Pyocele In the development of an abscess periappendikulyarnogo depending on the severity of his capsule distinguish 3 stages:
1) PAA-1 – a collection of pus around the destructive changes of the appendix, a loose demarcation of local inflammation infiltrated tissues, the presence of delicate fibrinous deposits.

2) PAA-2 – presence of severe capsule abscess, the walls of which is flexible.

3) PAA-3 – the presence of capsules ulcer with dense rigid walls.

In children, the most frequently observed PAA PAA -1 and -2 because of the weaker ductile properties of the peritoneum, and the rapid transition to a local inflammatory process spills when upon reaching a certain pressure within the abscess breakthrough occurs capsules ulcer and abdominal infections. Continue reading

Diffuse appendicular peritonitis (PDR) Assessment of severity of diffuse peritonitis at based on clinical symptoms, laboratory tests and evaluation on the changes detected in the step (a form of appendicitis, the rate of change of the peritoneum, the nature and amount of effusion in the abdomen and the severity of intestinal paresis).

Distinguish 3 stages ATM clinical characteristics. The proposed division stage ATM allows articulate the scope and nature of surgical interventions that facilitates the solution of tactical problems faced by the surgeon during surgery and in the postoperative period. Demarcated appendicular peritonitis (CAP). Continue reading

Cause of acute abdominal syndrome Inflamed appendix is ​​not modified Seen and other echografically revealed changes (most – education cystic right ovary) are regarded as a cause of acute abdominal syndrome. Reduce the likelihood of false- echo – graphic conclusions can be exactly as described in the study of children with acute abdominal pain, as well as by increasing the time and the frequency of the study.

During prolonged compression in the right iliac region by cecal growth spasm decreases the influence of artifacts associated with the presence of gas in it and chyme. In some cases it is advisable to carry out follow-up study in 1-2 hours if the patient’s condition allows. Must also be aware of the possibility of the child comorbidity non currently cause of acute abdominal syndrome. Unchanged appendix evaluated as inflammatory transformed. Continue reading

The location of the appendix Retroperitonealnoe location of the appendix is very rare. All children with a similar localization usually come to the hospital for 3-4th day of onset. In this regard, the ultrasound revealed only complicated forms of acute appendicitis as periappendikulyar – ing infiltrate. Identifying these changes because of the large size, the presence of a liquid component and a pronounced reaction periappendikulyarnyh structures presents no significant difficulties. Continue reading

Echo-graphy When sonographic study with a significant degree of confidence not only to determine the form of inflammatory transformation of the appendix, but also to obtain data on the characteristics of its location. This is of particular importance in atypical localizations appendix. It is the location of the appendix determines the clinical manifestations of appendicitis in children, creating additional diagnostic difficulty. Sonography in such situations in most cases allows to specify the diagnosis, determine the characteristics of surgical access during appendectomy. By atypical localization include obstructive, pelvic, and retroperitoneal location retrotsekalnoe appendix.

When podpechepochnom location echo graphic identification of the amended appendix enough available due to the fact that the edge of the liver acts in these cases as an acoustic window, creating additional conditions for the determination of the appendix. Continue reading

Place perforation In some patients with severe inflammatory transformation can not see the place in the form of wall perforation defect circuit sizes from 2 to 3.5 mm. Perforations may detect a location by using sensors with frequencies of 7.5-10 MHz, since the lower frequency transducers have a resolution. When scoping study of the abdominal cavity and retroperitoneal space defined diffuse changes in other internal organs.

These changes (given the lack of appropriate anamnestic data and fast dynamics of postoperative edema) can be regarded as reactive (secondary) on the background of intoxication expressed. Do vsehdetey determined changes in the liver in the form of a significant increase in its vascular pattern, increasing the anterior-posterior size of the right lobe 10-15 mm compared with middle-aged norm. Continue reading

Changes periappendikulyarnyh tissues In some cases, such changes are also seen periappendikulyarnyh tissues kakomentit, cecitis, inflammatory transformation of mesenteric glands ileocecal angle. Inflammatory changes in the dome of the cecum (typhlitis) are characterized by significant thickening of its walls from 4-5 to 10-11 mm with a pronounced stratification wall mainly due to swelling of the mucous layer, and rigidity cecal wall. Similar changes were observed in the study of the terminal ileum quiche ki, which are regarded as ileitis reactive nature. Inflammatory transformation fragments omentum (omentit) is often seen in patients with destructive forms of inflammation of the appendix. Omentit identified by the presence of inhomogeneous education mainly increased echogenicity without clear smooth contours.

The structure of education – close-meshed, it is intimately adherent to the amended appendix and other structures of the ileocecal region does not move during compression. Continue reading

Patients with abscess form Overwhelming majority of patients with acute appendicitis abscess form can not get the full longitudinal – process, is determined only by a fragment in the transverse or longitudinal section. OD phlegmonous modified appendix ranges from 6.5 to 11.5 mm and is not dependent on the age of the patient.

It should be noted that the outer diameter dimension, which is an important diagnostic of inflammatory transformation be carried out at a cross section available vizualization most fragment modified process. In all cases it is possible to detect a significant thickening of the wall layers visible appendix. Continue reading

Inflammatory process in the appendix Inflammatory process in the appendix alters its normal ehotraficheskuyu characteristic. First of all, it decreases displaceability appears rigidity (can not be compressed), significantly transformed its internal structure, changing the diameter. Together, these factors contribute to a more favorable environment for the determination process on the background peristaltiruyuschih, flexible (subject to compression) bowel loops.

In addition, the presence of effusion (in mezhpetlevyh spaces projected right lateral canal and pelvis), often accompanying protsessuv acute abdomen, especially in children, creates additional conditions contrasting increased in size fixed inflamed appendix. Echographic semiotics amended appendix is very variable and depends strongly on the nature of the inflammation. The greatest difficulty is identifying reliable echographic semiotics catarrhal form of acute appendicitis in children. Continue reading

Research the right iliac region The methodology of research right iliac region in children with suspected acute appendicitis is graded compression technique. He is to put pressure line sensor to the anterior abdominal wall at the point of maximum tenderness – for leveling artifacts associated with the presence of gas in the terminal ileum and cecum dome, as well as to minimize the distance between the skin and the appendix. That allows the use of a sensor with high resolution.

Compression should be the most gentle, given the severity of the child’s negative reaction to pain, good imaging capabilities with ultrasound in children, small depth “area of interest”, as well as a possible shift of the target organ of the ultrasound slice. In some cases, the surface location of the inflamed appendix is a need for compression generally disappears. In addition to the research area of maximum tenderness less sensitive areas are also examined to detect changes in periappendikulyar – structures ileitis, tiflita, omentita, mesadenitis – ha mezhpetlevyh infiltrates and abscesses. Continue reading