Does everyone get appendicitis? How to diagnose appendicitis at home. Acute appendicitis in a child

Appendicitis is an inflammatory process that affects the vermiform appendix located in the area of ​​the cecum, this appendix is ​​called the appendix. Appendicitis, the symptoms of which may differ depending on whether the inflammatory process manifests itself in an acute form or in a chronic form, and in the latter form it is now not so common, and mainly only for the reason that it turns out to be impossible to remove the appendix due to the development of complications.

general description

Acute appendicitis, unlike chronic appendicitis, is one of the most common diseases in surgery, due to which patients end up in the hospital. According to various data, it is known that acute appendicitis is detected on average in 5-10% of patients, and for the same reason the said appendix is ​​also absent in 5-10%. If we denote an approximate number, then appendicitis occurs on average in 6 people out of a thousand. Most often, appendicitis is diagnosed in children and young people (15-35 years old).

In acute appendicitis, immediate surgery is necessary. Symptoms of acute appendicitis require immediate response and calling an ambulance. There are also certain mortality rates for this disease; in particular, it is known that appendicitis in the world kills an average of 0.1% of patients. In this case, we are talking about the lack of necessary treatment for appendicitis and the development of peritonitis, which in itself is a complication leading to death.

Let's dwell on the anatomical features. The dimensions of the appendix are approximately 10 cm in length and about 7 mm in thickness. The appendix has its own mesentery, which looks like a duplicate of the peritoneum; this mesentery contains nerves, blood vessels and adipose tissue. Also, due to the mesentery, relative mobility of the process and its simultaneous retention are ensured.

In most cases, the cecum and appendix are located on the side of the right iliac region, although other location options are also possible, let’s focus on them:

• Pelvic location of the appendix. The process is located in the environment of the pelvic cavity.
• Retrocecal location of the appendix. The location of the process is concentrated in the area behind the cecum.
• Subhepatic location of the process. The direction of the process is upward, with the apex upward, which, in turn, provided that the process is of sufficient length, can reach the region of the subhepatic space.
• Medial location of the process. The process is located along the area of ​​the wall of the cecum.
• Anterior location of the process. The appendix is ​​located in front of the cecum.
• Lateral location of the process. The process is located in the area of ​​the right lateral canal, along the lateral wall of the intestine.

If there is such a feature as inversion of organs (that is, their “mirror” arrangement), then the listed areas in which the process can be located will be located not on the right, but on the left. In addition, the appendix can be located behind the peritoneum, which, in turn, causes additional difficulties during the operation. When searching for the vermiform appendix, they are guided by muscle bands, there are three of them in total, they are located along the length of the large intestine, including the cecum. These muscle bands have the form of longitudinal muscle fibers; they also act as components of the longitudinal outer muscle layer in the colon. In the area where the domes of the last ribbon converge, the area in which this occurs is the area from which the appendix emerges. The location of the base of this process is generally located a few centimeters below the area where the ileum flows into the cecum.

The walls of the appendix contain several layers: the serous layer, the muscular layer, the submucosal layer, and the mucous layer. The serous layer is presented in the form of peritoneum, the muscular layer includes a longitudinal outer layer based on muscle fibers and a circular inner layer. The submucosal layer includes elastic and collagen fibers and also contains many lymphatic follicles. The mucous membrane of the appendix is ​​covered with simple unbranched tubular glands - these are crypts, which, in turn, contain Paneth cells.

The appendicular artery provides blood supply to the appendix, and venous outflow is provided through the corresponding veins. There are also two types of nerve plexuses in the appendix, the muscular plexus (or Auerbachian) and the submucosal plexus (or Meissnerian). Nerves contain parasympathetic and sympathetic fibers.

Lymphatic vessels originate from the mucous membrane of the appendix; they collect lymph from each layer of the appendix, which, in turn, spreads to the regional lymph nodes in it (in particular, the ileocecal and appendicular lymph nodes).

Due to the fact that the walls of the appendix contain large numbers of lymphatic follicles, this organ is often designated differently than the vermiform appendix or the appendix - the intestinal tonsil. It is not completely clear what the functional purpose of the appendix is, although its endocrine, secretory and barrier functions are proven. It is also known that the appendix is ​​involved in maintaining normal microflora in the intestinal environment and in the formation of appropriate immune responses.

Appendicitis: causes

There are many theories regarding the development of acute appendicitis, with the leading position given to Aschoff’s infectious theory. Based on this theory, it is explained that acute appendicitis is provoked by the influence of local microflora, which at a certain point in time has become virulent, that is, infectious or pathogenic, capable of causing disease. Due to the increased virulence to which the microflora has been exposed, a lesion forms on the mucous membrane. Over time, this lesion becomes widespread, thereby causing inflammation of the entire appendix.

Depending on the actual etiological factor, acute appendicitis can be either specific or nonspecific. Nonspecific acute appendicitis develops as a result of exposure to nonspecific flora, such as streptococci, Escherichia coli, and staphylococci. As for the specific nature of acute appendicitis, it is caused by the corresponding type of infections, for example, tuberculosis, dysentery, typhoid fever, etc.

In addition to the infectious theory, there is also a vascular theory of the development of appendicitis; this theory was proposed by Ricoeur. Based on the principles on which this theory is built, the appendix becomes inflamed due to spasm of the blood vessels, which provide nutrition to this appendix. Unlike the previous infectious theory, in which the inflammatory process develops from the area of ​​damage to the primary focus of the mucous membrane with the subsequent spread of this process and the development of destructive forms of appendicitis, the vascular theory made it possible to initially determine why these destructive forms develop.

Infectious and vascular theories are not mutually exclusive; moreover, they complement each other in considering the picture of the disease. Based on the data on these theories, it is possible to identify factors that provoke the development of appendicitis, in particular, these include the following options:

• immunodeficiency;
• vasospasm, which causes the possibility of necrosis developing in the wall of the appendix;
• obstructive processes in the lumen of the appendix, leading to stagnation of the contents in it (foreign bodies, helminthic infestation, proliferation of lymphoid tissues, fecal stones, deformation of the appendix).

You can also identify the following additional factors, also related to those already mentioned:

• violation of the diet - with the constant presence of meat in the diet in large quantities, as scientists indicate, there is a greater risk of developing appendicitis, while fasting sharply reduces this risk;
• hereditary predisposition (in the presence of a certain type of antigen);
• individual characteristics inherent in the anatomy of the process (the process is too long, bends in it and other factors causing stagnation of the contents in it);
• thrombosis of the artery, which provides nutrition to the appendage, which is important for patients with diseases of the cardiovascular system, atherosclerosis;
• reduction of protective mechanisms in the body due to smoking, alcohol abuse, stress;
• the transition of inflammation in women from the uterine appendages to the appendix, located in close proximity.

Appendicitis: classification

As already noted, appendicitis can be acute or chronic, and each of these forms has several clinical and morphological varieties.

Thus, acute appendicitis can manifest itself in a simple (or catarrhal) form or in a destructive form (and this is phlegmonous or phlegmonous-ulcerative appendicitis, apostematous appendicitis or gangrenous appendicitis).

With catarrhal appendicitis, there are signs indicating a disorder of lymph and blood circulation in the appendix; foci of a purulent-exudative inflammatory process develop in the mucous layer. This is accompanied by swelling of the appendix, as well as congestion of its serous membrane.

Due to the progression of the catarrhal inflammatory process, acute destructive appendicitis develops. A day after the start of the development of the inflammatory process, infiltration spreads to the entire thickness of the wall of the appendix, and this already determines phlegmonous appendicitis. This form of the pathological process is characterized by significant thickening of the wall of the appendix, redness and swelling of the mesentery, and the release of purulent secretion through the lumen of the appendix.

If diffuse inflammation is accompanied by the formation of multiple microabscesses, a form of pathological process such as apostematous appendicitis develops, and if the mucous membrane is covered with ulcerations, then a form such as phlegmonous-ulcerative appendicitis occurs. With subsequent progression of pathological destructive processes, gangrenous appendicitis develops.

As a result of the involvement of tissues surrounding the appendix in the actual purulent process, periappendicitis develops, and if its own mesentery is involved, mesenteriolitis develops. As complications accompanying acute appendicitis (this mainly concerns phlegmonous-ulcerative appendicitis), perforation of the appendix occurs, which, in turn, causes the development of a limited or diffuse form of peritonitis, that is, an appendiceal abscess develops.

Among the forms of chronic appendicitis, there are a residual form, a primary chronic form, and a recurrent form. Chronic appendicitis itself in its course is accompanied by the development of sclerotic and atrophic processes that manifest themselves directly in the appendix. In addition, here there is also the development of inflammatory-destructive changes with subsequent growth in the wall and lumen of the process of granulation tissue, adhesions are formed, they are formed between the tissues surrounding the process and its serous membrane. As a result of the accumulation of serous fluid in the lumen of the appendix, a cyst is formed.

Appendicitis: symptoms

The symptoms of appendicitis are mainly determined by the age of the patient, the location of the appendix in the abdominal cavity, and the presence/absence of complications associated with the pathological process.

Symptoms of acute appendicitis are as follows:

Pain. This symptom is the first and main symptom of appendicitis. The localization of abdominal pain, again, is determined by where exactly the appendage is located. Basically, the onset of acute appendicitis is accompanied by the appearance of pain in the upper abdomen (such pain is also referred to as epigastric pain), the intensity of pain at this moment is weakly expressed, that is, there is a dull pain. During the first hours from the onset of the disease, the patient is unable to determine exactly where the pain began; this feature is characteristic of acute appendicitis.

After about 5-6 hours from the onset of pain in the abdomen with acute appendicitis, pain moves from the upper abdomen to the right side. This feature is also characteristic of acute appendicitis; it does not appear in other diseases. Pain in the right side with appendicitis manifests itself in a fairly pronounced form; the patient has to take a certain position due to its intensity (in particular, a lying position with legs bent at the knees).

Due to the fact that the pain does not become less intense, the patient becomes irritable, and additionally develops weakness and headache. In some cases, acute appendicitis is accompanied by pain in the legs (usually in the right leg), and this symptom is also characteristic specifically for appendicitis. While walking, the patient tries to lean on the sore leg as little as possible.

The transition of pain from the upper abdomen to the right iliac region is defined as Kocher's symptom. If such a feature is identified, again, the diagnosis of “acute appendicitis” will be more than certainly confirmed. The indicated nature of pain is inherent in the typical area where the appendix is ​​located.

If there is pelvic location appendix, then the localization of pain will be concentrated in the lower abdomen. If there is subhepatic location appendix, then pain will appear in the right hypochondrium, which is why it can be confused with the pain that appears during acute cholecystitis. In addition, the hepatic location of the process may be characterized by the spread of pain to the area of ​​the right forearm. If there is retrocecal location, then the pain will appear in the lower back on the right, with possible spread to the right thigh. Here, too, pain can be confused with another disease, in particular we are talking about pain with renal colic. Medial location process is accompanied by the appearance of pain in the navel area. If relevant organ inversion, then the pain will appear, respectively, on the opposite side, that is, on the side of the left iliac region, on the left in the lower back, in the left hypochondrium.

The onset of the disease may be characterized by the already noted pronounced intensity of pain, but over time, such pain may not manifest itself so strongly, or even disappear altogether. This feature requires the attention of a doctor, because when the pain decreases/disappears, gangrene of the appendix may be relevant. The possibility of the opposite scenario is also possible, in which initially the pain does not appear too intensely, but later it intensifies. This scenario is possible when the appendix wall is perforated.

In children and the elderly, the pain is somewhat different; it is simply a dull ache in the abdomen that lasts for several hours/days. Because of this feature, diagnosing appendicitis can be difficult. If abdominal pain appears in a pregnant woman, then it resembles pain during a miscarriage or pain during contractions; this also requires immediate medical attention.

Nausea, vomiting. Nausea can occur in combination with a single vomiting; such vomiting does not bring relief to patients; it appears mainly at the peak of pain. According to the nature of the manifestation, vomiting does not necessarily manifest itself as a reflex symptom; it can also act as a general sign indicating intoxication against the background of the development of a complication of appendicitis, which in particular is considered to be peritonitis. If vomiting occurs repeatedly, serious complications may occur that threaten the patient's life.

Dysuria. If the pelvic or retrocecal location of the appendix is ​​relevant, then dysuria may develop (this term refers to urination disorders, usually caused by difficulty in excreting urine against the background of compression of the urethra). In this case, dysuria is associated with the location of the process near the bladder or right ureter.

Frequent loose stools (diarrhea). This symptom mainly appears in children. In addition to diarrhea, constipation may also develop, which is caused by actual intestinal paresis (weakening of the motor function of the muscular system against the background of damage to the nervous system).

Temperature. In acute appendicitis, the temperature is not too high, however, its presence makes it possible to distinguish this disease from other diseases accompanied by similar symptoms (the same renal colic). In some cases, appendicitis manifests itself without fever, this particularly applies to the onset of the disease in older people.

Thus, we can briefly summarize that acute appendicitis manifests itself mainly with the appearance of acute pain in the abdomen, accompanied by a general deterioration in health, then nausea, single vomiting and, finally, fever.

An important detail that should be paid attention to is to avoid taking any painkillers before the ambulance arrives, because such a measure can cause difficulties in making an adequate diagnosis, while simultaneously contributing to the development of complications of this disease.

Acute appendicitis in children: symptoms

In the first years of life, acute appendicitis in children is diagnosed extremely rarely. The disease is mainly diagnosed at the age of 7 years and older. The symptoms discussed earlier in the general picture of the disease can also occur in children, although, as a rule, the picture of this disease in them is not so specific. The following manifestations accompanying the disease in children are distinguished:

• lethargy, moodiness of the child, loss of appetite;
• the appearance of a dull pain in the right side;
• slight increase in temperature (within 37 degrees);
• vomiting (it can be once or twice, or may be absent altogether);
• a specific position in bed when these symptoms appear (with knees pressed to the stomach).

Chronic appendicitis: symptoms

Acute appendicitis, as the reader was able to notice from the description above, is characterized by rapid development, in which days, and even hours, count. Basically, it is in its acute form that appendicitis makes itself felt. Meanwhile, chronic (subacute) appendicitis is also no exception, and it is characterized by some features. In particular, this concerns the mild manifestation of symptoms and the slow development of the disease.

The abdominal pain that appears is dull and quite tolerable in nature; nausea, vomiting and fever may not appear at all.

Another feature of chronic appendicitis is that it can end in spontaneous recovery, which almost never happens if the course of the acute form of this disease is considered.

Appendicitis: first aid

Of course, given the seriousness of the sick person’s condition, the question arises of what help can be provided to him before the arrival of qualified specialists. Let us highlight the main measures that will temporarily alleviate his general condition:

• Call an ambulance. This point, as is clear, does not require any special explanation; such assistance should be the main one when symptoms of appendicitis appear. In the future, this will require surgical intervention (with preliminary diagnosis of the patient’s condition).
• Before the ambulance arrives, the patient is put to bed. You need to put ice on your right side. A warm heating pad on the stomach is not an acceptable option for appendicitis! This can cause the appendix to rupture, leading to peritonitis.
• We repeat: no painkillers until the ambulance arrives. The consumption of food and liquids before this time is also excluded.
• Even if the pain has subsided or disappeared, a doctor is still needed for the listed symptoms! As already noted, this does not indicate normalization of the condition, but, on the contrary, may indicate complications.
• It is prohibited to take laxatives, otherwise arbitrary rupture of the appendix may also occur, followed by the development of peritonitis.

Complications of appendicitis

The main complications of appendicitis are as follows:

• Peritonitis (or inflammation of the abdominal cavity). A fairly serious complication that accompanies a ruptured appendix. Here, not only are the chances of normalization of the condition and recovery significantly reduced, but there are also prerequisites for death.
• Intestinal obstruction. Signs indicating intestinal obstruction include nausea, bloating and repeated vomiting.
• Purulent inflammation affecting the portal vein with the formation of small abscesses in the liver organ.

Appendicitis: diagnosis and treatment

Before moving on to the main method of treating appendicitis, and we are talking about the previously noted need for surgical intervention, it is necessary to diagnose whether appendicitis is a problem. To do this, a blood test (general) is taken, as well as a urine test; the results are usually available within half an hour. An examination is also carried out by a surgeon, who should outline the characteristics of his own condition. Additionally, you will need to undergo an ultrasound, girls/women are sent to a gynecologist (this allows you to exclude the presence of diseases of the uterine appendages, which is accompanied by similar symptoms).

The most accurate is an examination by a surgeon to make a diagnosis, during which the relevant areas are felt (palpated). Other diagnostic methods are only auxiliary, because even with the help of ultrasound it is not always possible to detect the appendix.

Then, when the diagnosis is confirmed, the patient is subject to hospitalization. If the picture of the manifestation of the disease is unclear, he may remain in the surgical department to monitor the dynamics of the general condition. Additionally, laparoscopy may be performed. To do this, using local anesthesia, a puncture is made in the navel area, through which, in turn, a laparoscope is inserted, allowing an examination of the appendage.

If there is a need for surgery, the appendix is ​​removed (called an appendectomy). This method of treatment is the only correct one; general anesthesia is performed for the operation. Removal can be done classically, through an incision on the right, in the iliac region, or laparoscopically, for which three small incisions are made. Laparoscopic incisions are the most preferable option, because the rehabilitation period (i.e., recovery) after surgery in this case is reduced significantly.

Appendicitis: postoperative period

During the first 12 hours after the operation, the patient remains in bed; food intake is excluded during this time. After another 12 hours, you are allowed to sit in bed and roll over to the other side. If there is no nausea, then you are allowed to drink water with lemon added (small portions, interval - 2 hours). If the doctor allows, then on the second day after the operation you can get out of bed and walk. A quick recovery can be achieved through an active motor regimen; in addition, this also helps prevent the formation of blood clots in the veins of the legs. All information regarding acceptable food intake is provided by the attending physician. The main manifestations indicating the need to eat are a feeling of hunger, gas, the appearance of stool and the absence of nausea - all this indicates that intestinal functions are being restored.

Usually, by the second day after surgery, liquid food is allowed, and this is oatmeal, juice, low-fat cottage cheese and kefir, and baby food. Portions are small, take no more than 6 times a day. By the third day, boiled chicken meat, steamed cutlets, and soup (low-fat broth) are allowed. The portions are also small, this is allowed if the patient’s health is normal. By the eighth day, nutrition can be standard.

Sutures are removed 7-8 days after the operation. After 1.5-3 months. the possibility of playing sports (running, sports dancing, swimming, etc.) is allowed. Heavy physical activity is allowed after 3-6 months. after surgery, in particular, this time is necessary for a dense scar to form and for a hernia to not form at the incision site. The required strength of the scar, which is based on connective tissue, appears precisely during the last specified period, that is, after 3-6 months. after operation.

A separate topic is appendicitis and sex. Similar to playing sports, you will have to exclude sex as such for some time. You can do it only after the wound has completely healed. Accordingly, until the stitches are removed and until the wound is completely healed, sex should be avoided.

As for the general period of disability, it may differ, which depends in particular on the specifics of the inflammatory process and on the presence/absence of associated complications, as a rule, this is a period of 16-40 days.

If symptoms indicating appendicitis appear, you must call an ambulance; in the future, this will also require visiting a surgeon and a gynecologist (for women).

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What is appendicitis?

Acute appendicitis accounts for about 65–70 percent of all acute diseases of the abdominal organs. Among all emergency surgical interventions, appendicitis accounts for 60–80 percent. Approximately 10 percent of the population undergoes appendectomy surgery in European countries.

According to statistics, appendicitis is a problem that is most often encountered by young people. About 75 percent of patients who have their appendix removed are men and women under 35 years of age. The highest risk group includes girls and boys aged 15 to 19 years. This pathology practically does not occur in children under one year of age and in elderly people over 70 years of age. After 50 years, this disease occurs in only 2 percent of the population.

Women undergo an appendectomy (removal of the appendix) more often than men. At the same time, complications are diagnosed in female patients much less often than in male patients.

The problem of appendicitis has been familiar to humanity for a long time. The characteristic cut mark on the abdomen was found on an Egyptian mummy dating back to the eleventh century. The first to describe the vermiform appendix of the cecum in his works was Leonardo da Vinci. This body was officially recognized by scientists after a long time.
The term “appendicitis” was proposed by an American professor in 1886 in his work on the symptoms of inflammation of the appendix.

According to one version, the cause of death of the famous illusionist Harry Houdini was appendicitis. One of the magician's tricks was that he allowed the audience to give themselves strong blows to the stomach. Houdini knew how to strongly strain his abs, as a result of which the blows did not bring him much discomfort. Once, tired after a performance, the illusionist allowed himself to be hit in the stomach by one of the fans who made his way into the dressing room. Soon after Houdini's blows, severe abdominal pain began to bother him, and some time later the magician died from peritonitis, the cause of which was an appendicitis that burst due to the blow.

Causes of appendicitis

Anatomy of the appendix

A large accumulation of lymphatic tissue in the lumen of the appendix provides it with a protective function. Immunocompetent cells that are located in the lymph nodes produce antibodies against bacteria that enter the intestine. The appendix is ​​also a reservoir of beneficial bacteria and, thus, participates in the normalization of intestinal microflora.

Causes of acute appendicitis

Microorganisms involved in the development of appendicitis

Theories for the development of appendicitis are:

• mechanical theory;
• neuro-reflex theory;
• allergic theory;
• vascular theory.

Thus, the basis for the inflammatory process is blockage of the lumen of the appendix, that is, a mechanical factor. Various pathologies can act as this factor.

Mechanical factors that can cause obstruction of the appendix lumen are:

• helminths - for example, a ball of roundworms can clog the intestinal lumen;
• fecal stones – often found in older people;
• adhesions and cicatricial adhesions;
• carcinoid (slow-growing tumor) of the appendix;
• enlarged lymph nodes can also close the lumen of the appendix.

Allergic theory of appendicitis development
This theory believes that acute appendicitis is based on allergic reactions of the third and fourth types. There are five known types of allergic reactions, each of which is observed in certain pathologies. For example, the first type of reaction is an allergic reaction of the anaphylactic type, which can be observed with anaphylactic shock, urticaria, and bronchial asthma.

According to the allergic theory of appendicitis, with the third and fourth hypersensitivity reactions, a weakening of the protective barrier of the appendix mucosa occurs. This is accompanied by the penetration of an additional amount of opportunistic bacteria from the cecum into the lumen of the appendix. Weakening of the protective properties on the one hand and an increased concentration of bacteria on the other forms the basis for the development of inflammation.

Vascular theory of the development of appendicitis
This theory is based on various disorders of vascular circulation at the level of the mucous membrane of the appendix. These disorders can be triggered by both systemic diseases (for example, vasculitis) and local circulatory disorders (for example, vascular spasm). In both cases, swelling and venous congestion are observed in the mucous membrane, against the background of which the infectious process progresses.

In addition to the main theories listed above, there is also an alimentary (food) theory of appendicitis. According to it, people who abuse meat foods with low plant fiber content have a much higher risk of developing appendicitis. According to scientists, it is precisely this diet that provokes the development of “lazy intestines.” With this syndrome, the transit of intestinal contents is significantly reduced, which causes stagnation. Prolonged constipation, which is formed in this case, leads to a decrease in the protective properties of the mucous membrane and stimulates the activation of pathogenic flora.

Signs of acute appendicitis

Symptoms of acute appendicitis are:

• pain;
• disturbance of stool and urination.

Pain from appendicitis

Acute appendicitis is characterized by a certain migration of pain. So, in the first hours of the disease, the pain is localized in the epigastric region or is diffuse in nature (the patient feels pain throughout the abdomen). In children and adolescents, pain at the beginning of the disease may be concentrated near the navel. After a few hours, the pain descends to the right iliac fossa. From this moment on, the patient complains of pain in the right lower side. This migration of a pain symptom from the epigastrium to the right iliac region is called Kocher's symptom. This diagnostic sign speaks in favor of acute appendicitis, but may also indicate other surgical pathologies (for example, a perforated gastric ulcer).

On which side is appendicitis localized?

Variants of the position of the appendix and localization of pain in this case

Fever and other general symptoms of acute appendicitis

All of the above symptoms are a consequence of the formation of an infectious focus in the appendix. This focus is the result of infiltration (impregnation) of the walls of the appendix with virulent bacteria. Initially, the infectious focus is small and general symptoms develop as a result of reflex-visceral reactions. A similar reaction of the digestive tract to a nearby inflammatory process causes such general symptoms as dry mouth, fever, reflex vomiting, and moderate bloating. The patient's condition is assessed as moderate. Later, with the development of numerous complications and the spread of the infectious process, symptoms progress against the background of endogenous intoxication.

Disorders of stool and urination in acute appendicitis

Peritonitis and other complications in acute appendicitis

Complications of appendicitis are:

• peritonitis;
• appendicular infiltrate;
• abscess.

The main symptom is pain. But unlike appendicitis, the pain does not have a clear localization, but is diffuse in nature. The intensity of the pain is very strong, unbearable. The patient is in the fetal position characteristic of peritonitis - lying on his side with his knees bent and his legs brought up to his stomach. The patient's skin is pale, sometimes even marbled. Severe pain is accompanied by repeated vomiting, which does not bring relief, a drop in blood pressure, rapid pulse, and an increase in body temperature up to 39 degrees.

The clinical picture of peritonitis depends on the area of ​​the peritoneum affected. There are local, widespread and limited peritonitis. Local peritonitis occupies only one anatomical part of the abdominal cavity. Most often it affects the peritoneum around the appendix. Extensive peritonitis occupies two to five anatomical areas. In this case, the inflammatory process covers not only the appendix, but also the area of ​​the cecum and sigmoid colon. Total peritonitis affects the entire abdominal cavity and is a critical condition in surgery.

Treatment of peritonitis is exclusively surgical. During surgery, the source of peritonitis is found and removed, that is, the inflamed and burst appendix. After this, the peritoneum itself is washed several times with antiseptic solutions. The operation ends with drainage of the abdominal cavity. During the operation, rubber tubes are inserted into the abdominal cavity for drainage, through which the abdominal cavity is washed in the postoperative period.

Appendiceal infiltrate
Infiltrate is a conglomerate of organs fused together that surround the appendix. Thus, the appendiceal infiltrate includes the cecum, part of the sigmoid colon, the greater omentum, and sometimes the uterine appendages (ovaries, fallopian tubes). This infiltrate develops as a protective reaction to the spread of the inflammatory process. When the appendix bursts, its contents enter the abdominal cavity. To prevent it from spreading further to the entire abdominal cavity with the development of diffuse peritonitis, the inflammatory process is localized by the above organs.

Infiltration develops on the fifth day from the onset of the disease. Initially, the clinical picture repeats the symptoms of acute appendicitis - there is pain, a moderate increase in temperature. However, on the 2nd – 3rd day from the onset of the disease, the pain begins to subside, the temperature drops to normal. On days 4–5, against the background of mild pain, a dense, painful and inactive formation is palpated (palpated) in the right iliac region. If a doctor palpates this type of formation in a patient, then it is necessary to carry out a differential diagnosis with a tumor of the cecum.

Treatment of infiltration is completely conservative, that is, only based on medications. Bed rest, diet and antibiotic therapy are prescribed. Due to the increased risk of relapse (repeated exacerbation) after 3 months of conservative treatment, removal of the appendix is ​​indicated.

Abscess
An abscess is a localized collection of pus. It can develop both in acute and chronic appendicitis. The location of the abscess depends on the initial position of the appendix. So, the abscess can be pelvic, subdiaphragmatic or interintestinal. The most common is a pelvic abscess, since purulent exudate under the influence of gravity accumulates in the lowest parts. Pain from a pelvic abscess is localized in the perineal area. They are accompanied by a false urge to defecate and difficulty urinating.

A subphrenic abscess is localized in the upper parts of the epigastrium, under the diaphragm. The pain is located in the lower part of the chest. They intensify with a deep sigh, coughing, shortness of breath. With an interintestinal abscess, pain is felt by the patient deep inside the abdomen. Due to the soldering of intestinal loops together, intestinal obstruction may occur, in which long-term constipation is noted.
Abscesses are treated exclusively surgically by opening the abscess through an incision on the anterior abdominal wall.

Chronic appendicitis

• primary form;
• residual (residual) form;
• recurrent form.

Residual form of chronic appendicitis
The residual form of chronic appendicitis develops against the background of acute inflammation of the appendix. This occurs when an acute attack of appendicitis is treated independently or with medication without the use of surgery. As a result of acute inflammation, many adhesions often remain in the abdominal cavity. They cause aching, dull pain in the area of ​​the cecum and appendix.

Recurrent form of chronic appendicitis
A recurrent form of chronic appendicitis may appear after surgery to remove the appendix. The inflammatory process develops in the stump of the appendix and often spreads to the cecum and surrounding tissues. Relapses (repeated exacerbations) are usually observed when the remaining appendage stump is longer than 2 centimeters.
There are many risk factors that contribute to the development of chronic forms of appendicitis.

Risk factors for developing chronic appendicitis include:

• hypothermia of the body;
• psycho-emotional stress;
• alcohol abuse;
• unhealthy diet;
• constipation;
• chronic diseases (diabetes mellitus, hepatitis);
• age group over 70 years and under 2 - 3 years.

Causes of development of chronic appendicitis

The adhesive process can be present both between the abdominal organs and inside the appendix itself, causing its deformation and obliteration (blockage of the lumen). Based on this, several morphological forms of chronic appendicitis are distinguished.

The morphological forms of chronic appendicitis are:

• dropsy of the appendix;
• mucocele of the appendix;
• empyema of the appendix;
• fibroplastic appendicitis.

Fibroplastic appendicitis is an overgrowth of fibrous tissue in the wall of the appendix. This leads to its thickening and enlargement of the process.

Signs of chronic appendicitis

Symptoms of attacks of exacerbation of chronic appendicitis are:

• pain in the right iliac region, increasing in case of increased intra-abdominal pressure;
• pain in the abdominal area;
• nausea;
• vomit;
• periodic flatulence;
• body temperature is within 37.5 degrees.

Poor nutrition also leads to increased pain. In female patients, exacerbations may occur during menstruation.

Symptoms of the period of remission of chronic appendicitis include:

• mild pain syndrome;
• emotional lability with increased irritability;
• sleep disorders;
• decreased muscle tone of the anterior abdominal wall on the right.

Objective symptoms of chronic appendicitis

Appendicitis in children

At the slightest inflammation, the fluid that accumulates in the lumen of the appendix has difficulty leaving it. This creates conditions for its stagnation and inflammation. In children, there are practically no conditions for stagnation, since the cecum, narrowing funnel-shaped, immediately passes into the appendix. Between them there is not even a sphincter, which is present in adults. That is why cases of acute appendicitis in children under 4–5 years of age are extremely rare. However, with age, these anatomical features undergo changes, and by the age of 7, the appendix in children becomes identical to an adult.

Symptoms of acute appendicitis in children

The disease begins suddenly with a sharp deterioration in the child’s well-being and an increase in temperature to 38 - 39 degrees (while adults are characterized only by low-grade fever, that is, a not very strong increase in temperature). There is repeated vomiting and intestinal upset in the form of frequent and loose stools. All these symptoms (vomiting, fever, diarrhea) lead the doctor to think about an intestinal infection.

The specific symptoms of acute appendicitis in children are also due to the presence of abdominal syndrome. This syndrome occurs not only with appendicitis, but also with pneumonia, influenza, scarlet fever and other diseases. It manifests itself as very strong and widespread pain (all over the abdomen). In young children, pain is often concentrated near the navel, which again makes it difficult to quickly diagnose acute appendicitis.

Symptoms of acute appendicitis in children are:

• frequent, loose and unformed stools;
• repeated vomiting;
• severe, widespread pain throughout the abdomen or pain near the navel;
• temperature rise to 39 degrees;
• severe bloating.

Features of the clinical picture of acute appendicitis in children

Features of the development of acute appendicitis in children include:

• the presence of a “light gap”;
• atypical positions of the appendix;
• pronounced intoxication syndrome.

Atypical positions of the appendix
In children, due to incomplete growth of the body, atypical positions of the appendix are much more common. Quite often there is a high position of the appendix, when it and the rectum are located under the liver. In this case, pain and tension in the abdominal muscles are diagnosed not in the right iliac space, but in the right hypochondrium. This localization of pain along with vomiting often imitates the clinical picture of acute cholecystitis. Also, the vermiform appendix can be located retrocecally, that is, behind the cecum. In this case, there is no tension in the abdominal muscles, but there is pain in the lumbar region.

Severe intoxication syndrome

Diagnosis of acute appendicitis in children

It is necessary to examine the child in a warm room after at least minor contact has been established with him. It is also necessary to palpate with warm hands so as not to provoke additional stress for the child. However, immediately before palpating, it is necessary to pay attention to the position of the child in bed. As a rule, they lie on their right side with their legs brought to their stomach. Children are calm, do not rush around (unless it is a 4-5 year old child), but when you try to pick them up, they resist. This is explained by the fact that lifting the child provokes increased abdominal pain.

Appendicitis is not characterized by the child's agitation when he spins, spins, climbs on and off the couch. If a child exhibits such behavior, then appendicitis is ruled out. The doctor examines not only the abdomen, but the entire child as a whole. The skin is examined for rashes, the throat for inflammation, and the lungs are listened for wheezing. This is done for differential diagnosis. It must be remembered that abdominal syndrome accompanies most childhood diseases.

Palpation of the abdomen is not accompanied by the questions “does it hurt?”, because, as a rule, the answer is written on the child’s face. Also, children’s answers are often biased; they can repeat any question after the doctor - “does it hurt?” - “it hurts”, “doesn’t it hurt?” - “it doesn’t hurt.” Most children are terrified of the hospital and therefore hide their complaints in order to quickly get rid of the doctor.

Palpation should begin from the least painful part, that is, from the left iliac fossa. Next, following clockwise, the doctor ascends to the left hypochondrium, epigastric region, right hypochondrium and descends to the right iliac fossa. Palpating each section, the doctor observes the child's facial expression and reaction.

In acute appendicitis, the child's abdomen is moderately swollen, and moderate muscle tension is noted in the lower right region. Then you need to ask the child to turn on his left side and carefully monitor how he does this. If at the same time he groans and holds his right side with his hand, then this is considered a positive symptom of Rovsing (this symptom speaks in favor of appendicitis).

The symptom of peritoneal irritation (Shchetkin-Blumberg symptom) is rarely detected in children, since the child cannot tell when it hurts more - before or after pressure. Moreover, often when trying to press on the right iliac fossa, the child pushes the doctor’s hand away. But in children it is often possible to identify another appendiceal symptom - a symptom of pulling up the legs. It manifests itself in the fact that when the doctor presses on the right iliac region, the child not only tries to push away the doctor’s hand, but at the same time pulls the right leg towards the stomach.

Appendicitis in pregnant women

Symptoms of acute appendicitis in pregnant women

Often pain is present in the right hypochondrium or mesogastrium, while the protective tension of the abdominal wall muscles is completely absent. Diagnosis is also complicated by the presence of physiological leukocytosis in pregnant women. All this leads to the fact that the correct diagnosis at the prehospital stage is made to only 40 percent of women. The rest are given a preliminary diagnosis - the threat of premature termination of pregnancy.

Diagnosis of acute appendicitis during pregnancy

Palpation of a pregnant patient with suspected appendicitis is carried out in a lying position on the left side. This makes it more likely to provoke local pain in the right iliac fossa. Ultrasound examination (US) is of great diagnostic importance. It helps to exclude other surgical pathologies and the threat of miscarriage. For clearer visualization of the appendix, the method of dosed compression with a linear sensor in the right lower quadrant of the abdomen (the location of the appendix) is used today. This method makes it possible to detect inflammation of the appendix even before the development of destructive complications. However, the dosed compression method does not allow diagnosing acute appendicitis in pregnant women with 100 percent accuracy.

Therefore, emergency laparoscopy becomes more important in diagnosis. Until recently, pregnancy was a contraindication to laparoscopy. However, if we compare the risks of complications after laparoscopy and during surgery, then diagnostic laparoscopy is the most preferred option. The complication rate for this procedure is less than 0.75 percent, while 25 percent of operations are complicated by premature birth. At the same time, if neither diagnostic laparoscopy nor surgical intervention is undertaken, a ruptured appendix leads to serious (sometimes fatal) complications in 100 percent of cases.

Complications of acute appendicitis during pregnancy

Complications of acute appendicitis during pregnancy are:

• infectious processes- with catarrhal appendicitis they occur in 15 percent of cases, with a ruptured appendix - in 90 percent;
• intestinal obstruction– 20 percent of cases;
• premature termination of pregnancy after appendectomy– 25 percent;
• maternal mortality– 16 percent for appendix ruptures and peritonitis, 0 percent for uncomplicated appendicitis.

Types and stages of appendicitis

• catarrhal appendicitis;
• purulent appendicitis;
• gangrenous appendicitis;
• stage of appendix rupture.

Catarrhal appendicitis

Due to blurred symptoms, a mild clinical picture and the absence of appendiceal symptoms, diagnosing appendicitis at this stage is difficult. Laboratory tests reveal moderate leukocytosis (up to 12 x 10 9) and an increase in ESR (erythrocyte sedimentation rate).

Purulent appendicitis

Due to the fact that the inflammatory process covers all layers of the appendix and spreads to the peritoneum, symptoms of peritoneal irritation appear in the clinical picture. This, as well as laboratory data (severe leukocytosis) facilitate the diagnosis of appendicitis at this stage.

Gangrenous appendicitis

In fact, at the moment the patient begins to weaken sharply. Dead tissue breaks down into cells (decomposition products), which are carried throughout the body through the bloodstream. As a result, powerful intoxication of the body develops. Body temperature reaches 39 - 40 degrees, pressure drops to less than 90 millimeters of mercury, and pulse increases to more than 100 beats per minute. However, sometimes there may be no temperature in patients with gangrenous appendicitis. In this case, a symptom of “toxic scissors” is observed, when, against a background of normal temperature, the pulse reaches 120 beats per minute. Despite the fact that the pain is slightly muted, the patient is very weak. He suffers from repeated vomiting, which does not bring him relief. Frequent vomiting causes dehydration.

When examining the patient, pale gray skin and a dry tongue covered with a gray coating are revealed. Muscle tension extends to the entire abdomen, and intestinal motility is absent. This makes the patient's stomach not only painful, but also hard and bloated.
This form of appendicitis can lead to fatal complications such as sepsis and septic thrombophlebitis. If the patient is not urgently operated on at this stage, the appendix bursts and its purulent contents enter the abdominal cavity.

Stage of appendix rupture

With peritonitis, the patient's condition reaches critical level - the pressure drops, the pulse quickens, and consciousness becomes foggy. Often patients become lethargic, lying in bed unable to answer questions. The skin becomes pale gray, the tongue becomes covered with a brown coating. Despite this critical condition, there is a weakening of the pain syndrome, which is an unfavorable sign.

Inflammation of the appendix is ​​the most common cause of purulent peritonitis. If you recognize the first signs of appendicitis in time and begin treatment, then serious consequences can be avoided.

Symptoms of the disease are associated with inflammation of the appendix of the cecum

How does appendicitis develop?

The causes of appendicitis are still not fully understood. There are several theories about the development of the disease. There is no consensus on the leading etiological factor in the scientific community.

Possible causes of inflammation of the appendix:

• mechanical blockage of the opening between the cecum and the appendix;
• intraintestinal infection;
• disorders of the nervous regulation of the vessels of the intestinal wall;
• excessive production of serotonin by cells of the APUD system in the appendix;
• disturbances of peristalsis and constipation;
• diet features (lack of plant fiber in the menu, excess protein and fats).

In the early stages of appendicitis, there is swelling of the mucous and submucosal membrane of the appendix, impaired outflow of contents into the cecum, deterioration of microcirculation in arterioles, venules and capillaries, and activation of microflora. The first symptoms of appendicitis are associated with the development of the initial phenomena of inflammation.

Signs of appendicitis in adults

Signs of appendicitis appear acutely against the background of good health.

The first symptoms of appendicitis:

• pain syndrome;
• loss of appetite;
• diarrhea;
• nausea, vomiting;
• fever.

Symptoms of inflammation of the appendix in the first 6-12 hours constantly bother the patient, but do not disturb his general condition.

Signs of inflammation of the appendix are gradually increasing. Abdominal pain increases, fever and nausea increase.

Pain from appendicitis

If the patient has anatomical features of the location of the appendix, then the pain can move from the epigastrium to the lumbar region, right or left hypochondrium, to the periumbilical region.

If the appendix is ​​close to the ureters or internal genital organs, frequent urination and irradiation of discomfort to the groin area may occur.

At the initial stages of inflammation, the pain syndrome is quite moderate, but the intensity of the discomfort is constantly increasing.

Important: If you have acute abdominal pain, you should not take painkillers until examined by a doctor.

Digestive tract disorders

Nausea, vomiting and loose stools occur as a reflex with appendicitis. They appear secondarily after the onset of acute pain.

In acute appendicitis, loss of appetite occurs several hours before the onset of abdominal discomfort. Patients do not refuse to drink water.

Nausea is persistent and increasing. But vomiting is observed only 1-2 times. Loose stools occur in a small percentage of patients.

Frequency of symptoms of digestive tract disorders:

• loss of appetite – 99-100% of cases;
• nausea – 40% of cases;
• vomiting – 20% of cases;
• diarrhea – 10% of cases.

Fever

How does the body's general reaction to appendicitis manifest itself? Patients experience fever (low-grade fever) from the first hours. An increase in body temperature is a manifestation of the functioning of the immune system. In the early stages of inflammation of the appendix, the fever does not exceed 37.5-38 degrees Celsius.

Important: If acute abdominal pain is combined with fever, seek medical help immediately.

Early signs of appendicitis in children

Symptoms of the disease at the initial stage depend on the age of the patient. The first signs of appendicitis in adults and children can differ dramatically. Preschool children often experience an atypical onset of the disease. The first manifestations of inflammation of the appendix may be high fever, vomiting, and deterioration in general condition.

Young children are less able to tolerate discomfort and have difficulty describing how they feel. The development of acute pain is indicated by the forced position of the child’s body (tucked legs), increased crying in the arms of adults.

Tips for parents: Do not apply a heating pad (warm diaper) to the baby's belly. Give your child enough water, do not insist on eating.

Checking for symptoms of peritoneal irritation in a child

Symptoms of the disease in men and women

Features of appendicitis in representatives of different sexes are associated with the location of internal organs in the pelvis, the likelihood of pregnancy or ovarian apoplexy in women.

Inflammation of the appendix occurs 2 times less often in men. The involvement of the appendix in the pathological process is likely to occur with oophoritis, salpingitis, endometritis, and colpitis.

Advice: Women with chronic pelvic inflammation should undergo a full course of treatment from a gynecologist. By eliminating the infectious process in the genitals, you will reduce the risk of appendicitis.

Unfortunately, inflammation of the appendix often occurs in pregnant women. Surgical intervention for this reason is the most common abdominal operation in expectant mothers. The first signs of appendicitis in pregnant women are subtle. A blurred clinical picture often leads to late diagnosis of the disease. In addition, difficulties in detecting appendicitis are associated with changes in the position of the appendix in pregnant women. After 20 weeks, the characteristic acute pain is usually recorded in the right hypochondrium, and not in the iliac region. To detect inflammation of the appendix in expectant mothers, Michelson and Taranenko symptoms are checked.

They often fit into the classical picture and are easier to evaluate. To confirm the diagnosis, the doctor must check the symptoms of Horne, Laroque, Britten.

Pain with appendicitis in men

This disease is an inflammation. It is quite common in our country. And it is considered the most common abdominal disease. Often requires urgent surgical intervention. If the form is advanced or is more than two days old, the appendix may burst. In this case, it occurs. Therefore, it is very important to diagnose it in a timely manner and perform surgery.

causes of the disease

So why is it escalating? Let's look at how appendicitis appears. The reasons for its occurrence have not yet been precisely established. It is difficult to say for what reason inflammation begins. But research into the disease shows that two conditions are required for its development. The first is the presence of necessary bacteria in the intestine, the second is blockage of the lumen of the appendix with feces, seeds or various bones. Sometimes foreign bodies, such as small parts from toys, are found in the appendix.

The disease begins with pain, but it is usually not possible to independently determine its precise location. It seems to a person that he just has a stomach ache, but after five hours the pain begins to concentrate in the right iliac region of the body. The appendix can generally be located in different ways, depending on the individual body structure.

In the normal position of the process, pain is observed in the right region. If the appendix is ​​located a little higher, then it appears under the ribs, on the right. If the process is located below, then pain will be observed in the pelvic region. In addition, vomiting and sometimes even diarrhea may begin.

There are other symptoms by which an exacerbation can be determined: dry mouth (mainly the tongue), increased temperature (often up to 40 degrees). During pregnancy, when a woman is in a supine position, she experiences pain when turning her body from the left to the right side.

Diagnostics

The causes of appendicitis are still unclear, and they are not so easy to determine. Symptoms vary depending on the location of the inflamed process. Diagnosis is based on blood tests (much more white blood cells appear in it) and urine (the amount of protein increases). X-rays are performed quite rarely, as they do not determine an accurate diagnosis. Thanks to the image, only the fecal stone that has blocked the opening of the appendix is ​​revealed.

To determine acute appendicitis, an ultrasound is additionally performed. Sometimes - tomography on a computer. With its help, an enlarged image of the appendix is ​​obtained. At the same time, intestinal tissues that have changed are clearly visible.

Complications

One of the most common complications is perforation. It can lead to a periappendiceal abscess (a collection of infected pus) or generalized peritonitis (infection of the entire abdominal cavity). The causes are acute: incorrect diagnosis and delay in treatment.

Intestinal obstruction is much less common. It can occur when inflammation around the appendix stops the intestinal muscles from working, preventing stool from passing through it. The abdomen swells and vomiting and nausea occur. The part of the intestine that is located above the place where patency is impaired is filled with gas and liquid.

But the most important and dangerous complication is (otherwise known as sepsis). This is a painful condition when bacteria enter the bloodstream and spread throughout the body. The complication can even lead to death.

Treatment

How is appendicitis treated? The reasons for its occurrence can be very different. For example, exacerbation sometimes occurs as a result of complications of intestinal or stomach diseases. But simply eating seeds with husks can also lead to appendicitis. If it is definitely established that it has manifested itself, then in order to avoid side effects, you should not take any laxatives or painkillers, much less apply heating pads. It is best to put something cool on the area that hurts and call an ambulance immediately. If appendicitis is confirmed, the appendix is ​​removed using one of four methods: typical, retrograde, laparoscopic and transluminal.

Postoperative period

With an uncomplicated form of the disease, the patient, even on the first day after surgery, can begin to gradually turn over in bed, on the second day - sit down, on the third or fourth - stand up. You can eat food only from the 3rd day, and it should be liquid or mushy. From the sixth day they usually switch to dietary nutrition.

Pediatric appendicitis

In the first years of life it is extremely rare. Mostly occurs after 7 years. And the initial sign may be abdominal pain. This does not speak specifically about this disease, since this symptom can also arise for other reasons. However, you still need to visit a doctor to get checked. Why else can appendicitis occur? The reasons for its appearance may lie in slagging of the gastrointestinal tract or infection in the body.

This inflammation can be chronic or acute. The latter form is most often diagnosed in children. In this case, the child experiences pain suddenly, nausea and even vomiting immediately begins. After a few hours, the pain moves down the abdomen and begins to pulsate near the cecum. It gets worse when you cough or try to lie down on your left side. At the same time, the mouth begins to dry out, and constipation or diarrhea may occur.

With small children under 7 years old, you need to be very careful with such symptoms, since appendicitis is generally quite difficult to determine. Because they simply cannot tell where and what exactly hurts.

Causes of appendicitis in adolescents and children. Why does it occur?

The disease is very common in adolescence. Typically, exacerbation occurs in spring or autumn. Causes of appendicitis in children and adolescents: in most cases, the disease occurs due to decreased immunity. As a result, the body is unable to resist viruses and bacteria; an infection enters the vermiform appendix, causing inflammation.

Other causes of appendicitis in children: it can be caused by a changed diet and impaired stomach function. Often, inattentive consumption of seeds, nuts, and berries plays a big role. Children often swallow husks, shells, and small seeds, so parents should carefully monitor them. Even common worms can also cause the disease.

Since the child’s body is not yet fully formed, it can be quite difficult to make an accurate diagnosis. In a child, the development of the disease occurs much faster than in an adult. Children become apathetic, there is a sharp decrease in appetite, chills, nausea, constipation and acute abdominal pain. Temperatures can rise to 40 degrees.

In adults

Many cases of exacerbation occur between the ages of 20 and 30 years. Appendicitis often occurs in pregnant women who are predisposed to diseases of the intestinal tract and suffer from constipation. Although the pathology does not depend on gender. Who gets appendicitis more often? The reasons for it are approximately the same at any age. However, in children the appendix is ​​underdeveloped and is easily emptied, while in adults it is the opposite. Consequently, the latter suffer more from this disease.

Causes of appendicitis in adults: it can be any intestinal disease, abdominal trauma, inflammation of the digestive tract or helminthic infestations. In addition, doctors believe that the cause may be the abuse of protein foods.

Acute form

What causes acute appendicitis? The reasons for the occurrence of this form: first - blockage of the appendix, the second is the entry of staphylococci, E. coli, streptococci and enterococci into it. They are interconnected, since in both cases ideal conditions are created for the rapid proliferation of bacteria. In the first case, everything leads to stagnation of the contents and inflammation of the walls of the appendix, and in the second, it provokes the occurrence of intestinal kinks and the impossibility of emptying.

In the West, doctors have identified a separate cause of exacerbation - when fusobacteria enter the appendix, which causes necrotization in its tissues. The infection develops rapidly and causes purulent and inflammatory processes. Conservative treatment is common in the West, but in Russia it is used quite rarely.

Other causes of acute appendicitis: yersiniosis, typhoid fever, tuberculosis, amoebiasis, etc. In addition, the process is facilitated by the excessive formation of proteins in the body, which leads to their rapid disintegration in the intestines and the beginning of the rotting process. A tendency to constipation is also identified as a separate cause, as a result of which timely bowel movements do not occur and conditions are created for the rapid proliferation of bacteria.

Chronic appendicitis

In adults, it is registered quite rarely, no more than one percent of all cases of appendicitis. A person experiences periodic pain that worsens when walking and coughing. In case of relapse, the symptoms are the same as in acute appendicitis. In this case, the body temperature can be normal or subfebrile. Often such appendicitis is classified as pyelonephritis, peptic ulcer, or chronic disease of the abdominal cavity.

Purulent appendix

This is an inflammation of the appendix, combining several types of acute disease. Why does purulent appendicitis occur? The reasons may be the following: abundance of lymph, poor blood supply, the presence of a tortuous narrow lumen, variability of location. In this case, microbes penetrate into the appendix by hematogenous, lymphogenous or (most often) enterogenous means. With this type of inflammation, the flora is polymicrobial. (second and third days). The ends of the process die off, general intoxication in the body increases, and tachycardia is pronounced. The temperature drops sharply, the abdomen swells, and there is a lack of peristalsis.

Difficulties in diagnosis

Why is it sometimes difficult to diagnose appendicitis? Doctors still find it difficult to name the exact reasons for its occurrence. The position of the process varies. More often it is located in the lower abdomen - in the right region, but may have a mesentery. This is a sheet-like film that attaches the appendage to structures found in the abdominal cavity. With a long mesentery, the process sometimes moves noticeably. In addition, it can sometimes be longer than usual.

In some cases, the appendix descends into the pelvic area, and in women it is located between its joints. It can also be located behind the colon. In such cases, the symptoms are similar to inflammation of various organs (for example, pelvic).

It is also difficult to determine appendicitis in situations where a person has other inflammatory processes that can give similar symptoms. Therefore, the patient is initially observed for some time in order to accurately make a diagnosis, since they may manifest themselves more characteristically after some time.