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What is acute phlegmonous appendicitis?
Acute phlegmonous appendicitis – this is a kind of acute inflammation of the appendix, which is based on its purulent, but not destructive changes. This means that with this form of the disease, pathological changes in the appendix develop in a short period of time (hours).
But the inflammation is so intense that immediately its walls undergo purulent fusion. At the same time, the integrity of the process is not violated, and it retains its structure. It is possible to ascertain acute phlegmonous appendicitis only after examining the appendix during the operation.
Signs of phlegmonous appendicitis are:
sharp swelling and thickening of the walls, their friability
tension of the appendix
fibrinous deposits
purulent contents in the lumen
Causes of phlegmonous appendicitis
Phlegmonous appendicitis develops in two ways:
Primary purulent inflammation in the process;
Secondary phlegmonous transformation of the appendix, as one of the stages of progression of simpler forms of acute appendicitis.
In the pathogenesis of the causal mechanisms of the occurrence of purulent inflammation of the appendix, one can distinguish:
Infection of the inflamed mucous membrane with pathogenic pyogenic microorganisms of the intestine;
High activity of immune cells, which are concentrated in the appendix, as an immune organ of the abdominal cavity. They contribute to the progression of the inflammatory process;
Obliteration of the lumen of the process, making it difficult to outflow from it, which leads to stagnation of purulent contents;
Thrombosis of appendicular vessels with microcirculatory disorders. In this case, ischemia of the appendix occurs, which makes it even more susceptible to the action of all these causes.
Complications of phlegmonous appendicitis
Phlegmonous appendicitis, as one of the forms of a purulent process in the abdominal cavity, in the absence of timely treatment, can be complicated by such pathological conditions:
Progression of a phlegmonous lesion with its transition to destructive forms of appendicitis (gangrenous, gangrenous-perforative);
Process perforation;
Local and widespread peritonitis (serous-fibrinous or purulent);
Pylephlebitis – purulent inflammation and thrombosis of the veins of the liver;
Appendicular infiltrate – the connection of the greater omentum, loops of the small intestine and the abdominal wall to each other around the modified appendix to limit it from the free abdominal cavity;
Appendicular abscess – purulent fusion of the appendix in a limited space;
Abdominal sepsis and septic shock is a systemic spread of pyogenic microbes throughout all organs and tissues with the development of severe violations of their function.
Postoperative period
Regardless of whether laparoscopic or standard appendectomy was performed, a sparing regimen is recommended for a month after the intervention. All other moments of the postoperative period have the following features:
In the case of an uncomplicated typical operation, it is possible to get up and walk after a few hours. The main criterion for the possibility of performing these actions is the complete restoration of breathing, consciousness and coordination of movements after anesthesia. By the evening, usually all patients go to the toilet on their own. It is better if this happens with the help of medical personnel or relatives. Patients with a burdened history or complicated features of the intervention should better refrain from early activation in such a volume. Such patients must move, but in bed conditions (movement of the limbs, turning over to one side, landing with support;
Exercise therapy and breathing exercises. It is shown to all, without exception, patients who have undergone an appendectomy. Their volumes are different, determined by the general condition of the patient, the complexity and duration of the intervention, the term of the postoperative period;
Proper and balanced nutrition, ensuring the normal functioning of the intestines and replenishment of the body’s regenerative resources;
Bandaging of the abdomen in the area of the postoperative wound. For this, the usual tying with a thick sheet or a diaper folded in several layers in a wide strip is enough. Instead, a special postoperative bandage can be used;
Daily dressings. At the same time, the postoperative wound is treated with antiseptics, its healing is assessed, appropriate manipulations are performed if there are signs of a violation of the normal course of the wound process;
Removal of stitches. If intradermal cosmetic sutures were applied with absorbable threads, they do not need to be removed. External seams are removed on the 7-8th day;
Heavy physical labor is prohibited for 3 months.
Diet for phlegmonous appendicitis
Most of the operated are interested in the question of what should be the diet after phlegmonous appendicitis. For two weeks after the operation, you should adhere to the following recommendations:
Products are excluded: pickled, spicy, peppery, salty and spiced dishes, hard, fried, smoked, fatty foods, soda, strong coffee and tea, rich bakery products;
The main emphasis is on boiled, baked and steamed products. They should be soft, liquid, mushy or mashed;
From specific dishes are allowed: white stale bread, dietary meats (beef, chicken, rabbit), fish, dairy products, cottage cheese in the form of a casserole, soft-boiled eggs, boiled vegetables (except cabbage), hated broths, soups, boiled cereals from any cereals seasoned with sunflower oil, jelly, fruit and dried fruit decoctions, chocolate in moderation, steam cutlets and meatballs (from permitted meats and fish), weak tea and cocoa, non-concentrated fruit juices, non-carbonated mineral water.
The most stringent dietary restrictions should be observed on the first day of the postoperative period. The volume of allowed products for phlegmonous appendicitis should be decided only by the attending physician. He is always guided by the general condition of the patient, the course of the postoperative period and the presence of intestinal motility.
Therefore, on the first day after phlegmonous appendicitis, it is advisable not to eat any dense food. eat better 5-6 times a day in small portions. It can be kefir, liquid mashed potatoes or hateful broth. If the postoperative period proceeds smoothly, on the second day the diet expands. The criterion for the transition to a normal diet is the first stool. Once this happens, the patient can eat all permitted foods. After a month after phlegmonous appendicitis, a person can return to their usual diet.