Pathogenesis of appendicitis and Shvartsman's phenomenon

Inflammation of the appendix is ​​the most common form of inflammation in the abdominal cavity. According to statistical data, 30-35% of all surgical patients are operated on for appendicitis. Studies by various authors have proven that appendicitis develops as a result of the action of virulent bacteria on the mucous membrane of the appendix. Until now, it has not been possible to establish whether a specific causative agent of appendicitis exists, although numerous studies in this area would allow this to be done, if such in fact existed (Rushev). Rosenov in his studies in 70% of cases of appendicitis discovered a special type of streptococci, which, in his opinion, cause appendicitis. Will identified an anaerobe that looks like you. perfringens and bac. oedematis (in acute appendicitis): According to Ashof (1927), appendicitis is caused by Diplostreptococcus (enterococcus) and gram-positive rods. Fonio (1923) believes that appendicitis is caused by a special gram-positive diplococcus and a special thin stick; Fischer is of the same opinion. However, all these data have not received general confirmation and the presence of a specific pathogen has not been proven. According to the research of many authors (Dejen and Michiner, Jings, Brutt, etc.) we have a mixed infection with appendicitis with a predominance of streptococci and E. coli in acute cases. There are many works devoted to the bacteriology of appendicitis, which cannot be listed in our brief work, the conclusion can be drawn as follows: diseases of the appendix are caused by a mixed infection. The normal process always contains various microbial forms. Chronic appendicitis also always contains various types of microbes. What are the ways of appendicitis? Enterogenic pathway — the disease of the appendix is ​​caused by microbes located in the appendix itself, due to abnormal conditions for its nutrition and position. This includes all kinds of closure of the lumen by the contents, whether it is the semi-liquid contents of the appendix, fecal calculus, swelling of the mucous membrane, or something else. The same mechanical obstacles can create bends of the appendix and its retroperitoneal position. All these points are reduced to the theory of the so-called. "Cavité close" (Talamon) (1892), Dielafoy (1896). Despite various objections and conflicting facts, the thought expressed by Dielafoy remains valid to this day. This position is confirmed by numerous studies of Boseno (1897), Rouville, Bois-Heyd (1912), Geil, Mordvinkin and others, not as the only cause of appendicitis, but as a factor contributing to it.