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Chronic appendicitis

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Chronic appendicitis

Chronic appendicitis

Chronic appendicitis is a chronic inflammation of the appendix originating from the cecum. This disease is quite rare and is observed much less frequently than acute appendicitis.

In antiquity, appendicitis was known as an "inflammatory tumor" or "iliac sores". This disease was considered fatal, with patients dying in agony. Only with the development and development of surgery, appendicitis has become a routine disease, which can be eliminated in any surgical department.

With the development of the theory of evolution, many scientists began to look at the appendix as an unnecessary human organ, without which it is possible to do without. This led to the fact that the number of operations for the removal of the appendix has increased unnecessarily. However, after its functions were discovered, doctors began to adhere to a more moderate position, and today the voices of scientists for preserving the appendix and conservative treatment of appendicitis with antibiotics are becoming more and more active.



Structure and function of the appendix

The vermiform appendix departs from the cecum and is located almost at the very beginning of the large intestine. Most often it is located to the right and down from the navel, but sometimes it can be found to the left with the appropriate location of the gastrointestinal tract. Microscopic examination of the appendix revealed that it contains a large amount of lymphoid tissue.

In the lower abdomen on the left, in some people, another process can be found - Meckel's diverticulum, which forms in the ileum and is 10 –100 cm in length from the appendix and cecum. For this reason, the inflammation of this diverticulum (especially if it is located close to the appendix) may resemble a picture of acute or chronic appendicitis.

The functions of the process:

  1. Lymphopoiesis and immunogenesis. It is these appendix functions that have given the right to consider this process as an organ of the immune system, and many researchers call it the “intestinal amygdala”.
  2. Propagation of Escherichia coli followed by dissemination through the intestines.
  3. Regulation of the function of the valve that separates the small intestine from the colon.
  4. Secretory (produces amylase).
  5. Hormonal (peristaltic hormone synthesis).
  6. Antimicrobial. Some researchers have found that the appendix secretes a special antimicrobial substance, the action and purpose of which is not yet completely understood.


The causes of chronic appendicitis and its types

There are the following types of chronic appendicitis:

  1. Primary chronic appendicitis . In this case, the causes of inflammation are not precisely established, and some authors generally consider this form of the disease to be non-existent. Such a diagnosis is established only after a thorough examination and exclusion of any other pathology of the abdominal organs.
  2. Secondary chronic appendicitis . He might be:
  • residual - occurs after acute appendicitis, which has not been operated on,
  • recurrent - periodically there are repeated attacks of acute appendicitis with a minimum number of symptoms between them.

Recurrent appendicitis can develop even after the appendix is ​​removed due to acute appendicitis, if its stump remains more than 2 cm long.

The development of chronic inflammation in the appendix is ​​promoted by cysts, adhesions, hyperplasia of the lymphoid tissue, excesses of the appendix, impaired blood circulation in this organ.

Symptoms of chronic appendicitis

  1. Pain As a rule, these are periodic complaints from the patient to pain in the iliac or paraumbilical region. These pains can be periodic or constant, most often are moderate and radiating to the right thigh, groin, lower back. Increased pain occurs with increased physical exertion, coughing, sneezing, defecation, errors in diet.
  2. Dyspeptic disorders . During exacerbation may be nausea, vomiting.
  3. Breaking stool In chronic appendicitis, diarrhea or constipation is often observed.
  4. Normal body temperature . Chronic appendicitis, as a rule, is not accompanied by fever or reaches subfebrile values ​​in the evenings.
  5. Relatively good overall condition . Symptoms such as general weakness, fatigue, etc. are usually absent.
  6. Discomfort and heaviness in the lower right abdomen .
  7. The presence of syndromes of the pelvic organs:
  • urinary - frequent and painful urination,
  • rectal - pain in the rectum, especially during rectal examination,
  • vaginal - pain during intercourse, gynecological examination.

During the examination, the surgeon may detect a slight irritation of the peritoneum during palpation of the abdomen, and reveal a positive symptom of Obraztsov (increased pain when raised in the prone position in the knee of the right leg).

During an exacerbation a classic picture of acute appendicitis may develop. Then appear:

  • Intense abdominal pain.
  • Temperature rise.
  • White, coated tongue.
  • Dry mouth, nausea.
  • Positive symptoms of Aaron, Bartome-Michelson, Bassler, etc.

Diagnostics

The diagnosis of chronic appendicitis is made on the basis of the clinical picture, characteristic complaints, as well as additional laboratory and instrumental examination:

  • Blood test (total) - a slight increase in leukocytes.
  • Urinalysis (general) - the norm (necessary to exclude pathology from the urinary system).
  • Abdominal ultrasound - detection of abscess or cysts of the appendix, the exception pathology of the pelvic organs, etc.
  • Computed tomography - the exclusion of tumors in this area.
  • Diagnostic laparoscopy - a visual assessment of the state of the appendix.
  • Radiocontrast irrigoscopy - diagnosis of deformity, the shape of the process, the narrowing of its lumen.

Differential diagnosis is carried out with such diseases as:

Treatment of chronic appendicitis

The treatment of acute and chronic appendicitis is performed mainly by abdominal or general surgeons.
If an acute appendicitis is treated predominantly by surgery, then a uniform tactic has not yet been developed for chronic appendicitis, therefore, chronic appendicitis is treated both by a conservative method and by surgery.

Conservative treatment

It consists in taking anti-inflammatory, antibacterial drugs, as well as anti-spastic drugs.

Surgery

Gives a good effect in the case of the development of secondary chronic forms of chronic appendicitis, but may be ineffective in the primary chronic form of the disease. It is especially recommended to remove the inflamed process in the presence of adhesions, cicatricial changes in the wall of the appendix, as well as in the first trimester of pregnancy.

Currently, appendicitis is removed in a classic and endoscopic manner.

Preparation for surgery

You can not warm the abdomen, use drugs, laxatives, alcohol. On the eve it is recommended to have dinner and not eat anything on the day of the operation.

Types of appendectomy

Typical appendectomy . A surgeon makes an incision in the right iliac region, then the vermiform process is brought into the surgical wound, his mesentery is tied up, and the appendix is ​​then cut off. The stump of the appendix is ​​sutured with a special type of sutures (purse-string, Z-shaped) and plunges into the cecum.

Retrograde appendectomy . This operation is used in cases where due to adhesions it is impossible to withdraw a process in the surgical wound. In this case, first, the appendix is ​​cut off from the rectum, then its stump is sutured and plunges into the rectum, and then the surgeon gradually releases the appendix, bandages its mesentery and removes it outside.

Laparoscopic appendectomy . Small punctures are made in the abdominal wall, through which endoscopic instruments are then inserted and the appendix is ​​cut off and taken out.

Transluminal apendectomy . This is a relatively new way to remove the appendix, when endoscopic instruments are inserted through the incision:

  • in the wall of the stomach - transgastral appendectomy,
  • in the wall of the vagina - transvaginal appendectomy.

In this case, there are no stitches on the skin, and recovery is much faster.

Postoperative period

After a wound operation, sutures are applied, which are removed on the 10th day or are resolved independently. The first days may be pain in the postoperative wound, which passes after taking painkillers. Also, after the operation, antibiotics, detoxification drugs are prescribed for some time, and dressings are performed.

As a rule, the recommendations of surgeons are as follows:

  1. Bed rest and hunger for the first 12 hours after surgery.
  2. It is allowed to sit after 12 hours from the moment of the operation and drink in small sips with lemon.
  3. After a day you can get up and walk.

It is very important to adhere to a special diet in the first days after the removal of the appendix:

1-2 days after surgery (# 0a) . Food is liquid, jelly-like, mushy and puree-like dishes, sour cream, whole milk, grape and vegetable juices, carbonated drinks are completely excluded. Allowed fat-free uncaring meat broth, fruit jelly, sweet broth hips, jelly. Meal in small portions (up to 300 g), 7–8 times per day.

3-4 day . It is allowed to eat mucous soups from grits, liquid grated rice or oatmeal, steam omelet from protein, lean meat or fish puree, raw egg.

From 5–7 day (table №1) . You can rubbed soups, meat and fish pureed dishes, vegetable and fruit puree, dairy drinks, white crackers, baked apples.

From the 8th day the patient is allowed to go to the general table No. 15 (excluding spicy, too fatty foods, alcohol).

Recovery period

The period when you can return to the usual way of life depends on the type of appendectomy and the nature of the postoperative period: after endoscopic interventions, healing is faster. On average, exercise is limited for 2 months, then running, swimming, and riding are allowed, and lifting weights is only allowed after 3–6 months. Do not refrain from visiting the bath or sauna for at least 3-4 weeks.

Complications of chronic appendicitis

  1. Transformation into acute appendicitis with subsequent surgical treatment.
  2. The appearance of appendicular infiltrate. In this case, he is treated conservatively using cold, anti-inflammatory, painkillers and antibiotics, physiotherapy. After the inflammation subsides, it is recommended to remove the appendix in 2-4 months.
  3. Abscess appendicular infiltrate. It is treated operatively (opening and drainage of the abscess, and after cure - removal of the appendix after a few months).
  4. The formation of adhesions. It is treated by physiotherapeutic methods, as well as surgically.

Forecast

Most often, signs of chronic appendicitis disappear after removal of the process. However, in cases where the appendix was almost unchanged, the pain and other symptoms after surgery can only worsen.

Children, teenagers and pregnant

In children, chronic appendicitis practically does not occur. In adolescence, the likelihood of developing chronic appendicitis increases if there has already been an attack of acute appendicitis, which was not treated surgically.

Pregnancy due to the gradual displacement of the abdominal organs can provoke an exacerbation of the symptoms of chronic appendicitis, therefore in the case of pregnancy planning, it is recommended to remove the appendix in advance.


| 21 December 2014 | | 4,326 | Diseases of the digestive tract
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