Appendicular abscess

Description:

Abscess appendicular is the abscess which is formed in an abdominal cavity at an acute appendicitis.

Pathogeny:

Frequent complication at an acute inflammation of a worm-shaped shoot.

Distinguish primary abscesses developing near the shoot, and secondary, arising at distance. Formation of an abscess is preceded by development of appendicular infiltrate which the organism of the patient fences off the inflamed shoot from other part of an abdominal cavity.

Infiltrate is formed as a result of a fibrinous exudate and a spayaniye of a sick epiploon, loops of intestines, an abdominal wall and the shoot.

At attenuation of inflammatory process in a worm-shaped shoot infiltrate resolves. However at spread of a pyogenic infection out of shoot limits that is more often observed at destructive appendicitis, develops infiltrate suppuration.

Appendicular abscesses, depending on localization of a shoot, can be located very different in an abdominal cavity.

Optimum for the patient development of an abscess in ileal area at the lateral provision of a shoot where the last is best of all fenced off by commissures with a front and side and back abdominal wall.

Quite often the shoot holds medial position, from a caecum to the left, being located freely among loops of small bowels.

The abscess in this area is located in a conglomerate of small bowels more often, is seldom accustomed to drinking with a front abdominal wall and constantly threatens with break in a free abdominal cavity.

At a retrocecal arrangement of a shoot the abscess is localized out of bryushinno, is frequent in pararenal area. At the pelvic provision of a shoot the abscess develops in a small basin.

Secondary abscesses are formed in other way. A pyogenic infection, getting out of shoot limits on numerous lymphatic ways, under the known conditions causes development of abscess and various sites of a mesentery of small bowels, under a liver, under a diaphragm and in the field of a right kidney.

By similar way secondary abscesses and after removal of a worm-shaped shoot can be formed at destructive forms of appendicitis.

Symptoms of appendicular abscess:

Symptoms — a febricula, a fever, sweat. High evening temperature. The localized abdominal pains.

The patient is afraid to turn in a bed. The abdominal wall is strained according to the place of localization of an abscess. The delimited motionless infiltrate is palpated. Quite often fluctuation is defined. High leukocytosis (over 15000) with shift blood counts to the left.

At an interintestinal arrangement of abscess the stomach is blown moderately up, the nature of pains skhvatkoobrazny, the phenomena of partial obstruction of intestines are noted. At pelvic abscess pains and swelling in the lower half of a stomach, pain at defecation are observed, the speeded-up desires on a bottom and on an urination, mucifying from an anus.

At an obligatory research painful protrusion of a front wall of a rectum is defined by a rectum by a finger; it is quite often possible to define fluctuation on the limited site.

Diagnosis:

Recognition is helped by well collected anamnesis indicating an attack of appendicitis at which a week later from the beginning of a disease of pain not only do not abate but also amplify.

Temperature continues to remain high and has remittiruyushchy character inherent to suppurative process. The blood leukocytosis increases.

Infiltrate which increases is defined, on its place the zybleniye appears. The diagnostic trial puncture is admissible only during operation on the operating table.

Treatment of appendicular abscess:

In an infiltrate stage a high bed rest under observation of the surgeon in stationary conditions. Ice on a stomach.

Penicillin intramusculary in a dose from 400000 to 1000000 PIECES daily. Sparing dithis – the vegetable wiped soups, liquid porridge, boiled vegetables, compote. Laxatives and drugs are contraindicated.

At pelvic infiltrates microclysters 2–3 times a day are recommended hot (40 °). Such enemas quite often promote a rassasyvaniye of infiltrate or accelerate formation of an abscess.

At a sformirovaniye of an abscess or at sudden deterioration in the general state indicating break of an abscess in a free abdominal cavity an urgent operative measure is shown.

At operational opening of an abscess it is necessary to be limited to removal of pus and the fecal stones which dropped out in a cavity. The shoot is not deleted, the cavity of an abscess is filled up with penicillin, Norsulfazolum, streptomycin and tamponed; the wound seams is not narrowed.