SURGICAL TREATMENT OF GANGRENEOUS AND PERFORATED APPENDICITIS. CLINICAL MANIFESTATIONS AND DIRECT RESULTS
Authors: Ievtushenko O. V. 
Published: October 2022

Introduction. Acute appendicitis remains the most common surgical pathology of the abdominal cavity. Perforation is found in 13-20% of patients with acute appendicitis, and intra-abdominal or pelvic abscess develops in 3-8%.

Aim: analysis of results of surgical treatment in patients with gangrenous and perforated appendicitis, complicated by abdominal abscess or peritonitis.

Materials and methods. A retrospective analysis of surgical treatment results for 151 patients with complicated appendicitis (gangrene of perforation), treated in one surgical department of KNP MBL №18 during 2010-2020.There were 80 men (53%) and 71 women (47%) of median age 46 years (ranged from 19 to 85 years)

Patients with gangrenous appendicitis accounted for 16.4% of operated patients with acute appendicitis, perforation was found in 39.1% of them.

Results. The time between symptom onset and hospitalization ranged between 1 and 14 days, average - 3 days. CBS revealed leukocytosis (WBC) with neutrophilic shift, lymphopenia. Elevated hematological indices were determined. CRP level averaged 198.5 mg / l (23-48 times higher NR), IL-6-16.7 IU (2-7 times higher). Open appendectomy (McBurney) was performed in 124 (82.1%) cases, laparoscopic appendectomy in 8 (5.3%), and midline laparotomy - in 19 (12.6%).

Appendicular abscess was found in 3 (0.2%), periapendicular abscess in 59 (39,1%), pelvic abscess in 4 (2.6%), fibrinous-purulent or purulent peritonitis was found in 85 (56.3%). Gangrenous appendicitis without perforation was found in 89 (59,9%), gangrenous appendicitis with perforation in 62 (41,1%).

Complications in the postoperative period were observed in 12 (7.95%) patients, of which Grade 3b-11 (7.28%), Grade 5-1 (0.66%). Relaparatomy were performed in 12 (7.95%) patients. The reason for relaparatomy in 2 (16.7%) was bleeding from the appendicular artery, in 1 (8.3%) - pelvic abscess, in 2 (16.7%) - abdominal abscess. In 7 (58.3%) patients, relaparatomy were performed in connection with the development of early adhesions obstruction of the small intestine and enteral insufficiency, clinical peritonitis.

Relaparatomy were performed in 11 (7.7%) of 143 patients after open appendectomy. 7 of them underwent McBurney appendectomy, 4 underwent laparotomy, appendectomy, draining of the abdominal cavity in connection with widespread peritonitis. Perforation of gangrenous appendicitis was in -7, gangrene without perforation in -4 patients. Laparoscopic appendectomy (8 patients) was performed, relaparatomy were performed in 1 (12.55%) patient with gangrenous-perforating appendicitis due to the clinic of peritonitis and the development of adhesions obstruction of the small intestine, enteric insufficiency. 1 (066%) patient with a clinic of abdominal sepsis died.

Conclusions: gangrenous appendicitis was found in 16,4% of patients, gangrenous appendicitis and its perforation in 41,1% of them. The development of gangrenous appendicitis is accompanied by significant changes in WBC formula: leukocytosis with neutrophilic shift, decreased lymphocytes raised inflammatory markers (CRP and IL-6). Serious complications that require surgical interventions after treatment of gangrenous and perforated appendicitis occurred in 7,95%. The causes for relaparatomy were bleeding from appendicular artery, abscess of the abdominal cavity or small pelvis, early adhesions obstruction of the small intestine.