Acute phlegmonous appendicitis: what is it, causes, symptoms, diagnosis, methods of treatment, varieties, forms, complications, consequences

Acute phlegmonous appendicitis is a surgical pathology that requires urgent surgical intervention. The appendix is ​​a small outgrowth of the intestine with a length of 5 to 15 cm. It is localized in the area of ​​the cecum. Its walls have many lymphoid follicles. If the initial stages of an acute inflammatory process can still be stopped with drug treatment, then after 6-24 hours at the stage of phlegmon, the removal of the process is required.

Phlegmon is a diffuse acute purulent inflammation that affects all layers of the appendix. Because of this, the wall of the organ becomes edematous, a large number of leukocytes and dead microbes accumulate in it. If untreated, purulent inflammation can spread to the peritoneum, signs of acute peritonitis appear.

Why does acute phlegmonous appendicitis develop?

There are always bacteria in the intestinal lumen - Escherichia coli, staphylococci, enterococci, clostridium, proteus and others. With a weakening of immunity and getting into the appendicular process of microorganisms, inflammation progresses.

The development of acute phlegmonous appendicitis is facilitated by the overlap of the appendix lumen:

• foreign body;
• feces;
• accumulation of parasites.

Compression of the organ by adhesions and constrictions, tumors of the abdominal cavity, atypical congenital form (it is narrow, bent) plays a role.

It is possible that microbes get into the bloodstream from distant organs. This is observed in the presence of serious infectious diseases. In this case, the symptoms of acute phlegmonous appendicitis are superimposed on the existing signs of the disease (sore throat, ear, cough).

Injury, circulatory problems, unhealthy diet (low vitamins, fiber, overeating, fatty, protein foods) can also lead to acute phlegmonous appendicitis.

Symptoms of phlegmonous appendicitis

As for any purulent process, pronounced intoxication - the temperature rises to 38-39 ° С. It may have a hectic character - it rises, then falls with strong sweating at this moment (more than 3 degrees). Most often, this indicates the penetration of pathogenic microorganisms into the human blood.

In the acute form of phlegmonous appendicitis, symptoms appear:

• weakness;
• dryness of the oral mucosa;
• nausea;
• vomiting is possible;
• violation of the stool in the form of diarrhea or constipation.

Man refuses to eat because of lack of appetite. Intestinal peristalsis decreases, so stool may be absent.

Reduced reactivity is observed in the elderly and debilitated people. Therefore, they may not have hyperthermia even with phlegmonous appendicitis and peritonitis. Often, inflammation develops against the background of acute circulatory disorders.

There are features of the course of pathology in children. They are characterized by a pronounced temperature reaction up to 39-40 degrees - even in the absence of a purulent process. Vomiting is usually repeated.

The main signs of acute phlegmonous appendicitis in them:

• general anxiety;
• pain in the abdomen (more often the child points to the navel area or cannot name where it hurts);
• refusal to eat.

Small children cry, pull their legs to the stomach, react strongly to touching the anterior abdominal wall, push the doctor's hand away.

The development of inflammation and the spread of the process to other organs in a child is much more intense and faster. Therefore, parents need to react as soon as possible.

With acute phlegmonous appendicitis, a person complains of abdominal pain. They can increase with movement, coughing, sneezing, deep breathing. With the standard position of the appendix, pain is localized in the right iliac region.

There is an atypical position of the appendix - it is wrapped posteriorly or anterior to the cecum, displaced upward by an enlarged uterus during pregnancy or a large myoma. Then the pain is felt:

• near the navel;
• above the pubis;
• in the lumbar region;
• under the rib on the right;
• can give to the leg, perineum.

In very rare cases, there is a mirror-like arrangement of organs in the abdominal cavity. Then the appendix will be on the left, and the sigmoid colon on the right.

If the process is in the pelvic region or closer to the lumbar region, one of the symptoms may be an acute urinary disorder - painful, frequent, does not bring relief.

At the initial stage, pain often appears in the epigastric region. Then, after 6-8 hours, they go down. Doctors call this the Kocher-Volkovich symptom.

The pain decreases in the position on the right side with the legs pulled up to the abdomen. This is because the appendix is ​​less mobile in this position.

On palpation of the abdomen, painful sensations intensify. But, if the pain is stronger, when they do not press, but withdraw the hand, this is a symptom of Shchetkin-Blumberg. It is typical for a beginner peritonitis.

During the examination, the doctor reveals other symptoms of acute phlegmonous appendicitis:

• the muscles of the abdominal wall in the lower right abdomen are tense, which is felt with superficial palpation. This area moves less during a deep inhalation-exhalation in comparison with other departments;
• Obraztsova - the pain increases if a person is asked to raise a straightened right leg (the psoas muscle strains and shifts the appendix);
• Mendel - soreness when tapping fingers at the site of the projection of the process on the anterior abdominal wall;
• Sitkovsky - if a person lies on his left side, the pain intensifies;
• Bartomier-Michelson - if the process is palpated when the patient is lying on his side, the pain will be stronger than lying on his back;
• Voskresensky - quick sliding hand movements along the front wall of the abdomen from top to bottom lead to increased pain.

Additional research methods

The presence of an acute phase of phlegmonous appendicitis is confirmed by blood tests - leukocytes are increased, young forms of cells prevail, accelerated ESR. Sometimes they are additionally prescribed:

• Ultrasound of the abdominal organs;
• MRI;
• CT;
• x-ray.

Laparoscopy is used. It can be diagnostic and therapeutic. With the help of an optical device inserted into the abdominal cavity, the surface of the intestine is examined, the condition of the peritoneum is assessed.

During the intervention, a thickened, hyperemic appendix can be seen. He is tense, bluish-purple in color. On the surface of the serous membrane, plaque from fibrin deposits is possible. If the appendix has ruptured, an urgent open abdominal surgery is required with thorough flushing of the abdominal cavity with antiseptics and the introduction of antibiotics.

The final diagnosis of acute phlegmonous appendicitis is established after the operation according to the results of histological examination. When examining tissue under a microscope, one of the types of inflammation is determined:

• catarrhal - there is edema with a slight infiltration of cells;
• phlegmonous - the tissues are saturated with leukocytes, the remnants of microbial bodies. One of the variants of phlegmonous appendicitis is empyema, in which the lumen of the appendix is ​​enlarged and filled with pus;
• gangrenous - cell death as a result of circulatory disorders and inflammation. Nerve endings also die, therefore, at this stage, despite the increase in intoxication, the pain decreases or is absent;
• perforated - with damage to one of the walls of the organ.

Methods for the treatment of phlegmonous appendicitis

If the walls of the appendicular process are intact, you can limit yourself to laparoscopic surgery. The appendix is ​​removed, the wall of the cecum, bleeding vessels and the anterior abdominal wall are sutured. They can go home in a few days. In the postoperative period, the wound is looked after, after 6-7 days the stitches are removed.

In complicated forms of acute phlegmonous appendicitis with the development of perforation, peritonitis, severe general condition, they resort to open surgery on the abdominal cavity. Examine the organs adjacent to the appendix, since the inflammation could spread to them (ileum, in women - appendages). Non-viable tissues are removed. After such an operation, recovery can take 2-3 weeks.

Surgical treatment of acute phlegmonous appendicitis is complemented by antibiotic therapy. They start it even before the operation, which reduces the risk of spreading the infection. Solutions for detoxification are injected intravenously, according to indications - drugs to maintain the activity of the heart and blood vessels.

The most important thing in the treatment of acute phlegmonous appendicitis is a timely visit to a doctor. Symptoms may be subtle or atypical. In the hospital, the patient is under the supervision of a doctor. With the smallest changes in the state for the worse, he is assisted, an operation is performed.

The choice of pain relief depends on the general condition of the patient, the presence of concomitant diseases of the heart, kidneys, liver. With local anesthesia, the tissues to be cut are infiltrated with a solution of novocaine or another anesthetic. In general, inhalation or intravenous administration of drugs is carried out - the patient falls asleep. After the operation, he should be under the supervision of a doctor until all body functions are fully restored.

What can not be done with phlegmonous form of appendicitis

It is life-threatening to prescribe treatment for yourself:

• taking painkillers before a doctor's examination can distort the clinical picture, the characteristic symptoms will not appear;
• you can't heat the place where it hurts. This accelerates the development of acute purulent inflammation, since heat creates good conditions for the reproduction of microbes;
• no need to take antibiotics. They can eliminate visible symptoms, inflammation will take a protracted course, dangerous by the development of the adhesive process;
• do not eat or drink until the doctor arrives. If you are very thirsty, you can take a couple of sips of water.

It is better to go to bed and take a position in which pain is least disturbing, call a doctor at home or an ambulance.

Acute phlegmonous appendicitis is a serious illness that endangers the patient's life. Any abdominal symptoms that are accompanied by a rise in temperature, digestive disorders and do not go away within 1-2 hours should be alerted. You should immediately consult a doctor. Early diagnosis is the key to effective and less traumatic treatment.

If you can restrict yourself to endoscopic intervention, the time of hospitalization and recovery is significantly reduced, and the risk of postoperative complications becomes less. Have you encountered acute phlegmonous appendicitis? How was his treatment?

We recommend watching a video on the topic: Appendix - when is the organ removed?

Sources:

• http://xn--1-7sbc2aomf1e8b.xn--80acgfbsl1azdqr.xn--p1ai/file/8c78cdd5265aaf90698069e9e916b266
• https://www.emcmos.ru/articles/ostryy-appendicit