appendiceal abscess

Appendiceal abscess - a complication of destructive forms of acute appendicitis (identify approximately 2% of all types of acute appendicitis). Originally formed appendicular infiltration, which then either dissolves under the influence of conservative therapy, either, despite appropriate treatment, abscessed.

Symptoms within. At the beginning of the disease is marked more or less pronounced pain typical of acute appendicitis. As a result of late uptake or incorrect prehospital diagnosis of acute appendicitis disease can go in two ways: the progression of peritonitis and distinguishing inflammatory process. In the latter case, after 2-3 days reduced pain, reduced temperature. On palpation in the right iliac region is determined infiltration. From 5 to 7-day temperature rises again, worse pain in the right iliac region, dyspeptic symptoms. The pain increases with coughing, walking, riding tryasskoy. On examination, tongue moist, overlaid. Belly breathing is lagging behind at the lower right quadrant of the centuries, there can also be determined by bulging. On palpation, a muscle strain, soreness in the area (sometimes very severe), low positive symptoms of irritation of the peritoneum. With deep palpation determined sharply painful, fixed infiltrates (fluctuations almost never happens). There may be mild expressed phenomena paralytic ileus - at the Review abdominal X-ray can detect fluid levels and intestinal pneumatosis in the right half of the abdomen. For rectal or vaginal study, pain, sometimes you can palpate the lower pole of education. In the blood - high leukocytosis with a shift to the left. Dynamic observation marks an increase leukocytosis, temperature takes hectic nature. Gradually increases pain, increase infiltration and tenderness in the right iliac region. The size of the abscess and its exact location is set on ultrasound.

Treatment operative. Before the operation required premedication with antibiotics and metronidazole. Under general anesthesia produced an autopsy ulcer, it is best to use the extraperitoneal access. The cavity is washed with antiseptic and drain Winternitz drainage mi aspiration for active content with washing in the postoperative period. From the introduction of tampons in the wound is better to abstain. Postoperatively, disintoxication therapy, antibiotics (aminoglycosides) in combination with metronidazole.

Complications: sepsis, pylephlebitis, liver abscesses, abscess breakthrough in the free abdominal cavity with the development of diffuse peritonitis.

Forecast serious, it depends on the timeliness and adequacy of surgical intervention.