitoring the condition of the operated patient.
• Periodically inspects the seam site.
• Conducts a survey of the patient about sensations and appetite. Monitors the frequency of bowel movements.

The postoperative period of patients with removed gangrenous appendicitis has some features and will be different:

• The patient is prescribed drugs that have a strong antibacterial effect: Cephalosporin, Amikacin, Ornidazole, Levofloxacin.
• The patient is prescribed analgesics. These medications are taken as needed.
• To support the body, various solutions are administered intravenously: saline, glucose, albumin, rheosorbilact, fresh frozen plasma.
• Preventive measures are taken to prevent the formation of blood clots in blood vessels. Prevention is aimed against the occurrence of ulcers of the stomach and intestines due to stress. The operated patient wears elastic bandages on his legs and is injected with anticoagulant agents. Medicines are taken that reduce the production of bile secretions: Omez and Kvamatel.
• A blood test is taken every day.

• Dressing the wound. The dressings are changed daily, the wound is washed, and the drainage system is disinfected. At the same time, an assessment of healing and the appearance of purulent discharge occurs.
• Undergoing therapeutic procedures: exercise therapy, breathing exercises, massage. The duration and number of procedures are determined according to the patient's condition. The sooner a person activates all body functions, the faster and more successful the recovery process will be.

Compliance with dietary nutrition in the postoperative period is a factor in speedy recovery:

1. For the first 24 hours after an appendectomy, you should not eat, only drink. The water must be clean, mineral, without gas. You can also consume weak sweet tea, compote, and low-fat kefir. You can eat pureed low-fat soup or chicken broth. There is a little, but often.
2. Second 24 hours. Add puree and pureed lean meat. They add to the menu: casserole with cottage cheese, boiled sausages, porridge cooked in water.
3. In the following days, diet No. 5 is prescribed. Exclude spicy, smoked, marinades, and pickles from the diet. Eat little, but often.

Complications

Carrying out surgery before perforation of the appendix walls occurs reduces the risk of complications. In this case, an infection occurs at the suture site and pus appears. Treatment of these complications does not require repeated surgery.

When a patient is on the surgical table with purulent peritonitis, the following consequences are possible:

• Not only pus, but also fecal matter gets into the abdominal cavity.
• The appendix is ​​separated from the body of the cecum.
• Multiple formation of small purulent wounds in the pelvis, in the area of ​​the diaphragm.
• The appearance of infiltration. This factor becomes an obstacle to surgery. Only after the formation has resolved can appendicitis be removed.
• Peritonitis with purulent formations.

Appendicitis is a disease characterized by inflammation of the appendix of the cecum. The disease manifests itself in various types, one of them is gangrenous appendicitis. The gangrenous form of acute appendicitis is characterized by tissue necrosis. The signs of appendicitis gangrene are noticeably different from other symptoms, so it is important to pay attention to your health status, promptly consult with medical specialists and strictly follow their instructions for treatment and nutrition in the postoperative period. The consequences of gangrenous appendicitis are very difficult to cure: perforation of the organ wall and release of purulent and feces into the abdominal cavity can occur.

Inflammation occurs through several stages of development. It can develop into phlegmonous, gangrenous or gangrenous-perforated appendicitis. The appearance of these types of diseases occurs due to the following reasons:

• Appendicitis was not noticed within one day and tissue necrosis began.
• The formation of the disease in adulthood and old age. Vascular changes that occur in older people can cause accelerated development of the disease.
• Poor circulation in the intestines.
• Thrombotic plaques in the blood vessels that penetrate the appendix.
• Atherosclerosis of intestinal vessels.
• The appearance of infection in the area where the disease occurs.
• Excessive activity of immune cells.
• Disturbances in the outflow of the contents of the appendix, stagnation of exudate.

Symptoms

The following signs indicate the appearance of a gangrenous type of appendicitis:

1. The disease is characterized by necrosis and death of nerve endings, so the intensity of pain can be significantly reduced compared to ordinary appendicitis.

2. In the acute stage of the disease, the main symptom will be uncontrollable vomiting, which does not bring relief.

3. The tongue is dry, sometimes with a brown coating.

4. Various symptoms of intoxication of the body are possible - nausea, lethargy, cold sweat.

5. Despite the appearance of the inflammatory process, body temperature will remain within normal limits.

6. Pathologically rapid heartbeat ("toxic scissors" syndrome).

8. Pain, if it appears, is located in the right iliac zone.

Treatment methods

Treatment of gangrenous disease involves abdominal surgery to remove the inflamed area (appendectomy). Surgical intervention is performed in two ways:

1. Traditional - the appendage is removed by a surgeon through an incision in the abdominal wall. The operation is performed under general anesthesia.

2. Laparoscopy - instruments to remove a gangrenous appendix are placed directly into the abdominal cavity through several microscopic punctures. One such instrument is a small camera located at the end of a microtube. During surgical procedures, the doctor sees the image transmitted by the camera on the monitor screen, which helps to carry out the operation as accurately as possible.

Postoperative period

Therapeutic manipulations for a speedy recovery of a patient who has undergone appendectomy for a disease in gangrenous form will be as follows:

1. Prescription of strong, targeted antibiotic therapy, administered under the strict supervision of a medical specialist. Most often, the doctor prescribes drugs from the Cephalosporin, Macrolide or Levomycytin group.

2. Relief of pain with the help of narcotic and non-narcotic analgesics, which are administered to the patient intramuscularly.

3. Conducting detoxification therapy using physiological infusion solutions (sodium and potassium chloride, glucose, plasma, albumin).

4. Prevention of the formation of blood clots in the operated areas of blood vessels (wearing elastic bandages and stockings, anticoagulant pharmaceuticals) and the occurrence of diseases of the gastrointestinal tract (enzymatic agents, blockers of increased secretion of hydrochloric acid).

5. Compliance with a special diet, a special diet.

6. Daily blood test.

7. Dressings are performed every day, with complete disinfection of wounds, drainages, and the use of only sterile dressings. Junior medical staff daily assesses mechanical damage and the stage of wound healing. Prevention of purulent complications is carried out.

8. Prescribing simple exercises and a complex of physical therapy as the patient recovers. Breathing exercises and walking.

Diet

When recovering from an appendectomy, problems with peristalsis and digestive activity in the gastrointestinal tract may occur. If the consequence of the disease is inflammation in the abdominal cavity, then this further aggravates the painful condition. The surgical procedure is more difficult and heals more difficult than with ordinary appendicitis. Of course, this is also reflected in the characteristics of postoperative nutrition. Diet is an important point of treatment:

1. On the first day, it is advisable for the patient to even fast a little. He is allowed to drink warm water without sugar and gas, weak tea, weak meat broth without adding salt. It is better to take water or food 6-7 times a day, in small teaspoonfuls. It is necessary to carefully monitor the condition after each meal.

2. Second day. If no unpleasant symptoms or complications appear, you can supplement liquid nutrition with pureed dietary meat, light vegetable or fruit puree from non-allergenic products. It is acceptable to give the patient some sugar-free yogurt, low-fat cottage cheese or dried fruits soaked in water. In cases of deterioration of the patient's condition, the diet is left at the same liquid, fresh stage.

3. On the third day, the intestines are usually actively restored, digestive and excretory processes begin. In this case, the menu can be significantly expanded; the list of food products will include small pieces of butter, mashed jam, fermented milk products and puree soups.

In the process of drawing up a menu for the patient, it is necessary to remember that the food taken in the first week after the operation should be without salt and spices. Compliance with the diet and nutrition regimen agreed with the doctor is mandatory, as they are fundamental factors in the success of treatment and the speed of recovery.

Possible complications

Inflammation of the appendix in the gangrenous form and gangrenous-perforated appendicitis are very dangerous due to their consequences, such as:

• purulent abscesses in the pelvic area;
• separation of the appendix from the cecum;
• the formation of a dense infiltrate around gangrenous appendicitis. The appearance of such a neoplasm requires long-term treatment. Only after the infiltrate disappears can you begin to remove the inflamed appendix;
• purulent and purulent-fecal inflammation of the peritoneum. If help is not prompt, peritonitis sometimes leads to death;
• entry of the abscess into the bloodstream.

Any complication of phlegmonous gangrenous appendicitis is very difficult in the body and can cause significant damage to health, so in no case should you take the disease lightly and allow it to develop. When the first symptoms of appendicitis occur, an urgent visit to a specialist is required.

When pain occurs in the lower abdomen on the right, the first thing that comes to mind is appendicitis. Inflammation of the appendix is ​​a very common situation; the problem can occur in both children and adults, and at the same time it is extremely dangerous. Delayed medical attention can lead to widespread infection and death. There are several varieties of this inflammatory process, one of the most unfavorable is gangrenous appendicitis.

What is gangrenous appendicitis

The gangrenous form of inflammation of the appendix of the cecum implies necrotic processes in the tissues of the appendix, which are irreversible. Often, death occurs only in some part of the organ, but sometimes it affects it completely. In the vast majority of cases, the gangrenous process is one of the stages of acute appendicitis, which develops after a couple of days if the patient does not seek help. In old age, this process can be an independent disease.

Gangrenous appendicitis is a common occurrence in children and adults.

If a patient with gangrenous appendicitis does not receive correct medical care, then the process becomes more complicated, turning into a gangrenous-perforating form - perforations form on the walls of the appendix.

At risk are older people due to specific age-related changes in their body and those patients who ignore the symptoms of developing appendicitis. In childhood, the process is most dangerous, since in case of infection it will spread extremely quickly throughout the body.

Causes

As already mentioned, gangrenous inflammation is a consequence of the development of a purulent form of appendicitis, thus, the main cause of the disease is a prolonged inflammatory process. Usually, it takes two days for the disease to develop into this form, but some factors can have a negative impact and significantly speed up this process:

• infectious infection;
• autoimmune diseases;
• disruption of the normal outflow of the contents of the appendage of the cecum.

However, there are also situations where the inflammatory-necrotic process is primary, and factors such as:

• old age, when the blood supply system to organs is disrupted due to damage to the walls of blood vessels;
• arterial atherosclerosis (the presence of cholesterol plaques on the walls of blood vessels);
• thrombosis of the blood vessels supplying the appendix;
• congenital form of arterial hypoplasia (narrowing of the lumen) - in this case, appendicitis will most likely manifest itself in childhood.

When blood flow is disrupted, a so-called appendix infarction occurs, which is the impetus for the development of necrotic processes.

Symptoms

The main feature of gangrenous appendicitis, which is the result of an acute purulent form, is the presence of specific symptoms that are not typical for other forms of the disease. Thus, due to the necrotic process, the nerve endings also die off - at first the patient feels a decrease in painful sensations, and some do not feel any significant pain at all. Other symptoms may also occur:

• frequent and profuse vomiting, which does not alleviate the condition;
• manifestations of intoxication of the body - severe weakness, but body temperature can be either absolutely normal or even reduced;
• the surface of the tongue is covered with a yellowish or whitish coating, the main density of the layer of which is concentrated at the root;
• “toxic scissors” syndrome - against the background of a serious condition and normal temperature, there is pronounced tachycardia, the heart rate can be twice as high as normal.

Doctor's note: the problem has no symptomatic features depending on age and gender, but if the disease occurs in a child, the manifestations will increase catastrophically quickly, and the time to provide assistance will be significantly less than with gangrenous appendicitis in an adult.

If appendicitis occurs as a primary disease, then it is characterized by other manifestations. In such a situation, the pain is pronounced and sharp, but episodic. The serious condition is characterized by an increase in temperature, and the abdomen is tense and painful.

It is especially worth noting the specific symptoms of gangrenous-perforated appendicitis:

• when a wall rupture forms, the patient experiences a sharp pain that does not stop and gradually spreads throughout the entire abdominal region;
• the temperature rises significantly;
• heart rate increases;
• the surface of the tongue becomes dry, the coating becomes brown;
• vomiting becomes continuous;
• the stomach is swollen, intestinal peristalsis completely disappears;
• no stool;
• tension gradually spreads throughout the abdominal cavity.

Diagnostic measures

Diagnosis of gangrenous appendicitis as a secondary disease is considered difficult due to atypical symptomatic manifestations: pain is practically absent, as is temperature, the abdomen is soft. Such indicators often force doctors to determine that there is no reason for hospitalization, however, at the slightest suspicion, it is still necessary to undergo a series of studies. Diagnostic methods for gangrenous and perforated appendicitis:

• the first stage is palpation. In the absence of painful sensations, the specialist must examine the muscles extremely carefully and very carefully - the slightest change in them should be the reason for further measures;
• computed tomography, ultrasound and x-ray;
• blood tests (signs of leukocytosis) and urine (appearance of protein in it).

Treatment methods

Regarding treatment methods, the patient has no choice - this is only surgery. The procedure is called appendectomy, involves removal of the appendix and can be performed by two methods: conventional resection or a less traumatic method - laparoscopy. The traditional option involves creating a small incision through which the appendix is ​​removed along with the cecum. The inflamed appendage is bandaged in the area of ​​connection with the intestine, after which it is cut off and sutures are applied. If there has been an organ rupture, the abdominal cavity is washed with antiseptic solutions and dried with tampons, after which a drainage system is installed.

During laparoscopy, the appendage is cut off without bringing the organs out, that is, a special device with a camera is inserted into the abdominal cavity through several small holes, thanks to which all procedures are performed by the doctor inside the body. The operation in any case involves general anesthesia.

Postoperative period

The recovery period after surgical treatment of gangrenous appendicitis has its own characteristics compared to other forms of the disease. Thus, it is necessary to take such measures as:

• active antibacterial therapy using drugs such as Levofloxacin or Cephalosporin;
• introduction of detoxifying compounds into the bloodstream (glucose, albumin, refortan, etc.);
• Blood tests are carried out daily;
• They also carry out dressings daily - changing the bandage with washing the wound and drainage;
• taking painkillers;
• prevention of complications depending on the condition of the patient’s body (anticoagulants, proton pump blockers may be prescribed to reduce the level of gastric juice secretion, etc.).

Expert opinion: it is believed that the patient simply needs early activation after surgery, so the patient is prescribed breathing exercises, physical therapy and massage procedures.

A very important element of correct recovery after surgery is diet, since after the gangrenous form of appendicitis, the functioning of the digestive system is much more damaged than in other forms.

Nutrition after surgery - table

Day after surgery	Patient nutrition
First	A minimal diet and the patient’s appetite usually corresponds to this. Still water, sweet tea, uzvar, pureed potato soup and well-cooked cereals, weak chicken broth or low-fat kefir are allowed. It is better to divide your meals into 5 meals, and eat about 7 spoons or sips at one time.
Second	If the recovery period proceeds normally, you can supplement the diet with liquid mashed potatoes, chopped dietary meat, liquid porridge with a small amount of butter. If complications are observed, then the diet is kept similar to the first day.
Third	Usually on the third day the intestines begin to function normally, and the first bowel movement occurs after surgery. The diet can be expanded; it should be based on general rules for excluding harmful foods, the list of which is given below.
Next week	Unleavened foods that must be prepared in liquid or pureed form to ease the burden on the digestive system. You can eat vegetable and chicken broths; zucchini, potatoes, carrots, and beets will be useful. A small amount of rice won't hurt. It is recommended to add fresh greens to your food to improve digestion. It is also worth drinking liquid in large quantities, this can be self-prepared sweet juices, compotes, tea. Fresh and natural fermented milk products are necessary during recovery.

During the recovery period, you should avoid products such as:

• spices;
• legumes;
• tomatoes;
• minimize, or better yet, stop eating salt altogether for at least a couple of weeks;
• smoked meats, fatty meats and fish;
• sausages;
• sauces – ketchup and mayonnaise;
• carbonated drinks.

Prohibited products after surgery in the photo

Possible complications and consequences

Lack of immediate medical care for gangrenous and gangrenous-perforating type of disease can lead to extremely life-threatening consequences, such as:

• the formation of purulent abscesses in different pelvic cavities;
• purulent peritonitis is a large-scale inflammatory process in the peritoneum, which without urgent medical intervention leads to sepsis and death of the patient;
• thrombophlebitis of the septic type - inflammation of the walls of the veins with the formation of thrombotic formations.

How appendicitis develops - video

Gangrenous appendicitis is one of the most complex forms of inflammation of the appendix, with a high risk of death. At the first suspicion of the development of a problem, you should consult a doctor, because the only way to treat the disease is surgical intervention and strict rules during the recovery period.