Acute appendicitis is one of the most common diseases of the abdominal cavity, which requires surgery.Acute appendicitis in most cases occurs in age from 18 to 30 years.Elderly people and children are ill with acute appendicitis is much rarer.The cause of acute appendicitis is an acute inflammation of the appendix cecum and appendix.Inflammation of the appendix is due to excessive activation of the intestinal flora in the background blockage of the lumen of the appendix fecal stones.Developing the disease within one day.The picture of the disease is characterized by paroxysmal sharp pains in the right upper abdomen.It can also be a rise in body temperature.
If you have this disease used the traditional method of treatment-appendectomy, ie surgical treatment of acute appendicitis.The most pressing problem in the treatment of acute appendicitis is a correct diagnosis of the disease.From well-diagnosis depends on the timely implementation of the operation.
Modern medicine classifies acute appendiciti
Acute appendicitis also differ in the prevalence of pathology and clinical picture: a typical clinical picture and with atypical clinical picture: a dysuric disorders with symptoms of biliary tract disease, with diarrhea, with symptoms of severe intoxication with purulent giperpireksiey.Klinika the disease also happensdifferent: fast retrogressive, non-progressive, slowly progressive and rapidly progressive.
patient with suspected acute appendicitis, examines a senior surgeon on duty.The diagnosis is established on the basis of medical history as well as the data of objective research, laboratory and instrumental examination of the patient.
With the localization of pain in the right lower abdomen, acute appendicitis is often differentiated from other diseases: in particular, gynecological, or in women with bacterial enterocolitis, urolithiasis, accompanied by colic and others.
After the diagnosis of the patient is admitted and prepared for surgery.Preoperative preparation of the patient is carried out taking into account the patient's condition and is determined by the surgeon and anesthesiologist.Along with the general hygienic measures, emptying the stomach by gavage, in the presence of widespread acute peritonitis held bladder catheterization to monitor hourly diuresis.
One of the objectives of preoperative preparation is a drug correction of disorders caused by endogenous intoxication and underlying diseases, if there is evidence.
in the surgical treatment of acute appendicitis, the following surgical approach:
- appendectomy from laparotomy (typical, atypical);
- laparoscopic appendectomy (typical, atypical);
- appendectomy from extraperitoneal access for retroperitoneal location process.
With appropriate equipment and trained surgeons preference should be given laparosokpicheskoy appendectomy.A more modern method of surgical treatment - endoscopic surgery, which is carried out using the latest equipment, cosmetic piercing through the peritoneum.
Surgical treatment involves the following methods stump of the appendix: amputation;
- ligature method (all layers of the appendix stump bandage is not immersed in the cecum);
- subserous method (a mucous-ligated submucosal process, stump immersed serous-muscular layers);
- without bandaging stump sprouts.
If in simple acute appendicitis was found exudate (hemorrhagic, gall, abscess, intestinal), as well as the inability to detect intraoperatively appendix in a typical place, conduct an audit of the abdominal cavity.
When gangrenous form of inflammation of the appendix, incomplete removal of the appendix, technical difficulties during surgery and in other cases conducted drainage of the abdominal cavity.
Install pliable PVC and silicone drains.If necessary, the establishment of drains in the abdominal cavity is preferable to install them through a separate incision.
to end the operation for appendicitis using the following options:
- stitching the abdomen tight;
- stitching the abdominal cavity and removal of drainage through a wound.
Sometimes after surgery, complications may occur, the reasons of which are:
- delayed aid from the late uptake of patients;
- untimely aid due to late diagnosis of the disease;
- tactical and technical errors.
most formidable postoperative complications are bleeding into the abdominal cavity, abdominal abscesses, peritonitis, retroperitoneal abscess, intestinal obstruction.Treatment is carried out surgical complications.
Postoperatively, the patient should be reduced to a minimum of physical activity and diet aimed at the normalization of the bowel.