Gangrenous appendicitis: causes, symptoms, diagnosis

Gangrenous appendicitis is a pathology thatis characterized by tissue necrosis of the worm-like segment and a typical clinical picture, which makes it possible to differentiate it from the remaining forms of the inflammatory process directly in the appendix. Most often it is acute and provokes to develop quite serious health consequences. That is why it is so important to seek help from a doctor in time to determine the causes of the pathological process and prescribe a therapy.

General information

Gangrenous appendicitis is a varietypurulent variant of the inflammation of the appendage, which is based on irreversible destruction. Most often, changes in the necrotic nature are observed in small areas of the appendix. Gangrenous inflammation is a form of an acute variant of the disease and appears only at a certain stage of its development (2-3 days of inflammation).

The main causes of the development of pathology

Acute gangrenous appendicitis develops then,when the inflammatory process in the appendage was not noticed during the first day. Then the normal sensitivity of the nerve endings disappears, so the pain syndrome may disappear. Many patients decide that the danger has passed, you can put off a visit to a doctor for a while. Such disregard for one's own health can lead to peritonitis.

The main risk factors for this pathology include the following:

• Elderly age.
• Formation of blood clots.
• Atherosclerosis of the intestinal arteries.

All these factors indicate thatthe immediate causes of the development of pathology are the so-called microcirculatory disorders. Their result is a violation of normal blood circulation, as a consequence - necrosis of the appendage. Other elements of pathogenesis (infection, autoaggression of immune cells) are joined only in the second turn, only aggravating the course of pathology.

What signs indicate a pathology?

In an acute period there is multiple vomiting,which constantly exhausts the patient and does not bring long-awaited relief. In view of the intoxication of the body due to the development of putrefactive inflammatory process, the temperature can remain normal or decreased.

Gangrenous appendicitis is manifested as a syndrome of "toxic scissors". The patient has a pronounced tachycardia (heart rate of about 100 beats per minute), but the temperature does not increase.

The patient's tongue is dry with a characteristic yellowish coating. In the case of primary gangrenous appendicitis, symptoms may differ somewhat:

• Painful discomfort in the right ileal zone, which suddenly appears and quickly subsides.
• The abdomen is hard, painful.
• The condition of the patient is regarded as severe.

If a person does not receive adequate andtimely treatment, after this form of the disease develops gangrenous-perforated appendicitis. Pathology is characterized by perforation of the wall directly of the vermicular appendix. In the period of his immediate breakdown, a person experiences severe pain, which gradually spreads throughout the stomach over time. Because of the increasing intoxication of the body, the temperature rises, there is an obvious tachycardia. The tongue becomes very dry, the plaque acquires a brownish hue. The patient suffers from severe vomiting.

Diagnostic measures

If you have the above symptoms,should immediately seek medical help from a doctor. If this pathology is suspected, the specialist will initially conduct a physical examination of the patient. When palpation, as a rule, the tension of the abdominal wall is observed, the abdomen is moderately inflated. A number of laboratory tests are then assigned, including a blood and urine test. Additionally, ultrasound, X-ray and computed tomography may be required. Based on the results of the tests, the doctor can confirm the diagnosis of gangrenous appendicitis.

Methods of treatment

Therapy involves surgical removal of the appendix. Appendectomy is performed in a traditional way or by means of laparoscopy.

In the first case, the doctor removes the vermiform appendix through a cut in the abdominal wall. Typically, this procedure is performed using general anesthesia.

Surgery for appendicitis by laparoscopyis characterized by low traumatism. The surgeon makes several microscopic punctures in the abdominal wall, through which tools for manipulation are introduced. The most important of these is the laparoscope - a tube with a camera at the end. During the operation, the doctor receives an image from her on the computer screen, which allows you to perform surgical manipulations as accurately as possible.

Postoperative period

Postoperative period in patients with such a fairly common diagnosis has a number of features:

• Use of antibacterial and analgesic drugs.
• Infusion detoxification therapy with the use of salt solutions, refortan, glucose and albumin.
• Daily blood tests.
• Prevention of ulcers and thromboembolic complications. In the postoperative period, patients are prescribed blockers of gastric secretion ("Kwamatel", "Omez"), anticoagulants ("Clexan").
• Daily dressings and washing of wounds.
• LFK, special massage, respiratory gymnastics.

Surgery for appendicitis is quite a serious surgical intervention. To prevent the development of complications in the future, the following recommendations should be used.

Talk about nutrition

For this pathology, problems with peristalsis of the intestine are characteristic, therefore, after the operation, special attention should be given to nutrition.

The first day allowed the use of low-fatkefir, mineral water without gases and light chicken broth. On the second day, if the postoperative period is not complicated by negative consequences, you can add mashed potatoes, liquid porridges on water and curd casserole to the diet. The following day diet should be diversified as part of diet number 5. It is better to give up fatty, spicy food and smoked foods.

Possible complications

This pathology is considered very dangerous, as it can lead to the development of quite dangerous for health complications. This process is especially critical for young patients.

What are the negative consequences of gangrenous appendicitis?

1. Purulent peritonitis. This is a rather dangerous condition, which requires immediate surgical intervention. If the help is not timely, blood can be contaminated.
2. Appendicular infiltration. In the area of ​​the inflamed process, a local conglomerate consisting mainly of organs and tissues is gradually formed. This problem always requires long-term conservative therapy.
3. Septic thrombophlebitis. The inflammatory process develops in the venous walls. As a result, it leads to the formation of thrombi in the lumen of the vein.
4. Local purulent abscess. Such formations predominantly develop in the diaphragm zone.

Do not ignore appendicitis. Purulent gangrenous variant of this pathology requires immediate treatment. Otherwise, the probability of complications and even death is increased. Especially dangerous is inflammation for children, they all pathological processes occur several times faster.