Causes and treatment of gangrenous appendicitis. Causes, symptoms and treatment of gangrenous appendicitis Gangrenous appendicitis postoperative period nutrition

Inflammation of the appendix in an acute gangrenous form leads the appendix to purulent processes, to the destruction of its walls.

Medicine classifies gangrenous appendicitis as a type of destructive form of inflammation.

This is an acute condition that should be operated on in a timely manner, otherwise general intoxication of the body may occur due to the penetration of purulent elements into the peritoneum from a burst appendix.

Gangrenous appendicitis

Appendicitis is an acute inflammation of the appendix of the caecum. It involves the passage of several stages, if you do not seek medical help in a timely manner.

Omitting the onset of the disease, it should immediately be said that the penultimate stage of acute purulent appendicitis is characterized by the development of necrosis of the walls of the intestinal process.

Perforation of the walls is very dangerous, purulent contents break into the abdominal cavity. Therefore, it is important to go to the hospital in time to start treatment.

Gangrenous appendicitis in acute form is the most dangerous type of inflammatory form of the appendix.

It develops if the patient went to the hospital late, if the specialists did not determine the phlegmonous form of the intestinal process, preceding acute gangrenous appendicitis.

Specialists assess the patient's condition by external signs and symptoms, carry out urgent diagnostics, and begin therapeutic treatment.

If drug therapy does not provide a quick improvement in the condition, surgical intervention is recommended, removal of the intestinal process, which at any time can develop into gangrene of appendicitis, or burst and create serious complications.

Perforation of the appendix causes sharp pain due to rupture of the intestinal process, after which the pain spreads throughout the abdomen.

The only true treatment in such a situation is an operation so that gangrenous perforated appendicitis does not end with peritonitis or appendicular abscess.

Pathoanatomy of gangrenous appendicitis

Inflammation begins with the stage of catarrhal changes:

• capillaries expand;
• the influx of lymphocytes increases - a protective reaction of the body to stop and localize the disease;
• edema and infiltration of the wall are formed;
• small purulent areas appear.

This stage develops rapidly - within 6 hours from the first attack of pain, therefore, it is repeatedly reminded that one should not dismiss pains in the abdomen, drink No-shpa and wait for improvement while continuing to work.

During the day, the appendix increases, its cavities are filled with purulent contents. So far, this is regarded as gangrenous perforative appendicitis with phlegmon - a limited abscess.

All layers of appendix tissues are melted from necrosis. It increases, becomes dirty green, the walls lose their elasticity, hemorrhages occur in flabby areas, and necrosis develops. The necrosis also occurs very quickly - in three days.

An intermediate picture of inflammation of the appendix is ​​a gangrenous perforative appendicitis with clearly visible phlegmonous-gangrenous changes in the tissues of the appendix.

The stage of gangrenous appendicitis is characterized by the transformation of inflammation to neighboring organs. Because of this, the tissues of the intestinal loop, the sheets of the peritoneum suffer.

When opening the abdominal cavity, surgeons see a plaque of fibrin, areas of hemorrhage, hyperemia on the omentums, tissues of the caecum and ileum.

With such a diagnosis as gangrenous appendicitis, diffuse peritonitis is considered a particularly dangerous consequence.

This means that the purulent contents of the appendix are poured directly into the abdominal cavity.

Peritonitis is localized when there are adhesions that do not allow the pathological fluid to spread.

This complication is very specific, can change the clinical picture, lubricate the symptoms.

It is clear that this is a very dangerous condition and the patient should be urgently hospitalized.

The absence of partial localization, the spread of purulent fluid throughout the abdominal cavity increases pain.

They spread over the entire surface of the peritoneum. These are clear signs that acute gangrenous appendicitis is developing, which should be treated with all caution, and immediately consult a doctor.

The general condition of the patient worsens:

• tachycardia is identified;
• a whitish coating appears on the tongue;
• consciousness becomes sluggish, inhibited.

In this case, the patient is tormented by multiple vomiting, but they do not bring relief.

They stop only after the operation, and before the operation, the surgeon must specify how long the pathological condition lasts, which is specified as acute gangrenous appendicitis.

Need to know! At the primary attack of appendicitis, it is necessary to observe its manifestations. The pain will be pronounced, sharp, but not constant, but arising from time to time. The condition of a sick person worsens from an increase in temperature, tension and soreness of the abdominal muscles.

Gangrenous appendicitis is characterized by clinical manifestations:

• lack of intestinal peristalsis;
• abdominal tension;
• irritation of the peritoneum;
• paralytic intestinal obstruction.

Blood tests show a significant increase in the number of leukocytes, an increase in ESR to a critical level - 40-60 mm per hour.

Urinalysis shows the presence of a large amount of protein, various cylinders - waxy, others. This indicates a toxic form of gangrenous inflammation.

Causes of gangrenous inflammation of the appendix

An inflammatory process is formed in the appendix - this is the development of gangrenous appendicitis.

It is important for doctors to know the duration of the condition, therefore, in case of acute pain in the abdomen, no matter how difficult it may be, to detect the time of the first attack.

The main risk factors for the development of gangrenous inflammation of the appendix of the primary form:

• middle age, when changes occur in the structure of blood vessels;
• children's age, when there is a genetically determined hypoplasia or displacement of the arteries that make up the structure of the appendix;
• atherosclerosis of the arterial walls of the intestine;
• development of blood clots in the arteries and veins of the appendix.

The direct causes of appendix inflammation are the acute formation of disorders associated with microcirculatory functions.

They form a destabilization of blood circulation in the process, which leads to necrosis, or partial appearance of areas of necrotic tissue.

This is joined by an infectious lesion, dysfunction of the outflow of fluid from an acute gangrenous affected appendix.

Such symptoms aggravate the course of the disease, give complications to neighboring organs in the abdominal cavity and beyond.

The main factor in the appearance of such a condition as gangrenous appendicitis is the transition of a simple form of appendicitis into a destructive one.

This happens with incorrect or late treatment. Then acute gangrenous appendicitis leads to the fact that the tissues of the appendix are melted by its own purulent contents, and the patient has to endure a long postoperative period.

The development of inflammation of the appendix goes through several stages, which include:

• phase of acute appendicitis;
• stage of perforated appendicitis;
• stage of purulent appendicitis;
• phase of acute gangrenous appendicitis.

Stages are divided into catarrhal, phlegmonous, gangrenous, perforative. Most often, secondary appendicitis is diagnosed, inflammation in which necessarily leads to appendicitis gangrene.

It develops on the 2-3rd day from the onset of the disease, if there is no medical care, it is rarely characterized by a rapid acute course - 6-12 hours.

Especially quickly acute purulent appendicitis develops in children. Primary gangrenous appendicitis is rarely stated, appendicitis is more often diagnosed, inflammation is an obligatory concomitant process.

Vascular problems can provoke the development of purulent appendicitis:

• age-related damage to the walls of blood vessels;
• atherosclerosis of the arteries that feed the intestines, with the presence of cholesterol plaques;
• genetic hypoplasia of the appendicular arteries in childhood;
• thrombosis of veins and arteries of the intestinal process.

With such deviations, circulatory disorders develop, appendix tissues die off, perforated appendicitis, or phlegmonous appendicitis, is formed.

Infections of various etiologies or autoimmune functions of the intestine can accelerate their development.

Symptoms of appendicitis at different stages

Gangrenous appendicitis is characterized by the absence of severe abdominal pain. This is due to tissue necrosis and the death of nerve cells of the intestinal process.

However, the onset of gangrenous inflammation is characterized by symptoms:

• unexpressed widespread pain;
• on palpation, a soft abdomen in all leads;
• no irritation on the peritoneum;
• normal body temperature.

With gangrene of appendicitis, when the doctor palpates the abdomen, with pressure and a sharp release of the hands, severe pains radiating to the right iliac region gradually decrease.

Prolonged vomiting does not bring relief. At normal temperature, tachycardia of 100-120 beats per minute is observed.

All varieties of chronic inflammation of the appendix give a similar clinical picture. At the same time, each of the forms of appendicitis gangrene has its own characteristics.

In particular, this applies to the acute form of gangrenous appendicitis. When it is a consequence of perforated appendicitis, then the characteristic symptoms will be the subsidence of pain until their complete disappearance.

• the disappearance of symptoms is associated with the death of nerve endings due to tissue necrosis of the process;
• multiple vomiting urges are associated with high intoxication of the body;
• dryness on the tongue;
• tension of the muscles and walls of the peritoneum;
• on palpation, the iliac region on the right is very painful.

In simple forms of appendicitis, symptoms begin classically:

• the occurrence of pain in the epigastrium;
• the appearance of nausea and vomiting;
• temperature rise.

Symptoms intensify rapidly: within 2 hours, pain radiates to the iliac region and hypochondrium on the right side, to the coccyx, to the center of the abdomen.

The acute form of inflammation of the appendix manifests itself against the background of an acute gangrenous-phlegmonous type of appendicitis.

This is manifested in jerking, throbbing pains, then they subside when the nerve endings in the walls of the intestinal process are destroyed.

Phlegmonous appendicitis is often taken as gangrenous by symptoms, however, if the diagnosis precedes the removal of appendicitis, then the nuances of the diagnosis no longer have practical significance.

With gangrene of appendicitis, the symptoms increase dramatically:

• vomiting becomes repeated;
• the temperature rises, accompanied by chills;
• the skin of the patient's body turns pale, becomes pasty;
• the whole body is covered with cold sweat.

Gangrenous inflammation is characterized by local pain, increased density of the abdominal muscles, the stomach is not involved in the respiratory process.

Differential diagnosis becomes more complicated in women, when right-sided adnexitis, rupture of the ovary or cyst, ectopic pregnancy should be promptly excluded.

If appendicitis is purulent, signs of general intoxication of the body appear - weakness increases, overall muscle tone decreases, body temperature either remains normal or decreases.

Important fact! When it comes to a child's illness, the manifestations of appendicitis must be kept under control: call an ambulance in a timely manner, since the symptoms grow catastrophically quickly, there is very little time left for prompt assistance.

Treatment of acute appendicitis

Conservative methods of treatment are admissible only at a catarrhal form of appendicitis. If we are talking about acute appendicitis of a gangrenous or perforated form, then only a technique for removing appendicitis is possible.

The operation is usually carried out "cito", urgently, when a patient with a clear picture of inflammation or gangrene of appendicitis is taken by ambulance to the surgical department.

The on-duty operational team acts quickly: it is necessary to operate quickly, within 2-4 hours, starting from the first pain attack.

This is done to exclude a rupture of the appendix and a spill of purulent contents into the abdominal cavity.

Conservative treatment of gangrenous appendicitis is not carried out, when such a diagnosis is established, the issue of performing an operation to remove appendicitis is immediately decided.

However, if emergency diagnosis does not show the likelihood of rupture, or fullness of the appendix with purulent contents, then a “delayed” approach is used to remove the appendix when the operation is postponed to a later date.

This is due to the severe general condition of the patient, which must first be stabilized so that the heart can withstand the burden of anesthesia and surgical intervention.

Quick methods, using droppers, normalize blood pressure, interruptions in the work of the heart, symptoms of intoxication are removed.

This creates normal conditions for the removal of appendicitis, so that the anesthesiologist and surgeon do not fear for the general condition of the patient.

It is easy for an ignorant person to say that appendicitis is an acute inflammation of the appendix of the caecum.

In fact, this is a rather serious operation, especially when the appendix is ​​in the stage of an acute gangrenous dangerous condition.

Preparation for surgery to remove gangrenous appendicitis includes detoxification of the body.

To do this, using a dropper, the patient is injected with saline, glucose. Injections of antibiotics, drugs to support heart function are given.

With the help of a probe, the contents of the stomach are washed out. It turns out the patient's tendency to allergies to drugs.

If the patient is conscious, he must sign the consent to the surgical intervention; for patients who are in an unconscious state, these documents are signed by relatives who brought him to the inpatient department.

For children, documents are signed by parents or guardians. The anesthesiologist, assessing the general condition of the patient, and how the diagnosis of gangrenous acute appendicitis went, chooses the method of anesthesia for the duration of the operation:

• create an anesthetic infiltrate;
• conduct a conductive blockade of the nerve plexuses;
• use classic general anesthesia.

The choice takes into account the age of the patient, his excitability, drug tolerance. Anesthesia should be sufficient for the surgeon to carry out the necessary manipulations according to the proposed operation plan.

How is the postoperative period

If gangrenous appendicitis was removed, the postoperative period has its own characteristics. The patient continues to receive detoxification agents and antibiotics.

The attending physician monitors temperature, urine output, daily diuresis. It is important to regularly listen to the noise in the intestines.

Proper nutrition is prescribed for the first postoperative days. When removing gangrenous appendicitis, the period after surgery is characterized by a longer course and the most benign diets.

In the very first days after the operation, the patient regains his strength, this is evidenced by the appearance of appetite, the restoration of defecation, and the normalization of temperature.

The postoperative period is different for all patients. It depends not only on the internal defenses of the body, but also on the psychological attitude of the patient himself for a speedy recovery.

Useful video

Gangrenous appendicitis is named according to the nature of the inflammation in the wall of the appendix. The form refers to the destructive. This means the inevitable destruction of the integrity of the wall.

In the abdominal cavity, surgeons find a fluid (effusion) of a serous or purulent nature with a rotten smell. The disease almost always proceeds with severe complications. The final diagnosis can only be made by visual inspection of the process.

The older the patient, the more likely the rapid development of gangrene. If in children and adolescents it is found in 8% of operated cases, then in older people after 60 years, the frequency reaches 33%.

Pathoanatomy of the inflamed process

The inflammatory process begins with the catarrhal stage, capillary expansion, an influx of lymphocytes trying to stop and localize the disease. Edema and infiltration of the wall are found. Small purulent foci are possible. Conventionally, this stage accounts for up to 6 hours from the onset of an attack in a patient.

Until the end of the first day, the appendix increases significantly, fills with pus. In 90% of cases, it is regarded as a phlegmon (delimited abscess).

If during this period the process is not removed, then foci of necrosis appear on the walls, and in the abdominal cavity the effusion takes on a purulent character. All layers are melted. The appendix looks dirty green in color, enlarged, the wall is flabby with areas of hemorrhage and necrosis. Up to three days are given for the development of necrosis.

An intermediate picture of appendicitis in a patient is caused by phlegmonous-gangrenous changes. In the gangrenous stage, adjacent tissues and organs join the inflammation of the process. Bowel loops, omentum, peritoneal sheets suffer. They show a plaque of fibrin, hemorrhages. Hyperemia and infiltration appear in the caecum and ileum.

The combination of an abscess and dead tissue is more often found in the very end zone of the appendix

The outcome is possible self-amputation of the appendix (detachment from) or perforation of the wall (perforation) due to rupture. Surgeons know that any manipulation against the background of a gangrenous appendix in a patient always leads to a breakthrough of purulent contents.

There is also an opinion that the speed of anatomical changes does not depend on the timing of the onset of an attack of pain. Therefore, the attitude to the given references to time is rather conditional.

What causes gangrenous disorders?

Important risk factors for the transition of inflammation to the stage of gangrene are:

• impaired blood circulation in the elderly patient due to widespread atherosclerosis;
• intestinal ischemia due to obstructed patency of the mesenteric arteries (thrombus formation);
• congenital underdevelopment of the supplying arteries (in pediatric patients).

These changes in the patient's body lead to the development of the main cause - impaired microcirculation in the wall of the process. Further joining:

They exacerbate the course of the disease. A gradual change in the forms of inflammation from catarrhal to phlegmonous is possible, untimely provision of specialized assistance, a transition to destruction and purulent fusion.

Manifestations

Symptoms of gangrenous appendicitis begin according to classical canons with catarrhal inflammation. The patient has pain in the epigastrium, nausea, vomiting, fever. For 2 hours, the pain "descends" into the right iliac region with the normal position of the process. They can radiate to the hypochondrium on the right, to the coccyx, to the central zone of the abdomen.

Acute gangrenous appendicitis, which develops from phlegmonous, first causes jerking or throbbing pains, then subsides due to the complete destruction of sensitive nerve endings in the wall. Phlegmonous appendicitis can be mistaken for gangrenous, which, with timely surgical intervention, is of no practical importance.

Vomiting becomes repeated, repeated. The temperature rises to high numbers, which is accompanied by chills. The patient turns pale, breaks out in a cold sweat. On examination, the doctor detects dryness of the tongue.

Local soreness and board-like density of the patient's abdominal muscles is a sign of peritoneal irritation, the stomach does not take part in the act of breathing

In a blood test, leukocytosis does not always rise sharply, but a significant shift of the leukocyte formula to the left draws attention. Differential diagnosis is particularly difficult in female patients. It is necessary to exclude right-sided adnexitis, rupture and torsion of an ovarian cyst, ectopic pregnancy, apoplexy of the appendages.

With an atypical location of the process, the disease gives a mask:

• diverticulitis of the large intestine;
• right-sided pyelonephritis;
• renal colic;
• acute cholecystitis;
• gastritis or duodenitis;
• perforated stomach ulcer;
• acute pancreatitis.

What helps in diagnosis?

The doctor has to focus on his practical experience and laboratory parameters, since ultrasound of the abdominal cavity is not an informative enough study for appendicitis. But hardware techniques make it possible to exclude gynecological pathology in women, pancreatitis, ectopic pregnancy, urolithiasis, pyelonephritis. A gynecologist is called for a consultation, a rectal examination is performed in men.

What is the difference between the gangrenous-perforative form?

Gangrenous-perforative is a form of inflammation of the process with a mandatory violation of the integrity of the wall. Its isolation emphasizes the severity of the course, substantiates complications and the risk of surgical intervention.

The danger lies in the presence of penetration of purulent contents into the abdominal cavity. There is local or diffuse peritonitis. The patient has pronounced signs of peritoneal irritation, there is no intestinal peristalsis. Disturbed by palpitations, dizziness, weakness.

In blood tests - leukocytosis and ESR are growing, the formula is shifted to the left. There are changes in the urine (cylinders, protein), which indicates toxic damage to the kidneys.

Treatment

If there are still opinions about the possibility of conservative treatment, then the gangrenous and gangrenous-perforated form can only be cured surgically. To stop the spread of the inflammatory process to the peritoneum, it is necessary to remove the source of pus.

The operation is most often performed according to emergency indications after 2-4 hours from the onset of the attack.

A planned approach at a later date is possible, but rather it should be called “delayed”. Time is spent on stabilizing the patient's condition with a drop in pressure, heart failure caused by intoxication, and decompensation of diabetes mellitus.

In preparation for a surgical operation, patients are detoxified, liquid, antibiotics, and agents to support cardiac activity are dripped. Through the probe, the contents of the stomach are removed. Doctors must find out the patient's tendency to allergic reactions.

It is important to know this for choosing the method of processing the surgical field, anesthesia. The patient must sign his consent to the surgical intervention, for the children - this is done by parents or guardians.

For complete anesthesia, one of the methods is used:

• creation of an anesthetic infiltrate;
• conductor block of the nearest nerve plexuses;
• general anesthesia.

The anesthetist chooses it depending on the patient's age, excitability, drug tolerance. Sufficient anesthesia helps to reduce the time of surgical intervention, the risks of postoperative complications, and complete healing.

Local anesthesia is not used in children, fear and excitement prevent them from completely relaxing the abdominal wall and examining the cavity. For adult patients, local anesthesia is quite enough for the catarrhal form of appendicitis, but probable peritonitis and the need to expand the operation for gangrene require general anesthesia. Since it suppresses the gag reflex, it relaxes the muscles when muscle relaxants are administered.

After processing the surgical field and anesthesia, the surgeon performs a layer-by-layer dissection of the peritoneal wall. The method allows suturing bleeding vessels, injuring muscles less. The incision should be long enough to allow the doctor to examine the cavity. The muscles and their aponeuroses are manually separated along the fibers.

The omentum and intestines are brought into the open abdominal cavity. For inspection, a check of 50 cm of length on each side of the appendix is ​​necessary. The inflamed process is detected at the beginning of the large intestine ribbons.

The process is isolated very carefully so as not to cause spontaneous rupture

The appendix is ​​removed, and the remaining stump is sutured with a special hermetic purse-string suture. It consists in immersion inward and the possibility of connecting the serous membranes. If an effusion is found in the peritoneum, it is washed with sterile solutions, an antibiotic is administered. The patient's abdominal wall is sutured with dense threads that dissolve after a while.

7-10 stitches are applied to the skin. The need to combat peritoneal phenomena requires leaving a drainage tube. After stabilization of the patient's condition, the drainage is removed. The operation usually takes up to three hours. There are no special regulations. Time is determined by the severity of the condition, age, complicating factors (adhesions in the abdominal cavity, abnormal location of the process).

How is the postoperative period for the patient?

The first day is called the early postoperative period. The patient continues the introduction of detoxification agents, antibiotics. The doctor controls the temperature, urine output and daily diuresis, listens to intestinal noises.

In the following days, a gradual recovery of the patient's condition is observed: appetite and defecation appear, the temperature returns to normal. With daily dressings, the surgical suture is examined, the wound is washed through the drainage. Anxiety is caused by pain in the suture area, discrepancy, prolonged absence of stool.

Unlike a simple form of appendicitis, the patient needs:

• stronger antibacterial agents (from the group of cephalosporins, antibiotics Levofloxacin, Ornidazole, Amikacin);
• painkillers;
• introduction to relieve intoxication Albumin, fresh frozen plasma, Rheosorbilact, Refortan;
• prevention of the development of thromboembolism and stress ulcers of the stomach.

Infusion therapy - the basis of recovery

Consequences of Delayed Surgical Care

With timely surgical intervention, if the process has not ruptured, patients quickly recover. It is noticed that they have more often than with other forms, suppuration of the wound is possible. The refusal of the operation threatens with serious consequences.

Delayed removal of the appendix provokes:

• perforation (perforation) of the wall, pus flows into the abdominal cavity;
• detachment (self-amputation) of the caecum due to tissue melting;
• the development of purulent and purulent-fecal peritonitis, while the patient's condition becomes heavier before the eyes, the temperature is rarely significant, there is no usual dependence on the pulse rate, a survey radiography of the abdominal cavity confirms peritonitis by the presence of a fluid level in the intestine;
• multiple abscesses in the organs of the abdominal cavity and pelvis;
• abdominal sepsis;
• pylephlebitis - purulent inflammation of the portal vein of the liver.

These conditions progress quickly, even at lightning speed, provoke insufficiency of internal organs. Irreversible damage leads to the death of the patient.

Diet after surgery

A special approach to nutrition in gangrenous appendicitis is associated with a longer violation of intestinal motility. The abdominal organs are more severely injured, which slows down the patient's digestion. In the first 24 hours, it is allowed to drink only boiled water, fat-free kefir, a decoction of dried fruits. From six to seven times a day they give small portions of liquid broth, soup with cereals.

It is allowed to drink mineral water without gas, slightly sweet weak tea, rosehip broth

On the second day, in the absence of signs of complications, mashed boiled meat, mashed potatoes, sausages, cottage cheese, liquid cereals with butter are added. Such a diet is maintained for patients until a sufficiently pronounced peristalsis appears.

From the third day, with full bowel function and defecation, it is allowed to expand the diet to table number 5. You will have to observe the exclusion of fatty and spicy dishes, smoked meats, marinades, lard, spices, eat often and little by little.

What regimens do patients need?

In an uncomplicated course, the patient can and even needs to get up 5-6 hours after the operation. Early active movements, therapeutic exercises, deep breathing exercises prevent pneumonia.

Against the background of complications, walking is delayed for 2 days. The first rise from bed is best done in the presence of relatives or medical personnel. Expansion of the regimen is allowed by the doctor individually. It is recommended to wear a bandage or wrap tightly with a towel for less pain.

The patient is usually discharged on the tenth day. During the month, a sparing regimen of physical activity is required. Heavy lifting is contraindicated for three months. Allowed exercises to strengthen the muscles of the legs, arms, leisurely walking.

Stitches are removed in the treatment room when the wound is in good condition.

Sports activities (running, weightlifting, football, volleyball) will have to be postponed for at least 3 months. The decision to allow exercise should be made with your doctor. A clear dependence of the complications and results of the operation in a patient on the neglect of the disease requires one's own control over abdominal pain, the timely call of an ambulance, and observation by specialists.

Appendicitis is a disease characterized by the appearance of inflammation of the appendix of the caecum. The disease manifests itself in various forms, one of them is gangrenous appendicitis. The gangrenous form of acute appendicitis is characterized by tissue necrosis. Signs of appendicitis gangrene are markedly different from other symptoms, so it is important to pay attention to the state of health, consult with specialist doctors in a timely manner and strictly follow their instructions for treatment and nutrition in the postoperative period. The consequences of gangrenous appendicitis are very difficult to treat: perforation of the organ wall and the release of purulent and fecal masses into the abdominal cavity can occur.

Inflammation occurs through several stages of development. It can turn into phlegmonous, gangrenous or gangrenous-perforative appendicitis. The appearance of such types of disease occurs due to the following reasons:

• Appendicitis was not noticed within one day and tissue necrosis began.
• The formation of the disease in adulthood and old age. Vascular changes that occur in older people can cause accelerated development of the disease.
• Violation of blood circulation in the intestines.
• Thrombotic plaques in blood vessels penetrating the appendix.
• Atherosclerosis of the intestinal vessels.
• The appearance of infection in the area of ​​\u200b\u200bthe disease.
• Excessive activity of immune cells.
• Violations of the outflow of the contents of the appendix, stagnation of exudate.

Symptoms

The following signs indicate the appearance of a gangrenous type of appendicitis:

1. The disease is characterized by necrosis and death of nerve endings, so the intensity of pain can be significantly reduced compared to ordinary appendicitis.

2. In the acute stage of the disease, the main symptom will be indomitable vomiting, which does not bring relief.

3. The tongue is dry, sometimes with a brown coating.

4. Various symptoms of intoxication of the body are possible - nausea, lethargy, cold sweat.

5. Despite the appearance of an inflammatory process, body temperature will remain within normal limits.

6. Pathologically rapid heartbeat (toxic scissors syndrome).

8. Pain, if it appears, is located in the right iliac zone.

Treatment Methods

The treatment of gangrenous disease is to perform an abdominal operation to remove the inflamed area (appendectomy). Surgery is performed in two ways:

1. Traditional - the process is removed by the surgeon through an incision in the abdominal wall. The operation takes place under general anesthesia.

2. Laparoscopy - tools for removing a gangrenous appendix are placed directly into the abdominal cavity through several microscopic punctures. One such tool is a small camera located at the end of the microtube. In the process of performing surgical procedures, the doctor sees the image transmitted by the camera on the monitor screen, which helps to perform the operation as accurately as possible.

Postoperative period

Therapeutic manipulations for the speedy recovery of a patient who has undergone an appendectomy of a disease in a gangrenous form will be as follows:

1. The appointment of a strong, targeted antibiotic therapy, with admission under the strict supervision of a specialist doctor. Most often, the doctor prescribes drugs from the group of Cephalosporins, Macrolides or Levomycetins.

2. Pain relief with the help of narcotic and non-narcotic analgesics, which are administered intramuscularly to the patient.

3. Carrying out detoxification therapy using physiological infusion solutions (sodium and potassium chloride, glucose, plasma, albumin).

4. Prevention of blood clots in the operated areas of blood vessels (wearing elastic bandages and stockings, anticoagulant pharmaceuticals) and the occurrence of diseases of the gastrointestinal tract (enzymatic agents, blockers of increased secretion of hydrochloric acid).

5. Compliance with a special diet, a special diet.

6. Daily blood sampling.

7. Dressings are made every day, with complete disinfection of wounds, drains, using only sterile dressings. The junior medical staff conducts a daily assessment of mechanical damage and the stage of wound healing. Prevention of purulent complications is carried out.

8. Appointment of simple exercises and a complex of physiotherapy exercises as the patient recovers. Breathing exercises and walking.

Diet

When recovering from an appendectomy, there may be problems with the motility and digestive activity of the gastrointestinal tract. If the consequence of the disease is inflammation in the abdominal cavity, then this further exacerbates the painful condition. The surgical intervention proceeds and heals more difficult than with ordinary appendicitis. Of course, this is reflected in the features of postoperative nutrition. Dieting is an important point of treatment:

1. On the first day, it is advisable for the patient to even starve a little. He is allowed to drink warm water without sugar and gas, weak tea, weak meat broth without added salt. It is better to take water or food 6-7 times a day, in small portions of a teaspoon. It is necessary to carefully monitor the condition after each meal.

2. Second day. If there are no unpleasant symptoms or complications, liquid nutrition can be supplemented with pureed dietary meat, light vegetable or fruit puree from non-allergic products. It is permissible to give the patient a little sugar-free yogurt, low-fat cottage cheese, or dried fruits soaked in water. In cases of deterioration of the patient's condition, the diet is left at the previous liquid insipid stage.

3. On the third day, the intestines are usually actively restored, digestive and excretory processes are launched. In this case, the menu can be significantly expanded, the list of foodstuffs will include small pieces of butter, pureed marmalade, sour-milk products and mashed soups.

In the process of compiling the menu for the patient, it must be remembered that the food taken should be free of salt and spices in the first week after the operation. Compliance with the diet and diet agreed with the doctor is essential, as they are fundamental factors in the success of treatment and the speed of recovery.

Possible Complications

Inflammation of the process in the gangrenous form and gangrenous-perforated appendicitis are very dangerous for their consequences, such as:

• purulent abscesses in the pelvic area;
• separation of the appendix from the caecum;
• the formation of a dense infiltrate around gangrenous appendicitis. The appearance of such a neoplasm requires long-term treatment. Only after the infiltrate disappears, you can begin to remove the inflamed appendix;
• purulent and purulent-fecal inflammation of the peritoneum. If help is not quick, peritonitis is sometimes fatal;
• an abscess entering the bloodstream.

Any complication of phlegmonous gangrenous appendicitis is very difficult in the body and can cause significant damage to health, so in no case should you take the disease lightly and allow it to develop. When the first symptoms of appendicitis occur, an urgent appeal to a specialist is required.

The appendix is ​​a appendix, an appendage of the caecum. Inflammation of a person's appendix is ​​called appendicitis. If you do not delay and consult a doctor in time, appendicitis is easily treated. This disease can have life-threatening complications. Types of gangrenous appendicitis: acute, purulent, with peritonitis. All types require surgical intervention. Causes and symptoms of the disease with peritonitis, what it is, acute purulent perforative and fecal appendicitis, diet and postoperative period, pictures - details below.

The main causes of acute gangrenous appendicitis

Knowing about the factors and causes that cause appendicitis, you can reduce the risk of the disease. Removing the appendix does not harm the body, but it is better not to bring it to surgery.

Doctors focus on such important factors:

1. Heart disease - atherosclerosis, tachycardia, bradycardia. Violation of the rhythm of heart contractions leads to thrombosis of the arteries, and poor circulation to inflammation of the appendix.
2. Chronic and acute inflammation of the intestine. Poor and long digestion of food affects the state of the intestinal microflora. stool obstruction causes congestion
3. intestinal contents and can also lead to inflammation of the appendix.
4. Poorly developed immunity, stress, bad habits. The inability of the body to resist pathogenic bacteria.
5. Women are at risk, bacteria from the fallopian tubes can pass into the appendix and cause inflammation. Regular examination by a gynecologist reduces the spread of inflammation throughout the body.
6. The reason may be the anatomical structure of the vermiform segment, its bends, length and width.
7. Chronic diseases of the genitourinary system, colitis.
8. Acute inflammation of the digestive system, liver and stomach.
9. Wrong nutrition. The use of sugar and salt, overeating, fast food, snacking in front of the TV. Insufficient amount of vegetables and fruits, natural vitamins in the diet. Food before bed.

The disease is much easier to prevent than to treat. Treatment carried out on the first day of illness is more effective. If primary symptoms appear, you should immediately contact a medical institution or call an ambulance. As soon as the following symptoms appear, urgently see a doctor - high fever, local pain in the navel, weakness, nausea and vomiting, severe sweating, sharp pain, sometimes subsiding, diarrhea, tachycardia;

Features of appendicitis with peritonitis

A dangerous form of complication of appendicitis is peritonitis. If surgical care is not provided in the first 24 hours, then a fatal outcome is possible. What is peritonitis? Inflammation of the peritoneum that occurs when an infection enters the abdominal cavity.

The main cause of peritonitis is a ruptured appendix.

Treatment of this disease is carried out only by surgery. During the operation, damaged tissues and organs are removed, the abdominal cavity is cleansed of pus, feces, lymph and stomach acid. Refusal of the operation will lead to negative consequences.

3 stages of peritonitis:

1. Reactive, accompanied by severe pain in the abdominal cavity. This stage lasts no more than a day after the rupture of the appendix. The temperature rises, the patient has nausea and vomiting.
2. Toxic stage up to 3 days. The body is dehydrated, pressure drops, general weakness appears. Toxic substances enter the blood.
3. The terminal stage is the hardest. The patient begins to have convulsions, the pulse is not felt. The patient loses consciousness and may fall into a coma.

The operation takes 30-40 minutes and is performed under general anesthesia. Before the operation, an enema is given to cleanse the stool. A hygienic shower, bandaging the limbs and emptying the bladder are important steps in preparing for the operation. Doctors check the patient's tests and find out the predisposition to allergies.

Purulent appendicitis: postoperative period

The operation is over, another important stage of the postoperative period begins. When leaving anesthesia, there is nausea and vomiting, so the patient must be turned to the left side. You can sit down and change the position of the body after 12 hours. The next day, it is recommended to carry out hygiene procedures and get up.

On day 3, the patient begins to walk.

During this period, you can not lift weights and all physical activity is excluded. Further treatment consists in the systematic administration of antibiotics. The internal sutures dissolve themselves, and the external ones are removed after 9 days. Gangrenous appendicitis - inflammation and necrosis of the entire appendix or some of its parts. Violation of blood circulation in the appendix of the caecum leads to tissue death - gangrene, sometimes a violation of the integrity of the walls.

Consequences of the disease in case of refusal of surgery:

• Blood poisoning;
• Formation of venous thrombi;
• Independent detachment of the appendix from the caecum;
• Leakage of pus and feces into the abdominal cavity;
• Severe intoxication;
• Rupture of the appendix.

If you do not treat gangrenous appendicitis, then it turns into acute gangrenous appendicitis and poses an even greater danger to human life. Intoxication of the body increases, the heartbeat quickens, the tongue becomes dry and dark. Urgent surgical intervention is needed.

Gangrenous appendicitis: postoperative period

Against the background of gangrenous changes in the appendix, the risk of postoperative complications increases. The postoperative period differs from the usual purulent appendicitis.

Postoperative measures:

• Daily blood tests;
• Washing the wound and drains;
• dressings;
• Narcotic and non-narcotic painkillers;
• Entering glucose and saline solutions;
• Powerful antibiotic therapy;
• Physiotherapy;
• Massage and breathing exercises.

It is important during this period to carefully and accurately follow all the recommendations of the doctor. Only 2 weeks after the operation, you can wash, and before that only shower. Only a month after the operation, you can slowly increase physical activity.

In the early days, it is better to stop smoking.

Proper nutrition is of great importance in the postoperative period. Since intestinal motility is disturbed, digestion slows down. In the first 24 hours, drink boiled water, kefir, a decoction of apricots, apples, dried apricots and other dried fruits. For lunch, liquid soup and broth. In the future, continue to follow the diet. More fresh vegetables and fruits, dairy products.

Exclude the following products:

• Hot sauces and seasonings;
• Chocolate and sweets;
• Fatty meals;
• Flour products.

Gangrenous appendicitis is a dangerous disease. Can lead to serious consequences. Knowing the causes of inflammation of appendicitis makes it possible to take action and avoid serious illness.

What is gangrenous appendicitis (video)

Timely access to medical institutions will reduce the risk of death. The surgery will save a life. Proper nutrition and diet will help you recover in the postoperative period.

At the penultimate stage of inflammation of the appendage of the caecum, gangrenous appendicitis develops. The condition is characterized by the death of the wall of the intestinal process with pronounced symptoms with certain features of the course in children and women. The consequences of the disease are extremely dangerous. This is the perforation of the wall, the outpouring of pus into the peritoneum. If left untreated, death occurs. Therapy is carried out in a complex - surgically with medication, diet and folk recipes.

Gangrenous appendicitis simultaneously causes necrosis of intestinal tissues.

What does it represent?

Gangrenous appendicitis is accompanied by death (necrosis) of the tissues of the inflamed appendix of the caecum. A vivid clinical picture is developing, which makes it possible to distinguish the pathology from other inflammations of the appendix. Necrosis is usually local without affecting the entire surface of the organ. Gangrene is classified as a secondary acute process that occurs on the 2nd-3rd day of the development of pathology in the absence of medical care. The primary type develops in old people against the background of an appendix infarction. The condition is caused by a violation of the blood supply to the organ, followed by tissue death.

If measures are not taken, the acute gangrenous form of inflammation of the appendix manifests itself on the 2nd-3rd day, and in especially severe cases - after 7-12 hours.

Reasons for the appearance

People with the following disorders are primarily at risk for developing gangrenous inflammation of the appendix:

• weakness of the walls of blood vessels (mainly in the elderly);
• the formation of cholesterol deposits on the walls of the arterial vessels of the intestine;
• anomalies in the development of arteries (congenital underdevelopment, which is typical for childhood);
• thrombosis of arteries and veins of the appendage of the caecum.

Gangrene may worsen if:

• weakening of the body against the background of infection;
• increased activity of immune cells;
• vascular problems;
• violation of the outflow of the contents of the appendix;
• improper treatment of acute appendicitis.

Symptoms and features

The clinical picture of secondary gangrenous inflammation of the appendix is ​​manifested by symptoms:

• indomitable, repeated vomiting without relief;
• symptom complex of "toxic scissors": temperature 36.6°C with tachycardia up to 100-120 bpm;
• body temperature remains within normal limits, less often - low;
• a mild general condition of the patient against the background of a powerful poisoning of the body with the products of tissue decay;
• dryness of the tongue with a whitish or yellowish coating of the root.

Primarily emerging gangrenous appendicitis is characterized by other symptoms, such as:

• Cutting pains on the right in the iliac zone - an acute stage of an epididymal infarction. Sensations - sudden, quickly subsiding due to the destruction of nerve endings;
• Tension, soreness of the abdomen up to the state of irritated abdominal muscles;
• Severe condition;
• Syndrome of intoxication of the body with fever and chills.

Features of inflammation in women

Along with the general signs of gangrene, women develop specific symptoms:

• Symptom of Shilovets, expressed by severe pain in the supine position. Sensations are intensified on the right iliac zone. When changing position to the left side, the pain shifts lower.
• Promptov's sign, manifested by palpation of the cervix through the vagina - when captured, the organ vibrates. The absence of pain indicates the development of inflammation of the appendix.
• Clinic Zhendrinsky, determined by the absence of pain when pressing on a point with a distance of 2 cm below the navel.

Features of the painless stage of gangrenous appendicitis - blurred, diffuse pain, soft, palpable abdomen, no signs of peritoneal irritation, normal temperature.

Features of symptoms in children

Diagnosis of primary or secondary gangrene of appendicitis according to the clinical picture in children is difficult. The clinic is blurred, but the development of gangrene of the appendage of the caecum is extensive. You can suspect appendicitis in babies by the following manifestations:

• increased stool;
• weakness and lethargy;
• pain when pressing on the stomach;
• restless sleep;
• refusal to eat;
• muscle tension on the right iliac zone.

Features of the child's behavior:

• restlessness;
• crying for no reason
• the desire to press the legs to the stomach for a long time.

Perforation of the appendix

Gangrenous-perforative appendicitis is the final stage of inflammation of the appendix following gangrene. The danger of the condition is the perforation of the walls of the appendage with the outpouring of its contents into the surrounding space of the peritoneum. During the rupture of the wall of the inflamed organ, the patient develops severe pain in the anterior-lateral section of the peritoneum on the right. Over time, the sensation intensifies and spreads throughout the abdomen.

Along with pain, repeated, debilitating vomiting appears due to progressive poisoning of the body. The patient has fever, tachycardia, dry tongue coated with brown coating. Gangrene with perforated appendicitis is characterized by a swollen, tense abdomen with a complete absence of intestinal peristalsis and stool. As a result, there is a risk of developing purulent inflammation of the peritoneum (peritonitis). But more often the process is completed by a local purulent abscess.

Examination methods

The following methods are used for diagnostics:

• clinical analyzes of biofluids (blood, urine);
• physical examination with palpation of the abdomen;
• Ultrasound, CT - to obtain data on the general condition and shape of the diseased organ;
• radiography - to visualize the structure of the process;
• diagnostic laparoscopy - a mini-operation that allows you to simultaneously diagnose (by thickening, greenish-black tint of the process of dead tissues) pathology and operate on the patient.

Detection of gangrene of the vermiform appendage is complicated due to the blurring of symptoms against the background of the death of nerve endings along with the tissues of the organ. The absence of pain makes patients think about the retreat of the disease.

Medical operation

Any form of appendicitis is treated surgically. An operation to remove an inflamed appendage is called an appendectomy. The following techniques are used:

• Classical with opening of the peritoneum. The diseased organ is removed and sent for analysis. When the contents are poured into the cavity, the cavity is flushed with the installation of drainage.
• Transluminal with excision of the appendage through natural openings in the human body with flexible instruments.
• Laparoscopic with the introduction of an instrument into small incisions on the abdominal wall.

Rehabilitation

Individually and strictly according to the doctor's indications, light exercises are prescribed in the form of therapeutic and breathing exercises, massage, medicines, diet, folk remedies. Rules for proper recovery after surgery for removal of the appendix with gangrene:

• control of the patient's condition;
• conducting detoxification;
• physiology recovery tracking.