What is dangerous gangrenous appendicitis and how to treat it?

Gangrenous appendicitis is the last stage of an acute purulent form of the disease. It is characterized by the development of necrosis of the appendix wall.

This stage is extremely dangerous for the patient, as the wall of the appendage can break through, and the pus will enter the peritoneum.

Symptomatic of this stage of the disease differs from the others, therefore it is necessary to contact a specialist as soon as possible.

Causes of gangrenous appendicitis

Acute appendicitis passes through certain phases as it develops. The disease can be divided into catarrhal and purulent. Purulent inflammation can be phlegmonous, gangrenous and perforating.

Acute gangrenous appendicitis is formed approximately on the second or third day of the disease, if the appropriate measures are not taken in time. There are cases when gangrene occurs after 7 to 12 hours.

At the first sign of the onset of the development of the inflammatory process in a child or adult, one should consult a doctor, since the gangrenous form can develop very quickly.

The most common reasons provoking a gangrene of an appendix, such:

• walls of vessels - mainly at people of advanced age are amazed;
• on the walls of the intestinal arteries formed cholesterol plaques;
• underdevelopment of arteries - occurs in children, refers to congenital pathology;
• arteries and appendectomy veins with thrombi.

There are a number of factors that cause a worsening of the course of the disease.

These include:

• the presence of an infection in the human body;
• immune cells are characterized by increased activity;
• the presence of problems with the vessels, as a result of which the tissues of the appendage die off;
• in the vermiform appendage the outflow was disturbed, therefore the contents of the appendix can not leave.

Diagnosis and symptomatology of the disease

At the beginning of the examination, the doctor must determine what complaints the patient has, regardless of the reasons that triggered the onset of the inflammation.

If the timely treatment does not start, then gangrenous-perforated appendicitis is formed.

In this case, the perforation of the appendix wall occurs, and all the contents go to the peritoneum. As a result, purulent peritonitis occurs. This stage is dangerous for human life.

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Diagnosis of gangrenous appendicitis is similar to the methods for determining other forms of the disease:

• the doctor conducts the examination of the patient by the method of palpation. The abdominal wall of the patient is tense. The tension increases when the doctor tries to feel the stomach. Inflammation of the peritoneum is moderate, there is no peristalsis of the intestine. Symptoms of Shchetkin-Blumberg reaction are positive - the doctor gently presses on the stomach, then abruptly removes the hand. At the moment of withdrawal of the fingers, the patient feels pain. The reaction of Voskresensky gives a positive reaction. The doctor's hand slides over the patient's stomach in the direction from the rib to the groin. In the ileum, the patient has painful sensations;
• blood tests, urine tests. If the patient leukocytes formula is shifted to the left, and the protein is present in the urine, then the patient has a gangrenous form of appendicitis;
• ultrasound;
• X-ray;
• CT.

Gangrenous appendicitis is characterized by the death of the appendage tissues, then the nerve endings also die off, so the patient is not so acutely feeling the painful sensations as with other forms of appendicitis. There are cases when the pain does not bother the person at all.

The acute course of the disease is characterized by vomiting, it occurs in the patient many times. After vomiting, the patient does not receive relief.

With gangrenous form develops putrefactive process, so intoxication of the body. The condition of the patient is characterized as extremely difficult.

Against the background of a general unsatisfactory state, body temperature does not increase. In some cases, it may even be slightly below normal.

Another symptom of gangrenous form is a syndrome called "toxic scissors".

The patient's condition is very severe, but his body temperature is normal. Against this background there is tachycardia.

The number of beats per minute is 120. It is worth noting that the heart rate is 80 beats per minute.

The patient's tongue has a white or yellow coating, which is more pronounced closer to the root.

Regardless of the reasons that triggered the onset of the disease, the onset of gangrenous appendicitis is characterized by the following symptoms:

• , the patient experiences severe pain, but it subsides in a short time, as the nerve endings of the appendix die;
• the abdomen of the patient is tense, there is a pain when the doctor touches the peritoneum;
• the patient's condition worsens as a result of intoxication.

How to treat the disease?

Gangrenous-perforated appendicitis, like other forms of the disease, is treated with only one method - surgical. The doctor conducts the removal of the inflamed appendix.

During the preparation for the operation, the patient must be emptied. The enema to the patient before operation to put it is impossible. On the area of ​​the operating field, hair is removed by shaving, after which the skin is treated with ether or alcohol.

A doctor can perform a classic surgical operation. On the patient's body a cut is made up to 12 cm. The appendix and part of the caecum are excised into the wound.

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After removal of the appendix, a seam is placed on the intestine, after which the doctor removes the pus in the abdominal cavity.

If the pus enters the abdominal cavity, the doctor will leave the drainage - a special tube. In addition, the patient will be administered antibiotics.

The removal of the gangrenous process can be performed in another way - laparoscopy. During the operation, the doctor observes the procedure on the monitor.

If the patient has a gangrenous form, then it is preferable to perform laparoscopy. In this case, the risk of complications is several times lower, and the recovery period will be faster.

After removal of the appendix, a postoperative period occurs. Particular attention should be given to children and the elderly.

To avoid complications and accelerate the process of rehabilitation, it is necessary to follow the recommendations:

• the patient is prescribed antibiotics of different groups and painkillers;
• in the postoperative period is required detoxification therapy;
• the patient daily takes blood to monitor the condition and for the timely detection of complications;
• dressings should be changed frequently, with the scar and drain tube washed. In this case it is possible to avoid suppuration or infection of the suture;
• conducts activities for the prevention of blood clots and ulcers;
• in the postoperative period the patient should perform exercise therapy and respiratory gymnastics. Such activities will help avoid pathologies after surgery.

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The gangrenous stage of the disease is very insidious. If the doctor makes an incorrect diagnosis, the patient will have serious problems.

A correct evaluation of all the symptoms, a correctly diagnosed diagnosis, a timely operation will help prevent complications and shorten the patient's recovery period.