Contents
What is an appendicular infiltrate?
Infiltrate in the appendicular form is an acute complication of appendicitis of the intermediate stage lasting up to 5 days. It is an accumulation of altered tissues of an inflamed appearance, tightly connected to each other. This conglomerate includes the appendix itself and the formations adjacent to it: the small intestine, omentum, caecum. Appendicular infiltrate is formed on the 3rd-4th day from the onset of the disease. In this case, the right iliac region (sometimes another region) acquires a limited-type formation, dense, motionless and painful when pressed.
Symptoms of appendicular infiltrate
The lack of timely surgical intervention can lead to a purulent-infiltrative process in the right iliac region, where an accumulation of organs is created, including the appendix, the tissues of which have an inflamed appearance. Observations fix the presence of an appendicular abscess in 15% of patients who were operated on on the basis of a gynecological disease, and the secondary retraction of the appendix into a purulent process in the presence of a gynecological abnormality, according to some data, is about 10%.
The disease begins with a sudden pain of a paroxysmal nature, which at the initial stage is localized in the navel. At the same time, there is no characteristic connection of the disease with risk factors in which inflammatory processes of the internal genital organs develop. Nevertheless, a carefully collected anamnesis initially allows you to establish a pathology of a surgical nature. On the fourth day after an acute attack or later, if anti-inflammatory or antibacterial treatment was used, an appendicular infiltrate is formed.
After a few days, the pain becomes less, but the intoxication of the endogenous species persists. There is a steadily elevated temperature up to 37,8°C with a moderate increase in heart rate and leukocytosis. By palpation, it is possible to determine an infiltrate in the iliac region on the right side, which has a dense texture with clearly defined boundaries. However, it can resolve in 30-40 days, but suppuration is the most likely.
In the worst case, the patient’s condition deteriorates rapidly, and all the symptoms of purulent inflammation occur: sharp fluctuations in body temperature, chills, increasing and sharp pain in the infiltrate, local fluctuation, uneven consistency.
Diagnosis of appendicular infiltrate
Diagnosis of appendicular infiltrate is to conduct a medical examination. Clarification of the diagnosis can be done after echography. When it is carried out in the iliac region, an infiltrate is detected on the right side, which has an irregular shape of an echo-positive formation without a clear capsule, and the presence of reduced echogenicity in relation to adjacent tissues is determined in it. Examination can reveal abscessing of the infiltrate structure and fix cystic formations that have a clear capsule and liquid content, which indicates the accumulation of pus.
Treatment of appendicular infiltrate
Treatment of appendicular infiltrate is conservative, but should be carried out only in a hospital setting. It consists in antibiotic therapy, diet, restriction of physical activity. Surgical treatment is not required. As a rule, the appendicular infiltrate resolves after 2 weeks of treatment.
Emergency surgery is performed only for certain indications: perforation of an abscess into the bladder or abdominal cavity, and septic shock. The operation of an emergency order in the development of a purulent process has technical difficulties and may threaten the prospect of developing septic shock. Technically, the operation is the same, but in especially serious conditions, patients undergo a palliative intervention, that is, an abscess is drained or the caecum is stomized, and during the period of remission, a reconstruction operation is performed. Therefore, it is so important to recognize and operate on the appendicular infiltrate in a timely manner.
A thorough collection of information about the symptoms of the disease gives grounds to make an accurate diagnosis of a surgical disease even before surgery. Running cases, even with a section of the womb, cause difficulties in determining the root cause. The tactics of the operation does not change from this, in any case, an appendectomy and a gynecological surgical intervention corresponding to the case with further drainage of the abdominal cavity are performed.