Appendicitis

Appendicitis – an inflammation of the worm-shaped shoot called by an appendix. It is the small blind appendage of a colon located on border of a small and large intestine. Because of anatomic features the appendix quite often inflames – the acute appendicitis is the most frequent surgical disease.

There is it so often that in the thirties the last century in Germany the proposal to delete an appendix to children at early children's age, in the form of a preventive measure for fight against appendicitis was made. Those years was considered that the appendix represents atavism, absolutely useless anatomic education without which it is quite possible to do. However results of an experiment were depressing: at those children to whom at early age removed a worm-shaped shoot the severe form of an immunodeficiency developed afterwards.

The acute appendicitis at rejection of urgent medical measures is dangerous that it leads to suppuration and a rupture of the inflamed worm-shaped shoot, with spillage of pus and distribution of an inflammation on a peritoneum – peritonitis, a dangerous complication which can lead to a lethal outcome develops.

Appendicitis reasons

Believe that obstruction of a gleam of a worm-shaped shoot is the main reason for appendicitis. It can happen because of an appendix excess, and also as a result of mechanical obturation, at hit in a gleam of fecal stones or foreign bodys. Hit of foreign bodys in an appendix – one of the frequent reasons of development of appendicitis in children, and appendicitis is more often caused in adults by fecal stones. One more mechanism of an inflammation of an appendix, this emergence of ulcers on his mucous membrane, as a rule, as a result of the postponed viral infection.

Appendicitis symptoms

The main symptom of appendicitis is suddenly appeared abdominal pain. The following is characteristic of a pain syndrome at an acute appendicitis:

• Initially pain is localized in epigastric area;
• In 6-8 hours pain moves to the right ileal area (Kokhera-Volkovich's symptom, or a symptom of movement of pains);
• Further pain accepts diffuse character;
• Pain is constant, there can be periods of strengthening and easing of pain, but the bezbolevy periods are absent;
• Pain amplifies at the movement therefore patients with an acute appendicitis often move, holding the right side of a stomach with hands that is one of characteristic an appendicitis symptom;
• Sharp pain testifies to a purulent inflammation of a worm-shaped shoot (an appendix empyema);
• Remitting at an acute appendicitis – an adverse sign as the beginning of a sphacelism and death of nerve terminations can be the cause of it.

In addition to a pain syndrome, symptoms of appendicitis are appetite loss, nausea, single vomiting, a chair delay, increase of an urination is possible.

Appendicitis usually does not cause sharp deterioration in the general state in adults, in any case before development of peritonitis. Perhaps slight increase of temperature, to subfebrile figures (37-37,5 °C). Adult patients can have a simple appendicitis and destructive. At a destructive current all symptoms are more brightly expressed, pain more considerable and the general state suffers.

Appendicitis at children proceeds much more violently, the inflammation progresses quickly, and peritonitis develops much quicker. At appendicitis at children severe pain in a stomach can have diffuse character at once, the general symptoms are brightly expressed: severe nausea, repeated vomiting, fever. Appendicitis at children practically always proceeds as destructive appendicitis at adults.

Diagnosis of appendicitis

In a classical form the disease does not cause difficulty with diagnosis which is put on the basis of characteristic symptoms of appendicitis. The following tests help to specify the diagnosis:

• Morbidity in the right ileal area at a stomach palpation;
• Morbidity in the right ileal area at easy effleurage (Razdolsky's symptom);
• Strengthening of pain at sharp hand otnyatiya after pressing of a front abdominal wall (impty Shchetkina-Blyumberg);

• Strengthening of pain at position of the patient lying on the left side (Sitkovsky's symptom);
• The palpation is much more painful at a prone position on the left side (Bartomye-Michelson's symptom);
• Strengthening of pain at a raising of the straightened right leg in a dorsal decubitus (Obraztsov's symptom);
• Strengthening of pain in the right ileal area at the movement by a hand from an upper part of a stomach to the right ileal area through the tense shirt (Voskresensky's symptom);
• Morbidity in the right ileal area at pushes fingers in the left ileal area (a symptom of Rovzinga).

These symptoms of appendicitis have important diagnostic value. However in certain cases, at the abnormal provision of a worm-shaped shoot, the clinical picture can be greased, and some of the described signs can be negative. Also there can be symptoms, uncharacteristic for appendicitis, for example, diarrhea.

Any signs of an acute abdomen have to guard concerning an appendicitis attack therefore, as a rule, the specifying diagnosis is carried out already to operation time (a diagnostic laparotomy) as the delay can lead to heavy complications, life-threatening. Because of difficulties in diagnosis abnormal forms of an acute appendicitis become much more often the reason of a lethal outcome.

Treatment of appendicitis

Treatment consists in surgical removal of appendicitis.

At suspicion of an acute appendicitis of the patient it is necessary to lay and provide it rest before arrival of an ambulance crew. Transportation in hospital also happens in a prone position. It is forbidden to give enemas and accept laxative, food, water, reception of the anesthetizing drugs, because of the subsequent difficulties in carrying out diagnosis is also undesirable.

Removal of appendicitis should be carried out as soon as possible to avoid a rupture of a worm-shaped shoot and development of peritonitis. To reduce probability of infection during removal of appendicitis, before operation enter antibacterial agents. Antibiotics are appointed also in the postoperative period.

Removal of appendicitis is carried out under the general anesthesia, in certain cases at thin patients use of local anesthesia is possible.

Now at a simple form of appendicitis prefer the laparoscopic operations which are not demanding abdominal section. In this case the endoscopic tool is entered into an abdominal cavity through a small puncture in fabrics. Removal of appendicitis allows to avoid this way an operational injury and to reduce the recovery period many times. The risk of development of postoperative complications during removal of appendicitis by a laparoscopic method is minimum.