Appendicular abscess is a complication of destructive forms of acute appendicitis (detected in approximately 2% of all types of acute appendicitis).
Initially, an appendicular infiltrate is formed, which then either resolves under the influence of conservative therapy, or, despite appropriate treatment, abscesses.
The reasons
- Abscess formation of the appendicular infiltrate (errors in diagnosis, inadequate treatment, late visit to the doctor)
- In the case of progression, an abscess may break into the abdominal cavity with the development of peritonitis, into the retroperitoneal space (with the formation of retroperitoneal phlegmon) or into hollow organs (often into the intestinal lumen).
Symptoms
At the beginning of the disease, more or less pronounced typical pain syndrome of acute appendicitis is noted. As a result of late referral or incorrect prehospital diagnosis of acute appendicitis, the disease can go in two ways: the progression of peritonitis and the delimitation of the inflammatory process. In the later case, after 2-3 days, the pain syndrome is reduced, the temperature decreases. On palpation in the right iliac region, an infiltrate is determined. From the 5-7th day, the temperature rises again, the pain in the right iliac region increases, dyspeptic symptoms increase. Pain increases with coughing, walking, jolting driving.
Diagnosis
On examination, the tongue is moist and lined. The abdomen lags behind when breathing in the right lower quadrant, bulging can also be determined here. On palpation – some muscle tension, soreness in this area (sometimes very pronounced), weakly positive symptoms of peritoneal irritation.
With deep palpation, a sharply painful, motionless infiltrate is determined (fluctuations almost never happen).
There may be mildly pronounced phenomena of paralytic ileus – with a survey fluoroscopy of the abdominal organs, fluid levels and intestinal pneumatosis in the right half of the abdomen can be detected.
With rectal or vaginal examination, pain, sometimes you can palpate the lower pole of the formation. In the blood – high leukocytosis with a shift of the formula to the left. With dynamic observation, an increase in leukocytosis is noted, the temperature takes on a hectic character. The pain syndrome gradually increases, the infiltrate and pain in the right iliac region increase. The size of the abscess and its exact localization is determined by ultrasound.
Treatment
Treatment is operative. Before surgery, premedication with antibiotics and metronidazole is necessary. Under general anesthesia, an abscess is opened, it is better to use extraperitoneal access. The cavity is washed with antiseptics and drained with 2-lumen drains for active aspiration of the contents with washing in the postoperative period. It is better to refrain from introducing tampons into the wound. In the postoperative period, detoxification therapy, antibiotics (aminoglycosides) in combination with metronidazole.