complexity of diagnosing appendicitis in women is due to the many features of the female body, among which the first place is a series of anatomical and physiological factors.Many authors have long found that usually the caecum is lower in women than in men.
| appendicitis in women: |
| Appendicitis |
examination of patients with suspected acute appendicitis
Symptoms of acute appendicitis
appendicitis and menstrual cycle
Acute appendicitis and pregnancy
Acute appendicitis and ectopic pregnancy
And. P. Zhendrinsky studying differential diagnosis salpingoophoritis, appendicitis and ectopic pregnancy, has established laws of location of the cecum and appendix in women.He observes that the cecum women unmarked line was above 12.5% of the level of the line - in 34,1%, below the line - 38.4% and in the pelvic cavity - 14.5%.IP Zhendrinsky distinguishes 5 types appendix location in relation to the cecum: a straight line (3.8%), medial (31.9%), retrotsekalny (15.1%), lateral (9%) and subtsekalny (4
, 2%).In direct location appendix directly relating to the rights of the uterus in 65%, with the medial - to 34.6%, while retrotsekalnom - 65%, while the lateral - 34.6%;when subtsekalnoy localization process is not in contact with the uterus.Dupuy de Fresnel distinguishes between two degrees of pelvic location of appendix: I degree - cecum is in the iliac region, and its process is lowered into a small basin, touching the tip of his right-wing of the uterus;Grade II - the cecum is omitted in the pelvis and along with the offshoot is located near the appendages.
Among the most practically important variants of deviation from the normal position of the cecum VI Kolesov low notes, or breech, a position common in men 16% and women 30%.Relevant data TF Lavrova - 23.7 and 43.5%.According to her data, women especially often observed location of the appendix is entirely in the pelvic cavity.
increasingly important to change the topography of the cecum and appendix in connection with pregnancy, when there is a shift of the cecum and appendix upwards and outwards increasing the uterus.
position of the cecum in the different stages of pregnancy
X-ray examination, NA Vinogradov found that in the first half of pregnancy cecum is in its usual place: the horizontal position of women - 5-7cm, while the vertical - 9.5 cm below the iliac crest.In V-VI months pregnant cecum in a horizontal position already at 1 cm will stand above the crest of the ilium, and the vertical is only 5.5 cm below it.VI-VII In the month and the horizontal and vertical position rises above the cecum ilium respectively 2.2 and 0.5 cm, and VIII-IX month lowered (horizontal) to the level of the iliac crest.
After birth intestine falls down and becomes greater mobility than before pregnancy.Highly mobile and low cecum is located in a lot of women giving birth.
options location of the cecum and appendix are explained: a) the mobility of the cecum;b) length mesenteriolum process;c) a tendency to prolapse of internal organs, in particular visceroptosis in nulliparous women.
between lymphatic system ileocecal angle (and appendix), on the one hand, and the lymphatic system, a number of bodies (and in particular, the right ovary) - on the other hand, a significant number of anastomoses, which play a significant role in the spread of the inflammatory process.It was found that on the right ovary departs greater lymphatic vessels than on the left.
vermiform process of innervate richer than other portions of the gastrointestinal tract.Powerful innervation of the appendix has not yet found a satisfactory explanation, and serves as the main argument of scientists do not consider the appendix vestigial organ.Contrary to this, according to the AG Brzhozovsky rich neural network process helps the body to wither away to resist harmful influences.
Innervation of the appendix is derived from branches of the superior mesenteric and solar plexus, and this explains the so-called epigastric pain phase (symptom Kocher) in acute appendicitis.Job SD Astrinskogo who found morphological connection between the sun and the pelvic plexus that innervate the female genital organs, throws light on the similar painful symptom of appendicitis, and some diseases of the female reproductive organs.According to A. Blind, you can select the complex neural connections with morphological basis for the formation of mezhorgannyh reflexes: the bladder - the uterus - fallopian tube - the large intestine.
abdomen in women is not closed as in men, and is in contact with the outside world through the fallopian tubes.It is likely that in this way the peritoneum systematically infected.On the one hand, it can cause inflammation of the peritoneum more frequent in women, and the other - explains its increased resistance to infection.
At low location of the appendix to the value for the flow of appendicitis has a high suction capacity of the pelvic peritoneum.
Gynecologist KN Rabinowitz in a paper read at a memorial in the history of the doctrine of appendicitis Leningrad regional and city conference, pointed out that the course of appendicitis in women aged blooming effect such a powerful sex gland, like the ovary.Moreover, he rightly believed that a greater incidence of appendicitis in women and at the same time easier for it can be attributed to cyclical which take blood to the pelvic organs, trenirovannostju peritoneum in fighting infection (the connection with the outside world), greater resistancethe female body to infection and blood loss due to the nature of the reticulo-endothelial system.According to this author, "the existence of the pelvis of the uterus of women and appendages is the cause of lower mortality rate of women from appendicitis. The inclusion of these bodies near the appendix creates more favorable conditions for the formation of adhesions, process limitations. Undoubted impact on the nearby appendages appendixproviding menstrual cycle. "
In order to objectively determine the effect of appendicitis at pregnant uterus GI Ivanov used the method of outdoor hysterography in 55 pregnant women, of whom 9 were suffering acute and 46 chronic appendicitis.Based on the analysis gisterogramm author I came to the conclusion that "inflammation of the appendix has an effect on uterine activity by changing its laws, due to the timing of pregnancy This influence can be both inhibitory and excitatory;. Recently there more often."
Interesting data on the effect of pregnancy on the pathology of the appendix obtained Tedeschi and Botta.Histologically 90 of the appendix removed at various stages of pregnancy, in 15 specimens (16.6%) was found ectopic decidua reaction, and in 2 cases - in conjunction with endometriosis process.
All these considerations give reason to believe that a woman's body has a complex anatomical and physiological conditions, firstly, contributing to higher incidence of appendicitis, secondly, complicating its detection, thirdly causing its more favorable course.
relationship appendix and female reproductive organs explains the difficulty of identifying the source of pathology with pain in the right lower quadrant of the abdomen in women.It also causes the simultaneous participation in the pathological process of process and appendages - the so-called appendiceal-genital syndrome, which is officially recognized as a nosological entity in 1951 at the International Congress of gynecologists in France.Miller, being a supporter of Sali theory that considers both the abdominal appendicitis tonsillitis, explains the frequent incidence of young women with chronic tonsillitis and appendicitis negative effect of estrogens on the lymphoid apparatus.According to him, based on an analysis of more than 6,000 cases of acute appendicitis, acute inflammation of the appendix usually occurs in men.It is hardly convincing these arguments in favor of the theory of Sali.
Abroad popular mechanical theory of appendiceal-genital syndrome, which explains its origin as follows.Changes in the female genital area, especially during menstruation and pregnancy, contribute to the formation between the process and the appendages of adhesions, which is a transition of infection from infected to a healthy body.Under these conditions, the slightest violation of the circulation or peristalsis of the appendix can lead to inflammation.This idea was expressed earlier and domestic authors.However, despite a number of provisions of the rational mechanical theory, it should be recognized that the complexity of appendiceal-genital syndrome does not fit in its narrow confines.
Female magazine www.BlackPantera.ru: Eugene Dekhtyar