Appendicitis

Appendicitis is an acute inflammation of the appendix, usually manifested by abdominal pain, anorexia and abdominal pain.

The diagnosis is established clinically, often supplemented by CT or ultrasound.

Treatment of appendicitis consists in surgical removal of the appendage.

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Causes of the appendicitis

It is believed that appendicitis develops due to obturation of the lumen of the appendage, usually as a result of hyperplasia of the lymphoid tissue, but sometimes with calculous stones, a foreign body or even helminths. Obturation leads to an expansion of the process, rapid development of infection, ischemia and inflammation.

In the absence of treatment, necrosis, gangrene and perforation occur. If the perforation is covered with an epiploon, an appendicular abscess is formed.

In the United States, acute appendicitis is the most common cause of acute abdominal pain requiring surgical treatment.

At certain times, more than 5% of the population develops appendicitis. This disease is the most common in adolescents and 20-year-old young people, but can develop at any age.

Other causes that affect the process include carcinoid, cancer, villous adenoma and diverticulum. The outgrowth may also be involved with Crohn's disease or ulcerative colitis with pancolitis.

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Symptoms of the appendicitis

The classic symptoms of acute appendicitis are pain in the epigastric or periumbilic area, accompanied by short-term nausea, vomiting and anorexia; After a few hours, the pain moves to the right lower quadrant of the abdomen. Pain is worse when coughing and moving.

Classical signs of appendicitis are localized directly in the right lower quadrant of the abdomen and at the point McBurney (point located outside 1/3 of the line connecting the navel and the anterior tip of the ilium), where pain is manifested when there is a sudden decrease in pressure during palpation (eg, a symptom Shchetkin-Blumberg).

Additional symptoms include pain that appears in the right lower quadrant when the left lower quadrant is palpated (sign of the roving), pain intensification with passive flexion in the right hip joint, in which the iliopsoas muscle contraction (psaas symptom) occurs, or the pain that occurs when passive internal rotation of the bent hip (obturator symptom). Usually subfebrile body temperature is observed [rectal temperature 37.7-38.3 ° C (100-101 ° F)].

Unfortunately, these classic signs are observed in just over 50% of patients. There are different variants of symptoms and signs.

Pain with appendicitis may not be localized, especially in infants and children. Soreness can be diffuse or, in rare cases, absent. The chair is usually rare or absent; In the case of diarrhea, the retrocecal location of the process should be suspected. Urine may contain red blood cells or leukocytes. Atypical symptomatology is common in elderly patients and pregnant women; in particular, pain and local soreness may be unexpressed.

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Diagnostics of the appendicitis

In the case of the presence of classical symptoms and signs, the diagnosis is established clinically. In such patients, delayed laparotomy due to additional instrumental studies only increases the likelihood of perforation and subsequent complications. In patients with atypical or questionable data, instrumental studies should be performed without delay.

CT with contrast enhancement has reasonable accuracy in the diagnosis of appendicitis and can also verify other causes of an acute abdomen. Ultrasound with dosed compression can usually be performed more quickly than CT, but the study is sometimes limited by the presence of gas in the intestine and less informative in differential diagnosis of the causes of non-painful pain. The use of these studies reduced the percentage of negative laparotomy.

Laparoscopy can be used for diagnosis; the study is particularly useful in women with unexplained pain of unclear etiology in the lower abdomen. Laboratory studies usually indicate leukocytosis (12,000-15,000 / μl), but these data are highly variable; the content of leukocytes should not serve as a criterion for the exclusion of appendicitis.

[21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33]

Treatment of the appendicitis

Treatment of acute appendicitis consists in the removal of the inflamed vermiform appendage; since lethality increases with delayed treatment, 10% of negative appendectomy is considered quite acceptable. The surgeon usually removes the outgrowth, even if it is perforated. Sometimes it is difficult to determine the location of the appendage: in these cases, the process usually lies behind the blind or ileum, as well as the mesentery of the right flank of the large intestine.

Contraindication to the removal of the process are inflammatory bowel diseases involving the cecum. However, in cases of terminal ileitis with an unchanged cecum, the process must be removed.

Removal of the process should be preceded by intravenous administration of antibiotics. Preferably - the third generation cephalosporins. With uncomplicated appendicitis, further use of antibiotics is not required. If perforation has occurred, antibiotic therapy should be continued until the patient's body temperature and leukocyte formula normalize (approximately 5 days). If surgical operation is not possible, antibiotics, although not a method of treatment, significantly improve survival. Without surgical treatment or antibiotic therapy, lethality reaches more than 50%.

In case of detection of a large inflammatory volumetric education with involvement of the appendix in the process, the distal part of the ileum and cecum, resection of the entire formation and ileostomy is preferable.

In neglected cases in which a pericolic abscess has already formed, the latter is drained by a tube transdermally under the supervision of an ultrasound or an open operation (followed by a delayed removal of the shoot). Meckel's diverticulum is removed in parallel with the removal of the process, but only if the inflammation around the process does not interfere with this procedure.

Forecast

With a timely surgical intervention, lethality is less than 1%, and recovery usually comes quickly and definitively. With complications (perforation and development of abscess or peritonitis), the prognosis is worse: repeated operations and prolonged recovery are possible.

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