Possible early postoperative complication in appendicitis. The most common complication in patients with host appendicitis

Appendicitis - inflammation of the bud under the name of the appendix. Symptoms of acute appendicitis: more clearly in the abdomen, disordered etching, high temperature.

When the first symptoms are revealed, one should turn for help to the hospital. The only rejoicing is the appearance of a scorched appendix. In some cases, appendicitis is aggravated.

Signs are more complicated

As it was written more, appendicitis is the burning of a worm-like bud. The appendix is a sleepy exit of the colon.

If the wines are changed, be it some kind of exits, it may start burning. At tsomu vpadku nadobitsya vykljuchno help of the surgeon.

Show yourself an appendix if you can. Most often, already in the transitional period, it is brought about by a problem.

Inodia appendicitis is not carried out for all life. In this rank, it’s impossible to turn over її.

With the appearance of the first symptoms, direct to the surgeon. Tolerate and then start more like a glee in the minds of the home at the same time is not necessary.

If you don’t go to the liquor every hour, then you can have different consequences, right up to a lethal result.

The earlier to carry out the operation and recognize the outpatient treatment, the greater the efficiency of the day, be it any comfort.

Already after 3-7 days of retirement, a person turns to a wonderful life. It turns out to be less physical vanity.

The most popular in the list of complications is peritonitis. This is the aggravation of blame for the later re-pumping of the pus of the child and the exit of the middle of the organs.

One of the forms of development of peritonitis is called appendicular infiltrate.

Appendicular infiltrate can be reduced to some extent. It is blamed for the fact that a small number of rot enters the body, and that one is trying to get out of the problem on its own.

The biggest problem in ciomu is the confusion of symptoms. In this case, doctors can diagnose an operation. Given the possibility of blood poisoning, which is practically impossible to predict.

Over the years, the symptoms of infection are less likely to get worse. Festering starts, pain gets worse. Naturally, about the igniting process, the body maintains temperature changes.

In cases of peritonitis, surgical intervention may be appropriate. A form for the development of appendicitis has already been launched, but it is no longer expected to be successful, but a lethal result is checked for a person.

Diagnosing complications can be less than the knowledge of the surgeon. In deyakih fluctuations, the first glance of the line and palpation.

But, unfortunately, it’s the same, that the aggravated development of appendicitis is less than an hour away from the operation.

Іsnuyut different types of complexity. Kozhen maє its symptoms. Any kind of heritage will require a nega vyshennya.

Classification

Different officials pour in on the blame for serious nasledkiv. They feed them hour by hour on pre-operative and post-operative.

The first type of complication of guilt is the succession of a tribal introduction of doctors. Most of the stench is due to the aphid of incorrect diagnosis and further therapy.

Before preoperatively, they include: appendicular infiltrate, plephlebitis, peritonitis, phlegmon of the transverse cell, abscess.

The post-operational complication will be blamed in a deaky hour after the removal of the child. Sometimes the stench is seen for a sprat of tizhniv.

Before the post-operative period, pathologies of the vascular organs and consequences, which were caused by ailments in the course of the surgical procedure, are noted.

Reasons for blaming post-operative consequences:

Wrong dotrimannya regime.
Inaccurate diagnosis.
Chronic and ill sleeping sickness in the sudіdnih organs.
Dovge animal help.
Pardons for the hour of the operation.

The aggravation after the operation may also be different in the place of localization. You can use:

Cherevno empty.
I'll open the place.
Be-yakі іnshі sudіdnі organs of the system.

Actual problems are blamed practically immediately, otherwise for a long time they are at the stage of development.

Also, fakhіvtsі see 2 possible options for the development of a more comfortable way:

Early. Viyavlyayutsya stretch 14 days. Varto see like this: peritonitis, rupture of the seam, bleeding, pathology of the vascular organs.
Piznі. Receipt no later than 14 days. You can see burrows, keloid scars, suppuration, infiltrates, abscesses, intestinal obstruction, adhesions in the empty stomach.

In order to understand all the nuances of the early and early stages, it is necessary to look in more detail at the skin of the able-bodied moods.

perforation

Blame it on an early stage. Tse aggravation, which was the result of a severe inflammation of the appendix, and suppuration of that melting of the walls.

Gnіy go out at the heart of the empty, crying out rattle. Perforation is accompanied by peritonitis.

Looking at the clinical picture of pathology, you can see the signs:

Nudota is bullshit.
Strong pain in the abdomen.
All symptoms of intoxication.
Fever.
Signs of peritonitis.

Naturally, earlier likuvalna therapy began, then the lower risk for the development of perforation. Most of the blame is on quiet people, who turned away for help at the last stage.

Appendicular infiltrate

For the statistics of this complication, more than 3% of patients with a diagnosis of host appendicitis are seen. Appendicular infiltrate can be reduced to some extent.

It is also established through the appointment of an additional help. Vinicated for 5 days after the ear of the ignition process in the child. Inflammation damages the susceptible organs and tissues.

Pochatkov signs:

Fever.
Intoxication.
I am a sharp expression of pain in the stomach.
Significant features show peritonitis.

Signs of illness are characterized by varying symptoms of the upper body. In whom it is important to have a problem, even diagnosing the problem is important. The missing surgeon can simply skip the sign.

At this moment, the patient begins to feel better, more or less, and then he feels better. The only thing left over is the temperature. Її the badge is obliged to go down.

When looking around, the surgeon does not see the m'yazovo's tension in the spine. The only one that can show this kind of complication is the sickly one, the weaker one that is weakly made up near the right air space.

It is necessary to understand that the operation in this case can no longer be significant. The problem is solved by a conservative method.

The medicines of the antibiotic group are taken as a basis. You need strong preparations to prevent a serious development.

Appendicular infiltrate may expand or develop an abscess in the middle of the body. In the shortest depression, as if there is no suppuration in the inflamed area, then the exultation is no more than 5 days.

In another turn, decay may continue, which will lead to peritonitis.

appendicular abscess

Such important forms of development of pathologies can lead to any stage of progression.

The place of localization can be:

Club area rights.
Outer space.
Diaphragm. To be found near the right subdiaphragmatic recess. Symptoms: clear and severe manifestations of intoxication, dry cough, pain in the sternum, and more difficult breathing. On palpation, fahivets signifies: painful sensation, great feeling of the liver, soft life. Dihannya is practically not seen by the right legend.
In choloviki - the place between the sich mikhur and the rectum, in the women - between the rectum and the uterus. Signs: show dizurichni, bіl near the rectum, interstices, parts of the call before emptying. Suppuration can be diagnosed through the rectum.
At the loops of the intestine. It is also important to diagnose the problem at an early stage of development. Dalі the symptomatology becomes brighter in character: the temperature rises, attack the pain, the m'yazi of the cranial wall becomes tense, palpable infiltrate.

To zagalnyh signs can be seen:

Hyperthermia.
Intoxication.
Strong bill.
High level of leukocytes and COE in blood.

Ultrasound is used for diagnosis. How exuberant vicorists are promptly delivered.

Festering pus with appendicular abscess opens up, and the wounded empty is washed out. She will have drainage installed and the wound will be sewn up.

After the operation, it will take another hour to wash the empty stuff through the drains. It is necessary, to see the excesses of pus, that they were stingy. Also, at the empty place, the necessary faces are introduced.

Pilephlebit

This is one of the most important developments in the aggravation of severe appendicitis. Pilephlebitis is a severe purulent-septic inflammation of the liver vein. On the body, a sprat of rots is established.

Basic signs:

The patient suffers from a sharp deterioration in self-perception.
Strong symptoms of intoxication.
Blind shkira.
Butt.
Hypotension.
Recovery of the spleen and liver.
Fever.

Before the course of likuvannya, enter as quickly as possible, so i medicinal treatment. When approved rotten їх open and vlashtovuyut promyvanya.

From the conservative exuberance, the emphasis is on taking anticoagulants and antibiotics.

Important! In 97% of the patient, there is no vryatuvat. The high immovability of death.

Peritonitis

In the wake of the acute ignition process of the appendix, the empty stomach is affected. Signs:

Hyperthermia.
Strong bіl near the cherevnіy zone.
Blіdіst.
Tachycardia.

Tіlki dosvіdcheniy likar can be made so complicated. On palpation, some peculiarities were noted: it grew bigger after that, like a doctor, having pressed on the ropes, it was sharply let out.

With this onslaught, it does not give any particular discomfort.

Therapy can be complex. Before it enter methods:

Symptomatic.
Antibacterial.
Surgical.
Detoxification.

Fistulas in the intestines

Up to the last post-operational complications, the very norms are brought in. For such a pathology, the walls of the nearest intestinal loops are affected by further destruction.

Pressed with thick gauze bandages on the empty lace.
Underdoing the norms for the completion of the appendix.

If the wound is sewn up, then the symptomatology is clearly pronounced and that cuff. In case of incompletely sewn up wounds, the intestines protrude, which makes it easier after the nose.

Signs:

Attack-like pain in the right airway.
In this part, there is a deep infiltrate.
Symptoms of impaired bowel function.
Signs of peritonitis.

Likuvannya bezposeredno stale in the case of an individual overrun of pathology. Therapy includes both the usual medical method and the surgical one.

In the general order, there are anti-sample, antibacterial faces. Utvorennye intestinal burrows are given to negainny vydalennya.

Fistulas can open independently. Which one cannot be allowed at any time. Vіdbuvaetsya tse 10-25 days after the removal of appendicitis. And a small risk of death.

Lіkuvannya ukladnen

As prevention, at the stage of diagnosis of appendicitis, therapy should be carried out.

Ways of exaltation and advancement of inheritance:

Hematomy. Є the most popular type of development is folded. The main symptom is suturing in the mist. When diagnosing hematomas, the doctor prescribes rosetine to the wound and cleansing. They gave them immunotherapy, physiotherapy and prescribe antispasmodics.
Dorimuvatsya recognized by the regime, especially in the first days.
In case of apparent complication of eating, go through injections and urticaria. If I become rich, I will be allowed to wipe porridge and rare products.
For the recovery of tissue ailment, it may be necessary to take antibiotics and antispasmodic medications.
In the first month, there are contraindications for physical vanity, sickness and sharp fluctuations.
It is essential to keep a close eye on the symptoms. About whether there is a new manifestation of varto, speak to the doctor. You cannot engage in self-deception.

Only more correctly, that timely introduction of fahivtsiv can prevent the development of complications after appendicitis.

It is impossible to reach the advanced stage of development. Only respect for one's body is built up from the start to help.

Korisne video

Early complication is blamed on the prolongation of two days from the moment of the operation. This group includes more complications from the side of the postoperative wound (purulent-inflammation processes, rupture of the edges of the wound; bleeding from the wound of the anterior celiac wall) and all complications from the side of the accessory organs.

Bleeding from the vessels of the bridge blamed for the result of technical injuries during the operation, or during the ignition / necrotic process, which may lead to erosive bleeding. Peculiarities of the clinical picture of post-operative bleeding are signs of acute hemorrhage and rapid development of peritonitis. This complication will require a minor reoperation.

The impossibility of kuksi of a worm-like vine m / t will open in the first year and days after the appendectomy. It is most often blamed in ailments with destructive forms of appendicitis; in case of changes, it is not only a worm-like bud, but also the dome of the cecum, which makes it easier to cut the cornrow. With the development of this aggravation, fecal peritonitis develops rapidly, which will require a negligible revision of the empty stomach.

20. Life complication after surgery due to severe appendicitis.

The postoperative complications develop when the two postoperative period merge. One can see them folded from the side of the postoperative wound- Abscess, infiltrate, postoperative hernia, ligature fistula, neurinomial scars, keloid scars; hospitality ignition processes at the red empty- Abscesses, infiltrati, cultitis; folded SHKT- spike disease and mechanical intestinal obstruction.

Dynamic intestinal obstruction caused by functional changes in the motility of the intestinal musculature without any mechanical disturbances that shift the intestinal tract. Mostly paralytic in character. Intestinal peristalsis is attached, due to swelling due to the associated process of wetting and venous congestion at the intestinal wall. Clinic: the first symptom is bloating of the intestines, not associated with pain. An increase in swelling is accompanied by vomit in the back of the head in the place of the slug, then I live, and the rest period is fecal masses. Trivale zduttya intestines lead to the collapse of the intestinal wall, which is accompanied by the penetration of bacteria through it into the empty stomach. It should be done before the appearance of symptoms of secondary peritonitis.

Postoperative infiltrate settled in the ileocecal duct as a legacy of inf-ії, which was lost after the removal of a worm-like bud. With this, there is a puffy-like seal at the right ileocecal space, more painful on palpation. Treatment of post-operative infiltrate is conservative: application of broad-spectrum antibiotics, detoxification therapy, UHF, stings.

Subdiaphragmatic abscess i-i aggravated peritonitis and har-s aggregated pus between the diaphragm (burn) and internal organs- liver, shlunk, spleen, omentum, intestinal loops (from below). Abscess can sometimes roztashovuvatisya and in the transverse space.

Abscesses of the Douglas expanse utvoryuyuyutsya in rez-ti runoff exudate ignition into the empty pelvis. One of the early signs of pelvic abscess is dysuric manifestations, call for defecation, tenesmus, dull pain in the lower abdomen, chills, high temperature. In case of rectal and vaginal obstruction, it is possible to indicate sickness in the Douglas space. At the center of infiltrate, fluctuations are often missed, tobto. abscess. In the cob period, a conservative treatment should be carried out (antibiotics, enemas with chamomile infusion), and if the abscess has formed, rotting it.

Mіzhzhіchnі abscesses. Clinic: pain in the abdomen, partly rare stilts, chills, severe weakness. Then there are symptoms of teasing of the neck, paresis of the intestine. On palpation of the abdomen, there is a puffy-like cavity in the empty stomach of various localizations, often in the middle of the abdomen.

Pilephlebit- thrombosis of the breech and commissar veins. It develops as a result of necrotic processes and thrombosis of the vessels of the breech of the child with distant lesions of the mesenteric vessels of the vein. The severity of the clinic depends on the rate and extent of blockage of the hepatic veins. The aggravation often begins acutely, after 1-2 days after appendectomy. A sick person has severe pain in the epigastric space, or in the right subrib, which is predicted for the intensity of the attack of hepatic colic. Pain is accompanied by boredom, often crooked vomiting, collapse. This is characterized by an aggravated temperature of a hectic character, the appearance of yellowness of the sclera and skirnih curves as a sign of toxic hepatitis. Abdominal pain in the right subcostal area, liver enlargement, ascites, liver failure are noted. Quite often serous hepatitis is observed in the right pleural cavity. In some cases, expanded right portal vein thrombosis and rupture of the hepatic-duodenal ligament may result in compression of the gallbladder duct with advanced mechanical zhovtyanitsa.

BODY. It is blamed on the first 2nd day after the operation. Clinic BODY to lie down depending on the size of the embolus and the degree of blockage of the lumen of the artery. In case of a new blockage of the legenous artery, death sets in mittvo, or as the closest quills after the embolism is blamed. The main sign of this aggravation is the rapid deterioration of the deadly state, which is manifested by severe pain in the chest, a sharp buttock, tension, urivchast, partial breathlessness and may be mittevim pulse. Razka blіdіst skіrnіkh pokrivіv zminyuєtsіanoz vlichchі i upper half of the tunic. There is a severe insufficiency of the right vidiliv of the heart, infirm ailments and swidko gin.

Gostry appendicitis you can be married with important, often threatening to life comforts. They include appendicular infiltrate (abscess), abscesses, peritonitis and plephlebitis. Appendicular infiltrate develops on the 2nd-4th day of illness and manifests itself in the appearance in the right airway, more often in other areas of a scaly, sore, slit and indestructible ablation of various sizes. On palpation, local soreness is indicated. The Blumberg-Shchetkin symptom can be saved for a few days. The temperature increased to 37-38 ° C, the blood died of leukocytosis with damage to the left.

What do you care appendicular infiltrate It is one of the forms of subcutaneous peritonitis, the results of which are even more variable. Infiltrate - a coat in sheep's clothing" (L. G. Brzhozovsky). With a friendly overrun of wines, more ailments are rozmoktuєtsya. However, in the rank of Vipadkiv, it is possible to shuddly in the stomach, Scho manifests themselves to rings painfully in the stomach, to the leukocytosis, fucked tannies, Zagali, Zb_lighnemi Romіра інфілтрції, VIKLENNYE ENTOSTІ YOhOG, IFTOMI VIPTUCIA SELECTION SELECTION.

Peritonitis lie down to themselves unsafe conditions for severe appendicitis and one of the leading causes of death. Yogo klinіka i kuvannya vykladenі at spetsial'nomu rasdіlі.

Complicated appendectomy can be from the side of the wound (mistse), intracranial and systemic. Hematomas, suppuration, fuse infiltrates and ligatures lie before the mast. Hematomas are blamed on the first day after the operation. There is pain and swelling in the area of the suture. Deformation of hematomas is the main method of її usunennya. Suppuration of the wound is the most complicated operation. Zustrichaetsya and 1-6% in the fall, fallow in the form of appendicitis. Likuvannya suppuration heals in the sutures, razvednі edges of the wound, zastosuvanni bandages with antibacterial agents and enzymes, immunotherapy is evident up to the phases of the wound process.
With flaming infiltrates prescribe antibiotics and physiotherapeutic procedures (quartz, UHF, electrophoresis, etc.).

complication from the side of the abdominal emptying, it can be classified as important and not safe for life and includes intracranial abscesses (pelvic, subdiaphragmatic, interstitial, transocular), interstitial peritonitis, peliflebitis, intestinal obstruction, visceral obstruction 19% of intracranial abscesses fall on a part of abscesses after acute appendicitis. Pelvic abscesses are blamed for the localization of destructive appendicitis in the small pelvis or in depressions, if the exudate descends to the lower abdomen. Sound on the 7th-12th day after the operation, the temperature rises again and leukocytosis increases, pains appear above the womb or in the deep pelvis.

Often are afraid of discord, as well as bіl during defecation, tenesmus. In case of rectal or vaginal dosledzhenniy ailing infiltrate is indicated, which hangs, often with rozm'akshennyam. Likuvannya is poured at the rupture of the abscess through the rectum in men and through the back of the crypt in women.

Subdiaphragmatic abscess suffers in 0.1-0.5% depression and progresses with high temperature, severe intoxication, buttocks, chest pains on the side of the wound when inhaled. Diagnosis is important. Lіkuvannya pogaє at the abscess gap, bazhano pozacherevinnymi or postpleural access. Mіzhkіshkovі Absheezi Ta Perigod Forms Provenna Vіdrіznayuznayuznuyu-Klіnіyu picture, Prothe Nadali at Zb_lshennіniki Z''Iniyuzhei Means of Gniino ІNToksikatsії TEIBOCE ON THE HALVOBLE WITH THE ROOM ABO ZLIVA VІD NIGO ZULAMY MO'YUVIV, POSITIVE SYMPTOM OF BLUBYBERA - SHOP. Likuvannya - expansion and drainage of an abscess.

To rіdkіsnyh, but even more unsafe to lay down pilephlebitis, or viscous thrombophlebitis of the portal vein with pemia and multiple liver abscesses. Wines are characterized by an extremely important purulent-septic overflow, intoxication, rapid build-up, high fever, icterus, liver disease, tachycardia and hypotension. Serious prognosis, lethality 90-98%. The use of large doses of antibiotics and the recognition of anticoagulants is considered to be the best. For the presence of liver abscesses, their roztins are shown. Spike process after appendectomy can cause intestinal obstruction in the immediate and distant periods. Before systemic conditions lie thromboembolic complications, pneumonia, acute myocardial infarction, disorder from the side of the sieve system and other.

Russia has a lot of chances of over 1 million. appendectomy from lethality close to 0.2%. The main cause of mortality is the aggravation of acute appendicitis, described above. The stench is connected with a late diagnosis, a delayed operation and її complications. The greatest complication of this lethality is in the midst of children and especially frail and old age.

- Turn to zmіstu rasdіlu "

Side 1 of 43

I. M. MATYASHIN Yu. V. BALTAYTIS
A. YA. YAREMCHUK
Complicated appendectomy
Kiev - 1974
The monograph gives a description of the most important reasons that lead to aggravation of appendectomy, outlines the main principles of management before the post-operative period, including advancement and complication from the side of the surgical wound, organs of the abdominal emptying and other systems. Descriptions are given of the complications that are blamed on the calf walls and the organs of the calf emptying, methods of their explication.
The book was secured by doctors-surgeons and senior students of medical institutes.

Type of authors
The appendectomy has become famous for one of the easiest empty operations, and, perhaps, one of the first ones, as if trusting a young fakhivtsi. The whole world is explained by the fact that the technique of the operation is detailed in detail, all types of changes are not accompanied by great technical difficulties.
Possibly, it is also connected with the majestic flow of appendectomies, in connection with which it has become the most widely available operation for a young doctor. Every hour a student, like a proyshov subordination, may have already performed dozens of appendectomies on his rahunka, at one time without failing more simple and safe operations.
Young lіkar, yaky Shvydko opanuvav navichki operatsії vidalennya chervopodіbnogo vіdrostka not zustrіvshis Zi digit trudnoschami i sposterіgayuchi, yak Shvydko normalіzuєtsya mill ailments, come up hibnogo visnovku about those scho vіn becoming tsіlkom pіdgotovlenim i kvalіfіkovanim hіrurgom i tse daє Yomou right of deyakim poblazhlivіstyu staviti to such “going” operations. In practice, to demonstrate your art, such a doctor does not hesitate to show your surgical virtuosity. For some wines, to work on it is small, shortening the hour of the operation to a few thins, rozrakhovuychi, that the very same moments can characterize him as an accomplished and brilliant surgeon-majstra.

So trivaє doti, the docks of a young doctor do not get stuck with heavy complications. Quite often, with acute appendicitis, the surgical situation is already complicated, if, as it were, the operation becomes more complicated. The notification about appendicitis as a way to endure a lung surgical disease has crossed the threshold of surgical clinics and widely used population. As a chain of the world, so for uncomplicated forms of illness, then often after appendectomy they blame the death of the disease, as it can become the cause of a lethal result, or it could be a stream illness with a whole series of offensive operational interventions, as if it were possible.
The death of an operated ailing patient is always tragic, especially in cases of depression, if the aggravation of an ailing operation could be ahead of time, or be put aside for the correct surgical tactics with their own rational actions. Remarkable numbers of postoperative mortality in appendicitis are small, they reach two to three tenths of a hundred, but in the guise of a majestic number of ailments, operations for acute appendicitis, tenths of a number of hundredths of a hundred are significantly more significant. And for such a skin death, there was a heavy set of conditions, at the hour you didn’t recognize the disease, and it’s technically tactful pardon of the doctor.
Why the problem of appendicitis and appendectomy is now supralingually relevant, and blame it is necessary to once again emphasize the respect of practical doctors, especially young ones, on the details of the operation, possible serious consequences and watch out for both tactful and technical ones.

Causes of postoperative complications of appendectomy

The problem of aggravation of acute and chronic appendicitis and appendectomy in an hour before a previously completed operation (Mahomed in 1884 and Kronlein in 1897) is discussed in the literature. Promoted respect to tsієї problem nevipadkov. Lethality after appendectomy, regardless of the significance of the decrease in the river, still continues to be high. Minimal lethality in acute appendicitis becomes the average close to 0.2%. If you take it to heart that in our country there are 1.5 million appendectomies on a large scale, then it will become obvious that such an insignificant number of post-operative lethality is large in number of deaths. Do you want to add illustrative indicators of post-operative mortality for the Ukrainian RSR in 1969. - 0.24%, or 499 died after appendectomy. Have 1970 r. they were reduced to 0.23% (449 deaths), so that the decrease in mortality by 0.01% decreased the number of deaths by 50 deaths. At the link with the cim, they understood the pragnennia clearly and set the reasons for quiet complications, as they are a fatal problem for the ailing person who is operated on.
The authors (G. Ya. Iosset, 1958; M. I. Kuzin, 1968; A. V. Grigoryan z spivavt., 1968; A. F. Korop, 1969; M. X. Kanamatov) , 1970; M. I. Lupinskiy z spivavt., 1971; T. K. Mrozek, 1971, that іn) made it possible to reveal the most serious complications, which were fatal for the result of illness. Among them, there is peritonitis, thromboembolic aggravation, including thromboembolism of the legenous artery, sepsis, inflamed leg, acute cardiac and vascular insufficiency, spike intestinal obstruction and other.
Named nayvazhchi, griznі ukladnennya, but far from all. It is important to transfer, as if aggravated, it can cause especially important consequences, to a deadly result. It is not uncommon to induce some light post-operational complications, having removed a long-term failure of a severe development, it is significant to overcome the illness and cause the illness to death.
From the other side, it is not so difficult, especially in the case of a sluggish, torpid streak of illness, to delay the terms of exaltation and further rehabilitation of ailments in the minds of an outpatient care. In the appearance of a majestic number of appendectomies, it appears that they are similar, navitably easily flow into a serious escalation in the global system of the treatment of appendicitis.
Everything was longing for more profound treatment of all complications of appendectomy and the causes of their vindication. In the literature, various classifications of postoperative conditions have been introduced (G. Ya. Osset, 1959; L. D. Rosenbaum, 1970 and іn). The most complicated representation is in the classification of G. Ya. Ioset. In practice, create the most complete classification, a lot of authors have been smashed over the top of the cumbersome. We vvazhaemo for dotsіlne povnistyu bring one of them.

Classification of complications after appendectomy(for G. Ya. Ioset).

Complicated from the side of the surgical wound:
Festering wound.
infiltrate.
Hematoma at the wound.
Razbіzhnіst kraїv rani, without eventration and with eventration.
Ligaturny fistula.
Bleeding from the wound of the cervical wall.
Gostrі zapalnі protsesi in cherevnіy empty:
Infiltrate and abscesses of the ileocecal region.
Infiltrate the Douglas space.
Infiltrate and abscesses of the small intestine.
Infiltrates and abscesses are intermittent.
Infiltrates and abscesses of the subdiaphragmatic.
Infiltrate and liver abscesses.
Mystic peritonitis.
Diffuse peritonitis.
Side fold dichal system:
Bronchitis.
Pneumonia.
Pleurisy (dry, exudative).
Abscesses and gangrene legen.
Atelectasis of the leg.
Flattening from the side of the slung-intestinal tract:
Dynamic obstruction.
Gostra mechanical obstruction.
Intestinal burrows.
Shlunkovo-intestinal bleeding.
Side-folding of the cardiovascular system:
Cardiovascular insufficiency.
Thrombophlebitis.
Pilephlebit.
Embolism of the legenous artery.
Bleeding at the cherevnu empty.
Folding from the side of the vision system:
Shelter of the siege.
Hostile cystitis.
Gostriy pielit.
Host jade.
Hostry pyelocystitis.
Other folds:
Gostry parotitis.
postoperative psychosis.
Zhovtyanitsya.
Fistula between the gut and the ventricle.

Unfortunately, the author did not include a large group of other complications of appendectomy. It is not possible to wait for more and with the proponated systematization: for example, intracranial bleeding, which the author has included before the section “Complexation from the side of the heart-vascular system”.
Later, the classification of early conditions was changed (L. D. Rosenbaum, 1970), and there were also minor defects. In practice, to systematize the complication according to the principle of cohesion of the pathological process, the author distinguishes between different groups such close complication, like the razbіzhnіst edges of the wound, suppuration, bleeding; Abscesses of the empty stomach are considered in one group, and peritonitis is especially special, at the same time, abscesses of the empty stomach with a full basis can be surrounded by peritonitis.
In the case of early and late complications of appendectomy, we laid the basis for the essential classification, pragmatic, however, to strictly separate the main groups. We respect the fundamentally different early and late complication, the oscules of them are similar to the terms of guilt, and the reasons, especially the clinical overshoot due to the change in the reactivity of the disease and its adaptation to the van pathological process of the disease. Tse, with its own chergoy, vmagaє different tactful installations of terms such as likuvannya, recognition of operational work, special features of technical methods of tsikh vtruchan toshcho.
Early aggravation is considered more dangerous, which means that the majority of ailments have the introduction of terminology approaches for their adoption and the advancement of the expansion of the pathological process. The inconsistency of these visits is due to the nature of the aggravation, its localization. Therefore, it is logical to consider in the next groups of complications, which are blamed in the surgical wound (at the borders of the anterior ventral wall) and the ventral empty. In its own line, in the qi group, the inclusion of an aggravated ignition character (suppuration, peritonitis), which are overwhelmed, and others, in the middle of which the smut is occupied by bleeding. Particularly, they can be seen in a deep complication, not tied directly to the operating area (on the side of the organs of the respiratory system, the cardiovascular system of the skin).
It is also logical to look at the similar order of life in two great groups: folded from the side of the organs of the empty stomach and folded in the anterior ventral wall.
The third group is made up of a complicated functional character, in which there are signs of coarse morphological changes. In the practice of a skin surgeon, there was a lot of caution, if in the distance the terms after appendectomy ailments indicate pain in the area of the transferred operation, which may be trivaly and obstructive in nature and are accompanied by disorders of the intestines. Rіznі likuvalnі come in, scho are assigned to you, do not bring relief. The unsuccessfulness of exuberance in a number of vipadkivs spontaneously speaks to them with a special emotional and psychological attitude of the sick. The basis of such recurrence of pain after appendectomy, as a rule, is structural changes, which are not detected by the best methods of clinical follow-up. This problem seems serious to us, as it requires a special look.
According to the frequency of post-operational complications in the current literature, there are super-clear appearances. V.I. Kolesov (1959), relying on the opinions of other authors, showing that prior to the stagnation of antibiotics, the rate of reduction was from 12 to 16%. The stagnation of antibiotics caused a decrease in the number of complications by 3-4%. At the last hour, at the link with the discrediting of antibiotic therapy, no reduction is restored. G.Ya. Yosset (1956) does not think of such a virulent significance of antibiotic stagnation, but he did not expect a decrease in the number of purulent conditions during the period of the most intensive stosuvannya. B.I. Chulanov (1966), relying on literature data (M. A. Azina, A. V. Grinberg, X. G. Yampil'ska, A. P. Kiyashov), write about 10-12% complications after appendectomy. At that very hour Ege. A. Sakfeld (1966) posterіgav worsening in 3.2% of operated diseases. Kazarian (1970), indicating that the intake of sulfanamides and antibiotics allowed a significant reduction in mortality in acute appendicitis. The number of folds does not change, but tends to increase (Table 1).
An analysis of the statistical data of the clinic for 6 years (1965-1971) established that out of the total number of operated ailments (5100), 506 patients (9.92%) had complications, and 12 (0.23%) died during the whole period. Vіdomosti about the frequency of different conditions is induced in different divisions.

TABLE 1. Correlation of perforation frequency, complication and mortality in acute appendicitis for Kazarian

	Before antibiotics	Sulfanil amidi	Today data
Number of sick people
Hundreds of perforated
appendicitis
Vіdsotok ukladnen
Lethality

Looking at the causes of unfavorable naslіdkіv surgical treatment appendicitis, most surgeons resort to the following: delay of epilepsy, delayed diagnosis in the elderly, late acute appendicitis with other ailments, frailty and ailments (T. Sh. Magdiev, 1961; V. I. Fedorov in).
When the causes of post-operative complications are eliminated, the main groups can be seen. Here lie the diagnosis of illness. Undoubtedly, the stages of the development of the pathological process, the vindication of low pathological symptoms from the side of the total organs, the reaction of the acute phase, the destruction of the lower systems of the diseased organism by the power forces determine the nature of the interruption of the postoperative period and become the cause of the onset of
Another reason is the peculiarity of the pathological process of this individual. Perebіg zahvoryuvannya perebuє have a close connection with the individual characteristics of the body, yogo development, immunobiological authority, nareshti, the reserve of spiritual strength, the sickness. Transferred from the past illness, that and just survive, strengthen the strength of the people, reduce resistance, health to fight with various ills, including those with an infectious cob.
However, offending a group of reasons is guilty, imovirno, vvazhatsya such that they create a background, on which far away the disease progresses, or it becomes more complicated that it has developed. The need for their appearance is obvious. Tse maє nationality of the surgeon should choose the method of anesthesia and suggest pevnі taktichnі priyomi, sob zapobіgti razvitku grіznі sládnen or pom'yakshiti їх.
What kind of world is right to look at the complication that vinicles in a sick person in the postoperative period have a ligament with a transferable hand, as the main cause of the disease became pathological, installed before the operation? It’s worth it and quiet comfort, as it was the last moment that passed, and it appeared already in the postoperative period. Tse pitanya is superimportant, it repeatedly screwed up the respect of surgeons. During the rest of the hour, a discussion was held in special journals about the initiative of Yu. I. Dathaeva. A number of other surgeons in our country took the fate of her: V.I. Struchkov, N. I. Krakovsky, D. A. Arapov, M. I. Kolomiichenko, V. P. Teodorovich. Most of the participants in the discussion respected for a correct look at the aggravation of the disease itself and the postoperative aggravation. An absolutely special group is made up of concurrent illnesses, sometimes even important ones, to induce ailments to death. On the proposition of some authors (M. I. Kolomiychenko, V. P. Teodorovich), the stench cannot be included to the group of post-operative complications.
You can take into account the thoughts of the participants in the discussion with those who are not intended to be complicated by the direct comprehension of the word, so that the stench is not the result of incorrect tactful installations of such technical tricks, vtruchannya. At the same time, with the richness of the stink of the stench, it is guilty to be seen in this wild group.

Regardless of the uninterrupted development of modern surgery, there is still a large number of complications in pathology. This is due to the low level of information of the population, and to the unsatisfied need to seek medical assistance, as well as to the insufficient qualifications of the doctors. So let's take a look at how the disease manifests itself and how it is aggravated after appendicitis, mothers can be.

What is appendicitis?

Appendicitis is a disease, as it is characterized by inflamed walls of the appendix (worm-like growth of the cecum). The veins of the lacerations at the lower right part of the abdomen, which is also called the club area. In a grown-up organism, the appendix does not have the necessary functions, therefore, yogo removal (appendectomy) does not govern the health of a person.

Most often, the worm-like windrow is ignited in people for 10 to 30 years.

Main symptoms

The first step is to proceed without delay until such time as a complication after acute appendicitis can be taken by the mother, perhaps, if the symptoms help to suspect the presence of inflamedness for the timely treatment for medical help.

If a chronic inflammation of a worm-like child can not show itself for an hour and does not cause handicap to an ailing person, then hostile appendicitis may cause symptoms:

a sharp strong pain in the upper part of the abdomen (epigastria), which gradually descends down and to the right (into the windmill);
worsening pain when turning right-handed, when coughing, walking;
the tension of the m'yaziv of the anterior abdominal wall, which is felt through the pain, as if blaming the patient for an hour with the collapse of the m'yazami of the abdomen;
possible accumulation of gases in the intestines, constipation;
subfebrile temperature (up to 37.5 ° C).

Classification of appendicitis

Possibly, for the dwellers there is no great significance, as the very inflamed worm-like wind is guarded by the times. However, it is important for the surgeon to know the type of appendicitis, even if it is stale, it is possible to determine the prognosis of a far-reaching illness and morbidity. І tse chooses surgical tactics.

See this for appendicitis:

catarrhal chi is simple - the widest form;
superficial;
phlegmonous - rotten inflamed growth;
gangrenous - with a development of necrosis of the growth;
perforative - from the collapse of the appendix and the penetration of the intestine into the empty stomach.

The most phlegmonous and gangrenous sights are the most unfriendly from the point of view of the development of a more complicated development. Different types of appendicitis require the greatest respect of the surgeon and non-guided surgical intervention. A perforative look, in fact,

See the complication

Complicated after appendicitis can be divided into large groups.

Prior to the first, there is an aggravation without the middle of the very inflamed, which often lead to untimely ambulance for medical assistance. It’s so complicated, like:

appendicular infiltrate - the incorporation of a conglomerate of intestinal loops, breeches and other organs of the abdominal emptying like a worm-like growth;
abscesses in the lower abdomen (in the small pelvis, between intestinal loops, under the diaphragm);
peritonitis - inflammation of the queue;
pylephlebitis - inflammation of the portal vein (vessel that carries blood to the liver), as well as її gіlok.

Complicated postoperative appendicitis most often develops in the wound of the empty stomach. However, there may be complications in the dichal organs, organs of the sechostatic and cardiovascular systems.

Appendicular infiltrate

If the diet is good, if it can be aggravated after appendicitis, it is necessary for us to see the adoption of appendicular infiltrate. Vіn є a group of organs soldered to each other and tissues of the empty stomach, like a border between the appendix in the open space of the empty stomach. As a rule, the disease develops in a few days after an ear of illness.

Symptoms of aggravation after appendicitis, without middle appendicular infiltrate, are characterized by a decrease in the intensity of pain in the lower abdomen. Vaughn becomes not so hostile, but dull, not able to clearly localize, the trochs get bigger only when walking.

On palpation of the empty stomach, one can miss the lack of light, which is characterized by sickness. Dalі іnfiltrat shіlnіє, kontіry become more razmitimi, bіl vanish.

Infiltrate can rozmoktatisya protyazh second-two tizhniv, prot can suppurate from the abscess. With suppuration of the ailing camp, it sharply gets worse, the temperature appears, the life becomes painful on palpation, the anterior cervical wall is tense.

appendicular abscess

Festering, prognostically unacceptable, aggravated after appendicitis and the abscess of a worm-like growth. Ale, pustules can be established not only in a child, but also in other places of the empty stomach. Tse vіdbuvaєtsya, if vipіt at the cherevnu empty pouchovuєtsya and pereskodzhaє development of expanded peritonitis. Often such a picture is blamed as an aggravation after phlegmonous appendicitis.

For the diagnosis of this complication and the investigation of abscesses in the empty stomach, it is recommended to perform ultrasound and computerized tomography. As an abscess has settled down as an aggravation after appendicitis in women, pelvic localization is characteristic. The same manifestation can be attributed to the help of vaginal obstruction.

More presented is CT scan of the anterior ventral wall abscess.

Purulent peritonitis and pylephlebitis

These two seem to be more comfortable, but the most unfriendly for the patient. Peritonitis, as an aggravation after appendicitis, is the cause of less than 1% of cases. But pathology itself is the main cause of death for patients with appendicitis.

The most common stasis in case of inflamed worm-like growth is ce pilephlebitis (septic inflamed portal vein). As a rule, there are complications after the operation of appendectomy, which may progress to surgical insertion. It is characterized by a sharp deterioration in the sickness of the sickly camp, a high temperature, and a sharply swollen stomach. As the ears are veins, as if they pass without a trace at the tissue of the liver, they blame the liver, the liver is enlarged, liver failure develops. The most important result of this will be the death of the sick.

The complication that is blamed on the surgical wound

And now let's talk about the complication after the appendicitis operation. The first group is more comfortable - those who are surrounded by an operative wound. Most often, inflammation and suppuration develop. As a rule, it is blamed for 2-3 days after the removal of the appendix, with which the already calm wound turns again, the body temperature rises, the burning camp becomes warmer.

On the wound, when the bandage is removed, reddening and swelling of the shkir are visualized, the threads of the postoperative seams are cut into the shkir. On palpation, there is a sharp soreness and an acute infiltrate is spread.

After a few days, if you don’t get involved in the hour, it doesn’t show likuvannya, infiltrate can fester. Some yogo between become less clear, with palpation, you can know the symptom of fluctuation, which characterizes the presence of purulent rіdina. If you do not open and drain an abscess, you may develop a chronic overflow. Then the camp of the ailing becomes all the best and the best. Vіn worse, vysnazhuєtsya, appetite decreases, blame constipation. After a singing hour, the rotten process from the undercoat fabrics expands to the skin and independently expands. Tse suprovodzhuetsya vitikannym pus and relieved I will become ill.

Crimium of rehabilitated more than the widest complications after the removal of appendicitis can be blamed for such pathological conditions in the postoperative wound:

hematoma;
bleeding;
border crossing.

Hematoma

Incomplete bleeding spot after the hour of surgical insertion can cause hematoma. The most frequent localization is in the subcutaneous fat, more often due to the accumulation of blood between the mucosal fibers. The next day, after the operation, the ill turbulent dull pains in the wound wound, in the presence of a vice. The surgeon, when looking around, showed swelling of the right hand at the bottom of the abdomen, pain on palpation.

For the usunennya process, it is necessary to frequently remove surgical stitches and clean up blood clots. Then the seams are put on again, the animals are fixed with a bandage. Before the wound it is applied colder. In vipadias, if the blood has not burned out yet, it is possible to pierce and see a hematoma for an additional puncture. The smut in the hematoma is not good, the shards of the wound can suppurate, which will kill the camp of the sick and the prognosis of illness.

bleeding

The photo in the article shows one of the types of surgical adoption of a bleeding dzherel - clipping of a judge.

Griznim folds can bleed from a worm-like weed. On the back, you may not show yourself in any way, but then you blame the burning and miserable signs of blood loss.

Sered badge see the following symptoms:

head bіl that confusion;
Severe weakness;
the glare of the skies;
cold pet;
a decrease in the pressure and a change in the frequency of the heart rate is fast with severe bleeding.

Among the manifestations of this aggravation after the appearance of appendicitis, the most characteristic symptom is pain in the abdomen, which progressively increases. The heart is quiet and it’s not like the turbulence of an ailing person to tell about the teasing of the queue. But if I don’t bleed at the same time, I’ll become strong Daedalus, what can you say about development

With a significant accumulation of blood in the cherevniy empty, on the look around, the surgeon will irregular shape belly. During percussion (tapping on the anterior vertebral wall), a dull sound appears in the blood pools, muffled peristaltic sounds of the intestines.

In order not to miss this complication and to give help to the sick, it is necessary to regularly review these indications:

hot camp of the patient;
arterial vice that pulse;
the camp of the abdomen, including symptoms of teasing of the edge (the most widening and informative - a symptom of Shchetkin-Blumberg).

The only possible method of treatment in this situation is relaparotomy, in order to re-route the vertebral wall, inflict bleeding from the bunion and the tooth with a surgical path.

Infiltrate and abscess: healing

How do you treat the most common complications after an appendectomy?

The healing of the infiltrate is repaired from novocaine blockade. Antibiotics are also prescribed, cold on the spot of light. In addition, the surgeon in conjunction with a physiotherapist may recognize a low number of procedures, such as UHF. For zastosuvati tі therapeutic come in at once, the clothes are cleared already for a few days.

Even if medication does not help, the camp becomes sick, and there are signs of an abscess, it is necessary to return to surgical intervention.

Since the abscess is not deep, but subshkirny, it is necessary to remove the sutures, widen the edges of the wound and remove the rot. They gave the wound a reminiscent of tampons, soaked with chloramine or furacil. If an abscess is found more prominently in the empty stomach, which is often blamed for the recognition of an abscess after the operation, it is necessary to repeat the laparotomy and see suppuration. After the operation, it is necessary to work on dressings with cleansed wounds with water peroxide, after fixing on the wound granulation, vicarious dressings with ointments, as if they were sprayed on the wound with ointments.

Sound of these complications do not deprive the body of the trace, prote, with a strong swelling of the m'yazіv, it is possible to establish a hernia.

In women after appendectomy, an infiltrate of the Douglas expanse may develop, which can be buried between the uterus and the rectum. Pіdkhіd to lіkuvannya tsgogo sládnennya is the same as in case of infiltrate of other localization. However, here you can add more such procedures, like warm enemas with furacilin and novocaine, douching.

Side-folding of other organs and systems

In the initial period after the operation, it can be blamed not only for the aggravation of the post-operative wound, but also for the pathology of other organs.

So, in the spring period, the appearance of bronchitis and pneumonia is frequent. The main preventive method is likuvalna gymnastics. It is necessary to repair the yakomoga earlier after the operation. It is necessary to save the passive bed of the ailing in a lie, the shards of this sprya viniknennia of haunted manifestations wild ways. The ailment is guilty of bending and spreading legs, turning from side to side, victorious dihal gymnastics. To control the regularity and correctness of the vikonnannya, the likarni may have a methodologist. Since there is no such thing, the control of the vikonnanny has the right to lie on nurse vіddіlennya.

Even though legeneví sládnennya nevertheless developed, antibiotic therapy is prescribed, make sure that phlegm (mucolytics) is exhaled and relieved.

One of the reasons for appendicitis can be a reflex influx on the nerve plexus from the side of the surgical wound, so it is elementary to go to the toilet in the supine position. I want surgeons to regularly chirp with an ailing person about yogo sechoviprosy, as if ailing to be ashamed to talk about such a problem. In such cases, the surgeon can detect tension and swelling in the suprapubic dilatation, the sick person has pain in the lower abdomen.

After catheterization and removal instead of the slash fur, all the skargs grow up, the camp becomes sickly. However, first of all, going into catheterization, you can use simpler methods. Once the patient is put on his feet, an act of secession is performed. It is also possible to put heating pads on the lower abdomen, sechogins.

Postoperative complications in children

Unfortunately, at the same time there is a high rate of complications after appendectomy in children for up to three years - from 10 to 30%. This is due to a more important malady and a partial development of destructive forms of appendicitis.

Among the complications after appendicitis in children, the following pathological conditions are most often blamed:

infiltrate and abscess;
post-operative obstruction of the intestine due to established adhesions;
intestinal fistula;
protracted peritonitis.

It is a pity that children often have a lethal end after an operative intervention in older children.

If you want to aggravate after appendicitis, everything is more likely to be blamed for our time, it is important to know these symptoms in order to ward off unsafe incidents.