Appendicitis: symptoms, causes, treatments, prevention

Appendicitis is an inflammation of the vermiform appendix of the cecum (appendix) and occurs in people of any age.

Acute appendicitis

Acute appendicitis is an acute inflammation of the appendix. It occurs very often, over 50% of intestinal inflammation occurs due to appendicitis. Most often, this disease develops between the ages of 10 and 30 years. It is rare over the age of 50, but complications occur more often.

Reasons for development

A number of factors can cause inflammation of appendicitis.

The most common cause is inflammation from bacterial infections such as:

• Eschirichia coli;
• enterococci;
• clostridia;
• viruses.

Another reason is the entry of fecal stones into the appendix. They damage the mucous membrane of the appendix, causing circulatory problems (ischemia) of the intestinal wall and its inflammation.

A fairly common cause of acute appendicitis is swallowed foreign bodies or a large amount of fruits and seeds eaten. Sometimes inflammation can be caused by worms.

The appendix is ​​an important part of the body's immune system, since its walls contain a large amount of lymphoid tissue, as in the throat (similar to tonsils). However, in inflammatory diseases, lymphoid follicles enlarge and can cause blockage of the process. Therefore, the general state of immunity plays a big role in the likelihood of developing acute appendicitis.

It is this reason that causes the frequent development of acute appendicitis in adolescence, since the amount of lymphoid tissue at a young age is large and decreases with aging.

Often the inflammatory process in the appendix begins with a slight erosion of the wall,
leukocyte infiltration, which spreads deep into the wall of the appendix. Sometimes self-healing occurs, the inflammatory process stops. But, as a rule, the inflammatory process progresses and leads to the development

• phlegmous,
• ulcerative-phlegmous,
• gangrenous appendicitis.

These types of diseases require urgent surgical intervention.

Symptoms of acute appendicitis

Symptoms depend on the prevalence of the inflammatory process and on the anatomical position of the appendix.

In typical cases, pain appears first

• in the epigastric region (stomach pain),
• then appears around the navel
• and descends into the right iliac region (lower right abdomen).

The intensity of pain depends on the extent of damage to the appendix.

For superficial inflammation:

• the pain is not very severe;
• may stop on its own within a few hours;
• body temperature is normal;
• The blood test remains unchanged.

Symptoms of destructive forms of appendicitis are as follows:

• severe pain in the right iliac region;
• pain worsens when coughing;
• increased pain with sudden movements;
• may occur:
• nausea;
• vomit;
• loss of appetite.

During a physical examination, with light pressure on the abdomen, pain and muscle tension appear.

In uncomplicated forms of appendicitis, body temperature usually does not rise.
An increase in temperature above 37.5-38⁰С is characteristic of perforated appendicitis. In this case, tension appears in the anterior abdominal wall, as with peritonitis. And if peritonitis develops, then severe bloating is observed.

Dependence of pain on the anatomical location of the appendix

If the appendix is ​​located behind the cecum or in the pelvis, then the pain is localized in the lateral abdomen or appears during rectal examination in the right wall of the rectum.

In women with this location of the appendix, pain manifests itself in the right wall of the vagina during a gynecological examination.

Sometimes the process of urine formation may be disrupted.

Complications of appendicitis

With progressive inflammation without seeking medical help, infiltrates and perforation of the appendix may form. Its contents, as well as bacteria, can enter the abdominal cavity. In this case, inflammation can spread into the abdominal cavity.

Such a rupture of the appendix is ​​very dangerous and can even result in death, especially in elderly or weakened patients. Therefore, persons with suspected appendicitis should definitely consult a doctor.

Complications of appendicitis include:

• formation of infiltrate in the abdominal cavity;
• perforation of the process;
• peritonitis;
• abscesses in the abdominal cavity, pelvis and subphrenic space.

What to do in case of an attack of appendicitis?

If you have acute pain in the right iliac region, you should refuse food and call an ambulance. You can put cold on your stomach.

Forbidden!

Give laxatives and painkillers, place a heating pad on the stomach.

Diagnostics

Primary diagnosis is made by physical examination for the presence of a number of clinical symptoms.

• Shchetkin-Blumberg symptom: a sharp pain reaction at the moment of stopping pressure on the anterior abdominal wall during palpation of the cecum.
• Rovsing's symptom: the appearance of pain in the right iliac region with jerky palpation of the left parts of the colon.
• Razdolsky's symptom: pain in the area where the appendix is ​​located when percussing (tapping with fingers) the abdominal wall.

1. If appendicitis is suspected, a rectal examination should be performed, as described above.
2. If you have a fever, you can take the temperature in the anus (rectally). It will be at least one degree higher than the temperature measured in the armpit.
3. In unclear cases, a survey x-ray of the abdominal cavity must be taken. It allows you to see the presence of gas above the right dome of the diaphragm in case of perforation of the process.
4. Ultrasound also shows the presence of inflammation.
5. CT allows us to establish the anatomical location of the appendix.
6. To establish an accurate diagnosis, laparoscopy is used.

Diagnosis of appendicitis in women

In women, it is necessary to conduct a gynecological examination to distinguish appendicitis from the following diseases:

• acute inflammatory diseases of the pelvis;
• ectopic pregnancy.

In acute right-sided adnexitis and ovarian rupture, it is often impossible to distinguish these diseases from acute appendicitis and the final diagnosis is made during laparoscopy or laparotomy.

Diagnosis of appendicitis in men

In men, there are a number of additional signs by which inflammation of the appendix can be determined.

• Horn's sign: sharp pain when pressing on the scrotum.
• Larocque's sign: pulling up of the right testicle.
• Britten's sign: pulling up of the right testicle and muscle tension when pressing on the right lower abdomen with increasing pain and drooping of the testicle when the pressure decreases.
• If the appendix is ​​displaced to the pelvic area, then pain in men can manifest itself in the pubic area and even the penis.

What diseases is appendicitis similar to?

Symptoms of inflammation of appendicitis are similar to a number of other diseases:

• Meckel's diverticulum;
• Crohn's disease;
• urolithiasis disease;
• perforated ulcer of the stomach and duodenum ;
• intestinal obstruction;
• phlegmon of the small intestine;
• thrombosis of intestinal vessels;
• pinched hernia;
• acute cholecystitis;
• acute pancreatitis.

If an attack of appendicitis is accompanied by severe vomiting and diarrhea, then an acute infectious disease or poisoning should be excluded.

The distinctive signs of these diseases are:

• paroxysmal abdominal pain;
• high body temperature with chills.

It is very difficult to distinguish an attack of appendicitis from the appendicular form of yersiniosis .
Symptoms characteristic of yersiniosis are the presence of an infiltrate in the right iliac region, which can be detected by palpation, and a slower rate of development.

In the differential diagnosis with the acute form of Crohn's disease, the long course of the disease with periodic exacerbations and the presence of infiltrate in the abdominal cavity are taken into account. If Crohn's disease develops acutely, it is impossible to distinguish it from appendicitis.

Treatment of acute appendicitis

Treatment of acute appendicitis is surgical. Typically, a traditional appendectomy is performed. The sooner the operation can be performed, the better.

It is permissible not to perform the operation immediately if there is infiltration in the right iliac region. In this case, treatment with broad-spectrum antibiotics is prescribed. The infiltrate gradually resolves, abdominal pain disappears.

In this case, appendectomy is performed as planned, after 3-4 months. For planned surgery, laparoscopic appendectomy is often used, which is more gentle.

The success of treatment depends on the accuracy and timeliness of diagnosis.
It is important not to waste time in case of perforated appendicitis, therefore, in doubtful cases, laparotomy is performed and an accurate diagnosis is established during the operation.

Types of operations to remove appendicitis

Appendectomy is one of the most common operations. To remove an inflamed appendix, a traditional appendectomy (open surgery) or laparoscopy with three small incisions is used.

The surgeon decides which operation to perform in each case separately, taking into account factors such as:

• nature of inflammation;
• patient weight;
• patient's age;
• general condition of the patient.

Traditional appendectomy

During this operation, an incision about 5-8 cm long is made in the right lower abdomen. The vermiform appendix is ​​separated at its junction with the cecum and removed.
The peritoneum is tightened and sutured with absorbable sutures (the sutures are not removed). The skin is tightened and interrupted sutures are placed, which are then removed.

When the appendix breaks through and its contents spill into the abdominal cavity, the cavity is sanitized and temporary drainage is secured in order to remove the products of inflammation (pus) outside the body. This drainage is removed earlier than skin sutures, immediately after the body’s condition has stabilized.

There are no standards for the time of the operation; it can last from 20 minutes to 2-3 hours, depending on the severity of the disease, physique, age of the patient, location of the appendix in the abdominal cavity, the presence of complications and many other factors.

Laparoscopic appendectomy

Through a very small incision in the navel, the surgeon inserts an endoscope into the abdominal cavity. To separate the intestines from the abdominal wall, carbon dioxide is simultaneously pumped into the abdominal cavity through a special channel. Through the endoscope camera, the surgeon sees all the organs of the abdominal cavity, which is especially important in case of an unclear diagnosis. Two more small incisions in the lower abdomen are needed to insert additional instruments.

The appendix is ​​separated and removed from the body through a special sleeve. Three holes are sutured.

This option for removing the appendix is ​​the least traumatic, the rehabilitation period is shorter and is relatively simpler. In addition, with the help of laparoscopy, the treatment of appendicitis will be safer for patients diagnosed with diabetes mellitus.

Types of anesthesia during surgery

When removing appendicitis, several methods of pain relief can be used:

• tight infiltration method;
• conduction blockade;
• general anesthesia.

All methods, when performed correctly, have a sufficient analgesic effect. With the first two methods of anesthesia, the patient is conscious during the operation.

There are contraindications for them:

• young children;
• patients with peritonitis;
• patients undergoing laparoscopic surgery;
• patients with heightened emotional reactions.

In Europe, experts believe that all types of these operations should be performed under general anesthesia.

Risks and complications of surgery

In rare cases, after appendectomy, pain remains in the right iliac region, with which patients consult a doctor. As a rule, they are caused by formed adhesions.

Sometimes more serious postoperative purulent complications develop, in which a repeat laparotomy is necessary. These patients, as a rule, develop severe adhesive disease of the abdominal cavity with constant pain, stool disorders and occasional attacks of intestinal obstruction. In this case, dissection of adhesions and subsequent anti-inflammatory treatment have a good effect.

Postoperative period

After surgery, hospitalization usually lasts about four to five days, usually no more than 10 days. After normalization of intestinal function and the general condition of the patient, he is discharged from the clinic.

You can get up after surgery with your doctor’s permission, usually on the third or fourth day. To prevent stitches from coming apart, you should sometimes wear a bandage or wrap a towel around your stomach. On the first day after surgery, you are given fluids. From the second day, nutrition is indicated according to the diet recommended by a nutritionist.

What should I pay attention to after surgery?

• There is no need to endure pain in the abdomen and in the area of ​​the stitches,
• make sure that defecation and urination are carried out without straining,
• There should be no discomfort when moving or the seams getting wet.

If any of the above concerns you, be sure to tell your doctor.

When are stitches removed after appendectomy?

Usually the sutures are removed on the seventh, sometimes tenth day.

For several days after discharge from the hospital, you should be careful with physical stress - even a well-healed surgical wound may have its edges separated.

Seam divergence

The cause of suture dehiscence is usually non-compliance with the regimen after discharge from the hospital. Both internal and external seams can come apart.

Signs of divergence of internal seams

Several visually observable signs in the suture area will help identify this complication:

• protrusion (hernia) of the skin in the area of ​​the surgical wound, without compromising the integrity of the skin;
• When you lightly press the area of ​​the protrusion of the abdominal wall, you feel a jelly-like or slightly harder formation - this is the omentum.

In addition, pain may occur, causing vomiting.

In this case it is necessary:

• lie on your back on a hard surface;
• call an ambulance;
• if the protrusion goes inside, tie a towel around your stomach;
• try to relax and calmly wait for the doctor, as anxiety contributes to abdominal tension and aggravates the situation.

Signs of divergence of external seams

If the outer seam is torn apart, a red wound is visible on it. It may bleed or be dry.

In this case it is necessary:

• lie on a horizontal, hard surface on your back;
• cover the wound with a sterile napkin;
• Do not put pressure on the wound under any circumstances.

Chronic appendicitis

The development of chronic appendicitis is impossible without periodic exacerbations. Repeated attacks of simple (non-destructive) appendicitis do not require surgery. However, they may be accompanied by the development of typhlitis, peritiphlitis and adhesions in the right iliac region.

In these cases, over time, examination reveals signs of an acute process, and moderate symptoms create the impression of a chronic inflammatory process.

Symptoms of chronic appendicitis

Chronic appendicitis is manifested by symptoms such as:

• more or less pronounced pain in the right iliac region (lower right abdomen);
• pain increases with physical activity;
• pain when pressing on the abdomen in the projection of the cecum;
• splashing noise in the area of ​​the cecum when pressed.

Diagnosis of chronic appendicitis is difficult. Careful examination is required to distinguish inflammation of the appendix from other similar diseases.

If the diagnosis is established, then appendicitis is treated surgically.

If the diagnosis was established correctly and the altered appendix was removed as a result of the operation, then recovery occurs. If the appendix turns out to be unchanged, then surgery can further increase the pain syndrome.

The case should be taken into account when, upon palpation of the right iliac region, pain spreads throughout the abdomen. This is often a sign of irritable bowel syndrome.

Prevention

Measures to prevent the development of appendicitis are:

• proper organization of nutrition;
• animal proteins (meat, poultry, fish) should be consumed with vegetables;
• a sufficient amount of dairy products (if well tolerated);
• a sufficient amount of fruit in the diet;
• avoid intestinal overload (overeating);
• prevention and control of constipation .

If you have pain in the lower right abdomen, you should consult a doctor and undergo an examination. In case of acute pain, call an ambulance, as lost time can complicate the situation.