Complications of appendicitis: complete list, signs

The first day after the intervention

Surgery to remove the appendix is considered a non-hazardous procedure.

The rehabilitation period after appendectomy is 2 months. Young patients who led a healthy and active lifestyle before the intervention recover faster. It is more difficult for children and overweight people to recover.

It is important to understand that removal of the appendix is a wide-ranging open intervention and the doctor’s recommendations on behavior in the postoperative period should be taken with full attention!

After the operating room, the patient goes to the surgical ward, and not to the intensive care unit. Intensive care unit after appendectomy is not indicated.

The intervention is carried out under general anesthesia, so in the first hours after the operation it is important to properly remove the patient from this state, prevent disturbances in brain function and prevent vomit from entering the trachea and lungs. What should you do on the first day:

Lie for the first 8 hours after the intervention and only on your left side. This promotes free passage of vomit and less additional trauma to the patient.
If the patient's condition is satisfactory, then after 8 hours he is allowed and even prescribed to sit down, make careful movements, stand with the help of a nurse or on his own.
During this period, the administration of injectable painkillers and antibiotics is prescribed to stop a possible inflammatory process.

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The duration of stay in the surgical department is no more than 10 days. If the patient is confidently recovering, then, as a rule, he is transferred to outpatient treatment on the 4th day after the intervention. What medical staff must do:

monitoring of temperature, blood pressure, condition of sutures;
monitor the quality and quantity of urination and bowel movements;
dressings;
prevention of possible complications.

Accumulation of gases due to complications of appendicitis

In the absence of treatment, catarrhal inflammation in appendicitis passes into the phlegmonous stage, and then into the necrotic stage. Perforation of infected masses from the appendix due to divergence of the tense walls of the organ leads to the development of acute peritonitis, that is, inflammation of the entire peritoneum.

This complication can occur one to three days after the onset of the disease. This happens mainly due to the fact that a sick person does not consult a doctor at the first sign of illness. When appendicitis passes into the necrotic stage, the pain often stops, this is due to the fact that the nerve endings die at this moment.

The patient believes that everything has returned to normal and therefore is often admitted to the hospital in critical condition, when pain due to an extensive inflammatory process begins to increase again.

Abdominal bloating, observed with peritonitis, is a characteristic sign of extensive inflammation. With peritonitis, almost all parts of the abdomen are involved in the inflammatory process, and this directly affects digestion and the accumulation of gases. Bloating is also associated with the fact that peritonitis causes intestinal atony, and the passage of gases does not occur, that is, they accumulate and manifest symptoms that are unpleasant for the patient.

Peritonitis, which develops as a complication of appendicitis, is manifested by several characteristic signs. Pain in this condition is no longer localized in one place, but spreads throughout all parts of the abdomen. The patient has tachycardia, severe weakness, may have a high temperature, and blood pressure decreases.

Developing peritonitis requires immediate surgery; the later treatment of this pathology begins, the worse the prognosis for the sick person.

How to live after discharge?

After having your appendix removed, you should not overexert yourself.

After discharge, vigorous physical activity should be avoided. But at the same time, do not lie in bed all day.

This will lead to stagnant processes, the formation of adhesions, and disruption of the blood supply to organs.

On the third day after the intervention, you should begin to move around the bed and visit the bathroom independently to relieve your own needs. Wearing a bandage is indicated. Obligatory for obese patients.

During any sudden movements - coughing, sneezing, laughing - you should support your stomach. This will reduce the stress on the seam area. Don't lift weights! Within 14 days after the intervention, you should lift no more than 3 kg.

In agreement with the doctor, the patient is prescribed a course of therapeutic exercises. At home, quiet walking is recommended. Active sexual life is allowed 2 weeks after discharge and if there are no problems with the healing of the suture.

Bloating and flatulence with appendicitis, as a sign of the disease

Flatulence is an excessive accumulation of gases due to their increased formation or poor removal from the intestines. Flatulence is characterized by a feeling of abdominal distension, cramping pain in different parts of the intestines, a feeling of heaviness and bloating. Flatulence appears during the development of appendicitis almost simultaneously with pain, although in some people this sign of the disease may be absent.

The reason why excessive accumulation of gases is observed in appendicitis can be attributed to several changes at once, and all of them are associated with disorders occurring during acute inflammation. Appendicitis is an inflammation of catarrhal, phlegmonous or other processes of the rectum. Abdominal bloating with appendicitis occurs due to blockage of the lumen of the organ with feces, a tumor, a ball of parasites, and in rare cases, a foreign body.

Appendicitis often occurs after infectious diseases or vascular pathologies. As a result of inflammation, local blood circulation is disrupted, a focus of infection occurs, and intestinal function is disrupted. Infectious inflammation leads to the growth of bacterial flora.

All these changes ultimately lead to the fact that the process of food digestion in the intestines is disrupted, its evacuation ability changes and putrefactive processes develop. The result of this can be called flatulence and bloating, which appears in acute appendicitis.

Naturally, increased accumulation of gases in the abdomen is not a defining sign of acute inflammation of the appendix; the doctor usually evaluates all manifestations of the disease together. In addition, it is important to carry out differential diagnosis.

Excessive accumulation of gases is also observed in other diseases of the digestive system. In order to avoid mistakes when making a diagnosis, it is necessary to evaluate the results of diagnostic measures, blood tests and instrumental examinations. In addition to bloating, which is related to dyspeptic disorders, appendicitis is also characterized by:

The appearance of pain. Initially, it is localized in the upper abdomen, then over the course of four to six hours it descends to the right iliac region.
An increase in temperature often occurs in children and this refers to manifestations of intoxication of the body.
In addition to flatulence, dyspeptic disorders also include nausea and vomiting. Accumulation of gases can be observed in all parts of the abdomen, and may be more disturbing on the right side, which is manifested by cramping pain. After the gases pass, temporary relief occurs.
On palpation, sharp pain and tension in the abdominal muscles on the right are noted.

All these signs are characteristic of the typical course of acute appendicitis, but there are also patients with an atypical course of the disease. They may not have pain or they may be located only in the upper abdomen, radiating to the lower back, liver, or rectum. Uncharacteristic pain is associated with different locations of the rectal process.

In adult patients, acute inflammation of the appendix can occur with scanty symptoms, so patients rarely go to the doctor on the first day of the disease, and this leads to complications.

The absence of pain during appendicitis is also typical for elderly patients; on the contrary, they may be more worried about bloating and flatulence. At this age, there is no noticeable tension in the muscles of the abdominal wall upon palpation. Therefore, the surgeon must be especially attentive to the examination of older patients.

Nutrition during the postoperative period

Diet after appendectomy is very important.

The second most popular question for a doctor after surgery is what can you eat? The patient will have to follow a diet for 14 days.

On the first day after the intervention, only drinking regimen is indicated. No solid foods. Non-carbonated mineral water or low-fat kefir are allowed.

On the second day you should start eating. This will allow you to quickly restore intestinal motility. Meals are fractional, in small portions - from 5 to 6 times a day. What to bring to the patient for lunch:

liquid porridge;
vegetable purees from non-fermentable vegetables;
fruit purees;
broths;
fermented milk products except sour cream;
pureed meat;
jelly;
compotes.

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On the fourth day, the diet expands. You can add dried bread, gradually introduce solid foods, herbs, baked apples, meat and fish. Fermented milk products in any form and quantity are indicated to normalize the microflora.

Subsequently, the patient returns to his usual diet. But any changes in diet should be agreed with your doctor.

How is abdominal surgery performed?

A cavity appendectomy takes 30-60 minutes. Its duration largely depends not only on the diagnosis, but also on the physical condition of the patient: his age, obesity, body structure. It is carried out according to this plan.

The patient is given anesthesia (or local anesthesia).
An oblique incision (about 7 cm) is made under the right lower rib. If at this moment a cloudy liquid appears, the doctor collects it and sends it for analysis.
The appendix along with the base of the intestine is brought out into the resulting incision.
The process is compressed, its mesentery is fixed with special medical forceps.
The doctor makes a suture on the blind intestine.
The base of the process is tightly bandaged. For this, medical thread is used.
The damaged appendix is removed, the stump is sutured and hidden in the cecum previously prepared for this purpose, tightly tightening the suture on it.
The intestine is immersed in place, the wound is sutured.

Sometimes, if there is bleeding or inflammatory changes in the intestine or other indications, the doctor leaves a drainage.

When surgical treatment of acute appendicitis is completed, the patient is sent to the ward for rehabilitation.

What should you exclude from your diet?

After appendix removal, alcohol is strictly prohibited.

You should follow your doctor’s nutritional recommendations not only in the early postoperative period, but also 2 weeks after discharge.

Any products that cause fermentation and irritation of the intestinal walls are strictly prohibited.

This diet is aimed at reducing the risk of rupture of internal sutures and postoperative bleeding during the rehabilitation period. The following foods and drinks are prohibited:

alcohol in any form. The use of alcohol-containing medications should be discussed with your doctor;
reduce the amount of salt consumed, do not use seasonings and spices;
beans, peas, other legumes;
exclude certain types of vegetables - tomatoes, raw green and onions, cabbage in any form, hot peppers;
smoked meats and semi-finished products;
conservation;
strong coffee;
carbonated sweet and mineral waters;
grape juice and wine.

This video will tell you how to eat properly after appendicitis removal:

Types of appendicitis

Today there are 4 types of appendicitis known. These are: catarrhal, phlegmonous, perforative; gangrenous.

The diagnosis of catarrhal appendicitis is made by a doctor if the penetration of leukocytes into the mucous membrane of the worm-shaped organ has been noted.

Phlegmonous is accompanied by the presence of leukocytes in the mucosa, as well as other deep layers of appendix tissue.

Perforated is observed if the walls of the inflamed appendix of the cecum have been torn, but gangrenous appendicitis is the wall of the appendix affected by leukocytes, which is completely dead.

Water treatments

Surgery, blood, a surge of adrenaline, vomiting and the patient realizes that after the operation he smells unpleasant. But you will have to wait a bit with water procedures.

Until the stitches are removed, bathing and showering are prohibited. It is allowed to wipe the body with water, wash your face, and wash your feet.

After the stitches and bandage are removed, the restrictions are removed, but you should not rush to the bath or sauna. Doctors recommend short-term bathing in the shower.

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The suture area should not be rubbed or massaged. It is not advisable to use decoctions of medicinal herbs while bathing, as they dry the skin.

After bathing, the suture area is treated with antiseptics prescribed by the attending physician.

Physical exercise

The postoperative period is characterized by low mobility, violations of the integrity of blood vessels lead to increased blood clotting and the formation of blood clots. Most doctors believe that dosed exercises help relieve many rehabilitation problems.

Physical therapy (physical therapy) is part of recovery methods. Together with physiotherapy, it improves metabolic processes, stimulates blood circulation, tones muscles and blood vessels.

Exercises are prescribed while on bed rest. Shown:

bending the legs at the knees;
turns of the feet and hands;
breathing exercises;
other exercises that do not affect the abdominals.

Usually after 3 days the patient can get up. To help the abdominal muscles, many patients are recommended to wear a bandage. The stomach should be protected from excessive tension when coughing and other tremors.

In the future, the increase in physical activity occurs gradually. For the initial 2-3 months, the best way to recover is walking. It is better to walk in parks, where there are good, smooth paths and fresh air.

An important part of rehabilitation is strengthening the immune system. The doctor may prescribe special means to increase it.

Lifting heavy objects weighing more than 3 kg is prohibited. You should not perform work that requires excessive effort and tension in the abdominal muscles.

For rehabilitation after removal of appendicitis, swimming in the pool is indicated. It helps, without overstraining the body, to increase the overall tone of all muscles.

Please note: you can start having sex 2-3 weeks after surgery, if your health allows.

Seam and care

After removing the appendix, you need to monitor the condition of the suture.

The patient sees only the outer seam on the skin. But fabrics are cut and sewn in layers, so internal seams require the same attention as external ones.

For several days or weeks, the patient will experience pain and a feeling of tissue tension.

This is fine. But there are a number of conditions in which pain is a symptom of a complication. Pathological conditions of the surgical suture:

hyperemia, swelling;
bloating and swelling appeared;
the seam began to get wet;
temperature increase;
discharge of pus and blood from the suture;
pain in the suture area lasting more than 10 days after the intervention;
pain in the lower abdomen of any location.

Why do complications develop in the area of the surgical suture? The reasons are varied and their occurrence equally depends on the behavior of both medical personnel and the patient:

wound infection during surgery and during the rehabilitation period;
violation of the rules for caring for surgical sutures;
abdominal tension – heavy lifting, not using a postoperative bandage;
impaired immunity;
elevated blood sugar levels.

Although pain in the suture area after an appendectomy is normal, you should not attribute any unpleasant sensations to it. Self-medication is prohibited and in case of any unpleasant phenomena you should contact a medical facility.

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When the right side or stomach may hurt

If after removal of appendicitis the right side hurts for a long time, one may suspect the development of undesirable consequences . Complications after the disease are varied, but if all medical recommendations are followed and the surgeon performs the operation correctly, they are extremely rare.

Chronic appendicitis

Chronic appendicitis occurs when the appendix is incompletely removed , when a stump remains at the site of excision. Over time, it becomes inflamed, the infectious process becomes sluggish, often lasting for months or even years.

Main symptoms:

nagging pain of a wave-like nature;
bowel dysfunction, alternating diarrhea and constipation;
moderate intoxication during exacerbation with nausea or vomiting.

An adequate method of treatment is repeated removal of the appendix, sanitation of the abdominal organs. Additionally, antibacterial and symptomatic therapy is prescribed.

Spikes

An adhesive process occurs after any surgical intervention and is formed due to irritation of the mucous membranes and impaired mucus secretion.
After removal of the inflamed appendix, adhesions form in the intestines and peritoneal organs - thin films that appear inside the cavity lumens and peritoneal organs. Among the symptoms of the adhesive process are :

discomfort in the lower abdomen, pain during bowel movements;
chronic constipation, prolonged absence of stool;
flatulence, gas formation.

To eliminate the adhesive process, most often it is enough to follow a diet with foods rich in fiber, take osmotic laxatives and drink plenty of fluids. Its complicated course requires surgical intervention.

Peritonitis

Inflammation of the abdominal organs and lining membranes of the peritoneum is a dangerous complication requiring emergency surgical intervention .

Symptoms of peritonitis are expressed in the following manifestations::

nagging and then sharp pain in the right hypochondrium;
acute intoxication: nausea, vomiting, fever;
“acute abdomen” syndrome – upon palpation, tension in the muscles of the abdominal wall is noticeable;
intestinal obstruction, difficulty in evacuating feces even after taking laxatives or enemas;
increased heart rate;
grayish complexion;
cold, sticky sweat.

Usually, the diagnosis of peritonitis does not require additional research : an experienced surgeon identifies the complication and understands its severity upon palpation of the peritoneum.

Peritonitis as a complication of appendicitis occurs extremely rarely , but occurs in patients with autoimmune pathologies, chronic appendicitis, and violation of appendectomy technique.

Hernia

Umbilical and inguinal-scrotal hernia are characterized by protrusion of scar tissue outward , resembling a small lump. This is due to weakness of the abdominal muscles. At risk are persons with a history of umbilical or inguinal-scrotal hernia (men), pathological weakness of smooth muscles of any nature, as well as elderly and elderly people.

Important! The main danger of a hernia is the possibility of strangulation, which is eliminated by abdominal surgery or laparoscopy; in other cases, they are limited to conservative treatment and wearing a special bandage.

Hernia symptoms:

pain and swelling;
bowel dysfunction;
increased gas formation, flatulence;
moderate dyspepsia.

Characteristic signs of a hernia are difficulty defecating, blood particles in the stool, pain in the lower abdomen after any physical activity or at rest. Complications include transient diseases of the gastrointestinal tract: enterocolitis, colitis, paraproctitis, etc.

Heart rhythm disturbances, shock due to acute pain due to the inflammatory process, respiratory disorders, difficulty urinating and defecating (as a side effect of certain medications), and local suppuration in the area of the postoperative scar are often observed.

Other reasons

After appendicitis, the stomach hurts for other reasons not related to the operation . Most often, pain is periodic due to physiological characteristics or existing concomitant diseases.

Nonspecific causes of pain in the right side after appendicitis:

Ovulation in women . The ovulation period occurs 1.5-2 weeks before menstruation. Women complain of moderate nagging pain and spotting vaginal discharge even before menstruation. Pain also occurs during pregnancy.
Gynecological diseases . Pain in the right side can be caused by ovarian cysts, tumors of any nature and morphological structure, endometriosis, and sexually transmitted infections. The clinical picture requires mandatory differential diagnosis.
Cholecystitis . Pain on the right also occurs against the background of cholelithiasis, acute cholecystitis, inflammation of the liver and organs of the hepatobiliary system. Acute pain is often observed during exacerbation of the pathological process.

Possible complications

The most dangerous complication is peritonitis - acute diffuse (spread) inflammation of the abdominal organs, accompanied by intoxication, septic complications, and severe signs of multiple organ failure. Mortality from peritonitis reaches 45-50%, and in a complicated form due to the lack of adequate medical care - 65%.

Other complications include digestive disorders, acute intestinal obstruction, stool disturbances, and suture dehiscence, but they can be easily treated with medication or as a result of repeated surgery.