Complications of the acute appendicitis The department of faculty and hospital surgery of the medical faculty of the Tashkent medical academy

HISTORY Patient with appendicular abssessus was operated by Fredrik Matouid in 1884 year first time in UK and patient with limited peritonitis was operated by Rudolf Krenleyn in Germany.

HISTORY In Russia K.P. Dombrovskiy in 1988 year at first operated patient with appendicular abssessus.

Complications of the acute appendicitis (before the operation) Appendicular infiltrate Appendicular abscess Peritonitis Pilephlebitis Flegmona of the extraperitoneal space

Complications of the acute appendicitis (early postoperative) Continuously peritonitis Early soldering intestinal obstruction Abscesses of the abdominal cavity Bleeding from the mesenterial artery Insolvency of the stitches

Complications of the acute appendicitis (lately postoperative) Soldering intestinal obstruction Postoperative ventral hernias

Appendicular infiltrate - Inflammatory conglomerate, contents of the inflammated appendix in the centre, around which there are the loops of the small and thick intestines, omentum, attached to the parietal peritoneum. Acute appendicitis Appendicular infiltrate 3-5 days

The diagnosis of the appendicular infiltrate stating on the base of: Complaints: pain in the right iliac area Anamnesis: beginning of the disease as at the acute appendicitis, the time after the beginning is about 3-5 days Examination: subfebril temperature of the body, tachycardia, in the right iliac area the thick and painful formation, attached to the iliac bone is palapated. Marking of the borders of the appendicular infiltrate

TREATMENT OF THE APPENDICULAR INFILTRATE CONSERVATIVE 1.Bed mode 2.Table №4 3.wide spectre antibiotics 4.Vitamins 5.Detoxication therapy If the treatment of the appendicular infiltrate, without results Surgical treatment

Differences between the appendicular infiltrate and abscess Appendicular infiltrateAppendicular abscess Subfebrile temperatureHectic temperature Without the rising of the leucocytes Leukocytosis with the increasing Reduction of the sizes of the infiltrate Increasing of the sizes of the infiltrate with the soft centre The fluctuation symptom is negative The fluctuation symptom is positive US: there is no the liquid in the centre of the formation US: there is the liquid in the centre of the formation

Diffuse peritonitis – serious complication of the acute appendicitis

Local peritonitis – install one drainage into the pelvis or right iliac area Diffuse peritonitis – install two drainages Massive peritonitis – drainage by the method of our clinic

я Method of our clinic

Pilephlebitis – festering thrombophlebitis of the branches of the portal vein

Treatment of the pilephlebitis hepatoprotectors detoxication Antibacterial therapy Rheological drugs

Treatment of the abscess of the liver

The most frequent localization of the abscesses in the abdominal cavity

Instrumental examination of the abscesses

Abscess of Douglas’s space

Abscess of the pelvis (research with the finger)

Open of the abscess of pelvis TransvaginalTransrectal

Openning of the abscess of pelvis by Jackson-Elem

Intraintestinal abscess

Abscess of the subdiaphragmal space

Openning of the abscess of the subdiaphragmal space

Openning of the abscess of the subdiaphragmal space by Melnikov

Acute soldering intestinal obstruction – capsof Kloyber

US criterion of the acute intestinal obstruction

Three balloons test AIO - AIO ,2,3

Treatment algorithm All the patients with the AIO must stay at the surgical department AIO + peritonitis Operation YesNo Conservative actions (during 2 hours) Effective Not effective Operative treatment Examination and planned treatment

Main directions of the conservative therapy Decompression of the stomach and intestine Action onto the vegetative nervous system

Decompression of the gastrointestinal patch Liberation of the distal part of the GIP Liberation of the proximal part of the GIP Siphon enema Cleaning enema Washing of the stomach Intubation of the intestine

Technique of the siphon enema

Dissection of the soldering. Laparoscopic dissection of the soldering

Not formed intestinal fistula Tube intestinal fistula Lip intestinal fistula

Plastic of the anterior abdominal wall by Voznesenskiy