Surgery
Surgery is done when rehydration and businesses drop in body temperature has been reached. Body temperature does not exceed 38 ° c, the production of urine ranges from 1-2 ml / kg / hour. Pulse under 120/menit.
Surgical technique
Transverse incision on the right just below the umbilicus. Fowler Weier incision is preferred because it can quickly reach the abdominal cavity and the incision when needed and could be extended to and facilitated by cutting medial rectum muscle. Before opening the peritoneal edge incision secured with gauze. Opening the peritoneum and the first few straws were prepared such that the pus can be sucked directly without contamination to the edge of the incision. Peritoneal incision is enlarged and pus continued exploitation. Apendektomi done as usual. Peritoneal cavity Perncucian absolutely done with physiological saline until completely clean. Fluid that added look weary when smoked again. The collection of pus usually found in the appendix fossa, below the diaphragm and pelvis ronga among the intestines. Incision wound was washed with physiological NaCl solution and also after the peritoneum lining the peritoneum and the fascia that attach muscles partially sewn. Suturing the cut should not be done too strong and tight. Dren intraperitoneal installation is controversial. When washing the peritoneal cavity is completely clean Dren is not required. Better than the washed out without Dren Dren fitted washed clean less.
Note
Infiltrate the inflamed appendix can spread is limited by the omentum and the intestines and peritoneum around it to form a mass (mass apendiceal). Appendix mass is generally formed on day 4, since the inflammation begins in case of no general peritonitis. The mass of the appendix is more often found in patients aged 5 tyahun or more, the immune system has progressed well and the omentum was long and thick enough to encapsulate the process of inflammation.
Therapy
Perforated appendicitis
Preparation prabedah: sonde installation and the action of gastric decompression. Rehydration, decreased body temperature. With broad spectrum antibiotics, adequate doses are given intravenously.
Appendicitis with generalized peritonitis complicating
Clients are generally in poor condition. Looks septic and hypovolemic conditions and hypertension. Hypovolemic due to long fasting, vomiting, and concentration of liquids in the process of inflammation, such as intraperitoneal organ edema, abdominal wall and the collection of fluid in the cavity of the intestine and the peritoneal cavity
Preparation Pre-Surgical:
1. Installation to decompress the stomach sonde
2. Catheters to control urine production
3. Rehydration
4. With broad spectrum antibiotics, high doses and administered intravenously
5. Drugs decrease the heat, as anti meninggigil Phenergan, largaksil to open the peripheral blood vessels is given after rehydration is achieved.
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