Rotten appendix. Ruptured Appendix: Causes, Symptoms, and Treatment Options

13.06.202309.06.2023 by alexxlab

What are the main causes of a ruptured appendix. How can you recognize the symptoms of appendicitis. What treatment options are available for a ruptured appendix. How is appendicitis diagnosed and managed. What are the potential complications of untreated appendicitis. How long is the recovery process after appendix surgery. Can appendicitis be prevented or its risk reduced.

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Understanding Appendicitis: The Precursor to a Ruptured Appendix

Appendicitis is a medical condition that occurs when the appendix, a finger-shaped pouch attached to the colon, becomes infected and inflamed. Located in the lower-right side of the abdomen, the appendix’s exact function remains a subject of debate among medical professionals. However, when it becomes infected, it can lead to a painful and potentially life-threatening condition if left untreated.

The incidence of appendicitis is relatively common, affecting approximately 1 in 1,000 people in the United States. While it can occur at any age, it most frequently strikes individuals between the ages of 10 and 30. Interestingly, there may be a genetic component to appendicitis, as individuals with a family history of the condition may be at a higher risk. Additionally, children with cystic fibrosis may have an increased likelihood of developing appendicitis.

Why does appendicitis occur?

Appendicitis typically develops when the appendix becomes blocked. This obstruction can be caused by various factors, including:

Fecal matter
Parasites
Growths or tumors
Digestive tract infections
Inflammatory bowel disease

When blockage occurs, it allows bacteria normally present in the appendix to proliferate uncontrollably, leading to infection and inflammation. In many cases, however, doctors are unable to pinpoint the exact cause of appendicitis.

Recognizing the Symptoms of Appendicitis

Early recognition of appendicitis symptoms is crucial for timely treatment and prevention of complications. The most common symptom is abdominal pain, which typically begins near the navel and gradually migrates to the lower right quadrant of the abdomen. This pain may intensify with movement, deep breathing, coughing, or sneezing.

Other symptoms that may accompany appendicitis include:

Loss of appetite
Nausea and vomiting
Fever
Diarrhea or constipation

Is appendicitis pain constant or intermittent? Appendicitis pain is typically constant and progressive, meaning it tends to worsen over time rather than coming and going in waves. If you experience these symptoms, especially severe abdominal pain that migrates to the lower right side, it’s crucial to seek medical attention immediately.

Diagnosing Appendicitis: The Path to Accurate Assessment

Diagnosing appendicitis involves a combination of physical examination, laboratory tests, and imaging studies. When a patient presents with symptoms suggestive of appendicitis, the diagnostic process typically unfolds as follows:

Physical Examination

The doctor will gently press on the patient’s abdomen, paying particular attention to the lower right quadrant. They will assess the location and severity of pain, as well as any signs of abdominal rigidity or rebound tenderness.

Laboratory Tests

Blood and urine tests are often performed to check for signs of infection and rule out other potential causes of abdominal pain. An elevated white blood cell count can indicate the presence of infection, which is common in appendicitis.

Imaging Studies

To confirm the diagnosis and rule out other conditions, imaging tests may be ordered. These can include:

Ultrasound: A non-invasive test that uses sound waves to create images of the appendix and surrounding tissues.
CT scan: Provides detailed cross-sectional images of the abdomen, allowing for accurate visualization of the appendix and any associated inflammation.
MRI: Offers high-resolution images without radiation exposure, which can be particularly useful for pregnant women or children.

How accurate are imaging studies in diagnosing appendicitis? While no single test is 100% accurate, the combination of clinical assessment and imaging studies can achieve a diagnostic accuracy of over 90% for appendicitis.

Treatment Options for Appendicitis and Ruptured Appendix

The treatment approach for appendicitis depends on the severity of the condition and whether the appendix has ruptured. The primary treatment options include:

Surgical Intervention

Appendectomy, the surgical removal of the appendix, is the most common treatment for appendicitis. There are two main types of appendectomy:

Open Appendectomy: This traditional approach involves making a single, larger incision in the abdomen to remove the appendix.
Laparoscopic Appendectomy: A minimally invasive technique that uses several small incisions and specialized instruments, including a camera, to remove the appendix.

In cases of a ruptured appendix, surgery is usually necessary to remove the infected appendix and clean out any infected fluids that have spilled into the abdominal cavity.

Antibiotic Therapy

Antibiotics play a crucial role in the treatment of appendicitis, whether used alone or in conjunction with surgery. In some cases of uncomplicated appendicitis, antibiotic therapy alone may be sufficient to resolve the infection without the need for surgery. However, this approach carries a risk of recurrence, and many doctors still recommend surgery as the definitive treatment.

For patients with a ruptured appendix, aggressive antibiotic therapy is essential to combat the spread of infection within the abdominal cavity.

Abscess Drainage

In cases where a ruptured appendix has led to the formation of an abscess (a collection of pus), drainage may be necessary before proceeding with surgery. This can be accomplished through:

Percutaneous drainage: Using a needle or catheter inserted through the skin under imaging guidance.
Surgical drainage: Performed during the appendectomy or as a separate procedure.

What factors determine the choice of treatment for appendicitis? The decision between surgical and non-surgical management depends on various factors, including the severity of symptoms, the presence of complications, the patient’s overall health, and the preferences of both the patient and the treating physician.

Complications of Untreated Appendicitis: The Dangers of Delay

Untreated appendicitis can lead to serious and potentially life-threatening complications. The most significant risk is the rupture of the appendix, which can occur within 24 to 72 hours after the onset of symptoms. When the appendix ruptures, the infection inside spills into the abdominal cavity, leading to a condition called peritonitis.

Peritonitis: A Serious Consequence

Peritonitis is an inflammation of the peritoneum, the membrane lining the abdominal cavity. It can quickly become life-threatening if the infection spreads to the bloodstream, leading to sepsis. Symptoms of peritonitis include:

Severe abdominal pain and tenderness
Abdominal swelling or bloating
Fever and chills
Nausea and vomiting
Rapid heartbeat and breathing
Decreased urine output

How quickly can appendicitis progress to peritonitis? The progression from appendicitis to peritonitis can occur rapidly, often within 24 to 48 hours of symptom onset. This underscores the importance of seeking prompt medical attention when appendicitis is suspected.

Abscess Formation

In some cases, instead of causing widespread peritonitis, a ruptured appendix may lead to the formation of an abscess. An abscess is a walled-off collection of pus that forms as the body attempts to contain the infection. While less immediately life-threatening than peritonitis, abscesses can cause ongoing health problems and may require additional procedures to drain and treat.

Recovery After Appendix Surgery: What to Expect

Recovery after appendix surgery varies depending on the type of procedure performed and whether complications, such as a rupture, occurred. Here’s what patients can typically expect during the recovery process:

Immediate Post-Operative Period

After surgery, patients are monitored in a recovery room until their vital signs stabilize. Pain medication is administered as needed, and patients are encouraged to get out of bed and move around as soon as possible to promote healing and prevent complications like blood clots.

Hospital Stay

The length of hospital stay depends on the type of surgery and the patient’s condition:

Laparoscopic appendectomy: Patients may be discharged within 24 to 48 hours.
Open appendectomy: Hospital stay may extend to 2-3 days.
Complicated cases (e.g., ruptured appendix): Patients may need to stay in the hospital for a week or longer.

At-Home Recovery

Upon discharge, patients are given instructions for at-home care, which typically include:

Pain management with prescribed medications
Wound care and hygiene instructions
Dietary recommendations, starting with clear liquids and progressing to solid foods
Activity restrictions, such as avoiding heavy lifting for several weeks
Follow-up appointment scheduling

How long does it take to fully recover from appendix surgery? Most patients can return to normal activities within 1 to 3 weeks after laparoscopic surgery, or 2 to 4 weeks after open surgery. However, complete internal healing may take 4 to 6 weeks.

Potential Complications During Recovery

While most appendectomies result in smooth recoveries, patients should be aware of potential complications and seek medical attention if they experience:

Increasing abdominal pain or swelling
Fever or chills
Persistent nausea or vomiting
Redness, swelling, or discharge from the incision site
Constipation or inability to pass gas
Difficulty urinating

Preventing Appendicitis: Is It Possible?

While there’s no surefire way to prevent appendicitis, certain lifestyle factors may help reduce the risk or severity of the condition. Consider the following preventive measures:

Dietary Considerations

A diet rich in fiber may help prevent appendicitis by promoting regular bowel movements and reducing the risk of fecal matter blocking the appendix. Good sources of fiber include:

Whole grains
Fresh fruits and vegetables
Legumes
Nuts and seeds

Hydration

Staying well-hydrated can help maintain healthy digestion and prevent constipation, which may contribute to appendicitis.

Regular Exercise

Physical activity promotes overall digestive health and may help reduce the risk of appendicitis.

Hygiene Practices

Good hygiene, particularly in food preparation and consumption, can help prevent infections that may lead to appendicitis.

Can appendicitis be completely prevented? While these measures may help reduce the risk, it’s important to note that appendicitis can still occur even in individuals who maintain a healthy lifestyle. The key is to be aware of the symptoms and seek prompt medical attention if appendicitis is suspected.

Living Without an Appendix: Long-Term Considerations

For those who have undergone an appendectomy, it’s natural to wonder about the long-term implications of living without an appendix. Fortunately, the appendix is not considered an essential organ, and its removal typically does not lead to any significant long-term health consequences.

Digestive Function

The absence of an appendix does not typically affect digestive function or nutrient absorption. Most people can eat and digest food normally after recovering from surgery.

Immune System Impact

Recent research suggests that the appendix may play a role in maintaining gut health and supporting the immune system. However, the body has numerous other mechanisms to support immune function, and the removal of the appendix does not appear to significantly compromise overall immunity.

Future Health Considerations

While living without an appendix is generally considered safe, some studies have suggested potential associations between appendectomy and certain health conditions. These include:

Slightly increased risk of certain gastrointestinal infections
Potential changes in gut microbiome composition
Possible associations with certain autoimmune conditions (though more research is needed to confirm these links)

It’s important to note that these associations are generally weak, and the overall health impact of appendix removal is considered minimal for most individuals.

Does the absence of an appendix require any special lifestyle modifications? For the vast majority of people, no specific lifestyle changes are necessary after recovering from an appendectomy. Maintaining a healthy diet, staying physically active, and practicing good hygiene remain important for overall health, regardless of appendix status.

In conclusion, while a ruptured appendix can be a serious medical emergency, prompt recognition of symptoms and appropriate treatment can lead to excellent outcomes. Understanding the causes, symptoms, and treatment options for appendicitis empowers individuals to seek timely medical care and potentially avoid complications. With modern surgical techniques and comprehensive post-operative care, most patients recover fully from appendicitis and go on to lead healthy lives, with or without their appendix.

Causes, Symptoms, Treatment, and More

Medically Reviewed by Carol DerSarkissian, MD on January 17, 2022

Your appendix is a finger-shaped pouch attached to your colon. It’s in the lower-right side of your belly. Experts aren’t sure exactly what it does. But if it becomes infected and inflamed, you get a painful condition called appendicitis. Most people who get it need surgery to remove their appendix, and they recover completely. Appendicitis can be life-threatening, though, if you don’t get it treated.

Appendicitis can make your appendix burst, or “rupture.” If that happens, the infection inside it could spill out and spread through your abdomen. It’s a complication called peritonitis, and it can turn deadly if the infection gets into your bloodstream. Treatment can keep this from happening or stop it from getting worse.

You’ll usually have serious stomach pain. It may start near your belly button and gradually move to the lower right. It might also get worse when you move around, breathe deeply, cough, or sneeze. You may also have signs like:

No appetite
Nausea and vomiting
Fever
Diarrhea or constipation

Call your doctor right away if you have these symptoms.

About 1 in 1,000 people in the U.S. get appendicitis. You can have it at any age, but it usually strikes when you’re between 10 and 30. You may be more likely to get it if one of your relatives had it. And if you have a child with cystic fibrosis, their odds of getting appendicitis may also be higher.

Appendicitis usually happens when something blocks your appendix, like feces, parasites, or growths. This lets bacteria that normally live inside your appendix grow out of control, making it infected and swollen. Other things that can bring on appendicitis include digestive tract infections and inflammatory bowel disease. A lot of the time, doctors can’t pinpoint the cause.

Your doctor may press gently on your belly and ask you about your pain. They may also give you blood and urine tests. You may need to get imaging tests, like an ultrasound, CT scan, or MRI, that make pictures of the inside of your abdomen. Exams like these help your doctor spot signs of appendicitis or rule out other conditions.

Most people with appendicitis get an operation, especially if the appendix bursts. A surgeon removes the ruptured appendix and cleans out any infected fluids in your belly. If your appendix hasn’t burst, your doctor may be able to treat it with antibiotics alone. But there’s a chance your appendicitis could come back, so your doctor may still recommend surgery.

Your doctor may give you antibiotics to treat any infection. If the appendix has ruptured, some people need a procedure to treat a collection of pus called an abscess that can form inside the belly. Your doctor might drain it through a needle or tube that goes in your belly. After the abscess is drained and your infection is under control, which could take a few weeks, you’ll get surgery to take out your appendix.

It’s called an appendectomy. You’ll get medicine called anesthesia so that you’re asleep and pain-free during the operation. There are two types of surgery. If you get an “open appendectomy,” your surgeon makes one long cut in your belly and removes your appendix through it. In “laparoscopic surgery,” the doctor makes several small cuts and puts in small tools that let them see inside your belly and take out your appendix.

Your care team will move you to a recovery room, where they’ll watch your heart rate, breathing, and blood pressure. Once these “vital signs” are stable and you’re awake, they’ll take you to your hospital room and give you medicine for pain. You might get out of bed and move around after a few hours if you had laparoscopic surgery, or the next day if you had open surgery. You may go home in 1 to 2 days, or longer if your appendix burst.

If the hospital lets you go home shortly after surgery, you may have trouble thinking clearly for a day or two while the anesthesia wears off. Don’t drive or drink alcohol until your doctor says it’s OK. If your doctor gives you medicine for pain, take it exactly as prescribed. Also drink plenty of clear liquids to stay hydrated. As your appetite returns, eat bland foods like crackers, mashed potatoes, rice, and toast.

Let your doctor know if you have any of these symptoms:

Belly pain, swelling, or cramping
Pain around the surgery wound that gets worse
Fever, chills, or vomiting
Surgery wound looks red, bleeds, or smells bad
No appetite after 2 days
No bowel movements or can’t pass gas for 2 days
Watery diarrhea for more than 3 days
Constant cough, shortness of breath, or trouble breathing

Keep it clean and dry. Wash your hands before and after you touch the skin near it. Follow your doctor’s instructions on how to bathe and when to change or remove your bandage. Don’t wear clothes that are tight or made of rough material because they can irritate your wound. Keep the area covered from the sun to avoid a darker scar. Your wound may heal in about 4 to 6 weeks, and the scar may get softer and fade over the next 12 months.

It’s normal to feel more tired than usual at first, so get extra sleep if you need it. Follow your doctor’s instructions on how to slowly get more active. You may need to wait up to 2 weeks before you can do anything strenuous. Ask your doctor if it’s OK to go back to work as soon as you feel up to it.

IMAGES PROVIDED BY:

1) SCIENCE PHOTO LIBRARY / Science Source

2) magicmine / Getty Images

3) (Clockwise from top left) pakornkrit / Getty Images, EVAfotografie / Thinkstock, Ridofranz / Thinkstock, SasinParaksa / Getty Images

4) Doug McKinlay / Getty Images

5) Stocktrek Images / Science Source

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8) Turtle Rock Scientific / Science Source

9) (Left to right) Okrasyuk / Getty Images, BARRY SLAVEN / Science Source

10) SCIENCE PHOTO LIBRARY / Science Source

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14) Aja Koska / Getty Images

SOURCES:

American College of Surgeons: “Appendectomy: Surgical Removal of the Appendix. “

Medline Plus: “Appendicitis Tests,” “Appendicitis.”

Harvard: “Appendicitis.”

Up to Date: “Patient education: Appendicitis in adults (The Basics),” “Patient education: Appendicitis in children (The Basics).”

National Digestive Diseases Information Clearinghouse: “Appendicitis.”

National Institute of Diabetes and Digestive and Kidney Diseases: “Treatment for Appendicitis,” “Definition & Facts for Appendicitis,” “Symptoms & Causes of Appendicitis,” “Diagnosis of Appendicitis.”

American Pediatric Surgical Association: “Ruptured Appendicitis.”

University of Rochester Medical Center: “Appendicitis in Children.”

Children’s National: “Pediatric Appendicitis.”

Boston Children’s Hospital: “Appendicitis.”

Stanford Children’s Health: “Appendicitis.”

Johns Hopkins Medicine: “Appendectomy.”

Mayo Clinic: “Appendicitis.”

Columbia Surgery: “Appendicitis & Appendectomy.”

Saint Luke’s: “After Laparoscopic Appendectomy (Appendix Removal). “

Kids Health: “What Is an Appendectomy?”

Appendicitis – NHS

Appendicitis is a painful swelling of the appendix. The appendix is a small, thin pouch about 5 to 10cm (2 to 4 inches) long. It’s connected to the large intestine, where poo forms.

Nobody knows exactly what the appendix does, but removing it is not harmful.

Symptoms of appendicitis

Appendicitis typically starts with a pain in the middle of your tummy (abdomen) that may come and go.

Within hours, the pain travels to the lower right-hand side, where the appendix usually lies, and becomes constant and severe.

Pressing on this area, coughing or walking may make the pain worse.

You may lose your appetite, feel sick and have constipation or diarrhoea.

When to get medical help

If you have abdominal pain that’s gradually getting worse, contact a GP or your local out-of-hours service immediately.

If these options are not available, call NHS 111 for advice.

Call 999 to ask for an ambulance if you have pain that suddenly gets worse and spreads across your abdomen, or if your pain temporarily improves before getting worse again.

If your pain eases for a while but then gets worse, your appendix may have burst, which can lead to life-threatening complications.

Read more about diagnosing appendicitis and complications of appendicitis.

How appendicitis is treated

If you have appendicitis, it’s likely your appendix will need to be removed as soon as possible.

Removal of the appendix, known as an appendicectomy or appendectomy, is 1 of the most common operations in the UK and its success rate is excellent.

It’s most commonly carried out as keyhole surgery (laparoscopy).

Several small cuts are made in the abdomen, allowing special surgical instruments to be inserted.

Open surgery, where a larger, single cut is made in the abdomen, is usually used if the appendix has burst or access is more difficult.

It usually takes a couple of weeks to make a full recovery after your appendix has been removed.

But strenuous activities may need to be avoided for up to 6 weeks after having open surgery.

What causes appendicitis?

It’s not clear what causes appendicitis. In many cases it may be that something blocks the entrance of the appendix.

For example, it could become blocked by a small piece of poo, or an upper respiratory tract infection could cause the lymph node within the wall of the bowel to become swollen.

If the obstruction causes inflammation and swelling, it could lead to increased pressure within the appendix, which may then burst.

As the causes of appendicitis are not fully understood, there’s no guaranteed way of preventing it.

Who’s affected

Appendicitis is a common condition. In England, around 50,000 people are admitted to hospital with appendicitis each year.

You can get appendicitis at any age, but it usually affects people aged between 10 and 30 years.

Video: what is appendicitis?

Watch this animation to learn about what causes appendicitis and how it’s treated.

Media last reviewed: 1 May 2021
Media review due: 1 May 2024

Page last reviewed: 21 October 2022
Next review due: 21 October 2025

Purulent appendicitis – causes, symptoms, diagnosis and treatment

Purulent appendicitis is an acute inflammation of the appendix of the intestine, accompanied by purulent fusion of its tissues. It is characterized by the occurrence of severe pain in the epigastrium, migrating to the right iliac region, nausea and vomiting, fever. Diagnosis is based on clinical examination and identification of specific symptoms. The treatment is only surgical, it is possible to perform the operation both according to the classical method (laparotomy) and the more modern endoscopic method (laparoscopy is performed only in the absence of diffuse peritonitis, abdominal abscesses).

General information

Purulent appendicitis is the most common surgical pathology of the abdominal organs (up to 90%), among all surgical diseases, purulent appendicitis is diagnosed in 30% of cases. The frequency of purulent inflammation of the appendix is 1 case per 200-300 people per year.

Usually purulent appendicitis affects the adult population, women get sick twice as often as men. In children, the elderly and pregnant women, purulent appendicitis is quite rare, but it is more severe, has an erased clinical picture and is difficult to diagnose. In surgical practice, this is the most common cause of peritonitis. In general, with timely surgical treatment, the outcome of purulent appendicitis is favorable; if complications occur, the prognosis worsens significantly.

Purulent appendicitis

Causes

Purulent appendicitis accounts for about 60% of all forms of the inflammatory process in the appendix. Currently, there are several theories of the occurrence of purulent appendicitis: mechanical, infectious, vascular and endocrine. To understand these theories, one should know what the appendix is used for in the body. The appendix acts as an immune filter for the intestines and other internal organs.

According to the mechanical theory, the development of purulent appendicitis is predisposed to the structural features of the appendix: it has a narrow convoluted lumen, poor blood supply, and often bends. In this regard, there is often a blockage of the lumen of the appendix with coprolites (fecal stones). Most often, their formation is associated with an insufficient amount of consumed fiber, fluid, as well as with the individual characteristics of the body. Obturation of the lumen of the appendix can be caused not only by coprolite (35% of cases), but also by hyperplastic lymphatic follicles, a tumor, a foreign body, parasites.

After blockage of the lumen of the process, pressure builds up in it, blood supply worsens, intestinal flora begins to actively multiply. This leads to the onset and progression of inflammation, which within a few days can lead to necrosis and perforation of the appendix wall, the spread of the inflammatory process to the peritoneum (peritonitis). The composition of the microbial flora in purulent appendicitis is polymorphic and nonspecific.

Infectious theory indicates the possibility of a local inflammatory process in the appendix in amoebiasis, yersiniosis, typhoid fever, tuberculosis. However, scientists have not proven the specific nature of inflammation. Less recognized theories of the formation of purulent appendicitis are vascular and endocrine. The first hypothesis suggests the possibility of pathology on the background of vasculitis – more often this occurs in older people (primary appendicitis).

The endocrine theory considers the appendix as a collection of specific cells that secrete serotonin, an inflammatory hormone. Also, there are various ways of infection penetration into the appendix: most often it is an enterogenic way, much less often hemato- or lymphogenous.

Pathoanatomy

The phlegmonous appendix looks thickened, hyperemic during the operation, the serous membrane is covered with fibrin plaque. On the incision, ulcerations of the mucous membrane of the appendix are determined, and accumulations of pus are found in its cavity. During the operation, the gangrenous altered appendix spreads in the hands, areas of necrosis are visible in its wall, thrombosis of the mesenteric vessels is noted. The color of the gangrenous process is dirty green, an unpleasant putrefactive odor emanates from it. Around the caecum, a moderate amount of cloudy fibrin effusion is determined (provided that perforation has not occurred). If the progression of inflammation leads to rupture of the appendix, most often it ends in local or diffuse peritonitis.

Classification

Classification is closely related to the pathological changes occurring in the appendix. At the initial stages of the formation of the inflammatory process in the appendix, before the onset of purulent impregnation of tissues, appendicitis is catarrhal. The progression of inflammation leads to the infiltration of the tissues of the appendix with leukocytes – the stage of purulent phlegmonous appendicitis begins. Further melting leads to tissue ruptures – gangrenous-perforative purulent appendicitis is formed.

Symptoms of purulent appendicitis

The first manifestation of a phlegmonous process is usually pain. It occurs most often in the epigastrium, then moves to the right iliac region. The pain is moderate, dull, constant, aggravated in the position on the left side, with straining and coughing. As the inflammatory process progresses, the pain may decrease and even disappear for a short time (this is due to the death of nerve fibers). However, within a few hours, the pain syndrome returns, becomes stronger, accompanied by an increase in temperature to febrile numbers, symptoms of severe intoxication – this usually indicates the development of diffuse inflammation of the peritoneum.

The patient may experience nausea, vomiting once or twice, and diarrhea. Quite rarely, tachycardia, episodes of increased blood pressure are noted. In the initial stages, the temperature increase is usually insignificant, not higher than 38°C. The course of the disease can be complicated by untimely treatment to the clinic, as well as by a long postponement of the operation. The appendix gradually melts, an inflammatory infiltrate forms around it. Over time, either further tissue melting occurs with the formation of an appendicular abscess, or the process spreads to neighboring organs.

Complications

A complication of the disease in the form of peritonitis in just a few hours can lead to the development of abscesses not only around the appendix, but also between intestinal loops (interintestinal abscess), in the small pelvis, under the liver. This often causes necrosis of the intestinal walls, the formation of adhesions and fistulas, intestinal obstruction, pylephlebitis. It is possible to spread the process to the organs of the chest cavity (pneumonia, pleurisy), small pelvis (endometritis).

Diagnosis

Diagnosis of purulent appendicitis is usually not difficult, although a correct diagnosis sometimes requires observation of the patient for 2-3 hours. Examination by an abdominal surgeon allows for a differential diagnosis of purulent appendicitis with other diseases of the abdominal organs. If other pathology is excluded, but the diagnosis of purulent appendicitis remains in doubt, an endoscopist consultation may be required, followed by diagnostic laparoscopy.

Great importance is attached to the clinical examination of the patient. Rectal examination reveals pain in the anterior wall of the rectum due to inflammatory effusion in the abdominal cavity. There is a difference between rectal and axillary temperature of more than 1 degree. Kocher’s symptom is characteristic – pain moves to the right iliac region within a few hours from the onset of the disease, Bartomier’s symptom – pain in the right iliac region increases with palpation on the left side. Shchetkin-Blumberg’s symptom also testifies to inflammation – if, during palpation in the projection of the appendix, gently press the palm of your hand on the anterior abdominal wall, and then sharply take your hand away, the pain will intensify.

Of the clinical tests, only a general blood test is informative: in it, with a phlegmonous process, inflammatory changes will be detected, which are significantly aggravated against the background of the development of gangrenous appendicitis. Ultrasound of the abdominal organs, plain radiography are prescribed only if differential diagnosis with another pathology is necessary. If acute appendicitis is suspected, electrocardiography is mandatory, since this diagnosis is often erroneously made in acute myocardial infarction.

Differential diagnosis of purulent appendicitis is carried out with renal colic and right-sided pyelonephritis, acute pathology of the right ovary, ectopic pregnancy (rupture of the right fallopian tube), Meckel’s diverticulitis, various inflammatory diseases of the small and large intestines, peptic ulcer in the acute stage, especially with perforation of the stomach ulcer , cholecystitis, right-sided pneumonia and pleurisy.

Treatment of purulent appendicitis

Only surgical treatment of pathology. In the first hours of the disease, it can be quite difficult to determine the medical conclusion, in this case the patient is sent for observation to the department of abdominal surgery, where the correct diagnosis should be made within two to three hours and preoperative preparation should be carried out. Preparation for surgery includes sanitization (hygienic shower), prevention of thromboembolic complications (tight bandaging of limbs, administration of heparin). If the patient has been eating during the last six hours before the operation, the stomach is washed through a tube. You also need to empty your bladder. If necessary, sedatives are prescribed.

Surgical intervention for uncomplicated forms of purulent appendicitis (phlegmonous, gangrenous without perforation) is usually performed by laparoscopic method – the frequency of complications after such an operation is minimal, the postoperative period is much easier, the ability to work is restored faster. There are no rough scars on the body, the postoperative wound rarely becomes inflamed.

In the presence of complications (perforation, peritonitis, formation of abdominal abscesses), it is better to perform the operation by classical laparotomy appendectomy, which will allow a thorough revision of the abdominal cavity, detect abscesses, adhesions, sanitize foci of infection. In the postoperative period, it is recommended to follow a diet, limit physical activity. The patient should be observed by the surgeon, to carry out careful care of the postoperative wound.

Prognosis and prevention

There is no specific prevention of purulent appendicitis, it is recommended to eat a proper diet with a sufficient amount of fiber, liquid, sanitation of foci of chronic infections. The prognosis for uncomplicated forms of pathology is quite favorable, but with the spread of inflammation it worsens significantly.