Destructive Appendicitis Research Articles

The use of physical factors in the postoperative period with destructive appendicitis in children: the current state of the problem

Acute appendicitis is the most common childhood surgical disease. With the use of laparoscopic appendectomy for destructive appendicitis in children, the number of postoperative complications significantly decreased. However, in recent years there has been no tendency towards their further decline. The use of non-drug exposure, which has both local and systemic anti-inflammatory effects, can lead to further improvement in the treatment results of the most severe forms of the disease. As a result of a literature review, it was found that there is very little information about the use of physical factors in the postoperative period with destructive appendicitis in children. The effectiveness of the physical factors of systemic exposure (intravenous laser irradiation of blood, the use of ozone) was noted, but currently there are no recommendations on the application of local exposure physiotherapy techniques. Thus, the study of the effectiveness of the use of physical factors in the postoperative period with destructive appendicitis in children at the present stage remains relevant.

Experience of Treating Acute Appendicitis in Tashkent

Modern diagnostics of acute appendicitis in children should include abdominal ultrasound investigation upon admission to a specialized hospital, if necessary, in an ultrasound monitoring mode during clinical dynamic observation of the child. Surgical treatment is indicated only for destructive appendicitis. The method of a surgical treatment choice is laparoscopic surgery including destructive appendicitis complicated by appendicular peritonitis. Surgeries in acute appendicitis make up 75% of all emergency surgical interventions. Annually only in the Republican Research Centre of Emergency Medicine 700 appendectomies in children are made on average. The article summarizes data obtained in the retrospective analysis of case histories of 6 256 patients with acute appendicitis and its complications who were hospitalized in the pediatric department of emergency surgery for 12 years. The following incidence of acute appendicitis in children is reported: from 1 to 3 years old - 0.6 per 1 000; from 4 to 7-1.4 - 2.6 per 1 000; 13 years of age - 8 per 1 000. The authors discuss specific features in the clinical picture of acute appendicitis in children depending on patient’s age and anatomical location of the appendix. The clinical picture in children of older age and of the first three years of life is discussed separately. Among 6 256 pediatric patients with acute appendicitis 72 (1.15%) were children younger than 3 years. The authors have substantiated a complex of diagnostic and therapeutic manipulations as well as tactic options to the treatment of this category of patients. Widespread implementation of the laparoscopic technique into surgical practice has significantly changed the tactics of treatment. The number of surgeries for simple appendicitis in children has decreased up to 3.9-7%.

Thermometric panel of the anterior abdominal wall and prognostic axillary-abdominal coefficient

Complications of acute appendicitis in children, infiltrates, abscesses and peritonitis remain relevant in pediatric surgery because they are difficult to diagnose and they have clinical features. Finally, they make up 75% of the patients in the surgical departments which carried out urgent surgical intervention. On appendicular peritonitis accounts for up to 28% of children with delays in seeking medical help.In addition, despite the latest technology, 20% of patients with acute appendicitis is not installed on time and, as a consequence, the development of complications. Appendicular infiltrate is diagnosed from 0.2% to 14.6% of cases. Periappendicular abscess record in patients from 1.5% to 12.6%. Purulent inflammation of the greater omentum in the form of destructive appendicitis was diagnosed in 30% of patients under the age of 7 years and 70% of patients older than 7 years.On postoperative infiltrates and abscesses of an abdominal cavity has from 1.1% to 10.5% of patients of the total number of limited forms of peritonitis and to 40.3% of the patients with General peritonitis, as a complication of postoperative infiltrative omantic occurs in patients from 0.02% to 4.52%.In the diagnosis of important localization, reasons for the development of infiltrates, abscesses of abdominal cavity in children.Described in the guidelines for surgery in the first half of the twentieth century "softening" tumoroids for today practically does not occur. Feeling dense sedentary infiltration even during the operation makes it impossible to judge about the organ and tissue structure and the presence of abecedarian. Traditional laboratory data are not specific for the diagnosis of intra-abdominal infiltrates and abscesses. They characterize the presence of the inflammatory process and to some extent the intensity of inflammation.In recent years, among medical imaging systems septic foci and control of the postoperative period, takes its place remote infrared thermometry.Despite the use of modern methods of diagnosis and treatment, there is a stable mortality rate from 0.2 to 0.4%, while appendicularia peritonitis, they account for between 0.7 and 23%.Thus, from the above information it follows that at the present stage in the early stages of the formation of infiltrates and abscesses of abdominal cavity in children reliable verification difficult.Materials and methods. The work is based on the analysis of the results of thermometry of the anterior abdominal wall of 33 patients with appendicular infiltrates and abscesses of the abdominal cavity, who used remote infrared thermometry. The comparison group included 70 children who were hospitalized in the surgical department with suspected acute appendicitis. The age of patients ranged from 5 to 17 years (10,21±0,37 years).When determining the temperature of the anterior abdominal wall, patients were in a horizontal position on the bed with an open abdominal wall. After adapting the skin to the microclimate for 10 minutes, at an ambient temperature of 19-22°C, on an empty stomach and with an empty bladder. According to the scientific literature, the temperature of the anterior abdominal wall, in the absence of an inflammatory focus, is 34.2-34.6°C.The local temperature of the anterior abdominal wall was measured at 26 points, located on a plane forming the panel of the anterior abdominal wall, at the intersection at right angles of 5 vertical and 6 horizontal lines, starting from the upper divisions from right to left.Results. Thermometry has been shown to indicate the variability of the temperature of the anterior abdominal wall in children - various indicators for both primary and secondary infiltrates, abscesses of the abdominal cavity.The average temperature of the anterior abdominal wall in children without surgical pathology, according to measurements at the points of the thermometric panel, was 34,25±0,05°C. The average axillary temperature was 36,65±0,01°C. The prognostic axillary-abdominal coefficient (PAAC) in this group of patients was at the level of 2,43±0,07°C.In patients with infiltrates and abscesses of the abdominal cavity, PAAС had a value of -1,16±0,06°С<0°С – left shift, at the maximum point of hyperthermia (39,16±0,14°С) on the thermometric panel of the anterior abdominal wall. With primary abdominal infiltrates -0,82±0,08°С<0°С and 38,9±0,47°С, PAA -1,25±0,05°С<0°С and 39,28±0,14°C. In patients with a SAI development of -0,5°С<0°С and 37,9°С (one observation), and in the conditions of the development of SAA -1,57±0,21°С<0°С and 39,45±0,28°С. This indicator indicates the focus of inflammation and determines the boundaries of the spread of the inflammatory process in the abdominal cavity.Conclusions. In the postoperative period, the determination of PAAC allowed in 33.3% of patients to promptly correct the treatment and prevent the development of postoperative infiltrates and abscesses, in the absence of ultrasound signs of inflammation.

CLINICAL AND MORPHOLOGICAL JUSTIFICATION OF THE SURGICAL TREATMENT OF CHRONIC ABDOMINAL SYNDROME IN CHILDREN

The chronic recurrent abdominal syndrome (CRAS) in the right lower fossa in children is believed not to be independent nosological unit and is diagnosed as an exception. We carried out comparative studies of the clinical picture, results of morphological and immunohistochemical studies of remote appendicitis in 55 CRAS children and 35 children with acute destructive appendicitis. The low prognostic significance of appendicular scales for the determination of indications to the surgical treatment of CRAS was established. Morphological examination in most cases revealed signs of chronic inflammation with fibrosis of the mucosa and submucosa of the appendix in CRAS children. Immunohistochemical studies revealed the pronounced expression of protein VEGF, MMP-9 and VCAM-1 predominantly in the submucosal and the muscular layer, moderate expression for Collagen-III-alpha-1. The low number of positively stained cells for the VIP protein located both in the mucosa and in the submucosa. The number of MMP-9-positive cells was the largest, there was seen a moderate amount of VEGF, VIP and Collagen-III-alpha-1-positive cells. The disappearance of the abdominal syndrome after appendectomy was noted in 6% of CRAS patients. Recurrence of pain was observed in girls of pubertal age with the irregular menstrual cycle. The established changes in remote appendicitis, other than acute inflammation, make it possible to consider reasonable appendectomy as a way of treating CRAS in children.

LYMPHANGIOMA AS A CAUSE OF ILEUS

Introduction. Lymphangiomas are mature benign tumors emanating from the lymphatic vessels making up 9-10% of all benign neoplasms in pediatric oncology. In our practice, we have encountered a rare complication of the lymphangioma of the abdominal cavity - an ileus Objective: To present a clinical picture, diagnostic and surgical tactics in a rare clinical observation of mesenteric lymphangioma, complicated by ileus. Material and methods. Boy aged of 6 years 4 months. He was taken to the emergency department of the Research Institute of NDHiT by an ambulance team (SMP) with suspected acute appendicitis 6 hours after the onset of the disease. Results. According to the results of clinical, laboratory and echographic examination, a child with a clinical picture of “acute abdomen” was suspected of an abdominal lymphangioma. For the purpose of the differential diagnosis of a complicated course of the lymphangioma of the abdominal cavity with complicated destructive appendicitis, 2 hours after hospitalization, laparoscopy was performed and there was confirmed lymphangioma of the ileum mesentery, complicated by the twisting of the latter. After elimination of the torsion, a section of the ileum with a tumor was resected with an end-to-end anastomosis. Histologically, the diagnosis of lymphangioma was confirmed. Conclusion. The cause of “acute abdomen” may be the development of complications of the mesenteric lymphangioma. Timely hospitalization of the child in a specialized hospital allows making a diagnosis in a timely manner, select the optimal surgical tactics and prevent life-giving complications

Ранняя диагностика бактериальной обсемененности брюшной полости при деструктивном аппендиците у детей с помощью тест-системы “D-лактам”

Ранняя диагностика бактериальной обсемененности брюшной полости при деструктивном аппендиците у детей с помощью тест-системы “D-лактам”

THE POSSIBILITIES OF APPLICATION OF DECIMETER-WAVE THERAPY IN DESTRUCTIVE APPENDICITIS CHILDREN

Introduction. The article presents a comparative study of the postoperative period after laparoscopic appendectomy for destructive appendicitis in children with and without application of decimetric-wave therapy (DMWT). Material and methods. The study included 299 children aged from 3 to 17 years, the average age of children accounted for 10.7 ± 3.3 years. Patients were operated on for various forms of destructive appendicitis. The patients observed included 201 boys (67.3%) and 98 girls (32.7%), Destructive appendicitis (DA) was diagnosed in 129 (43.1%) children, appendicular peritonitis (AP) - in (56.9%). Patients of the main group received DMWT, starting from the 1st day after surgery. Patients in the comparison group did not receive physiotherapy. To assess the effectiveness of the use of UHF-therapy in the postoperative period, the following groups were taken into account: 1) intestinal insufficiency syndrome (ISS) and systemic inflammatory response syndrome (SSRS); 2) postoperative complications; 3) abdominal ultrasound data; 4) the dynamics of common laboratory indices 4) the duration of the inpatient stay. Results. In DA cases without peritonitis, ISS and SSRS in the main group were observed by 15.7 and 12.8 times less than in the comparison group, with the duration of ISS decreased by 2.13 times, SSRS by 3.3 times. In AP patients the frequency of ISS decreased by 1.68 times, SSRS - by 1.97 times. By the 5th day of the postoperative period in the main group, both in DA and AP cases, there was a significant increase in the incidence of patients with both leukocytes and lymphocytes count normal for the age, LII, CRP. The inpatient stay in the main group decreased by 1.0±0.7 days in DA patients, in AP cases - by 3.3±0.7 days. Conclusion. Evaluation of the postoperative period, as well as traditional laboratory indices, confirm the effectiveness of DMWTin the postoperative period in DA cases YES, in that the local and systemic anti-inflammatory effect is more pronounced in with AP patients.

Acute appendicitis within the strangulated femoral hernia

Femoral hernia strangulation is usually observed in middle-aged women. There are few case reports of appendix strangulation in the femoral hernia. Acute appendicitis in a strangulated femoral hernia is relatively rare (0.4% of cases). Clinical case of acute destructive appendicitis within a strangulated femoral hernia in an elderly woman is reported in the article. If there is doubt about the urgency of surgical intervention, surgeon needs to take a proactive stance and lean toward emergency surgery. Surgeon should be aware of possible strangulation-associated destructive appendicitis due to injury of the appendix.

Laparoscopic interventions in children with complicated appendicitis

The article presents an overview of laparoscopic appendectomy experience in 3,766 children with complicated appendicitis in the clinic of the Department of Paediatric Surgery of the Russian State Medical Academy of Continuous Vocational Education (Moscow). The authors showed the high efficiency of laparoscopic techniques in the operative treatment. The features of tactics in destructive appendicitis and peritonitis are highlighted.

A NEW METHOD OF TREATMENT FOR APPENDICEAL STUMP

Background.In 30% of acute destructive appendicitis, the disease is accompanied by typhlitis, which makes it difficult to perform classical methods of appendiceal stump treatment.Aim of study.To improve the way of appendiceal stump treatment in the destructive form of acute appendicitis complicated by significant typhlitis.Material and methods.We studied 57 cases of acute destructive appendicitis complicated by typhlitis, which were divided into two groups depending on the method of treatment. The first group (comparison group) consisted of 30 patients who underwent a standard method for treating the appendiceal stump after appendectomy, such as ligation at the base and putting the stump into the cupula of the cecum and fixing it with interrupted serous-muscular sutures or with a purse and Z-shaped sutures. The second (main) group included 27 patients, who were treated by the method we proposed. The essence of the method is successive U-shaped stitching of the stump. After that, the stump curls in the form of a cochlea, peritonizes, reaching the necessary tightness without going into the cupula of the cecum. In this case, the abdominal cavity of patients in both groups was adequately sanitized and drained.Results.In the first group of patients there were technical difficulties associated with immersion of the appendiceal stump, which caused the serous damage, hematoma of the cupula of the cecum in 7 (23.3%) patients. In the second group of patients, due to the developed method of forming the appendiceal stump, technical difficulties did not arise, there were no complications. The duration of appendectomy in the first group of patients with standart treatment (interrupted serous-muscular sutures or purse and Z-shaped stiches) was 28.7±5.4 minutes, and in the second group of patients appendectomy with stump management with the suggested method lasted 20.3±6.1 minutes, p <0.05, which reduced the operation time by 8 minutes on the average. Purulent-inflammatory wound complications in the first group were detected in 7 patients (23.3%), and in 1 (3.7%) patient of the second group, which is significantly less by 19.6%.Conclusion.The proposed method is technically simple, as peritonization of the stump is performed without putting it into the cupula of the cecum. The use of this method is indicated in destructive forms of acute appendicitis complicated by severe typhlitis, which significantly reduces the operation trauma and contributes to reduction in the number of postoperative wound purulent-inflammatory complications by 19.6%. Findings The proposed method for treating the appendiceal stump during appendectomy for acute destructive appendicitis complicated by typhlitis is simple enough, reliable, characterized by low traumatism and shortens the duration of surgery by 8 minutes on the average (p <0.05).

THE EFFECT OF MICROWAVES OF A DECIMETER RANGE ON THE FUNCTIONAL ACTIVITY OF MITOCHONDRIA IN DESTRUCTIVE APPENDICITIS IN CHILDREN

Introduction. The article assessed the effectiveness of decimeter wave therapy (DWT) in the postoperative period after laparoscopic appendectomy for destructive appendicitis in children. Authors relate positive clinical effects with the activation of mitochondrial energy metabolism. Material and methods. The study included 132 patients (46 destructive appendicitis cases, 86 h appendicular peritonitis patients). Among them, there were 75 (56.8 percent) boys and 57 (43.2 percent) girls aged of from 3 to 17 years (mean age of 10.7 ± 3.07 years). Patients of the main group received DWT procedures with the use of the apparatus DMV-02 “Solnyshko” starting from the 1st day after the surgery. Patients from the reference group received no physiotherapy treatment. The activity of dehydrogenases of lymphocytes (succinic dehydrogenase (SDH) and NADH-dehydrogenase) in patients from the main group and the comparison group were determined by means of cytomorphological method with the use a hardware-software visualization complex “Videotest” and the “Morphology 5.2” (Russia), at the 1st, 3rd and 5th day of the postoperative period. Results. Under the influence of DWT in the postoperative period the frequency of intestinal insufficiency syndrome, systemic inflammatory response syndrome, infiltrative adhesions was established to decline. There was noted a gain in the activity of mitochondrial enzymes, reflecting the first and second stages of the respiratory chain (SDH and NADH-dehydrogenase). In children with destructive appendicitis against the background of DWT, the normalization of the activity of LDH in moderate activation of NADH-dehydrogenase, and in appendicular peritonitis cases - the significant elevation in LDH activity of lymphocytes and activation of NADH-dehydrogenase occurs. In patients from the main group, the absolute number of peripheral blood lymphocytes normalized Conclusion. Under the influence of DWT there was noted the activation of enzymes of mitochondria that provides a mild course of the postoperative period.

ПОСЛЕОПЕРАЦИОННАЯ ПНЕВМОНИЯ: ПРОФИЛАКТИКА И ЛЕЧЕНИЕ В НЕОТЛОЖНОЙ АБДОМИНАЛЬНОЙ ХИРУРГИИ

Objective: Preventive maintenance and treatment of postoperative pneumonia in patients with urgent abdominal pathology. Methods: The results of examination and treatment of 86 patients with postoperative pneumonia (PP) for the period from 2005 to 2017 analyzed. There were 51 men (59.3%), women – 35 (40.7%). All patients were operated for the diffuse peritonitis caused by acute destructive appendicitis (n=21), perforated gastroduodenal ulcer (n=10), strangulated ventral hernia (n=4), acute intestinal obstruction (n=19), destructive forms of acute calculous cholecystitis (n=18) and acute destructive pancreatitis (n=14). In addition, the work presents the results of the application of the preventive measures developed by authors in 70 patients with urgent diseases of the abdominal cavity without PP. Results: To reduce the frequency of PP in patients with urgent surgical diseases of the abdominal cavity, complicated by intraperitoneal hypertension syndrome and enteral insufficiency, a method of antegrade intubation of the small intestine has been developed. In cases when after approaching of the edges of laparotomic wounds, the intra-abdominal pressure was above 15 mm Hg, the operation completed by hemming to the edges of the aponeurosis using a polypropylene mesh. The use of preventive endoprosthetics allowed to increase the volume of the abdominal cavity and, thereby, to level out the high standing of the diaphragm and the lung compressions, which was a surgical preventive maintenance of PP. After completion of the operation, in 22 cases, a catheterization of the small intestine mesentery was performed with subsequent introduction of 10 mg of serotonin adipate twice daily with a microdose jet pump SN-50. The patients observed the resolution of paresis on the second day after the surgery. Conclusion: Proposed measures for the prevention of PP allow to significantly improve the immediate results of surgical treatment of urgent diseases of the abdominal cavity by reducing the incidence of nonspecific complications. The use of serotonin adipate promotes the normalization of automatism and contractile activity of the smooth muscles of the intestine and allows reducing the frequency of complications and lethality among this complex category of patients. Keywords: Postoperative pneumonia, abdominal cavity, serotonin adipate.

Comparative analysis of the results of computerized phonoenterography in patients with acute destructive appendicitis before surgery and in the postoperative period

Using the method of computerized phonoenterography we made an analysis of motor-evacuation function of the gastrointestinal tract in 35 patients with acute destructive appendicitis before surgery and in the postoperative period and in 30 patients without abdominal pain syndrome and concomitant pathology of the organs of the abdominal cavity. The obtained results of computerized phonoenterography different in the group of patients with acute appendicitis before appendectomy in comparison with group of patients without acute abdominal pathology (control group). For patients after appendectomy statistically significant differences with the control group in the vast majority of bands wasn’t obtained. Given the fact that the densities of the spectral power of acoustic signals of the abdominal cavity to assess the motor-evacuation function of the intestine in these groups of patients, we showed a reduction of motor-evacuation function of the intestine in patients with acute destructive appendicitis before surgery in comparison with patients of control group and recover in the postoperative period. Thus, the method of computerized phonoenterography is advisable to apply for the diagnosis of lower motor function of the intestine in patients with acute appendicitis, and in the early postoperative period in patients with acute destructive appendicitis for monitoring recovery of intestinal motility.

Modern tendencies in diagnostics and treatment of destructive appendicitis

Modern tendencies in diagnostics and treatment of destructive appendicitis

THE CASE OF DIFFICULTY DIAGNOSIS OF ACUTE APENDICITIS IN ATYPICAL POSITION ON THE APPENDIX ON THE BACKGROUND OF THE MALFORMATION OF ABDOMINALCAVITY

The article presents a clinical case of acute destructive appendicitis on the background of the anomalies of the abdominal cavity. This observation demonstrates the significant difficulties in the diagnosis of acute appendicitis occurring against the background of an atypical location of the appendix if you can not perform a diagnostic laparoscopy.