PROBLEMS OF ACUTE APPENDICITIS DIAGNOSTICS AND SURGICAL TREATMENT

Acute appendicitis is a "chameleon disease" that requires in many cases a complex differential diagnosis. Inflammation of the appendix is one of the most common surgical diseases. Difficulties in the verification of acute appendicitis, the severity of complications associated with late diagnosis indicate that the problems of diagnosis and treatment of this pathology has not lost its relevance. The most difficult question for the surgeon is to diagnose acute appendicitis in time and carry out surgical treatment, prevent all possible complications and minimize the frequency of removal of the unaltered appendix. The aim of the study to determine and systematize the causes of difficulties in diagnosing acute appendicitis at the preoperative stage. A retrospective analysis of 586 medical records of inpatients who were treated in the surgical department was performed. Among the operated 511 (87.2%) patients, the diagnosis of acute appendicitis before and after surgery coincided, which was confirmed morphologically. In 75 cases, which is 12.8%, the diagnosis of acute appendicitis had atypical symptoms or was masked by the clinic of another pathology. Observations of atypical cases of acute appendicitis in combination with other pathologies were the following diseases that occurred under the clinic signs, or combined with them: perforation of the small intestine with fish bone - 4 cases; perforation of Meckel's diverticulum - 2. In one case perforation by a fish bone, in another inflammation with its perforation. - terminal ileitis - 1; torsion and necrosis of the fatty suspension of the elongated sigmoid colon - 2; perforation of the diverticulum of the elongated sigmoid colon - 1, rupture of the ovarian cyst - 9 cases, including two children 13 and 17 years; piosalpinx - 2, 1 case of combination of acute calculous cholecystitis with gangrenous appendicitis, which was detected during the audit of the abdominal cavity; inflammatory infiltrate of the omentum - 3; torsion and gangrene of the omentum - 2, a combination of acute appendicitis with omentitis - 8 cases; combination of acute appendicitis with mesoadenitis - 39 cases; rupture of the spleen - 1. Conclusions: Under the clinic of acute appendicitis or in combination with it other acute diseases of the abdominal cavity can mask, up to 12.8%, which are difficult or in some cases impossible to diagnose in the preoperative period. One of the reasons for the difficulties of diagnosis is the omission by patients of anamnesis data regarding the onset and course of the disease, as well as alcohol consumption. Difficulties in diagnosis occur in children, especially young people, which is 61.3% of cases. The combination of acute appendicitis with mesoadenitis was observed in 6.6%. Among these patients, acetonemic syndrome was observed in 87.2% of cases. This group of patients is dominated by children. Gynecological diseases are disguised under the clinic of acute appendicitis in 1.9%, which requires a joint examination by a surgeon and obstetrician-gynecologist of patients with suspected acute appendicitis in the preoperative period. Deciding on surgical treatment for suspected acute appendicitis is a clinic of acute peritonitis, which was observed in 63.3%, requires proper clinical thinking of the surgeon combined with experience, laboratory and instrumental examination.

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Method of spleen reduction in laparoscopic splenectomy in children with hereditary autoimmune hemolytic anemia

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care ◽

10.17816/psaic710 ◽

2020 ◽

Vol 10 (4) ◽

pp. 429-433

Author(s):

Vyacheslav G. Svarich ◽

Ilya M. Kagantsov ◽

Violetta A. Svarich

Keyword(s):

Surgical Treatment ◽

Hemolytic Anemia ◽

Autoimmune Hemolytic Anemia ◽

Laparoscopic Splenectomy ◽

Surgical Intervention ◽

Abdominal Cavity ◽

Operation Time ◽

Spleen Tissue ◽

Surgical Department ◽

Large Size

Purpose. This study aimed to improve the results of surgical treatment of children with hereditary autoimmune hemolytic anemia by laparoscopic splenectomy. Materials and methods. In the period from 1991 to 2020, a total 47 patients with hereditary autoimmune hemolytic anemia were treated in the surgical department of the Republican Childrens Clinical Hospital of Syktyvkar. Splenectomy was performed by the open method in 25 children, and laparoscopic method in 22 patients. Since 2019, the method of spleen reduction during laparoscopic splenectomy has been used in 3 patients when the large size of the mobilized spleen does not correspond to the size of the endoscopic container. Results. On average, surgical intervention using the above-described method of spleen reduction lasted for 19 2 min lesser than with laparoscopic splenectomy without the above method, due to the possibility of removing a significantly smaller volume of spleen tissue from the endoscopic sac outside the abdominal cavity. However, the most important achievement was the almost complete elimination of the risk of getting free fragments of a pathologically altered spleen with its possible replantation and recurrence of the clinic of autoimmune hemolytic anemia. The postoperative period was smooth, and all patients were discharged at their place of residence 7 days after the laparoscopic splenectomy. Intra-abdominal complications and relapses of the disease associated with the above-described method of operation did not occur in any patient within 612 months postoperative. Conclusion. The proposed method of spleen reduction during laparoscopic splenectomy made it possible to avoid relapses of the disease, reduce the operation time, as a result, improved the results of surgical treatment in children with hereditary autoimmune hemolytic anemia.

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One - stage laparoscopic treatment of chronic inﬂammatory complications of diverticular colon disease

Sechenov Medical Journal ◽

10.47093/22187332.2019.2.70-76 ◽

2019 ◽

Vol 10 (2) ◽

pp. 70-76

Author(s):

E. A. Gallyamov ◽

Y. B. Busyrev ◽

I. V. Gorbacheva ◽

V. A. Dugin

Keyword(s):

Laparoscopic Surgery ◽

Sigmoid Colon ◽

Abdominal Cavity ◽

Prostate Gland ◽

Long Term Results ◽

Surgical Department ◽

Aged People ◽

One Stage ◽

Short Time ◽

And Control

Introduction. Diverticulosis of the colon is one of the most common diseases of the intestine. In recent years, there has been an increasing tendency for diverticular disease (DD) to manifest itself at earlier age, as well as to the more frequent development of complications in young and middle - aged people. Most interventions for planned surgical treatment of DD complications are performed by two - stage access for laparotomy. One - stage laparoscopic intervention is a relatively new approach to treatment. Case report. 40-year - old man was hospitalized in the surgical department with complaints of air release during urination and aching pain in the lower part of abdomen. Outpatient examination excluded the pathology of the prostate gland and revealed inﬁltration between the urinary bladder and sigmoid colon. A complex examination, including cystoscopy, colonoscopy, multispiral computed tomography with contrast, showed the presence of chronic paracolic inﬁltration and blad - derntestinal ﬁstula, which complicated the latent course of colon DD. Laparoscopic opening the abscess, resection of the sigmoid colon, the formation of descendo - rectal anastomosis was performed in one - step. Intra - and postoperative complications were not observed, dynamic observation and control examination after 6 months showed no symptoms. Discussion. One - stage laparoscopic surgery in the treatment of chronic inﬂammatory complications of colon DD is currently available procedure, which allows in a short time to relieve patients from symptoms and has good immediate and long - term results. The condition for the use of this technique is a suﬃcient experience of laparoscopic surgery of the abdominal cavity, retroperitoneal space and pelvis.

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The role of bacteriophages in the complex treatment of peritonitis of appendicular origin (experimental study)

Vestnik of Experimental and Clinical Surgery ◽

10.18499/2070-478x-2017-10-4-265-268 ◽

2017 ◽

Vol 10 (4) ◽

pp. 265-268

Author(s):

Evgeny Mikhailovich Mokhov ◽

Artem Mikhailovich Morozov ◽

Victor Alekseevich Kadykov ◽

Elshad Magomedovich Askerov ◽

Nina Evgenievna Serova

Keyword(s):

Surgical Treatment ◽

Postoperative Complications ◽

Acute Appendicitis ◽

Intraperitoneal Injection ◽

Abdominal Cavity ◽

Experimental Studies ◽

Morphological Data ◽

White Rats ◽

Single Intraperitoneal Injection ◽

Significant Difference

Relevance: with the management of laparoscopic methods of surgical treatment of acute appendicitis, the problem of the occurrence of early postoperative complications has not changed at present, which makes it necessary to carry out preventive measures. Objective: to study the possibility of improving the results of surgical treatment of peritonitis, the most frequent complication of acute appendicitis, by reducing the number of postoperative complications of infectious genesis. Methods: Studies were performed on 47 non-linear white rats weighing 200-250 grams by modelling peritonitis using the biological model as an example, followed by antibiotic therapy and combination therapy using bacteriophages. To model peritonitis, the infection of the abdominal cavity with the E. coli strain 25922 was used. The laboratory animals were divided into 3 groups: the first group was control group, the second group received treatment in the form of a single intraperitoneal injection of Cefipime, the third group received treatment as a single intraperitoneal injection of the Sextapage. Results: the evaluation of the methods was carried out on the basis of the study of the clinical picture of the course of peritonitis in experimental animals, the data of pathomorphological and histological examination of the sectional peritoneum. As a result of experimental studies, there was no significant difference in the methods of perioperative prevention of complications of acute appendicitis, which makes it possible to perform monotherapy with bacteriophages. Phages in comparison with antibiotics have no less therapeutic efficacy. Conclusions: Thus, our experimental studies revealed completely satisfactory results of monotherapy of experimental peritonitis with a bacteriophage. According to the morphological data, the inflammatory process in the abdominal cavity is stopped by the phage fast enough and there is a tendency for a faster fading of the inflammation than in the treatment with antibiotics.

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Diagnosis and surgical treatment of acute intestinal obstruction caused by extragenital form of endometriosis

HERALD of North-Western State Medical University named after I I Mechnikov ◽

10.17816/mechnikov202012197-101 ◽

2020 ◽

Vol 12 (1) ◽

pp. 97-101

Author(s):

Zemlyanoy V. Р. P. Zemlyanoy ◽

B. V. Sigua ◽

D. S. Syomin ◽

D. V. Gurzhiy ◽

D. H. Qalandarova

Keyword(s):

Surgical Treatment ◽

Gastrointestinal Tract ◽

Intestinal Obstruction ◽

Sigmoid Colon ◽

Clinical Laboratory ◽

Acute Intestinal Obstruction ◽

Intestinal Lumen ◽

Childbearing Age ◽

Surgical Department ◽

Extragenital Endometriosis

Damage to the gastrointestinal tract with extragenital endometriosis is a very rare pathology. According to the literature, the frequency of damage to the gastrointestinal tract in endometriosis, after previously performed gynecological operations, is less than 1%. At the same time, involvement in the pathological process of the intestine is noted in 337% of women of childbearing age with diagnosed genital endometriosis. In most clinical cases extragenital endometriosis occurs intraoperatively due to the complexity of early diagnosis. This article presents a clinical case of successful surgical treatment of a 43-year-old patient admitted to a surgical department with signs of intestinal obstruction. According to the anamnesis the patient had been suffering from recurrent pains in the lower abdomen in the right mesogastrium and constipation. The day before hospitalization, the above mentioned symptoms become worse with additional nausea, vomiting, lack of gases and feces. Based on the clinical laboratory and instrumental data the diagnosis of acute intestinal obstruction was established; and the urgent surgical treatment was carried out. Two formations were revealed intraoperatively (in the terminal ileum and in the elongated loop of the sigmoid colon). Both formations circularly narrowed the intestinal lumen, however the ileum was the cause of obstruction. Due to the lack of histological verification and the inability to exclude the malignant nature of the formation, the surgical treatment was carried out taking into account oncological standard in the amount of ileum resection and obstructive resection of the sigmoid colon with lymphadenectomy and small intestine intubation. Pathohistological examination confirmed intestinal endometriosis. The course of the postoperative period revealed no complications. The patient was discharged on the 12th day for outpatient treatment under the supervision of a surgeon and a gynecologist at the place of residence with recommendations and subsequent planned hospitalization in order to conduct reconstructive surgery to restore intestinal patency.

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Ūminio apendicito gydymas Šiaulių ligoninėje

Lietuvos chirurgija ◽

10.15388/lietchirur.2004.1.2380 ◽

2004 ◽

Vol 2 (1) ◽

pp. 0-0

Author(s):

Rolandas Kopūsta ◽

Vida Belko ◽

Vincas Abalikšta

Keyword(s):

Acute Appendicitis ◽

Abdominal Wall ◽

Abdominal Cavity ◽

Clinical Findings ◽

Patient Treatment ◽

City Hospital ◽

Terminal Ileitis ◽

Chronic Appendicitis ◽

Abdominal Abscesses ◽

Clinical Diagnoses

Rolandas Kopūsta2, Vida Belko1, Vincas Abalikšta21 Šiaulių ligoninės I chirurgijos skyrius,V. Kudirkos g. 99, LT-5400 Šiauliai2 Šiaulių ligoninės II chirurgijos skyrius,V. Kudirkos g. 99, LT-5400 ŠiauliaiEl paštas: [email protected] Tikslas Išanalizuoti Šiaulių ligoninės pirmajame ir antrajame chirurgijos skyriuose 1998–2002 m. gydytų ligonių apendicitų formas, gulėjimo stacionare laiką, komplikacijas, katarinio ir lėtinio apendicito galutines klinikines diagnozes, palyginti šiuos duomenis su 1978–1982 m. duomenimis. Ligoniai ir metodai Retrospektyviai išanalizuotos 1998–2002 m. operuotų nuo ūminio apendicito asmenų ligos istorijos, siekiant įvertinti ligos formas, gulėjimo stacionare trukmę, komplikacijas. Palyginta apendicito gydymo rezultatų dinamika prieš 20 metų ir dabar. Rezultatai 1998–2002 m. Šiaulių ligoninėje nuo ūminio apendicito buvo operuoti 1586 ligoniai, iš jų 783 (49,37%) vyrai ir 803 (50,63%) moterys. Apendicito formos: katarinis buvo 326 (20,55%) ligoniams, flegmoninis – 712 (44,89%), gangreninis – 279 (17,59%), perforacinis – 220 (13,87%), infiltracinis – 17 (1,07%), lėtinis – 32 (2,02%). Šeši ligoniai (visos moterys) išoperuoti videolaparoskopu. Vidutinė gulėjimo stacionare trukmė analizuojamu laikotarpiu sutrumpėjo nuo 6,5 iki 4,7 dienos. Pagrindinė komplikacija ankstyvuoju pooperaciniu laikotarpiu – pilvo sienos pūlinys – buvo 48 (3,03%) ligoniams. Relaparotomijų dėl intraabdominalinių komplikacijų ir mirčių atvejų nebuvo. Katarinio ir lėtinio apendicito formos diagnozuotos 358 (22,57%) ligoniams, iš jų ginekologinė patologija – 76 (21,23%), mezadenitas – 70 (19,55%), terminalinis ileitas – 12 (3,35%). Nereikalingų (negatyvių) apendektomijų atlikta 174 (10,97%). 1978–1982 m. Šiaulių ligoninėje nuo ūminio apendicito operuoti 2049 ligoniai. Katarinis apendicitas nustatytas 675 (32,94%), flegmoninis – 925 (45,14%), gangreninis – 231 (11,27%), perforacinis – 181 (8,83%), infiltracinis – 37 (1,81%) ligoniams. Komplikacijų skaičius ankstyvuoju pooperaciniu laikotarpiu sudarė 6,69% ir labai priklausė nuo apendicito formos: operuojant katarinį – 17 atvejų (2,52%), flegmoninį – 31 (3,35%), gangreninį – 34 (14,72%), perforacinį – 52 (28,73%), infiltracinį – 3 (8,11%). Pilvo sienos pūlinių buvo 96 (4,69%), intraabdominalinių pūlinių – 24 (1,17%), žarnų nepraeinamumas – 8 (0,39%), dezinvaginacija – 3 (0,15%), kraujavimas į pilvo ertmę – 3 (0,15%) ligoniams. Atliktos 45 relaparotomijos, iš jų septynios – du kartus, trys – tris kartus. Mirė 9 ligoniai. Mirštamumas sudarė 0,44%. Išvados Ryškų pooperacinių komplikacijų, lovadienių skaičiaus sumažėjimą lėmė nauja operacijų technika, tikslinė antibiotikų terapija. Dabar sumažėjo katarinio apendicito formų, tačiau gangreninio ir perforacinio – nemažėja. Jei klinikiniai radiniai abejotini, būtina pasitelkti ultragarsinį tyrimą ir kompiuterinę tomografiją. Tikslinga daugiau apendektomijų atlikti laparoskopu. Prasminiai žodžiai: ūminis apendicitas, chirurginis gydymas, komplikacijos Treatment of acute appendicitis in Šiauliai city hospital Rolandas Kopūsta2, Vida Belko1, Vincas Abalikšta2 Objective Objective of this work is to traverse forms of appendicitis in patients being treated in 1-st and 2-nd departments of Šiauliai city hospital in the period of the years 1998–2002, duration of in-patient treatment, complications, to pay attention on the final clinical diagnoses of catarrhal and chronic appendicitis, to compare these data with the data of the years 1978–1982. Patients and methods During testing, histories of disease of the individuals that had a surgery against acute appendicitis in the years 1998–2002 were analyzed retrospectively, seeking to evaluate forms of disease, duration of staying in hospital, and complications. Current dynamics of appendicitis treatment results was compared with that of 20 years ago. Results 1586 patients had surgeries against acute appendicitis in Šiauliai hospital in the period of the years 1998–2002: 783 (49.37%) men and 803 (50,63%) women among them. Forms of appendicitis: catarrhal 326 (20.55%), phlegmonous 712 (44.89%), gangrenous 279 (17.59%), perforating 220 (13.87%), infiltration 17 (1.07%), chronic 32 (2.02%). Six patients (all women) were operated by video-laparoscope. Average duration of in-patient treatment in hospital during analyzed period had shortened from 6.5 to 4.7 days. Main complication in the early post-surgical period – abscess of abdominal wall 48 (3.03%). There were no relaparotomies due to intra-abdominal complications or cases of deaths. Forms of catarrhal and chronic appendicitis 358 (22,57%). Among them: gynecological pathology 76 (21.23%), mesadenitis 70 (19.55%), terminal ileitis 12 (3.35%). 174 (10.97%) unnecessary (negative) appendectomies were accomplished. During the years 1978–1982 in Šiauliai hospital 2049 patients had surgeries against acute appendicitis. Catarrhal 675 (32.94%), phlegmonous 925 (45.14%), gangrenous 231 (11.27%), perforating 181 (8.83%), infiltration 37 (1,81%). Number of complications in the early post-surgical period made up 6.69% and was very much dependant on the form of appendicitis: catarrhal – 17 cases (2.52%), phlegmonous 31 (3.35%), gangrenous 34 (14,72%), perforating 52 (28.73%), infiltration 3 (8.11%). Abscesses of abdominal wall 96 (4.69%), intra-abdominal abscesses 24 (1.17%), obstruction of intestines 8 (0.39%), desinvagination 3 (0.15%), bleeding into abdominal cavity 3 (0,15%). 45 relaparotomies were accomplished. 7 – two times, and 3 – three times. 9 patients died. Mortality rate was 0,44%. Conclusions Substantial decrease of post-surgical complications and days of staying in bed is conditioned by emerging of new surgical technique and purposive antibiotic-therapy. Forms of catarrhal appendicitis strikingly decreased. However there is no decrease in a number of gangrenous and perforating forms. When clinical findings are doubtful, it's necessary to use ultrasonic testing and computer tomography more widely. It's purposive in future execute more appendectomies using laparoscope. Keywords: acute appendicitis, surgery, complications

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ANALISIS OF THE STTUCTURE OF ABDOMINAL PAIN SINDROME IN CHILDREN IN CONDITIONS OF THE CENTRAL REPUBLICAN HOSPITAL

Russian Journal of Pediatric Surgery ◽

10.18821/1560-9510-2019-23-1-35-37 ◽

2019 ◽

Vol 23 (1) ◽

pp. 35-37

Author(s):

Nail V. Rayanov ◽

R. N. Rayanov ◽

N. R. Nizaev

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Pediatric Surgery ◽

Surgical Intervention ◽

Abdominal Cavity ◽

Emergency Operation ◽

Acute Calculous Cholecystitis ◽

Abdominal Organs ◽

Functional Nature ◽

Calculous Cholecystitis

Abdominal pain is a serious problem in pediatric surgery. Abdominal pain is one of the most frequent complaints addressed by children and their parents to doctors of various specialties: pediatrician, gastroenterologist, infectious diseases specialist, pediatric surgeon, ambulance workers. Abdominal pain is a symptom of many diseases of organs of abdominal cavity. It may be of a functional nature, which does not pose a threat to the life of the child and does not require surgical intervention, and pain associated with acute pathology of the abdominal organs (acute appendicitis, invagination of the intestine, diverticulitis, intestinal obstruction, acute calculous cholecystitis, injuries of the abdominal cavity and so on. e) requiring an emergency operation.

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ARROSIVE BLEEDING FROM THE APPENDICULAR ARTERY IN ACUTE DESTRUCTIVE APPENDICITIS

Kharkiv Surgical School ◽

10.37699/2308-7005.1.2021.25 ◽

2021 ◽

pp. 133-136

Author(s):

A. V. Kapshitar ◽

A. A. Kapshitar

Keyword(s):

Acute Appendicitis ◽

Research Methods ◽

Antibacterial Therapy ◽

Emergency Surgery ◽

Clinical Case ◽

Rare Complication ◽

Abdominal Cavity ◽

Favorable Outcome ◽

Surgical Department ◽

Prolonged Delay

Summary. Objective of the study: to present to the surgical community a rather rare complication of severe destructive appendicitis – arrosive bleeding and the cause of its development. Material and methods. Published a rare clinical case from prac-tice — the development of perforation of the appendix and arrosive bleeding from the appendicular artery in a patient with acute gangrenous appendicitis. Results and its discussion. The atypical course of acute appendicitis of undulating nature under the mask of acute adnexitis and antibacterial therapy has led to a prolonged delay with surgery in the surgical department. Only the appendicular abscess, which spontaneously opened into the abdominal cavity, made it possible to diagnose acute appendicitis and determine indications for emergency surgery, during which arrosive bleeding was diagnosed. The favorable outcome of the disease is due to the local purulent-necrotic process and small hemoperitoneum. Findings. Timely diagnosis of acute appendicitis, with the involvement of additional research methods in unclear cases, and subsequent appendectomy, are the prevention of a rather rare complication — arrosive bleeding from the appendicular artery in the development of severe complicated forms of acute destructive appendicitis.

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