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Postoperative complications of appendicitis - causes and symptoms. Complications of acute appendicitis

Complications of appendicitis develop depending on the duration of the inflammatory process. The first day of the pathological process, as a rule, is characterized by the absence of complications, since the process does not extend beyond the vermiform appendix. However, in case of untimely or incorrect treatment, complications such as perforation of the appendix, peritonitis or thrombophlebitis of the mesenteric veins may develop after a few days.

To prevent the development of complications of acute appendicitis, it is necessary to promptly contact a medical facility. Timely diagnosed pathology and surgery to remove the inflamed appendix is ​​a preventive measure against the development of life-threatening conditions.

Classification

Complications of appendicitis are formed under the influence of various factors. Many of the following consequences can develop in the human body both in the preoperative period and after surgery.

Preoperative complications arise from the prolonged course of the disease without treatment. Occasionally, pathological changes in the appendix may occur due to incorrectly selected treatment tactics. Based on appendicitis, the following dangerous pathologies can form in the patient’s body - appendiceal infiltrate, abscess, retroperitoneal cellulitis, pylephlebitis and peritonitis.

And postoperative complications are characterized according to clinical and anatomical criteria. They may appear several weeks after surgery. This group includes consequences that are associated with postoperative injuries and pathologies of neighboring organs.

Consequences may develop after removal of appendicitis for various reasons. Most often, clinicians diagnose complications in the following cases:

  • late seeking medical help;
  • late diagnosis;
  • errors in the operation;
  • non-compliance with doctor's recommendations in the postoperative period;
  • development of chronic or acute diseases of neighboring organs.

Complications in the postoperative period can be of several types depending on the location:

  • at the site of the surgical wound;
  • in the abdominal cavity;
  • in neighboring organs and systems.

Many patients are interested in the question of what consequences may occur after surgery. Clinicians have determined that complications after surgery are divided into:

  • early - can form within two weeks after surgery. These include dehiscence of wound edges, peritonitis, bleeding and pathological changes in nearby organs;
  • late - two weeks after surgical treatment, wound fistulas, suppuration, abscesses, infiltrates, keloid scars, intestinal obstruction, and adhesions in the abdominal cavity may form.

Perforation

Perforation is an early complication. It forms several days after the inflammation of the organ, especially in the destructive form. With this pathology, purulent melting of the walls of the appendix occurs and pus is poured into the abdominal cavity. Perforation is always accompanied by peritonitis.

Clinically, the pathological condition is characterized by the following manifestations:

  • progression of pain in the abdominal area;
  • high fever;
  • nausea and vomiting;
  • intoxication;
  • positive symptoms of peritonitis.

In acute appendicitis, organ perforation occurs in 2.7% of patients in whom therapy began in the early stages of the disease, and in the later stages of the disease, perforation develops in 6.3% of patients.

Appendiceal infiltrate

This complication is typical for acute appendicitis in 1–3% of patients. It develops due to the patient’s late seeking of medical help. The clinical picture of the infiltrate appears 3–5 days after the development of the disease and is provoked by the spread of the inflammatory process from the appendix to nearby organs and tissues.

In the first days of the pathology, the clinical picture of destructive appendicitis appears - severe abdominal pain, signs of peritonitis, fever, intoxication. At the late stage of this consequence, the pain syndrome subsides, the patient’s general well-being improves, but the temperature remains above normal. When palpating the appendix area, the doctor does not detect muscle tension in the abdomen. However, a dense, slightly painful and inactive formation may be detected in the right iliac zone.

If an appendiceal infiltrate is diagnosed, surgery to remove (appendectomy) the inflamed appendix is ​​postponed and conservative therapy, based on antibiotics, is prescribed.

As a result of therapy, the infiltrate can either resolve or abscess. If there is no suppuration in the inflamed area, the formation may disappear after 3–5 weeks from the moment the pathology develops. In case of an unfavorable course, the infiltrate begins to suppurate and leads to the formation of peritonitis.

Appendiceal abscess

Complicated forms of acute appendicitis develop at various stages of pathology progression and are diagnosed in only 0.1–2% of patients.

Appendiceal abscesses can form in the following anatomical regions:

  • in the right iliac region;
  • in the recess between the bladder and rectum (pouch of Douglas) - in men and between the rectum and uterus - in women;
  • under the diaphragm;
  • between intestinal loops;
  • retroperitoneal space.

The main signs that will help identify a complication in a patient are the following:

  • intoxication;
  • hyperthermia;
  • an increase in leukocytes and a high level of ESR in the general blood test;
  • severe pain syndrome.

In addition to general symptoms, Douglas pouch abscess is characterized by dysuric manifestations, frequent urge to defecate, and a feeling of pain in the rectum and perineum. A purulent formation of this location can be palpated through the rectum, or through the vagina in women.

A subdiaphragmatic abscess appears in the right subphrenic recess. If a purulent formation develops, there are pronounced signs of intoxication, difficulty breathing, unproductive cough and chest pain. When examining the inflamed area, the doctor diagnoses a soft abdomen, a large volume of the liver and pain on palpation, light and barely perceptible breathing in the lower part of the right lung.

Interintestinal purulent formation is characterized by a mild clinical picture at the initial stages of the pathological process. As the abscess grows, tension in the abdominal wall muscles, attacks of pain appear, the infiltrate is palpated, and a high body temperature is noted.

An appendiceal abscess can be diagnosed using an ultrasound of the abdominal cavity, and the disease is eliminated by opening the purulent formation. After washing the cavity, a drainage is installed in it, and the wound is sutured up to the tube. The following days, the drains are washed to remove residual pus and introduce medications into the cavity.

Pylephlebitis

A complication of acute appendicitis, pylephlebitis, is characterized by severe purulent-septic inflammation of the portal vein of the liver with the formation of multiple ulcers. It is characterized by the rapid development of intoxication, fever, an increase in the volume of the liver and spleen, pallor of the skin, tachycardia and hypotension.

The lethal outcome with this pathology reaches 97% of cases. Therapy is based on the use of antibiotics and anticoagulants. If abscesses have formed in the patient’s body, then they must be opened and washed.

Peritonitis

Peritonitis is an inflammation of the peritoneum, which is a consequence of acute appendicitis. Local limited inflammatory process of the peritoneum is characterized by the following clinical picture:

  • severe pain syndrome;
  • hyperthermia;
  • paleness of the skin;
  • tachycardia.

The doctor can identify this complication by determining the Shchetkin-Blumberg symptom - when pressing in the painful area, the pain does not intensify, but when it is suddenly released, more pronounced pain appears.

Therapy consists of the use of conservative methods - antibacterial, detoxification, symptomatic; and surgical drainage of purulent foci.

Intestinal fistulas

One of the late complications that appear after removal of appendicitis are intestinal fistulas. They appear when the walls of the nearest intestinal loops are damaged, followed by destruction. Also, the reasons for the formation of fistulas include the following factors:

  • disrupted technology for processing the appendage;
  • squeezing the abdominal tissues with too thick gauze.

If the surgeon does not completely suture the wound, then intestinal contents will begin to leak through the wound, which leads to the formation of a fistula. When the wound is sutured, the symptoms of the disease worsen.

In the case of fistula formation, 4–6 days after the operation to remove the organ, the patient feels the first pain attacks in the right iliac zone, where a deep infiltrate is also detected. In extreme cases, doctors diagnose symptoms of poor bowel function and peritonitis.

Therapy is prescribed by the doctor on an individual basis. Drug treatment is based on the use of antibacterial and anti-inflammatory drugs. In addition to drug treatment, surgical removal of fistulas is performed.

Voluntary opening of fistulas begins 10–25 days after surgery. In 10% of cases, this complication leads to the death of patients.

Based on the above, we can conclude that the formation of complications of appendicitis can be prevented by promptly seeking medical help, since timely and correct appendectomy contributes to the fastest recovery of the patient.

The infiltrate manifests itself with pronounced symptoms, but the symptoms disappear a few days after the onset. A tumor is a contraindication to appendectomy.

Reasons

The most common cause of this complication is late seeking medical help for appendicitis. Up to 90-95% of patients go to the hospital 1-2 days after inflammation of the appendix.

The appearance of infiltration may also be associated with a deterioration in general health, as well as with anatomical features. Provoking factors:

  • decreased immunity;
  • specific location of the appendix (in front or behind the cecum);
  • peritoneal reactivity (ability to limit acute inflammatory processes).

Most often, infiltration is diagnosed in children aged 10-14 years, much less often in adults.

Symptoms

There are two types of appendicular infiltrate – early and late. The first develops within 1-2 days after the first signs of appendicitis appear, and the second only on the 5th day.

Symptoms of infiltration:

  • severe pain in the right iliac region;
  • increased body temperature, chills;
  • nausea and vomiting;
  • lack of stool.

With late infiltration, the symptoms of acute appendicitis come to the fore, since the tumor forms only on the 4-5th day, when the pain has already decreased. With palpation, you can feel a formation measuring 8x10 cm.

The tumor forms within 12-14 days. During this period, the symptoms are pronounced, then the signs gradually subside. Next n for appendicular infiltrateThere are 2 options for the development of events:

  • The tumor will resolve itself. This happens in more than 90% of patients. The resorption stage can last 1-1.5 months.
  • An appendicular abscess forms (the infiltrate suppurates).

The last option is dangerous for the patient's life. In case of such a complication, emergency surgery is performed. The infiltrate suppurates and increases significantly in size. Painful sensations in the right iliac region intensify, body temperature rises to 40˚C, general condition worsens, and signs of intoxication appear. Sometimes symptoms of peritoneal irritation are present.

If you do not provide timely assistance to the patient, then as a result of an abscess, even sepsis may develop. These complications can be fatal.

Symptoms that indicate life-threatening consequences:

  • high body temperature up to 40 ˚С;
  • rapid breathing and heart rate;
  • increased sweating, cold sweat;
  • pale skin;
  • an increase in the level of leukocytes in the blood, which indicates an inflammatory process.

Quite rarely, a purulent infiltrate can become chronic. In this case, when exposed to unfavorable factors, it becomes inflamed.

Which doctor treats appendiceal infiltration?

The infiltrate is treated by a gastroenterologist, and then by a surgeon.

Diagnostics

Primary diagnosis is similar to examination for. The doctor listens to the patient's complaints, palpates the abdomen, examines the skin and mucous membranes. As a result of intoxication, there is a white coating on the tongue. On palpation, the patient notes pain in the appendix area; a dense and elastic formation can be identified.

It is sometimes possible to palpate an abscess using vaginal or rectal digital examination. During the examination, a dense, painful protrusion of the vaginal vault or rectal wall is detected.

To make an accurate diagnosis, the infiltrate must be differentiated from certain diseases of the digestive tract and genitourinary system, which have similar symptoms. These are Crohn's disease, ovarian cyst, inflammation of the appendages, tumor of the cecum. For differentiation, the following instrumental examination methods are used:

  • Ultrasound of the abdominal cavity, as well as the organs of the genitourinary system (necessary to determine the size of the tumor, as well as the presence of fluid);
  • X-ray of the abdominal organs.

Sometimes the patient is prescribed a CT scan.

Treatment

Treatment of appendiceal infiltrate is conservative. It is carried out in a hospital setting. The patient is monitored regularly. After the infiltrate has resolved, removal of the inflamed appendix is ​​indicated.

It takes up to 3-4 months for the infiltrate to resolve; in elderly patients and children, the tumor disappears after six months.

Conservative treatment:

  • drug therapy;
  • bed rest;
  • dietary nutrition;
  • physiotherapeutic procedures.

The main essence of therapy is to stop the inflammatory process, prevent it from spreading to neighboring organs, and relieve pain. For appendicitis complicated by infiltration, the patient is hospitalized in the surgical department. He must remain in bed and eat properly. The diet involves eliminating carbonated drinks and alcohol, avoiding foods high in fiber (vegetables and fruits), and also eliminating smoked, hot and spicy foods from the diet.

As first aid to inhibit the spread of bacterial flora and reduce pain, an ice compress is placed on the patient’s stomach.

Drug therapy:

  • broad-spectrum antibiotics (Ceftriaxone, Amoxiclav, Azithromycin, Cefepime, Tienam and Metronidazole);
  • probiotics to normalize microflora after antibacterial treatment;
  • antispasmodics (No-Shpa);
  • NSAIDs (Nimesil, Nurofen);
  • detoxification therapy to remove toxic substances from the body (Hemodez or Reopoliglyukin);
  • vitamins.

The course of treatment is up to 10 days. If the therapy is successful, then the signs of inflammation of the appendix should disappear. The patient is observed for up to 3 months, if his condition has returned to normal, a planned appendectomy is performed. Surgical intervention involves removal of the appendix, separation of fused organs and sanitation of the cavity.

Emergency surgery to remove the appendix is ​​performed in the following cases:

  • suppuration of infiltrate;
  • perforation of the abscess;
  • septic shock;
  • ineffectiveness of therapy in the first 3-4 days of illness;
  • other complications of infiltration.

The abscess is punctured and then drained. In some cases, the vermiform appendix itself is removed.

You can prevent the appearance of infiltration and its complications if you go to the hospital on the first day with appendicitis.

If treatment is not timely, the likelihood of complications is very high. The most common are colitis, paranephritis, adhesive intestinal obstruction, phlegmon, subdiaphragmatic abscesses.

Appendiceal infiltration can cause severe complications and even death of the patient, so you should not hesitate to go to the hospital. The decision about the need for surgical treatment must be made by the doctor.

Useful video about complications of appendicitis

The inflammatory process in the appendix leads to a common disease of the abdominal cavity - appendicitis. Its symptoms are pain in the abdominal area, fever and digestive disorders.

The only correct treatment in case of an attack of acute appendicitis is appendectomy - surgical removal of the appendix. If this is not done, severe complications may develop, leading to death. What are the dangers of untreated appendicitis - our article is just about this.

Preoperative consequences

The inflammatory process develops at different speeds and symptoms.

In some cases, it goes into and may not manifest itself for a long time.

Sometimes 6–8 hours pass between the first signs of the disease and the onset of a critical condition, so you should under no circumstances hesitate.

For any pain of unknown origin, especially against the background of fever, nausea and vomiting, you should definitely seek medical help, otherwise the consequences may be unpredictable.

Common complications of appendicitis:

  • Perforation of the walls of the appendix. The most common complication. In this case, ruptures in the walls of the appendix are observed, and its contents enter the abdominal cavity and lead to the development of sepsis of the internal organs. Depending on the duration of the course and the type of pathology, severe infection can occur, even death. Such conditions account for approximately 8–10% of the total number of patients diagnosed with appendicitis. With purulent peritonitis, the risk of death increases, as well as exacerbation of accompanying symptoms. Purulent peritonitis statistically occurs in approximately 1% of patients.
  • Appendicular infiltrate. Occurs when the walls of nearby organs adhesion. The incidence is approximately 3–5% of clinical cases. It develops approximately on the third to fifth day after the onset of the disease. The beginning of the acute period is characterized by pain of unclear localization. Over time, the intensity of pain decreases, and the contours of the inflamed area can be felt in the abdominal cavity. The inflamed infiltrate acquires more pronounced boundaries and a dense structure, the tone of the muscles located nearby increases slightly. After about 1.5 - 2 weeks, the tumor resolves, abdominal pain subsides, general inflammatory symptoms decrease (high temperature and biochemical blood parameters return to normal). In some cases, the inflammatory area can cause an abscess to develop.
  • . Develops against the background of suppuration of the appendiceal infiltrate or after surgery with previously diagnosed peritonitis. Typically, the development of the disease occurs on days 8–12. All abscesses must be opened and debrided. To improve the drainage of pus from the wound, drainage is performed. Antibacterial therapy is widely used in the treatment of abscess.

The presence of such complications is an indication for urgent surgery. The rehabilitation period also takes a lot of time and an additional course of drug treatment.

Complications after appendectomy

Surgery, even if performed before the onset of severe symptoms, can also cause complications. Most of them cause death in patients, so any alarming symptoms should alert you.

Common complications after surgery:

  • . Very often occur after removal of the appendix. Characterized by the appearance of nagging pain and noticeable discomfort. Adhesions are very difficult to diagnose, because modern ultrasound and x-ray devices cannot see them. Treatment usually consists of absorbable medications and laparoscopic removal.
  • . It appears quite often after surgery. It manifests itself as prolapse of a fragment of the intestine into the lumen between the muscle fibers. Usually appears when the doctor’s recommendations are not followed, or after physical exertion. Visually manifests itself as a swelling in the area of ​​the surgical suture, which over time can significantly increase in size. Treatment is usually surgical, consisting of suturing, truncation or complete removal of a section of the intestine and omentum.

Photo of a hernia after appendicitis

  • Postoperative abscess. Most often it appears after peritonitis and can lead to infection of the entire body. Treatment uses antibiotics and physiotherapeutic procedures.
  • . Fortunately, these are quite rare consequences of appendectomy surgery. The inflammatory process spreads to the area of ​​the portal vein, mesenteric process and mesenteric vein. Accompanied by high fever, acute abdominal pain and severe liver damage. After the acute stage, it arises, and, as a consequence, death. Treatment of this disease is very difficult and usually involves the introduction of antibacterial agents directly into the portal vein systems.
  • . In rare cases (in approximately 0.2 - 0.8% of patients), removal of the appendix provokes the appearance of intestinal fistulas. They form a kind of “tunnel” between the intestinal cavity and the surface of the skin, in other cases - the walls of internal organs. The reasons for the appearance of fistulas are poor sanitation of purulent appendicitis, gross mistakes by the doctor during surgery, as well as inflammation of surrounding tissues during drainage of internal wounds and abscess areas. Intestinal fistulas are very difficult to treat; sometimes resection of the affected area or removal of the top layer of epithelium is required.

The occurrence of one or another complication is also facilitated by ignoring the doctor’s recommendations, non-compliance with hygiene rules after surgery and violation of the regime. If the condition worsens on the fifth or sixth day after removal of the appendix, most likely we are talking about pathological processes in the internal organs.

In addition, other conditions may arise during the postoperative period that require consultation with a doctor. They can be evidence of various ailments, and also have nothing to do with the surgery at all, but serve as a sign of a completely different disease.

Temperature

An increase in body temperature after surgery can be an indicator of various complications. The inflammatory process, the source of which was in the appendix, can easily spread to other organs, which causes additional problems.

Most often, inflammation of the appendages is observed, which can make it difficult to determine the exact cause. Often the symptoms of acute appendicitis can be confused with precisely such ailments, therefore, before the operation (if it is not urgent), an examination by a gynecologist and an ultrasound examination of the pelvic organs are required.

Fever can also be a symptom of an abscess or other internal diseases. If the temperature rises after an appendectomy, additional examination and laboratory tests are necessary.

Diarrhea and constipation

Digestive disorders can be considered as the main symptoms and consequences of appendicitis. Often, the functions of the gastrointestinal tract are disrupted after surgery.

During this period, constipation is worst tolerated, because the patient is forbidden to push and strain. This can lead to suture divergence, hernia protrusion and other consequences. To prevent digestive disorders, it is necessary to adhere to strict rules and not allow stool to become fixed.

Stomach ache

This symptom can also have different origins. Typically, pain continues for some time after surgery, but disappears completely within three to four weeks. Usually this is how much tissue will need to regenerate.

In some cases, abdominal pain may indicate the formation of adhesions, hernia and other consequences of appendicitis. In any case, the best solution would be to consult a doctor rather than try to get rid of discomfort with painkillers.

Appendicitis is a common pathology requiring surgical intervention. The inflammatory process occurring in the appendix of the cecum can easily spread to other organs, lead to the formation of adhesions and abscesses, and also give many more serious consequences.

To prevent this from happening, it is important to seek help from the hospital in a timely manner, and not to ignore warning signs that may indicate the development of the disease. How appendicitis is dangerous and what complications it can lead to is described in this article.

One of the most common diseases in people who need surgery is inflammation of appendicitis.

The atrophied part of the large intestine is the appendix; it looks like a vermiform appendix of the cecum. The appendix forms between the large and small intestines.

Doctors note that it is quite difficult to predict and prevent the disease. Experts do not recommend taking painkillers in case of appendicitis.

The appointment will prevent the doctor from making a correct diagnosis of the patient. This should be done exclusively by a specialist who will prescribe an ultrasound.

Thanks to them, it will be possible to understand what shape the inflamed appendix has. It may be clogged or swollen. It can only be removed surgically.

Forms of appendicitis

Today, the disease is divided into acute and chronic forms. In the first case, the clinical picture is pronounced.

The patient is very ill, and therefore emergency hospitalization cannot be avoided. In the chronic form, the patient feels a condition caused by acute inflammation with no symptoms.

Types of appendicitis

Today there are 4 types of appendicitis known. These are: catarrhal, phlegmonous, perforative; gangrenous.

The diagnosis of catarrhal appendicitis is made by a doctor if the penetration of leukocytes into the mucous membrane of the worm-shaped organ has been noted.

Phlegmonous is accompanied by the presence of leukocytes in the mucosa, as well as other deep layers of appendix tissue.

Perforated is observed if the walls of the inflamed appendix of the cecum have been torn, but gangrenous appendicitis is the wall of the appendix affected by leukocytes, which is completely dead.

Symptoms

Symptoms of the disease include:

  • acute pain in the abdominal area, or more precisely in the right half in the area of ​​the inguinal fold;
  • increased body temperature;
  • vomiting;
  • nausea.

The pain will be constant and dull, but if you try to turn your body, it will become even stronger.

It should be noted that it is possible that after a severe attack of pain the syndrome disappears.

Patients will mistake this condition for the fact that they feel better, but in fact, the subsidence of pain carries a great danger, indicating that a fragment of the organ has died off, and it is not for nothing that the nerve endings have ceased to respond to irritation.

Such pain relief ends with peritonitis, which is a dangerous complication after appendicitis.

Problems with the gastrointestinal tract may also be observed in symptoms. A person will feel a feeling of dry mouth, he may be bothered by diarrhea and loose stools.

Blood pressure may jump and heart rate may increase to 100 beats per minute. The person will suffer from shortness of breath, which will be caused by impaired heart function.

If the patient has a chronic form of appendicitis, then all of the above symptoms do not appear, with the exception of pain.

The most common complications after appendicitis

Of course, doctors set themselves the task of eliminating all complications after appendicitis removal, but sometimes they simply cannot be avoided.

Below are the most common consequences of appendicitis.

Perforation of the walls of the appendix

In this case, there are ruptures in the walls of the appendix. Its contents will end up in the abdominal cavity, and this provokes sepsis of other organs.

The infection can be quite severe. A fatal end is not ruled out. Such perforation of the walls of appendicitis is observed in 8-10% of patients.

If it is purulent peritonitis, the risk of death is high, and exacerbation of symptoms cannot be ruled out. This complication after appendicitis occurs in 1% of patients.

Appendiceal infiltrate

These complications after surgery to remove appendicitis are observed in the case of adhesions of organs. The percentage of such cases is 3-5.

The development of complications begins 3-5 days after the formation of the disease. Accompanied by pain of unclear localization.

Over time, the pain subsides, and the contours of the inflamed area appear in the abdominal cavity.

The infiltrate with inflammation acquires pronounced boundaries and a dense structure, and tension in nearby muscles will also be observed.

In about 2 weeks the swelling will go away and the pain will stop. The temperature will also subside, and blood counts will return to normal.

In many cases, it is possible that the inflamed part after appendicitis will cause the development of an abscess. It will be discussed below.

Abscess

The disease develops against the background of suppuration of the appendiceal infiltrate or surgery if peritonitis is diagnosed.

As a rule, it takes 8-12 days for the disease to develop. All abscesses need to be covered and debrided.

In order to improve the outflow of pus, doctors install drainage. During the treatment of complications after appendicitis, it is customary to use antibacterial drug therapy.

If there is a similar complication after appendicitis, urgent surgery is necessary.

After this, the patient will have to wait for a long rehabilitation period, accompanied by drug treatment.

Complications after appendectomy

Even if the operation to remove appendicitis was performed before the onset of severe symptoms, this does not guarantee that there will be no complications.

Many cases of death after appendicitis make people pay closer attention to any warning signs.

Below are the most common complications that may occur after removal of an inflamed appendix.

Spikes

One of the most common pathologies that appears after removal of the appendix. Accompanied by nagging pain and discomfort.

It is difficult to diagnose, because ultrasound and x-rays cannot see them. It is necessary to carry out a course of treatment with absorbable drugs and resort to the laparoscopic method of removing adhesions.

Hernia

The phenomenon is really common after appendicitis. There is a prolapse of part of the intestine into the area of ​​the lumen between the muscle fibers.

A hernia looks like a tumor in the suture area, increasing in size. Surgical intervention is provided. The surgeon will sew it up, trim it, or remove part of the intestine and omentum.

Abscess

Occurs in most cases after appendicitis with peritonitis. It can infect organs.

A course of antibiotics and special physiotherapeutic procedures is required.

Pylephlebitis

A very rare complication after surgery to remove appendicitis. Inflammation is observed, which spreads to the area of ​​the portal vein, mesenteric vein and process.

Accompanied by fever, severe liver damage, and acute pain in the abdominal area.

If this is an acute stage of the pathology, then everything can lead to death. Treatment is complex, requiring the introduction of antibiotics into the portal vein systems.

Intestinal fistulas

Occurs after appendicitis in 0.2-0.8% of people. Intestinal fistulas form a tunnel in the intestines and skin, sometimes in the walls of internal organs.

The reasons for their appearance may be poor sanitation of purulent appendicitis, surgeon errors, tissue inflammation during drainage of internal wounds and foci of abscess development.

It is difficult to treat pathology. Sometimes doctors prescribe resection of the affected area, as well as removal of the top layer of epithelium.

It should be noted that the occurrence of complications is facilitated by ignoring the doctor’s advice, failure to comply with hygiene rules, and violation of the regime.

Deterioration of the condition can be observed 5-6 days after surgery.

This will indicate the development of pathological processes in the internal organs. During the postoperative period, it is possible that you will need to consult with your doctor.

You should not avoid this; on the contrary, your body gives signals that other ailments are developing, they may not even be related to the appendectomy.

It is important to pay due attention to your health and do not hesitate to seek help from a doctor.

Increased body temperature

The inflammatory process can also affect other organs, and therefore it is possible that additional health problems may arise.

Women often suffer from inflammation of the appendages, which makes diagnosis and the exact cause of the disease difficult.

Often, the symptoms of acute appendicitis can be confused with similar pathologies, and therefore doctors prescribe an examination by a gynecologist and an ultrasound of the pelvic organs if the operation is not emergency.

Also, an increase in body temperature indicates that an abscess or other diseases of the internal organs are possible.

If the temperature rises after the operation, then you need to undergo an additional examination and be tested again.

Digestive disorders

Diarrhea and constipation may indicate a malfunction of the gastrointestinal tract after appendicitis. At this time, the patient has a hard time with constipation; he cannot push or strain, because this is fraught with protrusion of hernias, ruptured sutures and other problems.

To avoid indigestion, you need to stick to a diet, making sure that the stool is not fixed.

Pain attacks in the abdomen

As a rule, there should be no pain for 3-4 weeks after surgery. This is how long it takes for tissue regeneration to take place.

In some cases, pain indicates hernias or adhesions, and therefore there is no need to take painkillers, you should consult a doctor.

It is worth noting that appendicitis is often encountered in the medical practice of doctors. The pathology requires urgent hospitalization and surgery.

The thing is that inflammation can quickly spread to other organs, which will entail many serious consequences.

To prevent this from happening, it is important to visit a doctor in a timely manner and call an ambulance. Do not ignore those signals from the body that indicate the development of the disease.

Appendicitis is dangerous; even with a successful operation, deaths have been observed more than once, let alone when patients neglect their health.

Prevention

There are no special preventive measures for appendicitis, but there are some rules that should be followed to reduce the risk of developing inflammation in the area of ​​the appendix of the cecum.

  1. Adjust your diet. Moderate your intake of fresh herbs (parsley, green onions, dill, sorrel, lettuce), hard vegetables and ripe fruits, seeds, fatty and smoked treats.
  2. Take care of your health. It is worth paying attention to all signals about a malfunction in your body. There have been many cases in medical practice where inflammation of the appendix was caused by the penetration of pathogenic microorganisms into it.
  3. Detect helminthic infestations and provide timely treatment.

Summing up

Although appendicitis is not considered a dangerous disease, the pathology has a high risk of developing complications after surgical removal of the appendix of the cecum. Typically, they occur in 5% of people after appendicitis.

The patient can count on qualified medical care, but it is important not to miss the moment and see a doctor in a timely manner.

You need to wear a bandage, women can wear panties. This measure will help not only to eliminate complications after appendicitis, but also to keep the suture neat, without causing it to become defective.

Pay attention to your health, and even if appendicitis has been detected, try to do everything that the doctor directs to avoid problems in the future.

Useful video

Despite the ongoing development of modern surgery, there are still a large number of complications of this pathology. This is due both to low awareness of the population and reluctance to seek medical help, and to the insufficient qualifications of some doctors. Therefore, let's figure out how this disease manifests itself and what complications after appendicitis can occur.

What is appendicitis?

Appendicitis is a disease characterized by inflammation of the wall of the appendix (the vermiform appendix of the cecum). It is located in the lower right part of the abdomen, which is also called the iliac region. In the adult body, the appendix has no function, so its removal (appendectomy) does not harm human health.

Most often, the appendix becomes inflamed in people aged 10 to 30 years.

Main symptoms

Before moving directly to what complications may occur after acute appendicitis, we will look at what symptoms will help to suspect the presence of inflammation in order to promptly seek medical help.

If chronic inflammation of the appendix may not manifest itself for a long time and not cause inconvenience to the patient, then acute appendicitis has clear symptoms:

  • sharp, severe pain in the upper abdomen (epigastric region), which gradually descends down and to the right (into the iliac region);
  • increased pain when turning to the right side, when coughing, walking;
  • tension in the muscles of the anterior abdominal wall, which occurs due to pain that the patient experiences when moving the abdominal muscles;
  • possible accumulation of gases in the intestines, constipation;
  • low-grade fever (up to 37.5 °C).

Classification of appendicitis

Perhaps for ordinary people it does not matter much what kind of inflammation of the appendix is ​​observed in his case. However, it is very important for the surgeon to know the type of appendicitis, because depending on this, the prognosis for the further course of the disease and the likelihood of complications can be determined. This also determines surgical tactics.

The following types of appendicitis are distinguished:

  • catarrhal or simple - the most common form;
  • surface;
  • phlegmonous - purulent inflammation of the appendix;
  • gangrenous - with the development of necrosis of the process;
  • perforated - with destruction of the appendix and penetration of intestinal contents into the abdominal cavity.

It is the phlegmonous and gangrenous types that are the most unfavorable from the point of view of the development of complications. These types of appendicitis require the greatest attention from the surgeon and immediate surgical intervention. And the perforated appearance, in fact, is a complication after

Types of complications

Complications after appendicitis can be divided into two large groups.

The first includes complications of the inflammation itself, which often results from failure to seek medical help in a timely manner. These are complications such as:

  • appendicular infiltrate - the formation of a conglomerate from intestinal loops, mesentery and other abdominal organs around the appendix;
  • abscesses in the abdominal cavity (in the pelvis, between the intestinal loops, under the diaphragm);
  • peritonitis - inflammation of the peritoneum;
  • pylephlebitis - inflammation of the portal vein (the vessel that carries blood to the liver), as well as its branches.

Complications after appendicitis surgery most often develop in the wound and abdominal cavity. However, there may be complications in the respiratory organs, genitourinary and cardiovascular systems.

Appendiceal infiltrate

When answering the question of what complications there may be after appendicitis, first of all it is necessary to highlight the formation of appendiceal infiltrate. It is a group of abdominal organs and tissues fused together that limit the appendix from the rest of the abdominal cavity. As a rule, this complication develops a few days after the onset of the disease.

Symptoms of complications after appendicitis, specifically appendicular infiltrate, are characterized by a decrease in the intensity of pain in the lower abdomen. It becomes less sharp, but more dull, has no clear localization, and only increases slightly when walking.

When palpating the abdominal cavity, you can feel a fuzzy formation characterized by pain. Further, the infiltrate thickens, the contours become more blurred, and the pain disappears.

The infiltrate can resolve within one and a half to two weeks, however, it can fester and form an abscess. When suppuration occurs, the patient's condition sharply worsens, fever appears, the abdomen becomes painful on palpation, and the muscles of the anterior abdominal wall are tense.

Appendiceal abscess

A purulent, prognostically unfavorable complication after appendicitis is the formation of an abscess of the appendix. But ulcers can form not only directly in the appendix, but also in other places in the abdominal cavity. This occurs when the peritoneal effusion encystes and prevents the development of widespread peritonitis. Often this picture occurs as a complication after phlegmonous appendicitis.

To diagnose this complication and search for abscesses in the abdominal cavity, it is recommended to use ultrasound and computed tomography. If an abscess formed as a complication after appendicitis in women, its pelvic localization is typical. Then its presence can be determined using a vaginal examination.

Above is a CT scan showing the formation of an abscess in the anterior abdominal wall.

Purulent peritonitis and pylephlebitis

These two types of complications occur least frequently, but are most unfavorable for the patient. Peritonitis as a complication after appendicitis occurs only in 1% of cases. But this pathology is the main cause of death in patients with appendicitis.

The rarest condition with inflammation of the appendix is ​​pylephlebitis (septic inflammation of the portal vein). As a rule, it is a complication after appendectomy, however, it can develop even before surgery. It is characterized by a sharp deterioration in the patient’s general condition, high fever, and a sharply swollen abdomen. If the veins that pass directly into the liver tissue are damaged, jaundice occurs, the liver becomes enlarged, and liver failure develops. The most likely outcome of this condition is the death of the patient.

Complications arising from the surgical wound

And now we will talk about complications after appendicitis surgery. The first group of complications are those that are limited to the surgical wound. Inflammatory infiltrates and suppuration develop most often. As a rule, they occur 2-3 days after removal of the appendix, while pain in the wound that has already subsided returns again, body temperature rises, and general condition worsens.

On the wound, when the bandage is removed, redness and swelling of the skin are visualized, the threads of the postoperative sutures cut into the skin. On palpation, sharp pain is observed and a dense infiltrate is palpable.

After a few days, if you do not intervene in time and prescribe treatment, the infiltrate may fester. Then its boundaries become less clear; upon palpation, one can detect a symptom of fluctuation, which characterizes the presence of purulent fluid. If the abscess is not opened and drained, it can become chronic. Then the patient's condition becomes worse and worse. He loses weight, becomes exhausted, his appetite is reduced, and constipation occurs. After a certain time, the purulent process from the subcutaneous tissue spreads to the skin and opens on its own. This is accompanied by the leakage of pus and relief of the patient’s condition.

In addition to the most common complications listed above after removal of appendicitis, the following pathological conditions may occur in the postoperative wound:

  • hematoma;
  • bleeding;
  • divergence of edges.

Hematoma

Incomplete stoppage of bleeding during surgery can cause hematoma formation. The most common location is in subcutaneous fat; less often, blood accumulation occurs between muscle fibers. The day after the operation, the patient is bothered by dull pain in the wound area and a feeling of pressure. Upon examination, the surgeon determines swelling on the right side of the lower abdomen and pain on palpation.

To eliminate the process, it is necessary to partially remove the surgical sutures and remove blood clots. Next, the stitches are applied again and secured with a bandage on top. Something cold is applied to the wound. In cases where the blood has not yet coagulated, you can make a puncture and remove the hematoma using a puncture. The main thing in treating a hematoma is not to delay it, as the wound may fester, which will worsen the patient’s condition and the prognosis of the disease.

Bleeding

The photo in the article shows one of the types of surgical elimination of the source of bleeding - vessel clipping.

A serious complication can be bleeding from the stump of the appendix. At first it may not manifest itself in any way, but later general and local signs of blood loss appear.

Common signs include the following:

  • headache and dizziness;
  • general weakness;
  • pale skin;
  • cold sweat;
  • decreased blood pressure and decreased heart rate during severe bleeding.

Among the local manifestations of this complication after removal of appendicitis, the most characteristic symptom is gradually increasing abdominal pain. At first, moderate and not very disturbing to the patient, it indicates irritation of the peritoneum. But if the bleeding is not stopped in time, the pain becomes more and more severe, which may indicate the development of

If there is a significant accumulation of blood in the abdominal cavity, upon examination, the surgeon determines the irregular shape of the abdomen. With percussion (tapping on the anterior abdominal wall), a dull sound is detected in places where blood accumulates, and peristaltic sounds of the intestine are muffled.

In order not to miss this complication and to provide timely assistance to the patient, it is necessary to regularly check these indicators:

  • general condition of the patient;
  • blood pressure and pulse;
  • abdominal condition, including symptoms of peritoneal irritation (the most common and informative is the Shchetkin-Blumberg symptom).

The only possible treatment method in this situation is relaparotomy, that is, re-opening the abdominal wall, identifying the source of bleeding and stopping it surgically.

Infiltration and abscess: treatment

How to treat the most common complications after appendectomy?

Treatment of infiltration begins with novocaine blockade. Antibiotics and cold are also prescribed to the site of this formation. In addition, the surgeon, together with the physiotherapist, can prescribe a number of procedures, for example, UHF. If all these therapeutic measures are applied on time, recovery is expected within a few days.

If drug treatment does not help, the patient’s condition worsens, and signs of abscess formation appear, it is necessary to resort to surgical intervention.

If the abscess is not deep, but subcutaneous, it is necessary to remove the stitches, widen the edges of the wound and remove the pus. Next, the wound is filled with tampons moistened with a solution of chloramine or furatsilin. If the abscess is located deeper in the abdominal cavity, which often occurs when an abscess is recognized a week after surgery, it is necessary to perform a repeat laparotomy and remove the suppuration. After the operation, it is necessary to do daily dressings with cleansing the wound with a solution of hydrogen peroxide; after the formation of granulation on the wound, bandages with ointments are used, which promote rapid healing.

Usually these complications do not leave any trace, however, with severe muscle separation, the formation of hernias is possible.

Women after an appendectomy may develop an infiltrate of the pouch of Douglas, which is a depression between the uterus and rectum. The approach to treating this complication is the same as for infiltration of another location. However, here you can add procedures such as warm enemas with furatsilin and novocaine, douching.

Complications from other organs and systems

During the recovery period after surgery, not only complications in the postoperative wound, but also pathologies of other organs may occur.

Thus, in the spring, the appearance of bronchitis and pneumonia is quite common. The main preventive method is therapeutic exercises. It should be started as soon as possible after surgery. It is necessary to prevent the patient from lying passively in bed, as this contributes to the occurrence of congestion in the respiratory tract. The patient must bend and straighten his legs, turn from side to side, and perform breathing exercises. To control the regularity and correctness of the exercises, the hospital must have a methodologist. If there is none, control of the exercises falls on the department nurse.

If pulmonary complications do develop, antibiotic therapy, expectorants and sputum thinners (mucolytics) are prescribed.

One of appendicitis is its cause. Its cause can be either a reflex effect on the nerve plexuses from the side of the surgical wound, or simply the patient’s inability to go to the toilet in a supine position. And although surgeons regularly ask patients about their urination, some patients are embarrassed to talk about this problem. In such cases, the surgeon may observe tension and swelling in the suprapubic region, and the patient experiences pain in the lower abdomen.

After catheterization and removal of the contents of the bladder, all complaints disappear and the patient's condition improves. However, before resorting to catheterization, simpler methods can be used. Sometimes, after the patient gets to his feet, the act of urination occurs. It is also possible to use heating pads on the lower abdomen, diuretics.

Postoperative complications in children

Unfortunately, at this time, a high percentage of complications after appendectomy in children under three years of age is determined - from 10 to 30%. This is associated with a more severe course of the disease and the frequent development of destructive forms of appendicitis.

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

  • infiltrate and abscess;
  • postoperative intestinal obstruction due to the formation of adhesions;
  • intestinal fistula;
  • prolonged course of peritonitis.

Unfortunately, children are more likely to die after surgery than adults.

And although complications after appendicitis are becoming less common these days, it is important to know their symptoms to prevent dangerous consequences.