Update: October 2018
Acute appendicitis is a common pathology in
adults and the most common cause of surgical
interventions. Despite the long-known risk groups of this
pathology among the population, against acute appendicitis is not insured
one person, except those who have already removed the wormlike
Without exaggeration, it can be said that this disease is on hearing
every inhabitant of the planet, and many people know the main symptoms.
Such vigilance is not superfluous, since in the case of acute
appendicitis some delay can turn serious
Timely treatment to doctors, on the contrary, causes
favorable prognosis, both in terms of surgical volume
intervention and in terms of recovery time after removal
appendix. By the way, the possibility of laparoscopic
removal of the appendix practicing for
in recent years, allows the operation without a noticeable scar,
as it was before.
Aggravation of appendicitis can occur at any age. Groups
risk are children over 5 years old, adults 20-30 years old, pregnant
women. Pathology is equally characteristic of female and male
floor. Very rarely, appendicitis occurs in young children, which
due to the age anatomical feature of the appendix,
which is funnel-shaped and easy to empty, and weak
development of the lymphoid apparatus of the process.
Rarely are older people on the operating table because
lymphoid tissue in old age undergoes the opposite
development. but, это вовсе не значит, что данные группы населения
are insured against exacerbation of appendicitis – a patient of any age with
suspected appendicitis is subject to full examination.
Causes of acute appendicitis in adults
There are several причин, провоцирующих развитие острого
appendix undigested food particles, fecal
stones. The worm-shaped shoot not for nothing carries such name – it is not enough
the fact that it is thin and narrow, but the appendix also has a large
mobility. Occlusion отростка приводит к застою его содержимого
and inflammation of the wall.
- Hit in the wall of the appendix conditionally pathogenic and pathogenic
intestinal flora – Escherichia coli, Staphylococcus, Enterococci,
streptococci, anaerobes under certain conditions –
hyperplasia of lymphoid tissue, inflection of the process and the impossibility of its
The first and second causes of appendicitis are interrelated,
since stagnation of the contents of the process creates the ideal conditions for
pathological multiplication of bacteria and their penetration into the wall
- In the West, allocates a separate cause of appendicitis exacerbation –
penetration of fusobacteria in it causing tissue necrosis
scion. These bacteria are characterized by the ability to quickly cause
inflammatory processes, but very sensitive to
antibiotics. In our country is not taken to allocate
fuzobakterialny theory of appendicitis in a separate column, and
conservative treatment of appendicitis, very common in
Western countries, is used extremely rarely.
- Infectious and parasitic bowel disease – abdominal
typhoid, yersiniosis, amebiasis, tuberculosis and others.
- Nutrition with a high content of protein foods, contributing to
excessive formation of protein degradation products in the intestine and
development of processes of decay.
- Tendency to constipation – the impossibility of timely emptying
intestines and creating conditions for active reproduction
Spanish scientists studied 3,000 cases of acute appendicitis and
concluded that in almost 40% of cases an attack of appendicitis
was provoked by the use of roasted seeds or chips, more often
all in children under 14 years old.
The first signs of appendicitis in adults, stage of development
Symptoms of appendicitis in adults, characteristic of the typical
the course of appendicitis, have cyclical nature and manifestations,
corresponding to the progression of the pathological process. What kind
first signs of appendicitis in adults?
Stage catarrhal appendicitis (first twelve hours)
A typical appendicitis picture begins with discomfort and
pain in the stomach, often in the evening or at night.
Very often, these pains are reminiscent of gastritis and are
non-intensive, are dull in nature, so people do not give them
strong value. In the same period nausea occurs and arises
single vomiting. It is believed that nausea with appendicitis has
reflex nature, and often in older people, this symptom may
to be mild, which sometimes leads to late establishment
After a few hours, the pains move to the lower right sections.
abdomen (with right-sided appendix). Is changing
the nature of the pains – they become oppressive and pulsating with
нарастающей intensity. Diarrhea may occur, it becomes frequent.
urination. There is a subfebrile condition with a slight further
boost temperatures above 37 C.
Gradually, within six to twelve hours from the beginning
diseases develop typical symptoms of general intoxication
body – weakness, palpitations, dry mouth,
malaise. The pains become difficult to bear and even more
intense. The stomach at this stage remains soft but painful.
when pressing from the right side.
This stage is considered the most favorable for the operation,
however, most patients go to the doctor later.
Stage of phlegmonous appendicitis (end of the first day)
During this period, pain is clearly localized in the ileal region.
on the right, they are throbbing and intense in feeling.
There is a constant feeling of nausea, there is tachycardia until
90 beats per minute. Temperature fluctuates within 38 C. At
examination of the abdomen becomes noticeable lag in the right side
breathing process. The abdomen becomes tight in the lower right.
parts, which indicates the beginning of the transition of inflammatory
process on the peritoneum. At this stage, all become positive.
diagnostic symptoms (slip, Shchetkina-Blumberg,
Sitkovsky, Bartome-Michelson, Rovzinga) and the diagnosis becomes
At this stage, the patient most often falls into the operating room.
Stage of gangrenous appendicitis (second or third day)
At this stage, imaginary pain relief is observed – occurs
the dying off of the nerve endings of the appendix, which leads to a decrease in
sensitivity. At the same time, the symptoms of a common
intoxication of the body – severe tachycardia appears, possibly
appearance of vomiting. The temperature drops, sometimes even below 36 C. Belly
swollen, peristalsis is absent. Palpation of the localization area
appendix causes severe pain.
Stage perforated appendicitis (end of the third day)
The moment of perforation of the appendix wall is accompanied by the most acute
pain localized in the lower right abdomen, with increasing
intensity. There are no periods of relief, pain is
permanent character. Repeated vomiting occurs. Sick
experiencing severe tachycardia, the stomach becomes swollen and
tense, peristalsis is completely absent. White bloom on
language acquires a brown color. Body temperature rises to
critical values. The outcome of perforation of the appendix – purulent spilled
peritonitis or local abscess.
It is worth noting that the specified time and stage of progression
appendicitis are conditional – possibly hidden or fulminant
course of the disease.
How to determine appendicitis in a child can be learned from our
Articles Signs of appendicitis in children.
Atypical appendicitis and their symptoms
In some cases, the classical clinical picture is absent, but
pathological process develops in the body. There are several
Empyema is a rare form of the disease, characterized by the manifestation of
pain symptom immediately in the right iliac region with a smaller
intensity and slow increase of symptoms. Manifestations
intoxication (fever, chills, weakness) are observed
only 3-5 days from the onset of the disease.
Retrocecal appendicitis (5-12% of cases). Poorly characterized
pronounced first symptoms of peritoneal irritation, high
rises in temperature and the prevalence of semi-fluid stools with mucus in
symptomatology. Sometimes patients experience only back pain,
radiating to the right thigh.
Pelvic appendicitis is characteristic of females (9-18%
cases). There is a violation of urination (dysuria), diarrhea with
mucus, symptoms of peritoneal irritation and intoxication (temperature)
few expressed. The pain is felt in the lower abdomen, radiating to the area
Subhepatic appendicitis is distinguished by a painful symptom in the area
Left-sided appendicitis – characterized by classic
clinical picture, but with localization of pain in the left iliac
triangle. Therefore, the question which side hurts appendicitis
Right or left – the answer is ambiguous. Left-sided appendicitis
occurs in 2 cases where the cecum is overly active or
when a person has a reverse arrangement of internal organs.
Appendicitis in pregnant women of the second half of pregnancy is different.
moderate severity of pain with the localization of pain closer
to the right hypochondrium, a little pronounced temperature reaction and
mild symptoms of peritoneal irritation.
Symptoms of chronic appendicitis
Chronically appendicitis in adults is recorded
very rarely, no more than 1% of all cases. Symptoms are characterized by
only occasional recurring pains that
worse when coughing, walking. When relapse occurs
chronic appendicitis, its symptoms are identical to acute
appendicitis, body temperature can be either subfebrile, or
normal. The clinical picture is reminiscent of pyelonephritis, ulcerative
disease, chronic cholecystitis, chronic gynecological and
other diseases of the abdominal cavity.
The diagnosis of acute appendicitis is made on the basis of:
- patient survey data;
- data physical examination;
- laboratory blood tests (leukocytosis in dynamics);
- data узи-исследования брюшной полости (американские
Experts believe that ultrasound is not informative.
appendicitis, having many diagnostic errors, recommending
- temperature reaction.
Differentiate this pathology is necessary from acute
gastroenteritis and pancreatitis, covered perforation of gastric ulcer
or duodenum, intestinal dyskinesia, renal
colic, pleuropneumonia. With an atypical location of the appendix
the disease is differentiated from gynecological and urological
When in doubt in the diagnosis resorted to laparoscopic
appendix examination. This diagnostic procedure allows
to establish the diagnosis accurately and, upon confirmation, proceed immediately
for laparoscopic appendectomy.
Treatment of acute appendicitis
Removal of the inflamed vermiform appendix – generally accepted
treatment tactics. When an appendix is removed at an early stage
diseases performed minimally invasive laparoscopic surgery.
With the development of symptoms of peritonitis, abdominal surgery is indicated.
Sometimes surgery begins with laparoscopy and ends.
abdominal surgery (when the inflammatory process goes beyond
The postoperative period averages 7-10 days and
depends on the amount of surgery, stage
pathological process and postoperative complications. Than before
an appendectomy is performed (ideally at the catarrhal stage),
faster the patient can return to normal life.
Therefore, at the slightest suspicion of appendicitis, weighed down with
visiting a doctor is not allowed.
Conservative treatment is rarely used when
mild symptoms of appendicitis and intoxication and the presence
contraindications for surgery. With the progression of the process in any
case carry out the removal of the appendix.
In the West, intravenous antibiotic therapy is practiced, which
start as early as possible (see uncomplicated appendicitis can be
treat with medication). In our country, antibiotic therapy is shown
in the postoperative period.
Prognosis and complications of acute appendicitis
Complications of acute appendicitis include: limited
abscess of the abdominal cavity, appendicular infiltrate, spilled
peritonitis and pylephlebitis.
With timely appendectomy prognosis
favorable. If appendicitis is complicated by peritonitis – required
more extensive surgery followed
abdominal drainage and serious antibiotic therapy,
the recovery period is lengthened.
In case a person does not seek medical care,
the disease is fatal due to peritonitis and acute
intoxication of the body. Extremely rare appendicitis passes.
spontaneously with the formation of inflammatory infiltrate. but
you should not count on it, because in the future such an outcome
acute appendicitis results in the formation of adhesive processes and
foci of inflammation in the abdominal cavity.
Any sharp pain in the abdomen, worse when coughing, moving,
accompanied by low fever, nausea, diarrhea or
constipation, as well as involuntary tension of the abdominal muscles – a reason for
seek immediate medical attention!
Автор: врач-гигиенист, эпидемиолог