Appendicitis is an inflammation of the appendix, a finger-shaped extension of the cecum that is located in the lower right side of the abdomen. With appendicitis, pain occurs in the lower right corner of the abdomen. However, for most people, the pain starts around the belly button and then moves. As the inflammation progresses, the pain tends to get worse and eventually become intense. The localization of pain with appendicitis may be different depending on the age and gender of the patient. This is especially common in children and pregnant women.
The standard treatment for appendicitis is surgical removal of the inflamed appendix - appendectomy
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Course of the disease
The first period of illness lasts 2-24 hours, and its symptoms are similar to many acute diseases of the abdominal organs. It is characterized by acute pain in the epigastric region or throughout the abdomen (less often, pain appears immediately on the lower right), nausea, single vomiting, and a moist tongue with a coating.
In the appendix, blood circulation and lymph movement are disrupted, dystrophic changes occur in the intramural nervous system, the appendix flows away, and siderophages accumulate in it. In the second appendicular period, one can already suspect the development of appendicitis. In a person, acute pain moves to the right iliac region, the heart rate is up to 90-100 beats per minute, the abdomen is soft, the temperature is elevated, intestinal motor activity is preserved, and there is moderate leukocytosis in the blood.
A preliminary diagnosis can be made based on positive symptoms:
- Rovzinga (pushing pressure in the left iliac region when the descending segment of the large intestine is compressed leads to increased pain on the right side);
- Voskresensky (if you run your palm over the stomach from the right ribs downwards, pain will appear on the right in the groin area);
- Obraztsova (when palpating the right iliac region with the right leg raised straight, the pain becomes stronger).
If surgical intervention was not performed in the initial stages of the disease, then the inflammation extends beyond the appendix and the terminal period begins. It is characterized by pain in the right half of the abdomen, which can pass, sharply intensify, or remain approximately the same.
The patient may also experience repeated vomiting, increased heart rate (over 100 beats per minute), the tongue becomes dry, plaque is visible on it, intestinal motility is reduced or absent, body temperature is above 38 C, the temperature in the axillary and rectal area differs by one degree.
At this stage, the Shchetkin-Blumberg symptom is positive (the pain intensifies when the hand is quickly removed from the anterior abdominal wall). Sharp pain and tension in the abdominal muscles is a sign of peritonitis (the entry of purulent contents into the abdominal cavity).
Typically, all three phases of acute inflammation last 2-4 days and end with destruction and necrosis of the appendix
The changes that occur with superficial appendicitis are reversible, however, if the inflammatory process develops, then acute destructive appendicitis occurs. One day after the onset of the disease, the leukocyte infiltrate affects the entire wall of the appendix (phlegmonous appendicitis).
The process enlarges, a fibrinous coating appears on its surface, the wall becomes thicker and pus is released through it. If small pustules join diffuse purulent inflammation, then apostematous appendicitis is diagnosed, and if manifestations appear, then they speak of phlegmonous-ulcerative appendicitis.
Gangrenous appendicitis develops as a result of the spread of a purulent process to adjacent tissues, which will lead to thrombosis of the appendicular artery. Due to necrosis of the wall, a perforated hole appears through which pus flows out (perforated appendicitis), which leads to local peritonitis, which can develop into diffuse peritonitis.
6-12 hours after the onset of the disease, a simple one (catarrhal appendicitis) is usually diagnosed, after 12-24 hours the phlegmonous form already develops, after 24-48 hours the gangrenous form begins. After 48 hours, the appendix ruptures. However, the disease does not always proceed this way: in some cases, appendicitis remains catarrhal for several days, and in others, the appendix becomes gangrenous just a couple of hours after the onset of the inflammatory process.
At what stage of the disease laboratory and instrumental testing will help you find out.
In children, the greater omentum is underdeveloped and destructive processes develop in the abdominal cavity faster. In a child, unlike adults, abdominal pain is more diffuse, the intoxication syndrome manifests itself more clearly (the temperature rises to 39 C, tachycardia), and the dyspeptic syndrome is more pronounced (diarrhea, repeated vomiting, cramps).
Inflammation of the appendix is more reminiscent of gastroenteritis of infectious origin or dysentery; tension in the peritoneal muscles is not very pronounced. In older people, appendicitis, on the contrary, is erased due to a decrease in the body's reactivity. Abdominal pain is insignificant; an acute abdomen may not appear even at the destructive stage of the disease.
If the heart malfunctions, bradycardia may occur instead of tachycardia. Blood counts may be normal or leukocytosis may be mild. For any form of appendicitis, emergency surgery is required (excluding complications with the development of appendiceal infiltrate).
A complication of acute appendicitis is destruction of the appendix and leakage of pus. With phlegmonous-ulcerative appendicitis, a rupture of the appendix wall often occurs, which leads to the development of diffuse or limited peritonitis. If the purulent process involves the surrounding tissues and the cecum (peritiphlitis, periappendicitis), then ulcers form and inflammation spreads to the retroperitoneal tissue.
Duration of intervention
How long appendectomy surgery takes depends on several factors. The first thing to consider is the chosen access to the abdominal cavity. It can be laparoscopic or laparotomic, and the appendectomy itself can be transvaginal or transgastric.
The duration of the operation is also affected by the stage of appendicitis and the complications that arise. For uncomplicated acute appendicitis, the operation lasts 40-60 minutes. If purulent contents have penetrated into the abdominal cavity and limited peritonitis has developed, then additional primary sanitation, intestinal decompression, and drainage of the abdominal cavity will be carried out, which will require additional time.
In this case, the operation will last at least two hours. During the operation, adhesions may be discovered that make it difficult to access the required anatomical area. The atypical location of the appendix and the detection of other pathologies in the abdominal cavity, for example, a hernia, diverticulum, or tumor, can also increase the time costs.
The operation will last about two hours if the patient is under three years old
Signs of perforation of the appendix
As already mentioned, appendicitis can burst even a couple of hours after the onset of the pathological process, although most often this occurs within 24-48 hours. Bursting appendicitis causes the following symptoms:
Sick leave after appendicitis
- pain in the abdomen and back;
- the pain intensifies when laughing, coughing, or lying on the left side;
- nausea;
- vomiting;
- chills;
- diarrhea;
- trembling in the limbs;
- headache;
- tachycardia (130-140 beats per minute);
- temperature rise to 40 C.
If the pain disappears, then this is a sign of death of the nerve endings and gangrene of the appendix. If you suspect appendicitis, you should immediately seek medical help, since treatment consists of surgical removal of the inflamed appendix.
Until the ambulance team arrives, you should not drink, eat, take painkillers, or apply heat to your stomach.
Consequences of a ruptured appendix
When perforation of the appendix occurs in 15% of cases, peritonitis develops in one form or another. Appendiceal peritonitis has a number of features and is equated to perforation of the cecum, and therefore refers to fecal or colibacilar peritonitis.
Rupture of appendicitis can cause the development of local unlimited peritonitis. It appears in the gangrenous form or in the first time after the integrity of the vermiform appendix is broken. A sign of this type of peritonitis is muscle tension in the anterior abdominal wall in the right iliac region, symptoms of peritoneal irritation, and intoxication syndrome.
The appendix is removed, drained, and antibacterial and detoxification therapy is prescribed.
With diffuse peritonitis, the inflammatory-destructive process does not cover the entire abdominal cavity, but only one or two layers. It forms within 6-12 hours after the appendix bursts. It is possible to understand that diffuse peritonitis has developed by the tension of the abdominal wall muscles and symptoms of peritoneal irritation, which cover both iliac regions and the lower abdomen and can spread to the navel and even higher, while the epigastric region is intact.
A median laparotomy is performed, sanitation of the abdominal cavity, drainage with cigar and tubular drainages is necessary. After the operation, the patient is prescribed broad-spectrum antibiotics, medications that stimulate intestinal motility, detoxification and symptomatic treatment.
If 12-24 hours have passed since the appendicitis burst, then diffuse peritonitis has most likely already developed. The patient's abdominal muscles are tense and there are symptoms of peritoneal irritation throughout the entire anterior abdominal wall; signs of intoxication are pronounced.
After 24-72 hours, manifestations of multiple organ failure are already noticeable (acute abdomen is replaced by bloating, motor skills are absent, blood pressure decreases, consciousness is impaired, and the amount of urine excreted decreases). A wide laparotomy is performed, a thorough sanitation of the abdominal cavity is carried out, drainage is introduced, and depending on the severity of intestinal paresis, intestinal intubation or enterostomy is required.
After the operation, antibacterial and detoxification therapy is carried out, drugs are prescribed to stimulate intestinal motility and correct water and electrolyte balance, treatment of multiple organ failure and parenteral nutrition is necessary.
After appendectomy
As a rule, within 2-3 hours after laparoscopy for appendicitis, the patient can get up. Discharge from the hospital usually occurs 1 - 2 days after the operation. The patient can go home once he can eat, drink and move independently without pain. It takes about a week for complete recovery.
You should prepare in advance for postoperative recovery. Most people go home a day after having an appendectomy, but complications may increase the length of your hospital stay. In some cases, the surgeon may have to make an incision in the abdominal wall to remove the appendix. In this case, the patient will have to stay in the hospital for a longer period. It is not always possible to say exactly how the operation will proceed. If you have to stay in the clinic longer, you should immediately take personal items with you, for example, a toothbrush, comfortable clothes, gadgets, books or magazines, so that you don’t get bored.
Arrange for someone to take you home after discharge and look after you. Ask a friend or family member to drive you home and stay with you the first night after surgery.
How quickly a patient can return to normal activities after an appendectomy depends on the surgical procedure and overall health. Patients who have undergone a laparoscopic appendectomy can return to work within a few days. Patients who have open surgery take longer to recover and return to work.
Avoid strenuous physical activity immediately after surgery. If your appendectomy was performed laparoscopically, limit your activity for three to five days. If you have had an open appendectomy, limit your activity for 10 to 14 days. Ask your doctor about your activity restrictions and when you can return to normal activities after surgery.
When coughing, laughing or moving, support your stomach to reduce pain.
Start slowly and increase activity as needed. Start with short walks.
In the first days after surgery, you may feel sleepier than usual. Relax and rest whenever you need.
Talk to your doctor about returning to work or school.
