In accessible language about the complications of acute appendicitis. Rehabilitation and recovery after appendicitis surgery

Removal of appendicitis has long been recognized as one of the safest and easiest operations, which can be easily tolerated by both adults and children. However, errors cannot be ruled out here either: during the surgical intervention itself and in the postoperative period. That’s why it’s so important to know all the rules and stages of treatment. acute appendicitis after surgery - this will help to avoid complications and return to normal routine as quickly as possible.

Treatment after surgery to cut out appendicitis (appendectomy) does not have a specific time frame - it is individual for each patient. How many days does recovery after an appendectomy last on average? Usually this is one and a half to four weeks; for children under 10 years of age, the elderly and obese people, the time increases. Young and slender patients return to their usual rhythm of life much faster.

If no complications arise in the first 3-7 days after excision of the appendix, the patient is discharged, explaining the basic rules for further behavior. It is on their strict adherence that it depends on how many days a person will be able to live a normal pre-operative life.

Every day you need to walk short distances in the fresh air.
You can go to the pool and play sports only when a scar has formed after appendix removal (up to 2-6 months).
Lifting weights is prohibited for the first 2.5-3 months after appendicitis is removed.
Overweight patients and active sports people are recommended to wear a bandage for 3-7 days after surgery, and for several more months during any physical activity.
Sexual activity is allowed 2 weeks after surgery.

The first day after appendectomy

In the first 48 hours after surgery, patients are not given any special treatment - the main emphasis is on restorative measures: physical therapy, diet, and, if necessary, painkillers.

A standard operation to cut out the appendix takes 30-40 minutes, then the patient is transferred to the ward. How many days later can I go home? Official sick leave after an appendectomy usually does not exceed 2 weeks; after 3-4 days of hospitalization, the patient can be released for outpatient treatment.

The most important 24 hours in the rehabilitation process are immediately after an appendectomy. Surgical removal of the appendix is performed mainly under general anesthesia, and in the first hours after the operation it is especially important to ensure the right way out from anesthesia. The biggest health hazard during this period is vomiting. To prevent vomit from entering the respiratory tract and causing pneumonia or suffocation, the patient should be placed on the right side at the first urge.

For 12-24 hours after waking up, any food or drinking plenty of fluids. If there are no contraindications, you can give boiled, still mineral water or weak tea with sugar every 20-30 minutes - 2-3 teaspoons at a time.

Restrictions and prohibitions in the postoperative period

For the first 24 hours after surgery, patients must strictly adhere to strict bed rest. After how many hours can you move and walk? For 8-12 hours you need to lie motionless in bed, then you can sit up and turn around, after 24 hours you can get up and slowly move along the corridors (in consultation with the doctor!).

Eating is allowed every other day, provided that the patient does not experience vomiting. For the first 8 days, it is important to follow a strict postoperative diet, then you can gradually return to your usual diet.

Increased physical activity is strictly prohibited for several days, but physical inactivity is also very dangerous - it can provoke constipation, muscle atrophy, congestion in the lungs, and disturbances in blood and lymph flow. The ideal solution is special therapeutic exercises after acute appendicitis.

Sutures after appendectomy are removed on the 4-8th day, but only a couple of months after operational impact you can swim and do athletics (running, dancing, jumping, etc.). When 3-6 months have passed and the scar is fully formed, heavy physical activity is allowed.

Therapeutic exercises after appendicitis

Set of exercises physical therapy(physical therapy) after acute appendicitis is recommended for patients of all ages - it is an excellent prevention of congestion, intestinal paresis, thrombophlebitis, pneumonia and intestinal adhesions. How many days does a physical therapy course last? It is necessary to do gymnastics after appendectomy for the first 3-4 days after the operation, while the patient is on bed rest, then in consultation with the attending physician.

All exercises are performed from the starting position “lying on your back”, the number of approaches is 5-6 times.

Legs lie straight on the bed, arms along the body. Bend and unbend ankle joint both legs.
Legs straight, arms bent at the elbows. Bend and straighten your fingers into a fist.
Legs bent at the knees, place one hand on the chest, the other on the surgical suture. As you inhale, pull your stomach in, and as you exhale, push it out.
Legs straight, hands raised to shoulders. Alternately perform circular movements with the shoulder joint - forward and backward.
Legs lie straight, hands on shoulders. Bend your knees and straighten them, your heel should slide along the bed.
Legs are together, the left arm is extended along the body, the right arm lies on the stomach, on the surgical suture. As you inhale, raise your left arm up, and as you exhale, lower it.

The most important diet rules after appendix removal

Treatment after appendix removal primarily involves following a gentle diet. A special treatment menu will reduce the burden on a weakened body, restore and give strength, and also help prevent problems with stool and other complications.

To make recovery after acute appendicitis as easy as possible, it is important to follow the rules of the postoperative diet.

You need to eat fractionally: in modest portions 5-6 times a day. This will reduce the load on the intestines, and the patient simply will not have time to get hungry.
For the first 2-3 days after acute appendicitis, no solid food: only liquids, porridge, jelly and puree.
Food should not be ice cold or very hot - this irritates the already weakened intestines.
The basis of the menu is drinks, pureed and steamed food.

All patients are concerned with the question: after how many days can they again eat sweets, fried foods, salty foods, smoked foods and alcohol, and add their favorite spices to food? Doctors definitely recommend abstaining completely from junk food and drinks for 2-3 weeks, and then gradually introduce them into the diet - up to 2 months.

Features of the diet after acute appendicitis

How many days should it last therapeutic diet? It is necessary to return to a normal diet in stages: for the first day after surgery you will have to do without food at all. On the 2-3rd day, the basis of the hospital diet should be liquid porridge, chicken broth, pureed vegetable purees and jelly, rosehip infusion and rice infusion.

Then you can add bread, steamed chicken cutlets, light vegetable soups, steamed omelettes, low-fat sour milk, and fruit after 4-5 days to the menu.

The first three days after removal of the appendix, any solid food, milk, pea and bean soups, potatoes, grapes, fresh cabbage, products with increased content fiber.

For 2-3 weeks you will have to completely forget about alcohol, sausages, sweets and cakes, fatty and smoked foods. Any homemade preparations, marinades and canned goods will also have to be hidden away. It is necessary to give up strong tea, coffee and soda - they are replaced by still mineral water, weak tea, herbal infusions, jelly, fresh fruit and vegetable juices.

After 2-2.5 months, you can completely return to the pre-operative menu and favorite dishes.

Possible complications after surgery

Typically, an appendectomy is quick and without serious consequences for the patient, but there are exceptions. Complications, as a rule, arise after surgery with advanced appendicitis with peritonitis, non-compliance with rehabilitation rules in the first days and weak immunity at the patient.

Acute appendicitis can cause the following complications:
Wound infection – pus, formation of inflammatory infiltrate, abdominal wall abscess.
Large blood loss, resulting in interruptions in work cardiovascular system.
Peritonitis (inflammation of the peritoneum).
Intestinal adhesions and postoperative hernia.
Respiratory system disorders – bronchitis and pneumonia.
Constipation, bloating, gas and urinary retention.
Intestinal fistula is a hole in the intestinal wall through which its contents (bile, feces, undigested food) is thrown out.

Fever after appendectomy

An increase in temperature to 38º is very common occurrence after appendectomy. She might be natural reaction the body or signal possible complications - it all depends on how many days the temperature lasts.

The main causes of fever after acute appendix:

Infection due to non-compliance with sanitary rules.
Damage to internal organs during appendectomy and the development of inflammation.
A sharp decrease in immunity.
Severe blood loss.
Reaction to the installation of a drainage tube.

The norm is to preserve elevated temperature body up to 3 days; if the fever lasts longer and is accompanied by severe chills and increased sweating, additional treatment is prescribed.

A course of antibiotics (depending on the causative agent of the postoperative infection).
Antipyretic drugs (aspirin, paracetamol, etc.).
Anti-inflammatory drugs (ibuprofen, etc.).
In emergency cases, additional surgical intervention is required.

Treatment of complications

Serious complications after acute appendicitis occur in 5-10% of all cases and require serious comprehensive treatment. How many days after surgery do such dangerous consequences appear?

Suppuration of the wound, the appearance of infiltrate and abscess usually make themselves felt on the 3-4th day after removal of the appendix. The main symptoms are pain, fever, problems with bowel movements, noticeable swelling in the scar area). Treatment involves novocaine blockades, antibiotics, and physiotherapeutic procedures. If the outcome is favorable, the inflammatory process stops after 2-3 days.

For pulmonary and cardiovascular complications, therapeutic exercises, antibiotics, and inhalations are necessary. For intestinal fistulas, conservative treatment is also used; vacuum therapy is also effective.

The most dangerous consequence acute appendicitis is peritonitis. It occurs quite rarely and only when destructive forms diseases. The main symptom is persistent pain after surgery, followed by nausea and vomiting, dry mouth, gas and bloating, and constipation. There is only one treatment in such cases - repeated surgery.

Acute appendicitis is a fairly common disease. If you contact a surgeon in time and follow all medical recommendations in the postoperative period, the recovery process will go as quickly as possible. However, in advanced cases, the disease can cause complications, and how many days the recovery will last will depend only on the correct and complete treatment after surgery.

Rehabilitation after appendicitis lasts about two months, during which the patient must adhere to certain restrictions. Its duration depends on the general health of the patient, his age and the presence of complications before or after surgery.

The first days after appendectomy, bed rest is required

Young and middle-aged people who adhere to active image life. Children and overweight patients take longer to fully return to normal life.

First days after surgery

Upon completion, the patient is transported on a gurney to the ward, where he will be under close supervision of medical staff to monitor the process of recovery from anesthesia. In order to prevent suffocation if vomiting occurs, which may be caused by side effect narcotic drug, the patient is turned onto his healthy side. If there are no complications, then 8 hours after the operation the patient can sit up in bed and make careful movements. After appendicitis is removed, injectable painkillers are prescribed for several days, as well as antibiotics to prevent infectious complications.

If you follow all the doctor's recommendations, recovery after appendicitis surgery usually occurs without complications. The first day is the most difficult for the patient. The time spent in hospital, as a rule, does not exceed 10 days.

During this period the following is carried out:

daily monitoring of body temperature;
regular measurement of blood pressure levels;
control over the restoration of urination and defecation functions;
inspection and dressing of the postoperative suture;
monitoring the development of possible postoperative complications.

When removing appendicitis, the postoperative period, namely its duration, severity and the presence of complications, largely depends on the chosen surgical method (laparoscopy or abdominal surgery).

Nutrition after surgery

Rehabilitation after appendicitis includes following a certain diet for at least two weeks. On the first postoperative day you cannot eat; you are only allowed to drink plain and mineral water without gas or kefir with 0% fat content. On the second day, you need to start eating to restore the gastrointestinal tract. You should eat foods and feel a feeling of heaviness in the intestines. The diet should be fractional: it is recommended to eat food in small portions, divided into 5 or 6 meals.

Recommendation: In the postoperative period, consumption of low-fat fermented milk products is beneficial. They will contribute to the rapid normalization of the gastrointestinal tract and the restoration of intestinal microflora disturbed after the use of antibiotics.

Low-fat fermented milk products have positive influence on the gastrointestinal tract in the postoperative period

Products allowed for consumption during the postoperative period

For the first three days after surgery, you need to eat easily digestible food with a jelly-like or liquid consistency. The following products are allowed:

liquid porridge;
liquid purees from potatoes, carrots, zucchini or pumpkin;
rice water;
low-fat kefir or yogurt;
pureed boiled chicken meat;
chicken broth;
jelly and jelly.

On the fourth day, you can add black or bran bread, baked apples, pureed soups with dill and parsley, hard cereals, boiled meat and lean fish. With each subsequent day, it will be possible to further expand the list of products, gradually returning to the patient’s usual diet. The diet used should be in mandatory agreed with the attending physician. Despite some restrictions, a complete diet rich in vitamins and minerals is necessary, since during the rehabilitation period the body needs additional support.

Drinks allowed include rosehip decoction, freshly squeezed diluted juices, compotes, still mineral water, herbal or weak black tea. The amount of liquid consumed per day should total 1.5–2 liters.

Products prohibited for consumption during the postoperative period

When discharged from the hospital, for another 14 days of the postoperative period after removal of appendicitis, it is not allowed to consume foods that lead to irritation of the mucous membrane, the formation of gases and fermentation processes in the intestines. First of all, the purpose of such a diet is to prevent rupture internal seams and reducing the food load on the body. The following rules must be followed:

limit the amount of salt;
do not add spices and seasonings when cooking, as well as ketchup and mayonnaise;
exclude legumes from the diet;
give up rich bakery products;
avoid eating vegetables such as tomatoes, peppers, cabbage and raw onions;
completely eliminate smoked meats, sausages, fatty meats and fish.

During the postoperative period, it is also not allowed to drink carbonated drinks, juices from grapes and cabbage, and any drinks containing alcohol.

Physical activity in the postoperative period

During the rehabilitation process after appendectomy, it is necessary to adhere to certain restrictions on physical activity. This will speed up recovery and minimize the risk of possible complications. You are allowed to get out of bed and start walking three days after the operation. During the initial recovery period, it is recommended to use a support bandage, especially for overweight patients.

Tip: to prevent the sutures from coming apart, it is recommended to hold your stomach when making sudden movements such as sneezing, coughing, or laughing.

A sedentary lifestyle during the rehabilitation process is no less dangerous than high physical activity. It can cause the formation of adhesions, poor circulation, or the development of muscle atrophy. In this regard, almost immediately after the operation, in agreement with the doctor, in a supine position, it is recommended to perform a special complex of exercise therapy.

In the first two months, physical activity should be limited to daily walking and therapeutic exercises. During this period, it is prohibited to carry or lift weights weighing more than 3 kg. After 14 days after surgery, if there are no contraindications, you are allowed to resume sexual activity. When it heals completely postoperative scar, a visit to the pool is recommended.

You can learn more about nutrition rules after appendectomy from the video:

Developing acute appendicitis almost always requires emergency surgery, 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 of acute appendicitis are sometimes 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 during this period there is no surgical treatment, then other complications of appendicitis arise, which can cause death. In the late period of appendicitis, which occurs on the fifth day from the onset of inflammation of the appendix, diffuse peritonitis develops, and an appendiceal abscess and pylephlebitis are often detected.

Various complications are possible after surgery. The causes of postoperative complications are associated with untimely surgery, 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 very attentive attitude surgeon

Complications of appendicitis in the preoperative period

The development of complications before surgery in most cases is associated with a person’s untimely referral to medical institution. Less commonly, pathological changes in the appendix itself and the structures surrounding it develop as a result of incorrectly chosen tactics for the management and treatment of the patient by the doctor. The most dangerous complications that develop before surgery include diffuse peritonitis, appendicular infiltration, inflammation of the portal vein - pylephlebitis, abscess in the different departments 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. At an early stage, the infiltrate is similar in characteristics to destructive forms of appendicitis, that is, the patient has pain, symptoms of intoxication, and 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 a hospital using 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 the pathological process is limited by peritonitis. In the latter case, the abscess most often occurs after surgery. A preoperative abscess forms approximately 10 days after the onset of the 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 the general symptoms include painful, frequent stools, irradiation of pain into the rectum and perineum. 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 days 3-4 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, it is indicated to carry out emergency surgery, before surgery, the patient is prepared by administering antibacterial agents and anti-shock 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, wound dehiscence, bleeding, fistula.
Acute inflammatory reactions from the abdominal cavity. Most often these are infiltrates and abscesses that form in different parts of the 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 the 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, the purulent process from the appendix spreads to the portal vein of the liver and its branches, resulting in the formation of numerous ulcers 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. To the very obvious signs pylephlebitis includes:

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 the risk of complications after appendectomy can already be assumed based on the patient’s age and history of chronic diseases, such as diabetes mellitus. Undesirable changes often occur in patients prone to obesity. All these factors are taken into account both in the preoperative and postoperative periods.

The possible number of complications can only be minimized by timely consultation with a doctor. Early surgery prevents the most serious complications and shortens recovery period.

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 the late period of appendicitis, which occurs on the fifth day from the onset of inflammation of the appendix, diffuse peritonitis develops, and an appendiceal abscess and pylephlebitis are often detected.

Complications of appendicitis in the preoperative period

The development of complications before surgery in most cases is associated with a person’s untimely visit to a medical facility. Less commonly, pathological changes in the appendix itself and the structures surrounding it develop as a result of incorrectly chosen 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 of the abdominal cavity.

Appendiceal infiltrate

An appendiceal infiltrate occurs due to the spread of developing inflammation to organs and tissues located near the appendix, such as 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. At an 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.

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.

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

Abscess

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

The abscess is treated surgically, it is opened, drained and then antibiotics are used.

Perforation

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

Complications identified from the sutured wound. These are hematoma, infiltration, suppuration, wound dehiscence, bleeding, fistula.
Acute inflammatory reactions in the abdominal cavity. Most often these are infiltrates and abscesses that form in different parts of the 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 the postoperative period, some patients experience thrombophlebitis, pylephlebitis, pulmonary embolism, pneumonia, and 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 the use of compression garments before and after surgery and the administration of anticoagulants.

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

Pylephlebitis

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.

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 purulent inflammation develops. The resulting fistulas are eliminated surgically.

Complicated appendicitis requires careful diagnosis, identification of pathological changes and rapid 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 his history of chronic diseases, such as diabetes mellitus. Undesirable changes often occur in patients prone to obesity. All these factors are taken into account both in the preoperative and postoperative periods.

The possible number of complications can only be minimized by timely consultation with a doctor. Early surgery prevents the most serious complications and shortens the recovery period.

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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 surgery

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, high temperature body, lethargy, weakness, poor health. Surgical treatment: the abscess must be opened.
Peritonitis. This is a serious condition caused by pus from the appendix entering the abdomen. 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, and 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 an even more serious complication - adhesive intestinal obstruction, which is manifested by nausea, vomiting, bloating, lack of gas and stool, and cramping abdominal pain.
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 the complication occurs rapidly: the patient’s condition becomes serious due to pain in the right hypochondrium, tremendous chills, weakness, increased body temperature to thirty-nine to forty degrees, and severe 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, 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 vermiform appendix of the cecum:

Changes immune system that occurred without visible reasons. With this condition, the walls of the appendix become more susceptible to irritation and infection.
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).
Inflammatory processes in the walls of blood vessels - vasculitis.
Infectious diseases of a general nature - for example, tuberculosis, typhoid fever.

Please 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

Symptoms for the considered pathological condition is quite pronounced, doctors can make a diagnosis quickly and accurately, which reduces the risk of complications. The main symptoms of appendicitis include:

Pain syndrome. Localization of pain in appendicitis - upper part 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 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.

Please 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.

Please 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:

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.
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).

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:

The patient is partially sanitized, but it is advisable to take a full shower.
If diffuse varicose veins were previously diagnosed, the patient should bandage lower limbs elastic bandage. Please note: if there is a risk of thromboembolism, heparin drugs must be administered before surgery.
If the patient’s emotional background is labile (he is very excited, irritated, panicking), then doctors prescribe sedative (calming) medications.
If you eat food 6 hours before an attack of acute appendicitis, you will need to empty your stomach - vomiting is artificially induced.
Before surgery, the bladder is completely emptied.
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:

The classic method of performing the operation is to cut the abdominal wall (anterior) and cut out the inflamed vermiform appendix.
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 surgical method is the short recovery period and the virtual absence of scars on the body.

Please note: if symptoms of inflammation of the appendix of the cecum (or similar signs appendicitis) you should immediately seek medical help. 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.

Please 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

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

Preventive measures

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:

Correction of diet. This concept includes limiting the consumption of greens, hard vegetables and fruits, seeds, smoked and too fatty foods.
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).
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

Diagnostics appendicitis in most cases based on objective examination data. It consists of examining the patient by a doctor and identifying certain symptom complexes. Conducted in parallel laboratory diagnostics which consists of conducting general blood tests and urine tests. If necessary, resort to instrumental diagnostics, which is based on ultrasound examination(ultrasound) and diagnostic laparoscopy.

Examination of a patient with appendicitis

A patient with acute appendicitis is usually in a lying position on the right side, with both legs bent at the knees and hip joints. This position limits the movement of the abdominal wall, thereby reducing the intensity of pain. If the patient gets up, he holds the right iliac region with his hand. Externally, the patient looks satisfactory - the skin is slightly pale, the pulse is increased to 80 - 90 beats per minute.

The appearance of the patient as a whole depends on the form and evolution of appendicitis. In destructive forms, the skin is sharply pale (bloodless), the pulse quickens to 100 - 110 beats per minute, consciousness may be slightly clouded (the patient is sleepy, lethargic, lethargic). The tongue is dry and coated gray coating. With catarrhal appendicitis, the patient is relatively active and able to move independently.

After an external examination, the doctor begins palpation. The abdomen of a patient with appendicitis is slightly distended, and in the presence of concomitant peritonitis, there is pronounced bloating and tension of the abdomen. With pronounced pain syndrome, there is a lag in the right part of the abdomen in the act of breathing. The key symptom upon palpation of the abdomen is local pain and protective tension of the abdominal muscles in the lower right quadrant (projection of the iliac region). In order to identify pain upon palpation, the doctor compares the right and left side belly. Palpation begins from the left side and then counterclockwise the doctor feels the epigastric and right iliac region. Reaching the last one, he notes that the abdominal muscles in this area are more tense than in the previous ones. The patient also indicates the severity of pain in this particular location. Next, the doctor begins to identify appendiceal symptoms.

Diagnostic objective symptoms for appendicitis are:

Shchetkin-Blumberg symptom– the doctor presses on the abdominal wall in the right iliac region, after which he sharply withdraws his hand. This maneuver is accompanied by increased pain and even greater tension in the abdominal wall muscles.
Sitkovsky's symptom– when the patient turns on the left side, the pain in the right side intensifies. This symptom is explained by the displacement of the cecum and its tension, which increases the pain.
Cough symptom– when the patient coughs, the pain in the right iliac region (the site of projection of the appendix) intensifies.
Obraztsov's symptom(informative for atypical position of the appendix) - first the doctor presses on the right iliac region, and then asks the patient to raise his right leg. This leads to increased pain.

Diagnostic laparoscopy for appendicitis

Sometimes, when the clinical picture of appendicitis is blurred and the data obtained during ultrasound diagnostics are uninformative, the doctor resorts to the method of diagnostic laparoscopy. It should immediately be noted that laparoscopy can also be performed to remove the appendix. However, first, to find out the causes of the patient’s pain, laparoscopy is performed with diagnostic purpose, that is, to find out whether there is appendicitis or not.

Laparoscopy is a type of minimally invasive (low-traumatic) surgical intervention, during which special endoscopic instruments are used instead of a scalpel. The main instrument is the laparoscope, which is a flexible tube with an optical system. Through it, the doctor is able to visualize on the monitor the condition of the organs inside the abdominal cavity, namely the appendix. At the same time, laparoscopy allows you to visualize internal organs at thirty times magnification.

A small puncture is made with a trocar or a large needle in the umbilical area, through which carbon dioxide (CO 2) is supplied into the abdominal cavity. This maneuver allows you to straighten the folds of the intestine and visualize the appendix more clearly. Next, a laparoscope is inserted through the same hole, which is connected to a video monitor. Using a special clamp or retractor, which is also inserted into the abdominal cavity through a separate puncture, the doctor moves back the intestinal loops to better examine the appendix.

Signs of inflammation are hyperemia (redness) and thickening of the process. Sometimes it is covered with a whitish layer of fibrin, which speaks in favor of the development of destructive processes. If the above signs are present, then acute appendicitis should be suspected. In addition to the appendix, the doctor examines the terminal ileum, cecum, and uterine appendages. The right iliac fossa should also be carefully inspected for the presence of inflammatory exudate.

Tests for appendicitis

There are no specific tests that would indicate acute appendicitis. At the same time, a general blood test indicates the presence of an inflammatory process in the body, which, together with other studies conducted, will speak in favor of the diagnosis of acute appendicitis.

Changes in the general blood test for appendicitis are:

increase in the number of leukocytes more than 9x10 9 – with catarrhal forms more than 12x10 9, with destructive ones more than 20x10 9;
shift leukocyte formula to the left, which means the appearance of young forms of leukocytes in the blood;
lymphocytopenia – decreased number of lymphocytes.

Ultrasound for appendicitis

Ultrasound diagnosis of appendicitis is carried out if there is doubt about the diagnosis. It should be noted that the information content of the method is low - for catarrhal forms of appendicitis - 30 percent, for destructive forms - up to 80 percent.
This is explained by the fact that normally the appendix is not visible on ultrasound. However, during the inflammatory process, its walls thicken, which creates the appearance during examination. The longer infectious process, the more pronounced the destructive changes in the appendix. Therefore, the ultrasound diagnostic method is most valuable for appendiceal infiltrates and chronic appendicitis.

With simple inflammation, the process is visualized on ultrasound as a tube with layered walls. When the sensor is compressed onto the abdominal wall, the appendix does not shrink and does not change its shape, which indicates its elasticity. The walls are thickened, which causes an increase in the diameter of the process compared to the norm. Inflammatory fluid may be present in the lumen of the appendix, which is clearly visible during examination. In gangrenous forms of appendicitis, the characteristic layering disappears.

A ruptured appendix leads to the release of pathological fluid into the abdominal cavity. In this case, the appendix ceases to be visible on ultrasound. The main symptom in this case is the accumulation of fluid, most often in the right iliac fossa.

Echo signs of acute appendicitis are:

thickening of the appendix wall;
infiltration of the appendix and ileocecal junction;
disappearance of layering of the process wall;
accumulation of fluid inside the appendix;
accumulation of fluid in the iliac fossa, between the intestinal loops;
the appearance of gas bubbles in the lumen of the appendix.

Diagnosis of chronic appendicitis

Diagnosis of chronic inflammation of the appendix is based on the exclusion of other diseases that have a similar clinical picture, and a history of signs of acute appendicitis.

The main diseases that are excluded when making a diagnosis chronic appendicitis, are:

chronic form of pancreatitis (inflammation of the pancreas);
chronic form of cholecystitis (inflammation of the gallbladder);
chronic form of pyelonephritis (kidney inflammation);
inflammation of the genital organs;
benign and malignant abdominal tumors.

During an examination of a patient with suspected chronic appendicitis, the doctor prescribes a series of studies and tests that reveal indirect signs inflammation of the appendix.

Studies that are carried out for suspected chronic appendicitis

Type of study	Purpose of the study	Possible changes in chronic appendicitis
*General blood test*	identify signs of inflammation.	moderate leukocytosis; increase in ESR ( erythrocyte sedimentation rate) .
*General urine test*	exclude pathology of the urinary organs.	no pathological changes.
*Ultrasound examination of the abdominal organs*	identify pathology of the appendix; exclude pathology of the pelvic and abdominal organs.	thickening ( more than 3 millimeters) walls of the appendix; expansion of the appendix ( diameter more than 7 millimeters); a sign of inflammation in the form of increased echogenicity of tissues.
*X-ray of the intestine with contrast agent*	identify signs of partial or complete obliteration of the appendix.	retention of contrast agent in the lumen of the appendix; failure of the contrast medium to pass into the cavity of the appendix; fragmented filling of the appendix.
*Computed tomography of the abdomen*	determine the condition of the appendix; exclude pathology of other organs.	inflammation of the appendix and adjacent tissues; an increase in the size of the appendix and its walls.
*Diagnostic laparoscopy*	visual confirmation of the diagnosis of chronic appendicitis; exclusion of other pathologies of the abdominal organs.	changes in the appendix due to chronic inflammation ( enlargement, curvature); the presence of adhesions between organs and tissues surrounding the appendix; dropsy, mucocele, empyema of the appendix; inflammation of surrounding tissues.

Types of operations to remove appendicitis

For appendicitis, an operation called an appendectomy is performed. During this surgical procedure, the inflamed appendix is completely removed.

There are two main options for surgery for appendicitis. The first option is a classic abdominal appendectomy, which is performed by laparotomy. Laparotomy means cutting the anterior abdominal wall followed by opening the abdominal cavity. This type of surgery is also called open.

The second option for surgery for appendicitis is closed operation– laparoscopic appendectomy. It is carried out using a special instrument inserted into the abdominal cavity through small holes. Each type of operation has its own characteristics, advantages and disadvantages.

Removal of appendicitis using the classical method (classical appendectomy)

Currently, in case of appendicitis, they most often resort to classical surgery to remove the appendix. Like any surgery, it has its own indications and contraindications.

Indications for performing a classic appendectomy are:

positive diagnosis of acute appendicitis;
acute appendicitis complicated by peritonitis;
appendicular infiltrate;
chronic appendicitis.

In case of a positive diagnosis of acute appendicitis or the presence of signs of peritonitis, surgical intervention should be performed urgently. In case of appendiceal infiltrate, abdominal surgery is performed only after a course of conservative treatment and is planned. It is usually prescribed several months after the acute process has stopped. Chronic appendicitis is also an indication for elective appendectomy.

Contraindications for performing a classic appendectomy include:

the patient is in a state of agony;
written refusal of the patient from surgical intervention;
in case elective surgery– severe decompensation of the cardiovascular and respiratory systems, kidneys or liver.

Preparing the patient for abdominal appendectomy
To perform a classic appendectomy, the patient does not undergo any special preoperative preparation. In case of severe water-salt imbalance and/or peritonitis, the patient undergoes intravenous administration fluids and antibiotics.
The entire surgical process of classical appendectomy is divided into several stages.

In stages operational process classical appendectomy are:

Preparation surgical field;
creating access through the anterior abdominal wall;
revision of the abdominal organs and exposure of the appendix;
resection (cutting off) of the vermiform appendix;

Anesthesia
Operations to remove an inflamed appendix using the cavity method are most often performed under general anesthesia. The patient is put under anesthesia using intravenous and/or inhaled drugs. Less commonly, during classical appendectomy, spinal (epidural or spinal) anesthesia is performed.

Preparation of the surgical field
Preparation of the surgical field begins with the positioning of the patient. During the operation, the patient is in a horizontal position - lying on his back. The skin of the anterior abdominal wall in the area of the future incision is treated with antiseptics - alcohol, betadine (povidone-iodine) or alcohol solution Yoda

Creating access through the anterior abdominal wall
Access through the anterior abdominal wall during classical appendectomy depends on the location of the appendix. During the examination of the patient, the doctor determines the point of maximum pain. The vermiform appendix is located in this place. Based on this, the surgeon chooses the most suitable access to expose it.

Options for access through the anterior abdominal wall during abdominal appendectomy are:

oblique incision according to Volkovich-Dyakonov;
longitudinal Lenander approach;
transverse access.

The Volkovich-Dyakonov oblique incision is most often used in operations for appendicitis. The surgeon visually draws a line from the navel to the apex of the iliac wing on the right, dividing it into three segments. At a point between the middle and lower segments, he makes a skin incision perpendicular to this line. The incision usually does not exceed 7–8 centimeters. One third of the incision length is above the visual line and two thirds are directed downward. Longitudinal access is obtained by cutting the skin in the lower abdomen along the edge of the right rectus muscle. For a transverse approach, an incision is made parallel to the costal arch in the middle third of the abdomen.
After dissection of the skin, layer-by-layer separation of all tissues of the anterior abdominal wall follows.

Layer-by-layer separation of tissues of the anterior abdominal wall during abdominal appendectomy

Layers of fabrics	Separation method
*Subcutaneous adipose tissue*	Scalpel incision.
*Superficial fascia*	Dissection with a scalpel.
*Aponeurosis of the external oblique muscle*	Cut with special scissors.
*External oblique muscle*	Shift to the side by the retractor ( surgical instrument for retracting soft tissues).
*Internal oblique and transverse abdominis muscles*	Expansion with two blunt instruments - closed clamps – parallel to muscle fibers or fingers.
*Preperitoneal tissue* *(adipose tissue)*	Shifting to the side with a blunt object or hands.
*Peritoneum* *(inner lining of the abdominal cavity)*	Grasping with two tweezers or clamps and cutting between them with a scalpel.

After dissection of the peritoneum, its edges are pulled back with clamps and attached to the tissues of the surgical field. During layer-by-layer separation of tissues, sutures are immediately applied to all cut vessels to avoid large blood losses.

Revision of the abdominal organs and exposure of the appendix
In the opened abdominal cavity, the surgeon uses his index finger to inspect the large intestine. He mainly pays attention to the presence of adhesions and formations that may interfere with the exposure of the appendix. If there are none, then the doctor pulls out the cecum from the abdominal cavity, holding it with damp gauze. Following this, the inflamed appendix is exposed. The rest of the intestine and abdominal cavity are fenced off with damp gauze. If difficulties arise in releasing the intestine or appendix, the incision is enlarged. During all manipulations, the surgeon assesses the condition of the internal organs and peritoneum, paying attention to any morphological defects.

Resection of the vermiform appendix
After identifying the inflamed appendix, they begin to resection it and suturing the defects in its mesentery and cecum. The suture material is threads made of catgut or synthetic absorbable material.

Step-by-step manipulations for resection of the appendix during classical appendectomy are:

applying a clamp to the mesentery of the appendix at its apex;
piercing the mesentery at the base of the appendix;
applying a second clamp to the mesentery along the appendix;
suturing or ligating the vessels of the mesentery;
cutting off the mesentery from the appendix;
applying a clamp at the base of the appendix;
ligation of the appendix between the clamp and the cecum;
placing a special suture on the cecum;
cutting off the appendix between the clamp and the dressing site;
immersion of the stump of the process into the intestinal lumen with tweezers or a clamp;
tightening the suture on the cecum and applying an additional superficial suture in the form of the letter Z.

With appendicitis, it is not always possible to easily expose and bring the vermiform appendix into the lumen of the wound. Based on this, resection of the appendix is carried out in two ways - antegrade and retrograde. In most cases of acute uncomplicated appendicitis, when the appendix is easily brought out, the operation is performed in an antegrade manner. This method is considered standard. At the first stage of the operation, the mesentery of the appendix is ligated and cut off. At the second stage, the appendix itself is bandaged and cut off. When many adhesions are found in the abdominal cavity that make it difficult to release the appendix, retrograde appendectomy is resorted to. The stages of resection are performed in reverse. Initially, the appendix is resected from the cecum, and its end is immersed in the intestinal lumen. All adhesions going from the appendage to the surrounding organs and tissues are gradually cut off. And only then the mesentery is bandaged and cut off.

After resection of the appendix, the surgeon performs sanitation of the abdominal cavity using tampons or electric suction. If there were no complications, the cavity is tightly sutured. If there are special indications, special drains are installed.

Indications for drainage of the abdominal cavity during strip appendectomy are:

peritonitis;
abscess in the appendix area;
inflammatory process in the retroperitoneal tissue;
incomplete hemostasis (stopping bleeding);
surgeon's uncertainty complete removal process;
the surgeon’s uncertainty about the reliable immersion of the appendix stump into the cecum.

Drains are usually rubber tubes or strips through which inflammatory products are evacuated. They are placed into the abdominal cavity through an additional incision. Typically, after an appendectomy, one drain is left in the area of the removed appendix. But in case of peritonitis, additional drainage is installed along the right lateral canal of the abdominal cavity. As soon as the general condition of the body stabilizes and signs of inflammation disappear, the drains are removed. This happens in about 2 – 3 days.

Closing the surgical approach is performed layer by layer, in the opposite direction of the incisions.

Manipulations when closing surgical access are:

closure of the peritoneum with interrupted sutures;
removal of retractors and connection muscle fibers oblique and rectus abdominis muscles;
bringing together the ends of the aponeurosis of the external oblique abdominal muscle without suturing;
placing absorbable sutures on the subcutaneous tissue;
placing an intermittent suture on the skin using silk threads.

Time for surgery for appendicitis in the classic way on average it takes 40 – 60 minutes. Presence of complications, pronounced adhesive process and non-standard location of the appendix can prolong the operation by 2 – 3 hours. Recovery of general condition in the postoperative period occurs within 3 to 7 days. In the first 2–3 days, the patient must remain in bed. Skin sutures are removed 7–10 days after surgery.

Laparoscopy for appendicitis

Surgeries for appendicitis also include laparoscopic appendectomy. This type of surgical intervention is considered minimally invasive (low-traumatic), since the surgical wound is small. Removal of the inflamed appendage laparoscopic method has strict indications and contraindications.

Indications for laparoscopic appendectomy include:

acute appendicitis in the first 24 hours from the onset of the disease;
chronic appendicitis;
acute appendicitis in a child;
acute appendicitis in patients suffering from diabetes mellitus or high obesity;
the patient’s desire to be operated on laparoscopically.

Unlike the classic operation to remove the appendix, laparoscopic appendectomy has a wider range of contraindications. All contraindications can be divided into two groups - general and local.

Contraindications for laparoscopic appendectomy

Group of contraindications	Examples
*General contraindications*	pregnancy in the third trimester; acute diseases of the cardiovascular system ( acute heart failure, heart attack); acute respiratory failure due to pulmonary obstruction; pathology of blood clotting; contraindications for general anesthesia.
*Local contraindications*	acute appendicitis lasting more than 24 hours; generalization ( spreading) peritonitis; the presence of an abscess or phlegmon in the appendix area; pronounced adhesive process of the abdominal cavity; unusual location of the appendix; presence of appendicular infiltrate.

Preparing the patient for laparoscopic appendectomy
Laparoscopic surgery for appendicitis does not require any special training patient and should be performed as soon as possible from the onset of the disease. Before surgery, the patient is placed on a drip with saline solution or Ringer's solution and antibiotics are administered wide range actions. In the operating room, the anesthesiologist, after administering intravenous premedication (sedatives), installs an endotracheal tube with inhalation anesthesia. All laparoscopic appendectomies are necessarily performed under general anesthesia.

Laparoscopic appendectomy technique
To remove the inflamed appendix, a medical device called a laparoscope and special endoscopic instruments are used. A laparoscope is a flexible tube with an optical system that allows you to visualize on a monitor what is happening inside the abdominal cavity. The operation is performed in stages and with great care.

The stages of the surgical process of laparoscopic appendectomy are:

providing operational access;
inspection of the abdominal organs with detection of the appendix;
resection of the vermiform appendix with its mesentery;
sanitation and drainage of the abdominal cavity;
closing surgical access.

Providing operational access
Small openings in the anterior abdominal wall act as surgical access for laparoscopic appendectomy. Initially, three incisions of the skin and subcutaneous tissue are made, 10 to 15 millimeters long. The anterior wall of the abdomen is pierced through these incisions. Two punctures are located below the right hypochondrium and correspond to the projection of the cecum. The third puncture is made in the pubic area. Trocars (metal “tubes” through which endoscopic instruments are inserted) are installed into the resulting holes.

Revision of the abdominal organs with detection of the appendix
Through the first puncture, the abdominal cavity is filled with carbon dioxide to better visualize the internal organs. Then the laparoscope is inserted and the abdominal cavity and its contents are examined. If complications are found that make further manipulations difficult, they are considered contraindications for laparoscopic appendectomy. The laparoscope is removed, and subsequent removal of the appendix is performed using the classic open method.

Resection of the vermiform appendix with its mesentery
In the absence of contraindications, laparoscopic surgery continues. Endoscopic instruments are inserted into the remaining two holes, which are used to perform almost the same manipulations to remove the appendix as during a cavity appendectomy. The mesentery of the appendix is clamped and bandaged or special titanium clips are applied. A clamp and clip are then placed at the base of the appendix and an incision is made between them with scissors. The severed appendix is removed through the trocar. Due to limited space, all movements must be performed with extreme care and professionalism.

Sanitation and drainage of the abdominal cavity
The abdominal cavity is examined in detail using a laparoscope for the presence of bleeding and accumulation of pathological exudates. An electric suction helps remove all fluids and dry the cavity. For special indications, the abdominal cavity is drained.

Indications for drainage of the abdominal cavity during laparoscopic appendectomy are:

signs of peritonitis;
incomplete hemostasis;
the surgeon's uncertainty about sufficient resection of the appendix.

The drainage tube is left in one of the side punctures.

Closing operational access
After completing all manipulations and removing the laparoscope, the trocars are carefully removed one at a time. Then it is sutured subcutaneous tissue absorbable threads and a silk suture is placed on the skin.
Laparoscopic appendectomy without complications is usually completed in 30 to 40 minutes. The patient's postoperative recovery occurs quite quickly. The drainage is removed on the second day. After 2–3 days, the patient is discharged home with limited physical activity for two months.
Compared with abdominal appendectomy, laparoscopic surgery has a wide range of advantages.

The advantages of laparoscopic surgery for appendicitis are:

short period of hospitalization and rehabilitation;
absence of large cosmetic skin defects;
absence of severe pain after surgical procedures;
the tissues of the anterior abdominal wall are not severely injured;
the abdominal cavity is well visualized, which allows for detailed sanitation and identification of concomitant pathologies;
Peristalsis of the large intestine is quickly restored;
no strict bed rest;
the risk of postoperative complications is very low.

Despite the whole list of positive aspects, laparoscopic appendectomy is currently not used often enough in public hospitals. The reason for this is its some shortcomings.

The main disadvantages of laparoscopic surgery for appendicitis include:

special expensive equipment and tools are required;
qualified, trained personnel are required;
general anesthesia is required;
the surgeon has no tactile sensitivity;
visualization takes place in two-dimensional space.

Based on these disadvantages, in particular, the high cost of equipment, most often appendicitis is operated on using the classical abdominal method.

Scar after appendectomy

After removal of the sutures, a scar remains on the patient’s body, the size of which depends on how the appendix was removed. When appendicitis is removed using the laparoscopic method, small, unnoticeable scars remain, which dissolve over time (from one to three years). The biggest problem for patients, especially females, they represent traces that remain after traditional abdominal operations. The size of the seam varies from 8 to 10 centimeters and most often it looks like a horizontal line, which is located above the linen line. If the removal of appendicitis was accompanied by complications, the length of the suture can reach 25 centimeters.

How is a postoperative scar formed?
After removal of postoperative sutures, a dark burgundy incision mark remains on the patient’s body. As the incision site heals, a scar forms (approximately 6 months). A scar consists of connective tissue that the body uses to try to fill the wound left after surgery. Connective tissue different increased density. This is why post-operative scars feel harder to the touch. If the patient’s recovery after surgery occurs without complications, then the wound heals by primary intention, and a narrow, flat scar remains on the body.

If after surgery inflammation begins in the wound, and the doctor makes a second incision, the suture heals by secondary intention. In such cases, the formation of sloppy scars is possible, which after a long time are noticeably visible on the body.

Other circumstances also influence the formation of the final appearance of the scar. One of the primary factors is preventive care using special products.

Preventative care for a “fresh” scar
There are special absorbable preparations designed to care for “fresh” scars. Using them will not completely get rid of the scar, but will help make it less noticeable. After a course of using the correct product, the scar becomes less tall and voluminous, lighter and softer.
It is necessary to start using such drugs immediately after postoperative wound tightened, and all the crusts disappeared from its surface.

Scar preventive care products

Name	Effect	Application
*Strataderm*	The gel forms a film on the surface of the scar that protects it from external environment and provides sufficient hydration. As a result, the scar becomes smoother and softer.	Apply to washed and dried skin 2 times a day. To achieve the effect, it takes 2 to 6 months of daily use.
*Mederma*	The active components of the ointment well moisturize and nourish scar tissue, as a result of which it becomes softer. The drug also improves blood circulation in the suture area, which speeds up the healing process.	Apply with massage movements until completely absorbed. The scar is processed 3-4 times a day. The course must be continued from 3 months to six months.
*Contractubex*	Inhibits the formation of scar tissue. Moisturizes and nourishes the skin of the seam. Provides protection against infections.	Apply with light movements thin layer 3 times a day. Use for 3 – 6 months.
*Dermatix*	Softens the skin and forms a protective layer on the surface of the scar. As a result, the scar is formed more even and elastic.	Rub into the scar area twice a day for six months.
*Kelofibrase*	Removes the feeling of tightness in the seam area. Improves blood circulation, softens and smoothes the postoperative suture.	Apply to the skin, after which the seam area must be massaged. For large and deep scars, overnight compresses are recommended. Use for 2 – 3 months.

Fighting mature scars
If no prophylaxis was carried out for six months after the operation or it turned out to be ineffective, a scar with pronounced shapes and sizes remains on the patient’s body. Since the scar “matures” within 6 months, the use of absorbable drugs in the future is not advisable. To combat mature scars, there are other, more radical methods. Most of them are not able to completely eliminate this cosmetic defect, but can significantly improve appearance scar, making it neater and less noticeable.

Methods that can help improve the appearance of a mature scar include:

Surgical plastic surgery. The method involves re-dissecting the scar in order to make a more accurate suture in its place. In some cases, the patient's fatty tissue from other parts of the body is injected into the area of the old suture. As the scar heals, it turns into a thin and almost invisible strip.
Laser grinding. A laser is used to “evaporate” scar tissue. This promotes the formation of a new epithelial layer, which makes the scar smoother and less noticeable.
Cryodestruction. Exposing the scar to liquid nitrogen, causing it to freeze and turn into a blister. After some time, the bubble becomes covered with a dry crust and disappears. A slight swelling remains at the site of the blister pink color, which subsequently brightens and decreases in size.
Dermabrasion. Using a special abrasive substance, the upper layers of scar tissue are destroyed, as a result of which the scar becomes less pronounced.
Chemical peeling. Drugs are applied to the surface of the scar high concentration, which soften the scar and make it thinner.

Treatment of chronic appendicitis

For chronic appendicitis, doctors are not guided by a single treatment tactic. The severity of the inflammatory process and clinical symptoms promote the choice between conservative and surgical method treatment.

Conservative method of treatment of chronic appendicitis

In the case of chronic appendicitis with mild pain and rare periods of exacerbation, a conservative method of treatment is used. This method is presented drug therapy and physiotherapeutic procedures. Also, in case of chronic appendicitis, it is necessary to follow a certain diet.

The main points of the diet for chronic appendicitis are:

exclude spicy, fried, salty and fatty foods;
give up carbonated drinks;
reduce the consumption of seasonings and spices to a minimum;
exclude coffee and strong black tea;
maintain a balance of fats, proteins and carbohydrates;
five times daily meals in small portions.

Following a diet for acute appendicitis helps eliminate most intestinal disorders and normalize digestion. This improves the patient's quality of life.

Exists large number medicines, which are used in the treatment of chronic inflammation of the appendix.

Basic medications used in the treatment of chronic appendicitis

Prohibited products during the rehabilitation period are:

meat and fish with a high percentage of fat;
margarine and other types of modified fats;
foods fried or baked to a deep crust;
confectionery with a large number cream;
carbonated and/or alcoholic drinks;
products containing a large number of chemical additives (dyes, flavor enhancers);
industrial or home-made pickles and marinades;
legumes (can be consumed in limited quantities from 5–6 weeks of rehabilitation).

Drinking the required amount of fluid
For the first 3 to 7 days, the patient needs to drink at least one and a half liters of liquid per day. The main volume should come from clean water no gases. Subsequently, the daily amount of liquid should not be less than 2 liters. From the second week, various self-prepared juices from vegetables and fruits, rose hip decoctions, and weak teas are allowed.

Breathing exercises after surgery
Exercises to normalize breathing should begin immediately after surgery. Breathing exercises can speed up the process of removing anesthetics from the body and prevent the development of intoxication. Breathing training is also effective. preventive measure against pneumonia, which is a common complication after surgery.
All exercises are performed half-sitting in bed, and then standing. Inhalations must be taken through the nose, while inhaling as deeply as possible. Exhalations are made through the mouth. In this case, the exhalation should be loud and 3 times longer than the inhalation. Don't go overboard muscle tension during classes. Gymnastics are performed several times a day.

Breathing exercises are:

the right hand must be placed on the chest, applying gentle pressure during exhalation;
hands should be placed under the chest on the ribs, squeezing the chest on both sides when exhaling;
As you inhale, you need to raise both shoulders, and as you exhale, lower them;
alternately raising and lowering the right and then the left shoulder;
With an inhalation, you need to raise your arms up, and with an exhalation, lower them.

In addition to these exercises, to normalize breathing, the patient should inflate balloons every hour. You can also exhale into the bottle through a straw, stretching one exhalation for 20 - 30 seconds.

Self-massage
After the operation, while in bed, the patient is recommended to independently massage his earlobes, temples, forehead, palms and other parts of the body that he can reach. Such actions will activate blood circulation and eliminate body numbness. Massaging is carried out using the fingertips in a circular motion without pressure.

To prevent constipation, it is recommended to perform self-massage of the abdomen, since massaging the muscles improves intestinal motility. The procedure is carried out in 3 stages in a lying position.

The stages of self-massage are:

The patient should bring his legs to his stomach and, focusing on his feet, spread his knees to the sides. After this, you need to start stroking the abdomen with both hands, moving from the ribs to the groin area. Actions should be smooth and soft.
For 2 - 3 minutes, you should make circular movements in the navel area. The direction of movement should correspond to the clockwise direction, and the effort should be slightly greater than in the previous exercise. Massaging is performed with hands placed one on top of the other.
After this, you need to move on to massaging the lower abdomen, moving clockwise from right side to the left. The seam area cannot be massaged.

Limiting physical activity
In order for the postoperative suture to heal without complications, the patient must adhere to a gentle regime of physical activity. Immediately after the operation, it is forbidden to lift anything weighing more than 3 kilograms. This recommendation is valid for the next 2 - 3 months. In the first month, the only sports activities allowed are walks in the fresh air and simple exercises that do not involve the abdominal muscles. Then you can do swimming, race walking, and aerobics. Those sports that involve heavy lifting or excessive physical activity are not allowed for 5 to 6 months.

Sick leave after appendicitis removal

Surgery for appendicitis involves a recovery period, during which the patient is prescribed a home regimen. Therefore, people who have had their appendix removed are entitled to sick leave. The duration of sick leave is determined by the doctor, who takes into account the patient’s condition, the type of surgery undergone and the nature of the professional activities sick.

Most often, the duration of hospital rest after standard operations does not exceed 10 days. For appendicitis with various forms complications, the duration of sick leave is at least 15–20 days.

If the patient was given rest for, for example, 10 days after being discharged from the hospital, but during this period his condition worsens, the sick leave is extended. Upon provision sick leave the doctor also takes into account current legislation.

The maximum period for a certificate that a doctor can issue independently does not exceed 30 days. If during this period the patient’s condition has not returned to normal and he cannot go to work, the extension of sick leave is carried out after agreement with a special medical commission.

Before use, you should consult a specialist.