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. In some patients with destructive forms of appendicitis determined admit! abscessed omentita as clearly delineated sections decrease echogenicity. Most of the children accompanied by acute appendicitis accumulation of free fluid in mezhpetlevyh spaces, right lateral channel and in the pelvis.
Amount of exudate is not correlated with the shape transformation appendiceal inflammation and depends, apparently from individual plastic properties of the peritoneum. When gangrenous inflammation in the overwhelming majority of cases it is possible to see almost the entire appendix due to its considerable size, rigidity and pronounced changes in the periap – pendikupyarnyh structures (omentit, cecitis) creating conditions for its determination.
OD gangrenous appendix is modified in the range of 7 to 12 mm (in certain cases, it is 22 mm). One of the main sonographic criteria of this form is the absence of the layered structure of the wall of the appendix or a fragment thereof. The wall of the appendix looks homogeneous and hypoechoic, its thickness is on average 3-3.5 mm. Lumen of the appendix considerably expanded (4-7 mm), filled with heterogeneous content of fine sediment (purulent component fibrin fragments) and fecaloma as hyperechoic inclusions of various sizes with fuzzy acoustic shadow.