During an acute inflammatory process in the appendix of the cecum, a rapid change of stages occurs. Already 36 hours after the onset of inflammation, serious complications can arise that threaten the patient’s life. In pathology, simple or catarrhal uncomplicated appendicitis first occurs, when inflammation affects only the mucous membranes.

When the inflammatory process spreads deeper and involves the underlying layers in which the lymphatic and blood vessels, then they are already talking about the destructive stage of appendicitis. It is at this stage that pathology is most often diagnosed (in 70% of cases). If surgery is not performed, the inflammation spreads to the entire wall and pus accumulates inside the appendix, and the phlegmonous stage begins.

Wall vermiform appendix is destroyed, erosions appear, through which the inflammatory exudate penetrates into the abdominal cavity, and the cells of the organ die, that is, gangrenous appendicitis develops. Last stage- perforated, in which the appendix filled with pus bursts and the infection penetrates into the abdominal cavity.

What complications are possible with acute appendicitis?

The number and severity of complications directly depends on the stage of the disease. So, in early period(first 2 days) complications of appendicitis usually do not occur, since the pathological process does not extend beyond the appendix. In rare cases, more often in children and the elderly, destructive forms of the disease and even rupture of the appendix may occur.

On days 3-5 after the onset of the disease, complications such as perforation of the appendix, local inflammation of the peritoneum, thrombophlebitis of the mesenteric veins, and appendiceal infiltration may develop. On the fifth day of the disease, the risk of developing diffuse peritonitis, appendiceal abscesses, portal vein thrombophlebitis, liver abscesses, and sepsis increases. This division of complications into stages is conditional.

The following can cause complications in acute appendicitis:

• late surgical intervention, which happens when the patient does not apply in a timely manner, rapid progression of the disease, long-term diagnosis;
• defects in surgical technique;
• unforeseen factors.

Possible complications are divided into preoperative and postoperative. The former are especially dangerous because they can be fatal.

Preoperative pathologies

Preoperative complications of acute appendicitis include:

• peritonitis;
• perforation;
• pylephlebitis;
• appendicular abscesses;
• appendicular infiltrate.

In destructive forms of the disease, perforation usually occurs 2-3 days after the onset of the disease. When an organ ruptures, pain suddenly increases, severe peritoneal symptoms occur, clinical manifestations local peritonitis, leukocytosis increases.

If in the early stages the pain syndrome was not very pronounced, then perforation is perceived by patients as the beginning of the disease. The mortality rate for perforation reaches 9%. Rupture of appendicitis occurs in 2.7% of patients who applied in the early stages of the pathology and in 6.3% of patients who saw a doctor in the later stages.

In acute appendicitis, complications develop due to the destruction of the appendix and the spread of pus

Peritonitis is an acute or chronic inflammation peritoneum, which is accompanied by local or general symptoms diseases. Secondary peritonitis occurs when bacterial microflora penetrates from the inflamed organ into the abdominal cavity.

The clinic distinguishes 3 stages:

• reactive (pain, nausea, gas and stool retention, abdominal wall tension, body temperature rises);
• toxic (shortness of breath, coffee vomiting appears, the general condition worsens, the abdomen is swollen, the abdominal wall is tense, intestinal motility disappears, gas and stool are retained);
• terminal (with treatment by the 3-6th day of the disease, the inflammatory process can be limited and the intoxication syndrome can be reduced, due to which the patient’s condition improves. In the absence of therapy, an imaginary improvement occurs on the 4-5th day, abdominal pain decreases, the eyes become sunken, vomiting of greenish or brown liquid continues, breathing is shallow. Death usually occurs within 4-7 days.)

When treating peritonitis, it is necessary to eliminate the source of infection and carry out sanitation abdominal cavity, drainage, adequate antibacterial, detoxification and infusion therapy. Appendiceal infiltrate is called internal organs (omentum, intestines) that have grown together around the appendix and are changed by inflammation. According to various statistics, pathology occurs in 0.3-4.6 to 12.5 cases.

Rarely are such changes detected in the initial stages of the disease; sometimes they are discovered only during surgery. A complication develops on the 3-4th day of illness, sometimes after perforation. It is distinguished by the presence in the iliac region of a dense formation similar to a tumor, which is moderately painful when palpated.

Peritoneal symptoms subside, since the pathological process is limited, the abdomen becomes soft, and this makes it possible to palpate the infiltrate. The patient's body temperature is usually subfebrile, leukocytosis and stool retention are noted. If the location of the process is uncharacteristic, the infiltrate is palpated in the place where it is located; if it is located low, then it can be felt through the rectum or vagina.

An ultrasound examination can confirm the diagnosis. IN difficult cases A diagnostic operation (laparoscopy) is performed.

The presence of infiltrate is the only circumstance under which surgery is not performed. Surgical intervention cannot be performed until the infiltrate has abscessed, since there is a high risk that when trying to separate the appendix from the conglomerate, the fused organs (mesentery, intestines, omentum) will be damaged, and this can lead to serious consequences.

Therapy for infiltration is conservative and carried out in a hospital setting. Cold on the abdomen, a course of antibiotics, bilateral perinephric blockade, taking enzymes, diet therapy and other measures that help reduce inflammation are indicated. The infiltrate resolves in the vast majority of cases, usually within 7-19 or 45 days.

If the infiltrate does not disappear, then a tumor is suspected. Before discharge, the patient must undergo irrigoscopy to exclude tumor process in the cecum. If the infiltrate was detected only on the operating table, then the appendix is ​​not removed. Drainage is done and antibiotics are injected into the abdominal cavity.

Pylephlebitis is thrombosis of the portal vein with inflammation of its wall and the formation of a blood clot that closes the lumen of the vessel. The complication develops as a result of the spread of the pathological process from the mesenteric veins of the appendix through the mesenteric veins. The complication is extremely severe and usually ends in death after a few days.

It leads to high temperature with large daily fluctuations (3-4 C), cyanosis and jaundice appear. The patient has the strongest sharp pains all over the belly. Multiple liver abscesses develop. Treatment involves taking anticoagulants, antibiotics wide range actions that are administered through the umbilical vein or spleen.

Appendiceal abscesses appear in late period, before surgery, mainly as a consequence of suppuration of the infiltrate, and after surgery as a result of peritonitis. Complications appear 8-12 days after the onset of the disease. By location they are distinguished:

• ileocecal (paraappendicular) abscess;
• pelvic abscess;
• subhepatic abscess;
• subphrenic abscess;
• interintestinal abscess.

Early complications appendicitis can occur within 12-14 days, late ones can occur in a couple of weeks

Ileocecal abscess occurs when the appendix is ​​not removed due to abscess formation of the infiltrate (other types of abscesses appear after removal of appendicitis in destructive forms of the disease and peritonitis). Pathology can be suspected if the infiltrate increases in size or does not decrease.

It is opened under anesthesia, the cavity is drained and checked for the presence of fecal stones, then drained. The shoot is removed after 60-90 days. With phlegmonous-ulcerative appendicitis, perforation of the wall occurs, which leads to the development of limited or diffuse peritonitis.

If, with phlegmonous appendicitis, the proximal part of the appendix closes, then the distal part expands and an accumulation of pus (empyema) occurs. The spread of the purulent process to the tissues surrounding the appendix and the cecum (peritiphlitis, periappendicitis) leads to the formation of encysted ulcers, and inflammation of the retroperitoneal tissue occurs.

Postoperative conditions

Complications after appendicitis removal are rare. They usually occur in elderly and debilitated patients, patients whose pathology was diagnosed late. Classification of complications in postoperative period distinguishes:

• complications arising from surgical wounds (suppuration, ligature fistula, infiltration, seroma, eventration);
• complications manifested in the abdominal cavity (peritonitis, abscesses, ulcers, intestinal fistulas, bleeding, acute postoperative intestinal obstruction);
• complications from other organs and systems (urinary, respiratory, cardiovascular).

Pelvic abscess causes frequent loose stool with mucus, painful false urges to defecation, gaping of the anus or frequent urination. A characteristic complication is the difference between body temperature measured in armpit and rectally (normally the difference is 0.2-0.5 C, with complications it is 1-1.5 C).

At the infiltrate stage, the treatment regimen includes antibiotics, warm enemas, and douching. When the abscess softens, it is opened under general anesthesia, then washed and drained. The subhepatic abscess is opened in the area of ​​the right hypochondrium; if there is an infiltrate, then it is fenced off from the abdominal cavity, then cut purulent inflammation and drain.

A subphrenic abscess appears between the right dome of the diaphragm and the liver. It is quite rare. The infection penetrates here through the lymphatic vessels of the retroperitoneal space. Mortality rate this complication- 30-40%. Complications include shortness of breath, pain when breathing on the right side of the chest, and a dry cough.

General state severe, fever and chills appear, increased sweating, sometimes jaundice of the skin is noted. Treatment is only surgical; access is difficult, since there is a danger of infection of the pleura or abdominal cavity. Surgery knows several methods of opening the abdominal cavity, applicable in in this case.

Prevention of complications consists of early diagnosis of the inflammatory process and compliance with doctor’s recommendations in the postoperative period

Complications from surgical wounds are the most common, but they are relatively harmless. Infiltration, suppuration and suture dehiscence most often occur, and they are associated with how deep the incision had to be made and the suturing technique. In addition to observing asepsis, the method of operation, tissue sparing, and the general condition of the patient are also important.

Acute appendicitis is a dangerous disease that, in the absence of surgical treatment lead to death. Most complications occur if 2-5 days have passed after the appearance of the clinic. Preoperative complications are the most dangerous, since there is an infectious focus in the abdominal cavity that can burst at any moment.

Postoperative complications after appendectomy are less dangerous, but also more common. They can occur, including through the fault of the patient himself, for example, if he does not comply with bed rest or, conversely, does not get up for a long time after surgery, if in the postoperative period he does not follow dietary instructions, does not treat the wound or does abdominal exercises.

One of the most common diseases in people who need surgical intervention, is an 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 form. 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 appendage of the cecum have been torn, but gangrenous appendicitis represents the wall of the appendix affected by leukocytes, which is completely dead.

Symptoms

Symptoms of the disease include:

• acute pain in the abdomen, 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 with it great danger, indicating that the organ fragment died off; it was not for nothing that the nerve endings stopped reacting 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 agents drug therapy.

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

After this, the patient will have to wait a long time 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 the 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 during 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 the occurrence of additional health problems is possible.

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

Often, symptoms acute form 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 is having 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 often occurs in medical practice 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

Even though appendicitis is not considered a dangerous disease, the pathology has a high risk of developing complications after surgical removal process 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 seam 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

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

Causes

The most common cause of this complication is late treatment. medical care with 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 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, it is carried out emergency surgery. 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:

• heat body 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 skin covering and mucous membranes. As a result of intoxication, there is white coating. 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 put accurate diagnosis, the infiltrate must be differentiated from some 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 food;
• physiotherapeutic procedures.

The main essence of therapy is to stop the inflammatory process, prevent it from spreading to neighboring organs, and relieve pain. In case of appendicitis complicated by infiltrate, 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 painful sensations 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. Decision on necessity surgical treatment must be taken by a doctor.

Useful video about complications of appendicitis

Acute appendicitis is literally inflammation of the appendix. The vermiform appendix arises from the posterointernal segment of the cecum at the point where the three band muscles of the cecum begin. It is a thin convoluted tube, the cavity of which on one side communicates with the cavity of the cecum. The process ends blindly. Its length ranges from 7 to 10 cm, often reaching 15–25 cm, the diameter of the canal does not exceed 4–5 mm.

The vermiform appendix is ​​covered on all sides by peritoneum and in most cases has a mesentery that does not prevent its movement.

Depending on the position of the cecum, the appendix can be located in the right iliac fossa, above the cecum (if its position is high), below the cecum, in the pelvis (if its position is low), together with the cecum among the loops of the small intestine in the midline , even in the left half of the abdomen. Depending on its location, the corresponding clinical picture of the disease arises.

Acute appendicitis– nonspecific inflammation of the appendix caused by pyogenic microbes (streptococci, staphylococci, enterococci, E. coli, etc.).

Microbes enter it enterogenously (the most common and most likely), hematogenous and lymphogenous routes.

When palpating the abdomen, the anterior muscle abdominal wall tense. Pain at the site of the appendix upon palpation is the main, and sometimes the only, sign of acute appendicitis. It is more pronounced in destructive forms of acute appendicitis and especially in perforation of the appendix.

An early and no less important sign of acute appendicitis is local tension in the muscles of the anterior abdominal wall, which is often limited to the right iliac region, but can spread to the right half of the abdomen or along the entire anterior abdominal wall. The degree of tension in the muscles of the anterior abdominal wall depends on the body’s reactivity to the development of the inflammatory process in the appendix. With reduced reactivity of the body in exhausted patients and elderly people, this symptom may be absent.

If acute appendicitis is suspected, vaginal (in women) and rectal examinations should be performed, in which pain in the pelvic peritoneum can be determined.

Important diagnostic value in acute appendicitis has the Shchetkin-Blumberg symptom. To determine it, carefully press on the anterior abdominal wall with the right hand and after a few seconds tear it off from the abdominal wall, and a sharp pain or noticeable increase in pain appears in the area of ​​the inflammatory pathological focus in the abdominal cavity. With destructive appendicitis and especially with perforation of the appendix, this symptom is positive throughout the right half of the abdomen or throughout the entire abdomen. However, the Shchetkin-Blumberg symptom can be positive not only in acute appendicitis, but also in other acute diseases of the abdominal organs.

The symptoms of Voskresensky, Rovzing, Sitkovsky, Bartomier-Mikhelson, Obraztsov are of certain importance in making the diagnosis of acute appendicitis.

When symptom Voskresensky pain appears in the right iliac region when the palm is quickly passed through the patient’s stretched shirt along the anterior wall of the abdomen to the right of the costal edge downwards. On the left, this symptom is not detected.

Symptom Rovsing and is caused by pressing or pushing with the palm of the hand in the left iliac region. In this case, pain occurs in the right iliac region, which is associated with a sudden movement of gases from the left half of the large intestine to the right, resulting in vibrations of the intestinal wall and the inflamed appendix, transmitted to the inflammatory-changed parietal peritoneum.

When symptom Sitkovsky in a patient lying on his left side, pain appears in the right iliac region caused by the tension of the inflamed peritoneum in the area of ​​the cecum and mesentery of the appendix due to its marking.

Symptom Barthomier–Mikhelson– pain on palpation of the right iliac region with the patient positioned on the left side.

Symptom Obraztsova– pain on palpation of the right iliac region at the moment of raising the straightened right leg.

A critical and objective assessment of these symptoms enhances the diagnosis of acute appendicitis. However, diagnosis of this disease should be based not on one of these symptoms, but on a comprehensive analysis of all local and general signs of this acute disease of the abdominal organs.

To make a diagnosis of acute appendicitis, a blood test is of great importance. Changes in the blood are manifested by an increase in leukocytes. The severity of the inflammatory process is determined using the leukocyte formula. A shift in the leukocyte count to the left, i.e., an increase in the number of band neutrophils or the appearance of other forms with a normal or slight increase in the number of leukocytes, indicates severe intoxication in destructive forms of acute appendicitis.

There are several forms of acute appendicitis (according to histology):

1) catarrhal;

2) phlegmonous;

3) gangrenous;

4) gangrenous-perforative.

Differential diagnosis of acute appendicitis

Acute diseases of the abdominal organs have a number of main symptoms:

1) pain of various types;

2) reflex vomiting;

3) disorder of the normal passage of intestinal gases and feces;

Until a specific diagnosis of acute abdominal disease is established, patients should not be prescribed painkillers (the use of drugs relieves pain and smoothes the clinical picture of acute abdominal disease), gastric lavage, laxatives, cleansing enemas and thermal procedures.

Acute diseases of the abdominal organs are more easily differentiated into initial stage diseases. Subsequently, when peritonitis develops, it can be very difficult to determine its source. It is necessary to remember in this regard the figurative expression of Yu. Yu. Janelidze: “When the whole house is on fire, it is impossible to find the source of the fire.”

Acute appendicitis must be differentiated from:

1) acute stomach diseases – acute gastritis, food toxic infections, perforated ulcers of the stomach and duodenum;

2) some acute diseases of the gallbladder and pancreas (acute cholecystitis, cholelithiasis, acute pancreatitis, acute cholecystopancreatitis);

3) some intestinal diseases (acute enteritis or enterocolitis, acute ileitis, acute diverticulitis and its perforation, acute intestinal obstruction, Crohn's disease, terminal ileitis

4) some diseases of the female genital area (acute inflammation of the mucous membrane and wall of the uterus, pelvioperitonitis, ectopic pregnancy, ovarian rupture, twisted ovarian cyst);

5) urological diseases (nephrolithiasis, renal colic, pyelitis);

6) other diseases simulating acute appendicitis (acute diaphragmatic pleurisy and pleuropneumonia, heart disease).

Treatment of acute appendicitis

Currently, the only method of treating patients with acute appendicitis is early emergency surgery, and the earlier it is performed, the better the results. Even G. Mondor (1937) pointed out: when all doctors are imbued with this idea, when they understand the need for quick diagnosis and immediate surgical intervention, they will no longer have to deal with severe peritonitis, with cases of severe suppuration, with those remote infectious complications, which even now too often cloud the prognosis of appendicitis.

Thus, the diagnosis of acute appendicitis requires immediate surgery. The exception is patients with limited appendiceal infiltrate and patients requiring short-term preoperative preparation.

The phenomena of acute appendicitis can be detected in patients with myocardial infarction, severe pneumonia, acute cerebrovascular accidents, and decompensated heart disease. Such patients are monitored dynamically. If the clinical picture does not subside during observation, then vital signs resort to surgery. In acute appendicitis complicated by peritonitis, despite the severity of the somatic disease, the patient is operated on after appropriate preoperative preparation.

A number of authors indicate that in the complex of therapeutic measures for this category of patients with acute appendicitis, preoperative preparation is of great importance, which serves as one of the means of reducing the risk of surgical intervention, improves the general condition of the patient, normalizes homeostasis, and enhances immunoprotective mechanisms. It should not last more than 1 - 2 hours.

If during appendectomy it is impossible to use intubation anesthesia with muscle relaxants, then local infiltration anesthesia with a 0.25% solution of novocaine is used, which, if appropriate, can be combined with neuroleptanalgesia.

However, it is necessary to give preference to modern endotracheal anesthesia with the use of muscle relaxants, in which the surgeon has the maximum opportunity to conduct a thorough examination of the abdominal organs.

In mild forms of acute appendicitis, where the operation is short, appendectomy can be performed under mask anesthesia using muscle relaxants.

The most common access for uncomplicated acute appendicitis is the Volkovich-McBurney oblique incision. The incision proposed by Lennander is used somewhat less frequently; it is made for an atypical location of the appendix, widespread purulent peritonitis caused by perforation of the appendix, as well as for possible emergence peritonitis from other sources, when a wider inspection of the abdominal organs is necessary. The advantage of the Volkovich-McBurney incision is that it corresponds to the projection of the cecum and does not damage nerves and muscles, which minimizes the incidence of hernias in this area.

The transverse approach is convenient in that it can easily be expanded medially by intersecting the rectus abdominis muscle.

In most cases, after an appendectomy, the abdominal cavity is sutured tightly.

If, with perforated appendicitis, there is an effusion in the abdominal cavity, which is removed with gauze swabs or an electric suction device, then a thin rubber tube (polyvinyl chloride) is inserted into it for intraperitoneal administration of antibiotics.

For destructive forms of acute appendicitis in the postoperative period, antibiotics are prescribed intramuscularly, taking into account the patient's sensitivity to them.

Correct management of patients in the postoperative period largely determines the results of surgical intervention, especially in destructive forms of acute appendicitis. Active behavior of patients after surgery prevents the development of many complications.

In uncomplicated forms of acute appendicitis, the condition of patients is usually satisfactory, and no special treatment is required in the postoperative period.

After delivery from the operating room to the ward, the patient can immediately be allowed to turn on his side, change his body position, breathe deeply, and clear his throat.

Getting out of bed should begin gradually. On the first day, the patient can sit in bed and begin to walk, but he should not force himself to get up early. This issue must be approached strictly individually. Play a decisive role wellness and the patient's mood. Need to start early nutrition patients, which reduces the frequency of intestinal paresis and promotes normal function digestive organs. Patients are prescribed easily digestible food without overloading the gastrointestinal tract; from the sixth day they are transferred to a common table.

Most often, after an appendectomy, stool occurs on its own on the 4th – 5th day. During the first two days, gas retention occurs due to intestinal paresis, which most often stops on its own.

In the postoperative period, there is often urinary retention as a result of the fact that most patients cannot urinate while lying down. To eliminate this complication, a heating pad is applied to the perineum. If the patient’s condition allows, then he is allowed to stand near the bed, they try to evoke a reflex to urinate by releasing a stream from the kettle. You can administer 5–10 ml of a 40% solution of methenamine or 5–10 ml of a 5% solution intravenously magnesium sulfate. If there is no effect from these measures, catheterization is performed. Bladder with strict adherence to the rules of asepsis and mandatory washing after catheterization with a solution of furatsilin (1: 5000) or silver sulfate (1: 10,000, 1: 5000).

In the postoperative period, physical therapy is of great importance.

If no changes in the appendix are detected during the operation, then a revision should be carried out ileum(over 1 - 1.5 m) so as not to miss diverticulitis.

Complications of acute appendicitis

Complications in the preoperative period. If the patient does not consult a doctor in a timely manner, acute appendicitis can lead to a number of serious complications that threaten the patient’s life or life. long time deprive him of his ability to work. The main, most dangerous complications of untimely operated appendicitis are considered to be appendiceal infiltrate, diffuse purulent peritonitis, pelvic abscess, and pylephlebitis.

Appendicular infiltrate. This is a limited inflammatory tumor that forms around a destructively modified appendix, to which intestinal loops, the greater omentum and nearby organs are soldered with fibrinous deposits. The appendicular infiltrate is localized at the location of the appendix.

In the clinical course of appendiceal infiltration, two phases are distinguished: early (progression) and late (delimitation).

In the early stage, the appendiceal infiltrate is just beginning to form; it is soft, painful, without clear boundaries. Its clinical picture is similar to that of acute destructive appendicitis. There are symptoms of peritoneal irritation, leukocytosis with a shift in the leukocyte count to the left.

IN late stage the clinical course is characterized by the general satisfactory condition of the patient. General and local inflammatory reactions subside, temperature ranges from 37.5 to 37.8 °C, sometimes normal, pulse does not increase. Palpation of the abdomen reveals a low-painful dense infiltrate, which is clearly demarcated from the free abdominal cavity.

After the diagnosis is made, appendiceal infiltration begins to be treated conservatively: strict bed rest, food without a large amount of fiber, bilateral perinephric blockade with a 0.25% solution of novocaine according to Vishnevsky, antibiotics.

After treatment, the appendiceal infiltrate can resolve; if treatment is ineffective, it can fester and form an appendicular abscess, be replaced by connective tissue, not resolve for a long time and remain dense.

7–10 days after resorption of the appendiceal infiltrate, without discharging the patient from the hospital, an appendectomy is performed (sometimes 3–6 weeks after resorption as planned when the patient is re-admitted to the surgical hospital).

The appendicular infiltrate can be replaced by massive development of connective tissue without any tendency to resorption. V. R. Braitsev called this form of infiltration fibroplastic appendicitis. At the same time, a tumor-like formation is palpated in the right iliac region, in the same place It's a dull pain, symptoms of intermittent intestinal obstruction appear. Only histological examination after hemicolectomy reveals the true cause of the pathological process.

If the appendiceal infiltrate does not resolve within 3–4 weeks and remains dense, then the presence of a tumor in the cecum should be assumed. For differential diagnosis, it is necessary to perform irrigoscopy.

When the appendiceal infiltrate transitions into an appendiceal abscess, patients experience a high intermittent temperature, high leukocytosis with a shift in the leukocyte formula to the left, and intoxication.

Pelvic appendicular abscess. It can complicate pelvic appendicitis, and sometimes accompany phlegmonous or gangrenous forms of acute appendicitis.

With a pelvic appendicular abscess, purulent effusion descends to the pelvic floor and accumulates in the pouch of Douglas. The purulent contents push upward the loops of the small intestine and are delimited from the free abdominal cavity by adhesions that form between the intestinal loops, the greater omentum and the parietal peritoneum.

Clinically, a pelvic appendicular abscess is manifested by pain in the depths of the pelvis, pain when pressing above the pubis, and bloating. In some cases, there may be vomiting, which is caused by relative dynamic intestinal obstruction due to paresis of small intestinal loops involved in the inflammatory process.

A pelvic appendicular abscess is characterized by high temperature (up to 38–40 °C), high leukocytosis with a shift in the leukocyte count to the left. The tension in the muscles of the anterior abdominal wall is weak.

Local symptoms of irritation of organs and tissues adjacent to the abscess - rectum, bladder - are of great importance for establishing the diagnosis of pelvic appendicular abscess. In this case, there are frequent fruitless urges to lower oneself, diarrhea mixed with mucus, swelling of the mucous membrane around the anus, and the sphincter gapes. Urination is frequent, painful, and sometimes delayed. During a digital examination of the per rectum, a fluctuating painful tumor-like formation is determined on the anterior wall of the rectum, upon puncture of which pus is detected.

Treatment of pelvic infiltration before suppuration is the same as for appendicular infiltration; in case of suppuration, it is surgical (median incision with drainage of the abdominal cavity).

Pylephlebitis. This is purulent thrombophlebitis of the portal vein, very rare, but very dangerous complication acute appendicitis, which almost always ends in purulent hepatitis.

The initial symptoms of pylephlebitis are an increase in temperature to 38–40 °C, chills, indicating developing purulent hepatitis, and they are accompanied by intermittent pain in the right hypochondrium. Palpation reveals a painful liver, characterized by early-onset, not very intense jaundice, and high leukocytosis. The general condition of the patient is very serious. X-ray examination reveals high standing and limited mobility of the right dome of the diaphragm, sometimes in the right pleural cavity contains effusion.

Complications in the postoperative period. The classification of postoperative complications in acute appendicitis is based on the clinical and anatomical principle:

1. Complications from the surgical wound:

1) hematoma;

2) suppuration;

3) infiltrate;

4) divergence of the edges without eventration;

5) divergence of the edges with eventration;

6) ligature fistula;

7) bleeding from a wound in the abdominal wall.

2. Acute inflammatory processes in the abdominal cavity:

1) infiltrates and abscesses of the ileocecal area;

2) abscesses of the pouch of Douglas;

3) interintestinal;

4) retroperitoneal;

5) subdiaphragmatic;

6) subhepatic;

7) local peritonitis;

8) diffuse peritonitis.

3. Complications from the gastrointestinal tract intestinal tract:

1) dynamic intestinal obstruction;

2) acute mechanical intestinal obstruction;

3) intestinal fistulas;

4) gastrointestinal bleeding.

4. Side complications of cardio-vascular system:

1) cardiovascular failure;

2) thrombophlebitis;

3) pylephlebitis;

4) pulmonary embolism;

5) bleeding into the abdominal cavity.

5. Complications from the respiratory system:

1) bronchitis;

2) pneumonia;

3) pleurisy (dry, exudative);

4) abscesses and gangrene of the lungs;

4) pulmonary atelectasis.

6. Side complications excretory system:

1) urinary retention;

2) acute cystitis;

3) acute pyelitis;

4) acute nephritis;

5) acute pyelocystitis.

Chronic appendicitis

Chronic appendicitis usually develops after an acute attack and is the result of the changes that occurred in the appendix during the period of acute inflammation. Sometimes changes remain in the appendix in the form of scars, kinks, adhesions with nearby organs, which can cause the mucous membrane of the appendix to continue a chronic inflammatory process.

Clinical picture in various forms chronic appendicitis very diverse and not always sufficiently characteristic. Most often, patients complain of constant pain in the right iliac region, sometimes this pain is paroxysmal in nature.

If, after an attack of acute appendicitis, painful attacks in the abdominal cavity periodically recur, then this form of chronic appendicitis is called recurrent.

In some cases, chronic appendicitis occurs without an acute attack from the very beginning and is called primary chronic appendicitis or attack-free.

With chronic appendicitis, some patients associate attacks of abdominal pain with food intake, others - with physical activity, and many cannot name the reason for their appearance. They often complain of intestinal disorders, accompanied by constipation or diarrhea with vague pain in the lower abdomen.

If patients have a history of one or more acute attacks Appendicitis The diagnosis of chronic appendicitis sometimes does not present great difficulties.

During an objective examination, patients with chronic appendicitis complain only of pain on palpation at the location of the appendix. However, this tenderness may be associated with other abdominal diseases. Therefore, when diagnosing “chronic appendicitis,” it is always necessary to exclude other diseases of the abdominal organs through a thorough and comprehensive examination of the patient.

Chronic appendicitis must be differentiated from uncomplicated peptic ulcer stomach and duodenum, kidney diseases, liver, etc.; chronic kidney diseases (pyelitis, kidney stones); chronic cholecystitis– duodenal intubation, cholecystography. Women are excluded chronic diseases uterine appendages. In addition, it is necessary to differentiate chronic appendicitis from helminthic infestation and tuberculous mesoadenitis.

Treatment chronic appendicitis – surgical.

The technique of this operation is similar to the technique of surgery for acute appendicitis.

Page 1 of 43

I. M. MATYASHIN Y. V. BALTAITIS
A. Y. YAREMCHUK
Complications of appendectomy
Kyiv - 1974
The monograph provides characteristics the most important reasons that cause complications of appendectomy, the basic principles of management of the pre- and postoperative period, measures to prevent and eliminate complications from the surgical wound, abdominal organs and other systems are outlined. Late complications that arise in the abdominal wall and abdominal organs and methods of their treatment are described.
The book is intended for surgeons and senior students of medical institutes.

From the authors
Appendectomy has gained fame as one of the easiest abdominal operations, and, perhaps, this is one of the first interventions that is entrusted to a young specialist. This is largely explained by the fact that the surgical technique has been developed in detail, all its techniques are typical and, in most cases, it is not accompanied by great technical difficulties.
This may also be due to the huge influx of appendectomies, which is why it has become the most common and accessible operation for a young doctor. Sometimes a student who has completed subordination has already performed several dozen appendectomies, while at the same time not having performed a number of simpler and safer operations.
A young doctor, who quickly mastered the skills of the operation of removing the appendix, without encountering significant difficulties and observing how quickly the condition of the patients normalizes, comes to the false conclusion that he has become a fully trained and qualified surgeon and this gives him the right to treat with some leniency such “running” operations. In an effort to demonstrate his skill, such a doctor cannot resist the temptation to show his surgical virtuosity. To do this, he makes very small incisions, reduces the operation time to a few minutes, hoping that these very moments can characterize him as an experienced and brilliant master surgeon.

This continues until the young doctor encounters serious complications. Often, with acute appendicitis, a very complex surgical situation arises, when it would seem extremely simple operation becomes very difficult. View of appendicitis as fairly mild surgical disease crossed the threshold surgical clinics and is widespread among the population. If this is to some extent true for uncomplicated forms of the disease, then often after appendectomy serious complications arise that can cause fatal outcome or a long-term illness with a whole series of subsequent surgical interventions, which ultimately leads patients to disability.
The death of a patient undergoing surgery is always tragic, especially in cases where the complication of the disease or operation could have been prevented or eliminated with the correct surgical tactics and timely rational actions. Relative figures for postoperative mortality in appendicitis are small, usually reaching two to three tenths of a percent, but when taking into account huge amount patients undergoing surgery for acute appendicitis, these tenths of a percent increase in three digit numbers actually deceased patients. And behind each such death is a difficult combination of circumstances, an unrecognized disease or its complication, a technical or tactical error by a doctor.
That is why the problem of appendicitis and appendectomy is still extremely relevant, and there is a need to once again focus the attention of practicing doctors, especially young ones, on the details of the operation, its possible severe consequences and to warn them against tactical and technical mistakes in the future.

Causes of postoperative complications of appendectomy

The problem of complications of acute and chronic appendicitis and appendectomy since the first operation (Mahomed in 1884 and Kronlein in 1897) has been sufficiently covered in the literature. The increased attention to this problem is not accidental. Mortality after appendectomy, despite its significant decrease from year to year, still remains high. Currently, the mortality rate for acute appendicitis averages about 0.2%. If we take into account that in our country 1.5 million appendectomies are performed annually, it becomes obvious that such a small percentage of postoperative mortality corresponds to a large number of deaths. In this regard, the postoperative mortality rates for the Ukrainian SSR in 1969 are very illustrative - 0.24%, or 499 deaths after appendectomy. In 1970, they were reduced to 0.23% (449 deaths), that is, thanks to a decrease in mortality by 0.01%, the number of deaths decreased by 50 people. In this regard, the desire to clearly establish the causes of those complications that pose a mortal danger to the patient being operated on is completely understandable.
Study of the causes of mortality after appendicitis and appendectomy by many authors (G. Ya. Yosset, 1958; M. I. Kuzin, 1968; A. V. Grigoryan et al., 1968; A. F. Korop, 1969; M. X. Kanamatov , 1970; M. I. Lupinsky et al., 1971; T. K. Mrozek, 1971, etc.) made it possible to identify the most serious complications that turned out to be fatal for the outcome of the disease. Among them are primarily diffuse peritonitis, thromboembolic complications, including pulmonary embolism, sepsis, pneumonia, acute cardiovascular failure, adhesive intestinal obstruction, etc.
The most severe and dangerous complications have been named, but not all of them. It is difficult to foresee which complication may lead to particularly severe consequences, even death. Often, even relatively mild postoperative complications, which subsequently develop completely unexpectedly and severely, significantly aggravate the course of the disease and lead patients to death.
On the other hand, these are not so severe complications, especially with a sluggish, torpid course of the disease, delay the time of treatment and subsequent rehabilitation of patients under outpatient observation conditions. Taking into account the huge number of appendectomies performed, it turns out that such complications, even relatively mild ones, become a serious obstacle in common system treatment of appendicitis.
All this required a more in-depth study of all complications of appendectomy and the causes of their occurrence. The literature contains various classifications postoperative complications (G. Ya. Yosset, 1959; L. D. Rosenbaum, 1970, etc.). These complications are most fully presented in the classification of G. Ya. Iosset. In an effort to create the most full classification, many authors have made it extremely cumbersome. We consider it appropriate to present one of them in full.

Classification of complications after appendectomy(according to G. Ya. Yosset).

1. Complications from the surgical wound:
2. Suppuration of the wound.
3. Infiltrate.
4. Hematoma in the wound.
5. Dehiscence of wound edges, without eventration and with eventration.
6. Ligature fistula.
7. Bleeding from a wound in the abdominal wall.
8. Acute inflammatory processes in the abdominal cavity:
9. Infiltrates and abscesses of the ileocecal region.
10. Douglas pouch infiltrates.
11. Infiltrates and abscesses are interintestinal.
12. Retroperitoneal infiltrates and abscesses.
13. Subphrenic infiltrates and abscesses.
14. Liver infiltrates and abscesses.
15. Local peritonitis.
16. Diffuse peritonitis.
17. Complications from the respiratory system:
18. Bronchitis.
19. Pneumonia.
20. Pleurisy (dry, exudative).
21. Abscesses and gangrene of the lungs.
22. Pulmonary atelectasis.
23. Complications from the gastrointestinal tract:
24. Dynamic obstruction.
25. Acute mechanical obstruction.
26. Intestinal fistulas.
27. Gastrointestinal bleeding.
28. Complications from the cardiovascular system:
29. Cardiovascular failure.
30. Thrombophlebitis.
31. Pylephlebitis.
32. Pulmonary embolism.
33. Bleeding into the abdominal cavity.
34. Complications from the excretory system:
35. Urinary retention.
36. Acute cystitis.
37. Acute pyelitis.
38. Acute nephritis.
39. Acute pyelocystitis.
40. Other complications:
41. Acute mumps.
42. Postoperative psychosis.
43. Jaundice.
44. Fistula between the appendix and the ileum.

Unfortunately, the author did not include a large group of late complications of appendectomy. We cannot completely agree with the proposed systematization: for example, for some reason, intra-abdominal bleeding is included by the author in the section “Complications of the cardiovascular system.”
Later, a slightly modified classification of early complications was proposed (L. D. Rosenbaum, 1970), which also has certain defects. In an effort to systematize complications according to the principle of the commonality of the pathological process, the author classified into various groups such related complications as dehiscence of wound edges, suppuration, bleeding; abscesses of the abdominal cavity are considered in one group, and peritonitis is completely separate, while an abscess of the abdominal cavity can rightfully be considered limited peritonitis.
When studying early and late complications of appendectomy, we based the existing classifications, trying, however, to strictly distinguish between their main groups. We consider early and late complications to be fundamentally different, since they are separated not only by the timing of their occurrence, but also by the causes and features of the clinical course due to the changing reactivity of patients and their adaptation to the pathological process at different stages of the disease. This, in turn, requires different tactical guidelines regarding the timing of treatment, the purpose of surgical intervention, the specific technical techniques of these interventions, etc.
Early complications are considered more serious, requiring most patients to take the most urgent measures to eliminate them and prevent the spread of the pathological process. The urgency of these measures is determined by the nature of the complication itself and its location. Therefore, it is logical to consider in separate groups complications that arise in surgical wound(within the anterior abdominal wall) and in the abdominal cavity. In turn, both of these groups include complications of an inflammatory nature (suppuration, peritonitis), which are predominant, and others, among which bleeding takes the main place. Special mention can be made general complications, not directly related to the surgical area (from the respiratory organs, cardiovascular system, etc.).
Likewise, it is also logical to consider late complications in two large groups: complications from the abdominal organs and complications in the anterior abdominal wall.
The third group consists of complications of a functional nature, in which it is usually not possible to detect gross morphological changes. In the practice of every surgeon, there are many observations when, in the long term after appendectomy, patients report pain in the area of ​​the operation, which is long-lasting and persistent and accompanied by disorders of the intestinal tract. Various therapeutic measures, prescribed in this case, do not bring relief. The failure of treatment in some cases prompts us to associate them with the special emotional and psychological attitude of the patients. The basis for such relapses of pain after appendectomy, as a rule, is structural changes undetectable by conventional clinical research methods. This problem seems to us to be serious and requires special consideration.
There is conflicting information in the modern literature regarding the frequency of postoperative complications. V.I. Kolesov (1959), citing information from other authors, indicates that before the use of antibiotics, the number of complications ranged from 12 to 16%. The use of antibiotics led to a reduction in the number of complications by 3-4%. At a later time, due to some discreditation of antibiotic therapy, this decrease was not established. G. Ya. Yosset (1956) does not attach such decisive importance to the use of antibiotics, since he did not observe a decrease in the number of purulent complications during the period of their most intensive use. B. I. Chulanov (1966), citing literature data (M. A. Azina, A. V. Grinberg, Kh. G. Yampolskaya, A. P. Kiyashov), writes about 10-12% of complications after appendectomy. At the same time, E. A. Sakfeld (1966) observed complications in only 3.2% of operated patients. Interesting data are provided by Kazarian (1970), noting that the use of sulfonamides and antibiotics has significantly reduced mortality in acute appendicitis. The number of complications not only does not decrease, but tends to increase (Table 1).
An analysis of the clinic’s statistical data for 6 years (1965-1971) found that out of the total number of operated patients (5100), complications were observed in 506 (9.92%), and 12 (0.23%) died during this period. Information on the frequency of various complications is given in the relevant sections.

TABLE 1. Correlation of the frequency of perforations, complications and mortality in acute appendicitis according to Kazarian

	Before antibiotics	Sulfanil amides	Modern data
Number of patients
Percentage perforated
appendicitis
Complication rate
Mortality

Considering the reasons for unfavorable outcomes of surgical treatment of appendicitis, most surgeons refer to the following: late admission, late diagnosis in the department, combination of acute appendicitis with other diseases, advanced age of patients (T. Sh. Magdiev, 1961; V. I. Struchkov and B. P . Fedorov, 1964, etc.).
When studying the causes of postoperative complications, their main groups should be identified. This includes late diagnosis of the disease. Undoubtedly, the degree of development of the pathological process, the occurrence of a number of pathological symptoms from adjacent organs, the reaction of the peritoneum, certain changes in a number of systems of the diseased body themselves determine the nature of the course of the postoperative period and become the cause of the most important postoperative complications.
The second reason is the peculiarities of the pathological process in a given individual. The course of the disease is closely related to the individual characteristics of the body, its development, immunobiological properties, and finally, the reserve of its spiritual strength, and the age of the patient. Diseases suffered in the past, and simply experienced, undermine a person’s strength, reduce his resistance, ability to fight various harmful influences, including those with an infectious onset.
However, both of these groups of causes should probably be considered to create the background against which the disease or complication develops in the future. The need to take them into account is obvious. This should guide the surgeon regarding the choice of anesthesia method and suggest certain tactics to prevent the development of serious complications or mitigate them.
To what extent is it legitimate to consider the complications that arose in a patient in the postoperative period in connection with the intervention, if their main cause was pathological conditions established before surgery? This also applies to those complications that were the result of passing moments and emerged already in the postoperative period. This issue is extremely important; it has repeatedly attracted the attention of surgeons. IN Lately In special journals, a discussion was held on this issue, which arose on the initiative of Yu. I. Dathaev. A number of famous surgeons of our country took part in it: V. I. Struchkov, N. I. Krakovsky, D. A. Arapov, M. I. Kolomiychenko, V. P. Teodorovich. Most of the discussion participants considered it correct to consider separately the complications of the disease itself and postoperative complications. A very special group is made up of accompanying illnesses, sometimes very severe, even leading patients to death. According to the proposal of some authors (M. I. Kolomiychenko, V. P. Teodorovich), they cannot be included in the group of postoperative complications.
We can agree with the opinions of the participants in the discussion that these complications are not postoperative in the truest sense of the word, that is, they are not the results of incorrect tactical settings and certain technical errors of the intervention itself. However, for many reasons, they should be considered in this general group.