1. Complications of the acute appendicitis
The cathedra of the faculty and hospital surgery of the treatment faculty of the Tashkent medical academy
Complications of the acute appendicitis

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

3. 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

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

5. 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
3-5 days
Appendicular infiltrate

6. MSCT at the appendicular infiltrate

7. 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

8. TREATMENT OF THE APPENDICULAR INFILTRATE
CONSERVATIVE
Bed mode
Table №4
Antibiotics with the wide spectre of the actions
Vitamins
Detoxication therapy
If at the phone of treatment of the appendicular infiltrate, the surgical treatment
Surgical treatment

9. Differences between the appendicular infiltrate and abscess
Appendicular abscess
Subfebrile temperature
Gectic temperature
Without the rising of the leucocytes
Leucocytosis 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

10. Diffuse peritonitis – serious complication of the acute appendicitis

11. 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

12. я
Method of our clinic

13. Pilephlebitis – festering thrombophlebitis of the branches of the portal vein

14. Treatment of the pilephlebitis
Antibacterial therapy
hepatoprotectors
Rheological drugs
detoxication

15. Treatment of the abscess of the liver

16. The most frequent localization of the abscesses in the abdominal cavity

17. Instrumental examination of the abscesses

18. Abscess of Douglas’s space

19. Abscess of the pelvis (research by finger)

20. Open of the abscess of pelvis
Transvaginal
Transrectal

21. Open of the abscess of pelvis by Jackson-Elem

22. Intraintestinal abscess

23. Abscess of the subdiaphragmal space

24. Open of the abscess of the subdiaphragmal space

25. Open of the abscess of the subdiaphragmal space by Melnikov

26. Acute soldering intestinal obstruction – chalices of Kloyber

27. US criterion of the acute intestinal obstruction

28. Three balloons test at the acute intestinal obstruction3 1 2
1,2,3
AIO AIO +

29. Treatment algorithm AIO + peritonitis
All the patients with the AIO must stay at the surgical department
AIO + peritonitis
Yes No
Conservative actions
(during 2 hours)
Operation
Effective
Not effective
Operative treatment
Examination and planned treatment

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

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

32. Technique of the siphon enema

33. Dissection of the soldering.
Laparoscopic dissection of the soldering

34. Not formed intestinal fistula
Tube intestinal fistula
Lip intestinal fistula

35. Plastic of the anterior abdominal wall by Voznesenskiy