Acute gangrenous-perforated appendicitis - causes, symptoms, treatment and rehabilitation. Gangrenous appendicitis: symptoms, consequences, surgery, postoperative period Primary gangrenous appendicitis develops as a result of

An attack of appendicitis can happen to anyone. Inflammation of the appendix begins to appear unexpectedly and develops quickly. The pathology has several stages. The last and most dangerous is gangrenous appendicitis. This form of inflammation often ends in the death of a person.

At this stage of the patient’s disease, surgery does not always save the patient. The surgeon's manipulations can cause rupture of the tissue of the appendix. There is an instant outpouring into abdominal cavity its purulent contents.

Which appendicitis is considered gangrenous?

The disease reaches a dangerous stage two to three days after the first signs appear. acute inflammation appendix. Without rendering medical care the clinical picture worsens over time. The vermiform appendix changes pathologically beyond recognition. Its walls are destroyed, which manifests itself in their partial melting and necrosis.

When an incision is made into the abdominal cavity of a patient with gangrenous appendicitis, a putrid odor spreads. The process itself is characterized by:

• increase in size;
• color change to dirty green;
• presence of hemorrhages;
• tissue necrosis;
• release of pus.

Inflammation can spread to the peritoneal organs adjacent to the intestines.

Causes

In rare cases recorded by the medical history, gangrenous appendicitis can develop six hours after the first attack. This form of the disease is considered primary. It can be caused by dysfunction of the appendix, which:

• appear due to the presence of pathological changes in its vascular walls;
• arise due to the formation of cholesterol plaques in the gastrointestinal tract;
• caused by thrombosis of the arteries and veins of the intestine.

However, most often the cause of the development of gangrenous processes in the appendix is ​​the lack of medical care in the first two to three days after the onset acute appendicitis.

The following can also speed up the course of the initial (not so dangerous) stages and contribute to a more rapid appearance of suppuration in the intestines:

• disturbances in outflow from the appendix;
• his illness vascular network which led to partial tissue damage;
• excessive activation of immune processes;
• penetration of infections into the body and their development.

Symptoms

Gangrenous appendicitis has a characteristic clinical picture. It is caused by increasing intoxication of the body and the release of breakdown products into the blood. The patient's condition is characterized by:

• aversion to food;
• feeling of chills;
• an increase in temperature to thirty-nine degrees (not always);
• nausea turning into vomiting;
• defecation disorders (constipation, diarrhea);
• the appearance of plaque on the tongue (it can be white, yellow or brown);
• increased flatulence, hardening of the abdomen;
• general weakness;
• dry mouth;
• loss of strength;
• increased heart rate up to one hundred and twenty beats per minute;
• lethargy and tearfulness (in children).

Some patients may experience improvement. However, such relief is false. It is a negative indicator and indicates the death, along with the intestinal tissues, of the nerve endings responsible for pain.

Gangrenous-perforated appendicitis

Partial necrosis of the process can cause holes to appear in its walls. Doctors diagnose such tissue damage as a subtype of the main stage. It is called acute gangrenous-perforated appendicitis. Identification of complications in separate form important for making correct medical decisions during surgery and during postoperative care.

Perforation of the appendix wall is quite sensitive. At the moment of tissue rupture, a person experiences severe pain with right side belly. After some time, the pain becomes constant, the sensations spread throughout the entire abdominal cavity.

Consequences of lack of treatment

If at the stage of gangrenous appendicitis the patient does not see a doctor, then his condition worsens significantly. The main complications are:

• development of pylephlebitis - purulent inflammation accompanied by portal vein thrombosis;
• the occurrence of abscesses in the peritoneum (their localization occurs in the pelvic area, between the intestines, under the diaphragm);
• the appearance of tissue infiltration, protecting neighboring organs from the spread of the pathological process.

However, the most terrible complication that can result from inflammation of the appendix is ​​gangrenous peritonitis.

Appendicitis, in which the appendix ruptures, is feared by any surgeon. Indeed, in this case, saving the patient is not always possible. The patient may die from blood poisoning.

Diagnostics

Due to the pronounced symptoms, it is not too difficult to recognize gangrenous appendicitis. To do this, it is enough to examine the patient and listen to his complaints. Palpation is carried out extremely carefully. Excessive pressure can lead to rupture of the walls of the inflamed appendix.

Sometimes the course of the disease can be complicated by the development of other diseases. In case of doubt, if the patient’s condition allows, the doctor may prescribe additional methods emergency diagnostics:

• Blood and urine tests. Increased content leukocytes will indicate the presence of inflammation in the body.
• Ultrasound of the appendix. When the pus drains, the appendix will not be clearly visible.
• Tomography, radiography. Allows you to determine the structure and shape of the appendix.

In case of gangrenous form of appendicitis, its removal is mandatory. Cutting off the affected tissue as quickly as possible reduces the risk of complications after surgery.

Traditional appendectomy

Removal of the appendix can be done in several ways. The most commonly used method is traditional abdominal surgery.

1. The patient's peritoneum is opened using a scalpel.
2. The gangrenous appendix is ​​removed through the incision.
3. After the procedure is completed, a suture is applied.

Acute gangrenous appendicitis requires a quick response from doctors. Therefore, preparing the patient for surgery takes a minimum amount of time. It is limited to:

• prohibiting the patient from taking water and drinking;
• shaving the hair in the lower abdomen and pubic area.

If a classic appendectomy is performed on an adult in adequate condition, then it is sufficient to use local anesthesia. General anesthesia is administered in several cases: if a person is very overexcited, during operations on young children, and also in case of peritonitis.

The operation is carried out as follows:

• a small oblique incision is made;
• a ligature is applied;
• the gangrenous part of the appendix is ​​cut off;
• its remainder is inserted into the intestine, which is sutured;
• sanitation is done using an antiseptic;
• the wound is sutured.

In cases complicated by peritonitis, drainage is performed in the peritoneum.

Laparoscopy

In addition to the classic abdominal surgery, other types of appendix removal are also possible. The laparoscopic method involves the use of a micro-telecamera and is less traumatic.

1. A small hole is made in the patient's abdomen through which an optical device is inserted.
2. Laparoscopic manipulators are inserted through additional ports.
3. The gangrenous appendix is ​​cut off and removed.

This method is the safest. Rehabilitation period lasts a minimum amount of time.

Complications after appendix removal

Sometimes the operation does not have very successful consequences. Most often this happens if the patient sought help late and developed very severe gangrenous appendicitis. The postoperative period, in this case, will be long and difficult.

The most common negative consequences observed are:

• suppuration or inflammation of the suture;
• separation of the appendix from the intestine;
• development of aseptic thrombophlebitis;
• the occurrence of purulent peritonitis.

The quick response of doctors helps to successfully deal with complications that arise. However, because of them, recovery is delayed.

Rehabilitation

The duration and course of the postoperative period depends on the technique used to remove the appendix and the degree of complexity of the patient's condition. On the first day after the excision procedure, the patient is constantly monitored by a nurse. Her responsibilities include:

• monitor for symptoms of bleeding;
• control temperature;
• inspect the seam;
• question the person about the appearance of pain and appetite, monitor the need for bowel movements.

Those patients who had uncomplicated gangrenous appendicitis have good prognoses for these indicators. The postoperative period in the following days includes:

• taking antibiotics;
• anesthesia;
• infusion detoxification therapy;
• prevention of occurrence negative reactions the body in people at risk (stress ulcers of the intestines and stomach, thromboembolic complications);
• daily blood sampling for tests;
• dressings;
• breathing exercises, physical therapy, massage.

Rehabilitation can last from one and a half weeks to a month. Young children and overweight people take longer to recover.

Diet

In addition to following all the doctor’s recommendations and prescriptions, which will help you quickly forget what gangrenous appendicitis is, it is important to follow a diet after surgery.

• On the first day you can’t eat at all. Drinking in small quantities is allowed. Doctors recommend drinking low-fat kefir, tea with sugar, and still water.
• If the patient feels well, on the second day you can eat a little thin porridge, mashed potatoes, boiled lean meat, and cottage cheese casserole. If the patient’s condition has not improved, then the first day’s diet should be followed.

The food temperature should be between twenty and fifty degrees.

In the days following removal of gangrenous appendicitis, you can add vegetable purees, baked fruits, fish and meat broths to your diet. A week after the operation, you are allowed to eat dried apricots and honey.

There are foods that need to be excluded from the diet during the recovery period. These include:

• pickles, smoked foods, fatty, spicy, fried;
• bread, pastries;
• sauces, spices;
• alcoholic drinks;
• sausages.

A proper diet is an important component of the recovery process after removal of gangrenous appendicitis. Therefore, it is very important to make changes to your diet that your doctor recommends. Also, for several months after the operation, you should not lift heavy objects or physically strain the body. A gentle attitude will help him recover faster from a dangerous pathology.

Inflammation occurring in the appendix is ​​called appendicitis. As the disease develops, it goes through several stages from mild, correctable with drug treatment, to complex. Gangrenous appendicitis is a type of lesion of the appendix and the penultimate stage of the disease, dangerous in that it often leads to the death of a person.

In this position use surgical intervention is not salvation. As a result of the surgeon's actions, a violation of the integrity of the appendix may occur. The appendage bursts and the pus contained inside ends up on the abdominal organs. Peritonitis develops sharply and tissue necrosis occurs.

This stage of appendicitis does not occur immediately, but 2-3 days after the first signs of the disease appear. During this period, signs of phlegmonous-gangrenous changes in the tissues of the organ appear. Lack of therapy leads to deterioration of the patient's condition and the development of complications. The inflamed organ changes, the outer walls collapse and die. During the operation, the smell of rot comes from the wound. The appearance of the process is characteristic features last stage:

• Significant increase in size;
• The color of the appendix has changed to a dirty green hue;
• Areas of blood are observed;
• Tissue necrosis is visible;
• Sources of pus leakage.

The danger of acute damage to the appendix is ​​that it affects internal organs located close to the appendix. In particular, inflammation affects organs located in the abdominal cavity. If medical assistance is not received, gangrenous appendicitis turns into a gangrenous-perforated disease, the wall of the organ becomes perforated, and pus leaks out.

Gangrene of the appendix often develops due to the lack of adequate treatment on the third day. Fulminant development (6-12 hours) of the penultimate stage of appendicitis is extremely rare. May also occur in young children when the immune system is not fully formed and cannot resist the inflammatory process.

Causes leading to the occurrence of the disease:

• Patient's age and vascular system. With age, blood vessels develop pathological changes, contributing to a decrease in the quality of supply of oxygen and nutrients to the appendix, and also worsening outflow venous blood. Often the development of a primary gangrenous type of disease occurs.
• The appearance of cholesterol plaques in the arteries passing through the intestinal tract (atherosclerosis) leads to an insufficient amount of blood flowing to the intestinal tissues.
• In childhood, gangrene of the appendix can be caused by incomplete development of the vessels passing through the appendix. Hypoplasia in a child is a congenital disease.

• The development of thrombotic disease in the veins and arteries that supply and drain blood in the cecum.

Insufficient blood supply leads to oxygen starvation organ tissues, they begin to die. The rapid onset of the penultimate stage may be associated with infection or the occurrence of autoimmune processes in the lumen of the intestinal tract.

Symptoms

Acute appendicitis in the gangrenous stage will be characterized by a special clinical picture. The perforated type of the disease increases the intoxication of the body, more and more decay products are released into the blood (the tissue dies and releases toxins). The following symptoms appear:

• Loss of appetite and lack of perception appearance food.
• The patient is constantly shivering.
• Body temperature increases, the thermometer shows 39 degrees. It is worth noting that this does not always happen.
• State of nausea and vomiting.
• The patient's stool is disturbed. Periods of constipation may be followed by periods of diarrhea.
• IN oral cavity a coating appears on the tongue that is white, yellow or Brown color. The color change is noticeable near the root.
• More gases are produced in the intestines, and the stomach becomes hard.
• The patient feels weakness throughout the body and loss of strength.
• Dry mouth.
• The pulse quickens and reaches 120 beats in one minute.
• Young patients exhibit lethargy, moodiness, and tearfulness.

There comes a period when the patient feels that he is better, but this is only temporary relief, which is a false indicator of recovery. This means that along with the tissues of the appendix, the nerve endings responsible for pain also die.

Perforated disease

The dying tissue leaves behind small holes in the walls of the appendix. Medicine this phenomenon highlighted as separate and dangerous look gangrenous appendicitis, requiring certain treatment methods, surgery and further care in the period after surgery.

A perforated appendix is ​​painful. When tissue rupture occurs, the patient feels intense pain syndrome on right. At first, the pain manifests itself in attacks, but gradually turns into chronic stage and radiates throughout the entire abdomen.

Consequences

Lack of medical care in the event of gangrene of the appendix leads to a significant deterioration of the patient’s condition and the development of complications:

• Pylephlebitis develops inside. This means purulent inflammatory process provokes the formation of blood clots in the portal vein.
• The appearance of purulent sources in the peritoneal cavity. As a rule, the abscess is located between the intestines, in the area of ​​the diaphragm and small pelvis.
• An infiltrate consisting of tissue begins to form around the appendix. Its formation prevents the spread of inflammation to other internal organs.

The most dangerous complication considered a gangrenous form of peritonitis. This means that the walls of the appendix have ruptured. This development of the disease is fraught with blood poisoning. Surgeons try to prevent the onset of this stage, since the survival rate of patients is low.

Period after surgery

The chosen method of appendectomy and the severity of the disease determine the duration of the postoperative period. On the first day after gangrenous appendicitis and its removal, a nurse cares for the patient. It does the following:

• Observes the patient and records the appearance of symptoms of internal bleeding.
• Measures temperature, thereby monitoring the condition of the operated patient.
• Periodically inspects the seam site.
• Conducts a survey of the patient about sensations and appetite. Monitors the frequency of bowel movements.

The postoperative period of patients with removed gangrenous appendicitis has some features and will be different:

• The patient is prescribed drugs that have a strong antibacterial effect: Cephalosporin, Amikacin, Ornidazole, Levofloxacin.
• The patient is prescribed analgesics. These medications are taken as needed.
• To support the body, various solutions are administered intravenously: saline, glucose, albumin, rheosorbilact, fresh frozen plasma.
• Conducted preventive actions to prevent the formation of blood clots in blood vessels. Prevention is aimed against the occurrence of ulcers of the stomach and intestines due to stress. The operated person wears elastic bandages on his legs, he is injected with anticoagulant drugs. Medicines are taken that reduce the production of bile secretions: Omez and Kvamatel.
• A blood test is taken every day.

• Dressing the wound. The dressings are changed daily, the wound is washed, and the drainage system is disinfected. At the same time, an assessment of healing and the appearance of purulent discharge occurs.
• Completion of therapeutic procedures: exercise therapy, breathing exercises, massage. The duration and number of procedures are determined according to the patient's condition. The sooner a person activates all body functions, the faster and more successful the recovery process will be.

Compliance dietary nutrition in the postoperative period – a factor for speedy recovery:

1. For the first 24 hours after an appendectomy, you should not eat, only drink. The water must be clean, mineral, without gas. You can also consume weak sweet tea, compote, and low-fat kefir. You can eat pureed low-fat soup or chicken broth. There is a little, but often.
2. Second 24 hours. Add puree and pureed lean meat. They add to the menu: casserole with cottage cheese, boiled sausages, porridge cooked in water.
3. In the following days, diet No. 5 is prescribed. Exclude spicy, smoked, marinades, and pickles from the diet. Eat little, but often.

Complications

Carrying out surgical intervention before perforation of the walls of the appendix occurs, reduces the risk of complications. In this case, an infection occurs at the suture site and pus appears. Treatment of these complications does not require repeated surgery.

When a patient is on the surgical table with purulent peritonitis, the following consequences are possible:

• Not only pus, but also fecal matter gets into the abdominal cavity.
• The appendix is ​​separated from the body of the cecum.
• Multiple formation of small purulent wounds in the pelvis, in the area of ​​the diaphragm.
• The appearance of infiltration. This factor becomes an obstacle to surgery. Only after the formation has resolved can appendicitis be removed.
• Peritonitis with purulent formations.

When pain occurs in the lower abdomen on the right, the first thing that comes to mind is appendicitis. Inflammation of the appendix is ​​a very common situation; the problem can occur in both children and adults, and at the same time it is extremely dangerous. Delayed medical attention can lead to widespread infection and death. There are several varieties of this inflammatory process, one of the most unfavorable is gangrenous appendicitis.

What is gangrenous appendicitis

The gangrenous form of inflammation of the appendix of the cecum implies necrotic processes in the tissues of the appendix, which are irreversible. Often, death occurs only in some part of the organ, but sometimes it affects it completely. In the vast majority of cases, the gangrenous process is one of the stages of acute appendicitis, which develops after a couple of days if the patient does not seek help. In old age, this process can be an independent disease.

Gangrenous appendicitis is a common occurrence in children and adults.

If a patient with gangrenous appendicitis does not receive correct medical care, then the process becomes more complicated, turning into a gangrenous-perforating form - perforations form on the walls of the appendix.

At risk are older people due to specific age-related changes in their body and those patients who ignore the symptoms of developing appendicitis. In childhood, the process is most dangerous, since in case of infection it will spread extremely quickly throughout the body.

Causes

As already mentioned, gangrenous inflammation is a consequence of the development purulent form appendicitis, thus, the main cause of the disease is a prolonged inflammatory process. Usually it takes two days for the disease to develop into this form, but some factors can have an impact. Negative influence and significantly speed up this process:

• infectious infection;
• autoimmune diseases;
• disruption of the normal outflow of the contents of the appendage of the cecum.

However, there are also situations where the inflammatory-necrotic process is primary, and factors such as:

• old age, when the blood supply system to organs is disrupted due to damage to the walls of blood vessels;
• arterial atherosclerosis (the presence of cholesterol plaques on the walls of blood vessels);
• thrombosis blood vessels, supplying the appendix;
• congenital form of arterial hypoplasia (narrowing of the lumen) - in this case, appendicitis will most likely manifest itself in childhood.

When blood flow is disrupted, a so-called appendix infarction occurs, which is the impetus for the development of necrotic processes.

Symptoms

The main feature of gangrenous appendicitis, which is the result of an acute purulent form, is the presence of specific symptoms that are not typical for other forms of the disease. Thus, due to the necrotic process, the nerve endings also die - at first the patient feels a decrease in painful sensations, and some do not feel any significant pain at all. Other symptoms may also occur:

• frequent and profuse vomiting, which does not alleviate the condition;
• manifestations of intoxication of the body - severe weakness, but body temperature can be either absolutely normal or even reduced;
• the surface of the tongue is covered with a yellowish or whitish coating, the main density of the layer of which is concentrated at the root;
• “toxic scissors” syndrome - against the background of a serious condition and normal temperature there is pronounced tachycardia, the heart rate can be twice as high as normal.

Doctor's note: the problem has no symptomatic features depending on age and gender, but if the disease occurs in a child, the manifestations will increase catastrophically quickly, and the time to provide assistance will be significantly less than with gangrenous appendicitis in an adult.

If appendicitis occurs as a primary disease, then it is characterized by other manifestations. In such a situation, the pain is pronounced and sharp, but episodic. The serious condition is characterized by an increase in temperature, and the abdomen is tense and painful.

Separately worth noting specific symptoms gangrenous-perforated appendicitis:

• when a wall rupture forms, the patient experiences sharp pain which does not stop and gradually spreads throughout the abdominal area;
• the temperature rises significantly;
• heart rate increases;
• the surface of the tongue becomes dry, the coating becomes brown;
• vomiting becomes continuous;
• the stomach is swollen, intestinal peristalsis completely disappears;
• no stool;
• tension gradually spreads throughout the abdominal cavity.

Diagnostic measures

Diagnosis of gangrenous appendicitis as a secondary disease is considered difficult due to atypical symptomatic manifestations: pain is practically absent, as is temperature, the abdomen is soft. Such indicators often force doctors to determine that there is no reason for hospitalization, however, at the slightest suspicion, it is still necessary to undergo a series of studies. Diagnostic methods for gangrenous and perforated appendicitis:

• the first stage is palpation. In the absence of painful sensations, the specialist must examine the muscles extremely carefully and very carefully - the slightest change in them should be the reason for further measures;
• CT scan, ultrasonography and X-ray;
• blood tests (signs of leukocytosis) and urine (appearance of protein in it).

Treatment methods

Regarding treatment methods, the patient has no choice - this is only surgery. The procedure is called appendectomy, involves removal of the appendix and can be performed by two methods: conventional resection or a less traumatic method - laparoscopy. The traditional option involves creating a small incision through which the appendix is ​​removed along with the cecum. The inflamed appendage is bandaged in the area of ​​connection with the intestine, after which it is cut off and sutures are applied. If there has been a rupture of the organ, the abdominal cavity is washed antiseptic solutions and dried with tampons, after which a drainage system is installed.

During laparoscopy, the appendage is cut off without bringing the organs out, that is, a special device with a camera is inserted into the abdominal cavity through several small holes, thanks to which all procedures are performed by the doctor inside the body. The operation in any case involves general anesthesia.

Postoperative period

The recovery period after surgical treatment of gangrenous appendicitis has its own characteristics compared to other forms of the disease. Thus, it is necessary to take measures such as:

• active antibacterial therapy using drugs such as Levofloxacin or Cephalosporin;
• introduction of detoxifying compounds into the bloodstream (glucose, albumin, refortan, etc.);
• Blood tests are carried out daily;
• They also carry out dressings daily - changing the bandage with washing the wound and drainage;
• taking painkillers;
• prevention of complications depending on the condition of the patient’s body (anticoagulants, blockers may be prescribed proton pump to reduce secretion levels gastric juice etc.).

Expert opinion: it is believed that the patient simply needs early activation after surgery, so the patient is prescribed breathing exercises, physiotherapy and massage treatments.

A very important element of correct recovery after surgery is diet, since after the gangrenous form of appendicitis, the functioning of the digestive system is much more damaged than in other forms.

Nutrition after surgery - table

IN recovery period You should avoid products such as:

• spices;
• legumes;
• tomatoes;
• minimize, or better yet, stop eating salt altogether for at least a couple of weeks;
• smoked meats, fatty meats and fish;
• sausages;
• sauces - ketchup and mayonnaise;
• carbonated drinks.

Prohibited products after surgery in the photo

Possible complications and consequences

Lack of immediate medical care for gangrenous and gangrenous-perforative types of the disease can lead to extremely life-threatening consequences, such as:

• formation purulent abscesses in different cavities of the pelvis;
• purulent peritonitis is a large-scale inflammatory process in the peritoneum, which without urgent medical intervention leads to sepsis and death of the patient;
• thrombophlebitis of the septic type - inflammation of the walls of the veins with the formation of thrombotic formations.

How appendicitis develops - video

Gangrenous appendicitis is one of the most complex forms of inflammation of the appendix, in which there is a high risk fatal outcome. At the first suspicion of the development of a problem, you should consult a doctor, because the only way to treat the disease is surgical intervention and strict rules during the recovery period.

One of the very dangerous forms acute appendicitis – gangrenous, occurring with destruction (destruction) of the walls of the appendix. It can also be called a complication of acute timely treatment. Gangrenous appendicitis, according to statistics, occurs in almost 9% of cases of all acute forms and can often cause a sad outcome.

The most important reason for its development, occurring in most cases, is a violation of the blood supply to the vermiform appendix. Any disturbance of microcirculation leads to oxygen starvation of tissues, changes in their metabolism, and ischemia, due to which their necrosis (death) develops. The addition of an infectious component of inflammation leads to gangrenous appendicitis.

This pathology can occur at any age. In the elderly and senile period, it develops against the background of systemic atherosclerotic vascular damage, including in the appendix. In childhood and young age – against the background of congenital vascular anomalies. In every age period, gangrenous appendicitis is possible due to the formation of blood clots in the appendiceal veins and arteries.

Violation of the drainage of the appendix and stagnation of intestinal contents in it, accession bacterial infection greatly increase the likelihood of gangrenous changes. In addition, the development of necrosis and gangrene of the appendix can occur without initial vascular changes and be a consequence of an acute purulent form.

Clinical manifestations, diagnosis

Gangrenous appendicitis can be suspected based on some symptoms. The spread of necrotic changes in the tissues of the appendix also affects nerve fibers and ending, therefore, after severe abdominal pain, the patient feels their weakening or complete cessation. General state remains severe: intoxication of the body increases, nausea, vomiting becomes repeated.

But in practice, these changes in the clinical picture are rarely recorded, and the diagnosis of gangrenous appendicitis is made during surgery. The vermiform appendix is ​​visualized greatly increased in size, with loose walls that tear at the slightest manipulation, with purulent deposits, areas of necrosis (light) and gangrene (dark).

Diagnosis of purulent appendicitis, including the gangrenous form, is based on the patient’s complaints. This severe pain in the right half of the abdomen, fever, nausea and vomiting, stool disorders. Upon examination, severe pain and tension are revealed abdominal wall. IN clinical analysis blood - sharp leukocytosis, a significant increase in ESR, a shift in the leukocyte formula towards younger forms.

ESR is the erythrocyte sedimentation rate, an indicator used to identify inflammatory processes in the body.

Some diseases can create a similar clinical picture, so it is important to differential diagnosis. It is carried out in relation to peptic ulcer stomach or duodenum, acute cholecystitis, acute pancreatitis, adnexitis, Crohn's disease, intestinal diverticulosis.

Treatment

Diagnosing any form of acute appendicitis is an indication for emergency surgery, as delay leads to life-threatening complications. Contraindications to surgical treatment There is no purulent appendicitis. In each specific case, the surgical method is chosen: open appendectomy or laparoscopy.

The sooner the patient seeks help, the less likely it is that the purulent form of the disease will transform into gangrenous and subsequent rupture of the appendix. If the inflamed appendix is ​​not removed on time, the consequences of gangrenous appendicitis are very dangerous. This is perforation (rupture of the wall) with the entry of purulent masses and intestinal contents into the abdominal cavity and the development of peritonitis, the formation of multiple abscesses, and general blood poisoning (sepsis).

Peritonitis is an inflammatory process that occurs in the abdominal area. Peritonitis is characterized by a high mortality rate - 15-19% of the total number of cases.

Diagnosis of the gangrenous-perforated form of appendicitis is carried out, as a rule, already during the provision of emergency surgical care. This requires the further use of special tactics both during surgery and in the postoperative period.

Postoperative period

The tactics of postoperative management of a patient with gangrenous appendicitis concerns both drug therapy and adherence to a strict diet. The main directions of treatment are the prescription of powerful antibiotics, infusion therapy for detoxification (blood substitutes) and the prevention of blood clots.

Diet after surgery for gangrenous appendicitis is of utmost therapeutic importance. The products consumed should not only be balanced in proteins, fats and carbohydrates, but also have a minimal irritating effect on the intestines, and also be in the most digestible form.

After surgery, the intestines cannot peristalt normally and move food masses, intestinal villi not absorbed enough nutrients. The goal of the diet is to carefully and gently restore all intestinal functions in a short period.

On average, a strict diet is required for 2 weeks after surgery. With each new postoperative day, the range of permitted products expands, but the basic dietary principles remain unchanged. This is mechanical, physical and chemical sparing of the mucous membrane gastrointestinal tract. Therefore, all dishes should not be in the form of large pieces, but pureed, not too hot and not too cold. Among the methods of processing food, boiling and steaming are allowed, less often baking. For the purpose of chemical sparing, any seasonings, caffeine, and carbonated drinks are completely excluded. An important principle is split meals (5-6 times a day) in small portions.

By the end of the first day after surgery, you are allowed to drink a glass of water or weak broth. On the second day - vegetable puree, boiled and pureed chicken meat, jelly. From the third day, natural yoghurts, meat broths, a variety of boiled vegetables and cereals are allowed. In the second week, dairy and fermented milk products, baked vegetables and fruits, fish and steamed lean meat are introduced.

Gangrenous appendicitis is vital dangerous condition. Timely surgery, proper management of the postoperative period with adherence to a special diet are the main conditions for preserving the patient’s life and recovery.