Appendicitis is an inflammation of the appendix of the caecum. Despite the ongoing development of modern surgery, there are still a large number of complications of this pathology. This is due both to the low awareness of the population and the unwillingness to seek medical help, and to the insufficient qualifications of some doctors. Therefore, let's see how this disease manifests itself and what complications after appendicitis can occur.
What is appendicitis?
Appendicitis is a disease that is characterized by inflammation of the wall of the appendix (vermiform appendix of the caecum). It is located in the lower right part of the abdomen, which is also called the iliac region. In the adult body, the appendix has no function, so its removal (appendectomy) does not harm human he alth.
Most often, the appendix becomes inflamed in people over the age of 10under 30.
Main symptoms
Before we go directly to what complications after acute appendicitis can occur, let's look at what symptoms will help to suspect the presence of inflammation for timely seeking medical help.
If chronic inflammation of the appendix can not manifest itself for a long time and not cause inconvenience to the patient, then acute appendicitis has vivid symptoms:
- sharp severe pain in the upper abdomen (epigastrium), which gradually descends down and to the right (in the iliac region);
- increased pain when turning to the right side, when coughing, walking;
- tension of the muscles of the anterior abdominal wall, which occurs due to pain that occurs in the patient when moving the abdominal muscles;
- possible accumulation of gases in the intestines, constipation;
- subfebrile temperature (up to 37.5 °C).
Classification of appendicitis
Perhaps it doesn't really matter to the layman what kind of inflammation of the appendix is observed in his case. However, it is very important for the surgeon to know the type of appendicitis, because depending on this, it is possible to determine the prognosis of the further course of the disease and the likelihood of complications. It also determines the surgical tactics.
The following types of appendicitis are distinguished:
- catarrhal or simple is the most common form;
- superficial;
- phlegmonous - purulent inflammation of the process;
- gangrenous - withdevelopment of process necrosis;
- perforative - with the destruction of the appendix and the penetration of intestinal contents into the abdominal cavity.
It is the phlegmonous and gangrenous species that are the most unfavorable in terms of the development of complications. These types of appendicitis require the most attention of the surgeon and immediate surgical intervention. And the perforated appearance, in fact, is a complication after gangrenous appendicitis.
Types of complications
Complications after appendicitis can be divided into two large groups.
The first includes complications of the inflammation itself, which often leads to untimely seeking medical help. These are complications such as:
- appendicular infiltrate - the formation of a conglomerate of intestinal loops, mesentery and other abdominal organs around the appendix;
- abscesses in the abdominal cavity (in the pelvis, between intestinal loops, under the diaphragm);
- peritonitis - inflammation of the peritoneum;
- pylephlebitis - inflammation of the portal vein (a vessel that carries blood to the liver), as well as its branches.
Complications after appendicitis surgery most often develop in the wound and the abdominal cavity. However, there may be complications in the respiratory, genitourinary and cardiovascular systems.
Appendicular infiltrate
When answering the question of what complications after appendicitis can be, first of all, it is necessary to highlight the formation of appendicular infiltrate. He isa group of organs and tissues of the abdominal cavity soldered together, which limit the appendix from the rest of the abdominal cavity. As a rule, this complication develops a few days after the onset of the disease.
Symptoms of complications after appendicitis, specifically appendicular infiltrate, are characterized by a decrease in the intensity of pain in the lower abdomen. It becomes not so sharp, but more blunt, does not have a clear localization, increases slightly only when walking.
When palpation of the abdominal cavity, you can feel an indistinct formation, characterized by pain. Further, the infiltrate becomes denser, the contours become more blurred, the pain disappears.
The infiltrate can resolve within one and a half to two weeks, however, it can also fester with the formation of an abscess. With suppuration, the patient's condition deteriorates sharply, temperature appears, the stomach becomes painful on palpation, the muscles of the anterior abdominal wall are tense.
Appendicular abscess
Purulent, prognostically unfavorable complication after appendicitis is the formation of an abscess of the appendix. But abscesses can form not only directly in the process, but also in other places of the abdominal cavity. This occurs when the effusion in the abdominal cavity is encysted and prevents the development of widespread peritonitis. Often such a picture occurs as a complication after phlegmonous appendicitis.
To diagnose this complication and search for abscesses in the abdominal cavity, it is recommended to use ultrasound and computed tomography. If an abscesswas formed as a complication after appendicitis in women, its pelvic localization is characteristic. Then its presence can be determined using a vaginal examination.
Above is a CT scan of an anterior abdominal wall abscess.
Purulent peritonitis and pylephlebitis
These two types of complications are the least common, but the most unfavorable for the patient. Peritonitis as a complication after appendicitis occurs only in 1% of cases. But it is this pathology that is the main cause of death in patients with appendicitis.
The rarest condition in inflammation of the appendix is pylephlebitis (septic inflammation of the portal vein). As a rule, it is a complication after appendectomy surgery, however, it can develop even before surgery. It is characterized by a sharp deterioration in the general condition of the patient, high fever, and a sharply distended abdomen. If the veins that pass directly into the liver tissue are damaged, jaundice, liver enlargement, and liver failure develop. The most likely outcome of such a condition is the death of the patient.
Complications occurring in the operating wound
And now we will talk about complications after appendicitis surgery. The first group of complications are those that are limited to the surgical wound. Most often, inflammatory infiltrates and suppurations develop. As a rule, they occur 2-3 days after the removal of the appendix, while the already subsided pain in the wound returns again,body temperature rises, general condition worsens.
On the wound, when the bandage is removed, redness and swelling of the skin is visualized, the threads of the postoperative sutures cut into the skin. On palpation, there is a sharp pain and a dense infiltrate is felt.
After a few days, if you do not intervene in time and prescribe treatment, the infiltrate may fester. Then its boundaries become less clear, palpation can reveal a symptom of fluctuation, which characterizes the presence of purulent fluid. If the abscess is not opened and drained, it can become chronic. Then the patient's condition gets worse and worse. He is losing weight, emaciated, his appetite is reduced, constipation occurs. After a certain time, the purulent process from the subcutaneous tissues spreads to the skin and opens on its own. This is accompanied by the outflow of pus and relief of the patient's condition.
In addition to the most common complications listed above after removal of appendicitis, the following pathological conditions may occur in the postoperative wound:
- hematoma;
- bleeding;
- divergence of edges.
Hematoma
Incomplete control of bleeding during surgery can cause hematoma formation. The most common localization is in subcutaneous fat, less often there is an accumulation of blood between muscle fibers. The next day after the operation, the patient is disturbed by dull pains in the wound area, a feeling of pressure. On examination, the surgeon determines swelling on the right lower abdomen, pain on palpation.
Forto eliminate the process, it is necessary to partially remove the surgical sutures and remove blood clots. Then the seams are superimposed again, from above they are fixed with a bandage. Something cold is applied to the wound. In cases where the blood has not yet coagulated, a puncture can be made and the hematoma removed by puncture. The main thing in the treatment of a hematoma is not to postpone it, since the wound can fester, which will worsen the patient's condition and the prognosis of the disease.
Bleeding
The photo in the article shows one of the types of surgical elimination of the source of bleeding - clipping of the vessel.
A terrible complication can be bleeding from the stump of the appendix. At first, it may not manifest itself in any way, but later general and local signs of blood loss appear.
Among the common signs, the following symptoms are distinguished:
- headache and dizziness;
- general weakness;
- pale skin;
- cold sweat;
- lowering blood pressure and slowing heart rate in severe bleeding.
Among the local manifestations of this complication after removal of appendicitis, the most characteristic symptom is gradually increasing pain in the abdomen. At first, moderate and not very disturbing to the patient, it indicates irritation of the peritoneum. But if the bleeding is not stopped in time, the pain becomes stronger, which may indicate the development of diffuse peritonitis.
With a significant accumulation of blood in the abdominal cavity, the surgeon determines the irregular shape of the abdomen during examination. With percussion(tapping on the anterior abdominal wall) a dull sound is determined in places where blood accumulates, perist altic bowel sounds are muffled.
In order not to miss this complication and provide timely assistance to the patient, it is necessary to regularly check these indicators:
- general condition of the patient;
- blood pressure and pulse;
- abdominal condition, including symptoms of peritoneal irritation (the most common and informative symptom is Shchetkin-Blumberg).
The only possible treatment in this situation is relaparotomy, that is, re-opening the abdominal wall, determining the source of bleeding and stopping it surgically.
Infiltrate and abscess: treatment
How to treat the most common complications after appendectomy?
Treatment of infiltrate begins with novocaine blockade. Antibiotics are also prescribed, cold at the site of this formation. In addition, the surgeon, together with a physiotherapist, can prescribe a number of procedures, such as UHF. If all these therapeutic measures are applied on time, recovery is expected in a few days.
If medical treatment does not help, the patient's condition worsens, and signs of abscess formation appear, it is necessary to turn to surgical intervention.
If the abscess is not deep, but subcutaneous, it is necessary to remove the sutures, expand the edges of the wound and remove the pus. Next, the wound is filled with swabs moistened with a solution of chloramine or furacilin. If the abscess is located deeper in the abdominal cavity, which is oftenoccurs when an abscess is recognized a week after the operation, it is necessary to perform a second laparotomy and remove suppuration. After the operation, it is necessary to do daily dressings with cleansing the wound with a solution of hydrogen peroxide, after the formation of granulation on the wound, dressings with ointments are used, which contribute to the speedy healing.
Usually, these complications do not leave any trace, however, with a strong separation of the muscles, hernia formation is possible.
Women who have had an appendectomy may develop an infiltrate of the pouch of Douglas, which is a depression between the uterus and the rectum. The approach to the treatment of this complication is the same as for an infiltrate of another localization. However, here you can add the implementation of such procedures as warm enemas with furatsilin and novocaine, douching.
Complications from other organs and systems
In the recovery period after surgery, not only complications in the postoperative wound can occur, but also pathologies of other organs.
So, in the spring, the appearance of bronchitis and pneumonia is quite common. The main preventive method is therapeutic exercises. It should be started as soon as possible after the operation. It is necessary to prevent the patient from lying passively in bed, as this contributes to the occurrence of congestion in the airways. The patient should bend and unbend his legs, turn from side to side, perform breathing exercises. To control the regularity and correctness of the exercises in the hospital,be a Methodist. If there is none, the control of the exercise falls on the nurse of the department.
If pulmonary complications nevertheless develop, antibiotic therapy, expectorants and sputum thinners (mucolytics) are prescribed.
One of the complications after laparoscopy of appendicitis is acute urinary retention. Its cause can be both a reflex effect on the nerve plexuses from the side of the surgical wound, and the patient's elementary inability to go to the toilet in a supine position. And although surgeons are regularly interested in the patient about his urination, some patients are embarrassed to talk about such a problem. In such cases, the surgeon may observe tension and swelling in the suprapubic region, the patient has pain in the lower abdomen.
After catheterization and removal of the contents of the bladder, all complaints disappear, the patient's condition improves. However, before resorting to catheterization, simpler methods can be used. Sometimes, after the patient is put on his feet, an act of urination occurs. It is also possible to use heating pads on the lower abdomen, diuretics.
Postoperative complications in children
Unfortunately, at present, a high percentage of complications after appendectomy in children under the age of three years is determined - from 10 to 30%. This is due to a more severe course of the disease and the frequent development of destructive forms of appendicitis.
Among the complications after appendicitis in children, the following pathological conditions most often occur:
- infiltration andabscess;
- postoperative ileus due to adhesion formation;
- intestinal fistula;
- protracted course of peritonitis.
Unfortunately, children are more likely to die after surgery than adults.
Although complications from appendicitis are becoming less common these days, it is important to know their symptoms to prevent dangerous consequences.
