Appendicite: processo infiammatorio a carico di un piccolo diverticolo detto appendice vermiforme. Come si instaura il processo patogenetico? Diagnosi e terapie di una malattia dal carattere sociale.

L’appendicite acuta è una patologia comune, che interessa circa un individuo su sette nell’arco della vita colpendo soprattutto i giovani, tra i dieci e i trenta anni di età, che vivono in particolare nei paesi industrializzati e vengono sottoposti ad abitudini sedentarie e dieta squilibrata.

Anatomia dell'appendiceLa patogenesi ha un ruolo fondamentale in quella che è la manifestazione sintomatologica tipica dell’appendicite. L’infiammazione avviene tipicamente grazie alla congestione tissutale dovuta principalmente all’occlusione del lume dell’organo. L’ostruzione del lume porta ad un ristagno della flora batterica fisiologica che degenerando, causa infezione e quindi una risposta infiammatoria.
Questa situazione porta ad una iperproduzione di muco che, riversandosi nel lume appendicolare, determina un aumento della pressione che viene conseguentemente esercitata sulle pareti interne del viscere. Durante questa fase l’infezione è circoscritta e l’appendice risulta arrossata, tumefatta e associata alla presenza di vasi dilatati e ben visibili.
Successivamente la pressione esercitata sulle pareti provoca la formazione di aree di necrosi, segno evidente di ampliamento dell’infezione e congestione dell’organo che si presenta violaceo ed inspessito.
La fase più avanzata della patologia è caratterizzata da un colorito grigio verdastro dell’appendice associato alla presenza di ampie aree necrotiche talvolta perforate  con fuoriuscita di materiale purulento e fecale.


La patologia presenta una sintomatologia tendenzialmente aspecifica e di difficile interpretazione.
Nonostante questo, è spesso rappresentata da un senso di malessere generale, accompagnato ad una sensazione di dolore che spesso si localizza in sede epigastrica o mesogastrica. Entro le 24 ore dall’insorgenza dei primi sintomi, il dolore si irradia verso il basso localizzandosi nella zona della fossa iliaca destra in corrispondenza della sede anatomica propria dell’appendice. Il dolore può avere un interessamento renale, epatico, vescicale e addirittura ginecologico.
In generale i segni comuni si distinguono in dolore addominale in particolare alla palpazione, gonfiore addominale, meteorismo, vomito e diarrea.

Nonostante fino a pochi anni fa l’appendicectomia fosse considerata l’unica terapia utile in caso di appendicite acuta, oggi sempre più medici consigliano (ndr. nei casi non complicati) delle modificazioni della dieta (digiuno per qualche giorno e poi assunzione di almeno 6 g. di fibre alimentari al giorno) e l’utilizzo di antibiotici ad ampio spettro.
In particolare, l’uso di molecole ad azione battericida, è molto supportato anche qualora fosse necessaria l’asportazione chirurgica dell’organo in toto in quando si è visto come, l’inizio della terapia prima dell’intervento, favorisca una minore insorgenza di complicanze e ponga degli ottimi presupposti per una breve guarigione.
Importantissimo è invece intervenire subito chirurgicamente qualora l’organo fosse seriamente danneggiato dal processo infiammatorio in atto e si abbia una peritonite: ovvero la diffusione all’interno del foglietto peritoneale dei batteri normalmente presenti all’interno dell’intestino. Questa costituisce una delle cosiddette “emergenze chirurgiche” in quanto la vita del paziente è messa in serio rischio dalla diffusione dei microorganismi.


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