A dangerous complication of acute appendicitis is an appendicular abscess. It can occur both before surgical procedures and in the postoperative period. According to statistics, a serious complication occurs in 3% of patients and requires immediate intervention by surgeons.
Reasons
Under an abscess is understood tissue inflammation, characterized by the formation of a limited purulent cavity. Often the causative agent of this complication is Escherichia coli. Also, the cause of the appearance of an appendicular abscess is the human factor:
- Bad diagnosis: numerous errors made in the course of research that contribute to the development of complications of appendicitis.
- Long waiting period due to erased symptoms. Such a situation may arise fromfor the presence of other diseases with pronounced symptoms, as well as taking painkillers. As a rule, the erasure of signs is noted in elderly patients.
- Ineffective treatment regimen.
- Untimely contact with a medical facility.
Development Mechanisms
At the initial stage of the development of the disease, an infiltrate is formed - inflamed cells accumulate and tightly connect to each other. If, despite the conservative treatment, the seal does not resolve, but, on the contrary, abscesses, an emergency surgical intervention is indicated. Otherwise, the abscess can break into the abdominal cavity, provoking its inflammation. The transition of the pathological process into the intestinal lumen or retroperitoneal space is possible. Further, the purulent process quickly spreads to nearby tissues.
Symptoms
The formation of an infiltrate has signs that usually appear in acute appendicitis:
- general malaise;
- chill;
- rise in body temperature;
- excessive sweating;
- pain in the right iliac region.
As an appendicular abscess develops, the following symptoms appear:
- It becomes impossible to move the body due to bouts of cramping pain.
- Interintestinal abscess is accompanied by moderate bloating and partial bowel obstruction.
- Along withpulsating pain appears redness and swelling of the skin.
- When a pelvic abscess of appendicular origin is disturbed by pain and swelling in the lower abdomen. During defecation, the patient also experiences discomfort, and the process of exit of feces is accompanied by mucous secretions. Frequent urge to urinate.
When making a diagnosis, body temperature is of fundamental importance. If with appendicitis it rises slightly (up to 37.5 ° C), then with an appendicular abscess the thermometer shows 39-40 ° C.
Diagnosis
The clinical manifestations of the complication are similar to the signs of some diseases, therefore, first of all, it must be differentiated from them.
In addition, the diagnosis of appendicular abscess includes the following activities:
- Examination and history taking. The doctor probes the right iliac region to detect an infiltrate. With deep palpation, the accumulation of fluid in most cases is not detected. As a rule, the infiltrate is dense and immobile. Often, rectal or vaginal palpation is performed to detect a painful induration, which is the lower pole of the abscess. The doctor pays attention to the patient's tongue - in case of illness, it is wet and lined with a dense coating. In the process of breathing, you can notice the lagging of the abdomen in the right iliac region.
- Blood test. It is important for determining the level of leukocytes in the blood. With an appendicular abscess, there is a sharp increase in them.
- Ultrasound and radiography of the abdominal organs. With the help of datatypes of diagnostics is determined by the level of fluid in the right side of the abdomen, the exact localization and size of purulent inflammation.
Treatment
Surgical intervention is excluded at the stage of infiltrate formation.
Treatment is carried out on an inpatient basis and includes:
- compliance with bed rest;
- application to the stomach in the first three days of cold, in the following days - heat;
- injection of novocaine solution for the purpose of pain relief (taking drugs to reduce the severity of pain syndrome is excluded);
- special diet.
In case of successful resorption of the infiltrate, after 2 months, a planned operation is performed to remove the appendix (appendectomy). This is due to the fact that after some time, attacks of pain and the process of infiltrate formation can be repeated, increasing the risk of complications.
When an appendicular abscess is diagnosed, treatment involves emergency surgery. In the process, the abscess is opened and drained. The scope of access depends on its localization. As a rule, extraperitoneal access is used. The wound is washed with an antiseptic solution, after which drainage tubes are installed.
The opening of the appendicular abscess is performed under general anesthesia. At the discretion of the physician, the appendix may be removed, which is preferable.
Post-operative period
To the patient who underwentoperation, strict bed rest is indicated. Drainage requires special care - regular washing of the wound is carried out. The tubes are removed only after the pus stops separating from the cavity. The wound after their removal is not sutured, it heals on its own. Antibiotics and drugs that eliminate the symptoms of intoxication are shown. At the same time, therapy is carried out aimed at general strengthening of the body.
If the appendix was not removed during the operation, appendectomy is performed 2 months after the complete elimination of the inflammatory process.
Consequences
If you do not seek qualified help in time, spontaneous opening of the appendicular abscess may occur, after which there is a high probability of developing the following complications:
- purulent peritonitis - inflammation of the peritoneum;
- urinary tract infection;
- phlegmon - a purulent process that quickly spreads to neighboring tissues;
- paracolitis - inflammatory changes in the fiber of the retroperitoneal space;
- liver abscess - the destruction of he althy tissue and the formation of a purulent cavity;
- adhesive intestinal obstruction;
- purulent thrombophlebitis - the formation of blood clots and small foci of abscess in the veins;
- fistulas of the abdominal wall - channels connecting the internal organs with the surface of the body.
As for the prognosis, it is determined by the degree of promptness of diagnosis and surgical intervention.
Prevention
In order to prevent the development of dangerouscomplications, the patient at the first sign of acute appendicitis should call an ambulance. Prompt diagnosis and timely intervention will help to avoid an abscess. Ignoring the signs of the disease can lead to death.
Appendicular abscess is a serious complication characterized by the development of a purulent inflammatory process. At the initial stage, symptoms appear similar to those of acute appendicitis. As the inflammatory process develops, the patient's body temperature rises to high levels, it becomes impossible to perform body movements due to bouts of cramping pain. It is important to immediately call an ambulance to avoid dangerous consequences.
