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Sample records for acute appendicitis feasibility

  1. Acute Appendicitis

    DEFF Research Database (Denmark)

    Tind, Sofie; Qvist, Niels

    2017-01-01

    and treatment of AA it is important that the classifications are consistent. Furthermore, in the clinical settings, incorrect classification might lead to over diagnosing and a prolonged antibiotic treatment. The aim of our study was to investigate the concordance between perioperative diagnosis made......BACKGROUND: The classification of acute appendicitis (AA) into various grades is not consistent, partly because it is not clear whether the perioperative or the histological findings should be the foundation of the classification. When comparing results from the literature on the frequency...... patients were included. In 116 (89 %) of these cases, appendicitis was confirmed histological. There was low concordance between the perioperative and histological diagnoses, varying from 16 to 76 % depending on grade of AA. Only 44 % of the patients receiving antibiotics postoperatively had a positive...

  2. A Feasibility Study of Real-Time Remote CT Reading for Suspected Acute Appendicitis Using an iPhone.

    Science.gov (United States)

    Kim, Changsun; Kang, Bossng; Choi, Hyuk Joong; Park, Joon Bum

    2015-08-01

    We aimed to evaluate the feasibility of an iPhone-based remote control system as a real-time remote computed tomography (CT) reading tool for suspected appendicitis using a third-generation (3G) network under suboptimal illumination. One hundred twenty abdominal CT scans were selected; 60 had no signs of appendicitis, whereas the remaining 60 had signs of appendicitis. The 16 raters reviewed the images using the liquid crystal display (LCD) monitor of a picture archiving and communication system (PACS) workstation, as well as using an iPhone connected to the PACS workstation via a remote control system. We graded the probability of the presence of acute appendicitis for each examination using a five-point Likert scale. The overall sensitivity and specificity for the diagnosis of suspected appendicitis using the iPhone and the LCD monitor were high, and they were not significantly different (sensitivity P = 1.00, specificity P = 0.14). The average areas under the receiver operating characteristic curves for all CT readings with the iPhone and LCD monitor were 0.978 (confidence interval 0.965-0.991) and 0.974 (0.960-0.988), respectively, and the two devices did not have significantly different diagnostic performances (P = 0.55). The inter-rater agreement for both devices was very good; the kappa value for the iPhone was 0.809 (0.793-0.826), and that for the LCD monitor was 0.817 (0.801-0.834). Each rater had moderate-to-very good intra-observer agreement between the two devices. We verified the feasibility of an iPhone-based remote control system as a real-time remote CT reading tool for identifying suspected appendicitis using a 3G network and suboptimal illumination.

  3. Amoebiasis Presenting as Acute Appendicitis.

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    Ichikawa, Hitoshi; Imai, Jin; Mizukami, Hajime; Uda, Shuji; Yamamoto, Soichiro; Nomura, Eiji; Tajiri, Takuma; Watanabe, Norihito; Makuuchi, Hiroyasu

    2016-12-20

    We report a case of amoebic appendicitis without colitis symptoms. Acute appendicitis is commonly encountered by gastroenterologists in their daily practice. The number of cases of amoebiasis increases annually in Japan, and is thought to be associated with an increase in sexually transmitted disease or travel to endemic areas. However, acute amoebic appendicitis is rare and the prognosis is very poor compared to nonamoebic appendicitis. In our case, appendectomy was performed immediately after onset, and the patient was discharged without complications. It is difficult to differentiate between amoebic and nonamoebic appendicitis preoperatively, and the possibility of amoebic appendicitis should be kept in mind.

  4. ACUTE APPENDICITIS COMPLICATING PREGNANCY

    Science.gov (United States)

    Sprong, David H.; Pollock, William F.

    1959-01-01

    Acute appendicitis occurs as a complication of pregnancy in about 0.1 per cent of cases. Diagnosis may be somewhat more difficult during the second and third trimesters dur to the displacement of viscera and the increased incidence of pyelitis and constipation. It is based on the same symptoms and signs as in nonpregnant patients. The treatment is immediate operation regardless of the stage of pregnancy. A McBurney incision is preferred and it is placed somewhat higher than usual in the later stages of pregnancy. When operation is done promptly there is little danger to either mother or fetus. PMID:13833485

  5. Acute appendicitis in pregnancy: literature review.

    Science.gov (United States)

    Franca Neto, Antônio Henriques de; Amorim, Melania Maria Ramos do; Nóbrega, Bianca Maria Souza Virgolino

    2015-01-01

    suspected appendicitis is the most common indication for surgery in non-obstetric conditions during pregnancy and occurs in about one in 500 to one in 635 pregnancies per year. This occurs more often in the second trimester of pregnancy. Acute appendicitis is the most common general surgical problem encountered during pregnancy. a literature review on research of scientific articles, under the terms "acute appendicitis" and "pregnancy", in PubMed, Lilacs/SciELO, Scopus, Cochrane Library and Uptodate databases. the clinical manifestations of appendicitis are similar to non-pregnant women, however, without a classic presentation, which often occurs, diagnosis is difficult and must be supported by imaging. clinical diagnosis should be strongly suspected in pregnant women with classic findings such as abdominal pain that migrates to the right lower quadrant. The main purpose of imaging is to reduce delays in surgical intervention due to diagnostic uncertainty. A secondary objective is to reduce, but not eliminate, the negative appendectomy rate. Differential diagnosis of suspected acute appendicitis usually includes pathologies considered in non-pregnant people. the imaging study of choice is ultrasound, MRI may be used when the former is not conclusive and, as a last resort, a CT scan can be performed. The treatment remains appendectomy by laparotomy, since the feasibility of video- assisted surgery in these cases remains controversial.

  6. Treatment of acute appendicitis with one-port transumbilical ...

    African Journals Online (AJOL)

    Background: Laparoscopic appendectomy is a feasible and safe alternative to open appendectomy for uncomplicated appendicitis. In the past decade several laparoscopic procedures have been described using one or more ports. We report our experience in treating acute appendicitis with one-port transumbilical ...

  7. Acute appendicitis in pregnancy: literature review

    Directory of Open Access Journals (Sweden)

    Antônio Henriques de Franca Neto

    2015-04-01

    Full Text Available Introduction: suspected appendicitis is the most common indication for surgery in non-obstetric conditions during pregnancy and occurs in about one in 500 to one in 635 pregnancies per year. This occurs more often in the second trimester of pregnancy. Acute appendicitis is the most common general surgical problem encountered during pregnancy. Methods: a literature review on research of scientific articles, under the terms “acute appendicitis” and “pregnancy”, in PubMed, Lilacs/SciELO, Scopus, Cochrane Library and Uptodate databases. Results: the clinical manifestations of appendicitis are similar to non-pregnant women, however, without a classic presentation, which often occurs, diagnosis is difficult and must be supported by imaging. Discussion: clinical diagnosis should be strongly suspected in pregnant women with classic findings such as abdominal pain that migrates to the right lower quadrant. The main purpose of imaging is to reduce delays in surgical intervention due to diagnostic uncertainty. A secondary objective is to reduce, but not eliminate, the negative appendectomy rate. Differential diagnosis of suspected acute appendicitis usually includes pathologies considered in non-pregnant people. Conclusion: the imaging study of choice is ultrasound, MRI may be used when the former is not conclusive and, as a last resort, a CT scan can be performed. The treatment remains appendectomy by laparotomy, since the feasibility of video- assisted surgery in these cases remains controversial.

  8. Ultrasonography for the acute appendicitis

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    Suh, Hyoung Sim; Chung, Myung Hee; Kim, Kwang Tae [Dae Rim Saint Mary' s Hospital, Seoul (Korea, Republic of)

    1987-12-15

    The authors analysed ultrasonography (US) findings in patients with clinical signs of acute appendicitis during a recent 7-months period. The comparative analysis between US findings and surgical-pathologic findings was performed in 193 cases who underwent surgery. There were 52 cases with a sonographically non-visible appendix whose symptoms spontaneously resolved. The inflamed appendix was visualized by high-resolution, real-time US according to the graded-compression method described by Puylaert. The following results noted: 1. Sonographically visualized 136 cases were the target-appearance appendix in 47 cases, the fluid-filled appendix in 66 cases and the irregular marginated mixed echogenic mass-like density with surrounding fluid collection in 23 cases. The appendix was not visualized by US in 109 cases. 2. Appendicitis perforation was predictable in 21 cases of 24 cases. 3. Acute appendicitis was 24 cases (59%) among 41 cases who were sonographically visualized with appendiceal wall thickening less than 3mm and 77 cases (81%) among 95 cases with wall thickening more than 3mm. 4. When the results in women were analyzed separately (n=176), the sensitivity was 86%, the specificity was 76% and the accuracy was 80%. In women, US was helpful for the differential diagnosis between acute appendicitis and other gynecologic disease. 5. In men (n=69), the sensitivity was 88%, the specificity was 67% and the accuracy was 81%. 6. The overall sensitivity was 87%, the specificity was 75% and accuracy was 80% (n=245). Graded-compression US is the examination of choice in the patients with clinical signs of acute appendicitis, particularly in women.

  9. Acute Perforated Schistosomal Appendicitis: A Case Report ...

    African Journals Online (AJOL)

    Acute Perforated Schistosomal Appendicitis: A Case Report. AZ Mohammed, AA Yakubu, ST Edino. Abstract. Appendicitis is occasionally the first clinical manifestation of schistosomal infestation which may require treatment. A rare case of perforated schistosomal appendicitis in a 12 –year old Nigerian boy diagnosed on ...

  10. Sonography in the diagnosis of acute appendicitis

    Directory of Open Access Journals (Sweden)

    Ahmad Ryazi

    2003-09-01

    Full Text Available Graded compressive sonography may be useful as an adjuvant in the diagnosis of acute appendicitis. To determine the role of sonography in the differential diagnosis of acute appendicitis, preappendectomy sonographic data of 164 consecutive cases in Fatemeh-Zahra Teaching Hospital were evaluated. Of 113 (68.9% patients who had acute appendicitis in histopathology, 64 (56.6% cases had preoperative sonographic diagnosis of acute appendicitis. Of 51 patients who had normal appendices, 40 (78.4% cases had normal appendices in sonographic evaluations. Sensitivity, specificity and accuracy of sonography for acute appendicitis were 56.7%, 78.4% and 0.63, respectively. The positive and negative predictive values were 85.3% and 44.49% respectively. As a result, sonographic evaluation is an additional diagnostic tool in acute appendicitis.

  11. Simultaneous acute appendicitis with right testicular torsion

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    Tanveer Akhtar

    2012-01-01

    Full Text Available We present a child with both acute appendicitis and torsion of the right testis presenting at the same time. Testicular torsion possibly occurring due to vomiting in acute appendicitis so far has not been reported in the literature.

  12. Intraperitoneal orchitis mimicking acute appendicitis | Emedike | Port ...

    African Journals Online (AJOL)

    Background: Acute appendicitis readily comes to mind as a possible diagnosis in any patient presenting with right iliac fossa pain. Thus, a male patient with right sided lower intra-abdominal pain from orchitis, might be diagnosed as having acute appendicitis, especially if the physical examination has been inadequate.

  13. Perforated Duodenal Ulcer Presenting As Acute Appendicitis ...

    African Journals Online (AJOL)

    Background: Acute appendicitis has a lot of differential diagnoses. However, when there is perforated duodenal ulcer with the contents tracking into the right iliac fossa, it is often extremely difficult to distinguish this condition from acute appendicitis. Aims of study: To evaluate the diagnostic dilemma encountered in ...

  14. Management of acute appendicitis in pregnancy.

    Science.gov (United States)

    Kapan, Selin; Bozkurt, Mehmet Abdussamet; Turhan, Ahmet Nuray; Gönenç, Murat; Alış, Halil

    2013-01-01

    Acute appendicitis is the most common surgical non-obstetric pathology during pregnancy. In this report, pregnant patients operated with a diagnosis of acute appendicitis in the last three years are evaluated retrospectively. Between January 2009 and January 2011, 20 pregnant patients were operated for acute appendicitis. Patients were evaluated regarding age, gestational age, clinical and laboratory examinations, imaging studies, operative findings, mean hospital stay, mean operative time, and outcome. In 17 of 20 patients, acute appendicitis was confirmed and appendectomy was performed. Ten of the patients were operated with laparoscopic technique and the remaining 10 had open appendectomy. There was no fetal or maternal morbidity or mortality in any patient. All 20 patients delivered healthy babies during the postoperative course. Acute appendicitis is a challenging diagnosis in the pregnant patient; however, early surgical intervention should be performed with any suspicion. The type of surgery depends on the surgeon's preference and experience.

  15. MRI use in acute appendicitis in pregnancy

    International Nuclear Information System (INIS)

    Maleeva, A.

    2017-01-01

    Acute appendicitis is the most common surgical emergency in pregnancy. The incidence of appendicitis in pregnancy was one in 766 births. The preoperative diagnosis was correct in 75% of the cases. Because of considerable fetal loss after appendectomy during pregnancy in the first and second trimester, surgeons decide to use diagnostic imaging to prove the diagnosis. The American College of Radiology (ACR) approves of MR imaging of the pregnant patient in any trimester, including the first. In this case -30 years old, pregnant 12 week gestation, present with right lower quadrant abdominal pain. Acute appendicitis is suspected, because of positive Romberg and ilio-psoas sign and high WBC and CRP. After MR imaging the diagnosis of acute appendicitis was proved together with intrauterine gestation. Key words: Acute Appendicitis. MRI. Pregnancy. Fetal Loss [bg

  16. Acute appendicitis in pregnancy: literature review

    OpenAIRE

    Antônio Henriques de Franca Neto; Melania Maria Ramos do Amorim; Bianca Maria Souza Virgolino Nóbrega

    2015-01-01

    Introduction: suspected appendicitis is the most common indication for surgery in non-obstetric conditions during pregnancy and occurs in about one in 500 to one in 635 pregnancies per year. This occurs more often in the second trimester of pregnancy. Acute appendicitis is the most common general surgical problem encountered during pregnancy. Methods: a literature review on research of scientific articles, under the terms “acute appendicitis” and “pregnancy”, in PubMed...

  17. [Enterobius vermicularis causing symptoms of acute appendicitis].

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    Antal, András; Kocsis, Béla

    2008-08-01

    The authors present a case of enterobiasis of the appendix. Enterobius infection is an uncommon cause of acute appendicitis. Preoperative diagnosis of pinworm infestation is almost impossible unless there is a strong clinical suspicion. Parasites may produce symptoms which resemble acute appendicitis. Careful observation of the appendix stump may lead to intraoperative diagnosis of enterobiasis. A quick diagnosis and appropriate treatment may prevent future complications.

  18. Outpatient surgery for acute uncomplicated appendicitis

    Directory of Open Access Journals (Sweden)

    Juan Pablo Martínez

    2015-04-01

    Full Text Available Introduction: Acute appendicitis is one of the main indications to abdominal surgery. When the appendicitis is not complicated, is possible to do an outpatient surgery. Objective: To describe postsurgical evolution of the patients who present uncomplicated acute appendicitis. Methods: A prospective study was carried out about the evolution of 100 patients with outpatient surgery for appendectomy by uncomplicated acute appendicitis. The study was performed in the Hospital Susana Lopez de Valencia (HSLV of Popayán, Colombia. A telephone survey was conducted during the 24 hours after surgery, to determinate potential complications like pain, nausea, vomiting and oral intolerance. Clinical histories were reviewed to determinate in case the patient has re-entered because of a possible post operative complication during 30 next days after surgical intervention. Histopathological findings were also reported. Results: During postsurgical follow up, 58% of the patients did not present any kind of pain, 95% tolerated oral route, 97% did not have vomiting and 90% did not have nausea. 3% re-entered because of type 1 infection around the surgical area, 4% because of pain. We found a histopathological concordance with the acute appendicitis diagnostic in 94% of the cases. All patients reported to be satisfied with the given attention in the postsurgery. Conclusions: Patients undergo appendectomy by uncomplicated acute appendicitis treated outpatient, has an appropriate tolerance to oral route and pain control.

  19. MRI evaluation of acute appendicitis in pregnancy.

    Science.gov (United States)

    Dewhurst, Catherine; Beddy, Peter; Pedrosa, Ivan

    2013-03-01

    In recent years, magnetic resonance imaging (MRI) has become a valuable diagnostic tool for evaluation of acute abdominal pain in pregnancy. MRI offers an opportunity to identify the normal or inflamed appendix as well as a variety of other pathologic conditions that can masquerade clinically as acute appendicitis in pregnant women. Visualization of the normal appendix by MRI virtually excludes the diagnosis of acute appendicitis and may help reduce the negative laparotomy rate in this patient population. Here we discuss a comprehensive MRI protocol for evaluation of pregnant women with abdominal pain, focusing on the appearance and location of the normal and diseased appendix, and we describe an approach to diagnosing acute appendicitis and other conditions with MRI. Copyright © 2012 Wiley Periodicals, Inc.

  20. Evidence for eosinophil degranulation in acute appendicitis

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    Santosh G

    2008-04-01

    Full Text Available Finding of increased numbers of eosinophils in the muscle in cases of acute appendicitis has led to the hypothesis that it may have an allergic origin. This study aimed to measure the eosinophil degranulation resulting in a rise in the serum of eosinophil granule proteins that would be expected in such cases. The levels of serum eosinophil cationic protein (ECP measured by chemiluminescence assay in acute appendicitis were compared, with those of appropriate controls. Mean (95% CI serum ECP (µg/L levels were: acute appendicitis 45.3 (27.7-63.0; normal appendix 22.7 (16.0-29.3; asthma 24.2 (4.6-43.8; and healthy volunteers 13.2 (8.3-18.1. In cases of acute appendicitis, there is an inverse relationship between duration of symptoms and serum ECP. However, this was not statistically significant. Significant local eosinophil activation and degranulation occurs in acute appendicitis, enough to cause a rise in serum levels of eosinophil chemotactic protein

  1. ACUTE APPENDICITIS- SONOLOGICAL AND HISTOPATHOLOGICAL CORRELATION

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    Anjani M. Reddy

    2016-12-01

    Full Text Available BACKGROUND The aim of the study is to study the- 1. Correlation between sonological and histopathological diagnosis of acute appendicitis. 2. Prevalence of acute appendicitis in various age groups. MATERIALS AND METHODS The study was conducted in the Department of Radiodiagnosis, MVJ Medical College and Research Hospital, Bangalore, for a period of 2 years from March 2013 to February 2015. Data collection was prospective. A computer-assisted search of all the reports of ultrasonography with the diagnosis of acute appendicitis was conducted within the departmental database. A total of 244 patients (128 male patients and 116 female patients with acute appendicitis were identified and the study was conducted. RESULTS In the study, total of 244 patients were diagnosed with acute appendicitis. Out of these, 128 patients were males and 116 patients were females. The incidence of acute appendicitis was most prevalent in age group between 21 to 30 years (36.5% in our study. The least incidence was noted in age group of above 60 yrs. with only 1 out of 244 patients (0.4% was diagnosed with acute appendicitis. The histological features noted were suppuration/inflammation, gangrenous, lymphoid hyperplasia and perforation. In our study, 143 inflammation/suppuration (58.6%, 37 gangrenous (15.1%, 24 lymphoid hyperplastic (9.8% and 1 perforation (0.4% was noted. Hence, the incidence of inflammation/suppuration was found to be most common and perforation was found to be the least finding. The suppurative/inflammatory feature was most common histological type in all the age groups except for the age group above 60 yrs. The gangrenous features were most commonly seen in the age group between 11 to 20 yrs. followed by 20 to 30 yrs. Faecolith was most commonly found in age group of 21 to 30 yrs. (12 cases followed by age group of 11 to 20 yrs. (10 cases. CONCLUSION It was noted that the incidence of acute appendicitis was most commonly noted in younger age group

  2. The value of hyperbilirubinaemia in the diagnosis of acute appendicitis.

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    Emmanuel, Andrew

    2011-04-01

    No reliably specific marker for acute appendicitis has been identified. Although recent studies have shown hyperbilirubinaemia to be a useful predictor of appendiceal perforation, they did not focus on the value of bilirubin as a marker for acute appendicitis. The aim of this study was to determine the value of hyperbilirubinaemia as a marker for acute appendicitis.

  3. Imaging Acute Appendicitis: State of the Art

    Directory of Open Access Journals (Sweden)

    Diana Gaitini

    2011-01-01

    Full Text Available The goal of this review is to present the state of the art in imaging tests for the diagnosis of acute appendicitis. Relevant publications regarding performance and advantages/disadvantages of imaging modalities for the diagnosis of appendicitis in different clinical situations were reviewed. Articles were extracted from a computerized database (MEDLINE with the following activated limits: Humans, English, core clinical journals, and published in the last five years. Reference lists of relevant studies were checked manually to identify additional, related articles. Ultrasound (US examination should be the first imaging test performed, particularly among the pediatric and young adult populations, who represent the main targets for appendicitis, as well as in pregnant patients. A positive US examination for appendicitis or an alternative diagnosis of possible gastrointestinal or urological origin, or a negative US, either showing a normal appendix or presenting low clinical suspicion of appendicitis, should lead to a final diagnosis. A negative or indeterminate examination with a strong clinical suspicion of appendicitis should be followed by a computed tomography (CT scan or alternatively, a magnetic resonanace imaging (MRI scan in a pregnant patient. A second US examination in a patient with persistent symptoms, especially if the first one was performed by a less experienced imaging professional, is a valid alternative to a CT.

  4. Concurrent tubal ectopic pregnancy and acute appendicitis.

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    Hazebroek, Eric J; Boonstra, Onno; van der Harst, Erwin

    2008-01-01

    A 25-year-old woman had signs of an acute surgical abdomen. Differential diagnoses were ectopic pregnancy and acute appendicitis. Diagnostic laparoscopy revealed an apparent inflamed appendix and left-sided unruptured tubal ectopic pregnancy. This case illustrates the importance of considering multiple pathologic disorders in a patient with an acute surgical abdomen, especially in pregnancy. Furthermore, it shows that laparoscopy constitutes the optimal treatment modality in patients with multiple diagnoses, because it combines multifocal diagnosis and treatment without additional postoperative morbidity.

  5. Diagnostic performance of ultrasound in acute appendicitis

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    Omar Alejandro Ortega

    2012-12-01

    Full Text Available Background: acute appendicitis (AA is the acute surgical abdominal disease more common in the Hospital Susana López de Valencia Popayán, Colombia; its diagnosis is one of the most common problems in emergency. Objective: to determined the operating performance of emergency ultrasound in suspected acute appendicitis. Methods: retrospective study conducted with data obtained from the first of January to 31 December 2011, including patients with presumed diagnosis of AA and abdominal ultrasound before surgery. Results: a total of 134 individuals who underwent surgery, with pre-procedure ultrasound report and pathology report. The performance of ultrasound resulted in a sensitivity of 73.2%, specificity 86.3%, positive predictive value of 96.4%, negative predictive value of 38.7%. Conclusion: the overall performance of abdominal ultrasound in the diagnosis of acute appendicitis in our hospital is acceptable. But its usefulness is poor in excluding the diagnosis of acute appendicitis. Because of its accessibility and low cost is the best test available for diagnosis in doubtful cases in emergency or difficult diagnosis.

  6. Uncommon Caecum Diverticulitis Mimicking Acute Appendicitis

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    Özkan Yilmaz

    2016-01-01

    Full Text Available Diverticulum of the cecum is a rarely seen reason of acute abdomen and it is difficult to be distinguished from appendicitis. The diagnosis is generally made during operation. We have presented this case in order to remember that it is a disease which should be kept in mind in cases of right lower quadrant pain.

  7. Simultaneous acute appendicitis and ectopic pregnancy

    OpenAIRE

    Ankouz, Amal; Ousadden, Abdelmalek; Majdoub, Karim Ibn; Chouaib, Ali; Maazaz, Khalid; Taleb, Khalid Ait

    2009-01-01

    The acute abdomen in pregnancy is a surgical emergency. Ectopic pregnancy and appendicitis are two causes of acute abdomen in pregnancy. Difficulties in correctly identifying the cause of the pain can be hazardous to the patient and care needs to be taken in obtaining a prompt and accurate diagnosis enabling the most appropriate management. The case presented here underlies the pathogenesis of the simultaneous existence of these two conditions in a patient.

  8. Simultaneous acute appendicitis and ectopic pregnancy

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    Ankouz Amal

    2009-01-01

    Full Text Available The acute abdomen in pregnancy is a surgical emergency. Ectopic pregnancy and appendicitis are two causes of acute abdomen in pregnancy. Difficulties in correctly identifying the cause of the pain can be hazardous to the patient and care needs to be taken in obtaining a prompt and accurate diagnosis enabling the most appropriate management. The case presented here underlies the pathogenesis of the simultaneous existence of these two conditions in a patient.

  9. Acute amebic appendicitis: Report of a rare case

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    Singh Naorem

    2010-10-01

    Full Text Available Acute appendicitis of amebic origin is considered a rare cause of acute appendicitis. We report a case of amebic appendicitis presenting with fever, severe pain in the right lower quadrant of the abdomen and rebound tenderness. Lab investigations revealed neutrophilic leukocytosis. The patient underwent appendectomy. Histopathological examination revealed numerous Entameba histolytica trophozoites in the mucosa of the appendix. Acute appendicitis of amebic origin does not appear frequently. Appendicular amebiasis can give the clinical features of acute appendicitis and should be treated accordingly.

  10. Unenhanced MR Imaging in adults with clinically suspected acute appendicitis

    International Nuclear Information System (INIS)

    Chabanova, Elizaveta; Balslev, Ingegerd; Achiam, Michael; Nielsen, Yousef W.; Adamsen, Sven; Gocht-Jensen, Peter; Brisling, Steffen K.; Logager, Vibeke B.; Thomsen, Henrik S.

    2011-01-01

    Purpose: The purpose of the study was to evaluate unenhanced Magnetic Resonance Imaging (MRI) for the diagnosis of appendicitis or another surgery-requiring condition in an adult population scheduled for emergency appendectomy based on a clinical diagnosis of suspected acute appendicitis. Materials and methods: The prospective study included 48 consecutive patients (29 female, 19 male, 18-70 years old, mean age = 37.1 years). MRI examination was designed to be comfortable and fast; no contrast was administered. The sequences were performed during quiet respiration. The MRI findings were reviewed by two radiologists and one surgeon independent of each other and compared with surgical and pathological records. Results: According to the surgical and histopathological findings 30 of 48 patients (63%) had acute appendicitis. Of the remaining 18 patients, 4 patients had no reasons for the clinical symptoms and 14 patients had other pathology. For the three reviewers the performance of MRI in the diagnosis of acute appendicitis showed the following sensitivity, specificity and accuracy ranges: 83-93%, 50-83% and 77-83%. Moderate (κ = 0.51) and fair (κ = 0.31) interobserver agreements in the MR diagnosis of acute appendicitis were found between the reviewers. Sensitivity, specificity and accuracy values for overall performance of MRI in detecting pelvic abnormalities were 100%, 75% (3 of 4 healthy patients were identified by MRI) and 98%, respectively. Conclusion: Unenhanced fast MRI is feasible as an additional fast screening before the appendectomy. It may prevent unnecessary surgeries. The fast MRI examination can be adequately performed on an MRI unit of broad range of field strengths.

  11. Unenhanced MR Imaging in adults with clinically suspected acute appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Chabanova, Elizaveta, E-mail: elcha@heh.regionh.dk [Department of Diagnostic Radiology, Copenhagen University Hospital at Herlev (Denmark); Balslev, Ingegerd, E-mail: inbal@heh.regionh.dk [Department of Pathology, Copenhagen University Hospital at Herlev (Denmark); Achiam, Michael, E-mail: micach01@heh.regionh.dk [Department of Gastrointestinal Surgery, Copenhagen University Hospital at Herlev (Denmark); Nielsen, Yousef W., E-mail: yujwni01@heh.regionh.dk [Department of Diagnostic Radiology, Copenhagen University Hospital at Herlev (Denmark); Adamsen, Sven, E-mail: svad@heh.regionh.dk [Department of Gastrointestinal Surgery, Copenhagen University Hospital at Herlev (Denmark); Gocht-Jensen, Peter, E-mail: petgoc01@heh.reginh.dk [Department of Gastrointestinal Surgery, Copenhagen University Hospital at Herlev (Denmark); Brisling, Steffen K., E-mail: stkibr01@heh.regionh.dk [Department of Gastrointestinal Surgery, Copenhagen University Hospital at Herlev (Denmark); Logager, Vibeke B., E-mail: viloe@heh.regionh.dk [Department of Diagnostic Radiology, Copenhagen University Hospital at Herlev (Denmark); Thomsen, Henrik S., E-mail: heth@heh.regionh.dk [Department of Diagnostic Radiology, Copenhagen University Hospital at Herlev (Denmark)

    2011-08-15

    Purpose: The purpose of the study was to evaluate unenhanced Magnetic Resonance Imaging (MRI) for the diagnosis of appendicitis or another surgery-requiring condition in an adult population scheduled for emergency appendectomy based on a clinical diagnosis of suspected acute appendicitis. Materials and methods: The prospective study included 48 consecutive patients (29 female, 19 male, 18-70 years old, mean age = 37.1 years). MRI examination was designed to be comfortable and fast; no contrast was administered. The sequences were performed during quiet respiration. The MRI findings were reviewed by two radiologists and one surgeon independent of each other and compared with surgical and pathological records. Results: According to the surgical and histopathological findings 30 of 48 patients (63%) had acute appendicitis. Of the remaining 18 patients, 4 patients had no reasons for the clinical symptoms and 14 patients had other pathology. For the three reviewers the performance of MRI in the diagnosis of acute appendicitis showed the following sensitivity, specificity and accuracy ranges: 83-93%, 50-83% and 77-83%. Moderate ({kappa} = 0.51) and fair ({kappa} = 0.31) interobserver agreements in the MR diagnosis of acute appendicitis were found between the reviewers. Sensitivity, specificity and accuracy values for overall performance of MRI in detecting pelvic abnormalities were 100%, 75% (3 of 4 healthy patients were identified by MRI) and 98%, respectively. Conclusion: Unenhanced fast MRI is feasible as an additional fast screening before the appendectomy. It may prevent unnecessary surgeries. The fast MRI examination can be adequately performed on an MRI unit of broad range of field strengths.

  12. Recent trend of acute appendicitis during pregnancy.

    Science.gov (United States)

    Kumamoto, Kensuke; Imaizumi, Hideko; Hokama, Naoko; Ishiguro, Toru; Ishibashi, Keiichiro; Baba, Kazunori; Seki, Hiroyuki; Ishida, Hideyuki

    2015-12-01

    We report the clinical presentation, management and outcomes of 33 patients who underwent surgery for acute appendicitis during pregnancy between April 1997 and March 2011. Several variables were compared between these 33 patients (pregnant group, n = 33) and non-pregnant females aged 20-40 years who underwent an acute appendectomy during the same period (control group, n = 124). No significant differences were found between the two groups in terms of the type of anesthesia, operative method, duration of surgery, pathology, duration of antibiotic use, and incidence of surgical site infection, except for a higher frequency of pararectal incision performed and higher leukocyte counts in the pregnant group (P appendicitis during pregnancy can be managed successfully without fetal loss.

  13. HETEROTOPIC PREGNANCY MISDIAGNOSED AS ACUTE APPENDICITIS

    OpenAIRE

    ERSOY, Gülçin ŞAHİN; EKEN, Meryem

    2014-01-01

    The diagnosis of heterotopic pregnancy is usually more difficult than the other obstetric emergencies, necessitating a thorough anamnesis and a high diagnostic suspicion, followed by the utilization of ultrasonography as the most valuable diagnostic tool.In this report the intraoperative finding of a heterotopic pregnancy in an adult female patient was presented while being operated by the general surgeon with the working diagnosis of acute appendicitis under emergency conditions.Key words: h...

  14. Acute appendicitis in a duplicated appendix

    Science.gov (United States)

    Christodoulidis, Grigorios; Symeonidis, Dimitrios; Spyridakis, Michail; Koukoulis, Georgios; Manolakis, Anastasios; Triantafylidis, Georgios; Tepetes, Konstantinos

    2012-01-01

    INTRODUCTION Double appendix represents an extremely rare and commonly “missed” diagnosis, often with life threatening consequences. PRESENTATION OF CASE In this case report we present an interesting case of operative treatment of acute appendicitis in a doubled vermiform appendix stemming operative pitfalls. A 23-year-old female was admitted to the emergency room department complaining of diffuse abdominal pain, nausea, and vomiting over the past 36 h. As soon as the diagnosis of acute appendicitis was established a laparotomy via a McBurney incision was decided. Intraoperative findings included the presence of mild quantity of free fluid and surprisingly a thin non-inflamed appendiceal process. It was the preoperative ultrasound findings suggestive of acute appendicitis that dictated a more thorough investigation of the lower abdomen that led to the discovery of a second retrocecal inflamed appendix. Formal appendectomy was then performed for both processes. The patient had an uneventful recovery and was discharged on the fourth postoperative day. DISCUSSION Double appendix represents a challenging clinical scenario in cases of right lower quadrant pain. CONCLUSION Life threatening consequences with legal extensions can arise from the incomplete removal of both stumps. PMID:22922359

  15. Acute appendicitis mistaken as acute rejection in renal transplant recipients.

    Directory of Open Access Journals (Sweden)

    Talwalkar N

    1994-01-01

    Full Text Available Case histories of 2 renal transplant recipients are reported who had presenting features of fever, leukocytosis and pain/tenderness over right iliac fossa and were diagnosed to be due to acute appendicitis rather than more commonly suspected acute rejection episode which has very similar features. Diagnosis of acute appendicitis was suspected on the basis of rectal examination and later confirmed by laparotomy. The purpose of this communication is to emphasize the need for proper diagnosis in patient with such presentation; otherwise wrong treatment may be received.

  16. [Acute appendicitis during pregnancy: report of 4 cases].

    Science.gov (United States)

    Bolívar-Rodríguez, Martín Adrián; Cazarez-Aguilar, Marcel Antonio; Fierro-López, Rodolfo; Romero-Aguilar, Rosa Estela; Lizárraga-González, Hernán; Morgan-Ortiz, Fred

    2014-05-01

    Acute appendicitis is the more frequent no obstetric surgical emergency during pregnancy with an incidence of 1 in 1500 pregnancies. The clinical diagnosis is difficult because of the physiological changes of pregnancy itself. If not treated early increases the risk of maternal and fetal morbidity. To describe the diagnosis and treatment of four cases of acute appendicitis during pregnancy. Four cases of acute appendicitis during pregnancy diagnosed in the period of a month. Gestational age at diagnosis of appendicitis was between 8 and 13 week. All patients underwent laparotomy; three cases were appendicitis phase II and one phase III. The preoperative was managed with indomethacin and ceftriaxone. There were no maternal or obstetric complications. An early diagnosis and treatment of acute appendicitis during pregnancy, and a multidisciplinary approach between surgeon, obstetrician and anesthesiologist is the basis for success in the management of these patients.

  17. Water permeability is a measure of severity in acute appendicitis.

    Science.gov (United States)

    Pini, Nicola; Pfeifle, Viktoria A; Kym, Urs; Keck, Simone; Galati, Virginie; Holland-Cunz, Stefan; Gros, Stephanie J

    2017-12-01

    Acute appendicitis is the most common indication for pediatric abdominal emergency surgery. Determination of the severity of appendicitis on clinical grounds is challenging. Complicated appendicitis presenting with perforation, abscess or diffuse peritonitis is not uncommon. The question remains why and when acute appendicitis progresses to perforation. The aim of this study was to assess the impact of water permeability on the severity of appendicitis. We show that AQP1 expression and water permeability in appendicitis correlate with the stage of inflammation and systemic infection parameters, leading eventually to perforation of the appendix. AQP1 is also expressed within the ganglia of the enteric nervous system and ganglia count increases with inflammation. Severity of appendicitis can be correlated with water permeability measured by AQP1 protein expression and increase of ganglia count in a progressive manner. This introduces the question if regulation of water permeability can present novel curative or ameliorating therapeutic options.

  18. How to diagnose acute appendicitis

    DEFF Research Database (Denmark)

    Mostbeck, Gerhard; Adam, E Jane; Nielsen, Michael Bachmann

    2016-01-01

    and complementary imaging with MRI/CT if indicated. Accordingly, both ionizing radiation to our patients and cost of pre-therapeutic diagnosis of AA will be low, with low negative appendectomy and perforation rates. Main Messages • Ultrasound (US) should be the first imaging modality for diagnosing acute...... to keep both the negative appendectomy rate and the perforation rate low. Introduced in 1986, graded-compression ultrasound (US) has well-established direct and indirect signs for diagnosing AA. In our opinion, US should be the first-line imaging modality, as graded-compression US has excellent...

  19. A new adult appendicitis score improves diagnostic accuracy of acute appendicitis - a prospective study

    Science.gov (United States)

    2014-01-01

    Background The aim of the study was to construct a new scoring system for more accurate diagnostics of acute appendicitis. Applying the new score into clinical practice could reduce the need of potentially harmful diagnostic imaging. Methods This prospective study enrolled 829 adults presenting with clinical suspicion of appendicitis, including 392 (47%) patients with appendicitis. The collected data included clinical findings and symptoms together with laboratory tests (white cell count, neutrophil count and C-reactive protein), and the timing of the onset of symptoms. The score was constructed by logistic regression analysis using multiple imputations for missing values. Performance of the constructed score in patients with complete data (n = 725) was compared with Alvarado score and Appendicitis inflammatory response score. Results 343 (47%) of patients with complete data had appendicitis. 199 (58%) patients with appendicitis had score value at least 16 and were classified as high probability group with 93% specificity.Patients with score below 11 were classified as low probability of appendicitis. Only 4% of patients with appendicitis had a score below 11, and none of them had complicated appendicitis. In contrast, 207 (54%) of non-appendicitis patients had score below 11. There were no cases with complicated appendicitis in the low probability group. The area under ROC curve was significantly larger with the new score 0.882 (95% CI 0.858 – 0.906) compared with AUC of Alvarado score 0.790 (0.758 – 0.823) and Appendicitis inflammatory response score 0.810 (0.779 – 0.840). Conclusions The new diagnostic score is fast and accurate in categorizing patients with suspected appendicitis, and roughly halves the need of diagnostic imaging. PMID:24970111

  20. Imaging Findings of the Unusual Presentations, Associations and Clinical Mimics of Acute Appendicitis

    OpenAIRE

    Demir, Mustafa Kemal; Savas, Yildiray; Furuncuoglu, Yavuz; Cevher, Tarik; Demiral, Serdar; Tabandeh, Babek; Aslan, Melisa

    2017-01-01

    There are many kinds of unusual presentations or associations and clinical mimics of acute appendicitis, and definitive diagnosis requires knowledge of the imaging findings in some cases. The unusual presentations and associations of acute appendicitis included in this study are perforated appendicitis, acute appendicitis occurring in hernias, acute appendicitis with cystic endosalpingiosis, intussusception of appendix, and acute appendicitis with pregnancy. We also present uncommon gastroint...

  1. Acute Appendicitis in Children in Kumasi, Ghana:Macroscopic ...

    African Journals Online (AJOL)

    Background A lot has been written about acute appendicitis in children in the developed countries but very little is written about this condition among children in the sub Saharan region. It used to be said that acute appendicitis is rare in Africa but this is no longer the case. We are unable to find, in the literature, any reference ...

  2. Acute Appendicitis in Port Harcourt, Nigeria | Mangete | Orient ...

    African Journals Online (AJOL)

    Objective: To determine the pattern of occurrence of acute appendicitis in the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. Methods: A prospective study of patients who were admitted for acute appendicitis at the University of Port Harcourt Teaching Hospital in the 6 year period from 1984 to 1989 ...

  3. Intestinal helminths in some cases of acute appendicitis operated in ...

    African Journals Online (AJOL)

    Background: Acute appendicitis is the most frequent infectious surgical abdominal emergency and previous studies have noted the presence of parasites in the appendicular lumen. Objective: This study was done to determine the involvement of intestinal worms in the etiology of acute appendicitis. Materials and Methods: ...

  4. Acute appendicitis in situs inversus- a case report | Shugaba ...

    African Journals Online (AJOL)

    This was a case of acute appendicitis in a patient with situs inversus found at Surgery for twisted left ovarian cyst in a 26 year old married woman. The case was interesting because the diagnosis of acute appendicitis as apposed to twisted left ovarian cyst was made intraoperatively when it was found in the left iliac fossa ...

  5. Childhood Acute Appenditis In Nnewi Nigeria | Osuigwe | Nigerian ...

    African Journals Online (AJOL)

    Nigerian Journal of Clinical Practice ... Acute appendicitis is not common in the paediatric age group in our environment and far more negative appendicectomies are performed. A scoring system for acute appendicitis in children in our environment is hereby advocated to reduce the incidence of negative appendectomy.

  6. Acute Appendicitis in Port Harcourt, Nigeria | Mangete | Orient ...

    African Journals Online (AJOL)

    Acute Appendicitis was also found to be commoner in the better educated social classes. The duration of hospitalization and postoperative complications were affected by late presentation to surgery but not by the status of the operating surgeon. Conclusion: Acute appendicitis was diagnosed more often in females than in ...

  7. Caecal diverticulitis presenting as acute appendicitis: a case report

    Directory of Open Access Journals (Sweden)

    Ayantunde Abraham A

    2009-07-01

    Full Text Available Abstract Solitary caecal diverticulum is an uncommon entity and therefore difficult to diagnose except at surgery. Caecal diverticulitis is an infrequent cause of acute abdomen and usually presents in a manner similar to acute appendicitis. It is extremely difficult to differentiate it preoperative from acute appendicitis and such distinction is usually made in the operating room. The optimal management of this clinical condition is still controversial, ranging from conservative treatment with antibiotics to aggressive surgical resections. We report a case of a 61 year old Caucasian who presented with acute onset right iliac fossa pain indistinguishable from acute appendicitis. The true diagnosis of a perforated acute caecal diverticulitis with an abscess mass was only made at operation in the presence of a macroscopically normal appendix. We reviewed the literature to highlight the difficulty of a preoperative diagnosis and the need for a high index of suspicion especially in the older age group presenting in manner similar to acute appendicitis.

  8. Case report and management of suspected acute appendicitis in pregnancy.

    Science.gov (United States)

    Murariu, Daniel; Tatsuno, Brent; Hirai, Cori-Ann M; Takamori, Ryan

    2011-02-01

    Suspected cases of acute appendicitis in pregnancy are considered surgical emergencies due to the potentially devastating outcomes for both mother and unborn child if the appendix perforates. Acute appendicitis is also the number one cause of non-traumatic acute abdomen in pregnancy, as well as the number one cause of fetal death. We present a case report with a typical presentation of suspected acute appendicitis in a pregnant woman. The work up and diagnostic tools available are discussed at length, as well as the finer points in treatment of this population. Hawaii Medical Journal Copyright 2011.

  9. Appendicitis

    Science.gov (United States)

    ... function. A blockage inside of the appendix causes appendicitis. The blockage leads to increased pressure, problems with ... to pass gas Low fever Not everyone with appendicitis has all these symptoms. Appendicitis is a medical ...

  10. MRI features associated with acute appendicitis

    NARCIS (Netherlands)

    Leeuwenburgh, Marjolein M. N.; Jensch, Sebastiaan; Gratama, Jan W. C.; Spilt, Aart; Wiarda, Bart M.; van Es, H. Wouter; Cobben, Lodewijk P. J.; Bossuyt, Patrick M. M.; Boermeester, Marja A.; Stoker, Jaap; Bouma, Wim H.; Houdijk, Alexander P. J.; Richir, Milan C.; Stockmann, Hein B. A. C.; Wiezer, Marinus J.; Verhagen, Thijs

    2014-01-01

    To identify MRI features associated with appendicitis. Features expected to be associated with appendicitis were recorded in consensus by two expert radiologists on 223 abdominal MRIs in patients with suspected appendicitis. Nine MRI features were studied: appendix diameter >7 mm, appendicolith,

  11. Acute appendicitis following blunt abdominal trauma. Coincidence or causality?

    Directory of Open Access Journals (Sweden)

    Sergio Iván Latorre

    2017-01-01

    Full Text Available Acute appendicitis is a common disease in clinical practice; some well-defined causes include luminal obstruction by fecoliths, lymphoid hyperplasia, foreign bodies and intestinal parasites. Closed abdominal trauma has been associated as an etiological factor, although, their causal relationship is still unclear. This paper presents the case of a patient with appendicitis after a closed abdominal trauma.

  12. The role of computed tomography in diagnosis of acute appendicitis

    International Nuclear Information System (INIS)

    Dementaviciene, J.

    2000-01-01

    This article reviews the CT imaging features of acute appendicitis and other conditions that can mimic similar clinical presentation. CT is very reliable in differentiating such diseases as acute diverticulitis, tiphlitis, mesenteric ischemia, Cron's disease, apendagitis, tumour, traumatic or sponataneous hematoma (m. rectus or m. psoas), ovarian cyst and others. This kind of examination should be used more often for differential diagnosis of acute appendicitis to choose right kind of treatment and improve the results. (author)

  13. Acute appendicitis in pregnancy: Case series and review.

    Science.gov (United States)

    Burcu, Busra; Ekinci, Ozgur; Atak, Tuba; Orhun, Kivilcim; Eren, Turgut Tunc; Alimoglu, Orhan

    2016-01-01

    Acute appendicitis is one of the most common acute surgical pathology we encountered. In this study we investigated our pregnant cases of appendicitis, and reviewed literature. A total of 21 pregnant women who underwent appendectomy with the initial diagnosis of acute appendicitis in Istanbul Medeniyet University Clinics of General Surgery between January 2012, and December 2014 were retrospectively analyzed. The patients's ages, trimesters, complaints, abdominal examination, laboratory, and ultrasonographic findings, surgical techniques, complications and hospital stay were noted. The patients were in their first (n=12; 57.1%), second (n=5; 23.8%), and third trimesters (n=4; 19.0%) of their pregnancies Median age was 23.9 years. All of the patients had abdominal pain. Median value of WBC count was 13.297/mm³. Ultrasound was positive in 12 patients (57.1%). In 14 (66.6%) patients McBurney incision, and in 6 (28.6%) cases right paramedian incision were used. One patient (4.8%) underwent laparoscopic appendectomy. Nineteen cases were acute appendicitis (90.5%), and two cases were perforated appendicitis (9.5%). Average hospital stay was 3.8 days. Two cases with perforated acute appendicitis developed wound infection and treated conservatively. There were no fetomaternal mortality. Physiologically anatomic and biochemical changes occurring during pregnancy can delay the diagnosis of acute appendicitis threaten the lives of both the mother and the fetus Therefore, rapid diagnosis and appropriate treatment convey importance.

  14. Does the Intestinal Parasite Enterobius vermicularis Cause Acute Appendicitis?

    Science.gov (United States)

    Pirhan, Yavuz; Özen, Fatma Zeynep; Kılınç, Çetin; Güçkan, Rıdvan

    2017-06-01

    Although intestinal parasitic infections rarely cause acute appendicitis, they are common public health problems in undeveloped and developing countries. Parasitic infections should be kept in mind in patients clinically suspected of having acute appendicitis, and treatment procedures should be adopted according to the etiology. Herein we presented the cases of four patients with clinical findings of acute appendicitis. Patients were clinically suspected of having acute appendicitis, and Enterobius vermicularis was detected in the pathological examinations of specimens. Pinworm infections are common parasitic infections that may mimic appendicitis. The pathology of the four cases was noted when the file of 186 patients aged between 4 and 72 years who underwent surgery for acute appendicitis in my hospital was retrospectively reviewed. When the appendectomy specimen was examined histopathologically it was understood that acute appendicitis was caused by Enterobius vermicularis parasite. In Enterobius infections, performing systemic therapy for patients and their family members is sufficient. To prevent unnecessary appendectomy, this type of infection should be made to ask in the history and clinical findings of patients.

  15. MRI features associated with acute appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Leeuwenburgh, Marjolein M.N. [University of Amsterdam, Department of Surgery, Academic Medical Center, Amsterdam (Netherlands); University of Amsterdam, Department of Radiology, Academic Medical Center, Amsterdam (Netherlands); Academic Medical Center, Department of Radiology (G1-223.1), Amsterdam (Netherlands); Jensch, Sebastiaan [Sint Lucas Andreas Hospital, Department of Radiology, Amsterdam (Netherlands); Gratama, Jan W.C. [Gelre Hospitals, Department of Radiology, Apeldoorn (Netherlands); Spilt, Aart [Kennemer Gasthuis, Department of Radiology, Haarlem (Netherlands); Wiarda, Bart M. [Alkmaar Medical Center, Department of Radiology, Alkmaar (Netherlands); Es, H.W. van [Sint Antonius Hospital, Department of Radiology, Nieuwegein (Netherlands); Cobben, Lodewijk P.J. [Haaglanden Medical Center, Department of Radiology, Leidschendam (Netherlands); Bossuyt, Patrick M.M. [University of Amsterdam, Department of Clinical Epidemiology, Academic Medical Center, Amsterdam (Netherlands); Boermeester, Marja A. [University of Amsterdam, Department of Surgery, Academic Medical Center, Amsterdam (Netherlands); Stoker, Jaap [University of Amsterdam, Department of Radiology, Academic Medical Center, Amsterdam (Netherlands); Collaboration: on behalf of the OPTIMAP study group

    2014-01-15

    To identify MRI features associated with appendicitis. Features expected to be associated with appendicitis were recorded in consensus by two expert radiologists on 223 abdominal MRIs in patients with suspected appendicitis. Nine MRI features were studied: appendix diameter >7 mm, appendicolith, peri-appendiceal fat infiltration, peri-appendiceal fluid, absence of gas in the appendix, appendiceal wall destruction, restricted diffusion of the appendiceal wall, lumen or focal fluid collections. Appendicitis was assigned as the final diagnosis in 117/223 patients. Associations between imaging features and appendicitis were evaluated with logistic regression analysis. All investigated features were significantly associated with appendicitis in univariate analysis. Combinations of two and three features were associated with a probability of appendicitis of 88 % and 92 %, respectively. In patients without any of the nine features, appendicitis was present in 2 % of cases. After multivariate analysis, only an appendix diameter >7 mm, peri-appendiceal fat infiltration and restricted diffusion of the appendiceal wall were significantly associated with appendicitis. The probability of appendicitis was 96 % in their presence and 2 % in their absence. An appendix diameter >7 mm, peri-appendiceal fat infiltration and restricted diffusion of the appendiceal wall have the strongest association with appendicitis on MRI. (orig.)

  16. [Appendicitis versus non-specific acute abdominal pain: Paediatric Appendicitis Score evaluation].

    Science.gov (United States)

    Prada Arias, Marcos; Salgado Barreira, Angel; Montero Sánchez, Margarita; Fernández Eire, Pilar; García Saavedra, Silvia; Gómez Veiras, Javier; Fernández Lorenzo, José Ramón

    2018-01-01

    Non-specific acute abdominal pain is the most common process requiring differential diagnosis with appendicitis in clinical practice. The aim of this study was to assess the Paediatric Appendicitis Score in differentiating between these two entities. All patients admitted due to suspicion of appendicitis were prospectively evaluated in our hospital over a two-year period. Cases of non-specific acute abdominal pain and appendicitis were enrolled in the study. Several variables were collected, including Score variables and C-reactive protein levels. Descriptive, univariate and multivariate analyses and diagnostic accuracy studies (ROC curves) were performed. A total of 275 patients were studied, in which there were 143 cases of non-specific acute abdominal pain and 132 cases of appendicitis. Temperature and right iliac fossa tenderness on palpation were the variables without statistically significant differences, and with no discrimination power between groups. Pain on coughing, hopping, and/or percussion tenderness in the right lower quadrant was the variable with greater association with appendicitis. The Score correctly stratified the patients into risk groups. Substitution of temperature for C-reactive protein in the Score increased diagnostic accuracy, although with no statistically significant differences. The Paediatric Appendicitis Score helps in differential diagnosis between appendicitis and non-specific acute abdominal pain. It would be advisable to replace the temperature in the Score, since it has no discrimination power between these groups. C-reactive protein at a cut-off value of 25.5mg/L value could be used instead. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Imaging Findings of the Unusual Presentations, Associations and Clinical Mimics of Acute Appendicitis.

    Science.gov (United States)

    Demir, Mustafa Kemal; Savas, Yildiray; Furuncuoglu, Yavuz; Cevher, Tarik; Demiral, Serdar; Tabandeh, Babek; Aslan, Melisa

    2017-10-01

    There are many kinds of unusual presentations or associations and clinical mimics of acute appendicitis, and definitive diagnosis requires knowledge of the imaging findings in some cases. The unusual presentations and associations of acute appendicitis included in this study are perforated appendicitis, acute appendicitis occurring in hernias, acute appendicitis with cystic endosalpingiosis, intussusception of appendix, and acute appendicitis with pregnancy. We also present uncommon gastrointestinal, urinary and gynecologic clinical mimics of acute appendicitis including anomalous congenital band, duplication cysts, giant Meckel's diverticulitis, inflammatory fibroid polyp, renal artery thrombosis, spontaneous urinary extravasation and OHVIRA syndrome. Familiarity with these entities may improve diagnostic accuracy and enable the quickest and most appropriate clinical management.

  18. Diagnostic value of appendicular Doppler ultrasonography in acute appendicitis.

    Science.gov (United States)

    Uzunosmanoğlu, Hüseyin; Çevik, Yunsur; Çorbacıoğlu, Şeref Kerem; Akıncı, Emine; Buluş, Hakan; Ağladıoğlu, Kadir

    2017-05-01

    Acute appendicitis is one of the most common causes of acute abdominal pain prompting emergency department (ED) visits. It is critical for the physicians to promptly and accurately diagnose acute appendicitis. The present study aimed to evaluate the diagnostic efficacy of Doppler ultrasonography (USG) in patients with acute appendicitis and compare this new method with other commonly used radio-diagnostic tools. All patients who were diagnosed with acute appendicitis at the Kecioren Training and Research Hospital ED and later underwent appendectomy between October 2012 and April 2013 were included in the study. Approval from the ethics committee was obtained for this prospective study. The patients' demographic information, physical examination findings, vital signs, Alvarado scores, and laboratory and radiological exam results were recorded. A total of 60 patients were enrolled in the study. In 46 of the 60 patients, diagnosis of acute appendicitis was confirmed by histopathology results, whereas 14 patients, diagnoses was not confirmed by lab tests. Doppler USG could detect 43 of the 46 patients as true positives, and it detected 2 of the 14 patients with negative lab results as false positives. For diagnosis of acute appendicitis, sensitivity of appendicular Doppler USG was 93%, specificity was 85%, accuracy was 91%, positive likelihood ratio was 6.5, and negative likelihood ratio was 0.08. Doppler imaging can offer a high level of diagnostic success in patients with acute appendicitis. Appendicular Doppler USG offers a rapid and easy application without the need to expose patients to contrast medium and is superior to both USG and computed tomography. Therefore, we recommend the use of appendicular Doppler imaging as the primary radiological exam in diagnosing acute appendicitis.

  19. Unenhanced MR Imaging in adults with clinically suspected acute appendicitis

    DEFF Research Database (Denmark)

    Chabanova, Elizaveta; Balslev, Ingegerd; Achiam, Michael

    2011-01-01

    PURPOSE: The purpose of the study was to evaluate unenhanced Magnetic Resonance Imaging (MRI) for the diagnosis of appendicitis or another surgery-requiring condition in an adult population scheduled for emergency appendectomy based on a clinical diagnosis of suspected acute appendicitis. MATERIALS...... radiologists and one surgeon independent of each other and compared with surgical and pathological records. RESULTS: According to the surgical and histopathological findings 30 of 48 patients (63%) had acute appendicitis. Of the remaining 18 patients, 4 patients had no reasons for the clinical symptoms and 14...... patients had other pathology. For the three reviewers the performance of MRI in the diagnosis of acute appendicitis showed the following sensitivity, specificity and accuracy ranges: 83-93%, 50-83% and 77-83%. Moderate (kappa=0.51) and fair (kappa=0.31) interobserver agreements in the MR diagnosis of acute...

  20. Visceral Myopathy Presenting as Acute Appendicitis and Ogilvie Syndrome

    OpenAIRE

    Kharbuja, Punyaram; Thakur, Raghvendra; Suo, Jian

    2013-01-01

    Background. Visceral myopathy is rare pathological condition of gastrointestinal tract with uncertain clinical presentation and unknown etiology. It often presents with symptoms of chronic intestinal pseudoobstruction of colon. We report a case of visceral myopathy which presented to us as acute appendicitis and Ogilvie syndrome, and we managed it surgically. Method and Result. A case report of 20-year female clinically presented as acute appendicitis and we performed laparoscopic exploratio...

  1. Appendiceal diverticulitis and acute appendicitis: differences and similarities.

    Science.gov (United States)

    Lobo-Machín, Irene; Delgado-Plasencia, Luciano; Hernández-González, Ibrahim; Brito-García, Alejandro; Burillo-Putze, Guillermo; Bravo-Gutiérrez, Alberto; Martínez-Riera, Antonio; Medina-Arana, Vicente

    2014-08-01

    Acute appendiceal diverticulitis is an unusual cause of acute abdomen, considered clinically indistinguishable from acute appendicitis. In a historic cohort study with 27 cases of appendiceal diverticulitis and 54 cases of acute appendicitis, we compared clinical characteristics, diagnostic tests and pathology findings of the two processes. Mean age at presentation was lower in acute appendicitis (37.24 +/- 19.98 vs. 54.81 +/- 17.55 years, p diverticulitis group, 48.15 % had leukocytosis vs. 81.48 % in the appendicitis group (p = 0.02); there was no difference in leukocyte count (13770.37 +/- 4382.55 vs. 14279.63 +/- 4268.59, p = 0.61). Patients with appendiceal diverticulitis had a higher incidence of appendiceal mucocele (p = 0.01) and a lower proportion of appendiceal gangrene (p = 0.03). There were no differences in appendiceal perforation or ulceration. Symptom duration before emergency department attendance (71.61 +/- 85.25 hours vs. 36.84 +/- 33.59 hours; Z = -3.1 p = 0.002), duration of surgery (85 +/- 40 minutes vs. 60 +/- 21 minutes, Z = -3.2, p = 0.001) and the presence of appendicular plastron was higher in patients with diverticulitis vs. appendicitis (8 vs. 5 patients [p = 0.01, Odds ratio 2.2]). Appendiceal diverticulitis presents a series of clinical, epidemiological and pathological differences with respect to acute appendicitis. The former shows a more indolent course with delayed diagnosis.

  2. Diagnostic Value of Plasma Pentraxin-3 in Acute Appendicitis.

    Science.gov (United States)

    Aygun, Ali; Katipoglu, Burak; Ïmamoglu, Melih; Demir, Selim; Yadigaroglu, Metin; Tatli, Ozgur; Yurtsever, Selim; Usta, Arif; Mentese, Ahmet; Turkmen, Suha

    2017-10-11

    To measure serum PTX3 levels in patients admitted with right lower quadrant pain to emergency department and to investigate whether this parameter will be helpful for the diagnosis of acute appendicitis. This study was conducted with a group of 89 patients over 17 years of age who were admitted with the complaint of right lower quadrant pain to ED and had a preliminary diagnosis of acute appendicitis clinically and the control group of 31 healthy volunteers in a tertiary university hospital for 3 months. Median PTX3 levels were 3.28 (1.08-30.24) ng/mL in the acute appendicitis groups and 0.97 (0.34-2.62) ng/mL in the control group. A significant difference was observed between acute appendicitis groups and the control group (p < 0.05). PTX3 was found to be significantly higher in patient with acute appendicitis compared to the control group and the patients with non-specific abdominal pain. PTX3 can be used as an aid in the diagnosis of acute appendicitis.

  3. Successful nonsurgical treatment for synchronous acute cholecystitis and acute appendicitis: A case report and review of the literatures

    Directory of Open Access Journals (Sweden)

    Ting-Ying Lee

    2014-01-01

    Full Text Available Acute appendicitis and acute cholecystitis are commonly seen in acute abdominal disease. However, it is rarely described that synchronous acute cholecystitis and acute appendicitis presented. Here, we present a case of 78-year-old male suffered from cholelithiasis with acute cholecystitis synchronized with acute appendicitis treated with nonsurgical management successfully.

  4. Conservative treatment of acute appendicitis: an overview

    NARCIS (Netherlands)

    Wojciechowicz, K. H.; Hoffkamp, H. J.; van Hulst, R. A.

    2010-01-01

    Background. Although the standard treatment for appendicitis (since 1883) is an appendectomy, this is not always possible in a maritime or military setting. To avoid relying on improvisation in such situations this study examines the evidence for conservative management of appendicitis. Material and

  5. Value of ultrasonography in the diagnosis of acute appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Sohn, Seok Ho; Jung, Kun Sik; Kim, Jung Sik; Woo, Seong Ku; Chung, Ki Yong [School of Medicine, Keimyung University, Daegu (Korea, Republic of); Kim, Hee Jin [Fatima Hospital, Daegu (Korea, Republic of)

    1993-03-15

    During a 12-month period high-resolution, real-time ultrasonography (US) with graded compression was performed on 268 consecutive patients with clinically suspected acute appendicitis and its complications. US visualization of a fluid-filled, non-compressed appendix or a decompressed, thick-walled appendix was the primary criterion for a diagnosis of acute appendicitis. The sonographic findings were correlated with surgical-pathologic outcome in 92 cases and with the findings of clinical follow-ups in the remainder. US was found to be accurate in the diagnosis of acute appendicitis and its complication with a sensitivity of 93.3%, a specificity of 98.9%, and an accuracy of 97%. The predictive value of a positive test was 97.7%; that of a negative test was 96.7%. There were two false-positive examinations in patients with a thick-walled appendix or periapperdiceal abscess, which were surgically confirmed as appendiceal adenocarcinoma and perforated cecal diverticulitis respectively. There were six false-negative examinations in patients with a sonographically no-visible appendix, which were confirmed surgically as acute appendicitis (n=5) and perforated appendicitis (n=1). Our results show that high-resolution, real-time US is an accurate imaging modality in the diagnosis of acute appendicitis and the evaluation of its complications.

  6. Value of ultrasonography in the diagnosis of acute appendicitis

    International Nuclear Information System (INIS)

    Sohn, Seok Ho; Jung, Kun Sik; Kim, Jung Sik; Woo, Seong Ku; Chung, Ki Yong; Kim, Hee Jin

    1993-01-01

    During a 12-month period high-resolution, real-time ultrasonography (US) with graded compression was performed on 268 consecutive patients with clinically suspected acute appendicitis and its complications. US visualization of a fluid-filled, non-compressed appendix or a decompressed, thick-walled appendix was the primary criterion for a diagnosis of acute appendicitis. The sonographic findings were correlated with surgical-pathologic outcome in 92 cases and with the findings of clinical follow-ups in the remainder. US was found to be accurate in the diagnosis of acute appendicitis and its complication with a sensitivity of 93.3%, a specificity of 98.9%, and an accuracy of 97%. The predictive value of a positive test was 97.7%; that of a negative test was 96.7%. There were two false-positive examinations in patients with a thick-walled appendix or periapperdiceal abscess, which were surgically confirmed as appendiceal adenocarcinoma and perforated cecal diverticulitis respectively. There were six false-negative examinations in patients with a sonographically no-visible appendix, which were confirmed surgically as acute appendicitis (n=5) and perforated appendicitis (n=1). Our results show that high-resolution, real-time US is an accurate imaging modality in the diagnosis of acute appendicitis and the evaluation of its complications

  7. Mean Platelet Volume (MPV in Children with Acute Appendicitis

    Directory of Open Access Journals (Sweden)

    Ali Arian Nia

    2018-01-01

    Full Text Available BACKGROUND: Acute appendicitis is one of the causes of acute pediatric abdominal pain, requiring quick diagnosis with most cases requiring emergency surgery. Often another cause of acute abdominal pain is identified during surgery and this rate is significantly higher in children than adults. Mean platelet volume (MPV has been suggested as a biomarker of inflammation. Therefore, we examined the association of MPV with acute appendicitis in children. METHODS: This case-control study was conducted in 120 children. Sixty cases of acute appendicitis were identified, and 60 controls were identified who presented with abdominal pain but did not have acute appendicitis. Data on demographic and clinical characteristics and final diagnosis were extracted. Chi-square and t-tests were used to determine statistical significance. RESULTS: The mean age of the study participants was 7.18 years (standard deviation 3.37. There were 72 males (61% and 46 females (39%. Mean±SD of MPV was 8.2±0.1 fl, ESR was 24.8±2.0 mm/hour, white blood cell count was 11.5±4.1 x 103 per mL, neutrophils were 72%±1.6%, and lymphocytes were 26.5%±1.6%. There was no difference in MPV between patients with and without acute appendicitis as final diagnosis (8.27±0.13 f1 vs. 8.22±0.13 fl, P>0.05. CONCLUSION: We found no association between MPV and acute appendicitis in children. Other biomarkers need to be evaluated to support clinicians in making a diagnosis of acute appendicitis.

  8. Laparoscopic management of acute appendicitis in situs inversus

    Directory of Open Access Journals (Sweden)

    Golash Vishwanath

    2006-01-01

    Full Text Available Situs inversus is often detected incidentally in adults during imaging for a acute surgical emergency. We present a case of acute appendicitis in an adult who was previously unaware about his situs anomaly. A laparoscopic approach is helpful to deal with this condition. A 40 year old man was admitted with history of acute left lower abdominal pain, with uncontrolled diabetic keto-acidosis. Clinically, he was diagnosed as acute diverticulitis with localized peritonitis. Subsequent imaging studies and laparoscopy confirmed the diagnosis of situs inversus and acute left- sided appendicitis. He successfully underwent laparoscopic appendectomy. His postoperative recovery was uneventful. Although technically more challenging because of the reverse laparoscopic view of the anatomy, the laparoscopic diagnosis and management of acute appendicitis is indicated in situs inversus.

  9. Appendicitis

    Science.gov (United States)

    ... in other illnesses (like kidney stones, pneumonia, and urinary tract infections). That's why it's important to call your doctor. Development and Duration of Appendicitis Once the appendicitis symptoms appear, it can take as little as 24 ...

  10. Is Enterobius vermicularis infestation associated with acute appendicitis?

    Science.gov (United States)

    Akkapulu, N; Abdullazade, S

    2016-08-01

    Enterobius vermicularis might be seen in specimens of patients who underwent surgery due to acute appendicitis. There is still debate as to E. vermicularis infestation causes acute appendicitis. The primary aim of this study is to determine the incidence of E. vermicularis infestation, and the secondary aim is to determine the possible role of E. vermicularis in pathogenesis of appendicitis as well as the adequacy of demographic data and laboratory values in predicting infestation preoperatively. A retrospective investigation was conducted with all patients who underwent appendectomy due to acute appendicitis in a secondary care center. Patients with E. vermicularis were compared with 24 controls that underwent appendectomy during the same time period. Demographic data, preoperative white blood cell (WBC) count, eosinophil counts, and histopathological findings for both groups were analyzed and compared. Enterobius vermicularis was detected in the appendectomy materials in 9 of 1446 patients (0.62 %). Histopathologically, only one of nine patients had acute appendicitis while the others were diagnosed with lymphoid hyperplasia. There were no statistically significant differences between the groups except WBC count. However, the WBC count was significantly (p appendicitis. Also eosinophil count and elevation of white blood counts are inadequate for predicting preoperative E. vermicularis.

  11. Study of 150 cases of acute appendicitis in children

    Directory of Open Access Journals (Sweden)

    Fallahi Gh

    1998-06-01

    Full Text Available Acute appendicitis is the most common condidition, requiring emergency operation in children. Late appendicitis is still a major sours of morbidity and potential mortality. The charts of all pediatric appendectomy patients (150 cases treated between 1367-1373 (Iranian calender in Amir Kabir Medical Center were reviewed. Mean hospital stay was 4.7 days. Mean ages of patients was 8.5 years. Male to female ratio was 1.2/1. Most common symptom was abdominal pain (100% and deep tenderness in right lower quadrant in 94.6%. Mean temprature was 37.2 and leucocytosis (more than 10000 were in the 76.3%. 14 patients had perforated appendicitis and most common pathology was acut supporative appendicitis. Accuracy of diagnosis was 96.6% and post operative pelvic abccess was 2%. Mortality occurred in one case (0.6%

  12. Acute Appendicitis Complicated by Pylephlebitis: A Case Report

    Directory of Open Access Journals (Sweden)

    Ricardo Castro

    2013-01-01

    Full Text Available Pylephlebitis is defined as septic thrombophlebitis of the portal vein. It is a rare but serious complication of an intraabdominal infection, more commonly diverticulitis and appendicitis. It has an unspecific clinical presentation and the diagnosis is difficult. The authors report a case of a 21-year-old man with acute appendicitis complicated by pylephlebitis. The diagnosis was made with contrast enhanced CT.

  13. A Rare Complication of Acute Appendicitis: Superior Mesenteric Vein Thrombosis

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    Hendra Koncoro

    2016-12-01

    Full Text Available Superior mesenteric vein (SMV thrombosis caused by acute appendicitis is quite rare nowadays. These conditions occurs secondary to infection in the region drained by the portal venous system. In this case, we report a successfully treated case of SMV thrombosis and liver abscess associated with appendicitis with antibiotics and anticoagulant.Early diagnosis and prompt treatment are basic to a favorable clinical course.

  14. Dengue fever mimicking acute appendicitis: A case report.

    Science.gov (United States)

    McFarlane, M E C; Plummer, J M; Leake, P A; Powell, L; Chand, V; Chung, S; Tulloch, K

    2013-01-01

    Dengue fever is an acute viral disease, which usually presents as a mild febrile illness. Patients with severe disease present with dengue haemorrhagic fever or dengue toxic shock syndrome. Rarely, it presents with abdominal symptoms mimicking acute appendicitis. We present a case of a male patient presenting with right iliac fossa pain and suspected acute appendicitis that was later diagnosed with dengue fever following a negative appendicectomy. A 13-year old male patient presented with fever, localized right-sided abdominal pain and vomiting. Abdominal ultrasound was not helpful and appendicectomy was performed due to worsening abdominal signs and an elevated temperature. A normal appendix with enlarged mesenteric nodes was found at surgery. Complete blood count showed thrombocytopenia with leucopenia. Dengue fever was now suspected and confirmed by IgM enzyme-linked immunosorbent assay against dengue virus. This unusual presentation of dengue fever mimicking acute appendicitis should be suspected during viral outbreaks and in patients with atypical symptoms and cytopenias on blood evaluation in order to prevent unnecessary surgery. This case highlights the occurrence of abdominal symptoms and complications that may accompany dengue fever. Early recognition of dengue fever mimicking acute appendicitis will avoid non-therapeutic operation and the diagnosis may be aided by blood investigations indicating a leucopenia, which is uncommon in patients with suppurative acute appendicitis. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

  15. MR imaging of the normal appendix and acute appendicitis.

    Science.gov (United States)

    Nitta, Norihisa; Takahashi, Masashi; Furukawa, Akira; Murata, Kiyoshi; Mori, Masayuki; Fukushima, Masanobu

    2005-02-01

    To describe the MR appearance of the normal appendix and the MR imaging characteristics of acute appendicitis with correlation to pathological severity. A total of 20 volunteers participated in this study to demonstrate normal appendices by MR imaging. A total of 37 consecutive patients with clinically diagnosed acute appendicitis were also scanned. T1-weighted (T1WI) spin-echo images, T2-weighted (T2WI) fast spin-echo, and fat-suppressed spectral presaturation inversion recovery T2-weighted (T2SPIR) fast spin-echo images were obtained. The MR criteria for considering acute appendicitis were as follows: 1) thickening of the appendiceal wall with high intensity on T2WI or T2SPIR; 2) dilated lumen filled with high intensity material on T2WI or T2SPIR; and 3) increased intensity of periappendiceal tissue on T2WI or T2SPIR. The visibility of a normal appendix on MR imaging was 90% (18/20). It appeared as a cord-like structure of medium intensity without fluid collection in the lumen. A total of 30 cases with clinically diagnosed acute appendicitis had positive MR findings and all except one were pathologically proven. The one had cecal diverticulitis. These cases demonstrated filled lumen, with a hypointense wall on T1WI and slightly hyperintense on T2WI or T2SPIR. MR findings correlated well with pathological severity, especially a thicker wall, periappendiceal high intensity, and ascites were useful for suspecting severe appendicitis. Correct diagnosis of acute appendicitis was obtained with MRI, and correlated well with its pathological severity. MRI is a powerful alternative for diagnosing acute appendicitis especially for the patients in whom the radiation is major concern. (c) 2005 Wiley-Liss, Inc.

  16. Hydatidosis as a cause of acute appendicitis: a case report

    Directory of Open Access Journals (Sweden)

    Maryam Hajizadeh

    2013-02-01

    Full Text Available Acute appendicitis is considered the most common cause of emergency surgery in children and young adults. The association between parasitic infections and appendicitis has been widely investigated. Hydatidosis, a zoonotic helminthic disease caused by the larval stage of the Echinococcus granulosus, may cause illness in intermediate hosts, generally human and herbivorous animals. This disease is considered hyper endemic in northwest of Iran and is a serious public health problem. Hydatidosis predominantly is located in internal organs especially liver and lung but is considered a rare cause of acute appendicitis. Our aim was to study hydatid cyst that causes appendicitis. In this retrospective descriptive, 275 appendectomies performed during the years 2007-2012 in Tabriz Emam Reza hospital. Depending on the clinical notes, serological method, laboratory, surgical findings and attention to the histopathologic results, we found a patient with appendiceal hydatidosis. Acute appendicitis of hydatidosis origin is not seen frequently even in the hyper endemic area. Therefore, described an unusual cases of hydatidosis, should be considered in the differential diagnoses of appendicitis also education on how to prevent hydatidosis and eradication of stray dogs should be included in training programs to avoid and decrease the appendectomy operations.

  17. What is the complementary role of ultrasound evaluation in the diagnosis of acute appendicitis after CT?

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    Jang, Kyung Mi [Department of Radiology, Hallym University Sacred Heart Hospital, Anyang (Korea, Republic of); Lee, Kwanseop [Department of Radiology, Hallym University Sacred Heart Hospital, Anyang (Korea, Republic of)], E-mail: kwanseop@hallym.or.kr; Kim, Min-Jeong; Yoon, Hoi Soo; Jeon, Eui Yong; Koh, Sung Hye [Department of Radiology, Hallym University Sacred Heart Hospital, Anyang (Korea, Republic of); Min, Kwangseon [Department of Pathology, Hallym University Sacred Heart Hospital, Anyang (Korea, Republic of); Choi, Dongil [Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (Korea, Republic of)

    2010-04-15

    The objective of our study was to estimate the complementary role of ultrasound evaluation in the diagnosis of acute appendicitis after abdominoplevic CT. A total of 104 patients initially underwent abdominopelvic CT before appendix US due to acute abdominal pain. All CT examinations were evaluated retrospectively for the presence of acute appendicitis. The findings of appendix on CT were classified into five categories (definite appendicitis, probably appendicitis, equivocal CT findings for diagnosis of appendicitis, probably not appendicitis, and normal looking appendix). Appendix US images and their radiologic reports were also evaluated retrospectively. Then, CT and US findings were correlated with clinical or pathologic diagnosis. Three all patients with definite appendicitis initially on CT again showed US findings of appendicitis. In the 32 patients of probably appendicitis on CT, US showed normal looking appendix in seven patients (21.8%, 7 of 32) who improved with medical treatment and discharged. In the 16 patients of equivocal CT findings for diagnosis of appendicitis, US showed appendicitis in seven patients (43.8%, 7 of 16) and normal looking appendix in nine patients. In the 12 patients of probably not appendicitis on CT, US showed acute appendicitis in two patients (16.7%, 2 of 12). In the 41 patients of normal looking appendix on CT, US showed acute appendicitis in five patients (12.2%, 5 of 41). US reevaluation enables us to avoid misdiagnosis of appendicitis on CT and improve diagnostic accuracy of acute appendicitis.

  18. Primary torsion of vermiform appendix mimicking acute appendicitis.

    Science.gov (United States)

    Marsdin, Emma L; Griffiths, Carl

    2011-10-28

    Acute appendicitis is a common condition, 8% of the developed world have an appendicectomy in their lifetime. However, torsion of the appendix is a rare disorder first described in 1918 presenting in a manner undistinguishable from acute appendicitis. The authors describe a case of a 48-year-old man who presented with a short history consistent with acute appendicitis. At open appendicectomy, was found to have an acute clockwise torsion of the vermiform appendix at a point 0.5 cm from its base. Histological examination of the specimen was consistent with torsion of the appendix but no underlying cause for the torsion was identified. The postoperative recovery was uneventful; the patient received intravenous antibiotics for a further 48 h and was discharged home without any complications.

  19. Mean Platelet volume in diagnosis of acute appendicitis in children ...

    African Journals Online (AJOL)

    Background: The clinical diagnosis of acute appendicitis (AA) in children is still problematic in status. Objectives: To investigate the diagnostic value of mean platelet volume (MPV) in acute AA at childhood. Methods: One hundred patients diagnosed as AA patients and 100 healthy individuals. Laboratory tests were studied ...

  20. Faecal Impaction Presenting as Acute Appendicitis: A Report of 2 ...

    African Journals Online (AJOL)

    This paper highlights different manner in which faecal impaction presents i.e. with acute severe right lower quadrant abdominal pain. Two illustrative cases of young adult males are presented, they had clinical features suggestive of acute appendicitis, which turned out to be due to faecal impaction. Digital rectal examination ...

  1. Omental infarction in children misdiagnosed as acute appendicitis ...

    African Journals Online (AJOL)

    Omental infarction (OI) is a rare cause of acute abdomen in children. It is found in 0.1–0.5% of pediatric patients undergoing abdominal exploration for the suspect of acute appendicitis. OI is considered a self-limited entity, and conservative management should be considered. This approach implicates computer tomography ...

  2. Unenhanced MR Imaging in adults with clinically suspected acute appendicitis

    DEFF Research Database (Denmark)

    Chabanova, Elizaveta; Balslev, Ingegerd; Achiam, Michael

    2011-01-01

    patients had other pathology. For the three reviewers the performance of MRI in the diagnosis of acute appendicitis showed the following sensitivity, specificity and accuracy ranges: 83-93%, 50-83% and 77-83%. Moderate (kappa=0.51) and fair (kappa=0.31) interobserver agreements in the MR diagnosis of acute...

  3. Acute appendicitis in children: not only surgical treatment.

    Science.gov (United States)

    Caruso, Anna Maria; Pane, Alessandro; Garau, Roberto; Atzori, Pietro; Podda, Marcello; Casuccio, Alessandra; Mascia, Luigi

    2017-03-01

    An accurate diagnosis of acute appendicitis is important to avoid severe outcome or unnecessary surgery but management is controversial. The aim of study was to evaluate, in younger and older children, the efficacy of conservative management for uncomplicated appendicitis and the outcome of complicated forms underwent early surgery. Children with acute appendicitis were investigated by clinical, laboratory variables and abdominal ultrasound and divided in two groups: complicated and uncomplicated. Complicated appendicitis underwent early surgery; uncomplicated appendicitis started conservative treatment with antibiotic. If in the next 24-48h it was worsening, the conservative approach failed and patients underwent late surgery. A total of 362 pediatric patients were included. One hundred sixty-five underwent early appendectomy; 197 patients were at first treated conservatively: of these, 82 were operated within 24-48h for failure. The total percentage of operated patients was 68.2%. An elevated association was found between surgery and ultrasound. Conservative treatment for uncomplicated appendicitis had high percentage of success (58%). Complications in operated patients were infrequent. Our protocol was effective in order to decide which patients treat early surgically and which conservatively; specific red flags (age and onset) can identified patients at most risk of complications or conservative failure. treatment study. II. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Acute Appendicitis During Pregnancy: Different from the Nonpregnant State?

    Science.gov (United States)

    Segev, L; Segev, Y; Rayman, S; Nissan, A; Sadot, E

    2017-01-01

    Acute appendicitis is the most common nonobstetric indication for surgical intervention during pregnancy. However, the current literature is scarce and composed of relatively small case series. We aimed to compare the presentation, management, and surgical outcomes of presumed acute appendicitis between a contemporary cohort of pregnant women and nonpregnant women of reproductive age. The study group included 92 pregnant patients who underwent appendectomy for presumed acute appendicitis at a single tertiary medical center in 2000-2014. Preoperative, operative, and postoperative clinical data were derived from medical records and compared to data for 494 nonpregnant patients of reproductive age who underwent appendectomy in 2004-2007 at the same institution. Median age was 28 years (range 25-33) in the study group and 26 years (range 20-34) in the control group (P = 0.1). There were no between-group differences in mean white blood cell count, patient interval, hospital interval, or operative time. Preoperative abdominal ultrasound was used in a significantly higher proportion of patients in the pregnant group than in the nonpregnant group (73 and 27 %, respectively, P appendicitis (12 and 11 %, P = 0.9), and overall postoperative complications (15 and 12 %, P = 0.3). The clinical presentation and outcome of presumed acute appendicitis are similar in pregnant women and nonpregnant women of reproductive age. Therefore, similar perioperative management algorithms may be applied in both patient populations.

  5. Relationship between Enterobius vermicularis and the incidence of acute appendicitis.

    Science.gov (United States)

    Ramezani, Mohammad Arash; Dehghani, Mahmoud Reza

    2007-01-01

    The objective of this study was to evaluate the relationship between Enterobius vermicularis and the occurrence of acute appendicitis. Over a ten year period of time, all appendix specimens received by the department of pathology were reviewed for pathologic changes and the existence of E. vermicularis. Logistic regression was carried out to determine the odds ratio (OR) of the relationship between E. vermicularis and acute appendicitis. A total of 5048 specimens were reviewed. E. vermicularis was found in 144 (2.9%) cases. After separating by sex and adjusting for age logistic regression analysis showed the OR of E. vermicularis appendiceal infestation was 1.275 (95% CI = 0.42-3.9) for males and 1.678 (95% CI = 0.61-4.65) for females. Age was an independent risk factor for acute appendicitis in males (OR = 1.01, 95% CI = 1.003-1.017) and females (OR = 1.012, 95% CI = 1.005-1.02).

  6. Primary appendiceal lymphoma presenting as acute appendicitis: a case report

    International Nuclear Information System (INIS)

    Lee, Kang Hoon; Song, Kyung Sup; Kim, Hyeon Sook; Yun, Sang Sup; Han, Ji Youn

    1999-01-01

    Because primary lymphoma of the appendix is a very rare disorder and commonly presents as acute appendicitis, it is seldom diagnosed by preoperative imaging studies. We encountered a patient with pathologically proven primary appendiceal lymphoma associated with acute and chronic appendicitis. Ultrasonography revealed a non-compressible sausage-shaped hypoechoic mass with a linear hyperechoic center caused by the mucosa-lumen interface in the right lower quadrant. Post-contrast CT examination showed a markedly enlarged target-like appendix with obliteration of the lumen ; the outer layer showed higher attenuation than the central portion. There were also multiple strands in the periappendiceal fat and thickening of adjacent lateroconal fascia and the colonic wall, and this suggested acute appendicitis associated with appendiceal lymphoma

  7. Endometrial decidualization: a rare cause of acute appendicitis during pregnancy.

    Science.gov (United States)

    Murphy, Skyle J; Kaur, Anupinder; Wullschleger, Martin E

    2016-04-22

    Appendicular endometriosis is a rare and poorly understood pathology that affects women in their reproductive years. In the gravid woman, ectopic endometrial tissue undergoes decidualization. This physiological process can result in acute appendicitis in exceptional cases. Here we describe a patient in her second trimester of pregnancy who presented with right iliac fossa pain and clinical, laboratory and imaging findings consistent with acute appendicitis. A laparoscopic appendectomy was performed with intraoperative findings suspicious for malignancy. Histological analysis made the surprising diagnosis of decidualized endometriosis causing luminal constriction resulting in acute appendicitis. We also detail the challenging diagnostic and management issues faced by clinicians in such cases. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2016.

  8. Role of total leukocyte in diagnosis of acute appendicitis

    International Nuclear Information System (INIS)

    Kamran, H.; Naveed, D.; Ahmed, M.

    2008-01-01

    Acute appendicitis is a common surgical emergency. Diagnosis may be difficult with little help from radiological and laboratory investigations. Total leukocyte count is one of the helpful investigations, being evaluated in this study. The patients presenting with right lower quadrant abdominal pain whom were diagnosed as having acute appendicitis and later underwent appendicectomy were included in the study. The preoperative leukocyte count was compared with histo-pathology findings of removed appendix. Sensitivity and specificity of TLC was calculated by standard formulas. The sensitivity and specificity of TLC as calculated in this study is 76.5% and 73.7% respectively while positive predictive value is 92.5%. TLC although not a diagnostic criteria for acute appendicitis but still is helpful investigation in decision making. (author)

  9. [Synchronous acute cholecystolithiasis and perforated acute appendicitis. Case report].

    Science.gov (United States)

    Padrón-Arredondo, Guillermo; de Atocha Rosado-Montero, Manuel

    2016-01-01

    Acute appendicitis and acute cholecystitis are among the most common diagnoses that general surgeons operate on. However, it is rarely described in its synchronous form. A 43 year-old woman attending the clinic for right upper quadrant pain of 11 days duration. The patient refers to intermittent radiating pain in the right side, with positive Murphy, tachycardia, and fever. The laboratory results showed white cells 16,200/mm(3), glucose 345 mg/dl, abnormal liver function tests. Acute cholecystitis was reported with ultrasound. A Masson-type incision was made, noting an enlarged pyogenic gallbladder with thickened walls, sub-hepatic abscess of approximately 300 ml, greenish-yellow colour, and foetid. An anterograde subtotal cholecystectomy is performed due to difficulty in identifying elements of Calot triangle due to the inflammatory process, opening it and extracting stones. The right iliac fossa is reviewed, finding a plastron and a sub-serous retrocaecal appendix perforated in its middle third with free fecalith and an abscess in the pelvic cavity. An anterograde appendectomy was performed and the patient progressed satisfactorily, later being discharged due to improvement. In this patient, with a history of recurrent episodes of gallbladder pain and disseminated acute abdominal pain without peritoneal irritation, clinical suspicion was exacerbated cholecystitis with probable empyema of the gallbladder. Open surgery approach for this patient allowed access to both the appendix and gallbladder in order to perform a complete exploration of the abdominal cavity. The synchronous presentation of cholecystolithiasis and complicated appendicitis has not been reported in the literature. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  10. COMPARISON BETWEEN RIPASA AND ALVARADO SCORING IN DIAGNOSING ACUTE APPENDICITIS

    Directory of Open Access Journals (Sweden)

    Balakrishnan Subramani

    2017-02-01

    Full Text Available BACKGROUND Acute appendicitis is one of the most common cause of acute abdominal pain and emergency appendicectomy is the most common emergency surgery. The diagnosis of appendicitis is confirmed by histopathological examination that is not possible before appendicectomy. The negative exploration remains high in the rate of about 15-30%. 1 Scoring systems based on history, clinical examination and basic investigations are there in aiding the diagnosis of acute appendicitis and decreasing negative exploration. This study compares RIPASA and ALVARADO scoring systems in diagnosing acute appendicitis. 2 MATERIALS AND METHODS A comparative study was done between November 2014 to June 2015. Patients diagnosed as acute appendicitis in Department of General Surgery, Government Royapettah Hospital. 100 of them are to be selected on the basis of nonprobability (purposive sampling method. After considering the inclusion and exclusion criteria, 96 were enrolled into the study. A full history, clinical examination and both scoring systems were done on the patients. RESULTS In 96 patients, 46 patients (48% were male and 50 patients (52% were female. 65 patients underwent emergency appendicectomy based on the clinical decision. The sensitivity and specificity of the RIPASA scoring system was 98.0% and 80.43%, respectively. The sensitivity and specificity of the ALVARADO scoring system was 80.43% and 86.95%, respectively. The PPV (positive predictive value of RIPASA and ALVARADO was 84% and 85%, respectively. The NPP (negative predictive value of RIPASA and ALVARADO was 97% and 71%, respectively. The diagnostic accuracy was 89% for RIPASA and 77% for ALVARADO. CONCLUSION The RIPASA scoring is better than ALVARADO scoring in the diagnosis of acute appendicitis.

  11. A bibliometric analysis of the citation classics of acute appendicitis.

    Science.gov (United States)

    Varzgalis, Manvydas; Bowden, Dermot J; Mc Donald, Ciaran K; Kerin, Michael J

    2017-07-01

    Acute appendicitis is one of the most commonly encountered emergency surgical conditions. An understanding of the most highly cited research works in this field is key to good evidence based clinical practice. To perform a bibliometric analysis on the 100 most frequently cited articles in the field of acute appendicitis. The database of the Institute for Scientific Information (ISI) Web of Science Expanded citation index was searched to identify the 100 most frequently cited articles in the field of acute appendicitis. The web of science expanded citation index tracks article citations made since 1946. The top 100 most frequently cited articles were selected for analysis in this series. The most frequently cited article was cited 649 times and the least cited three article 93 times. The average number of citations per article was 167.74. The top 100 cited articles originated from 17 countries. Over half of the papers originated from the USA. Fifty-one of the papers concentrated on diagnostics of acute appendicitis. Thirty-six papers looked at the treatment of acute appendicitis with 30 of these dealing with the surgical management of the disease. There were 6 studies at level 1a, 20 studies at level 1b and 43,5,17 and 9 studies at levels 2, 3, 4 and 5 respectively. Bibliometric analysis of the citation classics in a given field can provide interesting insights into the relationship between the quality of research outputs and clinical practice. The study of acute appendicitis remains an active field of research with a growing body of higher quality evidence underpinning our clinical practice.

  12. Diagnosis of Acute Appendicitis by Endoscopic Retrograde Appendicitis Therapy (ERAT): Combination of Colonoscopy and Endoscopic Retrograde Appendicography.

    Science.gov (United States)

    Li, Yingchao; Mi, Chen; Li, Weizhi; She, Junjun

    2016-11-01

    Acute appendicitis is the most common abdominal emergency, but the diagnosis of appendicitis remains a challenge. Endoscopic retrograde appendicitis therapy (ERAT) is a new and minimally invasive procedure for the diagnosis and treatment of acute appendicitis. To investigate the diagnostic value of ERAT for acute appendicitis by the combination of colonoscopy and endoscopic retrograde appendicography (ERA). Twenty-one patients with the diagnosis of suspected uncomplicated acute appendicitis who underwent ERAT between November 2014 and January 2015 were included in this study. The main outcomes, imaging findings of acute appendicitis including colonoscopic direct-vision imaging and fluoroscopic ERA imaging, were retrospectively reviewed. Secondary outcomes included mean operative time, mean hospital stay, rate of complication, rate of appendectomy during follow-up period, and other clinical data. The diagnosis of acute appendicitis was established in 20 patients by positive ERA (5 patients) or colonoscopy (1 patient) alone or both (14 patients). The main colonoscopic imaging findings included mucosal inflammation (15/20, 75 %), appendicoliths (14/20, 70 %), and maturation (5/20, 25 %). The key points of ERA for diagnosing acute appendicitis included radiographic changes of appendix (17/20, 85 %), intraluminal appendicoliths (14/20, 70 %), and perforation (1/20, 5 %). Mean operative time of ERAT was 49.7 min, and mean hospital stay was 3.3 days. No patient converted to emergency appendectomy. Perforation occurred in one patient after appendicoliths removal was not severe and did not require invasive procedures. During at least 1-year follow-up period, only one patient underwent laparoscopic appendectomy. ERAT is a valuable procedure of choice providing a precise yield of diagnostic information for patients with suspected acute appendicitis by combination of colonoscopy and ERA.

  13. [Usefulness of imaging examinations in preoperative diagnosis of acute appendicitis].

    Science.gov (United States)

    Nitoń, Tomasz; Górecka-Nitoń, Aleksandra

    2014-01-01

    Acute appendicitis (AA) is the cause one of most operations perform in department of general surgery on emergency ward. Frequency of acute appendicitis range from 6-8% of population. Clinical presentation is frequently unspecified and despite common occurence leads to many difficulties in diagnosis. Diagnosis of acute appendicitis includes clinical examination, laboratory tests, diagnostic scoring systems, computer programs as physisian aids and imaging examinations. About 30-45% patients suspected of acute appendicitis have untypical clinical presentation and here use of US or CT is very helpful. Longstanding use of US resulted in high AA evaluation accuracy with high sensitivity (75-90%) and specificity (84-100%). CT demonstrates above 95% ratio of correct diagnoses, reduces negative appendectomy rates and perforation rates as well as unnecessary observations. CT sensitivity and specificity CT is estimated between 83-100% among different authors. Expedited AA diagnosis, surgery and reduced hospitalization time are possible advantages of imaging tests. Additionally these tests can detect alternative deseases imitating acute appnedicitis. Use of imaging tests especially CT is beneficial in fertile women because of frequent genito-urinary disorders leading to the most diagnostic errors. However thera are contraindications in use of CT, for example it can not be performed in early pregnancy etc...

  14. Validity of samul's paediatric appendicitis score (pas) in the diagnosis of acute appendicitis in children

    International Nuclear Information System (INIS)

    Rehman, S.; Butt, M. Q.

    2014-01-01

    Objective: To validate the paediatric appendicitis score for the diagnosis of acute appendicitis in children using histopathology as a gold standard. Study Design: Case control study. Place and Duration of Study: Military Hospital (MH) and Combined Military Hospital (CMH) Rawalpindi, Pakistan from Dec 2009 to Jul 2010. Patients and Methods: Eighty five children 1-7year old who came to our tertiary surgical department with the chief complaint of abdominal pain of less than 7 days duration were included in the study. Paediatric appendicitis score (PAS) components including fever > 380 C, anorexia, nausea/vomiting, cough/percussion/hopping tenderness, right-lower-quadrant tenderness, migration of pain, leukocytosis > 10,000 (109/1) and polymorphonuclear - neutrophilia > 7500 (109/1) were assessed and recorded on admission, but the sum was not calculated until later and the score did not play any role in the management of the patient. The diagnosis of appendicitis was made by the trainees and consultants clinically and with the aid of routine sonography of abdomen. After appendicetomies, resected specimens were sent for histopathological examination. Pre-operative PAS, histopathology report of resected appendix were endorsed on patient's performa. A two by two table was used to determine sensitivity, specificity, positive and negative predictive values and diagnostic efficacy of PAS. Results: Sensitivity of PAS was 92.16%, specificity 88.23%, positive predictive value 92.16%, negative predictive value 88.23% and the diagnostic efficacy 90.59%. Conclusion: PAS is a highly sensitive test with fair degree of specificity in diagnosing acute appendicitis in children and its routine usage may improve the diagnostic accuracy. (author)

  15. Acute appendicitis: An overview | Saidi | East African Medical Journal

    African Journals Online (AJOL)

    Objective: To provide an overview of the changing epidemiology of acute appendicitis in the developed and developing countries and the presumptive reasons. Data source: Major published series of the last two decades were reviewed using Medline Search and Index Medicus. The myriad of diagnostic approaches ...

  16. Omental torsion mimicking acute appendicitis: A case report ...

    African Journals Online (AJOL)

    This review discusses a 38 year old patient with all the signs and symptoms of acute appendicitis. At surgery a normal appendix and serosanguinous fluid were observed. Further routine exploration disclosed a twisted omentum. This segment was excised. Patient recovered quickly. There is a need for exploration of the ...

  17. Acute appendicitis in Olabisi Onabanjo University Teaching Hospital ...

    African Journals Online (AJOL)

    The hospital is a tertiary care facility in competition with a large number of private hospitals with different levels of competence. Objective: The objective of the study is to review the outcome of the surgical management of acute appendicitis in our hospital. Method: A retrospective study of subjects who had appendectomy for ...

  18. A Case of Appendicular Tuberculosis mimicking an Acute Appendicitis

    African Journals Online (AJOL)

    Les auteurs rapportent un cas rare de tuberculose de siège apendiculaire mimant un tableau d'appendicite aigue. La littérature sur cette question est revisée. Mots clés : tuberculose, appendice. The author report a rare case of appendiceal tuberculosis clinically presenting as acute appendicitis. The litterature is reviewed.

  19. Endometriosis of the appendix presenting as acute appendicitis: A ...

    African Journals Online (AJOL)

    Endometriosis is a common disease generally, but appendiceal endometriosis causing acute appendicitis is a very uncommon clinical phenomenon and a few cases have been reported. The authors aim to highlight the rarity of such clinical entity in Nigeria. A 29 year old nulliparous woman presented with severe right iliac ...

  20. Acute appendicitis in South Africa: a systematic review | Yang ...

    African Journals Online (AJOL)

    Background: Acute appendicitis is one of the most common surgical emergencies in the West. A large body of research is investigating the risk factors for disease and perforation. As South Africa has a social environment, health system structure, and population demography unique from developed nations, the findings may ...

  1. Trans-umbilical Laparoscopic Appendectomy for Acute Appendicitis ...

    African Journals Online (AJOL)

    We discuss a useful modification of trans-umbilical appendectomy for acute appendicitis using routine instruments. Materials and Methods: From August 2009 to March 2011, 164 patients were operated by this method at our rural center. Out of them, 102 were males and 62, females. Mean age for males was 27.5 years ...

  2. A bibliometric analysis of the citation classics of acute appendicitis

    Directory of Open Access Journals (Sweden)

    Manvydas Varzgalis

    2017-07-01

    Conclusions: Bibliometric analysis of the citation classics in a given field can provide interesting insights into the relationship between the quality of research outputs and clinical practice. The study of acute appendicitis remains an active field of research with a growing body of higher quality evidence underpinning our clinical practice.

  3. Alvarado vs Lintula Scoring Systems in Acute Appendicitis

    African Journals Online (AJOL)

    relocation of pain, location of pain, vomiting, elevated temperature, guarding, bowel sounds and rebound tenderness).The aim of this study was therefore, to compare the accuracy of two commonly applied scoring systems in the diagnosis of acute appendicitis, namely the Alvarado scoring system and the Lintula scoring ...

  4. Torsion of an Epiploic Appendix Pretending as Acute Appendicitis

    Directory of Open Access Journals (Sweden)

    Kamran Ahmad Malik

    2010-07-01

    Full Text Available Torsion of an epiploic appendix is a rare surgical entity. Its unusual symptomatology, wide variation in physical findings and the absence of helpful laboratory and radiological studies makes it very difficult to diagnose pre-operatively. This is a report of this rare entity found in a patient upon diagnostic laparoscopy performed for suspected acute appendicitis

  5. Appendicitis

    Science.gov (United States)

    ... However, in most people, pain begins around the navel and then moves. As inflammation worsens, appendicitis pain ... lower abdomen Sudden pain that begins around your navel and often shifts to your lower right abdomen ...

  6. Cecal diverticulitis mimicking acute Appendicitis: a report of 4 cases

    Directory of Open Access Journals (Sweden)

    Kurtulus Idris

    2008-04-01

    Full Text Available Abstract Diverticulum of the cecum is a rare, benign, generally asymptomatic lesion that manifests itself only following inflammatory or hemorrhagic complications. Most patients with inflammation of a solitary diverticulum of the cecum present with abdominal pain that is indistinguishable from acute appendicitis. The optimal management of this condition is still controversial, ranging from conservative antibiotic treatment to aggressive resection. We describe four cases that presented with symptoms suggestive of appendicitis, but were found at operation to have an inflamed solitary diverticulum.

  7. Case report of recurrent acute appendicitis in a residual tip.

    LENUS (Irish Health Repository)

    O'Leary, Donal P

    2010-01-01

    INTRODUCTION: Residual appendicitis involving the stump of the appendix has been well described in the literature in the past. CASE REPORT: We report the case of a 43 year old male with acute onset of abdominal pain who had undergone an appendicectomy ten years previously. Ultrasound revealed the presence of an inflamed tubular structure. Subsequent laparotomy and histology confirmed that this structure was an inflamed residual appendiceal tip. CONCLUSION: Residual tip appendicitis has not been reported in the literature previously and should be considered in the differential diagnosis of localised peritonitis in a patient with a history of a previous open appendicectomy.

  8. Association between climatic elements and acute appendicitis in Japan.

    Science.gov (United States)

    Sato, Yasuto; Kojimahara, Noriko; Kiyohara, Kosuke; Endo, Motoki; Yamaguchi, Naohito

    2017-05-01

    In Japan, it has been reported that an increase in atmospheric pressure is associated with a higher incidence of acute appendicitis. The aim of this epidemiologic study was to investigate the association between climatic elements and the incidence of acute appendicitis. A case-crossover design was used in the present study. Two wk before diagnosis was used for the target period. The same 2-wk period, but 1, 2, and 3 y before diagnosis, was used for the control period. The study participants were patients with acute appendicitis (10-29 y) from 14 facilities in the Greater Tokyo Area. Mean of the observed values for atmospheric pressure, temperature, relative humidity, and hours of sunshine calculated for each target and control period were used as climatic elements to investigate trends 1 and 2 wk before diagnosis. The year of diagnosis, a statistically significant moderate upward trend in atmospheric pressure was observed during the 2-wk period before diagnosis of acute appendicitis (tau = 0.47; P = 0.0213), whereas a weak nonsignificant downward trend was observed 1 y before diagnosis (tau = -0.29; P = 0.1596), and weak nonsignificant upward trends were observed 2 (tau = 0.24; P = 0.2505) and 3 y (tau = 0.28; P = 0.1634) before diagnosis. An association was found between atmospheric pressure and the incidence of acute appendicitis. However, no significant differences were found in relation to sex or age. These findings suggest that changes in atmospheric pressure are associated with the likelihood of patients visiting the hospital. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. CT diagnosis of suspected acute appendicitis in adult patients

    Energy Technology Data Exchange (ETDEWEB)

    Yamase, Hiroshi; Sahashi, Kiyomi; Kawai, Masayuki; Kishida, Yoshihiko; Sumida, Kei; Kawamura, Ken-ichi [Gifu Syakaihoken Hospital (Japan)

    1998-06-01

    In order to assess the CT diagnosis of suspected acute appendicitis, we performed abdominal contrasted CT measurements in 77 patients from 20 to 86 years old, and of 50 men and 27 women from June 1993 to June 1996. The surgical findings were compared with the preoperative CT findings. By the preoperative CT imaging, we can know the degree and the position of inflammation in appendix vermiformis and the degree and the spread of periappendicular inflammation in the case of appendicitis, and can make a differential diagnosis of diverticulitis or gynecological diseases from appendicitis. It is important to make a preoperative diagnosis by the objectively excellent abdominal CT imaging and to avoid unnecessary surgery. (K.H.)

  10. CT diagnosis of suspected acute appendicitis in adult patients

    International Nuclear Information System (INIS)

    Yamase, Hiroshi; Sahashi, Kiyomi; Kawai, Masayuki; Kishida, Yoshihiko; Sumida, Kei; Kawamura, Ken-ichi

    1998-01-01

    In order to assess the CT diagnosis of suspected acute appendicitis, we performed abdominal contrasted CT measurements in 77 patients from 20 to 86 years old, and of 50 men and 27 women from June 1993 to June 1996. The surgical findings were compared with the preoperative CT findings. By the preoperative CT imaging, we can know the degree and the position of inflammation in appendix vermiformis and the degree and the spread of periappendicular inflammation in the case of appendicitis, and can make a differential diagnosis of diverticulitis or gynecological diseases from appendicitis. It is important to make a preoperative diagnosis by the objectively excellent abdominal CT imaging and to avoid unnecessary surgery. (K.H.)

  11. Acute Appendicitis in Pregnancy and the Developing World

    Directory of Open Access Journals (Sweden)

    Tika Ram Bhandari

    2017-01-01

    Full Text Available Background. Acute appendicitis is the commonest nonobstetric surgical emergency during pregnancy. The aim of the study was to compare perioperative outcomes of acute appendicitis in pregnant and nonpregnant patients. Methods. A retrospective review of medical records of 56 pregnant patients between 2011 and 2016 who were compared with 164 nonpregnant women of reproductive age who underwent open appendectomy between 2014 and 2016 for acute appendicitis. The patient’s demographics and perioperative data were analyzed. Results. The median age of pregnant and nonpregnant patients observed was 26 years (range 19–37 and 26 years (range 18–43. There were no significant differences between the groups in negative appendectomy (21.4 and 21.3%, P=0.52, perforated appendicitis (25 and 23.8%, P=0.85, postoperative complications (28.6 and 26.8%, P=0.80, and median length of hospital stay (5 and 4.5 days, P=0.36. There were 3.6% preterm labour, no maternal mortality, and no fetal loss. In multivariate analysis, WBC >18000/mm3 and long patient time to surgery were independent risk factors for appendicular perforation and postoperative complication (P<0.05. Conclusion. Our results of appendectomy in pregnant patients are comparable with nonpregnant patients. Hence the same perioperative treatment protocol can be followed in pregnant and nonpregnant patients even in resource-poor setting.

  12. Acute Appendicitis in Pregnant Women: Our Clinical Experience.

    Science.gov (United States)

    Türkan, Ahmet; Yalaza, Metin; Kafadar, Mehmet Tolga; Değirmencioğlu, Gürka

    2016-12-01

    The purpose of this study was to analyse 13 patients who were treated in our clinic due to acute appendicitis during pregnancy. Records of the patients who received appendectomy with appendicitis diagnosis in our Turgut Özal University Research and Application Hospital between January 2007 and December 2015 have been analyzed retrospectively. Appendectomies were performed on 13 pregnant patients with an acute appendicitis diagnosis. Average age of the patients was 27.69 years (between 22-37 years). Most frequent complaint of the patients was abdominal pain and most frequent examination finding was tenderness at right lower quadrant. Ultrasonography was used in all cases for diagnosis. Surgery was decided with clinical diagnosis for five cases (38.5%) where appendix had not been identified with ultrasonography. While laparoscopic appendectomy was applied in one case (7.7%) and open appendectomy was applied using a McBurney incision in 12 cases (92.3%). Average hospitalization duration was 1.69 days. All patients were tracked together through the Gynaecology Department for two weeks after they had been discharged from the hospital. Preterm delivery, maternal and fetal loss did not occur. It is considered appropriate to apply ultrasonography routinely to all pregnant patients in whom acute appendicitis is suspected. Concern for maternal or fetal complication that may occur in consequence of an unnecessary surgery should not be at a level that will delay surgical treatment needed by the patient.

  13. Acute Appendicitis in Pregnancy and the Developing World.

    Science.gov (United States)

    Bhandari, Tika Ram; Shahi, Sudha; Acharya, Sarita

    2017-01-01

    Acute appendicitis is the commonest nonobstetric surgical emergency during pregnancy. The aim of the study was to compare perioperative outcomes of acute appendicitis in pregnant and nonpregnant patients. A retrospective review of medical records of 56 pregnant patients between 2011 and 2016 who were compared with 164 nonpregnant women of reproductive age who underwent open appendectomy between 2014 and 2016 for acute appendicitis. The patient's demographics and perioperative data were analyzed. The median age of pregnant and nonpregnant patients observed was 26 years (range 19-37) and 26 years (range 18-43). There were no significant differences between the groups in negative appendectomy (21.4 and 21.3%, P = 0.52), perforated appendicitis (25 and 23.8%, P = 0.85), postoperative complications (28.6 and 26.8%, P = 0.80), and median length of hospital stay (5 and 4.5 days, P = 0.36). There were 3.6% preterm labour, no maternal mortality, and no fetal loss. In multivariate analysis, WBC >18000/mm 3 and long patient time to surgery were independent risk factors for appendicular perforation and postoperative complication ( P < 0.05). Our results of appendectomy in pregnant patients are comparable with nonpregnant patients. Hence the same perioperative treatment protocol can be followed in pregnant and nonpregnant patients even in resource-poor setting.

  14. Cost analysis of nonoperative management of acute appendicitis in children.

    Science.gov (United States)

    Mudri, Martina; Coriolano, Kamary; Bütter, Andreana

    2017-05-01

    The purpose of this study was to determine if nonoperative management of acute appendicitis in children is more cost effective than appendectomy. A retrospective review of children (6-17years) with acute appendicitis treated nonoperatively (NOM) from May 2012 to May 2015 was compared to similar patients treated with laparoscopic appendectomy (OM) (IRB#107535). Inclusion criteria included symptoms ≤48h, localized peritonitis, and ultrasound confirmation of acute appendicitis. Variables analyzed included failure rates, complications, length of stay (LOS), and cost analysis. 26 NOM patients (30% female, mean age 12) and 26 OM patients (73% female, mean age 11) had similar median initial LOS (24.5h (NOM) vs 16.5h (OM), p=0.076). Median total LOS was significantly longer in the NOM group (34.5h (NOM) vs 17.5 (OM), p=0.01). Median cost of appendectomy was $1416.14 (range $781.24-$2729.97). 9/26 (35%) NOM patients underwent appendectomy for recurrent appendicitis. 4/26 (15%) OM patients were readmitted (postoperative abscess (n=2), Clostridium difficile colitis (n=1), postoperative nausea/vomiting (n=1)). Median initial hospital admission costs were significantly higher in the OM group ($3502.70 (OM) vs $1870.37 (NOM), p=0.004)). However, median total hospital costs were similar for both groups ($3708.68 (OM) vs $2698.99 (NOM), p=0.065)). Although initial costs were significantly less in children with acute appendicitis managed nonoperatively, total costs were similar for both groups. The high failure rate of nonoperative management in this series contributed to the total increased cost in the NOM group. 3b. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Hyperbilirubinemia as a predictive factor in acute appendicitis.

    Science.gov (United States)

    Eren, T; Tombalak, E; Ozemir, I A; Leblebici, M; Ziyade, S; Ekinci, O; Alimoglu, O

    2016-08-01

    Our aim was to establish the role of hyperbilirubinemia as a predictive parameter for the prediction of either acute, or gangrenous/perforated appendicitis as well as to compare other parameters in a similar role. Medical files of the patients who underwent appendectomies between September 2013 and September 2014 were evaluated. Age, gender, preoperative white blood cell count (WBC), neutrophil count (NEU), neutrophil percentage (NEU%), C-reactive protein (CRP), total/direct/indirect bilirubin levels, and the postoperative histopathological findings were recorded. The Fisher's exact, Pearson's χ (2), ANOVA, and Kruskal-Wallis tests while logistic regression for multivariate analysis was performed. p appendicitis in 100 (62 %), and appendiceal gangrene/perforation in 41 (25 %) patients. WBC, NEU, NEU%, and CRP levels were significantly higher in cases of acute and gangrenous/perforated appendicitis (p appendicitis (p < 0.01). According to multivariate analysis, elevated CRP levels were associated with 14 times, elevated total bilirubin levels were associated with five times, and elevated direct bilirubin levels were associated with 36 times greater risk for appendiceal gangrene/perforation (p < 0.01, p < 0.05, p < 0.01, respectively). Hyperbilirubinemia, especially with elevated direct bilirubin levels, may be considered as an important marker for the prediction of appendiceal gangrene/perforation.

  16. Laparoscopic appendectomy in surgical treatment of acute appendicitis

    Directory of Open Access Journals (Sweden)

    G. I. Ohrimenko

    2016-06-01

    Full Text Available Relevance of the topic. At the present time laparoscopic appendectomy has taken its own place at the urgent surgery. In spite of this less is studied in the field of the use of the minimally invasive technologies in the cases of complicated acute appendicitis. The aim of research: to investigate the close results of the patients with acute appendicitis treatment with laparoscopic appendectomy, and to compare them with the open appendectomy results; to estimate the possibilities of laparoscopic appendectomy in the cases of complicated acute appendicitis. Materials and methods. The results of surgical treatment of 146 patients with acute appendicitis were analyzed – 59 patients in the main group, who undergone laparoscopic appendectomy, and 80 patients in the control group, who undergone open surgery. 7 patients who passed through conversion were included in the additional group. Results. The frequency of acute appendicitis complications, which were diagnosed during the operation, in the both groups had no significant distinction (50.8 % in the main group and 47.5% in the control group. But 5 patients with diffuse peritonitis and appendicular abscesses needed a conversion of laparoscopic operation into open one, because of the full sanitation necessity and technique difficulties. In the postoperative period among the patients of main group the suppuration of the wound was observed in 2 (3.4% cases, in the control group – in 10 (12.5%. The average duration of laparoscopic operation was 33.12±2.51 min, open surgery – 66.45±3.33 min. The average hospitalization period in the control group was 6.95±0.2 days and was statistically proved higher than in the main group – 4.72±0.21 days (p≤0.01. Conclusion. Laparoscopic appendectomy can be wide used in the cases of acute appendicitis, including complications, but it can be restricted in the cases of diffuse peritonitis and appendicular abscesses. This minimally invasive surgical operation

  17. Visceral myopathy presenting as acute appendicitis and ogilvie syndrome.

    Science.gov (United States)

    Kharbuja, Punyaram; Thakur, Raghvendra; Suo, Jian

    2013-01-01

    Background. Visceral myopathy is rare pathological condition of gastrointestinal tract with uncertain clinical presentation and unknown etiology. It often presents with symptoms of chronic intestinal pseudoobstruction of colon. We report a case of visceral myopathy which presented to us as acute appendicitis and Ogilvie syndrome, and we managed it surgically. Method and Result. A case report of 20-year female clinically presented as acute appendicitis and we performed laparoscopic exploration which revealed inflamed appendix with grossly dilated ascending colon. We performed laparoscopic appendectomy and postoperatively managed the patients with IV fluids, antibiotics, neostigmine, and extended length rectal tube for enema and decompression. During postoperative period, she developed abdomen distension and peritonitis, and we ordered abdomen CT which revealed colon pseudo- obstruction. We performed right hemicolectomy with permanent ileostomy, and the histopathology reports of resected colon were visceral myopathy. Conclusion. Visceral myopathy is very rare group of disease and poorly understood condition that may present with chronic or acute intestinal pseudo-obstruction and often mimic other more common gastrointestinal disease. VM should be considered as differential diagnosis whenever the patient presents with acute appendicitis, uncharacteristic abdominal symptoms, recurrent attacks of abdominal distention, and pain with no radiological evidence of intestinal obstruction.

  18. Acute appendicitis in pregnancy: specific features of diagnosis and treatment.

    Science.gov (United States)

    Miloudi, N; Brahem, M; Ben Abid, S; Mzoughi, Z; Arfa, N; Tahar Khalfallah, M

    2012-08-01

    Acute appendicitis is the most frequent surgical emergency arising during pregnancy. Definitive diagnosis is often difficult. The therapeutic options remain the same, i.e. appendectomy. We present a series of 29 pregnant women who underwent surgery for acute appendicitis over a period of 10 years. The mean age was 28.6 years. Mean gravidity was 1.75 and mean parity was 0.84. The average period of gestation was 18 weeks and 5 days since the last menses. Seven patients underwent surgery during the 1st trimester, 15 during the 2nd trimester, and seven during the 3rd trimester. Eighteen patients underwent appendectomy through a laparoscopic approach and 11 through a McBurney incision. The postoperative course was uncomplicated in 27 patients. Two patients miscarried in the week following surgery. Acute appendicitis puts both maternal and fetal prognosis at risk. Management should be prompt and undertaken by a multidisciplinary team approach. Morbidity and mortality are not negligible. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  19. Short Communication - Acute Retrocaecal Appendicitis: A Case ...

    African Journals Online (AJOL)

    Background: Acute abdomen is a clinical diagnosis and not a definitive one. The use of ultrasound in management and diagnosis of acute abdomen is rarely invoked in our environment. The importance of definite diagnosis in surgical and medical management cannot be overemphasized Objective: To report a case of ...

  20. Risk of acute appendicitis in and around pregnancy: a population-based cohort study from England

    OpenAIRE

    Zingone, Fabiana; Sultan, Alyshah Abdul; Humes, David; West, Joe

    2015-01-01

    Objective: To determine the absolute and relative risk of acute appendicitis during the antepartum and postpartum periods compared with the time outside pregnancy among women of childbearing age. \\ud \\ud Background: Acute appendicitis is the most common nonobstetric surgical emergency during pregnancy. Estimates of the incidence of acute appendicitis in pregnancy remain imprecise and inconsistent. \\ud \\ud Methods: All potential fertile women aged 15 to 44 years registered within Clinical Prac...

  1. Comparison of Antibiotic Therapy and Appendectomy for Acute Uncomplicated Appendicitis in Children: A Meta-analysis.

    Science.gov (United States)

    Huang, Libin; Yin, Yuan; Yang, Lie; Wang, Cun; Li, Yuan; Zhou, Zongguang

    2017-05-01

    Antibiotic therapy for acute uncomplicated appendicitis is effective in adult patients, but its application in pediatric patients remains controversial. To compare the safety and efficacy of antibiotic treatment vs appendectomy as the primary therapy for acute uncomplicated appendicitis in pediatric patients. The PubMed, MEDLINE, EMBASE, and Cochrane Library databases and the Cochrane Controlled Trials Register for randomized clinical trials were searched through April 17, 2016. The search was limited to studies published in English. Search terms included appendicitis, antibiotics, appendectomy, randomized controlled trial, controlled clinical trial, randomized, placebo, drug therapy, randomly, and trial. Randomized clinical trials and prospective clinical controlled trials comparing antibiotic therapy with appendectomy for acute uncomplicated appendicitis in pediatric patients (aged 5-18 years) were included in the meta-analysis. The outcomes included at least 2 of the following terms: success rate of antibiotic treatment and appendectomy, complications, readmissions, length of stay, total cost, and disability days. Data were independently extracted by 2 reviewers. The quality of the included studies was examined in accordance with the Cochrane guidelines and the Newcastle-Ottawa criteria. Data were pooled using a logistic fixed-effects model, and the subgroup pooled risk ratio with or without appendicolith was estimated. The primary outcome was the success rate of treatment. The hypothesis was formulated before data collection. A total of 527 articles were screened. In 5 unique studies, 404 unique patients with uncomplicated appendicitis (aged 5-15 years) were enrolled. Nonoperative treatment was successful in 152 of 168 patients (90.5%), with a Mantel-Haenszel fixed-effects risk ratio of 8.92 (95% CI, 2.67-29.79; heterogeneity, P = .99; I2 = 0%). Subgroup analysis showed that the risk for treatment failure in patients with appendicolith increased, with a

  2. Acute appendicitis during pregnancy: case series of 20 pregnant women.

    Science.gov (United States)

    Arer, İlker Murat; Alemdaroğlu, Songül; Yeşilağaç, Hasan; Yabanoğlu, Hakan

    2016-11-01

    Acute appendicitis (AA) is the most common cause of acute abdomen during pregnancy. Most of the signs of appendicitis are also found during normal pregnancy period, however, and diagnosis of appendicitis during pregnancy remains challenging. The aim of the current study was to report our clinical experience of AA during pregnancy and investigate optimal management of this difficult situation. Records of 20 pregnant women with diagnosis of AA who underwent appendectomy between 2005 and 2015 were included in this study. Data were collected retrospectively. Patients were evaluated according to age, signs and symptoms, gestational age, physical findings, serum white blood cell count, ultrasound (US) findings, pathology reports, surgical technique, operation time, and complications. Of 20 patients, 16 (80%) underwent open appendectomy and 4 (20%) underwent laparoscopic appendectomy. Mean age of patients was 29.6±5.6 years. Most common symptom was abdominal pain (95%). Six (30%) patients were in first trimester, 9 (45%) patients were in second trimester and 5 (25%) patients in were in third trimester. US findings consistent with AA were found in 12 (60%) patients. Negative appendectomy rate was 30%. Maternal complication was seen in only 1 (5%) patient. No fetal complication was observed. Accurate diagnosis and prompt surgical treatment of AA in pregnant women should be performed due to high rates of maternal and fetal complications.

  3. Acute Appendicitis Complicating into Portal and Superior Mesenteric Vein Thrombosis.

    Science.gov (United States)

    Yousaf, Adnan; Ahmed, Mushtaq; Aurangzeb, Mahmud

    2016-06-01

    This case report describes a young man who presented with 9-day history of sudden-onset epigastric and right-sided lower abdominal pain. He was tachycardiac with temperature of 102°F. Tenderness was present in the peri-umbilical area and right iliac fossa. Investigations revealed a raised total leucocyte count (predominantly neutrophilic). Triphasic CTscan abdomen found thrombosis of right portal vein and its hepatic tributaries alongwith superior mesenteric vein (SMV) and its tributaries. Co-existent fluid in right hemipelvis abutting the cecum and appendiceal tip was suggestive of acute appendicitis. He was resuscitated with fluids and analgesics and started on intravenous metronidazole and ceftriaxone. Anticoagulation with subcutaneous heparin was commenced and eventually switched over to warfarin. Appendicectomy was not performed as the patient responded to conservative treatment. Appendicitis is associated with multiple complications but secondary venous thrombosis has rarely been reported with it.

  4. IMAGING AS AN AID TO THE DIAGNOSIS OF ACUTE APPENDICITIS

    Directory of Open Access Journals (Sweden)

    Lionel I Wijesuriya

    2007-01-01

    Full Text Available Acute appendicitis has been known as a disease entity for well over a century but a confident diagnosis before surgeryin all patients suspected of the condition is still not possible. Timely diagnosis is essential to minimise morbidity due topossible perforation of the inflamed organ in the event treatment is delayed; so much so that surgeons often preferredto operate at the slightest suspicion of the diagnosis in the past. This resulted in the removal of many normal appendixes.When the diagnosis of appendicitis is clear from the history and clinical examination, then no further investigation isnecessary and prompt surgical treatment is appropriate. Where there is doubt about the diagnosis however it is advisableto resort to imaging studies such as abdominal ultrasound or computed tomography to clear such suspicions beforesubjecting the patient to an appendicectomy. These studies would also help avoid delays in surgery in deservingpatients.

  5. [Coexistence of acute appendicitis and dengue fever: A case report].

    Science.gov (United States)

    Osuna-Ramos, Juan Fidel; Silva-Gracia, Carlos; Maya-Vacio, Gerardo Joel; Romero-Utrilla, Alejandra; Ríos-Burgueño, Efrén Rafael; Velarde-Félix, Jesús Salvador

    2017-12-01

    Dengue is the most important human viral disease transmitted by mosquitoes. It can be asymptomatic or it can present in any of its 3clinical forms: Dengue fever, dengue haemorrhagic fever and dengue shock syndrome. However, some atypical manifestations have been reported in surgical emergencies caused by acute appendicitis in patients with dengue fever. We report the case of an 18-year-old Mexican male who presented to the emergency department of the General Hospital of Culiacan, Sinaloa, with symptoms of dengue fever, accompanied by crampy abdominal pain with positive Rovsing and Dunphy signs. Dengue infection was confirmed by a positive NS1 antigen test performed by enzyme-linked immunosorbent assay. An abdominal ultrasound revealed an appendicular process; as the abdominal pain in the right side kept increasing, an open appendectomy was performed. Abundant inflammatory liquid was observed during the surgery, and the pathology laboratory reported an oedematous appendix with fibrinopurulent plaques, which agreed with acute ulcerative appendicitis. The patient was discharged fully recovered without complications during the follow-up period. Acute abdominal pain can be caused in some cases by dengue infection. This can be confusing, which can lead to unnecessary surgical interventions, creating additional morbidities and costs for the patient. This unusual and coincident acute appendicitis with dengue highlights the importance of performing careful clinical studies for appropriate decision making, especially in dengue endemic regions during an outbreak of this disease. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  6. Acute Appendicitis Is Associated with Peptic Ulcers: A Population-based Study

    OpenAIRE

    Tsai, Ming-Chieh; Kao, Li-Ting; Lin, Herng-Ching; Chung, Shiu-Dong; Lee, Cha-Ze

    2015-01-01

    Despite some studies having indicated a possible association between appendicitis and duodenal ulcers, this association was mainly based on regional samples or limited clinician experiences, and as such, did not permit unequivocal conclusions. In this case-control study, we examined the association of acute appendicitis with peptic ulcers using a population-based database. We included 3574 patients with acute appendicitis as cases and 3574 sex- and age-matched controls. A Chi-squared test sho...

  7. Twin pregnancy complicated with acute appendicitis and cholecystitis in the same gestational period.

    Science.gov (United States)

    Başaran, Ahmet; Bozdağ, Gürkan; Aksu, A Tarik; Deren, Ozgür

    2007-09-01

    Acute appendicitis and symptomatic biliary stones are the most common indications for non-obstetrical surgical procedures during pregnancy. However, combination of these two clinical presentations in the same gestational period is anecdotal. A 30-year-old twin pregnant patient complicated with acute appendicitis followed by cholecystitis was reported with poor fetal outcomes. Despite appropriate management when two conditions, appendicitis and cholecystitis, occur in the same gestational period one after another complications might become inevitable.

  8. Diagnosis of acute appendicitis during pregnancy: a systematic review.

    Science.gov (United States)

    Basaran, Ahmet; Basaran, Mustafa

    2009-07-01

    To perform a systematic review to evaluate the diagnostic performance of computed tomography (CT) and magnetic resonance imaging (MRI) for the diagnosis of appendicitis in pregnancy. A systematic literature search of MEDLINE from 1966 through August 2008, MEDION database, OVID MEDLINE from 1950 through August 2008, and bibliographies of review articles and eligible studies. Three articles related to the use of CT and 5 to the use of MRI for the diagnosis of acute appendicitis during pregnancy were identified. All of the identified studies were retrospective. Findings were compared to surgical pathology and/or clinical follow-up. Results were pooled using the Mantel-Haenszel fixed-effects model and the DerSimonian-Laird random-effects model. The pooled estimates of sensitivity and specificity, positive and negative likelihood ratios for the performance of CT in patients with prior normal/inconclusive ultrasonography result were 85.7% (95% CI: 63.7%-97%) and 97.4% (95% CI: 86.2%-99.9%), 10.1 (95% CI: 3.4-30.1), and 0.21 (95% CI: 0.05-0.88), respectively. The pooled estimates of sensitivity and specificity, positive and negative likelihood ratios for performance of MRI in patients with prior normal/inconclusive ultrasonography result were 80% (95% CI: 44%-98%) and 99% (95% CI: 94%-100%), 22.7 (95% CI: 6.0-87.5), and 0.29 (95% CI: 0.13-0.68), respectively. This review is limited by the small number and retrospective nature of the available studies. With these limitations in mind, CT and MRI seem to be highly sensitive and specific for the diagnosis of appendicitis in pregnancy and their use should be considered when the results of ultrasonography are normal or inconclusive and appendicitis is suspected.

  9. Retrospective evaluation of acute appendicitis incorrectly diagnosed on CT

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae Hoon [Dankook University Hospital, Cheonan (Korea, Republic of); Kim, Hyun Cheol [East-West Neo Medical Center, Kyung-Hee Univeristy, Seoul (Korea, Republic of)

    2006-07-15

    The purpose of our study was to retrospectively evaluate the CT images of patients suffering with surgically proven appendicitis to determine the causes of missed diagnoses. We reviewed the pathology reports of the patients with surgically proven appendicitis from two hospitals during a 3-year period. Thirty-seven such cases with a misdiagnosis were identified and they served as our misdiagnosed group (17 females and 20 males, mean age: 58 years, age range 15-68 years). These were cases that were misdiagnosed on preoperative abdominal CT. All 57 patients in the control group (30 females and 27 males, mean age: 44 years, age range: 21-78 years) had undergone laparotomy for acute appendicitis and they had been correctly diagnosed preoperatively on CT. Two abdominal radiologists evaluated the following items from all 94 CT examinations: 1) an abnormal appendix, 2) periappendiceal fat inflammation, 3) pericecal extraluminal fluid, 4) pericecal extraluminal air, 5) appendicolith, 6) cecal wall thickening, 7) small bowel dilatation, and 8) the pericecal fat content. Statistical analysis was performed using a Chi-squared test and Fisher's exact test. Any abnormal appendix was not visualized, even retrospectively, in 27 (73%) of the 37 patients from the misdiagnosed group, whereas it was not visualized in 13 (23%) of the 57 patients in the control group ({rho} = 0.001). Of the patients who had been misdiagnosed, inflammation of the pericecal fat was observed in 21 patients (57%) as compared to 50 (88%) patients in the control group ({rho} =0.001). Pericecal fluid and air were noted in 15 (41%) and 9 (24%) patients, respectively, in the misdiagnosed group and in 19 (33%) and 14 (25%) patients, respectively, in the control group, ({rho} = 0.477 and {rho} =0.901, respectively). Appendicolith was found in 3 (8%) misdiagnosed subjects and in 10 (18%) of the controls ({rho} = 0.001). Focal cecal wall thickening was noted in 14 (38%) misdiagnosed patients and in 28 (49

  10. Acute Appendagitis Presenting with Features of Appendicitis: Value of Abdominal CT Evaluation

    Directory of Open Access Journals (Sweden)

    Sukhpreet Dubb

    2008-05-01

    Full Text Available We report a case of acute appendagitis in a patient who presented initially with typical features of acute appendicitis. The diagnosis of acute appendagitis was made on pathognomonic signs on computed tomography (CT scan. Abdominal pain is a common surgical emergency. CT is not always done if there are clear features of acute appendicitis. The rare but important differential diagnosis of acute appendagitis must be borne in mind when dealing with patients with suspected acute appendicitis. A CT scan of the abdomen may avoid unnecessary surgery in these patients.

  11. Differentiation of Acute Perforated from Non-Perforated Appendicitis: Usefulness of High-Resolution Ultrasonography

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Gyu Chang [Dept. of Radiology, Gumi Hospital, Soonchunhyang University College of Medicine, Gumi (Korea, Republic of)

    2011-07-15

    To evaluate the usefulness of high-resolution ultrasonography (US) for the differentiation of acute perforated appendicitis from non-perforated appendicitis. The high-resolution US features in 96 patients (49 males, 47 females; mean age, 33.8 years; age range, 4-80 years) with pathologically proven acute appendicitis were evaluated. The following US findings were evaluated for differentiation of acute perforated appendicitis from non-perforated appendicitis: circumferential loss of the echogenic submucosal layer, periappendiceal fluid collection, disruption of the serosal layer, asymmetrical wall thickening, maximum overall diameter > 10.5 mm, and the presence of appendicoliths. The sensitivity and specificity of the US features in the diagnosis of acute perforated appendicitis were calculated. All of the US findings, except for appendicoliths, were significantly more common in the acute perforated appendicitis group (p < 0.001). The sensitivity of circumferential loss of the echogenic submucosal layer, periappendiceal fluid collection, disruption of the serosal layer, asymmetrical wall thickening, maximum overall diameter > 10.5 mm, and the presence of appendicoliths was 85.4, 73.2, 68.3, 70.7, 80.5, and 36.6%, respectively, while the specificity was 65.5, 89.1, 96.4, 98.2, 81.8, and 80.0%, respectively. High-resolution US was found to be useful for differentiating acute perforated appendicitis from non-perforated appendicitis.

  12. Changes in the epidemiology of acute appendicitis and appendectomy in Danish children 1996-2004

    DEFF Research Database (Denmark)

    Andersen, S B; Paerregaard, A; Larsen, K

    2009-01-01

    with a diagnosis of acute uncomplicated or complicated appendicitis, and/or a registered procedure code of appendectomy. These data were computed together with data on the background population, and incidences were calculated. RESULTS: A significant decrease in the incidence of acute uncomplicated appendicitis...

  13. Clinical and computed tomography findings of appendiceal diverticulitis vs acute appendicitis.

    Science.gov (United States)

    Ito, Daisuke; Miki, Kenji; Seiichiro, Shimizu; Hata, Shojiro; Kobayashi, Kaoru; Teruya, Masanori; Kaminishi, Michio

    2015-04-07

    To study the clinical features and computed tomography (CT) findings of appendiceal diverticulitis vs acute appendicitis. We retrospectively reviewed the records of 451 patients who had undergone appendectomy in our institution from January 2007 to September 2012. Patient demographics, clinical features, pathological findings, and surgical outcomes were analyzed. We also compared preoperative CT images of 25 patients with appendiceal diverticulitis with those of 25 patients with acute appendicitis. Among 451 patients, 44 (9.7%) were diagnosed to have appendiceal diverticulitis and 398 (86.9%) to have acute appendicitis. Patients with appendiceal diverticulitis were older (59 vs 37 years, P diverticulitis were higher (68% vs 27%, P diverticulitis cases, but in all acute appendicitis cases. CT findings suggestive of appendiceal diverticulitis included the absence of fluid collection in the appendix (84% vs 12%, P diverticulitis. Patients with appendiceal diverticulitis had different clinical features and CT findings from patients with acute appendicitis.

  14. Clinical and computed tomography findings of appendiceal diverticulitis vs acute appendicitis

    Science.gov (United States)

    Ito, Daisuke; Miki, Kenji; Seiichiro, Shimizu; Hata, Shojiro; Kobayashi, Kaoru; Teruya, Masanori; Kaminishi, Michio

    2015-01-01

    AIM: To study the clinical features and computed tomography (CT) findings of appendiceal diverticulitis vs acute appendicitis. METHODS: We retrospectively reviewed the records of 451 patients who had undergone appendectomy in our institution from January 2007 to September 2012. Patient demographics, clinical features, pathological findings, and surgical outcomes were analyzed. We also compared preoperative CT images of 25 patients with appendiceal diverticulitis with those of 25 patients with acute appendicitis. RESULTS: Among 451 patients, 44 (9.7%) were diagnosed to have appendiceal diverticulitis and 398 (86.9%) to have acute appendicitis. Patients with appendiceal diverticulitis were older (59 vs 37 years, P diverticulitis were higher (68% vs 27%, P diverticulitis cases, but in all acute appendicitis cases. CT findings suggestive of appendiceal diverticulitis included the absence of fluid collection in the appendix (84% vs 12%, P diverticulitis. Patients with appendiceal diverticulitis had different clinical features and CT findings from patients with acute appendicitis. PMID:25852277

  15. Acute Appendicitis as the Initial Clinical Presentation of Primary HIV-1 Infection

    DEFF Research Database (Denmark)

    Schleimann, Mariane H; Leth, Steffen; Krarup, Astrid R

    2018-01-01

    We report a case of an adolescent who presented at our emergency department with acute abdominal pain. While the initial diagnosis was acute appendicitis, a secondary and coincidental diagnosis of primary HIV-1 infection was made. Concurrent and subsequent clinical and molecular biology findings ...... form the basis of our argument that primary HIV-1 infection was the cause of acute appendicitis in this individual.......We report a case of an adolescent who presented at our emergency department with acute abdominal pain. While the initial diagnosis was acute appendicitis, a secondary and coincidental diagnosis of primary HIV-1 infection was made. Concurrent and subsequent clinical and molecular biology findings...

  16. Diagnostic value of lactate levels in acute appendicitis

    International Nuclear Information System (INIS)

    Kavakli, H.S.; Altintas, N.D.; Cevik, Y.; Becel, S.; Tanriverdi, F.

    2010-01-01

    Objective: To assess the value of lactate measurements in addition to standard diagnostic measurement of white blood cell count (WBC) and C-reactive protein (CRP) in the accuracy of preoperative acute appendicitis (AA) diagnosis. Methods: A total of thirty-six consecutive patients with histopathologically confirmed acute appendicitis were retrospectively included in the study. Fifteen volunteers were included as control group. Patient characteristics, preoperative ultrasonography (US) and laboratory assessment including WBC, C-reactive protein (CRP) and lactate values were collected. Receiver Operator Characters tics (ROC) curves for discriminant values and sensitivity, specificity, positive and negative predictive values (PPV, NPV) were calculated. Results: The male/female ratio of groups 1 and 2 were 25/11 and 9/6 respectively. Mean age: 34.13 +- 9.6 years. Area under ROC values for lactate were found significant and discriminant value was found to be 8 mg/dl. Specificity, sensitivity, PPV and NPV calculated for lactate were as follows: 53%, 80%, 77% and 57%. Conclusions: Increased lactate levels as well as other inflammatory parameters should be considered as a diagnostic parameter in diagnosis of AA. (author)

  17. Analysis of Recurrence Management in Patients Who Underwent Nonsurgical Treatment for Acute Appendicitis

    Science.gov (United States)

    Liang, Tsung-Jung; Liu, Shiuh-Inn; Tsai, Chung-Yu; Kang, Chi-Hsiang; Huang, Wei-Chun; Chang, Hong-Tai; Chen, I-Shu

    2016-01-01

    Abstract The recurrence rate for acute appendicitis treated nonoperatively varies between studies. Few studies have adequately evaluated the management of these patients when appendicitis recurs. We aimed to explore the recurrence rate and management of patients with acute appendicitis that were first treated nonoperatively. We identified patients in the Taiwan National Health Insurance Research Database who were hospitalized due to acute appendicitis for the first time between 2000 and 2010 and received nonsurgical treatment. The recurrence and its management were recorded. Data were analyzed to access the risk factors for recurrence and factors that influenced the management of recurrent appendicitis. Among the 239,821 patients hospitalized with acute appendicitis for the first time, 12,235 (5.1%) patients were managed nonoperatively. Of these, 864 (7.1%) had a recurrence during a median follow-up of 6.5 years. Appendectomy was performed by an open and laparoscopic approach in 483 (55.9%) and 258 (29.9%) patients, respectively. The remaining 123 (14.2%) patients were again treated nonsurgically. Recurrence was independently associated with young age, male sex, percutaneous abscess drainage, and medical center admission by multivariable analysis. In addition, age appendicitis, percutaneous abscess drainage, nor length of first time hospital stay had an influence on the selection of surgical approach. In conclusion, a laparoscopic appendectomy can be performed in recurrent appendicitis cases, and its application may not be related to previous appendicitis severity. PMID:27015200

  18. ACUTE INTESTINAL INFECTION AS A DISGUISE OF ACUTE APPENDICITIS IN CHILDREN

    Directory of Open Access Journals (Sweden)

    Y. Y. Dyakonova

    2016-01-01

    Full Text Available The issue of differential diagnosis of acute appendicitis and acute intestinal infections in contemporary medicine remains relevant for clinical practice of surgeons and pediatricians. Late diagnosis of appendicitis results in development of complicated forms of vermiform appendix inflammation. This prolongs operative intervention, duration of antibacterial therapy and duration of a child’s inpatient stay. The article presents clinical observation of three children treated for perforated appendix and generalized purulent peritonitis. The described cases demonstrate the need in multidisciplinary approach and complex diagnosis of patients with such complaints as abdominal pain, fever and diarrhea.

  19. Management and outcomes of acute appendicitis in pregnancy-population-based study of over 7000 cases.

    Science.gov (United States)

    Abbasi, N; Patenaude, V; Abenhaim, H A

    2014-11-01

    To compare outcomes and management practices among pregnant and nonpregnant women with acute appendicitis. Population-based matched cohort study. United States of America. A total of 7114 women with appendicitis among 7,037,386 births. Logistic regression analyses to calculate the odds ratio (OR) and corresponding 95% confidence intervals (95% CIs) for variables and outcomes of interest. Maternal morbidities associated with appendicitis; management practices for pregnant and age-matched nonpregnant women with appendicitis. There was an overall incidence of 101.1 cases of appendicitis per 100,000 births. Appendicitis was diagnosed in 35,570 nonpregnant women during the corresponding time frame. Peritonitis occurred in 20.3% of pregnant women with appendicitis, with an adjusted OR of 1.3 (95% CI 1.2-1.4) when compared with nonpregnant women with appendicitis. In pregnancy, there was an almost two-fold increase in sepsis and septic shock, transfusion, pneumonia, bowel obstruction, postoperative infection and length of stay >3 days. Whereas 5.8% of appendicitis cases among pregnant women were managed conservatively, they were associated with a considerably increased risk of shock, peritonitis and venous thromboembolism as compared to surgically managed cases. Compared with nonpregnant women, pregnant women with acute appendicitis have higher rates of adverse outcomes. Conservative management should be avoided given the serious risk of adverse outcomes in pregnancy. © 2014 Royal College of Obstetricians and Gynaecologists.

  20. Acute Appendicitis in Pregnancy: Predictive Clinical Factors and Pregnancy Outcomes.

    Science.gov (United States)

    Theilen, Lauren H; Mellnick, Vincent M; Shanks, Anthony L; Tuuli, Methodius G; Odibo, Anthony O; Macones, George A; Cahill, Alison G

    2017-05-01

    Objective  The objective of this study was to identify clinical factors predictive of appendicitis in pregnant women and associated obstetric outcomes. Study Design  We performed a single-center, retrospective cohort study of pregnant women who underwent magnetic resonance imaging for suspected appendicitis from 2007 to 2012. Rates and odds of appendicitis based on presenting signs and symptoms were estimated. We also estimated rates and odds of adverse obstetric outcomes among women with a diagnosis of appendicitis. Results  Of 171 pregnant women evaluated, 14 (8.2%) had pathology-confirmed appendicitis. White blood cell (WBC) count on admission was moderately predictive of appendicitis (area under the receiver operating characteristic curve, 0.74). A WBC count > 18,000 made the diagnosis of appendicitis more than 10 times more likely (adjusted odds ratio, 10.51; 95% confidence interval, 1.67-43.1). Of 127 women with complete pregnancy follow-up, women with appendicitis had a higher rate of pregnancy loss appendicitis. Appendicitis diagnosed in the first trimester was associated with increased risk of pregnancy loss  18,000 on admission is significantly associated with appendicitis in pregnant women undergoing evaluation for appendicitis. Appendicitis during the first trimester of pregnancy is associated with previable pregnancy loss. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  1. The clinical value of pathology tests and imaging study in the diagnosis of acute appendicitis.

    Science.gov (United States)

    Chen, Ko-Chin; Arad, Alon; Chen, Ko-Chien; Storrar, Jonathan; Christy, Andrew G

    2016-10-01

    To explore the diagnostic accuracy of acute appendicitis among different patient groups and evaluate the statistical diagnostic values of common pathology and imaging tests for the diagnosis of acute appendicitis. Proportions of histology-proven appendicitis in different patient groups. Statistical parameters including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (+LR), negative likelihood ratio (-LR) and diagnostic odds ratio (DOR) between the histology-proven appendicitis and abnormal results of U/S, CT, WCC, CRP, bilirubin, pancreatic, and combined test results of WCC and CRP. Our data showed that up to 25.7% of patients underwent appendectomy has normal appendix. Appendicitis is often accurately diagnosed among male patients, up to 90.3% of the time, while misdiagnosis of appendicitis among young females (appendicitis, sensitivity > 90%, and no individual pathology test out of those examined can rival the sensitivity of CT. Nevertheless, by examining the combined results of WCC and CRP, we found that abnormal results in one or both these yields sensitivity similar to CT scans in detecting acute appendicitis, up to 95%. Young female patients have highest risk of being falsely diagnosed with acute appendicitis and hence unnecessary surgery. Bilirubin and lipase exhibit no correlations with acute appendicitis. Combined interpretation of WCC or CRP abnormal results yields competitive sensitivity as CT. Hencewe would suggest that, under the appropriate clinical context, one can use both WCC and CRP as a simple tool to support the diagnosis of appendicitis. If both tests show normal results, we would highly recommend considering alternative diagnosis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  2. A STUDY ON OPEN VS. LAPAROSCOPIC APPROACH IN ACUTE APPENDICITIS

    Directory of Open Access Journals (Sweden)

    Savalam Bujjitha

    2016-05-01

    Full Text Available Reginald Fitz in 1986, first described acute appendicitis. Since the acute appendicitis was first described, the pathology remains the most common intra-abdominal condition requiring emergency surgery. The life time risk of having acute appendicitis is about 8%. Traditionally, the treatment of choice has been surgery. Before the only option was the open laparotomical meaning opening the abdominal cavity was the mode of operation. Laparoscopic appendectomy was described by Semm in 1983. This method was new and had its own benefits but this particular procedure has struggled to prove its superiority over the open technique. This is contrast to laparoscopic cholecystectomy which has promptly become the gold standard for gallstone disease despite little scientific challenge. This peculiarity might be because of the fact that the Open Appendectomy was used for centuries with good effect. The particular procedure withstood the test of time for more than a century since its introduction by McBurney unlike cholecystectomy. Open surgery is typically completed using a small right lower quadrant incision between the point joining the lateral one-third and medial two-third of a line drawn from anterior-superior iliac spine and the umbilicus. The postoperative recovery is usually uneventful. The overall mortality of OA is around 0.3% and morbidity about 11%. Despite numerous randomised trials, several meta-analysis and systematic critical reviews, the clear cut winner is unannounced. A sincere effort has been put to understand the different pros and cons of the two methods so that the patient can be benefited. METHODS One Hundred cases were studied in the Department of Surgery, King George Hospital, Visakhapatnam, Andhra Pradesh from 01-09-2015 to 29-02-2016. Out of these, fifty cases underwent open surgery and the rest through laparoscopic surgery. The first group (Open Surgery thus consisted of 50 cases and the second group (laparoscopic consisted of fifty

  3. Effectiveness of conservative management of uncomplicated acute appendicitis: A single hospital based prospective study

    Directory of Open Access Journals (Sweden)

    Mumtaz KH. Alnaser

    Full Text Available Background: Acute appendicitis is one of the commonest causes of acute abdomen. There is a wide discussion and controversy on the surgical and nonsurgical treatment of acute uncomplicated appendicitis. The aim of this study was to evaluate the efficacy and outcomes of the conservative management of selected cases of acute appendicitis with an antibiotic first plan. Patients and methods: This was a single hospital-based prospective study with a duration of 25 months. Patients with clinical and radiological features of acute appendicitis presenting within 72 h of the beginning of abdominal pain with Alvarado score ≥5 were included. The patients received a therapeutic dose of broad-spectrum antibiotics and symptomatic treatment. The follow-up period was 6 months. Results: 90 patients were evaluated, 54 (60% patients were female and 36 (40% patients were male with mean age 34.4 years. Conservative treatment was successful in 68 (75.6% patients and failed in 22 (24.4% patients. No mortality recorded in this study. The main complications which occurred in those patients who failed to respond to conservative treatment were perforated appendicitis (3 patients, appendicular abscess (3 patients and appendicular mass (4 patients. Conclusion: Majority of cases of the first attack of uncomplicated acute appendicitis can be treated successfully by conservative treatment. However, conservative treatment demands precise communication, close monitoring and follow-up to recognize failure which needs to be treated immediately by surgery. Keywords: Acute appendicitis, Conservative treatment, Surgery, Antibiotics

  4. Clinical use of MRI for the evaluation of acute appendicitis during pregnancy.

    Science.gov (United States)

    Patel, Darshan; Fingard, Jordan; Winters, Sean; Low, Gavin

    2017-07-01

    The purpose of this study was to determine the diagnostic accuracy of MRI for detecting acute appendicitis in pregnancy in a multi-institution study involving general body MR readers with no specific expertise in MR imaging of the pregnant patient. Retrospective review of MRI examinations on PACS in 42 pregnant patients was evaluated for acute right lower quadrant pain. Three fellowship-trained general body radiologists analyzed the MRI examinations in consensus and attempted to localize the appendix, assess for features of appendicitis, and exclude alternative etiologies for the right lower quadrant pain. Of the 42 MRI examinations, the readers noted 6 cases of acute appendicitis, 16 cases of a normal appendix, and 20 cases involving non-visualization of the appendix but where there were no secondary features of acute appendicitis. Based on the surgical data and clinical follow-up, there were 3 true-positive cases, 3 false-positive cases, 34 true-negative cases, and 2 false-negative cases of acute appendicitis on MRI. This yielded an accuracy of 88.1%, sensitivity of 60%, specificity of 91.9%, positive predictive value of 50%, and negative predictive value of 94.4% for the detection of acute appendicitis in the pregnant patient on MRI. Alternative etiologies for the right lower quadrant pain on MRI included torsion of an ovarian dermoid in 1 case and pyelonephritis in 1 case. MRI is an excellent modality for excluding acute appendicitis in pregnant patients presenting with right lower quadrant pain.

  5. Appendectomy and Resection of the Terminal Ileum with Secondary Severe Necrotic Changes in Acute Perforated Appendicitis

    OpenAIRE

    Shiryajev, Yuri N.; Volkov, Nikolay N.; Kashintsev, Alexey A.; Chalenko, Marina V.; Radionov, Yuri V.

    2015-01-01

    Patient: Female, 19 Final Diagnosis: Acute perforated appendicitis ? appendiceal abscess ? secondary necrosis of the ileal wall Symptoms: Right lower quadrant abdominal pain ? fever Medication: ? Clinical Procedure: Diagnostic laparoscopy ? open drainage of an appendiceal abscess ? appendectomy ? ileal resection Specialty: Surgery Objective: Management of emergency care Background: Resectional procedures for advanced and complicated appendicitis are performed infrequently. Their extent can va...

  6. A rare pathological trinity: an appendiceal ectopic pregnancy, acute appendicitis and a carcinoid tumour.

    Science.gov (United States)

    Thompson, R J; Hawe, M J G

    2011-06-01

    We present a case of a 27-year-old woman who was found to have an appendiceal ectopic pregnancy, a carcinoid tumour of the appendix and acute appendicitis existing concurrently. This triad of pathology has never been reported previously. This case highlights the importance of performing a pregnancy test in all women of childbearing age presenting with acute abdominal pain and also the need to consider other diagnoses that may mimic or present concurrently with acute appendicitis.

  7. Onset of Crohn’s Disease by Symptoms of Acute Appendicitis

    Directory of Open Access Journals (Sweden)

    Ya.I. Lomei

    2015-11-01

    Full Text Available The analysis of current views on Crohn’s disease (CD has been carried out. A case report of the sudden onset of CD by symptoms of acute appendicitis in young patient is described. The events took place as follows: cumulative negative impact of risk factors — acute CD with primary lesion of vermiform appendix — clinical manifestations of acute appendicitis — appendectomy — recovery, possibly deceptive.

  8. Bees Reproduction Cycle: A Solution to Diagnosis of Acute Appendicitis

    Directory of Open Access Journals (Sweden)

    Amir Jamshidnezhad

    2017-05-01

    Full Text Available For centuries, the natural laws have been the source of human creativity. Recently, simulation of the animal life and behavior as the algorithms have been studied in the optimization problems. In this article, an evolutionary algorithm was proposed to diagnosis a challenging disease which deals with several factors. The proposed algorithm was developed according to the honeybee reproduction cycle (HBRC to create the fuzzy decision rules in an acute appendicitis diagnostic system. In this article thus, the useful clinical factors available in the first hours of the pain were explored and the diagnosis knowledge was discovered using an evolutionary algorithm in a Fuzzyrule based system. The optimization process in the algorithm decreases the chance of local optima in comparison with other techniques such as genetic algorithms. Experimental results showed that the proposed algorithm improves considerably the optimization performance in the diagnostic problem.

  9. [The diagnostic value of rectal examination of patients with acute appendicitis].

    Science.gov (United States)

    Kremer, K; Kraemer, M; Fuchs, K H; Ohmann, C

    1998-01-01

    The results of rectal digital examinations performed on 477 patients upon admission with histopathologically proven acute appendicitis from a total of 2280 patients with acute abdominal pain were analyzed. Although 13.7% of the patients experienced pain on the right side and 7.4% pain in the pouch of Douglas during rectal examination, none of the rectal examination parameters was statistically significant for the diagnosis of acute appendicitis. There are well established and statistically significant clinical indications, such as guarding, rigidity, rebound tenderness or abdominal distention that actually make the unpleasant rectal-digital examination superfluous for patients with suspected appendicitis.

  10. Sonography of acute appendicitis in pregnant women: diagnostic accuracy by the stage of gestation

    International Nuclear Information System (INIS)

    Kim, Sam Soo; Lee, Sang Wook; Rho, Myung Ho

    2004-01-01

    To evaluate the diagnostic accuracy of a diagnosis of acute appendicitis in pregnant women according to the trimester. A retrospective review was performed on 103 pregnant women who underwent sonography with clinically suspected acute appendicitis. The sonographic technique used involved either the graded compression or a non-compression method. All the sonograms were obtained after changing the patient's position and identifying the diseased appendix. The criterion for a sonographic diagnosis of acute appendicitis was the visualization of a non-compressible appendix with a maximal diameter ≥ 6 mm. The sonographic findings were correlated with the surgical findings and clinical follow-up. Acute appendicitis was confirmed by both the surgical and pathological findings in 48 out of 103 pregnant women. Ultrasound established the diagnosis in 34 of the 48 patients with proven appendicitis. There were false-positives in 2 patients and false-negatives in 14 patients. Among the 55 patients who had a normal appendix, 30 patients improved at the clinical follow-up and 25 patients had other intra-abdominal disorders. The diagnostic accuracy of the ultrasound was 94% in the first trimester, 81% in the second trimester, and 76% in the third trimester. The overall accuracy was found to be 84%, with a 71% sensitivity and a 96% specificity. No significant difference was found in the diagnostic accuracy of the ultrasound according to the trimester in which the acute appendicitis occurred. Therefore, regardless of the stage of gestation, sonography is a valuable procedure for diagnosing acute appendicitis

  11. Synchronous presentation of acute acalculous cholecystitis and appendicitis: a case report

    LENUS (Irish Health Repository)

    Sahebally, Shaheel M

    2011-11-14

    Abstract Introduction Acute acalculous cholecystitis is traditionally associated with elderly or critically ill patients. Case presentation We present the case of an otherwise healthy 23-year-old Caucasian man who presented with acute right-sided abdominal pain. An ultrasound examination revealed evidence of acute acalculous cholecystitis. A laparoscopy was undertaken and the dual pathologies of acute acalculous cholecystitis and acute appendicitis were discovered and a laparoscopic cholecystectomy and appendectomy were performed. Conclusion Acute acalculous cholecystitis is a rare clinical entity in young, healthy patients and this report describes the unusual association of acute acalculous cholecystitis and appendicitis. A single stage combined laparoscopic appendectomy and cholecystectomy is an effective treatment modality.

  12. Acute appendicitis in children: ultrasound and CT findings in negative appendectomy cases

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Seong Ho; Choi, Young Hun; Kim, Woo Sun; Cheon, Jung-Eun; Kim, In-One [Seoul National University Hospital, Department of Radiology, Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2014-10-15

    To decrease the negative appendectomy rate in children, knowledge of the misleading imaging findings on US and CT in negative appendicitis cases is important. To evaluate the negative appendectomy rate and describe the imaging findings of US and CT that lead radiologists to misdiagnose acute appendicitis in children. From 2007 to 2013, 374 children operated for suspected appendicitis were proved to either have acute appendicitis (n = 348) or to be negative for appendicitis (n = 26) on pathological reports. Negative appendectomy rates were compared among imaging modalities, age groups and genders. We retrospectively reviewed US and CT findings from negative appendectomy cases. The overall negative appendectomy rate was 7.0% (26/374). There were no statistically significant differences among the subgroups. The most common misleading presentations on US were sonographic tenderness (9/16, 56%) and non-compressibility (9/16, 56%). The most common misleading finding on CT were the presence of an appendicolith or hyperdense feces (5/12, 42%). Periappendiceal fat inflammation was observed in only one case of negative appendicitis on US and on CT. Radiologists can misdiagnose children with equivocal diameters of appendices as having acute appendicitis when sonographic tenderness or non-compressibility is present on US and when an appendicolith or hyperdense feces is noted on CT. The possibility of negative appendicitis should be borne in mind when periappendiceal fat inflammation is absent or minimal in indeterminate cases. (orig.)

  13. [Appendectomies for suspected acute appendicitis during pregnancy: experience at a Chilean public hospital].

    Science.gov (United States)

    Butte, Jean Michel; Bellolio, M Fernanda; Fernández, Francisca; Sanhueza, Marcel; Báez, Sergio; Kusanovich, Rodrigo; Viñuela, Eduardo; González, Rogelio; Pruyas, Martha; Díaz, Verónica; Martínez, Jorge

    2006-02-01

    Acute appendicitis is the most common non obstetric surgical emergency during pregnancy. To asses our experience in the diagnosis and management of acute appendicitis occurring during pregnancy. Data from all pregnant patients who were subjected to an appendectomy for a suspected acute appendicitis from January 1998 to December 2002, were retrospectively analyzed. All pathological, surgical, clinical records and the delivery outcome registry of each patient were reviewed. Among 47,322 deliveries, 46 pregnant women aged 29+/-9 years and with a gestational age of 21+/-7 weeks, were operated because of a presumptive acute appendicitis. Forty (87%) had a histopathologically proven appendicitis; ten (25%) cases had a perforated appendix and 30 (75%) had a non-perforated appendicitis. Five (10.9%) patients had a negative laparotomy and one had a necrotic ovarian tumor. Patients with perforated and non perforated appendices had a similar lapse from the onset of symptoms to operation (69+/-45 and 50+/-34 hours respectively, NS) and a similar white cell count (15,667+/-3,707 and 13,006+/-5,206 cells/mm(3), respectively, NS). Wound infection was the most common surgical complication in 15%. Seven (15%) patients had a premature delivery and there was one fetal death (2.2%). There were no pregnancy complications on negative appendectomy cases. Acute appendicitis continues to be a challenge in diagnosis and treatment during pregnancy. Maternal and fetal outcome was better than previously reported.

  14. MODIFIED ALVARADO SCORING AS A DIAGNOSTIC TOOL IN ACUTE APPENDICITIS- A PROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    V. K. Arun Kumar

    2017-02-01

    Full Text Available BACKGROUND Acute Appendicitis commonest community-acquired intra-abdominal infections. Acute appendicitis and its associated complications are significant source of morbidity and sometimes mortality. The Modified Alvarado Scoring System (MASS has been reported to be a cheap and quick diagnostic tool in patients with acute appendicitis. Diagnostic accuracy have been observed if the scores were applied to various populations and clinical settings. The purpose of this study was to evaluate the diagnostic value of Modified Alvarado Scoring System in patients with acute appendicitis in our setting. The aim of the study is to evaluate the efficacy of the modified Alvarado score as a diagnostic tool in Acute Appendicitis, as the diagnosis of appendicitis depends on the onset of symptoms and the subjective interpretation of the physical examination. MATERIALS AND METHODS This was a prospective study carried out in Pondicherry Institute of Medical Science during the period of November 2013 to May 2015. This study was done on 50 patients diagnosed with Acute Appendicitis and admitted in General Surgery. RESULTS In this study, there were a total of 50 patients who were taken up for surgery based on clinical and radiological diagnosis. Our study demonstrates that modified Alvarado score applied to all adult patients of acute appendicitis in adults with a sensitivity of 60% and a specificity of 40% only. Showing it wasn’t efficient in diagnosing acute appendicitis. The positive predictive value shown by our study was 80% which is marginally lower than that explained in literature which reports 87.5%. Negative appendicectomy rate in this study is 12%. CONCLUSION Alvarado score is a non-invasive, safe diagnostic procedure, which is simple, fast reliable and repeatable; it can be used in all conditions, without expensive and complicated supportive diagnostic methods. Alvarado score increases the diagnostic certainty of clinical examination in diagnosis of

  15. A comparison between modified Alvarado score and RIPASA score in the diagnosis of acute appendicitis.

    Science.gov (United States)

    Singla, Anand; Singla, Satpaul; Singh, Mohinder; Singla, Deeksha

    2016-12-01

    Acute appendicitis is a common but elusive surgical condition and remains a diagnostic dilemma. It has many clinical mimickers and diagnosis is primarily made on clinical grounds, leading to the evolution of clinical scoring systems for pin pointing the right diagnosis. The modified Alvarado and RIPASA scoring systems are two important scoring systems, for diagnosis of acute appendicitis. We prospectively compared the two scoring systems for diagnosing acute appendicitis in 50 patients presenting with right iliac fossa pain. The RIPASA score correctly classified 88 % of patients with histologically confirmed acute appendicitis compared with 48.0 % with modified Alvarado score, indicating that RIPASA score is more superior to Modified Alvarado score in our clinical settings.

  16. A rare complication of acute appendicitis: complete bilateral distal ureteral obstruction

    NARCIS (Netherlands)

    Aronson, D. C.; Moorman-Voestermans, C. G.; Tiel-van Buul, M. M.; Vos, A.

    1994-01-01

    Three children treated for appendicitis developed anuria and acute renal insufficiency several days after appendicectomy. Associated hydronephrosis or hydroureters were present in two. At cystoscopy, marked swelling of the trigonum and ureteric orifices was seen. One patient developed unilateral

  17. Amebiasis presenting as acute appendicitis: Report of a case and review of Japanese literature

    Directory of Open Access Journals (Sweden)

    Daisuke Ito

    2014-01-01

    CONCLUSION: We report a case of acute amebic appendicitis in a 31-year-old woman and review the ages at presentation, causative factors, treatments, and outcomes of 11 cases reported in Japan between 1995 and 2013.

  18. EVALUATION OF PRE-OPERATIVE DIAGNOSTIC EFFICACY OF MODIFIED ALVARADO SCORING SYSTEM IN ACUTE APPENDICITIS

    Directory of Open Access Journals (Sweden)

    Anand Kumar Jaiswal

    2017-05-01

    Full Text Available BACKGROUND Acute Appendicitis is the one of the most common acute surgical condition of abdomen. Acute Appendicitis may occur but is most commonly seen in the second and third decade of life. Acute Appendicitis if not diagnosed early and treated properly, may lead to fatal outcome. MATERIALS AND METHODS A prospective study of 100 patients, with a clinical diagnosis of acute appendicitis, admitted in the department of general surgery, B.R.D. Medical College Gorakhpur during a period of one year. RESULTS The age group in which acute appendicitis occurred commonly was between 18 to 30 years. It is clear that incidence is less in younger and older is group with peak incidence in second and third decade. Female to male ratio was 1.8:1. Pain was the commonest presenting symptom and has been observed in all the cases (100% in present series followed by nausea/vomiting in 87% cases and anorexia in 49% cases. CONCLUSION In the diagnosis of acute appendicitis the modified Alvarado Scoring System has a diagnostic value of 88.66%. This system is simple, reliable, cheap, non-invasive and safe diagnostic modality. The application of this scoring system improved diagnostic accuracy and consequently reduced negative appendectomy rate.

  19. A study of preoperative diagnosis using abdominal computed tomography in acute appendicitis

    International Nuclear Information System (INIS)

    Sakai, Takehiro

    2004-01-01

    To evaluate the usefulness of computed tomography (CT) in differential diagnosis and decisions for operative indications in patients with acute appendicitis, CT was done in 45 patients diagnosed with acute appendicitis. CT was retrospectively analyzed for the following findings: enlarged appendix, hazy periappendiceal density, increased enhancement of the appendiceal wall, deficiency of the appendiceal wall, appendiceal stones, abscess, and ascites. Surgery was conducted 28 patients, of whom 25 were pathologically diagnosed with gangrenous or phlegmonous appendicitis. Seventeen improved without surgery, i.e., 9 with acute appendicitis, 7 with diverticulitis of the colon, and 1 with pelvic peritonitis. Except for 3 with severe abscess, enlarged appendix, hazy periappendiceal density, and increased enhancement of the appendiceal wall were observed in 22 with phlegmonous or gangrenous appendicitis. In 25 with phlegmonous or gangrenous appendicitis, appendiceal stones were observed in 32% and abscess or ascites in 60%. Sensitivity, specificity, and accuracy in CT diagnosis images were 100%, 80%, and 96%. CT findings thus provide useful information in differential diagnosis and decisions on operative indication in patients with acute appendicitis. (author)

  20. Accuracy of ultrasonography in diagnosing acute appendicitis during pregnancy based on surgical findings.

    Science.gov (United States)

    Kazemini, Alireza; Reza Keramati, Mohammad; Fazeli, Mohammad Sadegh; Keshvari, Amir; Khaki, Siavash; Rahnemai-Azar, Ata

    2017-01-01

    Background: Acute appendicitis is the most common nonobstetric surgical problem in pregnancy. Common signs and symptoms of appendicitis are less reliable during pregnancy due to physiological changes; thus, the role of imaging becomes prominent. Thus, in the present study, we aimed at assessing the accuracy of sonography in diagnosing acute appendicitis during pregnancy. Methods: In this prospective analytic study, among 1000 patients diagnosed and treated as acute appendicitis, clinical and sonographic findings of 58 consecutive pregnant patients, who underwent appendectomy, were recorded and analyzed. All surgically resected samples were evaluated and confirmed through histological evaluation. Sonographic criteria were utilized to judge the results for appendicitis. Diagnostic test performance characteristics (sensitivity, specificity, predictive values, and likelihood ratios) were calculated. Results: The mean age of the patients was 27.1±4.9 years, and the most common clinical symptom was right lower quadrant pain. There was no significant difference in the mean leukocyte count between the appendicitis group and normal appendix group (p=0.768). Left shift was also unrelated with the appendix pathology (p= 0.549). The sensitivity, specificity, predictive values (positive and negative), and likelihood ratios (positive and negative) were 80%, 75%, 91.4%, 52.9%, 3.2, and 0.26, respectively during all trimesters of pregnancy. Conclusion: Ultrasonography is the initially preferred imaging modality in pregnant women suspected of having acute appendicitis with an acceptable sensitivity; however, application of other imaging modalities such as CT scan or MRI is recommended after inconclusive ultrasonography results.

  1. Round ligament lipoma mimicking acute appendicitis in a 24-week pregnant female: a case report.

    Science.gov (United States)

    Miller, T J; Paulk, D G

    2013-04-01

    An exhaustive search of the literature using the Pub Med database revealed no reports of round ligament lipomas mimicking acute appendicitis in pregnant patients. There are relatively few articles on round ligament lipomas and even less on round ligament lipomas during pregnancy. This case report is on a 27-year-old 24-week pregnant female who presented with signs and symptoms similar to acute appendicitis who in fact had a large right pelvic round ligament lipoma that was causing her pain.

  2. Plasma D-Lactic Acid Level: A Useful Marker to Distinguish Perforated From Acute Simple Appendicitis

    Directory of Open Access Journals (Sweden)

    Mehmet Demircan

    2004-10-01

    Full Text Available Early diagnosis of perforated appendicitis is important for reducing morbidity rates. The aim of this study was to determine the value and utility of plasma D-lactic acid levels in identifying the type of appendicitis. In this clinical study, plasma D-lactic acid levels were assessed in 44 consecutive paediatric patients (23 with acute appendicitis, 21 with perforated appendicitis before laparotomy. D-lactic acid levels were determined by an enzymatic spectrophotometric technique using a D-lactic acid dehydrogenase kit. Patients with perforated appendicitis had higher D-lactic acid levels (3.970 ± 0.687 mg/dL than patients in the control group (0.478 ± 0.149 mg/dL and patients with acute appendicitis (1.409 ± 0.324 mg/dL; p < 0.05. For a plasma D-lactic acid level greater than 2.5 mg/dL, the sensitivity and specificity of the D-lactic acid assay were 96% and 87%, respectively. The positive predictive value was 87%, the negative predictive value was 96%, and the diagnostic value was 91%. These results suggest that the measurement of plasma D-lactic acid levels may be a useful adjunct to clinical and radiological findings in distinguishing perforated from acute non-perforated appendicitis in children.

  3. T1 bright appendix sign to exclude acute appendicitis in pregnant women.

    Science.gov (United States)

    Shin, Ilah; An, Chansik; Lim, Joon Seok; Kim, Myeong-Jin; Chung, Yong Eun

    2017-08-01

    To evaluate the diagnostic value of the T1 bright appendix sign for the diagnosis of acute appendicitis in pregnant women. This retrospective study included 125 pregnant women with suspected appendicitis who underwent magnetic resonance (MR) imaging. The T1 bright appendix sign was defined as a high intensity signal filling more than half length of the appendix on T1-weighted imaging. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the T1 bright appendix sign for normal appendix identification were calculated in all patients and in those with borderline-sized appendices (6-7 mm). The T1 bright appendix sign was seen in 51% of patients with normal appendices, but only in 4.5% of patients with acute appendicitis. The overall sensitivity, specificity, PPV, and NPV of the T1 bright appendix sign for normal appendix diagnosis were 44.9%, 95.5%, 97.6%, and 30.0%, respectively. All four patients with borderline sized appendix with appendicitis showed negative T1 bright appendix sign. The T1 bright appendix sign is a specific finding for the diagnosis of a normal appendix in pregnant women with suspected acute appendicitis. • Magnetic resonance imaging is increasingly used in emergency settings. • Acute appendicitis is the most common cause of acute abdomen. • Magnetic resonance imaging is widely used in pregnant population. • T1 bright appendix sign can be a specific sign representing normal appendix.

  4. Ultrasonography with a hand-held device for the diagnosis of acute appendicitis

    International Nuclear Information System (INIS)

    Kameda, Toru; Takahashi, Isao

    2009-01-01

    The purpose of this study was to evaluate the accuracy of ultrasonography (US) with a hand-held device for the diagnosis of acute appendicitis in the emergency room. US with a hand-held device was performed by the first author in 33 patients suspected of having appendicitis in the emergency room. From these 33 patients, 24 who subsequently underwent computed tomography (CT) or surgery were included in this study. The accuracy of US with the hand-held device for the diagnosis of acute appendicitis was evaluated based on the findings of CT or surgery. CT and surgery were performed in 22 and 12 patients, respectively. Final diagnoses were acute appendicitis (n=18), terminal ileitis (n=2), pelvic inflammatory disease (n=2), diverticulitis (n=1), and ureterolithiasis (n=1). The US yielded a sensitivity of 78% and a positive predictive value of 100%. The shortest distance between the abdominal wall and the appendix measured on CT was less than 40 mm in 11 patients. In ten (91%) of the 11 patients US with the hand-held device showed the swollen appendix. US with a hand-held device is potentially useful in the positive identification of acute appendicitis, but further investigation is needed to prove its utility in the routine diagnosis of acute appendicitis. (author)

  5. Optimisation of the MR protocol in pregnant women with suspected acute appendicitis

    International Nuclear Information System (INIS)

    Shin, Ilah; Chung, Yong Eun; An, Chansik; Kim, Honsoul; Lim, Joon Seok; Kim, Myeong-Jin; Lee, Hye Sun

    2018-01-01

    To investigate the optimal magnetic resonance (MR) imaging protocol in pregnant women suspected of having acute appendicitis. One hundred and forty-six pregnant women with suspected appendicitis were included. MR images were reviewed by two radiologists in three separate sessions. In session 1, only axial single-shot turbo spin echo (SSH-TSE) T2-weighted images (WI) were included with other routine sequences. In sessions 2 and 3, coronal and sagittal T2WI were sequentially added. The visibility of the appendix and diagnostic confidence of appendicitis were evaluated in each session using a 5-point grading scale. If diseases other than appendicitis were suspected, specific diagnosis with a 5-point confidence scale was recorded. Diagnostic performance for appendicitis and other diseases were evaluated. Twenty-five patients (17.1%) were diagnosed with appendicitis. Among the patients with normal appendix, 28 were diagnosed with other disease. Diagnostic performance including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve values for diagnosing appendicitis and other diseases showed no significant difference among sets for both reviewers (p>0.05). Diagnostic performance of MR in pregnant patients with suspected appendicitis can be preserved with omission of sagittal or both coronal and sagittal SSH-T2WI. (orig.)

  6. Improving diagnosis of acute appendicitis with atypical findings by Tc-99m HMPAO leukocyte scan

    Energy Technology Data Exchange (ETDEWEB)

    Shung-Shung, S.; Kao, A. [China Medical Coll. Hospital, Taichung (Taiwan). Dept. of Nuclear Medicine; Yu-Chien, S. [Dept. of Nuclear Medicine, Far Eastern Memorial Hospital, National Taiwan Univ., Taipei (Taiwan); Inst. of Biomedical Engineering, Coll. of Electrical Engineering, National Taiwan Univ., Taipei (Taiwan); Mei-Due, Y.; Hwei-Chung, W. [Dept. of Surgery, China Medical Coll. Hospital, Taichung (Taiwan)

    2002-02-01

    Aim: Even with careful observation, the overall false-positive rate of laparotomy remains 10-15% when acute appendicitis was suspected. Therefore, the clinical efficacy of Tc-99m HMPAO labeled leukocyte (TC-WBC) scan for the diagnosis of acute appendicitis in patients presenting with atypical clinical findings is assessed. Patients and Methods: Eighty patients presenting with acute abdominal pain and possible acute appendicitis but atypical findings were included in this study. After intravenous injection of TC-WBC, serial anterior abdominal/pelvic images at 30, 60, 120 and 240 min with 800 k counts were obtained with a gamma camera. Any abnormal localization of radioactivity in the right lower quadrant of the abdomen, equal to or greater than bone marrow activity, was considered as a positive scan. Results: 36 out of 49 patients showing positive TC-WBC scans received appendectomy. They all proved to have positive pathological findings. Five positive TC-WBC were not related to acute appendicitis, because of other pathological lesions. Eight patients were not operated and clinical follow-up after one month revealed no acute abdominal condition. Three of 31 patients with negative TC-WBC scans received appendectomy. They also presented positive pathological findings. The remaining 28 patients did not receive operations and revealed no evidence of appendicitis after at least one month of follow-up. The overall sensitivity, specificity, accuracy, positive and negative predictive values for TC-WBC scan to diagnose acute appendicitis were 92, 78, 86, 82, and 90%, respectively. Conclusion: TC-WBC scan provides a rapid and highly accurate method for the diagnosis of acute appendicitis in patients with equivocal clinical examination. It proved useful in reducing the false-positive rate of laparotomy and shortens the time necessary for clinical observation. (orig.)

  7. Utility of diffusion-weighted imaging in the diagnosis of acute appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Inci, Ercan; Hocaoglu, Elif; Aydin, Sibel; Bayramoglu, Sibel; Cimilli, Tan [Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Radiology, Istanbul (Turkey); Kilickesmez, Ozgur [Yeditepe University, School of Medicine, Department of Radiology, Istanbul (Turkey)

    2011-04-15

    To evaluate the value of diffusion-weighted MRI (DWI) in the diagnosis of acute appendicitis. 119 patients with acute appendicitis and 50 controls were enrolled in this prospective study. DWI was obtained with b factors 0, 500 and 1000 s/mm{sup 2} and were assessed with a visual scoring system by two radiologists followed by quantitative evaluation of the DW images and ADC maps. Histopathology revealed appendicitis in 79/92 patients (78%) who had undergone surgery. On visual evaluation, except for one patient with histopathologically proven appendicitis all inflamed appendixes were hyperintense on DWI (98.7%). Quantitative evaluation with DW signal intensities and ADC values revealed a significant difference with normal and inflamed appendixes (p < 0.001). The best discriminative parameter was signal intensity (b 500). With a cut-off value of 56 for the signal intensity the ratio had a sensitivity of 99% and a specificity of 97%. The cut-off ADC value at 1.66 mm{sup 2}/s had a sensitivity of 97% and a specificity of 99%. DWI is a valuable technique for the diagnosis of acute appendicitis with both qualitative and quantitative evaluation. DWI increases the conspicuity of the inflamed appendix. We recommend using DWI to diagnose acute appendicitis. (orig.)

  8. Ultrasound Findings of Lymphoid Hyperplasia of the Appendix in Children: Differentiation from Acute Appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Bong Jae; Seo, Jung Wook; Lee, Byung Hoon [Inje University Ilsan Paik Hospital, Koyang (Korea, Republic of)

    2009-12-15

    To evaluate the ultrasound (US) findings that can help differentiate lymphoid hyperplasia in the appendix from acute appendicitis. A total of 1230 patients (below 20 years old) suspected of having appendicitis received an appendectomy between November, 1999, and March, 2008, with US findings in 27 patients with pathologically proven lymphoid hyperplasia of the appendix. Of 167 patients that received an appendectomy from January, 2007, to December, 2007, 52 patients with acute appendicitis were retrospectively reviewed as a control group. Retrospective review of US images was performed by two radiologists who were blinded to the pathologic results. The review was based on 12 ultrasonographic criteria derived from reports on the diagnostic findings of the appendicitis. Compared with acute appendicitis, lymphoid hyperplasia in appendix had a smaller diameter (7.14{+-}1.22 mm vs 9.37{+-}1.80 mm, p < 0.001) and less wall thickening(1.38{+-}0.36 mm vs 1.74 {+-} 0.56 mm, p =0.001). Periappendicular inflammation (p < 0.001), intraluminal air (p = 0.006), round shape in transverse scan (p = 0.002),increased blood flow on color Doppler US (p = 0.03) were also different. US is a useful modality to differentiate lymphoid hyperplasia in the appendix from acute appendicitis

  9. EVALUATION OF HYPERBILIRUBINAEMIA AS A NEW DIAGNOSTIC MARKER FOR ACUTE APPENDICITIS AND ITS ROLE IN THE PREDICTION OF APPENDICULAR PERFORATION

    Directory of Open Access Journals (Sweden)

    Lalit Kumar Regar

    2016-07-01

    Full Text Available BACKGROUND There are various investigations recommended to diagnose acute appendicitis; however, till date there is no confirmatory laboratory marker to diagnose preoperatively acute appendicitis & appendicular perforation. The purpose of study is to evaluate hyperbilirubinaemia as a new diagnostic marker for acute appendicitis and its role in the prediction of appendicular perforation. Preoperative assessment of serum bilirubin appears to be a promising new laboratory marker for diagnosing acute appendicitis & have a predictive potential for the diagnosis of appendicular perforation. METHODS A prospective analytical study of 100 cases comprising of a non-randomised cohort. RESULTS Hyperbilirubinaemia was found in most of the patients diagnosed with acute appendicitis (68.23% or appendicular perforation (73.33%. The mean total bilirubin level in patients diagnosed with acute appendicitis was 1.34 mg% while in patients diagnosed with appendicular perforation was 2.12 mg%. CONCLUSIONS Preoperative assessment of serum bilirubin should be routinely performed in cases of acute appendicitis as it can help in diagnosis of acute appendicitis as well as also serve as an important maker of acute gangrenous appendicitis.

  10. No Circadian Variation in Surgeons' Ability to Diagnose Acute Appendicitis

    DEFF Research Database (Denmark)

    Jørgensen, Anders Bech; Amirian, Ilda; Kehlet Watt, Sara

    2016-01-01

    patients were included. There were no age limitations or selection in sex. RESULTS: There was no significant difference in the ability to diagnose appendicitis in day-evening hours vs night hours (p = 0.391), nor was any significant difference found on weekdays (Monday-Thursday) vs weekends (Friday...... of imaging had no effect on the ability to diagnose appendicitis. Male sex showed a higher probability of the diagnosis being appendicitis compared with other or no pathology (odds ratio: 3.094; p

  11. [Nature of the relation of acute appendicitis morbidity to meteorological and heliogeophysical factors].

    Science.gov (United States)

    Khaavel', A A; Birkenfeldt, R R

    1978-04-01

    The authors analyzed 2009 appendicitis case records for the period from 1964 to 1973. In a sea climate region an evident season distribution of the apendicitis morbidity was found, with the rise of the incidence rate in January, March and April. The rise of the appendicitis incidence rate during the periods of vast fluctuations of air temperature, increase of air humidity and decrease of actual duration of sun radiance was established. The rise of the incidence of acute appendicitis was also noted during the months of a great and extremely great magnetic storms.

  12. Midgut malrotation presenting with left-sided acute appendicitis and CT inversion sign

    Science.gov (United States)

    Çağlar, Emrah; Arıbaş, Bilgin; Tiken, Ramazan; Keskin, Suat

    2014-01-01

    In patients presenting with abdominal pain, appendicitis is the most common surgical disorder. Appendicitis causing pain in the left lower quadrant is extremely rare and can occur with congenital abnormalities that include true left-sided appendix or as an atypical presentation of right-sided long appendix, which projects into the left lower quadrant. We report a case of a 69-year-old man showing midgut malrotation with acute appendicitis presenting as left lower quadrant abdominal pain. PMID:24682135

  13. Risk of acute appendicitis in and around pregnancy: a population-based cohort study from England.

    Science.gov (United States)

    Zingone, Fabiana; Sultan, Alyshah Abdul; Humes, David James; West, Joe

    2015-02-01

    To determine the absolute and relative risk of acute appendicitis during the antepartum and postpartum periods compared with the time outside pregnancy among women of childbearing age. Acute appendicitis is the most common nonobstetric surgical emergency during pregnancy. Estimates of the incidence of acute appendicitis in pregnancy remain imprecise and inconsistent. All potential fertile women aged 15 to 44 years registered within Clinical Practice Research Datalink with linkages to the Hospital Episodes Statistics between 1997 and 2012 were identified. Absolute rates of acute appendicitis were calculated during the antepartum and postpartum periods and were compared with the time outside pregnancy in terms of incidence rate ratio (IRR) using a Poisson regression model. Among 1,624,804 women, there were 362,219 pregnancies resulting in live or stillbirths. Compared with the time outside pregnancy, the rate of acute appendicitis was 35% lower during the antepartum period [IRR, 0.65; 95% confidence interval (CI), 0.55-0.76], with the lowest rate reported during the third trimester (IRR, 0.47; 95% CI, 0.35-0.64) for all ages; no increased risk of acute appendicitis was observed in the postpartum period compared with the time outside pregnancy among women aged 15 to 34 years but an 84% increased risk for women older than 35 years (IRR, 1.84; 95% CI, 1.18-2.86). The highest and lowest rates of negative appendectomy were encountered in the second and the third trimesters, respectively. Pregnant women are less likely to be diagnosed with acute appendicitis than nonpregnant women, with the lowest risk reported during the third trimester.

  14. Correlation between the serum and tissue levels of oxidative stress markers and the extent of inflammation in acute appendicitis

    Science.gov (United States)

    Dumlu, Ersin Gürkan; Tokaç, Mehmet; Bozkurt, Birkan; Yildirim, Murat Baki; Ergin, Merve; Yalçin, Abdussamed; Kiliç, Mehmet

    2014-01-01

    OBJECTIVES: To determine the serum and tissue levels of markers of impaired oxidative metabolism and correlate these levels with the histopathology and Alvarado score of acute appendicitis patients. METHOD: Sixty-five acute appendicitis patients (mean age, 31.4±12.06 years; male/female, 30/35) and 30 healthy control subjects were studied. The Alvarado score was recorded. Serum samples were obtained before surgery and 12 hours postoperatively to examine the total antioxidant status, total oxidant status, paraoxonase, stimulated paraoxonase, arylesterase, catalase, myeloperoxidase, ceruloplasmin, oxidative stress markers (advanced oxidized protein products and total thiol level) and ischemia-modified albumin. Surgical specimens were also evaluated. RESULTS: The diagnoses were acute appendicitis (n = 37), perforated appendicitis (n = 8), phlegmonous appendicitis (n = 12), perforated+phlegmonous appendicitis (n = 4), or no appendicitis (n = 4). The Alvarado score of the acute appendicitis group was significantly lower than that of the perforated+phlegmonous appendicitis group (p = 0.004). The serum total antioxidant status, total thiol level, advanced oxidized protein products, total oxidant status, catalase, arylesterase, and ischemia-modified albumin levels were significantly different between the acute appendicitis and control groups. There was no correlation between the pathological extent of acute appendicitis and the tissue levels of the markers; additionally, there was no correlation between the tissue and serum levels of any of the parameters. CONCLUSIONS: The imbalance of oxidant/antioxidant systems plays a role in the pathogenesis acute appendicitis. The Alvarado score can successfully predict the presence and extent of acute appendicitis. PMID:25518019

  15. Correlation between the serum and tissue levels of oxidative stress markers and the extent of inflammation in acute appendicitis

    Directory of Open Access Journals (Sweden)

    Ersin Gürkan Dumlu

    2014-12-01

    Full Text Available OBJECTIVES: To determine the serum and tissue levels of markers of impaired oxidative metabolism and correlate these levels with the histopathology and Alvarado score of acute appendicitis patients. METHOD: Sixty-five acute appendicitis patients (mean age, 31.4±12.06 years; male/female, 30/35 and 30 healthy control subjects were studied. The Alvarado score was recorded. Serum samples were obtained before surgery and 12 hours postoperatively to examine the total antioxidant status, total oxidant status, paraoxonase, stimulated paraoxonase, arylesterase, catalase, myeloperoxidase, ceruloplasmin, oxidative stress markers (advanced oxidized protein products and total thiol level and ischemia-modified albumin. Surgical specimens were also evaluated. RESULTS: The diagnoses were acute appendicitis (n = 37, perforated appendicitis (n = 8, phlegmonous appendicitis (n = 12, perforated+phlegmonous appendicitis (n = 4, or no appendicitis (n = 4. The Alvarado score of the acute appendicitis group was significantly lower than that of the perforated+phlegmonous appendicitis group (p = 0.004. The serum total antioxidant status, total thiol level, advanced oxidized protein products, total oxidant status, catalase, arylesterase, and ischemia-modified albumin levels were significantly different between the acute appendicitis and control groups. There was no correlation between the pathological extent of acute appendicitis and the tissue levels of the markers; additionally, there was no correlation between the tissue and serum levels of any of the parameters. CONCLUSIONS: The imbalance of oxidant/antioxidant systems plays a role in the pathogenesis acute appendicitis. The Alvarado score can successfully predict the presence and extent of acute appendicitis.

  16. Summer Appendicitis

    African Journals Online (AJOL)

    hanumantp

    E‑mail: audafares@yahoo.com. Introduction. Several acute diseases exhibit a circannual pattern. Acute appendicitis has been reported to be present throughout the year, but some particular months are associated with higher incidences.[1] Cases of appendicitis have been reported by many researchers to be associated ...

  17. Acute appendicitis in inguinal hernia: report of two cases | Kidmas ...

    African Journals Online (AJOL)

    Amyand's hernia). One patient had gangrenous appendicitis that affected the adjoining caecum. A limited right hemicolectomy was done by extending the groin incision laterally and proximally. The second patient had simple appendicectomy.

  18. Can New Inflammatory Markers Improve the Diagnosis of Acute Appendicitis?

    DEFF Research Database (Denmark)

    Andersson, Manne; Rubér, Marie; Ekerfelt, Christina

    2014-01-01

    BACKGROUND: The diagnosis of appendicitis is difficult and resource consuming. New inflammatory markers have been proposed for the diagnosis of appendicitis, but their utility in combination with traditional diagnostic variables has not been tested. Our objective is to explore the potential of new...... inflammatory markers for improving the diagnosis of appendicitis.METHODS: The diagnostic properties of the six most promising out of 21 new inflammatory markers (interleukin [IL]-6, chemokine ligand [CXCL]-8, chemokine C-C motif ligand [CCL]-2, serum amyloid A [SAA], matrix metalloproteinase [MMP]-9......, and myeloperoxidase [MPO]) were compared with traditional diagnostic variables included in the Appendicitis Inflammatory Response (AIR) score (right iliac fossa pain, vomiting, rebound tenderness, guarding, white blood cell [WBC] count, proportion neutrophils, C-reactive protein and body temperature) in 432 patients...

  19. Eosinophilic acute appendicitis caused by Strongyloides stercoralis and Enterobius vermicularis in an HIV-positive patient.

    Science.gov (United States)

    Cruz, Dennis Baroni; Friedrisch, Bruno Kras; Fontanive Junior, Vilmar; da Rocha, Vívian Wünderlich

    2012-03-27

    A 29 year old female HIV-positive patient presented in emergency with acute right lower quadrant abdominal pain, fever, tenderness and positive Blumberg sign. Laboratorial tests revealed eosinophilia, anaemia and leukocytosis. She underwent exploratory laparotomy followed by appendectomy. The pathological analysis of the appendix revealed acute appendicitis, accentuated eosinophilia and infestation by Strongyloides stercoralis and Enterobius vermicularis. She did well after surgery and adequate treatment. To the authors' knowledge, this is the first case of eosinophilic acute appendicitis caused by these two parasitic worms reported in the medical literature.

  20. Abdominal CT Does Not Improve Outcome for Children with Suspected Acute Appendicitis

    Directory of Open Access Journals (Sweden)

    Danielle I. Miano

    2015-12-01

    Full Text Available Introduction: Acute appendicitis in children is a clinical diagnosis, which often requires preoperative confirmation with either ultrasound (US or computed tomography (CT studies. CTs expose children to radiation, which may increase the lifetime risk of developing malignancy. US in the pediatric population with appropriate clinical follow up and serial exam may be an effective diagnostic modality for many children without incurring the risk of radiation. The objective of the study was to compare the rate of appendiceal rupture and negative appendectomies between children with and without abdominal CTs; and to evaluate the same outcomes for children with and without USs to determine if there were any associations between imaging modalities and outcomes. Methods: We conducted a retrospective chart review including emergency department (ED and inpatient records from 1/1/2009–2/31/2010 and included patients with suspected acute appendicitis. Results: 1,493 children, aged less than one year to 20 years, were identified in the ED with suspected appendicitis. These patients presented with abdominal pain who had either a surgical consult or an abdominal imaging study to evaluate for appendicitis, or were transferred from an outside hospital or primary care physician office with the stated suspicion of acute appendicitis. Of these patients, 739 were sent home following evaluation in the ED and did not return within the subsequent two weeks and were therefore presumed not to have appendicitis. A total of 754 were admitted and form the study population, of which 20% received a CT, 53% US, and 8% received both. Of these 57%, 95% CI [53.5,60.5] had pathology-proven appendicitis. Appendicitis rates were similar for children with a CT (57%, 95% CI [49.6,64.4] compared to those without (57%, 95% CI [52.9,61.0]. Children with perforation were similar between those with a CT (18%, 95% CI [12.3,23.7] and those without (13%, 95% CI [10.3,15.7]. The proportion of

  1. Magnetic resonance imaging of acute appendicitis in pregnancy: a 5-year multiinstitutional study.

    Science.gov (United States)

    Burke, Lauren M B; Bashir, Mustafa R; Miller, Frank H; Siegelman, Evan S; Brown, Michele; Alobaidy, Mamdoh; Jaffe, Tracy A; Hussain, Shahid M; Palmer, Suzanne L; Garon, Bonnie L; Oto, Aytekin; Reinhold, Caroline; Ascher, Susan M; Demulder, Danielle K; Thomas, Stephen; Best, Shaun; Borer, James; Zhao, Ken; Pinel-Giroux, Fanny; De Oliveira, Isabela; Resende, Daniel; Semelka, Richard C

    2015-11-01

    The purpose of this study was to determine the diagnostic performance of magnetic resonance imaging (MRI) in the diagnosis of acute appendicitis during pregnancy in a multiinstitutional study. In this multicenter retrospective study, the cases of pregnant women who underwent MRI evaluation of abdominal or pelvic pain and who had clinical suspicion of acute appendicitis between June 1, 2009, and July 31, 2014, were reviewed. All MRI examinations with positive findings for acute appendicitis were confirmed with surgical pathologic information. Sensitivity, specificity, negative predictive values, and positive predictive values were calculated. Receiver operating characteristic curves were generated, and area under the curve analysis was performed for each participating institution. Of the cases that were evaluated, 9.3% (66/709) had MRI findings of acute appendicitis. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive values were 96.8%, 99.2%, 99.0%, 92.4%, and 99.7%, respectively. There was no statistically significant difference between centers that were included in the study (pair-wise probability values ranged from 0.12-0.99). MRI is useful and reproducible in the diagnosis of suspected acute appendicitis during pregnancy. Published by Elsevier Inc.

  2. Acute Appendicitis After Kidney Transplantation: Experience at a Tertiary Care Hospital in Mexico City.

    Science.gov (United States)

    Ortiz-Brizuela, Edgar; Quiroz-Compeán, Alejandro; Vilatobá-Chapa, Mario; Alberú-Gómez, Josefina

    2018-04-01

    Here, we describe the presentation, treatment, and outcomes of acute appendicitis in kidney transplant recipients at a tertiary care hospital in Mexico City. We conducted a retrospective case series study at a tertiary care hospital in Mexico City from January 2000 to January 2015. During our study period, 1186 patients received a kidney transplant; among these patients, we identified 10 cases of acute appendicitis (0.008%). Four patients (40%) were diagnosed on day 5 of symptom onset. Nine patients (90%) showed abdominal pain, 2 patients (20%) presented with a typical migratory pattern, and 2 patients (20%) showed symptoms of small bowel intestinal obstruction. Thirty percent of patients (3/10) presented a rule-out Alvarado score (≤ 3 points). A computed tomography scan was performed in all but one patient; among these 9 patients, 1 (11.1%) had a false-negative result. Among all patients with acute appendicitis, 50% (5/10) presented with a periappendiceal abscess and 40% (4/10) showed localized peritonitis. An open and laparoscopic appendectomy was performed in 7 of 10 patients (70%) and 3 of 10 patients (30%), respectively. All patients received ceftriaxone plus metronidazole or ertapenem for 5 to 7 days. There were no reported treatment failures or recurrence of symptoms. The diagnosis of acute appendicitis in kidney transplant recipients requires a high index of suspicion. Kidney transplant recipients with acute appendicitis had good outcomes with a therapeutic approach similar to that used in the general population.

  3. Acute appendicitis in preschoolers: a study of two different populations of children

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    Sivridis Efthimios

    2011-07-01

    Full Text Available Abstract Objective To assess the incidence and the risk factors implicated in acute appendicitis in preschoolers in our region. Methods Over a 7-year period, 352 children underwent appendectomy for suspected acute appendicitis. Of these, data for 23 children were excluded because no inflammation of the appendix was found on subsequent histology. Of the remaining 329, 82 were ≤ 5 years old (i.e., preschool children and 247 were 5-14 years old. These two groups of children were further divided according to their religion into Muslims and Christian Orthodox: 43 of the children aged ≤ 5 years were Muslims and 39 were Christian Orthodox. A household questionnaire was designed to collect data concerning age, gender, type of residence area, living conditions, vegetable consumption, and family history of surgery for acute appendicitis as preschool children. The removed appendices were also assessed histologically for the amount of lymphoid tissue. Results Acute appendicitis of preschoolers developed more frequently in Muslims (39.4% than in Christians (17.7%; p p p > 0.05. Conclusions In our region, the percentage of preschool-aged Muslim children with acute appendicitis was remarkably high. One possible explanation for this finding could be the higher amount of lymphoid tissue in the wall of the appendix in Muslim preschool children together with their low standard of hygiene.

  4. Studies on CT findings and operation findings for acute appendicitis in children

    Energy Technology Data Exchange (ETDEWEB)

    Sakakibara, Kenichi; Andoh, Shigemitsu; Karamatsu, Syouji; Urakami, Toshihiko; Tsuji, Hideki; Kobayashi, Tohru; Okahira, Kihiro [Toyota Memorial Hospital, Aichi (Japan)

    1995-04-01

    Pediatric CT findings of acute appendicitis were reviewed retrospectively. The subjects were 29 patients (15 boys and 14 girls with an average age of 8.2 years), consisting of 17 with necrotic, 8 with phlegmonous inflammatory, and 4 with catarrhal appendicitis. CT findings were compared with the degree of inflammation. CT revealed abscess in 64.7%, 12.5%, and 0% for necrotic, phlegmonous inflammatory, and catarrhal types, respectively, and 41.4% for all types. An enlarged appendicitis was shown on CT in 86.2% (25/29). Fecalithes were shown on CT in 67.7% (19/29), which was associated with necrotic and phlegmonous inflammatory types, but not with catarrhal type. The other CT findings included thickened paramesocolon of the right lower abdomen, undefined wall of the inner side of the cecum. Inflammation was relatively slight in cases of catarrhal appendicitis, Nine patients less than 5 years of age had phlegmonous inflammatory or necrotic appendicitis. CT allowed definitive diagnosis of appendicitis in 2 of 3 patients with necrotic type. Ct was considered to be very useful in the diagnosis of appendicitis. (N.K.).

  5. Feasibility of single-incision laparoscopic surgery for appendicitis in abnormal anatomical locations: A single surgeon′s initial experience

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    Sanoop K Zachariah

    2013-01-01

    Full Text Available Background: Single-incision laparoscopic surgery is considered as a more technically demanding procedure than the standard laparoscopic surgery. Based on an initial and early experience, single-incision laparoscopic appendectomy (LA was found to be technically advantageous for dealing with appendicitis in unusual anatomical locations. This study aims to highlight the technical advantages of single-incision laparoscopic surgery in dealing with the abnormally located appendixes and furthermore report a case of acute appendicitis occurring in a sub-gastric position, which is probably the first such case to be reported in English literature. Materials and Methods: A retrospective analysis of the first 10 cases of single-incision LA which were performed by a single surgeon is presented here. Results: There were seven females and three males. The mean age of the patients was 30.6 (range 18-52 years, mean BMI was 22.7 (range 17-28 kg/m 2 and the mean operative time was 85.5 (range 45-150 min. The mean postoperative stay was 3.6 (range 1-7 days. The commonest position of the appendix was retro-caecal (50% followed by pelvic (30%. In three cases the appendix was found to be in abnormal locations namely sub-hepatic, sub-gastric and deep pelvic or para-vesical or para-rectal. All these cases could be managed with this technique without any conversions Conclusion: Single-incision laparoscopic surgery appears to be a feasible and safe technique for dealing with appendicitis in rare anatomical locations. Appendectomy may be a suitable procedure for the initial training in single-incision laparoscopic surgery.

  6. Differential diagnoses of magnetic resonance imaging for suspected acute appendicitis in pregnant patients

    Science.gov (United States)

    Jung, Ji Yong; Na, Ji Ung; Han, Sang Kuk; Choi, Pil Cho; LEE, Jang Hee; Shin, Dong Hyuk

    2018-01-01

    BACKGROUND: Accurate and timely diagnosis of acute surgical disease in pregnant patient is challenging. Although magnetic resonance imaging (MRI) is the most accurate modality to diagnose acute appendicitis in pregnant patients, it is often used as a last resort because of high cost and long scan time. We performed this study to analyze differential diagnoses of appendix MRI and to investigate if there are any blood tests that can predict surgical condition in pregnant patients. METHODS: A retrospective, cross-sectional study was conducted on 46 pregnant patients who underwent non-enhanced appendix MRI in suspicion of acute appendicitis from 2010 to 2016. Differential diagnoses of appendix MRI were analyzed and blood tests were compared between those who had surgical and non-surgical disease. RESULTS: Appendix MRI differentiated two surgical disease; acute appendicitis and ovarian torsion; and various non-surgical conditions such as uterine myoma, hydronephrosis, ureterolithiasis and diverticulitis among clinically suspected acute appendicitis in pregnancy. The diagnostic accuracy of MRI for acute appendicitis in this study was 93.5%. Patients who had surgical disease showed significantly higher WBC count (≥11,000/mm3), proportion of neutrophils in the WBC (≥79.9%), neutrophil-to-lymphocyte ratio (NLR≥6.4), levels of C-reactive protein (CRP≥1.82 mg/dL) and bilirubin (≥0.66 mg/dL) than those who had non-surgical disease. CONCLUSION: MRI can reliably differentiate surgical conditions and several blood tests (WBC, proportion of neutrophils in the WBC, NLR, CRP, bilirubin) can help anticipate acute surgical condition among pregnant patients suspected to have acute appendicitis. PMID:29290892

  7. Differential diagnoses of magnetic resonance imaging for suspected acute appendicitis in pregnant patients.

    Science.gov (United States)

    Jung, Ji Yong; Na, Ji Ung; Han, Sang Kuk; Choi, Pil Cho; Lee, Jang Hee; Shin, Dong Hyuk

    2018-01-01

    Accurate and timely diagnosis of acute surgical disease in pregnant patient is challenging. Although magnetic resonance imaging (MRI) is the most accurate modality to diagnose acute appendicitis in pregnant patients, it is often used as a last resort because of high cost and long scan time. We performed this study to analyze differential diagnoses of appendix MRI and to investigate if there are any blood tests that can predict surgical condition in pregnant patients. A retrospective, cross-sectional study was conducted on 46 pregnant patients who underwent non-enhanced appendix MRI in suspicion of acute appendicitis from 2010 to 2016. Differential diagnoses of appendix MRI were analyzed and blood tests were compared between those who had surgical and non-surgical disease. Appendix MRI differentiated two surgical disease; acute appendicitis and ovarian torsion; and various non-surgical conditions such as uterine myoma, hydronephrosis, ureterolithiasis and diverticulitis among clinically suspected acute appendicitis in pregnancy. The diagnostic accuracy of MRI for acute appendicitis in this study was 93.5%. Patients who had surgical disease showed significantly higher WBC count (≥11,000/mm 3 ), proportion of neutrophils in the WBC (≥79.9%), neutrophil-to-lymphocyte ratio (NLR≥6.4), levels of C-reactive protein (CRP≥1.82 mg/dL) and bilirubin (≥0.66 mg/dL) than those who had non-surgical disease. MRI can reliably differentiate surgical conditions and several blood tests (WBC, proportion of neutrophils in the WBC, NLR, CRP, bilirubin) can help anticipate acute surgical condition among pregnant patients suspected to have acute appendicitis.

  8. Evaluation of a low-dose CT protocol with oral contrast for assessment of acute appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Platon, Alexandra; Jlassi, Helmi; Becker, Christoph D.; Poletti, Pierre-Alexandre [University Hospital of Geneva, Department of Radiology, Geneva 14 (Switzerland); Rutschmann, Olivier T. [University Hospital of Geneva, Emergency Center, Geneva (Switzerland); Verdun, Francis R. [University Institute for Radiation Physics, Lausanne (Switzerland); Gervaz, Pascal [University Hospital of Geneva, Clinic of Digestive Surgery, Geneva (Switzerland)

    2009-02-15

    The aim of this study was to evaluate a low-dose CT with oral contrast medium (LDCT) for the diagnosis of acute appendicitis and compare its performance with standard-dose i.v. contrast-enhanced CT (standard CT) according to patients' BMIs. Eighty-six consecutive patients admitted with suspicion of acute appendicitis underwent LDCT (30 mAs), followed by standard CT (180 mAs). Both examinations were reviewed by two experienced radiologists for direct and indirect signs of appendicitis. Clinical and surgical follow-up was considered as the reference standard. Appendicitis was confirmed by surgery in 37 (43%) of the 86 patients. Twenty-nine (34%) patients eventually had an alternative discharge diagnosis to explain their abdominal pain. Clinical and biological follow-up was uneventful in 20 (23%) patients. LDCT and standard CT had the same sensitivity (100%, 33/33) and specificity (98%, 45/46) to diagnose appendicitis in patients with a body mass index (BMI) {>=} 18.5. In slim patients (BMI < 18.5), sensitivity to diagnose appendicitis was 50% (2/4) for LDCT and 100% (4/4) for standard CT, while specificity was identical for both techniques (67%, 2/3). LDCT may play a role in the diagnostic workup of patients with a BMI {>=} 18.5. (orig.)

  9. Optimisation of the MR protocol in pregnant women with suspected acute appendicitis.

    Science.gov (United States)

    Shin, Ilah; Chung, Yong Eun; An, Chansik; Lee, Hye Sun; Kim, Honsoul; Lim, Joon Seok; Kim, Myeong-Jin

    2018-02-01

    To investigate the optimal magnetic resonance (MR) imaging protocol in pregnant women suspected of having acute appendicitis. One hundred and forty-six pregnant women with suspected appendicitis were included. MR images were reviewed by two radiologists in three separate sessions. In session 1, only axial single-shot turbo spin echo (SSH-TSE) T2-weighted images (WI) were included with other routine sequences. In sessions 2 and 3, coronal and sagittal T2WI were sequentially added. The visibility of the appendix and diagnostic confidence of appendicitis were evaluated in each session using a 5-point grading scale. If diseases other than appendicitis were suspected, specific diagnosis with a 5-point confidence scale was recorded. Diagnostic performance for appendicitis and other diseases were evaluated. Twenty-five patients (17.1%) were diagnosed with appendicitis. Among the patients with normal appendix, 28 were diagnosed with other disease. Diagnostic performance including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve values for diagnosing appendicitis and other diseases showed no significant difference among sets for both reviewers (p>0.05). Diagnostic performance of MR in pregnant patients with suspected appendicitis can be preserved with omission of sagittal or both coronal and sagittal SSH-T2WI. • Diagnostic performance of appendicitis is preserved with omission of sagittal/coronal T2WIs. • Diagnosis of other disease may be sufficient with axial T2WIs only. • Careful serial omission of sagittal and coronal T2WIs can be considered.

  10. Acute Appendicitis Is Associated with Peptic Ulcers: A Population-based Study.

    Science.gov (United States)

    Tsai, Ming-Chieh; Kao, Li-Ting; Lin, Herng-Ching; Chung, Shiu-Dong; Lee, Cha-Ze

    2015-12-08

    Despite some studies having indicated a possible association between appendicitis and duodenal ulcers, this association was mainly based on regional samples or limited clinician experiences, and as such, did not permit unequivocal conclusions. In this case-control study, we examined the association of acute appendicitis with peptic ulcers using a population-based database. We included 3574 patients with acute appendicitis as cases and 3574 sex- and age-matched controls. A Chi-squared test showed that there was a significant difference in the prevalences of prior peptic ulcers between cases and controls (21.7% vs. 16.8%, p < 0.001). The adjusted odds ratio (OR) of prior peptic ulcers for cases was 1.40 (95% confidence interval [CI]: 1.24~1.54, p < 0.001) compared to controls. The results further revealed that younger groups demonstrated higher ORs for prior peptic ulcers among cases than controls. In particular, the adjusted OR for cases < 30 years old was as high as 1.65 (95% CI = 1.25~2.19; p < 0.001) compared to controls. However, we failed to observe an association of acute appendicitis with peptic ulcers in the ≥ 60-year age group (OR = 1.19, 95% CI = 0.93~1.52). We concluded that there is an association between acute appendicitis and a previous diagnosis of peptic ulcers.

  11. Efficiency of unenhanced MRI in the diagnosis of acute appendicitis: Comparison with Alvarado scoring system and histopathological results

    Energy Technology Data Exchange (ETDEWEB)

    Inci, Ercan, E-mail: ercan_inci@mynet.com [Department of Radiology, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Incirli-Bakirkoy, Istanbul (Turkey); Hocaoglu, Elif; Aydin, Sibel; Palabiyik, Figen; Cimilli, Tan [Department of Radiology, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Incirli-Bakirkoy, Istanbul (Turkey); Turhan, Ahmet Nuray; Ayguen, Ersan [Department of Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul (Turkey)

    2011-11-15

    Purpose: The purpose of this study was to assess the diagnostic value of unenhanced magnetic resonance imaging (MRI) in the diagnosis of acute appendicitis and compare with Alvarado scores and histopathological results. Materials and methods: The study included 85 consecutive patients (mean age, 26.5 {+-} 11.3 years) who were clinically suspected of having acute appendicitis. Each patients Alvarado scores were recorded and unenhanced MRI was performed, consisting of T1-weighted, T2-weighted and fat-suppressed T2-weighted fast spin-echo sequences. The MR images were prospectively reviewed in consensus for the presence of acute appendicitis by two radiologists who were blinded to the results of the Alvarado scores. The study population were divided into three subgroups based on the MRI findings: Group I: definitely not appendicitis, Group II: probably appendicitis, Group III: definitely appendicitis. All patients were divided into two subgroups according to Alvarado scores as Group A (low: 1-6), and Group B (high: 7-10). MR findings were compared with Alvarado scores and histopathological findings. Results: Sixty-six (77.6%) of the 85 patients with clinically suspected acute appendicitis, had undergone surgery. The diagnosis of appendicitis could be correctly achieved with MRI in 55 (83.3%) of 57 (86.4%) patients with histopathologically proven acute appendicitis. The sensitivity, specificity, positive predictive value and negative predictive value of MRI examination and Alvarado scoring system in the diagnosis of acute appendicitis were 96.49%, 66.67%, 94.83%, 75.0% and 84.21%, 66.67%, 94.12%, 40.0%, respectively. Conclusions: MRI is a valuable technique for detecting acute appendicitis even in the cases with low Alvarado scores. To increase the diagnostic accuracy and preventing unnecessary laparotomies for suspected appendicitis, shorter and cheaper unenhanced basic MRI may be performed.

  12. Efficiency of unenhanced MRI in the diagnosis of acute appendicitis: Comparison with Alvarado scoring system and histopathological results

    International Nuclear Information System (INIS)

    Inci, Ercan; Hocaoglu, Elif; Aydin, Sibel; Palabiyik, Figen; Cimilli, Tan; Turhan, Ahmet Nuray; Ayguen, Ersan

    2011-01-01

    Purpose: The purpose of this study was to assess the diagnostic value of unenhanced magnetic resonance imaging (MRI) in the diagnosis of acute appendicitis and compare with Alvarado scores and histopathological results. Materials and methods: The study included 85 consecutive patients (mean age, 26.5 ± 11.3 years) who were clinically suspected of having acute appendicitis. Each patients Alvarado scores were recorded and unenhanced MRI was performed, consisting of T1-weighted, T2-weighted and fat-suppressed T2-weighted fast spin-echo sequences. The MR images were prospectively reviewed in consensus for the presence of acute appendicitis by two radiologists who were blinded to the results of the Alvarado scores. The study population were divided into three subgroups based on the MRI findings: Group I: definitely not appendicitis, Group II: probably appendicitis, Group III: definitely appendicitis. All patients were divided into two subgroups according to Alvarado scores as Group A (low: 1-6), and Group B (high: 7-10). MR findings were compared with Alvarado scores and histopathological findings. Results: Sixty-six (77.6%) of the 85 patients with clinically suspected acute appendicitis, had undergone surgery. The diagnosis of appendicitis could be correctly achieved with MRI in 55 (83.3%) of 57 (86.4%) patients with histopathologically proven acute appendicitis. The sensitivity, specificity, positive predictive value and negative predictive value of MRI examination and Alvarado scoring system in the diagnosis of acute appendicitis were 96.49%, 66.67%, 94.83%, 75.0% and 84.21%, 66.67%, 94.12%, 40.0%, respectively. Conclusions: MRI is a valuable technique for detecting acute appendicitis even in the cases with low Alvarado scores. To increase the diagnostic accuracy and preventing unnecessary laparotomies for suspected appendicitis, shorter and cheaper unenhanced basic MRI may be performed.

  13. The usefulness of computed tomography in the diagnosis and evaluation of surgical indication of acute appendicitis

    International Nuclear Information System (INIS)

    Kondo, Hiroshi; Shimizu, Ryoichi; Ozasa, Hiroaki; Eto, Ryuichi

    2009-01-01

    We evaluated the usefulness of computed tomography (CT) in diagnosing and management acute appendicitis. We studied 133 patients diagnosed with acute appendicitis confirmed by plain CT between March 2004 and November 2008. Sixty-nine of these patients underwent appendectomy, 64 were treated conservatively. Recurrence of acute appendicitis was recognized in 13 out of 64 patients treated conservatively, and appendectomy was done in 8. On the CT findings of 77 patients who underwent appendectomy, appendicoliths were shown in 50 patients. In 64 patients treated conservatively, 14 patients had images of calcified appendicoliths. Eight out of 14 patients with appendicoliths had small calcifications, which were not obstructive in inner lumen of appendix. Inflammatory signs (increased white blood cell (WBC) and C reactive protein (CRP), and fever) with positive signs on CT, including calcifications, periappendicular infiltration, free fluid etc., are useful in confirming the clinical diagnosis and directing treatment (operative versus conservative) of patient. (author)

  14. Evaluation of modified alvarado score in the diagnosis of acute appendicitis

    International Nuclear Information System (INIS)

    Jan, H.

    2007-01-01

    To evaluate Modified Alvarado Score in patients with right iliac fossa pain. One hundred consecutive patients with right right iliac fossa pain. Both male and female patients with ages >14 years were included. Basic data of all the patients was collected. They were divided into two groups on the basis of modified Alvarado score. Group-I: Alvarado score greater then 7. Group-II: Alvarado score smaller than 7. In Group-I 61 patients underwent surgery; amongst them 52 had acute appendicitis while nine had other pathology. In Group-II there were 39 patients; amongst them six underwent surgery later on because of increase in their scores during observation, all of them had acute appendicitis. The negative appendicectomy rate was 14.75% and positive predictive value 85.21%. Alvarado Score is an easy and simple complementary aid in the diagnosis of acute appendicitis. It works well in patients with a score of greater than 7. (author)

  15. Mucosal invasion by fusobacteria is a common feature of acute appendicitis in Germany, Russia, and China.

    Science.gov (United States)

    Swidsinski, Alexander; Dörffel, Yvonne; Loening-Baucke, Vera; Tertychnyy, Alexander; Biche-Ool, Salbakay; Stonogin, Sergei; Guo, Yi; Sun, Ning-Dong

    2012-01-01

    To investigate the geographic occurrence of mucosa-invading Fusobacteria in acute appendicitis. Carnoy- and formalin-fixated appendices from Germany, Russia, and China were comparatively investigated. Bacteria were detected using fluorescent in situ hybridization. Cecal biopsies from patients with inflammatory bowel disease and other conditions were used as disease controls. Fusobacteria represented mainly by Fusobacterium nucleatum were the major invasive component in bacterial infiltrates in acute appendicitis but were completely absent in controls. The occurrence of invasive Fusobacteria in Germany, Russia, and China was the same. The detection rate in Carnoy-fixated material was 70-71% and in formalin-fixated material was 30-36%. Acute appendicitis is a polymicrobial infectious disease in which F. nucleatum and other Fusobacteria play a key role.

  16. Primary signet ring cell carcinoma of the appendix mimicking acute appendicitis

    Directory of Open Access Journals (Sweden)

    Mario Fusari

    2012-10-01

    Full Text Available Primary signet ring cell carcinoma of the appendix is a very rare neoplasm that usually presents with signs and symptoms of acute appendicitis and in particular with a right lower abdominal pain. Preoperative imaging detection of appendiceal adenocarcinoma has an important value because it may result in an appropriate surgical procedure. We report a rare case of primary signet ring cell carcinoma of the vermiform appendix in an 80-year-old man who was misdiagnosed on computed tomography (CT scan as acute appendicitis.

  17. T1 bright appendix sign to exclude acute appendicitis in pregnant women

    International Nuclear Information System (INIS)

    Shin, Ilah; An, Chansik; Lim, Joon Seok; Kim, Myeong-Jin; Chung, Yong Eun

    2017-01-01

    To evaluate the diagnostic value of the T1 bright appendix sign for the diagnosis of acute appendicitis in pregnant women. This retrospective study included 125 pregnant women with suspected appendicitis who underwent magnetic resonance (MR) imaging. The T1 bright appendix sign was defined as a high intensity signal filling more than half length of the appendix on T1-weighted imaging. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the T1 bright appendix sign for normal appendix identification were calculated in all patients and in those with borderline-sized appendices (6-7 mm). The T1 bright appendix sign was seen in 51% of patients with normal appendices, but only in 4.5% of patients with acute appendicitis. The overall sensitivity, specificity, PPV, and NPV of the T1 bright appendix sign for normal appendix diagnosis were 44.9%, 95.5%, 97.6%, and 30.0%, respectively. All four patients with borderline sized appendix with appendicitis showed negative T1 bright appendix sign. The T1 bright appendix sign is a specific finding for the diagnosis of a normal appendix in pregnant women with suspected acute appendicitis. (orig.)

  18. T1 bright appendix sign to exclude acute appendicitis in pregnant women

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Ilah; An, Chansik; Lim, Joon Seok; Kim, Myeong-Jin; Chung, Yong Eun [Yonsei University College of Medicine, Department of Radiology, Research Institute of Radiological Science, Severance Hospital, 50-1 Yonsei-ro, Seodaemun-gu, Seoul (Korea, Republic of)

    2017-08-15

    To evaluate the diagnostic value of the T1 bright appendix sign for the diagnosis of acute appendicitis in pregnant women. This retrospective study included 125 pregnant women with suspected appendicitis who underwent magnetic resonance (MR) imaging. The T1 bright appendix sign was defined as a high intensity signal filling more than half length of the appendix on T1-weighted imaging. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the T1 bright appendix sign for normal appendix identification were calculated in all patients and in those with borderline-sized appendices (6-7 mm). The T1 bright appendix sign was seen in 51% of patients with normal appendices, but only in 4.5% of patients with acute appendicitis. The overall sensitivity, specificity, PPV, and NPV of the T1 bright appendix sign for normal appendix diagnosis were 44.9%, 95.5%, 97.6%, and 30.0%, respectively. All four patients with borderline sized appendix with appendicitis showed negative T1 bright appendix sign. The T1 bright appendix sign is a specific finding for the diagnosis of a normal appendix in pregnant women with suspected acute appendicitis. (orig.)

  19. Assessment of Urinary-5-Hydroxyindolacetic Acid as A Diagnostic Parameter in Early Detection of Acute Appendicitis

    Directory of Open Access Journals (Sweden)

    Zuhair B Kamal

    2017-04-01

    Full Text Available Background: Acute appendicitis is the most common abdominal surgical emergency especially in children and young adults. The diagnosis of appendicitis is difficult because half the cases are incorrectly identified. Serotonin was defined as a good diagnostic marker for many inflammations including appendicitis and it is metabolite into 5-hydroxyindolacetic acid (5-HIAA to be excreted in urine. 5-HIAA is suggested to be of diagnostic importance in the detection of this disease. The aim of this study was to evaluate the diagnostic importance of urinary-5-HIAA as an added parameter to Alvarado score. Methods: Seventy patients (35 females and 35 males with acute appendicitis (35 were mild and 35 severe-perforated and gangrenous were included in this study and 70 healthy individuals were taken as a control group. Urinary-5-HIAA was estimated in all patients and control group using ELISA method. Results: Sensitivity for the mild group is 94.2%, specificity 100% and diagnostic accuracy is 97.4%, while the sensitivity for the severe group is 37%. It was found that there is a highly significant difference between mild and control groups (P<0.05. The diagnostic accuracy for the mild group is 97.4% and for the severe is 68.5%. Conclusion: We conclude that urinary-5-HIAA is a high sensitive test for early detection of acute appendicitis.

  20. Association between pregnancy and acute appendicitis in South Korea: a population-based, cross-sectional study

    Science.gov (United States)

    Yuk, Jin-Sung; Kim, Yong Jin; Hur, Jun-Young

    2013-01-01

    Purpose To estimate the prevalence of acute appendicitis and the relationship between pregnancy and acute appendicitis among South Korean women in 2009. Methods This was a cross-sectional study over 1 year period using a national registry data. We analyzed a national patient sample (n = 1,116,040) from a database complied by the South Korean National Health Insurance in 2009. Results We identified 15,974 cases of acute appendicitis from 2009. The prevalence rate of acute appendicitis was 228 ± 2 per 100,000 persons. The prevalence in men was higher than in women. The peak prevalence of the disease in both genders occurred in patients aged 10 to 14 years. After that, prevalence declined with age. The prevalence of acute appendicitis in women aged 20 to 39 years was negatively associated with age and pregnancy (P appendicitis cases by age is represented by a U-shaped curve. The prevalence was highest in people less than five years of age and in people older than 60 years. Conclusion We found that the prevalence of acute appendicitis decreased with increasing age after early teens, and that the prevalence of acute appendicitis in pregnant women was lower than in nonpregnant women. PMID:23908964

  1. Acute Appendicitis: Incidence and Management in Nigeria | Alatise ...

    African Journals Online (AJOL)

    Appendicitis is the leading cause of surgical emergency admission in most hospital in Nigeria. It accounts for about 15-40% of all emergency surgery done in most centers in the country. All age groups can develop the disease including the fetus in utero, but the incidence is higher in the second and third decade of life.

  2. ACUTE APPENDICITIS: AN OVERVIEW H. S. SAIDI and J. A. ...

    African Journals Online (AJOL)

    hi-tech

    2000-03-03

    Mar 3, 2000 ... Intestinal obstruction. 5. Portal pyaemia. 6. Bleeding. 7. Deep Venous Thrombosis. 8. Tubal infertility in females. 9. Abdominal Actinomycoses with anorexia and vomiting, perforation is common. ... mathematical model for diagnosis of appendicitis yields ... ultrasound, white cell count and C-reactive protein.

  3. Diagnostic value of hyperfibrinogenemia as a predictive factor for appendiceal perforation in acute appendicitis.

    Science.gov (United States)

    Zhao, Lingling; Feng, Shaoguang; Huang, Songsong; Tong, Yulong; Chen, Zhongliang; Wu, Peng; Lai, Xin-He; Chen, Xiaoming

    2017-05-01

    Acute appendicitis is one of the most common emergency requiring operation. As the first discovered coagulation factor, plasma fibrinogen frequently increases with inflammation due to the activation of coagulation. The aim of this retrospective study was to investigate the diagnostic value of hyperfibrinogenemia as a preoperative laboratory marker for appendiceal perforation in patients with acute appendicitis. We identified 455 patients (202 females, 253 males; mean age, 31.7 years) with histologically confirmed acute appendicitis who underwent laparoscopic or open appendectomy. Results of preoperative laboratory values and post-operative histologic results were analysed retrospectively. A multivariate logistic regression model was performed to determine patient's age and laboratory tests associated with perforated appendicitis. Mean plasma fibrinogen level of all patients was 3.99 g/L (1.41 SD; range, 1.73-10.6 g/L; median, 3.69 g/L). Patients with appendiceal perforation had a mean fibrinogen level of 5.72 g/L (1.52 SD; range, 3.38-10.04 g/L; median, 5.28 g/L), which was significantly higher than those with nonperforated groups (P = 0.001). Multivariate analysis showed fibrinogen and D-dimer were associated with perforation (P = 0.001, P = 0.014, respectively). Areas under the receiver operating characteristic curve of fibrinogen for discriminating acute perforated appendicitis from non-perforated groups were larger than white blood cell and D-dimer. Hyperfibrinogenemia was common in patients with acute appendicitis and fibrinogen may be useful as a predictive factor for appendiceal perforation. © 2015 Royal Australasian College of Surgeons.

  4. Evaluation of obstetrical and fetal outcomes in pregnancies complicated by acute appendicitis.

    Science.gov (United States)

    Abbasi, Nimrah; Patenaude, Valerie; Abenhaim, Haim A

    2014-10-01

    The purpose of our study was to evaluate obstetrical and fetal outcomes in pregnancies complicated by acute appendicitis, and to specifically evaluate the impact of peritonitis. We conducted a population-based cohort study using the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from 2003 to 2010 to evaluate perinatal outcomes in pregnant patients with appendicitis and delivery in the same admission compared to women delivering without appendicitis. Logistic regression was used to calculate the odds ratio (OR) and corresponding 95 % confidence intervals (CIs) for variables and outcomes of interest. Among seven million maternities, there were 1,203 women with appendicitis who delivered in the same admission. Pregnant women with appendicitis were more likely to deliver preterm OR 2.68 (95 % CI 2.31-3.11) and had an increased risk in abruptio. Among the 27 % of patients with peritonitis, the rate of preterm birth was fourfold higher, and the caesarean section rate was almost doubled. Although rare, appendicitis in pregnancy is associated with adverse maternal outcomes and worsened in cases of peritonitis. Measures to decrease risk of peritonitis should be taken in order to limit associated morbidities.

  5. The Alvarado score for predicting acute appendicitis: a systematic review

    Science.gov (United States)

    2011-01-01

    Background The Alvarado score can be used to stratify patients with symptoms of suspected appendicitis; the validity of the score in certain patient groups and at different cut points is still unclear. The aim of this study was to assess the discrimination (diagnostic accuracy) and calibration performance of the Alvarado score. Methods A systematic search of validation studies in Medline, Embase, DARE and The Cochrane library was performed up to April 2011. We assessed the diagnostic accuracy of the score at the two cut-off points: score of 5 (1 to 4 vs. 5 to 10) and score of 7 (1 to 6 vs. 7 to 10). Calibration was analysed across low (1 to 4), intermediate (5 to 6) and high (7 to 10) risk strata. The analysis focused on three sub-groups: men, women and children. Results Forty-two studies were included in the review. In terms of diagnostic accuracy, the cut-point of 5 was good at 'ruling out' admission for appendicitis (sensitivity 99% overall, 96% men, 99% woman, 99% children). At the cut-point of 7, recommended for 'ruling in' appendicitis and progression to surgery, the score performed poorly in each subgroup (specificity overall 81%, men 57%, woman 73%, children 76%). The Alvarado score is well calibrated in men across all risk strata (low RR 1.06, 95% CI 0.87 to 1.28; intermediate 1.09, 0.86 to 1.37 and high 1.02, 0.97 to 1.08). The score over-predicts the probability of appendicitis in children in the intermediate and high risk groups and in women across all risk strata. Conclusions The Alvarado score is a useful diagnostic 'rule out' score at a cut point of 5 for all patient groups. The score is well calibrated in men, inconsistent in children and over-predicts the probability of appendicitis in women across all strata of risk. PMID:22204638

  6. [Contribution of abdominal sonography in acute appendicitis diagnostics--our experience].

    Science.gov (United States)

    Smíd, D; Skalický, T; Treska, V

    2009-08-01

    Acute apendicitis is the most frequent case of acute abdomen. During a two year period (2006-2007) it was performed in Department of Surgery of Faculty Hospital in Pilsen 678 appendectomies, 30 days post-operative mortality rate was 0%. Abdomen ultrasonography like helping method to clinic examination was performed in 313 patients, suspect of acute appendicitis was in 191 patients (61%), in remaining patients was normal ultrasound picture.

  7. The current utility of ultrasound in the diagnosis of acute appendicitis.

    Science.gov (United States)

    Lourenco, Pedro; Brown, Jacquie; Leipsic, Jonathan; Hague, Cameron

    2016-01-01

    The purpose of this study is to evaluate the current performance of ultrasound in the diagnosis of acute appendicitis. Retrospectively, patients who presented to a single institution between 2011 and 2012 were included. Diagnostic accuracy was calculated, with surgery considered gold-standard. Our data demonstrates that US relative to surgery-confirmed appendicitis has a sensitivity and specificity of 48.4% and 97.9%, respectively. The diagnostic accuracy was further increased when there was a low pre-test probability, with a NPV of up to 96.6%. Ultrasound has a strong PPV in the diagnosis of acute appendicitis, and in equivocal cases, the NPV is reliable. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Antibiotics versus appendectomy in the management of acute appendicitis: a review of the current evidence

    Science.gov (United States)

    Fitzmaurice, Gerard J.; McWilliams, Billy; Hurreiz, Hisham; Epanomeritakis, Emanuel

    2011-01-01

    Background Acute appendicitis remains the most common cause of the acute abdomen in young adults, and the mainstay of treatment in most centres is an appendectomy. However, treatment for other intra-abdominal inflammatory processes, such as diverticulitis, consists initially of conservative management with antibiotics. The aim of this study was to determine the role of antibiotics in the management of acute appendicitis and to assess if appendectomy remains the gold standard of care. Methods A literature search using MEDLINE and the Cochrane Library identified studies published between 1999 and 2009, and we reviewed all relevant articles. The articles were critiqued using the Public Health Resource Unit (2006) appraisal tools. Results Our search yielded 41 papers, and we identified a total of 13 papers within the criteria specified. All of these papers, while posing pertinent questions and demonstrating the role of antibiotics as a bridge to surgery, failed to adequately justify their findings that antibiotics could be used as a definitive treatment of acute appendicitis. Conclusion Appendectomy remains the gold standard of treatment for acute appendicitis based on the current evidence. PMID:21651835

  9. Acute appendicitis and adverse pregnancy outcomes: a nationwide population-based study.

    Science.gov (United States)

    Wei, Po-Li; Keller, Joseph J; Liang, Hung-Hua; Lin, Herng-Ching

    2012-06-01

    Acute appendicitis is the most common non-obstetric surgical procedure in pregnant women. Using two large-scale nationwide population-based datasets, this study aimed to assess the risk of adverse pregnancy outcomes between mothers with and without appendicitis in Taiwan. This study used two nationwide population-based datasets: the Taiwan National Health Insurance Research Dataset and the Taiwan national birth certificate registry. This study included 908 women who had live singleton births and who had been hospitalized with a diagnosis of acute appendicitis, and another randomly selected 4,540 women as a comparison group. Conditional logistic regression analyses were performed to calculate the risk of adverse pregnancy outcomes including low birth weight (LBW), preterm birth, small for gestational age (SGA), cesarean section (CS), congenital anomalies, Apgar scores at 5 min (appendicitis were 1.82 (95 % CI = 1.43-2.30), 1.59 (95 % CI = 1.25-2.02), 1.33 (95 % CI = 1.12-1.60), 1.24 (95 % CI = 1.07-1.44), and 2.07 (95 % CI = 1.07-4.03), respectively, compared with women without acute appendicitis after adjusting for highest maternal educational level, marital status, geographic region, gestational diabetes, gestational hypertension, coronary heart disease, anemia, hyperlipidemia, obesity, and alcohol abuse/alcohol dependence syndrome, infant sex and parity, and paternal age. There were increased risks for having LBW, preterm infants, SGA, congenital anomalies, and for experiencing CS among women with acute appendicitis than comparison women.

  10. Clinical utility of magnetic resonance imaging in the evaluation of pregnant females with suspected acute appendicitis.

    Science.gov (United States)

    Kereshi, Borko; Lee, Karen S; Siewert, Bettina; Mortele, Koenraad J

    2017-08-28

    To assess the diagnostic performance of magnetic resonance imaging (MRI) in a large cohort of pregnant females with suspected acute appendicitis and to determine the frequency of non-appendiceal causes of abdominal pain identified by MRI in this population. This HIPAA compliant, retrospective study was IRB-approved and informed consent was waived. 212 MRI exams were performed consecutively on pregnant women aged 17-47 years old suspected of having acute appendicitis; eight exams were excluded and analyzed separately due to equivocal findings or lack of clinical follow up. Radiology reports for the MRI and any preceding ultrasound exams were reviewed as well as the patients' electronic medical record for surgical, pathological, or clinical follow up. Fifteen (7.3%) of 204 MRI scans were determined to be positive for appendicitis, 14 of which were proven on surgical pathology, and one was found to have ileocecal diverticulitis. Out of the remaining 189 scans, none were subsequently shown to have acute appendicitis either surgically or based on clinical follow up. Negative predictive value (NPV) was 100% and positive predictive value was 93.3%. Sensitivity and specificity were 100% and 99.5%, respectively. Non-appendiceal findings which may have accounted for the patient's abdominal pain were seen in 91 (44.2%) of 189 scans. The most common extra-appendiceal causes of abdominal pain identified on MRI include degenerating fibroids (n = 11), significant hydronephrosis (n = 12), cholelithiasis (n = 6), and pyelonephritis (n = 3). Our large study cohort of pregnant patients confirms MRI to be of high diagnostic value in the workup of acute appendicitis with 100% NPV and sensitivity and 99.5% specificity. Furthermore, an alternative diagnosis for abdominal pain in this patient population can be made in nearly half of MRI exams which are deemed negative for appendicitis.

  11. The RIPASA score for the diagnosis of acute appendicitis: A comparison with the modified Alvarado score.

    Science.gov (United States)

    Díaz-Barrientos, C Z; Aquino-González, A; Heredia-Montaño, M; Navarro-Tovar, F; Pineda-Espinosa, M A; Espinosa de Santillana, I A

    2018-02-06

    Acute appendicitis is the first cause of surgical emergencies. It is still a difficult diagnosis to make, especially in young persons, the elderly, and in reproductive-age women, in whom a series of inflammatory conditions can have signs and symptoms similar to those of acute appendicitis. Different scoring systems have been created to increase diagnostic accuracy, and they are inexpensive, noninvasive, and easy to use and reproduce. The modified Alvarado score is probably the most widely used and accepted in emergency services worldwide. On the other hand, the RIPASA score was formulated in 2010 and has greater sensitivity and specificity. There are very few studies conducted in Mexico that compare the different scoring systems for appendicitis. The aim of our article was to compare the modified Alvarado score and the RIPASA score in the diagnosis of patients with abdominal pain and suspected acute appendicitis. An observational, analytic, and prolective study was conducted within the time frame of July 2002 and February 2014 at the Hospital Universitario de Puebla. The questionnaires used for the evaluation process were applied to the patients suspected of having appendicitis. The RIPASA score with 8.5 as the optimal cutoff value: ROC curve (area .595), sensitivity (93.3%), specificity (8.3%), PPV (91.8%), NPV (10.1%). Modified Alvarado score with 6 as the optimal cutoff value: ROC curve (area .719), sensitivity (75%), specificity (41.6%), PPV (93.7%), NPV (12.5%). The RIPASA score showed no advantages over the modified Alvarado score when applied to patients presenting with suspected acute appendicitis. Copyright © 2018 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.

  12. Evaluation of a low-dose CT protocol with oral contrast for assessment of acute appendicitis.

    Science.gov (United States)

    Platon, Alexandra; Jlassi, Helmi; Rutschmann, Olivier T; Becker, Christoph D; Verdun, Francis R; Gervaz, Pascal; Poletti, Pierre-Alexandre

    2009-02-01

    The aim of this study was to evaluate a low-dose CT with oral contrast medium (LDCT) for the diagnosis of acute appendicitis and compare its performance with standard-dose i.v. contrast-enhanced CT (standard CT) according to patients' BMIs. Eighty-six consecutive patients admitted with suspicion of acute appendicitis underwent LDCT (30 mAs), followed by standard CT (180 mAs). Both examinations were reviewed by two experienced radiologists for direct and indirect signs of appendicitis. Clinical and surgical follow-up was considered as the reference standard. Appendicitis was confirmed by surgery in 37 (43%) of the 86 patients. Twenty-nine (34%) patients eventually had an alternative discharge diagnosis to explain their abdominal pain. Clinical and biological follow-up was uneventful in 20 (23%) patients. LDCT and standard CT had the same sensitivity (100%, 33/33) and specificity (98%, 45/46) to diagnose appendicitis in patients with a body mass index (BMI) >or= 18.5. In slim patients (BMIor= 18.5.

  13. Pain management of acute appendicitis in Canadian pediatric emergency departments.

    Science.gov (United States)

    Robb, Andrea L; Ali, Samina; Poonai, Naveen; Thompson, Graham C

    2017-11-01

    Children with suspected appendicitis are at risk for suboptimal pain management. We sought to describe pain management patterns for suspected appendicitis across Canadian pediatric emergency departments (PEDs). A retrospective medical record review was undertaken at 12 Canadian PEDs. Children ages 3 to 17 years who were admitted to the hospital in February or October 2010 with suspected appendicitis were included. Patients were excluded if partially assessed or treated at another hospital. Data were abstracted using a study-specific, standardized electronic data extraction tool. The primary outcome was the proportion of children who received analgesia while in the emergency department (ED). Secondary outcomes included the proportion of children receiving intravenous (IV) morphine and the timing of analgesic provision. A total of 619 health records were abstracted; mean (SD) patient age was 11.4 (3.5) years. Sixty-one percent (381/616) of patients received analgesia in the ED; 42.8% (264/616) received IV morphine. Other analgesic agents provided included oral acetaminophen (23.5% [145/616]) and oral ibuprofen (5.8% [36/616]). The median (IQR) initial dose of IV morphine was 0.06 (0.04, 0.09) mg/kg. The median (IQR) time from triage to the initial dose of analgesia was 196 (101, 309.5) minutes. Forty-three percent (117/269) of children receiving analgesia received the initial dose following surgical consultation; 43.7% (121/277) received their first analgesic after abdominal ultrasound was performed. Suboptimal and delayed analgesia remains a significant issue for children with suspected appendicitis in Canadian PEDs. This suggests a role for multidimensional knowledge translation interventions and care protocols to improve timely access to analgesia.

  14. Clinical scores for prediction of acute appendicitis in children in a ...

    African Journals Online (AJOL)

    Materials and methods A prospective observational study was carried out of patients younger than 15 years of age with abdominal pain and suspected acute appendicitis (AA) attending the Pediatric Emergency in a Hospital of Lima, Peru. These patients underwent a survey to assess the parameters of the Alvarado score ...

  15. The role of radiolabeled leukocyte imaging in the management of patients with acute appendicitis

    International Nuclear Information System (INIS)

    Kipper, S.L.

    1999-01-01

    Acute appendicitis is a clinical challenging surgical disease particularly difficult to diagnosis in women and children. An atypical presentation of acute appendicitis is a major factor leading to delay in diagnosis and unnecessary surgery. Delay in diagnosis is associated with morbidity from perforation, abscess and prolonged hospitalization. The routine use of adjunctive imaging studies has not improved the diagnostic accuracy for acute appendicitis nor has impacted clinical outcome. 99m Tc HMPAO-labeled leukocyte imaging is one diagnostic imaging test that has the potential of altering the clinical management of acute appendicitis. 99m Tc HMPAO-labeled leukocyte imaging is highly sensitive for detecting even small inflammatory processes in the abdomen because of high target to background and early rapid uptake at sites of inflammation. The paper studies the use of 99m Tc HMPAO-labeled leukocyte for diagnosis and management of suspected acute appendicitis in 124 patients with an atypical clinical presentation. Emergent imaging was performed immediately following injection of labeled leukocytes and continued until positive or through 2 hours if negative. The scan correctly and rapidly detected acute appendicitis in 50 of 51 patients with a surgical confirmation for a sensitivity of 98%. The specificity was 82% leading to an overall accuracy of 90%. The high negative predicted value of 98% allowed early discharge from the emergency department. The negative exploratory laparotomy rate wae 4% in this patient population compared to 9% in a similar population of patients who were not scanned. These data have been confirmed now in over 600 patients scanned in that department. The main drawbacks of 99m Tc HMPAO-labeled leukocyte imaging are the requirement of blood handling and a delay in diagnosis because of 2-hours preparation time prior to imaging. There are new radiopharmaceuticals on the horizon which have the potential of replacing 99m Tc HMPAO-labeled leukocyte

  16. The role of radiolabeled leukocyte imaging in the management of patients with acute appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Kipper, S.L. (Tri-City Medical Center, Oceanside, CA (United States). Nuclear Medicine dept. of Imaging)

    1999-03-01

    Acute appendicitis is a clinical challenging surgical disease particularly difficult to diagnosis in women and children. An atypical presentation of acute appendicitis is a major factor leading to delay in diagnosis and unnecessary surgery. Delay in diagnosis is associated with morbidity from perforation, abscess and prolonged hospitalization. The routine use of adjunctive imaging studies has not improved the diagnostic accuracy for acute appendicitis nor has impacted clinical outcome. [sup 99m]Tc HMPAO-labeled leukocyte imaging is one diagnostic imaging test that has the potential of altering the clinical management of acute appendicitis. [sup 99m]Tc HMPAO-labeled leukocyte imaging is highly sensitive for detecting even small inflammatory processes in the abdomen because of high target to background and early rapid uptake at sites of inflammation. The paper studies the use of[sup 99m]Tc HMPAO-labeled leukocyte for diagnosis and management of suspected acute appendicitis in 124 patients with an atypical clinical presentation. Emergent imaging was performed immediately following injection of labeled leukocytes and continued until positive or through 2 hours if negative. The scan correctly and rapidly detected acute appendicitis in 50 of 51 patients with a surgical confirmation for a sensitivity of 98%. The specificity was 82% leading to an overall accuracy of 90%. The high negative predicted value of 98% allowed early discharge from the emergency department. The negative exploratory laparotomy rate wae 4% in this patient population compared to 9% in a similar population of patients who were not scanned. These data have been confirmed now in over 600 patients scanned in that department. The main drawbacks of [sup 99m]Tc HMPAO-labeled leukocyte imaging are the requirement of blood handling and a delay in diagnosis because of 2-hours preparation time prior to imaging. There are new radiopharmaceuticals on the horizon which have the potential of replacing [sup 99m

  17. Association between pluviometric index and the occurrence of acute appendicitis

    Directory of Open Access Journals (Sweden)

    Djalma Ribeiro Costa

    2017-10-01

    Full Text Available Background: Epidemiological studies demonstrate, for unknown reasons, the prevalence of appendicitis in the summer and in young male adults, and there are controversies about its association with the rainy season. There are no studies in the State of Piauí about such association. Objective: To establish an association between the occurrence of appendicitis and the pluviometric precipitation index. Methodology: This is a cross-sectional study that was carried out using the database of the pathology service at a public emergency hospital in Piauí, and the pluviometric precipitation index in the State of Piauí from January 2009 to April 2014, with data from the National Institute of Meteorology. Descriptive statistics and association measures were applied using the Pearson correlation coefficient and the χ2 test. Results: We found a predominance of appendicitis cases in male subjects, from 11 to 20 years of age, with a predominance of the monthly mean of appendicitis cases in the second semester, which conforms to the dry season in the State of Piauí. Pearson's correlation coefficient was −0.260. Conclusion: There is an association between the occurrence of appendicitis and the months of the year; however, this is a weak negative correlation between the monthly mean of cases of appendicitis and monthly pluviometric precipitation average in the State of Piauí. Resumo: Contexto: Estudos epidemiológicos demonstram, por razões desconhecidas, o predomínio dos casos de apendicite no verão e em adultos jovens do sexo masculino, havendo controvérsias sobre sua associação com o período chuvoso. Não há estudos realizados no Piauí sobre esta associação. Objetivo: Estabelecer uma associação entre a ocorrência de apendicite e o índice de precipitação pluviométrica. Metodologia: Realizou-se um estudo transversal através do banco de dados do serviço de patologia de um hospital de emergência público do Piauí e do índice de

  18. A case of asymptomatic ileal duplication cyst associated with acute appendicitis

    Directory of Open Access Journals (Sweden)

    Hülya İpek

    2017-07-01

    Full Text Available Duplications of the alimentary tract are infrequent anomalies. They are most frequently located in the terminal ileum, and majority of them became symptomatic before the age of 2. Presenting symptoms may include abdominal mass, intestinal obstruction, intussusception, rectal bleeding, and abdominal pain. Preoperative diagnosis is usually difficult, intra-abdominal duplications are usually diagnosed during surgical explorations of above complications. We presented a 12-year-old girl with asymptomatic ileal duplication cyst associated with non-complicated acute appendicitis, whose imaging studies at admission were compatible with complicated perforated appendicitis.

  19. Co-infection with Enterobius vermicularis and Taenia saginata mimicking acute appendicitis.

    Science.gov (United States)

    Saravi, Kasra H; Fakhar, Mahdi; Nematian, Javad; Ghasemi, Maryam

    2016-01-01

    In this report, we describe an unusual case of verminous appendicitis due to Enterobius vermicularis and Taenia saginata in a 29-year-old woman from Iran. The histopathological examinations and parasitological descriptions of both worms found in the appendix lumen are discussed. The removed appendix exhibited the macroscopic and microscopic features of acute appendicitis. Antihelminthic therapy was initiated with single doses of praziquantel for the taeniasis and mebendazole for the enterobiasis, and the patient was discharged. Copyright © 2015 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

  20. Case report of idiopathic cecal perforation presenting as acute appendicitis on ultrasound

    Directory of Open Access Journals (Sweden)

    Calista Harbaugh

    2016-08-01

    Full Text Available Cecal perforation is an uncommon phenomenon in a pediatric population. It has been linked to a number of underlying medical conditions, which may result in focal inflammation or relative ischemia including hematologic malignancy, infection, and inflammatory bowel disease. We present an otherwise healthy 16-year-old male diagnosed with acute uncomplicated appendicitis on ultrasound, who was found to have cecal perforation with normal appendix intraoperatively, ultimately requiring ileocectomy. With this report, we aim to present the numerous pathophysiologic etiologies of cecal perforation, and to promote a comprehensive differential diagnosis despite the clinical and radiologic findings consistent with uncomplicated appendicitis.

  1. [Radiological support for diagnosis of acute appendicitis: use, effectiveness and clinical repercussions].

    Science.gov (United States)

    Aranda-Narváez, José Manuel; Montiel-Casado, María Custodia; González-Sánchez, Antonio Jesús; Jiménez-Mazure, Carolina; Valle-Carbajo, Marta; Sánchez-Pérez, Belinda; Santoyo-Santoyo, Julio

    2013-11-01

    The aim of this study is to analyze the increasing need of radiological support in the diagnosis of acute appendicitis (AA), the clinical repercussions associated, and the parameters of diagnostic accuracy of ultrasound and computed tomography (CT) scan for AA. Observational and analytical study. Cohort, patients operated on for suspected AA at a tertiary referral hospital. Pregnancy and <14 years were exclusion criteria. January 2010-December 2011 (n1=419). set of patients aged 18 to 65 years old operated between October 2001-September 2003 (n2=237). Variables analyzed in both groups: 1) percentage of radiological support for diagnosis of acute appendicitis; 2) sensitivity and positive predictive value (PPV) of ultrasound and CT scan; 3) rate of surgical explorations with negative result or with diagnosis other than acute appendicitis. SPSS software, χ(2) test, statistical significance accepted with P<.05, 95% confidence interval (95% CI) for the odds ratio (OR). Age, gender, percentage of atypical locations and gangrenous/perforated episodes were similar in both groups. The number of radiological examinations needed for diagnosis was significantly higher in the study group (78.8% vs. 30.4%, P<.0,000). Sensitivity was significantly superior for CT than for ultrasound scan (97% vs. 86%), but PPV was similar in both tests (92% vs. 94%). Surgical exploration percent values with diagnosis of acute appendicitis was significantly higher in the study group (94.5% vs. 88.6%; P<.006, OR 2.2; CI 95% 1.25-4). CT and ultrasound scan are excellent diagnostic tools for acute appendicitis, and have contributed to a significant increase in surgical explorations with correct diagnosis. Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.

  2. Interleukin 6 and lipopolysaccharide binding protein - markers of inflammation in acute appendicitis.

    Science.gov (United States)

    Brănescu, C; Serban, D; Dascălu, A M; Oprescu, S M; Savlovschi, C

    2013-01-01

    The rate of incidence of acute appendicitis is 12% in the case of male patients and 25% in case of women, which represents about 7% of the world population. The appendectomy rate has remained constant (i.e. 10 out of 10,000 patients per year). Appendicitis most often occurs in patients aged between 11-40 years, on the threshold between the third and fourth decades, the average age being 31.3 years. Since the first appendectomy performed by Claudius Amyand (1681/6 -1740), on December, 6th, 1735 to our days, i.e., 270 years later, time has confirmed the efficiency of both the therapy method and the surgical solution. The surgical cure in case of acute appendicitis has proved to be acceptable within the most widely practised techniques in general surgery. The variety of clinical forms has reached all age ranges, which in its turn has resulted in a large number of semiotic signs. In the case of acute appendicitis, interdisciplinarity has allowed the transfer of concept and methodology transfer among many areas of expertise, aimed at a better, minute understanding of the inflammatory event itself. Acute appendicitis illustrates inflammation development at digestive level and provides for a diagnostic and paraclinical exploration which continually upgrades. The recent inclusion in the studies of the Lipopolysaccharide binding protein (LBP)- type inflammation markers has laid the foundation of the latter's documented presence in the case of acute appendicitis-related inflammation. Proof of the correlation between the histopathological, clinical and evolutive forms can be found by identifying and quantifying these inflammation markers. The importance of studying inflammation markers allows us to conduct studies going beyond the prognosis of the various stages in which these markers were identified. The present article shows the results of a 1-year monitoring of the inflammation markers' values for Interleukin-6 and Lipopolysaccharide binding protein (LBP)-types, both pre

  3. Intra-Appendiceal Air at CT: Is It a Useful or a Confusing Sign for the Diagnosis of Acute Appendicitis?

    Science.gov (United States)

    Cho, Hyun Suk; Woo, Ji Young; Lee, Yul; Yang, Ik; Hwang, Ji-Young; Kim, Han Myun; Kim, Jeong Won

    2016-01-01

    Objective To investigate the significance of intra-appendiceal air at CT for the evaluation of appendicitis. Materials and Methods We retrospectively analyzed 458 patients (216 men, 242 women; age range, 18-91 years) who underwent CT for suspected appendicitis. Two independent readers reviewed the CT. Prevalence, amount, and appearance of intra-appendiceal air were assessed and compared between the patients with and without appendicitis. Performance of CT diagnosis was evaluated in two reading strategies: once ignoring appendiceal air (strategy 1), and the other time considering presence of appendiceal air as indicative of no appendicitis in otherwise indeterminate cases (strategy 2), using receiver operating characteristic (ROC) analysis. Results Of the 458 patients, 102 had confirmed appendicitis. The prevalence of intra-appendiceal air was significantly different between patients with (13.2%) and without (79.8%) appendicitis (p appendicitis as compared with the normal group, for both reader 1 (p = 0.011) and reader 2 (p = 0.002). Stool-like appearance and air-fluid levels were more common in the appendicitis group than in the normal appendix for both readers (p appendicitis, it has a limited incremental value for the diagnosis of acute appendicitis. PMID:26798214

  4. Influence of delays on perforation risk in adults with acute appendicitis.

    LENUS (Irish Health Repository)

    Kearney, D

    2012-02-03

    PURPOSE: This study analyzed whether prehospital or in-hospital delay was the more significant influence on perforation rates for acute appendicitis and whether any clinical feature designated patients requiring higher surgical priority. METHODS: A retrospective analysis was conducted over one year at a tertiary referral hospital without a dedicated emergency surgical theater. Admission notes, theater logbook, and the Hospital Inpatient Enquiry system were reviewed to identify the characteristics and clinical course of patients aged greater than 16 years who were operated upon for histologically confirmed acute appendicitis. RESULTS: One hundred and fifteen patients were studied. The overall perforation rate was 17 percent. The mean duration of symptoms prior to hospital presentation was 38.1 hours with the mean in-hospital waiting time prior to operation being 23.4 hours. Although body temperature on presentation was significantly greater in patients found to have perforated appendicitis (P < 0.05), only patient heart rate at presentation and overall duration of symptoms, but not in-hospital waiting time, independently predicted perforation by stepwise linear regression modeling. CONCLUSION: In-hospital delay was not an independent predictor of perforation in adults with acute appendicitis although delays may contribute if patients are left to wait unduly. Tachycardia at presentation may be a quantifiable feature of those more likely to have perforation and who should be given higher surgical priority.

  5. Acute appendicitis mimicking intestinal obstruction in a patient with cystic fibrosis

    Directory of Open Access Journals (Sweden)

    Chun-Han Chen

    2012-10-01

    Full Text Available Cystic fibrosis (CF is an inherited disease of the secretory glands caused by mutations of the cystic fibrosis transmembrane regulator (CFTR gene. The clinical manifestations of CF are repetitive lung infections, biliary cirrhosis, pancreatic abnormalities, and gastrointestinal disorders. We report a 21-year-old Taiwanese man with CF who had abdominal pain for 2 days. The diagnosis of CF had been confirmed by peripheral blood analysis of the CFTR gene 5 years before admission. He presented to the emergency department with nausea, vomiting, abdominal distension, and crampy abdominal pain, which is atypical for acute appendicitis. The physical examination and a series of studies revealed intestinal obstruction, but acute appendicitis could not be ruled out. After conservative treatment, together with empiric antibiotics, the refractory abdominal pain and leukocytosis with a left-shift warranted surgical intervention. A diagnostic laparoscopy revealed a swollen, hyperemic appendix, a severely distended small intestine, and serous ascites. The laparoscopic procedure was converted to a laparotomy for open disimpaction and appendectomy. He was discharged on the eighth postoperative day. The histologic examination of the appendix was consistent with early appendicitis. In conclusion, acute abdominal pain in adult CF patients is often associated with intestinal obstruction syndrome. The presentation of concurrent appendicitis may be indolent and lead not only to diagnostic difficulties, but also a number of therapeutic choices.

  6. The impact of pregnancy on the accuracy and delay in diagnosis of acute appendicitis.

    Science.gov (United States)

    Hiersch, Liran; Yogev, Yariv; Ashwal, Eran; From, Anat; Ben-Haroush, Avi; Peled, Yoav

    2014-09-01

    To determine the accuracy and the delay in diagnosis of presumed acute appendicitis in pregnancy. Pregnant women undergoing appendectomy for presumed acute appendicitis were compared to non-pregnant age-matched women in a 3:1 ratio undergoing appendectomy in a tertiary medical center from 2001 to 2012. Out of 1618 women who underwent appendectomy during the study period, 81 (4.2%) were pregnant who were compared to 243 age-matched non-pregnant women. There was a significantly shorter interval between admission to the hospital and surgery and shorter surgery length (10.2 versuss 15.7 h, 1.2 ± 0.4 versus 1.4 ± 0.5 h, respectively, p appendicitis were 88.2% and 100%, and 92.9% and 57.1%, among the pregnant and the non-pregnant group, respectively. In multivariate analysis, early gestational age was found to be independently associated with higher rate of accurate US results (OR = 0.92, 95% CI 0.85-0.99, p = 0.39). Pregnant women undergoing appendectomy have shorter admission to surgery interval and surgical length with similar negative appendectomy rates compared to non-pregnant women. Ultrasound is an accurate tool for the diagnosis of acute appendicitis during pregnancy, especially during early gestation.

  7. Enterobius vermicularis (pinworm) infestation in a child presenting with symptoms of acute appendicitis: a wriggly tale!

    Science.gov (United States)

    Dunphy, Louise; Clark, Zoe; Raja, Mazhar H

    2017-10-06

    Acute appendicitis is the most common surgical emergency worldwide. However, it can still present a challenging diagnosis especially in the young, elderly and those individuals of reproductive age, thus encompassing a wide spectrum of varied clinical presentations. Parasitic infections of the appendix are a rare cause of acute appendicitis. However, they must be considered in children presenting with abdominal pain. We report a case of Enterobius vermicularis infestation mimicking the features of acute appendicitis in a 10-year-old girl. This case is a cautionary reminder of the importance of considering E. vermicularis infestation in children presenting with abdominal pain, but who do not have a significantly raised white cell count or high Alvarado scores. A history of anal pruritus is the most characteristic symptom, but the parasites can cause severe abdominal pain mimicking appendicitis. Prompt recognition and a high clinical index of suspicion are required to prevent an unnecessary appendicectomy. Caution is advised when performing a laparoscopic appendectomy, as in our case, to prevent contamination of the peritoneum. This infestation is easily treatable with mebendazole. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  8. Antibiotics vs. Appendectomy for Acute Uncomplicated Appendicitis in Adults: Review of the Evidence and Future Directions.

    Science.gov (United States)

    Huston, Jared M; Kao, Lillian S; Chang, Phillip K; Sanders, James M; Buckman, Sara; Adams, Charles A; Cocanour, Christine S; Parli, Sarah E; Grabowski, Julia; Diaz, Jose; Tessier, Jeffrey M; Duane, Therese M

    2017-07-01

    Acute appendicitis is the most common abdominal surgical emergency in the United States, with a lifetime risk of 7%-8%. The treatment paradigm for complicated appendicitis has evolved over the past decade, and many cases now are managed by broad-spectrum antibiotics. We determined the role of non-operative and operative management in adult patients with uncomplicated appendicitis. Several meta-analyses have attempted to clarify the debate. Arguably the most influential is the Appendicitis Acuta (APPAC) Trial. According to the non-inferiority analysis and a pre-specified non-inferiority margin of -24%, the APPAC did not demonstrate non-inferiority of antibiotics vs. appendectomy. Significantly, however, the operations were nearly always open, whereas the majority of appendectomies in the United States are done laparoscopically; and laparoscopic and open appendectomies are not equivalent operations. Treatment with antibiotics is efficacious more than 70% of the time. However, a switch to an antimicrobial-only approach may result in a greater probability of antimicrobial-associated collateral damage, both to the host patient and to antibiotic susceptibility patterns. A surgery-only approach would result in a reduction in antibiotic exposure, a consideration in these days of focus on antimicrobial stewardship. Future studies should focus on isolating the characteristics of appendicitis most susceptible to antibiotics, using laparoscopic operations as controls and identifying long-term side effects such as antibiotic resistance or Clostridium difficile colitis.

  9. Causes of delayed presentation of acute appendicitis and its impact on morbidity and mortality

    International Nuclear Information System (INIS)

    Asad, S.; Ahmed, A.; Ahmad, S.; Ali, S.; Ahmed, S.; Ghaffar, S.; Khattak, I.U.D.

    2015-01-01

    Background: Acute appendicitis is one of the commonest abdominal emergencies and appendectomy. is one of the commonest emergency procedures performed all over the world. The study was done with an objective to evaluate the different causative factors for delayed presentation of appendicitis. Method: This cross-sectional study was carried out in the Surgical C unit, at Ayub Teaching Hospital, Abbottabad, Pakistan from 20th June 2013 to 19th June 2014. A total of 130 patients presented with appendicitis in OPDs or emergency department. Detailed history, general physical and systemic examination especially abdominal examination was done along with investigations. Results: It was found that 23.08 percentage of complicated appendicitis presentation is due to missed diagnosis by physicians, 30.77 percentage is due to missed diagnosis by non-doctors, 23.08 percentage is due to conservative management at DHQ hospitals by surgeons, and 23.08 percentage presented late because of self-medication at home. Conclusion: All patients with pain Right iliac fossa, there should be suspected of appendicitis. Proper workup should be done to exclude it. If kept on conservative management then regular monitoring of vitals with laboratory investigations should be done. (author)

  10. A study of the usefulness of CT in diagnosis of diverticulitis of the right colon and acute appendicitis

    International Nuclear Information System (INIS)

    Watanabe, Jota; Watanabe, Hideo; Tohyama, Taiji; Kushihata, Fumiki; Kobayashi, Nobuaki

    2003-01-01

    It is difficult to differentiate between diverticulitis of the right colon and acute appendicitis based on pathological and hematological findings. This study was designed to investigate the usefulness of CT in differentiation between the both diseases and indications of operation. Eight cases of right colon diverticulitis and 39 cases of acute appendicitis undergone abdominal plain CT scan before surgery were enrolled in the study. As for diverticulitis cases, diverticulum was visualized on abdominal CT scan in seven (87.5%) out of the eight cases. Of 39 cases of acute appendicitis, the appendix vermiformis was able to be visualized on abdominal CT scan in 26 (66.7%) cases. Some correlations between CT findings and postoperative pathological diagnosis of appendicitis were observed. A comparison was made on acute appendicitis cases by dividing them into two groups; namely, the non-surgery group comprising of cases pathologically diagnosed as non-inflammatory and catarrhal' and the surgery group comprising of cases diagnosed as 'phlegmonous and gangrenous' after surgery. Statistically significant difference was noted between both groups in two factors, whole-circumferential thickening of the appendiceal wall and fading panniculus adiposus around the appendix. It is concluded that abdominal CT scan is useful for differential diagnosis between right colon diverticulitis and acute appendicitis, and further that CT diagnosis of acute appendicitis well reflects the severity of the disease and contribute to decide indication of operation. (author)

  11. Pain over speed bumps in diagnosis of acute appendicitis: diagnostic accuracy study.

    Science.gov (United States)

    Ashdown, Helen F; D'Souza, Nigel; Karim, Diallah; Stevens, Richard J; Huang, Andrew; Harnden, Anthony

    2012-12-14

    To assess the diagnostic accuracy of pain on travelling over speed bumps for the diagnosis of acute appendicitis. Prospective questionnaire based diagnostic accuracy study. Secondary care surgical assessment unit at a district general hospital in the UK. 101 patients aged 17-76 years referred to the on-call surgical team for assessment of possible appendicitis. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios for pain over speed bumps in diagnosing appendicitis, with histological diagnosis of appendicitis as the reference standard. The analysis included 64 participants who had travelled over speed bumps on their journey to hospital. Of these, 34 had a confirmed histological diagnosis of appendicitis, 33 of whom reported increased pain over speed bumps. The sensitivity was 97% (95% confidence interval 85% to 100%), and the specificity was 30% (15% to 49%). The positive predictive value was 61% (47% to 74%), and the negative predictive value was 90% (56% to 100%). The likelihood ratios were 1.4 (1.1 to 1.8) for a positive test result and 0.1 (0.0 to 0.7) for a negative result. Speed bumps had a better sensitivity and negative likelihood ratio than did other clinical features assessed, including migration of pain and rebound tenderness. Presence of pain while travelling over speed bumps was associated with an increased likelihood of acute appendicitis. As a diagnostic variable, it compared favourably with other features commonly used in clinical assessment. Asking about speed bumps may contribute to clinical assessment and could be useful in telephone assessment of patients.

  12. Diagnostic performance and useful findings of ultrasound re-evaluation for patients with equivocal CT features of acute appendicitis.

    Science.gov (United States)

    Kim, Mi Sung; Kwon, Heon-Ju; Kang, Kyung A; Do, In-Gu; Park, Hee-Jin; Kim, Eun Young; Hong, Hyun Pyo; Choi, Yoon Jung; Kim, Young Hwan

    2018-02-01

    To evaluate the diagnostic performance of ultrasound and to determine which ultrasound findings are useful to differentiate appendicitis from non-appendicitis in patients who underwent ultrasound re-evaluation owing to equivocal CT features of acute appendicitis. 62 patients who underwent CT examinations for suspected appendicitis followed by ultrasound re-evaluation owing to equivocal CT findings were included. Equivocal CT findings were considered based on the presence of only one or two findings among the CT criteria, and ultrasound re-evaluation was done based on a predefined structured report form. The diagnostic performance of ultrasound and independent variables to discriminate appendicitis from non-appendicitis were assessed. There were 27 patients in the appendicitis group. The overall diagnostic performance of ultrasound re-evaluation was sensitivity of 96.3%, specificity of 91.2% and accuracy of 91.9%. In terms of the performance of individual ultrasound findings, probe-induced tenderness showed the highest accuracy (86.7%) with sensitivity of 74% and specificity of 97%, followed by non-compressibility (accuracy 71.7%, sensitivity 85.2% and specificity 60.6%). The independent ultrasound findings for discriminating appendicitis were non-compressibility (p = 0.002) and increased flow on the appendiceal wall (p = 0.001). Ultrasound re-evaluation can be used to improve diagnostic accuracy in cases with equivocal CT features for diagnosing appendicitis. The presence of non-compressibility and increased vascular flow on the appendix wall are useful ultrasound findings to discriminate appendicitis from non-appendicitis. Advances in knowledge: Ultrasound re-evaluation is useful to discriminate appendicitis from non-appendicitis when CT features are inconclusive.

  13. Improving the Preoperative Diagnostic Accuracy of Acute Appendicitis. Can Fecal Calprotectin Be Helpful?

    Directory of Open Access Journals (Sweden)

    Peter C Ambe

    Full Text Available Is the patient really suffering from acute appendicitis? Right lower quadrant pain is the most common sign of acute appendicitis. However, many other bowels pathologies might mimic acute appendicitis. Due to fear of the consequences of delayed or missed diagnosis, the indication for emergency appendectomy is liberally made. This has been shown to be associated with high rates of negative appendectomy with risk of potentially serious or lethal complications. Thus there is need for a better preoperative screening of patients with suspected appendicitis.This prospective single center single-blinded pilot study was conducted in the Department of surgery at the HELIOS Universitätsklinikum Wuppertal, Germany. Calprotectin was measured in pre-therapeutic stool samples of patients presenting in the emergency department with pain to the right lower quadrant. Fecal calprotectin (FC values were analyzed using commercially available ELISA kits. Cut-off values for FC were studied using the receiver-operator characteristic (ROC curve. The Area under the curve (AUC was reported for each ROC curve.The mean FC value was 51.4 ± 118.8 μg/g in patients with AA, 320.9 ± 416.6 μg/g in patients with infectious enteritis and 24.8 ± 27.4 μg/g in the control group. ROC curve showed a close to 80% specificity and sensitivity of FC for AA at a cut-off value of 51 μg/g, AUC = 0.7. The sensitivity of FC at this cut-off value is zero for enteritis with a specificity of 35%.Fecal calprotectin could be helpful in screening patients with pain to the right lower quadrant for the presence of acute appendicitis or infectious enteritis with the aim of facilitating clinical decision-making and reducing the rate of negative appendectomy.

  14. Acute suppurative appendicitis associated with Enterobius vermicularis: an incidental finding or a causative agent? A case report.

    Science.gov (United States)

    Efared, Boubacar; Atsame-Ebang, Gabrielle; Soumana, Boubacar Marou; Tahiri, Layla; Hammas, Nawal; El Fatemi, Hinde; Chbani, Laila

    2017-10-06

    Histological acute appendicitis patterns associated with Enterobius vermicularis is an extremely rare finding. The exact role of this parasite in acute appendicitis is controversial as usually resected specimens show no evidence of histological inflammation. We present herein a case of a 21-year-old male Arabic patient who presented with clinical syndrome of acute appendicitis. Emergency appendectomy was performed and the histopathological examination of the resected specimen showed the presence of E. vermicularis as well as intense acute inflammatory patterns such as mucosal ulceration and suppurative necrosis. The post-operative course was uneventful and the patient was discharged with appropriate anti-helmintic drug prescription. Acute appendicitis due to E. vermicularis is a very rare occurrence. The histopathological analysis of resected specimens should pay special attention to search for this parasite for adequate post-operative treatment of patients.

  15. Acute right lower quadrant pain beyond acute appendicitis: MDCT in evaluation of benign and malignant gastrointestinal causes

    Directory of Open Access Journals (Sweden)

    Reem Hassan Bassiouny

    2014-09-01

    Conclusion: Using a systematic pattern approach MDCT has proved to be an extremely useful noninvasive method for evaluation of patients with acute RLQP, allowing diagnosis and management of not only the most common conditions such as appendicitis but also less common conditions.

  16. Acute Appendicitis in Henoch-Schönlein Purpura : A Case Report

    Science.gov (United States)

    Chung, Hae Yul; Kim, So Youn; Kim, Young Ok; Ryu, Seong Yeob; Kim, Jung Chul; Chung, Jae Hun

    2005-01-01

    Common complications of Henoch-Schönlein purpura (HSP) that lead to surgical intervention include intussusception, perforation, necrosis, and massive gastrointestinal bleeding. Acute appendicitis is rarely seen as a complication of HSP. A seven-year-old boy was admitted for arthralgia, abdominal pain, hematochezia, melena, and purpuric rash on the lower extremities. On admission day abdominal ultrasonography was normal, but on day 5, he became pyrexial and developed right iliac fossa pain and tenderness with guarding. Ultrasonography showed distended appendix surrounded by hyperechoic inflamed fat. On exploration an acutely inflamed, necrotic appendix was removed and grossly there was an appendiceal perforation in the appendiceal tip. Microscopically some of the small blood vessels in the submucosa showed fibrinoid necrosis with neutrophilic infiltrations. The authors report the case of a child who developed acute perforative appendicitis requiring appendectomy while on treatment for HSP. PMID:16224172

  17. Evaluation of the Appendix Base Location in Acute Appendicitis Using Sonography and its Clinical Significance

    International Nuclear Information System (INIS)

    Lee, Kwan Seop; Kim, Min Jeong; Ko, Eun Young; Hong, Myung Sun; Jeon, Eui Yong; Hwang, Hee Sung; Lee, In Jae; Yang, Ik; Lee, Eil Seong; Lee, Bong Hwa

    2005-01-01

    The purpose of this study is to investigate the location of appendiceal base using sonography in acute appendicitis and the usefulness of the appendiceal base marking in deciding the incision site of appendectomy. We performed appendix sonography in 813 patients and 381 patients were diagnosed as acute appendicitis. During sonography, we marked the base of the appendix on the skin of the patients' abdomen. After appendiceal base marking, we measured the distance from McBurney's point to the appendiceal base. The marking was used as the guide for incision site for appendectomy by the surgeon. Among 381 patients, we excluded 78 patients due to non visualization of the cecoappendiceal junction (n = 6), pregnancy appendicitis (n = 2), false positive appendicitis (n = 3) and no reply from the surgeon (n = 67). So we investigated 303 patients prospectively. After operation, we asked the surgeon whether the appendiceal base marking was helpful for appendectomy or not. The base of the appendix at McBurney's point were 31%, lying within 2 cm from McBurney's point were 20%, within 5 cm were 28%, more than 5 cm were 21%. For the usefulness of appendiceal base marking, 95% showed good correlation with marking and surgical incision, and 5% revealed poor correlation. The base of the appendix was located in diverse areas of the abdomen, although most frequent in the McBurney's point and within 2 cm from the McBurney's point. Appendiceal base marking on the skin of the abdomen after diagnosis of acute appendicitis could be an useful method to guide the surgeon for decision of surgical incision site

  18. A rare case of perforated "sub-hepatic appendicitis" - a challenging differential diagnosis of acute abdomen based on the combination of appendicitis and maldescent of the caecum.

    Science.gov (United States)

    Chiapponi, Costanza; Jannasch, Olof; Petersen, Manuela; Lessel, Wiebke; Bruns, Christiane; Meyer, Frank

    2017-01-01

    Unusual locations of the appendix vermiformis can result in delay in appropriate diagnosis and treatment of appendicitis. So an inflamed appendix in a sub-hepatic caecum caused by caecal maldescent for example can mimic cholecystitis, the pain being localized in the right upper quadrant. Here, we present a case of perforated sub-hepatic appendicitis with peritonitis, requiring open ileocaecal resection. Review of the existing literature has demonstrated that this pathology is uncommon, yet not so rare as one might presume. In conclusion, surgeons should be aware of this possibility in the diagnostic and therapeutic management of acute abdomen. Copyright © 2016. Published by Elsevier GmbH.

  19. The diagnosis of acute appendicitis in pregnant versus non-pregnant women: A comparative study.

    Science.gov (United States)

    Aras, Abbas; Karaman, Erbil; Pekşen, Çağhan; Kızıltan, Remzi; Kotan, Mehmet Çetin

    2016-10-01

    To investigate whether the diagnosis of acute appendicitis is affected by pregnancy or not. A retrospective study with the analysis of the medical records of all women suspected of having appendicitis who underwent appendectomy at our hospital between June 2010 and March 2015 were reviewed. The patients were divided into two groups according to whether they were pregnant or not during the surgery: group I, pregnant women, and group II, non-pregnant women. During the study period, 38 pregnant women and 169 non-pregnant women underwent appendectomy. The time from admission to the operation was not statistically different (2.17±1.47 days in group I vs. 1.98±1.66 day in group II; p=0.288). The pregnant group had longer hospital stay than the non-pregnant group (p=0.04). Ultrasonography (USG) was used as the first diagnostic modality in 36/38 patients in group I and 161/169 in group II. The non-visualized appendix on ultrasound was seen in 17 patients in group I and 51 patients in group II, which was not statistically different. Sensitivity and specificity of USG in diagnosis of acute appendicitis were 61.29 and 80.00% in group I, and 93.0 and 31.6% in group II, respectively. Although the diagnosis of appendicitis in pregnant women is not delayed, careful assessment of these patients suspected of having appendicitis should be encouraged when USG examination is normal or nondiagnostic.

  20. The diagnosis of acute appendicitis in pregnant versus non-pregnant women: A comparative study

    Directory of Open Access Journals (Sweden)

    Abbas Aras

    Full Text Available Summary Objective: To investigate whether the diagnosis of acute appendicitis is affected by pregnancy or not. Method: A retrospective study with the analysis of the medical records of all women suspected of having appendicitis who underwent appendectomy at our hospital between June 2010 and March 2015 were reviewed. The patients were divided into two groups according to whether they were pregnant or not during the surgery: group I, pregnant women, and group II, non-pregnant women. Results: During the study period, 38 pregnant women and 169 non-pregnant women underwent appendectomy. The time from admission to the operation was not statistically different (2.17±1.47 days in group I vs. 1.98±1.66 day in group II; p=0.288. The pregnant group had longer hospital stay than the non-pregnant group (p=0.04. Ultrasonography (USG was used as the first diagnostic modality in 36/38 patients in group I and 161/169 in group II. The non-visualized appendix on ultrasound was seen in 17 patients in group I and 51 patients in group II, which was not statistically different. Sensitivity and specificity of USG in diagnosis of acute appendicitis were 61.29 and 80.00% in group I, and 93.0 and 31.6% in group II, respectively. Conclusion: Although the diagnosis of appendicitis in pregnant women is not delayed, careful assessment of these patients suspected of having appendicitis should be encouraged when USG examination is normal or nondiagnostic.

  1. An atypical clinical presentation of acute appendicitis in a young man with midgut malrotation

    International Nuclear Information System (INIS)

    Pinto, Antonio; Di Raimondo, Domenico; Tuttolomondo, Antonino; Fernandez, Paola; Caronia, Aurelio; Lagalla, Roberto; Arnao, Valentina; Law, Robert L.; Licata, Giuseppe

    2007-01-01

    Midgut malrotation occurs as a result of failure in normal intestinal rotation and fixation during early pregnancy. Pathological conditions reported in the literature involving midgut malrotation predominantly relate to infants and children. In adults malrotation is often revealed as an incidental finding on computed tomography (CT), or the associated altered anatomy can be the cause of atypical clinical symptoms of relatively common intestinal disorders. An unusual presentation of acute appendicitis, with fever and recurrent pain in left iliac fossa is reported. Underlying intestinal malrotation delayed the correct clinical diagnosis of acute appendicitis. It was not until a CT scan was performed that a malrotation was identified. The predominant appearances of malrotation are the siting of the ascending colon, caecum (and appendix) in the left side of the abdomen and the right-sided placement of the duodenojejunal junction

  2. The Frequency of Enterobius Vermicularis Infections in Patients Diagnosed With Acute Appendicitis in Pakistan

    OpenAIRE

    Ahmed, Muhammad Umer; Bilal, Muhammad; Anis, Khurram; Khan, Ali Mahmood; Fatima, Kaneez; Ahmed, Iqbal; Khatri, Ali Mohammad; Shafiq-ur-Rehman,

    2015-01-01

    Introduction: The main aim of this study was to determine the frequency of Enterobius Vermicularis infections and other unique histopathological findings in patients diagnosed with acute appendicitis. Materials: This retrospective study was conducted in a tertiary care hospital of Karachi, Pakistan over a time period of 9 years from 2005 to 2013. The recorded demographic and histopathological data for the 2956 appendectomies performed during this time frame were extracted using a structured t...

  3. Don't be short-sighted: cervical incompetence in a pregnant patient with acute appendicitis.

    Science.gov (United States)

    Negrete, Lindsey M; Spalluto, Lucy B

    2018-01-31

    Delay in diagnosis of cervical incompetence can be detrimental to the fetus. Up to 20-25% of miscarriages in the second trimester can be attributed to the incompetent cervix. Given the profound impact of cervical incompetence on obstetric outcomes, careful attention should be given to evaluation of the cervix on MRI studies in pregnant patients. We present a case of incompetent cervix diagnosed incidentally at the time of MRI performed to evaluate for acute appendicitis. Published by Elsevier Inc.

  4. Infarcted epiploic appendage of the vermiform appendix masquerading as acute appendicitis.

    Science.gov (United States)

    Magnuson, April; Reber, Heather; Reyna, Petra; Ries, David; Aanning, H L

    2006-12-01

    Infrequent causes of right lower quadrant pain that mimic acute appendicitis include infarcted epiploic appendages. Although usually located in the colon, we report the very rare case of an infarcted epiploic appendage located directly on the serosal surface of the appendix itself. In a patient with right lower quadrant pain, the diagnosis of infarcted epiploic appendages is rarely made preoperatively and the incidence is rare. Definitive treatment is excision.

  5. [The results of open and laparoscopic appendectomy in pregnant women with acute appendicitis].

    Science.gov (United States)

    Panin, A V; Dubrovsky, A V; Petrov, D Yu; Smirnov, A V

    To compare conventional and laparoscopic appendectomy in pregnant women. The study included 86 patients with acute appendicitis who were surgically treated. In group 1 (42 women) laparoscopic approach was used, in group 2 (44 patients) - laparotomy. Postoperative complications were observed in 2 (4.8%) and 3 (6.8%) patients in groups 1 and 2 respectively. All complications related to Clavien-Dindo class I-II. There were no premature births and abortions in laparoscopy group. In case of conventional surgery premature births and abortions were observed in 2 (4.5%) and 1 (2.27%) observations respectively. Other women had timely childbirth in terms of 36-41 weeks. Risk of delay exceeds risk of vain appendectomy. All pregnant women with acute appendicitis should be examined by obstetrician-gynaecologist, surgeon, urologist, anesthesiologist. If acute appendicitis can not be excluded based on clinical data the patient should be operated. Diagnostic laparoscopy and laparoscopic appendectomy are advisable in case of pregnancy up to 24 weeks. Woman should be under observation of obstetrician-gynaecologist in perioperative period to prevent premature birth and abortion.

  6. Diagnostic performance of a biomarker panel as a negative predictor for acute appendicitis in adult ED patients with abdominal pain.

    Science.gov (United States)

    Huckins, David S; Copeland, Karen; Self, Wesley; Vance, Cheryl; Hendry, Phyllis; Borg, Keith; Gogain, Joseph

    2017-03-01

    Evaluate the diagnostic accuracy of the APPY1TM biomarker panel, previously described for use in pediatric patients, for identifying adult ED patients with abdominal pain who are at low risk of acute appendicitis. This study prospectively enrolled subjects >18years of age presenting to seven U.S. emergency departments with pain suggesting possible acute appendicitis. The APPY1 panel was performed on blood samples drawn from each patient at the time of initial evaluation and results were correlated with the final diagnosis either positive or negative for acute appendicitis. 431 patients were enrolled with 422 completing all aspects of the study. The APPY1 biomarker panel exhibited a sensitivity of 97.5% (95% CI, 91.3-99.3%), a negative predictive value of 98.4% (95% CI, 94.4-99.6%), a negative likelihood ratio of 0.07 (95% CI, 0.02-0.27), with a specificity of 36.5% (95% CI, 31.6-41.8%) for acute appendicitis. The panel correctly identified 125 of 342 (36.6%) patients who did not have appendicitis with 2 (2.5%) false negatives. The CT utilization rate in this population was 72.7% (307/422). Of 307 CT scans, 232 were done for patients who did not have appendicitis and 79 (34%) of these patients were correctly identified as negative with "low risk" biomarker panel results, representing 26% (79/307) of all CT scans performed. This biomarker panel exhibited high sensitivity and negative predictive value for acute appendicitis in this prospective adult cohort, thereby potentially reducing the dependence on CT for the evaluation of possible acute appendicitis. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. How To Approach The Patient Suspected Of Having Acute Appendicitis, Introducing New Criteria: (Two Out Of Three

    Directory of Open Access Journals (Sweden)

    M.R. Radpey

    2006-05-01

    Full Text Available Background:Acute appendicitis is the most common cause of acute surgical abdomen.Inspite of the introduction of ultrasonography, computed tomography scanning and laparoscopy in the years 1987-1997 the difficulty in accurate diagnosis of acute appendicitis has remained the same.Our way of reaching a decision for operating in a patient suspected of having acute appendicitis(which will follow has superiority to other introduced so far approaches. Methods:3046 patients suspected of having acute appendicitis were evaluated during the years 2003-2005 at Shohada Medical Center.We have adopted a 3 point system, giving 1 point each to history, physical examination and laboratory tests if they meet the criteria:   1. Typical history gets 1 point if: an abdominal pain shift from epigastrium or periumbilical area to RLQ accompanying anorexia, nausea and vomiting depending on age.  2. Typical physical findings: RLQ tenderness associated with rebound tenderness, 3. Laboratory tests: leukocytosis between 10,500 to 18,000/mm3 along with normal urinalysis or leukocyturia without presence of bacteria. In pregnancy where leukocyteosis exists shift to the left is considered positive. Each of the criteria gets zero or 1 point if it meets that mentioned above and those who get two or three points will be operated on, otherwise the patient will be observed for 12 hours until his symptoms improve or progress to have two or three point criteria when he or she will be operated on. The results of histopathological examination of appendix have been used for the accuracy of this method. Results: Among 3046 patients, 1241 (41% were operated on rightaway with diagnosis of acute appendicitis since they had 2 or 3 points on arrival. From these 1213 (97/1% had acute appendicitis. 1805 (59% patients who didn't get at least 2 points were observed for 12 hours, during this period 115 (6.4% patients, who got at least two points were operated on, and 92 (80.5% patients had non

  8. The impact of disease severity, age and surgical approach on the outcome of acute appendicitis in children.

    Science.gov (United States)

    van den Boom, A L; Gorter, R R; van Haard, P M M; Doornebosch, P G; Heij, H A; Dawson, I

    2015-04-01

    Although a national guideline has been implemented, the optimal approach for appendectomy in children remains subject of debate in the Netherlands. Opponents of laparoscopy raise their concerns regarding its use in complex appendicitis as it is reported to be associated with an increased incidence of intra-abdominal abscesses. The aim of this study was to evaluate the outcome of surgical approaches in both simple and complex appendicitis in paediatric patients. A 10-year retrospective cohort study was performed (2001-2010) in paediatric patients treated for suspected acute appendicitis. Patients were divided into either simple or complex appendicitis and into different age groups. Primary outcome parameters were complication rate (intra-abdominal abscess (IAA), superficial surgical site infection (SSI) and readmission) and hospital stay. In total, 878 patients have been treated (median age 12, range 0-17 years). Two-thirds of the patients younger than 6 years had complex appendicitis, compared to one quarter in the group aged 13-18. In the complex appendicitis group, LA was associated with more IAA and early readmissions. In the simple appendicitis group, the complication rate was comparable between the two approaches. Significantly more IAAs were seen after LA in the youngest age group. This study demonstrates the unfavourable outcome of LA in the youngest age group and in patients with complex appendicitis. Therefore, we advise to treat these patients with an open approach.

  9. The Value of Ultrasonography, Leukocyte Count and Clinical Results in Diagnosis of Acute Appendicitis and the Duration of Stay of the Patients in Emergency Department

    Directory of Open Access Journals (Sweden)

    Veysi ERYIGIT

    2014-03-01

    Conclusions: According to the present study results, acute appendicitis is commonly seen among the young adult male population. The coherence of ultrasonography findings with the diagnosis and its association with leukocytosis is significant and supportive. Additionally, the ultrasonography findings, leukocytosis, medical history and physical examination are important and essential factors for the diagnosis of acute appendicitis. A large number of patients with acute appendicitis were followed-up between 0–6 hours in the emergency department.

  10. [Validation of a diagnostic scoring system (Ohmann score) in acute appendicitis].

    Science.gov (United States)

    Zielke, A; Sitter, H; Rampp, T A; Schäfer, E; Hasse, C; Lorenz, W; Rothmund, M

    1999-07-01

    A diagnostic scoring system, recently published by Ohmann et al. in this journal, was validated by analyzing the clinicopathological data of a consecutive series of 2,359 patients, admitted for suspicion of acute appendicitis. The results of the scoring system were compared to the results of clinical evaluation by junior (provisional) and senior surgeons (final clinical diagnosis). To assess the diagnostic ability of the score, the accuracy and positive predictive value were defined as the major diagnostic performance parameters; the rate of theoretical negative laparotomies and that of diagnostic errors served as the major procedural performance parameters. Of 2,359 patients admitted for suspected acute appendicitis, 662 were proven to have acute appendicitis by histology, for a prevalence of 28%. The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the provisional clinical diagnosis were 0.50, 0.94, 0.77, 0.83, and 0.82; 0.93, for the score 0.63, 0.93, 0.77, 0.86 and 0.84, and for the final clinical diagnosis 0.90, 0.94, 0.85, 0.96, and 0.93, respectively. Of the main diagnostic performance parameter, the accuracy of the score was significantly better than that of provisional clinical diagnosis (P apendicitis, the score demonstrated a superior performance, with only 6 cases missed (0.9%). However, the number of patients with acute appendicitis, including those with perforated disease, who were not identified by the score, was almost four times that of the final clinical diagnosis (245 vs 63). With regard to the main procedural performance parameter, the score resulted in a significantly smaller number of diagnostic errors than the provisional clinical investigator (P < 0.05, chi 2 test). The results of this study indicate that the diagnostic scoring system might be helpful when experienced investigators or additional diagnostic modalities such as ultrasonography are not available. It may therefore be of value

  11. Acute appendicitis in children: comparison of clinical diagnosis with ultrasound and CT imaging

    International Nuclear Information System (INIS)

    Karakas, S.P.; Guelfguat, M.; Springer, S.; Singh, S.P.; Leonidas, J.C.

    2000-01-01

    Background. There is strong evidence that imaging with ultrasound and CT can be of substantial diagnostic value in the diagnosis of acute appendicitis in children, but there is limited information of the impact of imaging on the management of these patients and its possible effect on surgical findings. Objective. We studied the impact of imaging in the management of acute appendicitis, in particular its effect on the rate of negative appendectomies and perforations. Patients and methods. We reviewed retrospectively the clinical records and imaging findings of 633 consecutive children and adolescents seen on an emergency basis with clinical suspicion of acute appendicitis. Two hundred seventy patients were operated upon on clinical evidence alone, while 360 were referred for US or CT, and occasionally both, because of doubtful clinical findings. Results. Acute appendicitis was found in 237 of those on clinical grounds alone, 68 of whom had perforation and related complications. Thus the rate of negative exploration and the rate of perforation were13 % and 29 %, respectively. One hundred eighty-two patients had preoperative US (sensitivity 74 %, specificity 94 %), 119 had CT (sensitivity 84 %, specificity 99 %), and 59 had both US and CT (sensitivity 75 %, specificity 100 %, but often with interpretation at variance with each other). The rate of negative appendectomy and perforation was 8 % and 23 %, respectively, for US, 5 % and 54 % for CT, and 9 % and 71 % when both examinations were performed. There is no statistical significance between the rates of diagnostic performance of US, CT, or their combination, nor between the negative appendectomy rates of each group, but the rate of perforation was significantly higher when CT was performed, alone or after US. Conclusion. The retrospective nature of the study prevents precise definition of the clinical characteristics and selection criteria for diagnostic examinations that may contribute to the management of children

  12. Better Diagnosis of Acute Appendicitis by Using Artificial Intelligence

    Directory of Open Access Journals (Sweden)

    Mir Mekaeal Hosseini

    2017-08-01

    Conclusion: According to the results, we can say that using designed support vector machine in diagnosis of acute appendicitiswill be effective in order to timely detect, prevent unnecessary appendectomy, reduction the patient's length of stay and health care costs.

  13. The Frequency of Enterobius Vermicularis Infections in Patients Diagnosed With Acute Appendicitis in Pakistan.

    Science.gov (United States)

    Ahmed, Muhammad Umer; Bilal, Muhammad; Anis, Khurram; Khan, Ali Mahmood; Fatima, Kaneez; Ahmed, Iqbal; Khatri, Ali Mohammad; Shafiq-ur-Rehman

    2015-02-24

    The main aim of this study was to determine the frequency of Enterobius vermicularis infections and other unique histopathological findings in patients diagnosed with acute appendicitis. This retrospective study was conducted in a tertiary care hospital of Karachi, Pakistan over a time period of 9 years from 2005 to 2013. The recorded demographic and histopathological data for the 2956 appendectomies performed during this time frame were extracted using a structured template form. Negative and incidental appendectomies were excluded from the study. Out of the 2956 patients diagnosed with acute appendicitis, 84 (2.8%) patients had Enterobius vermicularis infections. Malignancy (n=2, 0.1%) and infection with Ascaris (n=1, 0.1%) was found very rarely among the patients.Eggs in lumen (n=22, 0.7%), mucinous cystadenoma (n=28, 1.0%), mucocele (n=11, 0.4%), lymphoma (n=9, 0.3%), obstruction in lumen (n=17, 0.6%) and purulent exudate (n=37, 1.3%) were also seldom seen in the histopathological reports. Enterobius vermicularis manifestation is a rare overall but a leading parasitic cause of appendicitis. Steps such as early diagnosis and regular de worming may help eradicate the need for surgeries.

  14. The Frequency of Enterobius Vermicularis Infections in Patients Diagnosed With Acute Appendicitis in Pakistan

    Science.gov (United States)

    Ahmed, Muhammad Umer; Bilal, Muhammad; Anis, Khurram; Khan, Ali Mahmood; Fatima, Kaneez; Ahmed, Iqbal; Khatri, Ali Mohammad; Shafiq-ur-Rehman

    2015-01-01

    Introduction: The main aim of this study was to determine the frequency of Enterobius Vermicularis infections and other unique histopathological findings in patients diagnosed with acute appendicitis. Materials: This retrospective study was conducted in a tertiary care hospital of Karachi, Pakistan over a time period of 9 years from 2005 to 2013. The recorded demographic and histopathological data for the 2956 appendectomies performed during this time frame were extracted using a structured template form. Negative and incidental appendectomies were excluded from the study. Results: Out of the 2956 patients diagnosed with acute appendicitis, 84 (2.8%) patients had Enterobius Vermicularis infections. Malignancy (n=2, 0.1%) and infection with Ascaris (n=1, 0.1%) was found very rarely among the patients. Eggs in lumen (n=22, 0.7%), mucinous cystadenoma (n=28, 1.0%), mucocele (n=11, 0.4%), lymphoma (n=9, 0.3%), obstruction in lumen (n=17, 0.6%) and purulent exudate (n=37, 1.3%) were also seldom seen in the histopathological reports. Conclusion: Enterobius Vermicularis manifestation is a rare overall but a leading parasitic cause of appendicitis. Steps such as early diagnosis and regular de worming may help eradicate the need for surgeries. PMID:26156929

  15. Acute appendicitis in pregnancy--risk factors associated with principal outcomes: a case control study.

    Science.gov (United States)

    Yilmaz, Hatice Gulsen; Akgun, Yilmaz; Bac, Bilsel; Celik, Yusuf

    2007-06-01

    The aim of this study was to determine the risk factors associated with the principal outcomes in acute appendicitis during pregnancy: appendix-perforation, and maternal and fetal mortality and maternal morbidity. Fifty-two pregnant women who were diagnosed and operated upon acute appendicitis in Dicle University Hospital, Diyarbakir, Turkey were presented. The frequency of appendicitis was higher in second trimester. On laparotomy 21 patients had perforated, 29 patients had non-perforated and 2 patients had normal appendix. Interval between symptom onset and operation was found as the only predictive variable, which was independently associated with the presence of appendiceal perforation. There was a significant difference between perforated and non-perforated patients about the rate of complications (52% vs. 17%). Gestational age (p=0.036), interval between symptom onset and operation (p=0.018) and white blood cell count (p=0.025) were the variables related with preterm labor. Tocolytic treatment after the onset of contractions could not prevent preterm labor. The rate of fetal mortality was 8%. Presence of perforation is the only predictive factor for maternal morbidity. The aim of the surgeon should be operating the patient before perforation. An observation period may be essential in equivocal patients, but should be individualized according to duration of symptoms and findings of physical examination. The interval between the symptom onset and operation should never exceed 20 hours. Tocolytics should be ordered for the patients with delayed presentation and advanced gestational age in order to prevent preterm labor and fetal loss.

  16. Validity of total leucocytes count and neutrophil count (differential leucocytes) in diagnosing suspected acute appendicitis

    International Nuclear Information System (INIS)

    Anwar, M.W.; Abid, I.

    2012-01-01

    Objective: To compare the diagnostic accuracy of Total Leucocytes Count (TLC) with Neutrophil count; Differential Leucocytes Count (DLC) in diagnosing cases of suspected acute appendicitis. Study design: Validation study. Place and duration of the study: Department of Surgery, Combined Military Hospital (CMH) Rawalpindi, from April 2008 to October 2008. Method: A total of 100 patients of Pain right iliac fossae who underwent appendicectomy were included. Detailed history of all the patients was taken for pain in right lower abdomen, its severity, its nature, relieving or provoking factors. Clinical examination was done in detail. Total and Differential Leucocytes Count was done. Every patient's appendix was examined grossly after appendicectomy for evidence of appendicitis. Diagnostic measures of TLC and DLC were calculated by standard formulas. Results: Sensitivity and specificity of TLC is 86.9% and 81.25% respectively and that of DLC is 82% and 68.75% respectively. Accuracy was 86% for TLC and 80% for DLC. Conclusion: TLC is more sensitive, specific and accurate test as compared to DLC and it should be used as diagnostic aid for suspected acute appendicitis cases. (author)

  17. Ileocecal Burkitt's Lymphoma Presenting as Ileocolic Intussusception With Appendiceal Invagination and Acute Appendicitis

    Directory of Open Access Journals (Sweden)

    Sheng-Mine Wang

    2010-06-01

    Full Text Available Intussusception is a common cause of abdominal pain in children. Although most cases are idiopathic, about 10% of cases have a pathologic lead point. Burkitt's lymphoma is not a common etiology. Burkitt's lymphoma might present primarily as intussusception in children but has rarely been associated with appendicitis. We report a case in which a 10-year-old obese boy who initially presented with acute appendicitis due to ileocolic intussusception with appendiceal invagination. He underwent one-trocar laparoscopy and antibiotic treatment. The symptoms recurred 10 days after discharge. Colonoscopy disclosed ileocecal Burkitt's lymphoma as the pathological lead point. This case emphasizes the importance of the age of the patient and the anatomic location of the intussusception related to possible etiology, and hence the most appropriate surgical procedure.

  18. Reassessment of CT images to improve diagnostic accuracy in patients with suspected acute appendicitis and an equivocal preoperative CT interpretation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyun Cheol; Yang, Dal Mo; Kim, Sang Won [Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Department of Radiology, Seoul (Korea, Republic of); Park, Seong Jin [Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Department of Radiology, Seoul (Korea, Republic of)

    2012-06-15

    To identify CT features that discriminate individuals with and without acute appendicitis in patients with equivocal CT findings, and to assess whether knowledge of these findings improves diagnostic accuracy. 53 patients that underwent appendectomy with an indeterminate preoperative CT interpretation were selected and allocated to an acute appendicitis group or a non-appendicitis group. The 53 CT examinations were reviewed by two radiologists in consensus to identify CT findings that could aid in the discrimination of those with and without appendicitis. In addition, two additional radiologists were then requested to evaluate independently the 53 CT examinations using a 4-point scale, both before and after being informed of the potentially discriminating criteria. CT findings found to be significantly different in the two groups were; the presence of appendiceal wall enhancement, intraluminal air in appendix, a coexistent inflammatory lesion, and appendiceal wall thickening (P < 0.05). Areas under the curves of reviewers 1 and 2 significantly increased from 0.516 and 0.706 to 0.677 and 0.841, respectively, when reviewers were told which CT variables were significant (P = 0.0193 and P = 0.0397, respectively). Knowledge of the identified CT findings was found to improve diagnostic accuracy for acute appendicitis in patients with equivocal CT findings. circle Numerous patients with clinically equivocal appendicitis do not have acute appendicitis circle Computed tomography (CT) helps to reduce the negative appendectomy rate circle CT is not always infallible and may also demonstrate indeterminate findings circle However knowledge of significant CT variables can further reduce negative appendectomy rate circle An equivocal CT interpretation of appendicitis should be reassessed with this knowledge. (orig.)

  19. Intra-appendiceal air at CT: Is it a seful or a onfusing sign for the diagnosis of acute appendicitis?

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Hye Suk; Cho, Hyun Suk; Woo, Ji Young; Lee, Yul; Yang, Ik; Hwang, Ji Young; Kim, Han Myun; Kim, Jeong Won [Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul (Korea, Republic of)

    2016-02-15

    To investigate the significance of intra-appendiceal air at CT for the evaluation of appendicitis. We retrospectively analyzed 458 patients (216 men, 242 women; age range, 18-91 years) who underwent CT for suspected appendicitis. Two independent readers reviewed the CT. Prevalence, amount, and appearance of intra-appendiceal air were assessed and compared between the patients with and without appendicitis. Performance of CT diagnosis was evaluated in two reading strategies: once ignoring appendiceal air (strategy 1), and the other time considering presence of appendiceal air as indicative of no appendicitis in otherwise indeterminate cases (strategy 2), using receiver operating characteristic (ROC) analysis. Of the 458 patients, 102 had confirmed appendicitis. The prevalence of intra-appendiceal air was significantly different between patients with (13.2%) and without (79.8%) appendicitis (p < 0.001). The amount of appendiceal air was significantly lesser in patients having appendicitis as compared with the normal group, for both reader 1 (p = 0.011) and reader 2 (p = 0.002). Stool-like appearance and air-fluid levels were more common in the appendicitis group than in the normal appendix for both readers (p < 0.05). Areas under the ROC curves were not significantly different between strategies 1 and 2 in reader 1 (0.971 vs. 0.985, respectively; p = 0.056), but showed a small difference in reader 2 (0.969 vs. 0.986, respectively; p = 0.042). Although significant differences were seen in the prevalence, amount, and appearance of intra-appendiceal air between patients with and without appendicitis, it has a limited incremental value for the diagnosis of acute appendicitis.

  20. The Association Between Ventriculo-Peritoneal Shunt and Acute Appendicitis in Patients with Traumatic Brain Injury: A 14-Year, Population-Based Study.

    Science.gov (United States)

    Lim, Sher-Wei; Ao, Kam-Hou; Ho, Chung-Han; Tseng, Chien-Jen; Wang, Jhi-Joung; Chio, Chung-Ching; Kuo, Jinn-Rung

    2017-07-01

    The association between preexisting ventriculoperitoneal (VP) shunt and the risk of new-onset acute appendicitis in patients with traumatic brain injury (TBI) is not well established. The aim of the present study was to determine the relationships between VP shunt and acute appendicitis in patients with TBI. A longitudinal cohort study matched by a propensity score in patients with TBI with (4781 patients) or without (9562 patients) VP shunt was conducted using the National Health Insurance Research Database in Taiwan between January 1993 and December 2013. The main outcome studied was diagnosis of acute appendicitis. The cumulative probability of acute appendicitis was not different between these 2 groups (P = 0.6244). A Cox model showed central nervous system (CNS) infection to be an independent predictor of acute appendicitis with an adjusted hazard ratio of 2.98. Patients with TBI with both a VP shunt and a CNS infection had a greater risk of developing new-onset acute appendicitis (hazard ratio 4.25; 95% confidence interval 1.84-9.81) compared patients with TBI without a VP shunt or CNS infection. We concluded that VP shunt is not a risk factor in the development of appendicitis in patients with TBI. Patients with TBI with a shunt and a CNS infection may have a greater risk of developing acute appendicitis. Therefore, care in avoiding CNS infection is a key for the prevention acute appendicitis in this patient population. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. ACUTE APPENDICITIS: AN OVERVIEW H. S. SAIDI and J. A. ...

    African Journals Online (AJOL)

    hi-tech

    2000-03-03

    Mar 3, 2000 ... Request for reprints to: Professor J.A. Adwok, Department of Surgery, College of Health Sciences, University of Nairobi, P.O. Box 19676, Nairobi, Kenya. ACUTE ... accuracy, high false negative rates and at times high costs. With the ..... cosmetic equivalent (Lanz), Rutherford Morrison, lower midline or lower ...

  2. The Role of Digital Rectal Examination for Diagnosis of Acute Appendicitis: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Takada, Toshihiko; Nishiwaki, Hiroki; Yamamoto, Yosuke; Noguchi, Yoshinori; Fukuma, Shingo; Yamazaki, Shin; Fukuhara, Shunichi

    2015-01-01

    Digital rectal examination (DRE) has been traditionally recommended to evaluate acute appendicitis, although several reports indicate its lack of utility for this diagnosis. No meta-analysis has examined DRE for diagnosis of acute appendicitis. To assess the role of DRE for diagnosis of acute appendicitis. Cochrane Library, PubMed, and SCOPUS from the earliest available date of indexing through November 23, 2014, with no language restrictions. Clinical studies assessing DRE as an index test for diagnosis of acute appendicitis. Two independent reviewers extracted study data and assessed the quality, using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Bivariate random-effects models were used for the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio (DOR) as point estimates with 95% confidence intervals (CI). The main outcome measure was the diagnostic performance of DRE for diagnosis of acute appendicitis. We identified 19 studies with a total of 7511 patients. The pooled sensitivity and specificity were 0.49 (95% CI 0.42-0.56) and 0.61 (95% CI 0.53-0.67), respectively. The positive and negative likelihood ratios were 1.24 (95% CI 0.97-1.58) and 0.85 (95% CI 0.70-1.02), respectively. The DOR was 1.46 (0.95-2.26). Acute appendicitis cannot be ruled in or out through the result of DRE. Reconsideration is needed for the traditional teaching that rectal examination should be performed routinely in all patients with suspected appendicitis.

  3. The value of pancreatic stone protein in predicting acute appendicitis in patients presenting at the emergency department with abdominal pain

    Directory of Open Access Journals (Sweden)

    Tschuor Christoph

    2012-10-01

    Full Text Available Abstract Background Pancreatic Stone Protein (PSP is a protein naturally produced mainly in the pancreas and the gut. There is evidence from experimental and clinical trials that blood PSP levels rise in the presence of inflammation or infection. However, it is not known whether PSP is superior to other established blood tests (e.g. White Blood Count, Neutrophils or C - reactive protein in predicting appendicitis in patients presenting with abdominal pain and a clinical suspicion of appendicitis at the emergency room. Methods/design The PSP Appendix Trial is a prospective, multi-center, cohort study to assess the value of PSP in the diagnostic workup of acute appendicitis. 245 patients will be prospectively recruited. Interim analysis will be performed once 123 patients are recruited. The primary endpoint of the study concerns the diagnostic accuracy of PSP in predicting acute appendicitis and therefore the evidence of appendicitis on the histopathological specimen after appendectomy. Discussion The PSP Appendix Trial is a prospective, multi-center, cohort study to assess the value of PSP in the diagnostic workup of acute appendicitis. Trial registration ClinicalTrials.gov: NCT01610193; Institution Ethical Board Approval ID: KEKZH- Nr. 2011–0501

  4. Effects of acupuncture on pain and inflammation in pediatric emergency department patients with acute appendicitis: a pilot study.

    Science.gov (United States)

    Nager, Alan L; Kobylecka, Monika; Pham, Phung K; Johnson, Leighanne; Gold, Jeffrey I

    2015-05-01

    Acupuncture has been shown to treat various medical conditions, including acute and chronic pain, and there is limited evidence that acupuncture produces anti-inflammatory effects. This pilot study evaluated the use of acupuncture to treat pain and determine if acupuncture can reduce the inflammatory response in pediatric patients diagnosed with acute appendicitis. This pilot study used convenience sampling and was conducted in the Pediatric Emergency Department (PED) of an urban tertiary care children's hospital. Patients conventionally evaluated and definitively diagnosed with appendicitis were eligible to voluntarily participate. The diagnostic homogeneity of the target population allowed for a standardized intervention protocol. A licensed acupuncturist performed a specific form of Japanese acupuncture known as the Kiiko Matsumoto Style on all study patients. Subjective pain was assessed immediately before the intervention and 20 minutes postintervention, using 3 measures: Faces Pain Scale-Revised (FPS-R), colored analog scale (CAS), and visual analog scale (VAS). Evidence of inflammation was assessed using two biomarkers: white blood cell (WBC) count and C-reactive protein (CRP). WBC and CRP were drawn and recorded 3 times: before the intervention, 2 minutes before removal of needles, and 30 minutes after needling. Six Latino/Hispanic patients (4 males, 2 females, median age=15 years) with no previous acupuncture experience participated in the study. Median pre/postacupuncture pain scores were as follows: FPS-R, 5 vs. 4; CAS, 6.1 vs. 4.8; VAS, 46 vs. 32. Median WBC (10(3)/μL) and CRP (mg/dL) across time were as follows: WBC, 13.2, 11.8, and 11.4; CRP, 4.5, 4.9, and 5.1. Median acupuncture duration was 28.5 minutes (range 22-32) and no complications were observed. Pilot data suggest that acupuncture may be a feasible and effective treatment modality for decreasing subjective pain and inflammation as measured by WBC. Acupuncture may be a useful

  5. Appendiceal Endometriosis and Carcinoid Presented as Acute Appendicitis in Pregnancy: A Rare Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Panagiotis A. Dimitriadis

    2013-01-01

    Full Text Available A 22-year-old pregnant woman presented at the twenty-seventh week of gestation in the Emergency Department with acute abdominal pain and right iliac fossa tenderness. Urgent MRI was done and was suggestive of acute appendicitis. A laparoscopy was performed that confirmed an inflamed and purulent appendix that was removed. The technique used is described in detail. The histopathologic findings were those of acute appendicitis, carcinoid, and endometriosis of the appendix. We report the first case of this extremely rare triad presented in pregnancy.

  6. Accuracy and Radiation Dose Reduction of Limited-Range CT in the Evaluation of Acute Appendicitis in Pediatric Patients.

    Science.gov (United States)

    Jin, Michael; Sanchez, Thomas R; Lamba, Ramit; Fananapazir, Ghaneh; Corwin, Michael T

    2017-09-01

    The purpose of this article is to determine the accuracy and radiation dose reduction of limited-range CT prescribed from the top of L2 to the top of the pubic symphysis in children with suspected acute appendicitis. We performed a retrospective study of 210 consecutive pediatric patients from December 11, 2012, through December 11, 2014, who underwent abdominopelvic CT for suspected acute appendicitis. Two radiologists independently reviewed the theoretic limited scans from the superior L2 vertebral body to the top of the pubic symphysis, to assess for visualization of the appendix, acute appendicitis, alternative diagnoses, and incidental findings. Separately, the same parameters were assessed on the full scan by the same two reviewers. Whole-body effective doses were determined for the full- and limited-range scans and were compared using the paired t test. The appendix or entire cecum was visualized on the limited scan in all cases, and no cases of acute appendicitis were missed on the simulated limited scan compared with the full scan. Two alternative diagnoses were missed with the limited scan: one case of hydronephrosis and one of acute acalculous cholecystitis. The mean effective dose for the original scan was 5.6 mSv and that for the simulated limited scan was 3.0 mSv, resulting in a dose reduction of 46.4% (p appendicitis and reduces the dose by approximately 46%.

  7. Usefulness of the inner hypoechoic band of the vermiform appendix as ultrasonographic criteria for the diagnosis of acute appendicitis in children

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Bong Soo; Choi, Guk Myung; Kim, Seung Hyoung; Park, Ji Kang; Kim, Kwang Sig; Kang, Hyun Wook; Kang, Ki Soo [Cheju National University College of Medicine, Jeju (Korea, Republic of)

    2007-11-15

    We wanted to evaluate the usefulness of the inner hypoechoic band in pediatric appendices as an ultrasonographic criterion to exclude or confirm acute appendicitis. Among the 169 consecutive children with right lower abdominal pain, the 149 appendices depicted on US were prospectively evaluated for an inner hypoechoic band in the appendiceal walls. The sensitivity, specificity, positive and negative predictive values and accuracy were assessed for loss of the inner hypoechoic band as a diagnostic criterion for acute appendicitis. The appendices in 12 (25%) patients with acute appendicitis show entire inner hypoechoic bands and those in 36 patient (75%) did not. The appendices in 97 (96%) patients without acute appendicitis showed entire inner hypoechoic bands, an those in 4 (4%) did not. The loss of inner hypoechoic band confirmed acute appendicitis with a sensitivity of 75%, a specificity of 96%, positive and negative predictive values of 89% and 90%, respectively, and an accuracy of 89%. The thickness of the inner hypoechoic band in patients without appendicitis was significantly higher than that in patients with appendicitis ({rho} = 0.03). The visualization of entire thickened inner hypoechoic band in the appendiceal wall helps to rule out acute appendicitis. However, the loss of the inner hypoechoic band is suggestive of acute appendicitis.

  8. Elevations of serum CA-125 predict severity of acute appendicitis in males.

    Science.gov (United States)

    Berger, Yaniv; Nevler, Avinoam; Shwaartz, Chaya; Lahat, Eylon; Zmora, Oded; Gutman, Mordechai; Shabtai, Moshe

    2016-04-01

    Acute appendicitis (AA) is a common indication for urgent abdominal surgery. CA-125 glycoprotein antigen is a non-specific marker for epithelial ovarian cancer; CA-125 serum levels also increased in the conditions of peritoneal inflammation. The aim of this study was to examine the correlation between serum CA-125 levels and AA. All emergency department (ED) patients with suspected AA were prospectively enrolled in the study. The serum level of CA-125 was checked in every patient on arrival to the ED in addition to the routine clinical and laboratory evaluation. Data regarding demographic, clinical, radiological, operative and pathological features were analysed. One hundred consecutive patients (48 males) were enrolled in the study. We found a statistically significant correlation between CA-125 levels in males and the severity of appendicitis as described in the operative and pathology reports (P = 0.008 and P = 0.02, respectively). In addition, we observed a trend towards higher levels of CA-125 in males with AA compared with males without AA (9.9 ± 4.7 versus 7.8 ± 3.2 U/mL, respectively; P = 0.09). CA-125 levels correlate with the severity of appendicitis in males and may serve as a surrogate marker for the severity of other intra-abdominal surgical diseases. © 2015 Royal Australasian College of Surgeons.

  9. Appendectomy and resection of the terminal ileum with secondary severe necrotic changes in acute perforated appendicitis.

    Science.gov (United States)

    Shiryajev, Yuri N; Volkov, Nikolay N; Kashintsev, Alexey A; Chalenko, Marina V; Radionov, Yuri V

    2015-01-25

    Resectional procedures for advanced and complicated appendicitis are performed infrequently. Their extent can vary: cecal resection, ileocecectomy, and even right hemicolectomy. We present a very rare case of appendectomy that was combined with partial ileal resection for severe necrotic changes and small perforation of the ileum. A 19-year-old female patient was hospitalized with right iliac fossa pain and fever 10 days after the onset of symptoms. On laparoscopy, a large mass in a right iliac fossa was found. The ultrasound-guided drainage of the suspected appendiceal abscess was unavailable. After conversion using McBurney's incision, acute perforated appendicitis was diagnosed. It was characterized by extension of severe necrotic changes onto the ileal wall and complicated by right iliac fossa abscess. A mass was bluntly divided, and a large amount of pus with fecaliths was discharged and evacuated. Removal of necrotic tissues from the ileal wall led to the appearance of a small defect in the bowel. A standard closure of this defect was considered as very unsafe due to a high risk of suture leakage or bowel stenosis. We perform a resection of the involved ileum combined with appendectomy and drainage/tamponade of an abscess cavity. Postoperative recovery was uneventful. The patient was discharged on the 15th day. In advanced appendicitis, the involved bowel resection can prevent possible complications (e.g., ileus, intestinal fistula, peritonitis, and intra-abdominal abscess). Our case may be the first report of an appendectomy combined with an ileal resection for advanced and complicated appendicitis.

  10. Complicated acute appendicitis presenting as an abscess in the abdominal wall in an elderly patient: A case report

    Directory of Open Access Journals (Sweden)

    Ibrahim Massuqueto Andrade Gomes de Souza

    Full Text Available Introduction: Appendicitis is a common cause of acute abdomen; however, the classic clinical signs are not often present, and it has unusual presentations. Thus, its diagnosis can be challenging. PRESENTATION OF CASE: We describe the case of an elderly man who presented with right abdominal wall abscess with spontaneous drainage in the emergency department. Since we suspected a subjacent abdominal pathology, we performed surgery, and intraoperatively, we observed that the Appendix tip had invaded the abdominal wall. Discussion: This patient had a challenging diagnostic process and surgical visualization of the appendicular tip invading the abdominal wall was an important characteristic in proving the cause of the abdominal wall abscess. Conclusion: The onset of an abdominal wall abscess without a known cause needs to be thoroughly investigated, with consideration of a subjacent abdominal cause and appendicitis necessitatis. Keywords: Appendicitis, Abdominal abscess, Appendicitis necessitatis, Case report

  11. Acute appendicitis in a young adult with midgut malrotation: a case report

    International Nuclear Information System (INIS)

    Bider, K.; Kaim, A.; Wiesner, W.; Bongartz, G.

    2001-01-01

    Midgut malrotation is defined as a developmental anomaly that may cause atypical clinical symptoms in relatively common intestinal disorders due to altered anatomy. A 27-year-old woman presented with acute left-sided abdominal pain. Underlying type Ia malrotation prevented the correct clinical diagnosis of perforated, ulcerated appendicitis. Cross-sectional imaging demonstrated all the typical signs of this type of malrotation, i.e., right-sided duodenojejunal junction, left positioned cecum and ascending colon, inverted position of the superior mesenteric vessels, and hypoplasia of the uncinate process of pancreas, and surgical treatment was initiated. (orig.)

  12. CT Findings of Foreign Body Reaction to a Retained Endoloop Ligature Plastic Tube Mimicking Acute Appendicitis: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Jae Hong; Kang, Chae Hoon; Choi, Soo-Jung; Park, Man Soo; Jung, Seung Mun; Ryu, Dae Shick; Shin, Dong Rock [Department of Radiology, Asan Foundation, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung 25440 (Korea, Republic of)

    2016-11-01

    Many hospitals experience one or more retained surgical instrument events with risk of patient morbidity and medicolegal problems. Identification of retained surgical instrument is important. The radiologists should be familiar with imaging finding of retained surgical instrument. In a 62-year-old female with a retained plastic tube, localized peritoneal infiltration around air-containing tubular structure mimicked acute appendicitis on abdomen computed tomography (CT), one year after laparoscopic cholecystectomy. We reported CT findings of foreign body reaction related to retained Endoloop ligature plastic tube mimicking acute appendicitis.

  13. Suspicion of acute appendicitis in the third trimester of pregnancy: pros and cons of a laparoscopic procedure.

    Science.gov (United States)

    Donkervoort, S C; Boerma, D

    2011-01-01

    The presentation of acute appendicitis during pregnancy may cause diagnostic and therapeutic difficulty. Delay in diagnosis may lead to increased maternal and fetal risk. Therefore, an aggressive surgical approach is mandatory, even though this may result in an increased number of appendectomies for normal appendices. Diagnostic laparoscopy, followed by laparoscopic appendectomy in case of inflammation, seems a logical strategy. We present the case of a 36-week pregnant woman who presented with suspicion of acute appendicitis. The pro and cons of a laparoscopic approach in the third trimester of pregnancy are discussed as is its safety by reviewing the literature.

  14. CT findings of foreign body reaction to retained endoloop ligature plastic tube mimicking acute appendicitis: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Jae Hong; Kang, Chae Hoon; Choi, Soo Jung; Park, Man Soo; Jung, Seung Mun; Ryu, Dae Shick; Shin, Dong Rock [Dept. of Radiology, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung (Korea, Republic of)

    2016-07-15

    Many hospitals experience one or more retained surgical instrument events with risk of patient morbidity and medicolegal problems. Identification of retained surgical instrument is important. The radiologists should be familiar with imaging finding of retained surgical instrument. In a 62-year-old female with a retained plastic tube, localized peritoneal infiltration around air-containing tubular structure mimicked acute appendicitis on abdomen computed tomography (CT), one year after laparoscopic cholecystectomy. We reported CT findings of foreign body reaction related to retained Endoloop ligature plastic tube mimicking acute appendicitis.

  15. Iterative reconstruction technique with reduced volume CT dose index: diagnostic accuracy in pediatric acute appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Didier, Ryne A. [Oregon Health and Science University, Department of Diagnostic Radiology, DC7R, Portland, OR (United States); Vajtai, Petra L. [Oregon Health and Science University, Department of Pediatrics, Portland, OR (United States); Oregon Health and Science University, Department of Diagnostic Radiology, DC7R, Portland, OR (United States); Hopkins, Katharine L. [Oregon Health and Science University, Department of Diagnostic Radiology, DC7R, Portland, OR (United States); Oregon Health and Science University, Department of Pediatrics, Portland, OR (United States)

    2014-07-05

    Iterative reconstruction technique has been proposed as a means of reducing patient radiation dose in pediatric CT. Yet, the effect of such reductions on diagnostic accuracy has not been thoroughly evaluated. This study compares accuracy of diagnosing pediatric acute appendicitis using contrast-enhanced abdominopelvic CT scans performed with traditional pediatric weight-based protocols and filtered back projection reconstruction vs. a filtered back projection/iterative reconstruction technique blend with reduced volume CT dose index (CTDI{sub vol}). Results of pediatric contrast-enhanced abdominopelvic CT scans done for pain and/or suspected appendicitis were reviewed in two groups: A, 192 scans performed with the hospital's established weight-based CT protocols and filtered back projection reconstruction; B, 194 scans performed with iterative reconstruction technique and reduced CTDI{sub vol}. Reduced CTDI{sub vol} was achieved primarily by reductions in effective tube current-time product (mAs{sub eff}) and tube peak kilovoltage (kVp). CT interpretation was correlated with clinical follow-up and/or surgical pathology. CTDI{sub vol}, size-specific dose estimates (SSDE) and performance characteristics of the two CT techniques were then compared. Between groups A and B, mean CTDI{sub vol} was reduced by 45%, and mean SSDE was reduced by 46%. Sensitivity, specificity and diagnostic accuracy were 96%, 97% and 96% in group A vs. 100%, 99% and 99% in group B. Accuracy in diagnosing pediatric acute appendicitis was maintained in contrast-enhanced abdominopelvic CT scans that incorporated iterative reconstruction technique, despite reductions in mean CTDI{sub vol} and SSDE by nearly half as compared to the hospital's traditional weight-based protocols. (orig.)

  16. Management, treatment and outcomes of acute appendicitis in an elderly population: a single-center experience.

    Science.gov (United States)

    Cohen-Arazi, O; Dabour, K; Bala, M; Haran, A; Almogy, G

    2017-10-01

    Only 5-10% of cases of acute appendicitis (AA) are diagnosed above the age of 60 years. Complicated AA is more common in the elderly, who also have more comorbidities. The goals of this study were to describe our experience with elderly patients and identify predictors of increased morbidity. Patients ≥65 years who were treated for AA between 2006 and 2013 were selected. The control consisted of patients aged 20-45 years, who were randomly selected from a pool of 900 patients. Seventy-four patients ≥65 years, mean age of 74.6 ± 7.4, were included. Time from onset of symptoms to surgery was similar between the groups. CT scan was performed for all patients in the elderly group compared to 55.6% in the younger group (p < 0.001). 77% of the younger patients underwent laparoscopic appendectomy compared to 43.2% of the elderly patients (p < 0.001). Pathological findings of severe appendicitis were significantly more common in the elderly group (39.2 vs. 10.5%, p < 0.001). Sixteen elderly patients (21.6%) developed complications, compared with 4 patients (3.2%) in the younger group (p < 0.001). The length of stay was longer in the elderly group and even longer for patients with complications (p < 0.001). There was no mortality. Cardiac disease was the only independent predictor of peri-operative complications (OR = 4.2). Severe forms of acute appendicitis and post-operative morbidity are higher in the elderly population. Cardiac disease is the only predictor for increased morbidity. Although CT scan was performed universally in the elderly group, it did not appear to increase time from presentation to surgery.

  17. Evaluation of a sequential multi-modality imaging algorithm for the diagnosis of acute appendicitis in the pregnant female.

    Science.gov (United States)

    Ramalingam, Vijay; LeBedis, Christina; Kelly, Jacqueline R; Uyeda, Jennifer; Soto, Jorge A; Anderson, Stephan W

    2015-04-01

    The purpose of this study is to evaluate the performance of a sequential multi-modality imaging algorithm for diagnosing acute appendicitis in pregnancy. This IRB-approved, HIPAA compliant study included 127 consecutive pregnant patients imaged for suspected appendicitis between October 2007 and May 2012; all patients initially underwent ultrasound (US) examination, followed by magnetic resonance imaging (MRI) if results of US were negative or equivocal. Computerized tomography (CT) was reserved for cases with inconclusive US and MRI results. The EMR was reviewed, recording results of imaging examinations and clinical outcomes. The diagnostic performance of this sequential multi-modality imaging algorithm was calculated with pathology correlation. Two (1.9 %) of the 127 US examinations reported suspected appendicitis; 125 (98.4 %) were inconclusive. Of the 125 patients with inconclusive US examinations, 103 underwent MRI, of which eight (6.2 %) demonstrated findings of acute appendicitis. Of the 103 patients that received MRI, nine (8.7 %) underwent CT. One patient had a CT performed directly after an inconclusive US exam. No additional cases of appendicitis were detected with CT. The sensitivity and specificity of US alone was 12.5 and 99.2 %, respectively; MRI was 100 and 93.6 %; the sequential multi-modality modality algorithm including US, CT, and MRI was 100 and 98.3 %. The diagnostic performance of this sequential multi-modality imaging algorithm for diagnosing acute appendicitis in pregnancy is high. Given the low yield of US, MRI should be considered the first-line imaging test. Although CT was employed in a small fraction of inconclusive MRI examinations, it still has a role in the diagnostic work-up of the pregnant patient with suspected appendicitis.

  18. Blunt abdominal trauma with handlebar injury: A rare cause of traumatic amputation of the appendix associated with acute appendicitis

    Directory of Open Access Journals (Sweden)

    Amanda Jensen

    2016-04-01

    Full Text Available We describe traumatic appendicitis in a 7-year-old boy who presented after sustaining blunt abdominal trauma to his right lower abdomen secondary to bicycle handlebar injury. With diffuse abdominal pain following injury, he was admitted for observation. Computed axial tomography (CT obtained at an outside hospital demonstrated moderate stranding of the abdomen in the right lower quadrant. The CT was non-contrasted and therefore significant appendiceal distention could not be confirmed. However, there was a calcified structure in the right pelvis with trace amount of free fluid. Patient was observed with conservative management and over the course of 15 h his abdominal pain continued to intensify. With his worsening symptoms, we elected to take him for diagnostic laparoscopy. In the operating room we found an inflamed traumatically amputated appendix with the mesoappendix intact. We therefore proceeded with laparoscopic appendectomy. Pathology demonstrated acute appendicitis with fecalith. It was unclear as to whether the patient's appendicitis and perforation were secondary to fecalith obstruction, his blunt abdominal trauma or if they concurrently caused his appendicitis. Acute appendicitis is a common acute surgical condition in the pediatric population and continues to be a rare and unique cause of operative intervention in the trauma population.

  19. A new technique for the diagnosis of acute appendicitis: abdominal CT with compression to the right lower quadrant

    Energy Technology Data Exchange (ETDEWEB)

    Kilincer, Abidin; Akpinar, Erhan; Uenal, Emre; Karaosmanoglu, Ali Devrim; Akata, Deniz; Oezmen, Mustafa [Hacettepe University Faculty of Medicine, Department of Radiology, Sihhiye, Ankara (Turkey); Erbil, Buelent [Hacettepe University Faculty of Medicine, Department of Emergency Medicine, Ankara (Turkey); Kaynaroglu, Volkan [Hacettepe University Faculty of Medicine, Department of General Surgery, Ankara (Turkey)

    2017-08-15

    To determine the diagnostic accuracy of abdominal CT with compression to the right lower quadrant (RLQ) in adults with acute appendicitis. 168 patients (age range, 18-78 years) were included who underwent contrast-enhanced CT for suspected appendicitis performed either using compression to the RLQ (n = 71) or a standard protocol (n = 97). Outer diameter of the appendix, appendiceal wall thickening, luminal content and associated findings were evaluated in each patient. Kruskal-Wallis, Fisher's and Pearson's chi-squared tests were used for statistical analysis. There was no significant difference in the mean outer diameter (MOD) between compression CT scans (10.6 ± 1.9 mm) and standard protocol (11.2 ± 2.3 mm) in patients with acute appendicitis (P = 1). MOD was significantly lower in the compression group (5.2 ± 0.8 mm) compared to the standard protocol (6.5 ± 1.1 mm) (P < 0.01) in patients without appendicitis. A cut-off value of 6.75 mm for the outer diameter of the appendix was found to be 100% sensitive in the diagnosis of acute appendicitis for both groups. The specificity was higher for compression CT technique (67.7 vs. 94.9%). Normal appendix diameter was significantly smaller in the compression-CT group compared to standard-CT group, increasing diagnostic accuracy of abdominal compression CT. (orig.)

  20. Diagnostic performance of contrast-enhanced MR for acute appendicitis and alternative causes of abdominal pain in children

    Energy Technology Data Exchange (ETDEWEB)

    Koning, Jeffrey L. [University of California San Diego, Department of Radiology, San Diego, CA (United States); Naheedy, John H.; Kruk, Peter G. [University of California San Diego, Department of Radiology, San Diego, CA (United States); Rady Children' s Hospital, Department of Radiology, San Diego, CA (United States)

    2014-08-15

    Unenhanced MRI has emerged as a useful tool for diagnosing pediatric acute appendicitis. The use of contrast-enhanced MRI for diagnosing pediatric appendicitis has not been documented. The purpose of this study is to examine the diagnostic performance of contrast-enhanced MRI for acute appendicitis and alternative entities in the pediatric population presenting with acute abdominal pain. A retrospective review was conducted of 364 consecutive pediatric patients undergoing contrast-enhanced MRI for the evaluation of possible appendicitis at a single institution between November 2012 and September 2013. There were 132 cases of pathologically confirmed appendicitis out of 364 pediatric patients (36.3%) included in the study. Overall sensitivity and specificity were 96.2% (95% CI [91.4-98.4%]) and 95.7% (95% CI [92.3-97.6%]), respectively. Positive predictive value and negative predictive value were 92.7% (95% CI [86.6-96.3%]) and 97.8% (95% CI [94.7-99.1%]), respectively. The appendix was visualized in 243 cases (66.8%). Imaging confirmed alternative diagnoses in 75 patients, including most commonly colitis, enteritis or terminal ileitis (n = 25, 6.9%), adnexal cysts (n = 25, 6.9%) and mesenteric adenitis (n = 7, 1.9%). Contrast-enhanced MRI is capable of accurately diagnosing acute appendicitis while detecting many alternative entities of abdominal pain, and it allows good visualization of the appendix. Further evaluation is needed to determine whether contrast-enhanced MRI provides an advantage over non-enhanced MRI for imaging evaluation of acute abdominal pain in the pediatric population. (orig.)

  1. Antibiotic therapy versus appendicectomy in uncomplicated acute appendicitis in terms of efficacy

    International Nuclear Information System (INIS)

    Zaidi, M.A.; Nazeer, T.B.; Aziz, O.B.A.; Asad, T.; Dar, Z.S.

    2017-01-01

    Objective: To compare antibiotic therapy and appendectomy in uncomplicated acute appendicitis in terms of efficacy. Study Design: Randomized controlled trial. Place and Duration of Study: Surgical Ward Forward Treatment Centre (FTC), 5 Mountain Medical Battalion Forward Kahuta Azad Jammu Kashmir (AJK), from Oct 2011 to Mar 2013. Material and Methods: A total of 103 patients with clinical diagnosis of acute appendicitis (AA) were admitted during the duration of study and divided into two groups by consecutive sampling. The antibiotic group consisted of 51 patients who received intravenous antibiotics for 48 hours and oral antibiotics for another 8 days. The appendectomy group comprised of 52 patients who all underwent standard appendectomy. All the patients were followed up at 1 month and 1 year for assessing efficacy and post treatment complications. Results: The efficacy of antibiotic treatment is 90.625 percent as compared to appendectomy which was 88.46 percent (p=0.759) at 1 month follow up after treatment. At one year post treatment, the comparison between the efficacy of antibiotic therapy (71.87 percent) and appendectomy (87.14 percent) remains statistically insignificant (p=0.055). Conclusion: Antibiotic therapy is comparable to appendectomy in AA in terms of efficacy at 1 month and 1 year post treatment. (author)

  2. Can Clinical Findings Prevent Negative Laparotomy in Parasitosis Mimicking Acute Appendicitis?

    Directory of Open Access Journals (Sweden)

    Musa Zorlu

    2016-01-01

    Full Text Available Objectives. Rates of negative laparotomy (NL for acute appendicitis have been reported as 15% and parasitosis contributed to 2%. This study was planned to reduce the rates of NL by preoperative determination of parasitosis. Methods. In retrospective examination of 2730 appendectomy specimens in Hitit University Department of General Surgery between 2008 and 2012, 55 patients were determined with parasitosis and compared with 102 age-matched randomly selected patients with lymphoid hyperplasia. Results. The parasite group comprised 63.6% females with a mean age of 15.1 years. The number of patients in the parasitosis group increased from city centre to rural areas of towns and villages (p2.2% was determined as a diagnostic value. Conclusion. It is important to determine parasitosis to prevent NL. When acute appendicitis is considered for young patients living in rural areas, the observation of high eosinophil together with negative sonographic findings should bring Enterobius vermicularis parasitosis to mind and thereby should prevent NL.

  3. Modified Alvarado Scoring System as a diagnostic tool for Acute Appendicitis at Bugando Medical Centre, Mwanza, Tanzania

    Directory of Open Access Journals (Sweden)

    Rambau Peter

    2011-02-01

    Full Text Available Abstract Background Decision-making in patients with acute appendicitis poses a diagnostic challenge worldwide, despite much advancement in abdominal surgery. The Modified Alvarado Scoring System (MASS has been reported to be a cheap and quick diagnostic tool in patients with acute appendicitis. However, differences in diagnostic accuracy have been observed if the scores were applied to various populations and clinical settings. The purpose of this study was to evaluate the diagnostic value of Modified Alvarado Scoring System in patients with acute appendicitis in our setting. Methods A cross-sectional study involving all patients suspected to have acute appendicitis at Bugando Medical Centre over a six-month period between November 2008 and April 2009 was conducted. All patients who met the inclusion criteria were consecutively enrolled in the study. They were evaluated on admission using the MASS to determine whether they had acute appendicitis or not. All patients underwent appendicectomy according to the hospital protocol. The decision to operate was the prerogative of the surgeon or surgical resident based on overall clinical judgment and not the MASS. The diagnosis was confirmed by histopathological examination. Data was collected using a pre-tested coded questionnaire and analyzed using SPSS statistical computer software. Results A total number of 127 patients were studied. Their ages ranged from eight to 76 years (mean 29.64 ± 12.97. There were 37 (29.1% males and 90 (70.9% females (M: F = 1:2.4. All patients in this study underwent appendicectomy. The perforation rate was 9.4%. Histopathological examination confirmed appendicitis in 85 patients (66.9% and the remaining 42 patients had normal appendix giving a negative appendicectomy rate of 33.1% (26.8% for males and 38.3% for females. The sensitivity and specificity of MASS in this study were 94.1% (males 95.8% and females 88.3% and 90.4% (males 92.9% and females 89.7% respectively

  4. Alvarado score: A valuable clinical tool for diagnosis of acute appendicitis –a retros-pective study

    Directory of Open Access Journals (Sweden)

    Swagata Brahmachari1 and Ashwini B. Jajee2

    2013-08-01

    Full Text Available Appendicitis is a common surgical emergency and diagnosis is still a great challenge. Accurate diagnosis and timely intervention re-duces morbidity and mortality. The present study was conducted to evaluate Alvarado scoring system for diagnosis of acute appen-dicitis in Indian set up. The study was carried out on 200 patients admitted in Surgery ward between January 2009 and December 2010 with right lower quadrant abdominal pain. Alvarado score was calculated and all patients were divided in three groups. Mean age of presentation was 29.12 years and male to female ratio was 1.27:1. Higher the Alvarado score, more is the sensitivity. So pa-tients having score 7 or above had sensitivity of 66%. We con-clude that Alvarado score is unique since it incorporates signs, symptoms and laboratory findings of suspicious patients. Alvarado score can be utilized safely for diagnosis of acute appendicitis.

  5. Ripasa score: a new diagnostic score for diagnosis of acute appendicitis

    International Nuclear Information System (INIS)

    Butt, M.Q.

    2014-01-01

    Objective: To determine the usefulness of RIPASA score for the diagnosis of acute appendicitis using histopathology as a gold standard. Study Design: Cross-sectional study. Place and Duration of Study: Department of General Surgery, Combined Military Hospital, Kohat, from September 2011 to March 2012. Methodology: A total of 267 patients were included in this study. RIPASA score was assessed. The diagnosis of appendicitis was made clinically aided by routine sonography of abdomen. After appendicectomies, resected appendices were sent for histopathological examination. The 15 parameters and the scores generated were age (less than 40 years = 1 point; greater than 40 years = 0.5 point), gender (male = 1 point; female = 0.5 point), Right Iliac Fossa (RIF) pain (0.5 point), migration of pain to RIF (0.5 point), nausea and vomiting (1 point), anorexia (1 point), duration of symptoms (less than 48 hours = 1 point; more than 48 hours = 0.5 point), RIF tenderness (1 point), guarding (2 points), rebound tenderness (1 point), Rovsing's sign (2 points), fever (1 point), raised white cell count (1 point), negative urinalysis (1 point) and foreign national registration identity card (1 point). The optimal cut-off threshold score from the ROC was 7.5. Sensitivity analysis was done. Results: Out of 267 patients, 156 (58.4%) were male while remaining 111 patients (41.6%) were female with mean age of 23.5 +- 9.1 years. Sensitivity of RIPASA score was 96.7%, specificity 93.0%, diagnostic accuracy was 95.1%, positive predictive value was 94.8% and negative predictive value was 95.54%. Conclusion: RIPASA score at a cut-off total score of 7.5 was a useful tool to diagnose appendicitis, in equivocal cases of pain. (author)

  6. Introduction of an acute surgical unit: comparison of performance indicators and outcomes for operative management of acute appendicitis.

    Science.gov (United States)

    Lancashire, John F; Steele, M; Parker, D; Puhalla, H

    2014-08-01

    The Acute Surgical Unit (ASU) is a recent change in management of acute general surgical patients in hospitals worldwide. In contrast to traditional management of acute surgical presentations by a rotating on-call system, ASUs are shown to deliver improved efficiency and patient outcomes. This study investigated the impact of an ASU on operative management of appendicitis, the most common acute surgical presentation, by comparing performance indicators and patient outcomes prior to and after introduction of an ASU at the Gold Coast Hospital, Queensland, Australia. A retrospective study of patients admitted from the Emergency Department (ED) and who underwent emergency appendectomy from February 2010 to January 2011 (pre-ASU) and after introduction of the ASU from February 2011 to January 2012 (post-ASU). A total of 548 patients underwent appendectomy between February 2010 and January 2012, comprising 247 pre-ASU and 301 post-ASU patients. Significant improvements were demonstrated: reduced time to surgical review, fewer complications arising from operations commencing during ASU in-hours, and more appendectomies performed during the daytime attended by the consultant. There was no significant difference in total cost of admission or total admission length of stay. This study demonstrated that ASUs have potential to significantly improve the outcomes for operative management of acute appendicitis compared to the traditional on-call model. The impact of the ASU was limited by access to theaters and restricted ASU operation hours. Further investigation of site-specific determinants could be beneficial to optimize this new model of acute surgical care.

  7. Sensitivity, Specificity and Reliability of the RIPASA Score for Diagnosis of Acute Appendicitis in Relation to the Alvarado Score.

    Science.gov (United States)

    Arroyo-Rangel, Celerino; Limón, Iván O; Vera, Ángel G; Guardiola, Pedro M; Sánchez-Valdivieso, Enrique A

    2018-03-01

    In order to avoid delay in the diagnosis of acute appendicitis and reduce the margin of error, the use of scales has been used. The aim of this study was to compare the effectiveness of the Alvarado and RIPASA scores in the clinical diagnosis of acute appendicitis and to correlate with the histopathological results. Prospective, longitudinal, analytical, comparative and observational study. Patients with abdominal pain syndrome suggestive of acute appendicitis and submitted to surgical intervention were included; the Alvarado and RIPASA scores were simultaneously applied. The pathology report was obtained and the efficacy of both scores for the diagnosis of acute appendicitis was compared. One hundred patients were included. It was shown that the RIPASA score demonstrated greater diagnostic accuracy compared to the Alvarado score, with sensitivity of 98,8% and specificity of 71,4% versus 90,7% and 64,3%, respectively. The RIPASA score showed an area under the curve of 0,88 and the Alvarado scale of 0,80. The RIPASA score is a more specific, convenient and accurate system than the Alvarado score for the Mexican population. Copyright © 2017 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. Acute appendicitis: Meta-analysis of diagnostic performance of CT and graded compression US related to prevalence of disease

    NARCIS (Netherlands)

    van Randen, Adrienne; Bipat, Shandra; Zwinderman, Aeilko H.; Ubbink, Dirk T.; Stoker, Jaap; Boermeester, Marja A.

    2008-01-01

    Purpose: This study was a head-to-head comparison of graded compression ultrasonography (US) and computed tomography (CT) in helping diagnose acute appendicitis with an emphasis on diagnostic value at different disease prevalences, commonly occurring in various hospital settings. Materials and

  9. Co-existence of acute appendicitis and inflammatory myofibroblastic tumor of the small intestine: A case report

    Directory of Open Access Journals (Sweden)

    Nurcan Unver

    2015-09-01

    Conclusion: Coexistence of inflammatory myofibroblastic tumor located in the gastrointestinal system with acute appendicitis is a rare event. Complete surgical excision should be regarded as the mainstay of the treatment. Long-term follow up with serial imaging techniques is recommended.

  10. Antibiotic therapy for acute appendicitis in adults. Fewer immediate complications than with surgery, but more subsequent failures.

    Science.gov (United States)

    2014-06-01

    Appendectomy is the standard treatment for acute appendicitis. Since the 1990s, antibiotic therapy has sometimes been proposed as an alternative to immediate appendectomy. How effective are antibiotics in adults with uncomplicated acute appendicitis, and what is the risk of complications? To answer these questions, we conducted a review of the literature using the standard Prescrire methodology. A systematic review with meta-analysis included four randomised trials of antibiotics versus immediate appendectomy, in 900 patients hospitalised with uncomplicated appendicitis. The studies included only patients with few severe symptoms, thus undermining the strength of the results. Antibiotic therapy was usually administered intravenously first, then orally. The antibiotics used were amoxicillin + clavulanic acid, cefotaxime, or a fluoroquinolone. Metronidazole or tinidazole was often added. The total duration of antibiotic treatment was 8 to 15 days. The overall incidence of complications of appendicitis (perforation, peritonitis and surgical wound infections) was 25% in the immediate appendectomy group versus 18% in the antibiotic group. The frequency of perforations and peritonitis did not differ between the groups. All symptoms of appendicitis disappeared, without relapse or rehospitalisation during the first month, in 78% of patients in the antibiotic group. After one year of follow-up, 63% of patients treated with antibiotics were asymptomatic and had no complications or recurrences. In another systematic review of five randomised trials, outcome at one year was optimal in 73% of patients treated with antibiotics alone versus 97% of patients who had immediate appendectomy. In practice, in early 2014, appendectomy remains the first-line treatment for uncomplicated acute appendicitis. In some still poorly characterised patients, the harm-benefit balance of antibiotic therapy is probably better than that of immediate appendectomy. When informed of the risks, some

  11. Economic evaluation of antibiotic therapy versus appendicectomy for the treatment of uncomplicated acute appendicitis from the APPAC randomized clinical trial.

    Science.gov (United States)

    Sippola, S; Grönroos, J; Tuominen, R; Paajanen, H; Rautio, T; Nordström, P; Aarnio, M; Rantanen, T; Hurme, S; Salminen, P

    2017-09-01

    An increasing amount of evidence supports antibiotic therapy for treating uncomplicated acute appendicitis. The objective of this study was to compare the costs of antibiotics alone versus appendicectomy in treating uncomplicated acute appendicitis within the randomized controlled APPAC (APPendicitis ACuta) trial. The APPAC multicentre, non-inferiority RCT was conducted on patients with CT-confirmed uncomplicated acute appendicitis. Patients were assigned randomly to appendicectomy or antibiotic treatment. All costs were recorded, whether generated by the initial visit and subsequent treatment or possible recurrent appendicitis during the 1-year follow-up. The cost estimates were based on cost levels for the year 2012. Some 273 patients were assigned to the appendicectomy group and 257 to antibiotic treatment. Most patients randomized to antibiotic treatment did not require appendicectomy during the 1-year follow-up. In the operative group, overall societal costs (€5989·2, 95 per cent c.i. 5787·3 to 6191·1) were 1·6 times higher (€2244·8, 1940·5 to 2549·1) than those in the antibiotic group (€3744·4, 3514·6 to 3974·2). In both groups, productivity losses represented a slightly higher proportion of overall societal costs than all treatment costs together, with diagnostics and medicines having a minor role. Those in the operative group were prescribed significantly more sick leave than those in the antibiotic group (mean(s.d.) 17·0(8·3) (95 per cent c.i. 16·0 to 18·0) versus 9·2(6·9) (8·3 to 10·0) days respectively; P antibiotic therapy for uncomplicated appendicitis incurred lower costs than those who had surgery. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

  12. ACUTE APPENDICITIS IN A SINGLE AND MULTIPLE PREGNANCY – A STUDY OF TWO CASES

    Directory of Open Access Journals (Sweden)

    Olga Adamczyk-Gruszka

    2013-11-01

    Full Text Available Appendicitis during pregnancy is a diagnostic and therapeutic problem. Removal of the appendix due to acute inflammation is one of the most difficult surgeries performed when immediate indications are concerned. Diagnosis and a decision on eligibility for the surgery are based on clinical criteria, subjective data from an interview and physical examination. The reason for great diagnostic difficulties and the not-so-rare mistakes in diagnosis of pregnant women is the anatomy of the abdominal cavity altered by the uterus during pregnancy. Some of the symptoms of appendicitis may be mistakenly interpreted as symptoms occurring typically in pregnancy. In pregnant women, the decision on eligibility for surgery is of special importance, because one must take into consideration the threat to foetal health. The diagnostic difficulties of differentiating this affliction in different trimesters of pregnancy in single and twin pregnancies have been discussed in the paper. An assessment was made of the influence of surgical treatment on further development of the pregnancy and development of the foetuses. Both pregnancies ended in Caesarean sections. The first one in the 37th week due to obstetric indications – a twin pregnancy with breech presentation of the first foetus; the second one in the 37th week with a simultaneous removal of the appendix.

  13. Quantitative measurement of elasticity of the appendix using shear wave elastography in patients with suspected acute appendicitis.

    Directory of Open Access Journals (Sweden)

    Seung-Whan Cha

    Full Text Available Shear wave elastography (SWE has not been studied for diagnosing appendicitis. We postulated that an inflamed appendix would become stiffer than a normal appendix. We evaluated the elastic modulus values (EMV by SWE in healthy volunteers, patients without appendicitis, and patients with appendicitis. We also evaluated diagnostic ability of SWE for differentiating an inflamed from a normal appendix in patients with suspected appendicitis.Forty-one patients with clinically suspected acute appendicitis and 11 healthy volunteers were prospectively enrolled. Gray-scale ultrasonography (US, SWE and multi-slice computed tomography (CT were performed. The EMV was measured in the anterior, medial, and posterior appendiceal wall using SWE, and the highest value (kPa was recorded.Patients were classified into appendicitis (n = 30 and no appendicitis groups (n = 11. One case of a negative appendectomy was detected. The median EMV was significantly higher in the appendicitis group (25.0 kPa compared to that in the no appendicitis group (10.4 kPa or in the healthy controls (8.3 kPa (p<0.001. Among SWE and other US and CT features, CT was superior to any conventional gray-scale US feature or SWE. Either the CT diameter criterion or combined three CT features predicted true positive in 30 and true negative in 11 cases and yielded 100% sensitivity and 100% specificity. An EMV of 12.5 kPa for the stiffest region of the appendix predicted true positive in 28, true negative in 11, and false negative in two cases. The EMV (≥12.5 kPa yielded 93% sensitivity and 100% specificity.Our results suggest that EMV by SWE helps distinguish an inflamed from a normal appendix. Given that SWE has high specificity, quantitative measurement of the elasticity of the appendix may provide complementary information, in addition to morphologic features on gray-scale US, in the diagnosis of appendicitis.

  14. Prevention of infectious complications after laparoscopic appendectomy for complicated acute appendicitis--the role of routine abdominal drainage.

    Science.gov (United States)

    Allemann, Pierre; Probst, Herve; Demartines, Nicolas; Schäfer, Markus

    2011-01-01

    Complicated acute appendicitis is still associated with an increased morbidity. If laparoscopy has been accepted as a valid approach, some questions remain concerning intra-abdominal abscess formation. Routine prophylactic drainage of the abdomen has been proposed. However, this practice remains a matter of debate, poorly validated in the literature. With the present study, we investigated the impact of drainage in laparoscopic appendectomy for complicated appendicitis. This is a case match study of consecutive patients operated on by laparoscopy in a single institution. One hundred and thirty patients operated for complicated appendicitis (local peritonitis without perforation, with perforation, or with periappendicular abscess) with prophylactic intraperitoneal drainage were matched one by one to 130 patients operated without drainage. Uncomplicated appendicitis and generalized peritonitis were excluded. Primary endpoint was surgical complications and secondary endpoints were transit recovery time and length of hospital stay. Patients without drain had significantly less overall complications (7.7% vs. 18.5%, p = 0.01). Moreover, the absence of drainage was of significant benefit for transit recovery time (2.5 vs. 3.5 days, p = 0.0068) and length of hospital stay (4.2 vs. 7.3 days, p drainage of the abdominal cavity during emergency laparoscopic treatment of complicated appendicitis. For this reason, this practice may be abandoned.

  15. Pre-operative stool analysis for intestinal parasites and fecal occult blood in patients with acute appendicitis.

    Science.gov (United States)

    Hatipoğlu, Sinan; Lök, Uğur; Gülaçtı, Umut; Çelik, Tuncay

    2016-09-01

    Etiology of acute appendicitis (AA) rarely involves parasitic infections of gastrointestinal (GI) tract. Preoperative diagnosis of parasitic infections in appendix remains difficult, although parasites can sometimes be observed inside the lumen during histopathological examination. The aim of the present study was to prospectively screen prevalence and species of intestinal parasites and adherence of fecal occult blood (FOB) in patients admitted to emergency department (ED) with clinical symptoms of AA who underwent appendectomy. Demographic and stool analysis data of a total of 136 patients (≥13 years old) who underwent appendectomy between July 2009 and December 2014 were prospectively assessed, and histopathological data of all patients were retrospectively assessed. In histopathological examination after appendectomy, of 136 patients, 75.5% (n=103) had AA, 11.1% (n=15) had perforated appendicitis (PA), and 13.2% (n=18) had a negative appendicitis (normal appendix, NA). Pre-operative stool analysis revealed that 25% (n=34) had intestinal parasites and 14.7% (n=20) of patients had positive fecal occult blood test (FOBT). Those with positive FOBT represented 9.7% (n=10) of 103 AA patients, 53.3% (n=8) of 15 PA patients, and 11.1% (n=2) of 18 NA patients; this was statistically more significant for PA than other groups (pparasites in stool might not be associated with appendicitis, but it can occasionally lead to pathological findings of appendicitis. A positive FOBT may be a predictor for PA.

  16. Right iliac vein thrombosis mimicking acute appendicitis in pregnancy: a case report.

    Science.gov (United States)

    Aroke, Desmond; Kadia, Benjamin Momo; Dimala, Christian Akem; Bechem, Ndemazie Nkafu; Ngek, Larry Tangie; Choukem, Simeon Pierre

    2017-01-03

    Right iliac vein thrombosis is uncommon in pregnancy. Nonetheless, when it does occur, its presentation could be very unspecific with important diagnostic challenges and this could have negative therapeutic consequences especially in a resource limited setting. The historical, clinical and laboratory data of a 30 year old G2P1001 woman of African ethnicity at 11 weeks of gestation pointed towards a right iliac vein thrombosis missed for an acute appendicitis with subsequent appendectomy and failure to cure. Following the diagnosis of right iliac vein thrombosis post-appendectomy, the patient was started on low molecular weight heparin and the clinical progress thereafter was favourable. Pelvic vein thrombosis should be considered a differential diagnosis of intractable lower abdominal pain in early pregnancy. A high index of suspicion could lead to early diagnosis, prompt management and a favourable prognosis even in a low-income setting.

  17. Comparison of clinical judgment and diagnostic ultrasonography in the diagnosis of acute appendicitis

    DEFF Research Database (Denmark)

    Jahn, H; Mathiesen, F K; Neckelmann, K

    1997-01-01

    OBJECTIVE: To evaluate the diagnostic accuracy of clinical judgment and diagnostic ultrasonography (US) used routinely and to create a scoring system to aid diagnosis. DESIGN: Prospective, double-blind study. SETTING: University hospital, Denmark. SUBJECTS: 222 Consecutive patients suspected...... of having acute appendicitis admitted between 0800 and midnight from June 1990 to June 1992. INTERVENTIONS: 148 Patients (67%) underwent appendicectomy and the remaining 74 patients were observed. 193 Patients (87%) had a diagnostic US examination. 21 Predictive variables were collected prospectively...... to create a scoring system. MAIN OUTCOME MEASURES: Results of surgical pathological findings, clinical outcome (observed group), diagnostic US, and values of diagnostic score. RESULTS: The decision to operate was made by a junior surgeon solely on the clinical examination, which yielded a diagnostic...

  18. Accuracy of Point-of-care Ultrasonography for Diagnosing Acute Appendicitis: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Matthew Fields, J; Davis, Joshua; Alsup, Carl; Bates, Amanda; Au, Arthur; Adhikari, Srikar; Farrell, Isaac

    2017-09-01

    The use of ultrasonography (US) to diagnose appendicitis is well established. More recently, point-of-care ultrasonography (POCUS) has also been studied for the diagnosis of appendicitis, which may also prove a valuable diagnostic tool. The purpose of this study was through systematic review and meta-analysis to identify the test characteristics of POCUS, specifically US performed by a nonradiologist physician, in accurately diagnosing acute appendicitis in patients of any age. We conducted a thorough and systematic literature search of English language articles published on point-of-care, physician-performed transabdominal US used for the diagnosis of acute appendicitis from 1980 to May, 2015 using OVID MEDLINE In-Process & Other Non-indexed Citations and Scopus. Studies were selected and subsequently independently abstracted by two trained reviewers. A random-effects pooled analysis was used to construct a hierarchical summary receiver operator characteristic curve, and a meta-regression was performed. Quality of studies was assessed using the QUADAS-2 tool. Our search yielded 5,792 unique studies and we included 21 of these in our final review. Prevalence of disease in this study was 29.8%, (range = 6.4%-75.4%). The sensitivity and specificity for POCUS in diagnosing appendicitis were 91% (95% confidence interval [CI] = 83%-96%) and 97% (95% CI = 91%-99%), respectively. The positive and negative predictive values were 91 and 94%, respectively. Studies performed by emergency physicians had slightly lower test characteristics (sensitivity = 80%, specificity = 92%). There was significant heterogeneity between studies (I 2 = 99%, 95% CI = 99%-100%) and the quality of the reported studies was moderate, mostly due to unclear reporting of blinding of physicians and timing of scanning and patient enrollment. Several of the studies were performed by a single operator, and the education and training of the operators were variably reported. Point-of-care US has relatively

  19. The Value of Ultrasonography, Leukocyte Count and Clinical Results in Diagnosis of Acute Appendicitis and the Duration of Stay of the Patients in Emergency Department.

    Science.gov (United States)

    Eryigit, Veysi; Mahsanlar, Yasin; Demirtas, Yoldas; Parlak, Ismet

    2014-03-01

    In this study, we aimed to compare the clinical data of patients diagnosed with acute appendicitis in our center with the literature. The patients who were diagnosed with acute appendicitis between 01.10.2010 and 01.10.2011 in Emergency Department of İzmir Bozyaka Training and Research Hospital were included in this study. Patient demographics, dates and times of emergency department application, dates and times of hospitalization in the general surgery ward, duration of stay in the emergency department, leukocyte count and its relationship with age, the perforation rate, the relationship of perforation with age and leukocyte count, and the final diagnosis and ultrasound findings were assessed in this study. A total of 482 patients who were diagnosed with acute appendicitis [300 (62.2%) male, mean age 30.7±12.03; 182 (37.8%) female, mean age 31.17±13.22)] were enrolled. The duration of stay in the emergency department was between 0-6 and 6-12 hours in 320 (66.4%) and 143 (29.7%) patients, respectively. The ultrasonography findings were consistent with acute appendicitis in 366 (75.9%) patients, and the mean leukocyte count of these patients was 13.141/mm(3). 46 (9.5%) of the patients were diagnosed with perforated appendicitis. The ultrasonography findings were not consistent with acute appendicitis in 36 (7.5%) patients and the leukocyte counts were less than 11.000/mm(3) in these patients. According to the present study results, acute appendicitis is commonly seen among the young adult male population. The coherence of ultrasonography findings with the diagnosis and its association with leukocytosis is significant and supportive. Additionally, the ultrasonography findings, leukocytosis, medical history and physical examination are important and essential factors for the diagnosis of acute appendicitis. A large number of patients with acute appendicitis were followed-up between 0-6 hours in the emergency department.

  20. How to differentiate acute pelvic inflammatory disease from acute appendicitis ? A decision tree based on CT findings.

    Science.gov (United States)

    El Hentour, Kim; Millet, Ingrid; Pages-Bouic, Emmanuelle; Curros-Doyon, Fernanda; Molinari, Nicolas; Taourel, Patrice

    2018-02-01

    To construct a decision tree based on CT findings to differentiate acute pelvic inflammatory disease (PID) from acute appendicitis (AA) in women with lower abdominal pain and inflammatory syndrome. This retrospective study was approved by our institutional review board and informed consent was waived. Contrast-enhanced CT studies of 109 women with acute PID and 218 age-matched women with AA were retrospectively and independently reviewed by two radiologists to identify CT findings predictive of PID or AA. Surgical and laboratory data were used for the PID and AA reference standard. Appropriate tests were performed to compare PID and AA and a CT decision tree using the classification and regression tree (CART) algorithm was generated. The median patient age was 28 years (interquartile range, 22-39 years). According to the decision tree, an appendiceal diameter ≥ 7 mm was the most discriminating criterion for differentiating acute PID and AA, followed by a left tubal diameter ≥ 10 mm, with a global accuracy of 98.2 % (95 % CI: 96-99.4). Appendiceal diameter and left tubal thickening are the most discriminating CT criteria for differentiating acute PID from AA. • Appendiceal diameter and marked left tubal thickening allow differentiating PID from AA. • PID should be considered if appendiceal diameter is < 7 mm. • Marked left tubal diameter indicates PID rather than AA when enlarged appendix. • No pathological CT findings were identified in 5 % of PID patients.

  1. How to differentiate acute pelvic inflammatory disease from acute appendicitis? A decision tree based on CT findings

    International Nuclear Information System (INIS)

    El Hentour, Kim; Millet, Ingrid; Pages-Bouic, Emmanuelle; Curros-Doyon, Fernanda; Taourel, Patrice; Molinari, Nicolas

    2018-01-01

    To construct a decision tree based on CT findings to differentiate acute pelvic inflammatory disease (PID) from acute appendicitis (AA) in women with lower abdominal pain and inflammatory syndrome. This retrospective study was approved by our institutional review board and informed consent was waived. Contrast-enhanced CT studies of 109 women with acute PID and 218 age-matched women with AA were retrospectively and independently reviewed by two radiologists to identify CT findings predictive of PID or AA. Surgical and laboratory data were used for the PID and AA reference standard. Appropriate tests were performed to compare PID and AA and a CT decision tree using the classification and regression tree (CART) algorithm was generated. The median patient age was 28 years (interquartile range, 22-39 years). According to the decision tree, an appendiceal diameter ≥ 7 mm was the most discriminating criterion for differentiating acute PID and AA, followed by a left tubal diameter ≥ 10 mm, with a global accuracy of 98.2 % (95 % CI: 96-99.4). Appendiceal diameter and left tubal thickening are the most discriminating CT criteria for differentiating acute PID from AA. (orig.)

  2. A SURVEY ON FREQUENCY OF ACUTE APPENDICITIS IN (15-70 YEARS DURING 1418-1420 (LUNAR

    Directory of Open Access Journals (Sweden)

    A DAVOUDABADI

    2003-12-01

    Full Text Available History and Objective: Since acute appendicitis occur as a surgical emergency and should be operated as soon as possible, our experiences showed some fluctuations of appendicitis in Various mouth. We Performed this study to define the frequency of it in 1418 - 1420. Material and Method: Affected Patients In all ages, and aged from 15 - 70 years old which tolerated fasting were enrolled in this study Age. sex and the number of operated patient in each month were considered. Results: Total number of docummended appendicitis Were 414 - 423 - 407 for the years of 1418, 1419 and 1420 respectively. The ratio of M/F=1.2:1 and total frequency was 110/100000.ln the Moharram and Shawal of 1418-20 the number of patients were 49-48-46 and 54-47-47 respectively, which was higher than other months Rmadan had the least frequent patients in these years (20-25-17 there was no significant difference in the number of patient among other months. Conclusion: The frequency of acute appendicitis is decreaed in Ramadan significantly which was most likely due to the fasting and diatary states of the ptients althouqh other nivestigation is rocommended.

  3. Acute Appendicitis, Somatosensory Disturbances ("Head Zones"), and the Differential Diagnosis of Anterior Cutaneous Nerve Entrapment Syndrome (ACNES).

    Science.gov (United States)

    Roumen, Rudi M H; Vening, Wouter; Wouda, Rosanne; Scheltinga, Marc M

    2017-06-01

    Anterior cutaneous nerve entrapment syndrome (ACNES) is a neuropathic abdominal wall pain syndrome typically characterized by locally altered skin sensations. On the other hand, visceral disease may also be associated with similar painful and altered skin sensations ("Head zones"). Aim of the study was to determine if patients with acute appendicitis demonstrated somatosensory disturbances in the corresponding right lower quadrant Head zone. The presence of somatosensory disturbances such as hyperalgesia, hypoesthesia, altered cool perception, or positive pinch test was determined in 100 patients before and after an appendectomy. Potential associations between altered skin sensations and various items including age, sex, history, body temperature, C-reactive protein (CRP), leukocyte count, and type of appendicopathy (normal, inflamed, necrotic, or perforated) were assessed. A total of 39 patients demonstrated at least one right lower abdominal quadrant skin somatosensory disturbance before the laparoscopic appendectomy. However, locoregional skin sensation normalized in all but 2 patients 2 weeks postoperatively. No differences were found concerning patient characteristics or type of appendicopathy between populations with or without altered lower abdominal skin sensations. A substantial portion of patients with acute appendicitis demonstrate right lower abdominal somatosensory disturbances that are similar as observed in acute ACNES. Both may be different sides of the same coin and are possibly expressions of segmental phenomena as described by Head. McBurney's point, a landmark area of maximum pain in acute appendicitis, is possibly a trigger point within a Head zone. Differentiating acute appendicitis from acute ACNES is extremely difficult, but imaging and observation may aid in the diagnostic process.

  4. Usefulness of computed tomography in patients with right inferior abdominal quadrant pain: acute appendicitis and its alternative diagnosis

    International Nuclear Information System (INIS)

    Rossini, Sebastian A.; Haberman, Diego; Gonzalez Villaveiran, Ruben F.

    2009-01-01

    Purpose: To review the tomography findings of the acute appendicitis, their complications and alternative diagnosis. To value the use of helicoidal computed tomography (HCT) in the diagnosis of acute appendicitis and in the study of patients with right inferior abdominal quadrant (RIQ) pain and acute abdomen, for diagnosis and eventual complications, in order to decide treatment. Materials and method: For five months, the populations included in this retrospectively study were all patients delivered for presenting with RIQ pain for a HCT exam. These exams were made with oral and intravenous contrasts, when there were not contraindications. The HCT results were correlated with clinical follow up, surgery and histopathologic exams. Results: Over a total of 100 patients studied, 53 presented tomographic diagnosis of appendicitis, 22 of which presented perforation signs; 27 showed an alternative diagnosis (ovaries follicles, ureteral litiasis, tiphlitis, diverticulitis, colitis, salpingitis), 18 patients did not present tomographic findings to support the clinical symptoms and 2 presented indeterminated results. These data represented a sensibility of 100%, specificity of 95,7%, positive predictive value (PPV) of 96,2% and negative predictive value (NPV) of 100% for the tomography diagnosis of acute appendicitis and a sensibility of 100%, specificity of 81,8%, PPV of 95,1% and NPV of 100% for the tomography diagnosis of the different etiology in patient with right inferior acute abdomen. Conclusion: HCT is extremely useful in the study of patients with acute abdomen with origin in the RIQ, not only to make a diagnosis, but also to evaluate the complications, so as to decide proper treatment. (authors) [es

  5. A new technique for the diagnosis of acute appendicitis: abdominal CT with compression to the right lower quadrant.

    Science.gov (United States)

    Kılınçer, Abidin; Akpınar, Erhan; Erbil, Bülent; Ünal, Emre; Karaosmanoğlu, Ali Devrim; Kaynaroğlu, Volkan; Akata, Deniz; Özmen, Mustafa

    2017-08-01

    To determine the diagnostic accuracy of abdominal CT with compression to the right lower quadrant (RLQ) in adults with acute appendicitis. 168 patients (age range, 18-78 years) were included who underwent contrast-enhanced CT for suspected appendicitis performed either using compression to the RLQ (n = 71) or a standard protocol (n = 97). Outer diameter of the appendix, appendiceal wall thickening, luminal content and associated findings were evaluated in each patient. Kruskal-Wallis, Fisher's and Pearson's chi-squared tests were used for statistical analysis. There was no significant difference in the mean outer diameter (MOD) between compression CT scans (10.6 ± 1.9 mm) and standard protocol (11.2 ± 2.3 mm) in patients with acute appendicitis (P = 1). MOD was significantly lower in the compression group (5.2 ± 0.8 mm) compared to the standard protocol (6.5 ± 1.1 mm) (P appendicitis. A cut-off value of 6.75 mm for the outer diameter of the appendix was found to be 100% sensitive in the diagnosis of acute appendicitis for both groups. The specificity was higher for compression CT technique (67.7 vs. 94.9%). Normal appendix diameter was significantly smaller in the compression-CT group compared to standard-CT group, increasing diagnostic accuracy of abdominal compression CT. • Normal appendix diameter is significantly smaller in compression CT. • Compression could force contrast material to flow through the appendiceal lumen. • Compression CT may be a CT counterpart of graded compression US.

  6. Laparoscopy: a safe approach to appendicitis during pregnancy.

    Science.gov (United States)

    Sadot, Eran; Telem, Dana A; Arora, Manjit; Butala, Parag; Nguyen, Scott Q; Divino, Celia M

    2010-02-01

    The aim of this study was to evaluate laparoscopic versus open surgery for suspected appendicitis during pregnancy. A hospital-based retrospective review of 65 consecutive pregnant patients who underwent surgery for suspected appendicitis from 1999 to 2008 was performed. Significance was determined by Pearson's chi(2) test, Fisher's exact test, Mann-Whitney test, and Kruskal-Wallis test. Of the 65 patients, 48 cases were laparoscopic and 17 open. Use of the laparoscopic versus open approach was significantly increased in the first (100% vs. 0%, p appendicitis. While methodological limitations preclude a definitive recommendation, laparoscopy appears to be a safe, feasible, and efficacious approach for pregnant patients with presumed acute appendicitis. We conclude that it is likely not the surgical approach but the underlying diagnosis combined with maternal factors that determine the risk for pregnancy complications. A benefit of laparoscopy is the diagnostic ability to identify other intra-abdominal pathology which may mimic appendicitis and harbor pregnancy risks.

  7. [The Alvarado score validation in diagnosing acute appendicitis in children at Braga Hospital].

    Science.gov (United States)

    Gonçalves, Jean Pierre; Cerqueira, Arnaldo; Martins, Sofia

    2011-12-01

    Acute appendicitis (AA) is the leading cause of emergency abdominal surgery in children. The diagnosis is essentially clinical, but some methodologies, such as Alvarado score (AS), have been developed in order to avoid non-therapeutic laparotomy (15-30%). AS ≥ 5 or 6 is compatible with AA and is an indication for the patient to remain on observations, if AS ≥ 7 a laparotomy procedure may be indicated. To validate the AS for the AA diagnosis of children admitted at Braga Hospital. A validation study of diagnostic method (AS) using the histological examination as a gold standard. The study population consisted of 192 children (4-17 years) with abdominal pain that underwent appendectomy in the last 20 months (December 2008 to July 2010). It was determined the values of sensitivity (S), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), likelihood ratio (LR) and the ROC curve for three different cut-off points (SA =5, 6 and 7). We found that as the cut-off point of AS decreases progressively the sensitivity and specificity increases and reduces the VPN and VPP. Assuming a cut-off value of 5, only 18 children would be false negatives, instead of the 67 children if the cut-off point was 7 points. The analysis of ROC curves demonstrated a greater area under the curve for a cut-off equal to or greater than 5 (AUC = 70%). We recommend using a cut-off value of 5 points, since only 18 children with AA were initially classified as appendicitis unlikely, this value would increase to 67 patients for the SA value of ≥ 7. The AS is a valuable tool in screening children with abdominal pain for the diagnosis of AA. Nonetheless the diagnosis and final decision must be based on clinical and systematic reassessment of patients.

  8. Acute Perforated Appendicitis as a Cause of Fetal Tachycardia at Term Pregnancy

    OpenAIRE

    Sabri Cavkaytar; Mahmut Kuntay Kokanali; Canan Uzun; Aylin Kalinbacoglu; Nafiye Karakas Yilmaz

    2015-01-01

    During pregnancy, appendectomy is the most common non-obstetrical surgery. But diagnosis of appendicitis is difficult in term pregnancy due to low sensitivity of ultrasound and nonspecific symptoms that interferes with pregnancy itself. Due to the delay in diagnosis, perforation of appendicitis is high in pregnant patients which is associated with adverse maternal and fetal outcomes. In this report, we present a term pregnant patient who had appendicitis with ruptured phlegmon during labour...

  9. [Ultrasonography and the Alvarado score in the diagnosis of acute appendicitis: impact on the negative appendectomy rate].

    Science.gov (United States)

    Genzor Ríos, Sixto Javier; Rodríguez Artigas, Juan Miguel; Giménez Maurel, Teresa; Vallejo Bernad, Cristina; Aguirre Prat, Naira; Miguelena Bobadilla, José María

    2016-01-01

    To establish the negative appendectomy rate (NAR) after patients with acute abdomen were evaluated with the Alvarado score and compare it to the NAR in patients evaluated with abdominal ultrasound. Cross-sectional, retrospective, descriptive study in patients who underwent emergency surgery for suspected acute appendicitis in a tertiary-care hospital over a period of 1 year. A total of 225 patients were included. The NAR was 7.11% for the series. An Alvarado score of 5 or more had an odds ratio (OR) of 7.46 (P=.0002) for acute appendicitis; sensitivity was 94.2%. Ultrasound findings consistent with acute appendicitis had an OR of 3.58 (P=.0125) for the diagnosis; the NAR was 5%. The high sensitivity of an Alvarado score of 5 or more supports using this tool to evaluate all patients who come to the emergency department with pain in the right iliac fossa. With scores of 7 or more the NAR falls to 3%. Abdominal ultrasound is a rapid, inexpensive diagnostic procedure associated with a low NAR.

  10. Uso de la antibioticoterapia perioperatoria en la apendicitis aguda: Use of perioperative antibiotic therapy Acute appendicitis:

    Directory of Open Access Journals (Sweden)

    Gimel Sosa Martín

    2009-09-01

    Full Text Available INTRODUCCIÓN. La apendicitis aguda es la afección que más frecuentemente requiere intervención quirúrgica de urgencia. El uso de profilaxis antimicrobiana disminuye la incidencia de sepsis de la herida quirúrgica y mejora la relación riesgo-beneficio y costo-beneficio de la operación. El presente estudio buscó diseñar e implantar un protocolo terapéutico para el uso de antimicrobianos, según estadio de la apendicitis aguda, para uso en centros de atención secundaria. MÉTODOS. Se realizó un estudio prospectivo de indicación-prescripción con elementos de consecuencias prácticas y un grupo de intervención. Se seleccionaron de manera aleatoria 215 pacientes con diagnóstico de apendicitis aguda, atendidos entre diciembre del 2002 y diciembre del 2006. Se establecieron dos grupos, uno de control y uno experimental. Se instauró un protocolo de profilaxis aplicado al grupo experimental, basado en textos de referencia y adecuado al contexto socioeconómico cubano. RESULTADOS. Se aplicó el protocolo de profilaxis a 105 pacientes. La incidencia de sepsis fue del 8,5 %, significativamente menor a la del grupo control (24,5 %. El costo fue igualmente menor en el grupo experimental. CONCLUSIONES. El uso racional de la terapéutica antimicrobiana para la profilaxis de la infección de la herida quirúrgica mejora la relación riesgo-beneficio y costo-beneficio del procedimiento quirúrgico y la calidad de la atención médica.INTRODUCTION: Acute appendicitis if the affection that more frequent requires of an emergence surgical intervention. Use of antimicrobial prophylaxis decreases sepsis incidence of surgical wound, and to improve the risk-benefit and the cost-benefit relation of surgery. Present study tried to design and to creates a therapeutical protocol for use of antimicrobials, according to acute appendicitis stage to use in secondary care centers. METHODS: We made a prospective study of prescription-indication with the elements

  11. Understanding the reasons for delay to definitive surgical care of patients with acute appendicitis in rural South Africa.

    Science.gov (United States)

    Kong, V Y; Aldous, C; Clarke, D L

    2014-02-01

    Acute appendicitis in rural South Africa is associated with significant morbidity due to prolonged delays before definitive surgical care. This audit aimed to quantify the delay in our healthcare system. From September 2010 to September 2012, all patients with confirmed acute appendicitis were interviewed and asked about the onset of symptoms and subsequent events in the disease process. Events before and after contact with the healthcare system were referred to as the pre-hospital or behavioural domain and the in-hospital or assessment domain, respectively. Of the 500 patients, 350 (70.0%) experienced a delay of>48 hours from onset of symptoms to definitive surgical care. The mean time before treatment for this group was 5 days (range 3 - 7), while the mean for the group without delay was 1.6 days (range 1 - 2) (pdelays, 291 were in the behavioural domain and 172 in the assessment domain; 178 patients (50.9%) experienced delay in the behavioural domain only, 59 (16.9%) in the assessment domain only, and 113 (32.2%) in both domains. The mean ambulance transport time from the district hospital to the regional hospital was 4.9 hours. There are barriers that prevent patients with acute appendicitis from accessing care. There are also prolonged delays within the system once care has been accessed. Both these sources of delay need to be addressed by quality improvement programmes.

  12. Comparison of Low- and Standard-Dose CT for the Diagnosis of Acute Appendicitis: A Meta-Analysis.

    Science.gov (United States)

    Yun, Seong Jong; Ryu, Chang-Woo; Choi, Na Young; Kim, Hyun Cheol; Oh, Ji Young; Yang, Dal Mo

    2017-06-01

    A meta-analysis was performed to compare low-dose CT and standard-dose CT in the diagnosis of acute appendicitis with an emphasis on diagnostic value. A systematic literature search for articles published through June 2016 was performed to identify studies that compared low-dose CT with standard-dose CT for the evaluation of patients suspected of having acute appendicitis. Summary estimates of sensitivity and specificity with 95% CIs were calculated using a bivariate random-effects model. Meta-regression was used to perform statistical comparisons of low-dose CT and standard-dose CT. Of 154 studies, nine studies investigating a total of 2957 patients were included in this meta-analysis. The pooled sensitivity and specificity of low-dose CT were 96.25% (95% CI, 91.88-98.31%) and 93.22% (95% CI, 88.75-96.00%), respectively. The pooled sensitivity and specificity of standard-dose CT were 96.40% (95% CI, 93.55-98.02%) and 92.17% (95% CI, 88.24-94.86%), respectively. In a joint model estimation of meta-regression, lowand standard-dose CT did not show a statistically significant difference (p = 0.71). Both lowand standard-dose CT seem to be characterized by high positive and negative predictive values across a broad spectrum of pretest probabilities for acute appendicitis. Low-dose CT is highly effective for the diagnosis of suspected appendicitis and can be considered a valid alternative first-line imaging test that reduces the potential risk of exposure to ionizing radiation.

  13. The diagnostic performance of ultrasound for acute appendicitis in pregnant and young nonpregnant women: A case-control study.

    Science.gov (United States)

    Segev, Lior; Segev, Yakir; Rayman, Shlomi; Nissan, Aviram; Sadot, Eran

    2016-10-01

    Ultrasonography is frequently used to diagnose acute appendicitis in women of reproductive age, but its diagnostic value in pregnant patients remains unclear. This study sought to compare the diagnostic performance of ultrasound in pregnant and young nonpregnant women with suspected acute appendicitis. The database of a single tertiary medical center was reviewed for all women of reproductive age who underwent appendectomy either during pregnancy (2000-2014) or in the nonpregnant state (2004-2007) following ultrasound evaluation. The performance of ultrasound in terms of predicting the final pathologic diagnosis was compared between the pregnant and non pregnant groups using receiver operating characteristic curve analysis. Of 586 young women treated for appendicitis during the study periods (92 pregnant, 494 non-pregnant), 200 underwent preoperative ultrasound [67 pregnant, and 133 nonpregnant young women]. The pregnant and nonpregnant groups were comparable in age and presenting symptoms. There was no significant difference in the predictive performance of ultrasound between the two groups (AUC 0.76 and 0.73 respectively, p = 0.78) or within the pregnant group, by trimester [first (n = 23), AUC 0.73; second (n = 32), AUC 0.67; third (n = 12), AUC 0.86; p = 0.4]. Ultrasound had a positive predictive value of 0.94 in the pregnant group and 0.91 in the nonpregnant group; corresponding negative predictive values were 0.40 and 0.43. There appears to be no difference in the ability of ultrasound to predict the diagnosis of acute appendicitis between pregnant women and nonpregnant women of reproductive age. Therefore, similar preoperative imaging algorithms may be used in both patient populations. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  14. Appendicitis: a continuing challenge.

    Science.gov (United States)

    Pal, K M; Khan, A

    1998-07-01

    Acute appendicitis is a common surgical emergency in urban setting, of a developing country. The computerised hospital patient database at Aga Khan University Hospital, Karachi, was utilised to obtain records of all adults with a histologically proven diagnosis of acute appendicitis. A review of patients treated over a 18 month period was undertaken. One hundred and three appendicectomies were performed for acute appendicitis during this period. The diagnosis was clinical in all cases. Investigations like leucocyte count and lower abdominal ultrasound scan were used to improve diagnostic accuracy without a clear advantage. A number of routine investigations like, haemoglobin estimation and urea, creatinine, electrolyte measurements, did not provide additional information. The duration of antibiotic treatment in acute simple appendicitis was empiric and could be reduced to a single preoperative dose. Peritoneal fluid culture studies had a poor yield (26%) and results were not found to effect management in acute simple appendicitis. The routine use of Ampicillin in all cases of bacterial peritonitis needs re-evaluation, as a high incidence (73%) of resistance was seen. Studies to define the role and duration of treatment, with a single antibiotic, in acute simple appendicitis should be undertaken. Acute appendicitis is probably the most frequently considered surgical differential diagnosis at any hospital dealing with acute surgical conditions. The established treatment continues to be surgical removal of the inflamed organ. The diagnosis and decision to operate both are accepted to be based on clinical judgement, though a number of investigative manoeuvres have been described to reduce the negative appendicectomy rate. Other areas of debate are the number and length of antibiotic treatment and use of bacterial culture studies in cases of simple acute appendicitis. To analyse present practice and identify areas for study and change, a retrospective study was

  15. Informative content of clinical symptoms of acute appendicitis in different terms of pregnancy

    Directory of Open Access Journals (Sweden)

    Kutovoy A.B.

    2015-09-01

    Full Text Available With the purpose to evaluate diagnostic efficacy of some clinical symptoms of acute appendicitis 75 women in different terms of pregnancy were examined. Informative content of such symptoms as Kocher- Volkovich, Rovsing, Bartomje - Michelson, Sitkovsky, Gabay, Brendo, Michelson, Ivanov was studied. Pain syndrome was fixed in all examined women. Pain localization was various and depended on the pregnancy term. During the I trimester of pregnancy the most often pain was manifestated in epigastrium and right lower quadrant, rarely in other abdomen regions. In the II trimester in majority of cases pain occurred in right lower quadrant. During III trimester pain prevailed in right upper quadrant of abdomen. Analyzing informative component of researching symptoms there was noted significant decrease (р<0,05; р<0,01; р<0,001 of their diagnostic value with growth of pregnancy term. Therefore Kocher – Volkovich and Rovsing symptoms were the most informative in the I trimester of pregnancy. Diagnostic efficacy of Brendo(67,3%, Michelson(55,7%, Ivanov(59,6% symptoms was higher than that of Kocher – Volkovich (36,5%, Rovsing (28,8%, Sitkovsky (51,9%, Bartomje – Michelson (55,7% symptoms, their value was diminishing together with increase of pregnancy terms.

  16. The role of DNA amplification and cultural growth in complicated acute appendicitis

    Directory of Open Access Journals (Sweden)

    Francesca Tocchioni

    2016-09-01

    Full Text Available Bacterial growth of peritoneal fluid specimens obtained during surgical procedures for acute appendicitis may be useful to optimize further antibiotic therapy in complicated cases. DNA amplification represents a fast technique to detect microbial sequences. We aimed to compare the potential of DNA amplification versus traditional bacterial growth culture highlighting advantages and drawbacks in a surgical setting. Peritoneal fluid specimens were collected during surgery from 36 children who underwent appendectomy between May and December 2012. Real-time polymerase chain reaction (RT-PCR and cultures were performed on each sample. RT-PCR showed an amplification of 16S in 18/36 samples, Escherichia coli (in 7 cases, Pseudomonas aeruginosa (3, Fusobacterium necrophorum (3, Adenovirus (2, E.coli (1, Klebsiella pneumoniae (1, Serratia marcescens/Enterobacter cloacae (1. Bacterial growth was instead observed only in four patients (3 E.coli and 1 P.aeruginosa and Bacteroides ovatus. Preoperative C-reactive protein and inflammation degree, the most reliable indicators of bacterial translocation, were elevated as expected. DNA amplification was a quick and useful method to detect pathogens and it was even more valuable in detecting aggressive pathogens such as anaerobes, difficult to preserve in biological cultures; its drawbacks were the lack of biological growths and of antibiograms. In our pilot study RT-PCR and cultures did not influence the way patients were treated.

  17. Rectal contrast-enhanced computed tomography in the diagnosis of acute appendicitis

    International Nuclear Information System (INIS)

    2000-01-01

    To assess the efficacy and utility of computed tomography (CT) in the diagnosis of appendicitis, and to evaluate the reliability of CT findings in right iliac fossa in the confirmation or exclusion of this diagnosis. Over a one-year period, 152 patients presenting clinical signs of appendicitis underwent CT scans. The images were reviewed by two radiologists who considered whether the appendix was normal or enlarged and the existence of other signs of appendicitis for the purpose of determining whether or not the patient presented appendicitis. The definitive diagnoses were established by surgery or by clinical follow-up. The sensitivity of CT for the diagnosis of appendicitis was 81.8%, the specificity was 95.3%, the positive predictive value was 93.1%, the negative predictive value was 87.2% and the reliability was 89.9%. The signs of appendicitis observed were: appendicoliths (sensitivity 30.3% and specificity 98.8%), fluid collections (sensitivity 19.7%, specificity 96.5%), cecal enlargement (sensitivity 21.2%, specificity 97.7%), inflammation of pericecal fat (sensitivity 72.7%, specificity 90.7%), fascial thickening (sensitivity 48.5%, specificity 91.9%) and an appendix measuring more than 6 mm (sensitivity 78.8%, specificity 94.3%). Adenopathy and free peritoneal fluid were not significantly related to appendicitis. The presence of a normal appendix filled with air or contrast material had an elevated negative predictive value with respect to appendicitis. In 35 of the 94 cases with negative CT scans, the images suggested alternative diagnoses. CT is a highly reliable diagnostic method for appendicitis. The observation of an appendix filled with air or contrast material has an elevated negative predictive value. The presence of appendicoliths has an elevated positive predictive value. (Author) 29 refs

  18. Ultrasound, computed tomography or magnetic resonance imaging - which is preferred for acute appendicitis in children? A Meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Hanfei; Liao, Meiyan; Chen, Jie; Zhu, Dongyong; Byanju, Sama [ZhongNan Hospital of Wuhan University, Department of Radiology, Wuhan (China)

    2017-02-15

    There is no established consensus about the relative accuracies of US, CT and MRI in childhood appendicitis. To compare, through meta-analysis, the accuracies of US, CT and MRI for clinically suspected acute appendicitis in children. PubMed, Embase, Web of Science and the Cochrane Library were searched. After study selection, data extraction and quality assessment, the sensitivity, specificity and the area under the curve of summary receiver operating characteristic were calculated and compared. Twenty-seven articles including 29 studies met the inclusion criteria, including 19 studies (9,170 patients) of US, 6 studies (928 patients) of CT and 4 studies (990 patients) of MRI. The analysis showed that the area under the receiver operator characteristics curve of MRI (0.995) was a little higher than that of US (0.987) and CT (0.982; P > 0.05). US, CT and MRI have high diagnostic accuracies of clinically suspected acute appendicitis in children overall with no significant difference. (orig.)

  19. Bedside Ultrasonography as an Adjunct to Routine Evaluation of Acute Appendicitis in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Samuel H.F. Lam

    2014-11-01

    Full Text Available Introduction: Appendicitis is a common condition presenting to the emergency department (ED. Increasingly emergency physicians (EP are using bedside ultrasound (BUS as an adjunct diagnostic tool. Our objective is to investigate the test characteristics of BUS for the diagnosis of appendicitis and identify components of routine ED workup and BUS associated with the presence of appendicitis. Methods: Patients four years of age and older presenting to the ED with suspected appendicitis were eligible for enrollment. After informed consent was obtained, BUS was performed on the subjects by trained EPs who had undergone a minimum of one-hour didactic training on the use of BUS to diagnose appendicitis.They then recorded elements of clinical history, physical examination, white blood cell count (WBC with polymophonuclear percentage (PMN, and BUS findings on a data form. We ascertained subject outcomes by a combination of medical record review and telephone follow-up. Results: A total of 125 subjects consented for the study, and 116 had adequate image data for final analysis. Prevalence of appendicitis was 40%. Mean age of the subjects was 20.2 years, and 51% were male. BUS was 100% sensitive (95% CI 87-100% and 32% specific (95% CI 14-57% for detection of appendicitis, with a positive predictive value of 72% (95% CI 56-84%, and a negative predictive value of 100% (95% CI 52-100%. Assuming all non-diagnostic studies were negative would yield a sensitivity of 72% and specificity of 81%. Subjects with appendicitis had a significantly higher occurrence of anorexia, nausea, vomiting, and a higher WBC and PMN count when compared to those without appendicitis. Their BUS studies were significantly more likely to result in visualization of the appendix, appendix diameter >6mm, appendix wall thickness >2mm, periappendiceal fluid, visualization of the appendix tip, and sonographic Mcburney’s sign (p6mm, appendix wall thickness >2mm, periappendiceal fluid were

  20. Acute Perforated Appendicitis as a Cause of Fetal Tachycardia at Term Pregnancy

    Directory of Open Access Journals (Sweden)

    Sabri Cavkaytar

    2015-06-01

    Full Text Available During pregnancy, appendectomy is the most common non-obstetrical surgery. But diagnosis of appendicitis is difficult in term pregnancy due to low sensitivity of ultrasound and nonspecific symptoms that interferes with pregnancy itself. Due to the delay in diagnosis, perforation of appendicitis is high in pregnant patients which is associated with adverse maternal and fetal outcomes. In this report, we present a term pregnant patient who had appendicitis with ruptured phlegmon during labour. [Cukurova Med J 2015; 40(2.000: 336-339

  1. Appendicular Diverticulosis with Appendicitis.

    Science.gov (United States)

    Hammad Alam, Syed Muhammad

    2017-03-01

    Appendicular diverticulosis is one of the very rare diseases which is also difficult to diagnose, especially clinically, due to its silent course and non-specific symptoms. It comes under the notation usually due to its complications like diverticulitis or perforation, but sometimes it also presents with acute appendicitis. This report describes a 44-year male patient who presented with the complain of right iliac fossa pain and was clinically diagnosed as acute appendicitis; but intraoperatively, it was found that the appendix also had diverticulosis along with appendicitis.

  2. Primary signet-ring cell carcinoma of vermiform appendix clinically and pathologically presenting as acute appendicitis

    Directory of Open Access Journals (Sweden)

    Tadashi Terada, MD, PhD

    2014-03-01

    Full Text Available Primary signet-ring cell carcinoma (SRCC of vermiform appendix is extremely rare; only three cases have been reported in the English literature. An 89-year-old man suddenly presented right lower abdominal pain, and transferred to a hospital, where he was diagnosed with acute appendicitis by physical data, blood data, and CT. He was further transferred to our hospital for emergency operation. Physical examination showed positive abdominal pain, Blunberg sign, and Rosenstein sign. Blood test showed leukocytosis and increased C-reactive protein. An appendectomy was performed. Gross examination during operation showed inflamed appendix, appendiceal adhesion, and acute peritonitis. Gross pathological examination showed no apparent tumor, but the proximal appendix showed wall thickening and luminal occlusion. The appendix was cut into three sections, and was observed under microscopically. Nests of carcinoma cells were seen in the proximal appendix. The carcinoma was composed of SRCC (70% and mucinous carcinoma (30%. The size of carcinoma was 6 × 7 mm. The carcinoma cells invaded into muscular layer. No lymphovascular permeation was seen. The cut margins were negative for carcinoma cells. Immunohistochemically, SRCC cells were positive for cytokeratin (CK AE1/3, CK CAM5.2, CK8, CK18, CK19, CK20, EMA, CEA, CA19-9, p53, Ki-67 (labeling = 30%, CDX2, MUC2, and MUC5AC. They were negative for CK34PE1, CK5/6, CK7, CK14, p63, vimentin, TTF-1, MUC1, MUC 5AC, NSE, synaptophysin, chromogranin, and CD56. No further treatments were performed, because the appendiceal carcinoma was small, the surgical margins were negative and the patient was very old. He was followed up by various imaging modalities. No recurrence or metastasis is found 17 months after the operation.

  3. C-reactive protein and white blood cell count do not improve clinical decision-making in acute appendicitis

    DEFF Research Database (Denmark)

    Tind, Sofie; Lassen, Annmarie Touborg; Zimmermann-Nielsen, Erik

    2015-01-01

    INTRODUCTION: Acute appendicitis (AA) remains a diagnostic challenge as indicated by the high rate of unnecessary surgery. Blood samples, primarily C-reactive protein (CRP) and leucocyte counts, are used as a diagnostic supplement despite their relatively low sensitivities and specificities....... However, their influence on diagnostic decision-making has not previously been investigated. The aim of the present study was to investigate if the results of CRP and leucocytes had any positive or negative influence on the decision-making of surgeons handling patients with suspected AA. METHODS...... appendicitis on histology. The surgeons changed their diagnosis in nine cases after assessing blood samples. The changes in the proportion of correct diagnoses, sensitivity, specificity and predictive values after assessing blood samples were not significant. CONCLUSIONS: The results of CRP and leucocyte...

  4. The diagnostic value of a panel of serological markers in acute appendicitis

    DEFF Research Database (Denmark)

    Farooqui, W; Pommergaard, H-C; Burcharth, J

    2015-01-01

    markers could increase the prognostic accuracy of diagnosing non-perforated and perforated appendicitis. MATERIAL AND METHODS: Demographic data, histological findings, blood tests, and clinical symptoms were collected on all patients who underwent a diagnostic laparoscopy, a laparoscopic appendectomy...

  5. Endometriosis of the vermiform appendix as an exceptional cause of acute perforated appendicitis during pregnancy.

    Science.gov (United States)

    Faucheron, J-L; Pasquier, D; Voirin, D

    2008-06-01

    The incidence of appendicitis presenting during pregnancy is less than 1 in 1500. Most cases of endometriosis of the appendix are discovered as a result of incidental appendectomy. True perforated appendicitis in an endometriotic area has not been reported before. The authors report the case of a 28-year-old woman in her 27th week of pregnancy who underwent an appendicectomy for inflamed, perforated appendix with transmural endometriosis and accompanying decidual reaction.

  6. Acute appendicitis: prospective evaluation of a diagnostic algorithm integrating ultrasound and low-dose CT to reduce the need of standard CT.

    Science.gov (United States)

    Poletti, Pierre-Alexandre; Platon, Alexandra; De Perrot, Thomas; Sarasin, Francois; Andereggen, Elisabeth; Rutschmann, Olivier; Dupuis-Lozeron, Elise; Perneger, Thomas; Gervaz, Pascal; Becker, Christoph D

    2011-12-01

    To evaluate an algorithm integrating ultrasound and low-dose unenhanced CT with oral contrast medium (LDCT) in the assessment of acute appendicitis, to reduce the need of conventional CT. Ultrasound was performed upon admission in 183 consecutive adult patients (111 women, 72 men, mean age 32) with suspicion of acute appendicitis and a BMI between 18.5 and 30 (step 1). No further examination was recommended when ultrasound was positive for appendicitis, negative with low clinical suspicion, or demonstrated an alternative diagnosis. All other patients underwent LDCT (30 mAs) (step 2). Standard intravenously enhanced CT (180 mAs) was performed after indeterminate LDCT (step 3). No further imaging was recommended after ultrasound in 84 (46%) patients; LDCT was obtained in 99 (54%). LDCT was positive or negative for appendicitis in 81 (82%) of these 99 patients, indeterminate in 18 (18%) who underwent standard CT. Eighty-six (47%) of the 183 patients had a surgically proven appendicitis. The sensitivity and specificity of the algorithm were 98.8% and 96.9%. The proposed algorithm achieved high sensitivity and specificity for detection of acute appendicitis, while reducing the need for standard CT and thus limiting exposition to radiation and to intravenous contrast media.

  7. Acute appendicitis: prospective evaluation of a diagnostic algorithm integrating ultrasound and low-dose CT to reduce the need of standard CT

    Energy Technology Data Exchange (ETDEWEB)

    Poletti, Pierre-Alexandre; Platon, Alexandra [University Hospital of Geneva, Department of Radiology, Geneva (Switzerland); University Hospital of Geneva, Emergency Center, Geneva (Switzerland); Perrot, Thomas de; Becker, Christoph D. [University Hospital of Geneva, Department of Radiology, Geneva (Switzerland); Sarasin, Francois; Rutschmann, Olivier [University Hospital of Geneva, Emergency Center, Geneva (Switzerland); Andereggen, Elisabeth [University Hospital of Geneva, Emergency Center, Geneva (Switzerland); University Hospital of Geneva, Department of Surgery, Geneva (Switzerland); Dupuis-Lozeron, Elise; Perneger, Thomas [University Hospital of Geneva, Division of Clinical Epidemiology, Geneva (Switzerland); Gervaz, Pascal [University Hospital of Geneva, Department of Surgery, Geneva (Switzerland)

    2011-12-15

    To evaluate an algorithm integrating ultrasound and low-dose unenhanced CT with oral contrast medium (LDCT) in the assessment of acute appendicitis, to reduce the need of conventional CT. Ultrasound was performed upon admission in 183 consecutive adult patients (111 women, 72 men, mean age 32) with suspicion of acute appendicitis and a BMI between 18.5 and 30 (step 1). No further examination was recommended when ultrasound was positive for appendicitis, negative with low clinical suspicion, or demonstrated an alternative diagnosis. All other patients underwent LDCT (30 mAs) (step 2). Standard intravenously enhanced CT (180 mAs) was performed after indeterminate LDCT (step 3). No further imaging was recommended after ultrasound in 84 (46%) patients; LDCT was obtained in 99 (54%). LDCT was positive or negative for appendicitis in 81 (82%) of these 99 patients, indeterminate in 18 (18%) who underwent standard CT. Eighty-six (47%) of the 183 patients had a surgically proven appendicitis. The sensitivity and specificity of the algorithm were 98.8% and 96.9%. The proposed algorithm achieved high sensitivity and specificity for detection of acute appendicitis, while reducing the need for standard CT and thus limiting exposition to radiation and to intravenous contrast media. (orig.)

  8. The RIPASA score is sensitive and specific for the diagnosis of acute appendicitis in a western population.

    Science.gov (United States)

    Malik, Muhammad Usman; Connelly, Tara M; Awan, Faisal; Pretorius, Frederik; Fiuza-Castineira, Constantino; El Faedy, Osama; Balfe, Paul

    2017-04-01

    The definitive diagnosis of acute appendicitis (AA) requires histopathological examination. Various clinical diagnostic scoring systems attempt to reduce negative appendectomy rates. The most commonly used in Western Europe and the USA is the Alvarado score. The Raja Isteri Pengiran Anak Saleha appendicitis (RIPASA) score achieves better sensitivity and specificity in Asian and Middle Eastern populations. We aimed to determine the diagnostic accuracy of the RIPASA score in Irish patients with AA. All patients who presented to our institution with right iliac fossa pain and clinically suspected AA between January 1 and December 31, 2015, were indentified from our hospital inpatient enquiry database and retrospectively studied. Operating theatre records and histology reports confirmed those who underwent a non-elective operative procedure and the presence or absence of AA. SPSS version 22 was used for statistical analysis. Standard deviation is provided where appropriate. Two hundred eight patients were included in the study (106/51% male, mean age 22.7 ± 9.2 years). One hundred thirty-five (64.9%) had histologically confirmed AA (mean symptom duration = 36.19 ± 15.90 h). At a score ≥7.5, the previously determined score most likely associated with AA in Eastern populations, the RIPASA scoring system demonstrated a sensitivity of 85.39%, specificity of 69.86%, positive predictive value of 84.06%, negative predictive value of 72.86% and diagnostic accuracy of 80% in our cohort. The RIPASA score is a useful tool to aid in the diagnosis of acute appendicitis in the Irish population. A score of ≥7.5 provides sensitivity and specificity exceeding that previously documented for the Alvarado score in Western populations. WHAT DOES THIS PAPER ADD TO THE LITERATURE?: This is the first study evaluating the utility of the RIPASA score in predicting acute appendicitis in a Western population. At a value of 7.5, a cut-off score suggestive of appendicitis in the

  9. Improving the false-negative rate of CT in acute appendicitis-Reassessment of CT images by body imaging radiologists: A blinded prospective study

    Energy Technology Data Exchange (ETDEWEB)

    Poortman, Pieter [Department of Surgery, St Elisabeth Hospital, Tilburg (Netherlands)], E-mail: ppoortman@wlz.nl; Lohle, Paul N.M. [Department of Surgery, St Elisabeth Hospital, Tilburg (Netherlands)], E-mail: plohle@elisabeth.nl; Schoemaker, Cees M. [Department of Surgery, St Elisabeth Hospital, Tilburg (Netherlands)], E-mail: mcschoemaker@elisabeth.nl; Cuesta, Miguel A. [Department of Surgery, VU Medical Centre, Amsterdam (Netherlands)], E-mail: ma.cuesta@vumc.nl; Oostvogel, Henk J.M. [Department of Surgery, St Elisabeth Hospital, Tilburg (Netherlands)], E-mail: h.oostvogel@elisabeth.nl; Lange-de Klerk, Elly S.M. de [Department of Epidemiology and Biostatistics, VU Medical Centre, Amsterdam (Netherlands)], E-mail: esm.delange@vumc.nl; Hamming, Jaap F. [Department of Surgery, Leiden University Medical Centre (Netherlands)], E-mail: j.f.hamming@lumc.nl

    2010-04-15

    Purpose: To compare the accuracy of computed tomography (CT) analyzed by individual radiology staff members and body imaging radiologists in a non-academic teaching hospital for the diagnosis of acute appendicitis. Patients and methods: In a prospective study 199 patients with suspected acute appendicitis were examined with unenhanced CT. CT images were pre-operatively analyzed by one of the 12 members of the radiology staff. In a later stage two body imaging radiologist reassessed all CT images without knowledge of the surgical findings and without knowledge of the primary CT diagnosis. The results, independently reported, were correlated with surgical and histopathologic findings. Results: In 132 patients (66%) acute appendicitis was found at surgery, in 67 patients (34%) a normal appendix was found. The sensitivity of the primary CT analysis and of the reassessment was 76% and 88%, respectively; the specificity was 84% and 87%; the positive predictive value was 90% and 93%; the negative predictive value was 64% and 78%; and the accuracy was 78% and 87%. Conclusion: Reassessment of CT images for acute appendicitis by body imaging radiologists results in a significant improvement of sensitivity, negative predictive value and accuracy. To prevent false-negative interpretation of CT images in acute appendicitis the expertise of the attending radiologist should be considered.

  10. Safety and efficacy of antibiotics compared with appendicectomy for treatment of uncomplicated acute appendicitis: meta-analysis of randomised controlled trials

    Science.gov (United States)

    Varadhan, Krishna K; Neal, Keith R

    2012-01-01

    Objective To compare the safety and efficacy of antibiotic treatment versus appendicectomy for the primary treatment of uncomplicated acute appendicitis. Design Meta-analysis of randomised controlled trials. Population Randomised controlled trials of adult patients presenting with uncomplicated acute appendicitis, diagnosed by haematological and radiological investigations. Interventions Antibiotic treatment versus appendicectomy. Outcome measures The primary outcome measure was complications. The secondary outcome measures were efficacy of treatment, length of stay, and incidence of complicated appendicitis and readmissions. Results Four randomised controlled trials with a total of 900 patients (470 antibiotic treatment, 430 appendicectomy) met the inclusion criteria. Antibiotic treatment was associated with a 63% (277/438) success rate at one year. Meta-analysis of complications showed a relative risk reduction of 31% for antibiotic treatment compared with appendicectomy (risk ratio (Mantel-Haenszel, fixed) 0.69 (95% confidence interval 0.54 to 0.89); I2=0%; P=0.004). A secondary analysis, excluding the study with crossover of patients between the two interventions after randomisation, showed a significant relative risk reduction of 39% for antibiotic therapy (risk ratio 0.61 (0.40 to 0.92); I2=0%; P=0.02). Of the 65 (20%) patients who had appendicectomy after readmission, nine had perforated appendicitis and four had gangrenous appendicitis. No significant differences were seen for treatment efficacy, length of stay, or risk of developing complicated appendicitis. Conclusion Antibiotics are both effective and safe as primary treatment for patients with uncomplicated acute appendicitis. Initial antibiotic treatment merits consideration as a primary treatment option for early uncomplicated appendicitis. PMID:22491789

  11. Comparison of ultrasonographic finding in men and women suspected of acute appendicitis: Usefulness and limitation of measurement of the outer diameter of the vermiform appendix

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Eun Joo; Kim, Soon; Oh, Yeon Hee; Kim, Seung Hyeon; Lee, Sung Woo [Gyeong Ju Hospital, Dongguk University School of Medicine, Gyeongju (Korea, Republic of)

    2004-03-15

    To evaluate the usefulness and limitations of measurement of the outer diameter of the vermiform appendix in men and women patients suspected of acute appendicitis on ultrasonography (US). Retrospectively, the review of the outer diameter of the appendix measured in 197 adult patients, 70 men and 127 women (age ranged from 16 to 83 years), suspected of acute appendicitis on sustained-compression US was done. The measured outer diameters were categorized into two groups according to the patient's sex, and relationships between categoric variables were analyzed by calculating sensitivity, specificity, positive and negative predictive values and accuracy. Data analyses were performed using MedCalc for windows version 7.1.0.1. The outer appendiceal diameters in men ranged between 3.2 and 15 mm, while those in women, between 3.4 and 17 mm. The diameters of acute inflamed appendices ranged from 6 to 17 mm. In men, a diameter equal to or larger than 6 mm was confirmed as acute appendicitis with the sensitivity, specificity and positive and negative predictive values of 100%, 57.6%, 70.2% and 100%, respectively. Meanwhile, in women, a diameter of {>=} 6 mm was confirmed as acute appendicitis with the sensitivity, specificity and positive and negative predictive values of 98%, 55.8%, 68.9% and 96.5%, respectively. The accuracy in women (67.7%) was lower than in men(75.7%), but no statistically significant difference (p=0.395) was seen between men and women. The outer appendiceal diameter of {>=} 6 mm as a sign of acute appendicitis provides a high sensitivity and negative predictive values. This diagnostic criterion is more useful in excluding acute appendicitis than confirming it. There was no statistically significant difference in the accuracy between men and women.

  12. Appendicitis during pregnancy.

    Science.gov (United States)

    Guttman, Rachelle; Goldman, Ran D.; Koren, Gideon

    2004-01-01

    QUESTION: A 26-year-old patient in our clinic, who was 18 weeks pregnant at the time, experienced acute abdominal pain and was diagnosed with appendicitis. The inflamed appendix was successfully removed. Is her pregnancy at risk? ANSWER: Appendicitis is not rare during pregnancy and is associated with increased reproductive risk. Women who have undergone appendectomy during pregnancy are at higher risk of fetal loss, especially in early pregnancy and with appendiceal perforation, and of premature contractions and labour. Despite the difficulty of diagnosing appendicitis during pregnancy, appendectomy should not be delayed. PMID:15318670

  13. Challenges in magnetic resonance imaging for suspected acute appendicitis in pregnant patients.

    Science.gov (United States)

    Ditkofsky, Noah G; Singh, Ajay

    2015-01-01

    The assessment of a gravid patient with abdominal pain is a clinical challenge, as one must consider not only the common etiologies for abdominal pain but also etiologies resulting from the pregnancy. Further complicating the assessment is the altered anatomy and physiology that result from the enlarged uterus displacing and compressing normal anatomical structures. This alteration of anatomy makes the symptoms of appendicitis more variable and thus the diagnosis more difficult. Appropriate and timely imaging can result in better patient outcomes, and when appendicitis is suspected, imaging investigation should not be delayed. This article reviews some of the challenges of magnetic resonance imaging in gravid patients with suspected appendicitis and presents strategies for imaging this population. Copyright © 2015 Mosby, Inc. All rights reserved.

  14. Appendicitis during pregnancy.

    OpenAIRE

    Guttman, Rachelle; Goldman, Ran D.; Koren, Gideon

    2004-01-01

    QUESTION: A 26-year-old patient in our clinic, who was 18 weeks pregnant at the time, experienced acute abdominal pain and was diagnosed with appendicitis. The inflamed appendix was successfully removed. Is her pregnancy at risk? ANSWER: Appendicitis is not rare during pregnancy and is associated with increased reproductive risk. Women who have undergone appendectomy during pregnancy are at higher risk of fetal loss, especially in early pregnancy and with appendiceal perforation, and of prema...

  15. Oxidative stress markers in laparoscopic vs. open appendectomy for acute appendicitis: A double-blind randomized study

    Directory of Open Access Journals (Sweden)

    Recep Aktimur

    2016-01-01

    Full Text Available Background: Oxidative stress is a complicated process, which was defined as an increase in prooxidants and decrease in antioxidants caused by various mechanisms, including inflammation and surgical trauma. The association between acute appendicitis and oxidative stress has been showed in previous studies. However, comparison of oxidative stress in laparoscopic or open appendectomy (OA has not been established. Patients and Methods: Patients who were diagnosed as acute appendicitis between October 2012 and January 2013 were randomized to open (OA, n = 50 and laparoscopic appendectomy (LA, n = 50. Blood samples for oxidative stress markers (total oxidant status [TOS] and total antioxidant status [TAS], C-reactive protein (CRP and white blood cells (WBC's were collected just before the surgery and 24 h after surgery. Results: There were no differences in preoperative values of WBC and CRP between LA and OA groups (P = 0.523 and 0.424, however, in postoperative 24th h, CRP was reduced in LA group (P = 0.031. There were no differences in preoperative levels of TOS, TAS, and oxidative stress index (OSI between LA and OA groups. In the postoperative 24th h, TOS and OSI were found to be significantly higher in OA group when compared to LA group (P = 0.017 and 0.002 whereas no difference was detected in TAS level in the postoperative 24th h (P = 0.172. Conclusions: This double-blind, randomized clinical trial provides evidence that LA for uncomplicated appendicitis is associated with significantly lower oxidative stress compared with OA. Some of the advantages of LA may be attributed to the significant reduction of oxidative stress in these patients.

  16. Descriptive analysis of sonographic findings, surgical and pathological in patients with acute appendicitis in the Hospital San Juan de Dios in the year 2010

    International Nuclear Information System (INIS)

    Murillo Arguello, Fabiola

    2012-01-01

    The Hospital San Juan de Dios has found without studies correlating the ultrasound findings, with the pathology of acute appendicitis by surgery and histological analysis, especially that meets in the same study the utility of ultrasound in the diagnosis. For that reason, the ultrasonographic findings, pathological and surgical of patients with appendiceal pathology are described in the Servicio de Radiologia of Hospital San Juan de Dios in the year 2010. A revision of 324 dossiers in patients with positive biopsy is performed; however, 23% have result without alterations by ultrasound. The female sex has obtained the largest number of diagnosis by ultrasound. The age group for both sexes is found between 21-30 years. The most common transoperative finding has been grade I appendicitis and no perforated appendicitis have prevailed regarding biopsies reported in the pathology service. The validity of ultrasonography is determined to aid in decision making in pathology of acute appendicitis in the emergency room and avoid or reduce complications that can lead a diagnostic doubt, this will inform the surgeon the possible findings when the surgical intervention. Additionally, the diagnosis of acute appendicitis may be discarded when are encountered other pathologies such as ovarian cysts, kidney stones, among others, avoiding unnecessary surgeries. The costs to the institution are reduced by decreasing the hospital stay and the use of operating rooms [es

  17. Schistosomiasis Presenting as a Case of Acute Appendicitis with Chronic Mesenteric Thrombosis

    Directory of Open Access Journals (Sweden)

    Mohammed H. Mosli

    2016-01-01

    Full Text Available The manifestations of schistosomiasis typically result from the host inflammatory response to parasitic eggs that are deposited in the mucosa of either the gastrointestinal tract or bladder. We present here a case of a 50-year-old gentleman with a rare gastrointestinal presentation of both schistosomal appendicitis and mesenteric thrombosis.

  18. Clinical scores for prediction of acute appendicitis in children in a ...

    African Journals Online (AJOL)

    Objective To determine the usefulness of the Alvarado score and the Pediatric Appendicitis score (PAS) in the Pediatric Emergency of the National Hospital. Daniel A. Carrion. Materials and methods A prospective observational study was carried out of patients younger than 15 years of age with abdominal pain and ...

  19. Meta‐analysis of antibiotics versus appendicectomy for non‐perforated acute appendicitis

    Science.gov (United States)

    Sallinen, V.; Akl, E. A.; You, J. J.; Agarwal, A.; Shoucair, S.; Vandvik, P. O.; Agoritsas, T.; Heels‐Ansdell, D.; Guyatt, G. H.

    2016-01-01

    Abstract Background For more than a century, appendicectomy has been the treatment of choice for appendicitis. Recent trials have challenged this view. This study assessed the benefits and harms of antibiotic therapy compared with appendicectomy in patients with non‐perforated appendicitis. Methods A comprehensive search was conducted for randomized trials comparing antibiotic therapy with appendicectomy in patients with non‐perforated appendicitis. Key outcomes were analysed using random‐effects meta‐analysis, and the quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results Five studies including 1116 patients reported major complications in 25 (4·9 per cent) of 510 patients in the antibiotic and 41 (8·4 per cent) of 489 in the appendicectomy group: risk difference −2·6 (95 per cent c.i. –6·3 to 1·1) per cent (low‐quality evidence). Minor complications occurred in 11 (2·2 per cent) of 510 and 61 (12·5 per cent) of 489 patients respectively: risk difference −7·2 (−18·1 to 3·8) per cent (very low‐quality evidence). Of 550 patients in the antibiotic group, 47 underwent appendicectomy within 1 month: pooled estimate 8·2 (95 per cent c.i. 5·2 to 11·8) per cent (high‐quality evidence). Within 1 year, appendicitis recurred in 114 of 510 patients in the antibiotic group: pooled estimate 22·6 (15·6 to 30·4) per cent (high‐quality evidence). For every 100 patients with non‐perforated appendicitis, initial antibiotic therapy compared with prompt appendicectomy may result in 92 fewer patients receiving surgery within the first month, and 23 more experiencing recurrent appendicitis within the first year. Conclusion The choice of medical versus surgical management in patients with clearly uncomplicated appendicitis is value‐ and preference‐dependent, suggesting a change in practice towards shared decision‐making is necessary. PMID:26990957

  20. Comparison of ultrasonography and computed tomography in the diagnosis of acute appendicitis

    International Nuclear Information System (INIS)

    Cura, J. L. del; Oleaga, L.; Grande, D.; Farina, M. A.; Isusi, M.

    2001-01-01

    The compare the efficacy of ultrasonography and computed tomography (CT) in cases of suspected appendicitis. To study to what extent age, sex and habits of the patients, as well as the clinical context, influence the diagnostic yield of these two technique. Over a one-year period, 152 patients underwent ultrasonography and CT because of the clinical suspicion of appendicitis. The studies were carried out independently, and the results of each in terms of the presence or absence of appendicitis were unknown to the specialists performing the other. The final diagnoses were established by surgical treatment or clinical follow-up. The sensitivity of CT for the diagnosis of appendicitis was 82%, the specificity was 95%, the positive predictive value was 93%, the negative predictive value was 87% and the reliability was 90%. Ultrasonography has a sensitivity of 83%, a specificity of 97%, a positive predictive value of 95%, a negative predictive value of 88% and a reliability of 91%. Ultrasound was more efficient in patients in which there was a high clinical suspicion and in children, while the results with CT were better in patients in which the clinical diagnosis was less clear. The incidence of false negatives and positives was higher with ultrasound, while CT was more frequently able to identify a normal appendix. Sex and habits had no influence on the respective efficacies, although the performance of ultrasound was simplified in thin patients and that of CT in obese individuals. Ultrasonography and CT are highly reliable in cases of suspected appendicitis, especially when this diagnosis is conformed. Ultrasound is recommended as the technique of choice in children and in patients in which the clinical suspicion is strong. The yield of CT is somewhat greater when the clinical signs and symptoms are less clear. However, the efficacy of both techniques ultimately depends on the expertise of the specialist who interprets them. (Author) 62 refs

  1. Appendicitis following blunt abdominal trauma.

    Science.gov (United States)

    Cobb, Travis

    2017-09-01

    Appendicitis is a frequently encountered surgical problem in the Emergency Department (ED). Appendicitis typically results from obstruction of the appendiceal lumen, although trauma has been reported as an infrequent cause of acute appendicitis. Intestinal injury and hollow viscus injury following blunt abdominal trauma are well reported in the literature but traumatic appendicitis is much less common. The pathophysiology is uncertain but likely results from several mechanisms, either in isolation or combination. These include direct compression/crush injury, shearing injury, or from indirect obstruction of the appendiceal lumen by an ileocecal hematoma or traumatic impaction of stool into the appendix. Presentation typically mirrors that of non-traumatic appendicitis with nausea, anorexia, fever, and right lower quadrant abdominal tenderness and/or peritonitis. Evaluation for traumatic appendicitis requires a careful history and physical exam. Imaging with ultrasound or computed tomography is recommended if the history and physical do not reveal an acute surgical indication. Treatment includes intravenous antibiotics and surgical consultation for appendectomy. This case highlights a patient who developed acute appendicitis following blunt trauma to the abdomen sustained during a motor vehicle accident. Appendicitis must be considered as part of the differential diagnosis in any patient who presents to the ED with abdominal pain, including those whose pain begins after sustaining blunt trauma to the abdomen. Because appendicitis following trauma is uncommon, timely diagnosis requires a high index of suspicion. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Suspected appendicitis in pregnancy.

    Science.gov (United States)

    Flexer, S M; Tabib, N; Peter, M B

    2014-04-01

    Acute appendicitis is one of the most common acute surgical presentations. However investigation and management is sometimes confounded in a pregnant patient. Appendicitis in pregnancy is often managed jointly by both the surgical and obstetric teams, which can lead to discrepant pathways, which may be detrimental to the patient. This review sets out to identify the normal physiological changes of pregnancy that pose diagnostic and therapeutic difficulties to the clinician, assess the more common differential diagnoses and review the current evidence to assist achieving a swift diagnosis and appropriate treatment. A literature review of the investigation and management of suspected appendicitis in pregnancy was undertaken. Guidelines by the relevant surgical, obstetric and radiological societies were also reviewed. There remains no consensus on the best diagnostic pathway for appendicitis in pregnancy; which is unsurprising given that appendicitis in non-pregnant patients can yield diagnostic conundrums. However this review identifies a role for MRI scanning as a useful adjunct in these patients. The increasing role of laparoscopy in these patients is also becoming more apparent. Appendicitis in pregnancy remains a complex problem necessitating a close working relationship between various specialties to achieve the best outcome for mother and fetus. Copyright © 2013 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  3. Immunoproteasome in the blood plasma of children with acute appendicitis, and its correlation with proteasome and UCHL1 measured by SPR imaging biosensors.

    Science.gov (United States)

    Matuszczak, E; Sankiewicz, A; Debek, W; Gorodkiewicz, E; Milewski, R; Hermanowicz, A

    2018-01-01

    The aim of this study was to determinate the immunoproteasome concentration in the blood plasma of children with appendicitis, and its correlation with circulating proteasome and ubiquitin carboxyl-terminal hydrolase L1 (UCHL1). Twenty-seven children with acute appendicitis, managed at the Paediatric Surgery Department, were included randomly into the study (age 2 years 9 months up to 14 years, mean age 9·5 ± 1 years). There were 10 girls and 17 boys; 18 healthy, age-matched subjects, admitted for planned surgeries served as controls. Mean concentrations of immunoproteasome, 20S proteasome and UCHL1 in the blood plasma of children with appendicitis before surgery 24 h and 72 h after the appendectomy were higher than in the control group. The immunoproteasome, 20S proteasome and UCHL1 concentrations in the blood plasma of patients with acute appendicitis were highest before surgery. The immunoproteasome, 20S proteasome and UCHL1 concentration measured 24 and 72 h after the operation decreased slowly over time and still did not reach the normal range (P appendicitis. © 2017 British Society for Immunology.

  4. Improving the diagnosis of acute appendicitis in children with atypical clinical findings using the technetium-99m hexamethylpropylene amine oxime-labelled white-blood-cell abdomen scan

    International Nuclear Information System (INIS)

    Yan Dahchin; Shiau Yuchien; Wang Jhijoung; Ho Shungtai; Kao Chiahung

    2002-01-01

    Heading AbstractBackground. Diagnosing acute appendicitis in children with equivocal signs and symptoms may be difficult. The usual approach is hospital observation and frequent re-examination. However, many surgeons are reluctant to delay surgery because of the risk of perforation and a negative laparotomy.Objective. To assess and compare the value of the technetium-99m hexamethylpropylene amine oxime ( 99m Tc-HMPAO)-labelled white-blood-cell (WBC) abdomen scan in the diagnosis of acute appendicitis in children with atypical clinical presentation.Patients and methods. Fifty children with acute right lower quadrant abdominal pain and possible acute appendicitis, but atypical findings were included. After IV injection of 99m Tc-HMPAO-labelled WBCs, serial anterior abdomen scans were obtained using a gamma camera.Results. Thirty-three children underwent surgery, while 17 children were managed conservatively and were followed up for at least 1 month. Four children had false-positive results and one child had a false-negative scan result. The overall sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the scan to diagnose acute appendicitis in children with atypical findings was 96.7, 80.0, 90.0, 87.8 and 94.1%, respectively.Conclusions. The 99m Tc-HMPAO WBC abdomen scan is a potential tool for diagnosing acute appendicitis in children with atypical clinical findings. The high sensitivity and negative predictive value allows early discharge from the emergency department to avoid costly observation in hospital and potentially unnecessary surgery in those patients with negative scans. (orig.)

  5. Clinical-epidemiological profile of acute appendicitis: retrospective analysis of 638 cases.

    Science.gov (United States)

    Lima, Amanda Pereira; Vieira, Felipe José; Oliveira, Gabriela Procópio DE Moraes; Ramos, Plínio Dos Santos; Avelino, Marielle Elisa; Prado, Felipe Garcia; Salomão, Gilson; Silva, Francisco Campos; Rodrigues, João Vicente Linhares

    2016-01-01

    to describe the clinical and epidemiological profile of acute appendicitis (AA) of the patients treated at a referral center in the Juiz de Fora macro-region, Minas Gerais State, Brazil. we conducted a retrospective, observational study in the Dr. Mozart Geraldo TeixeiraEmergency Hospital. We selected 638 patients diagnosed with AA, and analyzed the variables gender, age, evolutionary phase, length of hospital stay, pathological diagnosis, use of antibiotics, use of drains, complications and mortality. AA was more prevalent in young adults (19-44 years) and males (65.20%). The mean hospital stay was seven days and phase II was the most prevalent. We found the histopathological diagnosis of primary tumor of the appendix in six patients (0.94%), adenocarcinoma being the most common histologic type (66.7%). Regarding the use of antibiotics, 196 patients underwent antibiotic prophylaxis and 306 received antibiotic therapy. Eighty-one patients used some kind of drain, for an average of 4.8 days. Seventeen patients died (2.67%), predominantly males (70.59%), with mean age of 38.47 years. AA has a higher prevalence in males and young adults. The length of stay is directly associated with the evolutionary phase. The most common complication is infection of the surgical site. Mortality in our service is still high when compared with developed centers. avaliar a epidemiologia e os resultados do tratamento cirúrgico de doentes portadores de graus III e IV, mais avançados, da Síndrome de Mirizzi (SM) de acordo com a classificação de Csendes. estudo retrospectivo, de corte transversal através da revisão de prontuários de 13 pacientes portadores de graus III e IV da SM operados de dezembro de 2001 a setembro de 2013, entre 3691 colecistectomias realizadas neste período. a incidência da SM foi 0,6% (23 casos) e os graus III e IV perfizeram 0,35% deste número. Houve um predomínio de tipo IV (12 casos). O diagnóstico pré-operatório foi possível em 53,8% dos casos. A

  6. MRI for clinically suspected appendicitis during pregnancy.

    NARCIS (Netherlands)

    Cobben, L.P.; Groot, I.; Haans, L.; Blickman, J.G.; Puylaert, J.

    2004-01-01

    OBJECTIVE: The purpose of this study was to evaluate whether MRI can be used to accurately diagnose or exclude appendicitis in pregnant patients with clinically suspected appendicitis. CONCLUSION: Our results suggest that MRI is helpful in the examination and diagnosis of acute appendicitis in

  7. Comparison of imaging strategies with conditional versus immediate contrast-enhanced computed tomography in patients with clinical suspicion of acute appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Atema, J.J.; Gans, S.L.; Boermeester, M.A. [Academic Medical Centre, Department of Surgery (G4-142), Amsterdam (Netherlands); Randen, A. van; Stoker, J. [Academic Medical Centre, Department of Radiology, Amsterdam (Netherlands); Lameris, W. [Academic Medical Centre, Department of Surgery (G4-142), Amsterdam (Netherlands); Spaarne Hospital, Department of Surgery, Hoofddorp (Netherlands); Es, H.W. van; Heesewijk, J.P.M. van [St Antonius Hospital, Department of Radiology, Nieuwegein (Netherlands); Ramshorst, B. van [St Antonius Hospital, Department of Surgery, Nieuwegein (Netherlands); Bouma, W.H. [Gelre Hospital, Department of Surgery, Apeldoorn (Netherlands); Hove, W. ten [Gelre Hospital, Department of Radiology, Apeldoorn (Netherlands); Keulen, E.M. van [Tergooi Hospital, Department of Radiology, Hilversum (Netherlands); Dijkgraaf, M.G.W. [Academic Medical Centre, Clinical Research Unit, Amsterdam (Netherlands); Bossuyt, P.M.M. [Academic Medical Center, Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Amsterdam (Netherlands)

    2015-08-15

    To compare the diagnostic accuracy of conditional computed tomography (CT), i.e. CT when initial ultrasound findings are negative or inconclusive, and immediate CT for patients with suspected appendicitis. Data were collected within a prospective diagnostic accuracy study on imaging in adults with acute abdominal pain. All patients underwent ultrasound and CT, read by different observers who were blinded from the other modality. Only patients with clinical suspicion of appendicitis were included. An expert panel assigned a final diagnosis to each patient after 6 months of follow-up (clinical reference standard). A total of 422 patients were included with final diagnosis appendicitis in 251 (60 %). For 199 patients (47 %), ultrasound findings were inconclusive or negative. Conditional CT imaging correctly identified 241 of 251 (96 %) appendicitis cases (95 %CI, 92 % to 98 %), versus 238 (95 %) with immediate CT (95 %CI, 91 % to 97 %). The specificity of conditional CT imaging was lower: 77 % (95 %CI, 70 % to 83 %) versus 87 % for immediate CT (95 %CI, 81 % to 91 %). A conditional CT strategy correctly identifies as many patients with appendicitis as an immediate CT strategy, and can halve the number of CTs needed. However, conditional CT imaging results in more false positives. (orig.)

  8. Apendicite aguda: achados na tomografia computadorizada - ensaio iconográfico Acute appendicitis: computed tomography findings - an iconographic essay

    Directory of Open Access Journals (Sweden)

    Marcelo Eustáquio Montandon Júnior

    2007-06-01

    Full Text Available A apendicite aguda é a causa mais comum de dor abdominal aguda que requer intervenção cirúrgica no mundo ocidental. O diagnóstico precoce é essencial para minimizar a morbidade da doença. O uso dos métodos de imagem significou grande avanço no diagnóstico desta entidade, até então avaliada apenas com base na história clínica, exame físico e dados laboratoriais, haja vista que 20% a 33% dos pacientes apresentam sintomas atípicos. O diagnóstico é mais difícil nas crianças, nos idosos e nas mulheres em idade fértil. Os principais métodos de imagem para sua avaliação são a ultra-sonografia e a tomografia computadorizada. Os objetivos deste trabalho são: descrever a fisiopatologia da doença, comentar os principais aspectos técnicos da tomografia computadorizada, demonstrar e ilustrar os achados tomográficos e citar os principais diagnósticos diferenciais.Acute appendicitis is the most important cause of abdominal pain requiring surgical intervention in the Western world. The early diagnosis of this disease is of paramount relevance for minimizing its morbidity. Imaging methods have represented a huge progress in the diagnosis of this entity, which used to be based essentially on clinical history, physical examination and laboratory tests results, considering that 20% to 33% of patients present with atypical symptoms. Diagnostic difficulty is higher in children, the elderly, and women in childbearing age. The main imaging methods for evaluation of acute appendicitis are ultrasound and computed tomography. The present study is aimed at describing the disease physiopathology, commenting main computed tomography technical aspects, demonstrating and illustrating tomographic findings, and describing main differential diagnoses.

  9. An evaluation of the relationship between Enterobius vermicularis infestation and acute appendicitis in a paediatric population--A retrospective cohort study.

    Science.gov (United States)

    Fleming, C A; Kearney, D E; Moriarty, P; Redmond, H P; Andrews, E J

    2015-06-01

    Enterobius vermicularis is an often unexpected finding in appendectomy specimen, most commonly seen in paediatric cases. Predicting the presence of E. vermicularis in the setting of appendectomy is important to avoid unnecessary appendectomy and associated morbidity. We sought to identify the incidence of E. vermicularis in a paediatric population undergoing appendectomy for clinically suspected acute appendicitis and identify predictive factors for E. vermicularis. This study was performed in an 800-bed University Teaching Hospital, in the Republic of Ireland. We identified all paediatric appendectomies performed at our institute from January to December 2012 using prospectively maintained operating theatre logbooks. In-hospital Histopathology database, medical notes and operative findings were reviewed for each patient and relevant data recorded. Statistical analysis was performed using IBM SPSS, version 21. In total 182 paediatric appendectomies were performed during the year 2012 for clinically suspected acute appendicitis. Demographics included: Mean age 11.14 years (3-16), gender 1M: 1F. 58.8% of procedures were completed laparoscopically, 39% open and 2.2% were converted. The negative appendectomy rate was 22.5%. The annual incidence of E. vermicularis in acute appendicitis specimen from a paediatric cohort at our institute was 7% (1 in 14). In specimen containing E. vermicularis, 69% had no evidence of appendicitis and of those that had, no gangrene or perforation was seen. The presence of E. vermicularis in paediatric patients with RIF pain may be predicted by Eosinophilia (p = 0.016), normal WCC (p = 0.034) and normal Neutrophil count (p = 0.014). E. vermicularis is responsible for 7% of acute appendicitis. It is responsible for a significantly higher negative appendectomy rate which if predicted may avoid unnecessary appendectomy and associated morbidity. Copyright © 2015. Published by Elsevier Ltd.

  10. Neutral vs positive oral contrast in diagnosing acute appendicitis with contrast-enhanced CT: sensitivity, specificity, reader confidence and interpretation time

    Science.gov (United States)

    Naeger, D M; Chang, S D; Kolli, P; Shah, V; Huang, W; Thoeni, R F

    2011-01-01

    Objective The study compared the sensitivity, specificity, confidence and interpretation time of readers of differing experience in diagnosing acute appendicitis with contrast-enhanced CT using neutral vs positive oral contrast agents. Methods Contrast-enhanced CT for right lower quadrant or right flank pain was performed in 200 patients with neutral and 200 with positive oral contrast including 199 with proven acute appendicitis and 201 with other diagnoses. Test set disease prevalence was 50%. Two experienced gastrointestinal radiologists, one fellow and two first-year residents blindly assessed all studies for appendicitis (2000 readings) and assigned confidence scores (1=poor to 4=excellent). Receiver operating characteristic (ROC) curves were generated. Total interpretation time was recorded. Each reader's interpretation with the two agents was compared using standard statistical methods. Results Average reader sensitivity was found to be 96% (range 91–99%) with positive and 95% (89–98%) with neutral oral contrast; specificity was 96% (92–98%) and 94% (90–97%). For each reader, no statistically significant difference was found between the two agents (sensitivities p-values >0.6; specificities p-values>0.08), in the area under the ROC curve (range 0.95–0.99) or in average interpretation times. In cases without appendicitis, positive oral contrast demonstrated improved appendix identification (average 90% vs 78%) and higher confidence scores for three readers. Average interpretation times showed no statistically significant differences between the agents. Conclusion Neutral vs positive oral contrast does not affect the accuracy of contrast-enhanced CT for diagnosing acute appendicitis. Although positive oral contrast might help to identify normal appendices, we continue to use neutral oral contrast given its other potential benefits. PMID:20959365

  11. Appendicitis and cholecystitis in pregnancy.

    Science.gov (United States)

    Gilo, Noridelle B; Amini, Dennis; Landy, Helain J

    2009-12-01

    Acute abdominal pain in pregnancy may be attributable to a broad range of nonobstetrical causes. The evaluation of an acute abdomen during pregnancy must include in the differential diagnosis appendicitis and cholecystitis, which are 2 of the most common reasons for nonobstetric surgical intervention in pregnancy. Both conditions may be associated with significant maternal and fetal morbidity and/or mortality. This study will provide a contemporary synopsis regarding the diagnosis and management of appendicitis and cholecystitis during pregnancy.

  12. The value of {sup 99m}Tc-HMPAO labelled white blood cell scintigraphy in acute appendicitis patients with an equivocal clinical presentation

    Energy Technology Data Exchange (ETDEWEB)

    Colak, T.; Akaydin, M. [Akdeniz Univ. School of Medicine, Antalya (Turkey). Dept. of General Surgery; Guengoer, F.; Oezugur, S.; Yildiz, A.; Boz, A.; Karayalcin, B. [Dept. of Nuclear Medicine, Akdeniz Univ. School of Medicine, Antalya (Turkey); Bozan, H. [Emergency Dept., Akdeniz Univ. School of Medicine, Antalya (Turkey); Melikoglu, M. [Dept. of Paediatric Surgery, Akdeniz Univ. School of Medicine, Antalya (Turkey)

    2001-05-01

    Various imaging studies can be performed in the evaluation of patients with a clinical presentation equivocal for acute appendicitis. One of these studies is technetium-99m hexamethylpropylene amine oxime (HMPAO) labelled white blood cell (WBC) scintigraphy. The aim of this study was to evaluate the accuracy and clinical value of {sup 99m}Tc-HMPAO WBC scintigraphy in the aforementioned group of patients. Forty-one patients who had acute right lower quadrant abdominal pain with a clinical presentation equivocal for acute appendicitis were included in the study. The anterior abdomen and pelvis were imaged up to 4 h after the injection of 125-300 MBq {sup 99m}Tc-HMPAO WBCs and the results were immediately reported to the surgeon before a decision was taken on whether to perform laparotomy. Diagnostic accuracy was established by the intra-operative findings and the histopathology in operated patients. In non-operated patients, absence of abdominal symptoms 1 month after scintigraphy and/or identification of another cause of abdominal pain was used to rule out acute appendicitis. There were 16 patients with positive scintigraphy and 81% of these patients were positive within 2 h post injection. There were no false-positive or false-negative results. We operated on 17 (41.4%) patients, and only one patient (5.9%) underwent unnecessary laparotomy. We conclude that {sup 99m}Tc-HMPAO WBC scintigraphy is a rapid, highly accurate method for the exclusion of acute appendicitis and that its use can lower the unnecessarily high laparotomy rate in patients with an equivocal clinical presentation. (orig.)

  13. Complicaciones de la apendicectomía por apendicitis aguda Complications of the appendicectomy due to acute appendicitis

    Directory of Open Access Journals (Sweden)

    Zenén Rodríguez Fernández

    2010-06-01

    Full Text Available INTRODUCCIÓN. La apendicectomía por apendicitis aguda es la operación de urgencia más común en los servicios quirúrgicos, pero no está exenta de complicaciones condicionadas por factores poco conocidos, cuya determinación podría disminuir la morbilidad y mortalidad por esta causa. Fue objetivo de esta investigación identificar algunos factores relacionados con la aparición de complicaciones en los pacientes apendicectomizados por apendicitis aguda. MÉTODOS. Se realizó un estudio descriptivo, observacional y prospectivo de 560 pacientes apendicectomizados, con diagnóstico histopatológico de apendicitis aguda, egresados del Servicio de Cirugía General del Hospital Provincial Docente «Saturnino Lora» de Santiago de Cuba durante el 2006. RESULTADOS. El 21,6 % de la serie sufrió algún tipo de complicación, principalmente la infección del sitio operatorio. Las complicaciones aumentaron en relación con la edad y se presentaron más frecuentemente en los pacientes con enfermedades asociadas, estado físico más precario, mayor tiempo de evolución preoperatoria, así como en las formas histopatológicas más avanzadas de la afección (en las que se incluyen los 4 pacientes fallecidos. La aparición de tales complicaciones puede ser causa de reintervenciones y de aumento de la estadía hospitalaria. CONCLUSIONES. El diagnóstico precoz de la enfermedad y la apendicectomía inmediata con una técnica quirúrgica adecuada previenen la aparición de complicaciones posquirúrgicas y determinan el éxito del único tratamiento eficaz contra la afección más común que causa el abdomen agudo, cuyo pronóstico depende en gran medida y entre otros factores, del tiempo de evolución preoperatoria y de la fase en que se encuentre el proceso morboso al realizar la intervención.INTRODUCTION. Appendicectomy due to acute appendicitis is the commonest urgency operation in surgical services but it is not exempt from complications conditions by

  14. Conservative approach versus urgent appendectomy in surgical management of acute appendicitis with abscess or phlegmon Resultados del tratamiento conservador inicial y de la cirugía urgente en la apendicitis aguda evolucionada

    OpenAIRE

    J. M. Aranda-Narváez; A. J. González-Sánchez; N. Marín-Camero; C. Montiel-Casado; P. López-Ruiz; B. Sánchez-Pérez; A. Álvarez-Alcalde; C. P. Ramírez-Plaza; J. Santoyo-Santoyo

    2010-01-01

    Background: Surgical management of acute appendicitis with appendiceal abscess or phlegmon remains controversial. We studied the results of initial conservative treatment (antibiotics and percutaneous drainage if necessary, with or without interval appendectomy) compared with immediate surgery. Methods: We undertook an observational, retrospective cohort study of patients with a clinical and radiological diagnosis of acute appendicitis with an abscess or phlegmon, treated in our hospital betw...

  15. CT Diagnosis of Appendicitis

    Directory of Open Access Journals (Sweden)

    Christopher Libby

    2017-01-01

    Full Text Available History of present illness: A 19-year-old male with no previous medical history presented with 7/10 non-radiating, constant, sharp, periumbilical pain associated with nausea, and four episodes of vomiting. He was seen at urgent care where his labs showed a WBC of 16,000/mcL. He was subsequently sent to the emergency department (ED for concern of appendicitis. Of note, his pain worsened with bumps during the drive to the ED. After arriving to the ED the pain migrated to the right lower quadrant. Computed tomography (CT revealed acute appendicitis and the patient was admitted to the surgery service and taken to the operating room (OR for an appendectomy. Significant findings: The CT abdomen/pelvis with IV contrast shows a dilated appendix (see red outline with thickened, hyperenhancing wall (see blue outline best visualized in the axial and coronal planes. Discussion: Appendicitis is a common diagnosis in the emergency department in patients presenting with abdominal pain, occurring most frequently in young adults with a peak incidence in those aged 10-19.1 Failure to quickly diagnose acute appendicitis can result in perforation rates as high as 80 percent.2 While the diagnosis of appendicitis can be made clinically, CT is a non-invasive modality that improves the detection of appendicitis with sensitivities of 88–100%, specificities of 91–99%, positive predictive values of 92–98%, negative predictive values of 95–100%, and accuracies of 94–98%.3-8 The major advantage of CT over both clinical exam and ultrasound is the ability of the radiologist to exclude acute appendicitis if the appendix appears normal. However, CT carries the risks associated with ionizing radiation. While previously there was some debate on the best choice for type of CT scan and use of IV and oral contrast, recent studies have shown that CT abdomen/pelvis with IV contrast alone is sufficient for diagnosis of appendicitis.9, 10

  16. Vacation appendicitis.

    Science.gov (United States)

    Redan, Jay A; Tempel, Michael B; Harrison, Shannon; Zhu, Xiang

    2013-01-01

    When someone plans a vacation, one of the last things taken into consideration is the possibility of contracting an illness while away. Unfortunately, if people develop abdominal pain while planning for a vacation, they usually proceed with the vacation and do not consider getting medical attention for their pain. The purpose of this study was to examine the effect of being on vacation and its association with ruptured appendicitis. From January 1, 2007 to December 31, 2008, the incidence of ruptured appendicitis cases at Florida Hospital-Celebration Health, located 5 miles from Walt Disney World, was compared with that of Florida Hospital-Orlando, approximately 30 miles away from Walt Disney World. We evaluated whether patients "on vacation" versus residents of Orlando have an increased incidence of ruptured appendicitis. Of patients treated for presumed appendicitis, 60.59% at Florida Hospital-Celebration Health had ruptured appendicitis during this time versus 20.42% at Florida Hospital-Orlando. Of those 266 patients seen at Florida Hospital-Celebration Health, 155 were on vacation versus only 21 at Florida Hospital-Orlando. Although there is not a direct cause and effect, it is clear that there is a higher incidence of ruptured appendicitis in patients on vacation versus in the regular community in the Orlando, Florida area.

  17. Alfa-2-glicoproteína rica en leucina urinaria en pacientes con apendicitis aguda (Urinary leucine-rich alpha-2-glycoprotein in patients with acute appendicitis

    Directory of Open Access Journals (Sweden)

    Heberto Machado-Montero

    2015-04-01

    Full Text Available The objective of research was to determine diagnostic efficacy of urinary concentrations of leucine-rich alpha-2-glycoprotein (A2GRL in patients with acute appendicitis. There were included patients with high suspicion of acute appendicitis (group A; cases, n = 30. In group B (controls, n = 30 were included patients with non-surgical abdominal pain who attended to Hospital Central “Dr. Urquinaona”, Maracaibo, Zulia. General characteristics, urinary concentrations of A2GRL and diagnostic efficacy of assay were evaluated. Mean age of patients in group A was 36.3 +/- 8.8 years-old and in group B was 35.8 +/- 9.6 years-old (p = ns. There were not found significant differences in sex distribution, weight and height between groups (p = ns. Urinary concentrations of A2GRL were significantly higher in group A (1543.8 +/- 762.7 ng/mL compared with mean value in patients of group B (774.1 +/- 356.1 ng/mL; p < 0.0001. A2GRL presented a value below curve 0.81. A cut-off value of 1000 ng/mL, showed sensivity 73.3%, specificity 70.9%, positive predictive value 72.4% and negative predictive value 72.4%. It is concluded that urinary concentrations of A2GRL have a high diagnostic efficacy in patients with acute appendicitis

  18. Comparison and Efficacy of LigaSure and Rubber Band Ligature in Closing the Inflamed Cecal Stump in a Rat Model of Acute Appendicitis

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    Chun-Chieh Yeh

    2015-01-01

    Full Text Available Safety of either LigaSure or rubber band in closing inflamed appendiceal stump in acute appendicitis has been less investigated. In this study, cecal ligation followed by resecting inflamed cecum was performed to mimic appendectomy in a rat model of acute appendicitis. Rats were sacrificed immediately (Group A and 7 days (Group B after cecal resection, respectively. The cecal stumps were closed by silk ligature (S, 5 mm LigaSure (L, or rubber band (R. Seven days after cecal resection, the LigaSure (BL and silk subgroups (BS had significantly less intra-abdominal adhesion and better laparotomy wound healing than rubber band subgroup (BR. The initial bursting pressure at cecal stump was comparable among the three methods; along with tissue healing process, both BL and BS provided a higher bursting pressure than BR 7 days after appendectomy. BL subgroup had more abundant hydroxyproline deposition than BS and BR subgroup. Furthermore, serum TNF-α in BR group kept persistently increasing along with time after cecal resection. Thus, the finding that LigaSure but not rubber band is safe in sealing off the inflamed cecal stump in rat model of acute appendicitis suggests the possibility of applying LigaSure for appendectomy via single port procedure or natural orifice transluminal endoscopic surgery (NOTES.

  19. Laparoscopic Appendectomy in Pregnancy With Acute Appendicitis: Single Center Experience With World Review.

    Science.gov (United States)

    Maimaiti, Abudukaiyoumu; Aierkin, Amina; Mahmood, Khan Muddassar; Apaer, Shadike; Maimaiti, Yilihamu; Yibulayin, Xiaokaiti; Li, Tao; Zhao, Jin-Ming; Tuxun, Tuerhongjiang

    2017-12-01

    This clinical study is aiming to discuss the therapeutic benefit of laparoscopic appendectomy (LA) by comparing with conventional open appendectomy (OA) in pregnancy. The clinical data of 26 pregnant women who underwent appendectomy from 2012 to 2016 was retrospectively analyzed. The variables analyzed included baseline information, operation characteristics, maternal complications, and infant health outcomes. The patients were divided in 2 LA and OA groups according to the surgical approach and their clinical characteristics were compared. Of reported 26 patients, 7 underwent LA whereas the remaining 19 patients underwent OA. The median age of the patients was 28 years (range, 19 to 39 y). The median gestational period was 21.5 weeks (range, 5 to 33 wk). The postoperative pathology showed complicated appendicitis 7 cases. The result showed significantly shorter operation time (42.14±8.63 vs. 65.21±26.58 min, P=0.003), hospital stay (4.14±1.77 vs. 6.47±2.72 d, P=0.021), and earlier recovery of gastrointestinal function in the LA group compared with OA group. There were no maternal and fetal deaths occurred in perioperative period in both groups. LA has not increased morbidity and mortality but displayed shorter hospital stay, operation time and recovery of gastrointestinal function to OA as well as good cosmetic results. Therefore, LA in patients with pregnancy can be considered as preferred approach in sophisticated hands without increased risks.

  20. Consideraciones actuales sobre el diagnóstico de la apendicitis aguda: Current criteria Diagnosis of acute appendicitis:

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    Zenén Rodríguez Fernández

    2009-09-01

    Full Text Available INTRODUCCIÓN. El objetivo de la presente investigación fue identificar algunos aspectos relacionados con el diagnóstico preoperatorio de la apendicitis aguda, según variables seleccionadas, así como establecer comparaciones con los hallazgos de otros autores. MÉTODOS. Se realizó un estudio observacional, descriptivo y prospectivo de 560 pacientes operados y dados de alta con el diagnóstico histopatológico de apendicitis aguda. Los pacientes fueron atendidos en el Servicio de Cirugía General del Hospital Provincial Docente «Saturnino Lora» de Santiago de Cuba, durante el 2006. RESULTADOS. Entre los resultados más importantes sobresalieron el predominio de los varones jóvenes con mediana de edad de 25,5 años y la preponderancia del diagnóstico clínico. La mediana del tiempo de evolución preoperatoria fue mayor en los hombres y predominaron las variedades gangrenosa y perforada, aunque la primacía correspondió a la apendicitis supurada. En los fallecidos se detectaron las formas histopatológicas más graves, y estos fueron ancianos con manifestaciones clínicas atípicas de la enfermedad. CONCLUSIONES. El método clínico continúa teniendo una importancia capital, pues a través de él se puede diagnosticar precozmente esta urgencia tan común y reducir el tiempo de evolución preoperatoria, cuya prolongación es causa de morbilidad y mortalidad innecesarias.INTRODUCTION: The aim of present paper was to identify some features related to preoperative diagnosis of acute appendicitis, according the selected variables, as well as to establish comparisons with findings from other authors. METHODS: We made a prospective, descriptive and observational study of 560 patients operated on and discharged with the histopathology diagnosis of acute appendicitis. Patients were seen in General Surgery Service of the "Saturnino Lora" Teaching Provincial Hospital of Santiago de Cuba during year 2006. RESULTS: Among the more significant results

  1. Portal vein thrombosis complicating appendicitis | Ayantunde | West ...

    African Journals Online (AJOL)

    Appendicitis is still the most common acute surgical abdomen all over the world and its complications may be grave. We report an adult case of acute appendicitis complicated by Portal Vein Thrombosis (PVT) and ascending portomesenteric phlebitis treated successfully with antibiotics and anticoagulation with no residual ...

  2. Single-incision Laparoscopic Appendectomy for acute Appendicitis using a 10-mm Laparoscope and the Glove Port Technique.

    Science.gov (United States)

    Tsushimi, Takaaki; Mori, Hirohito; Sudo, Manabu; Minami, Yoshihide; Ueki, Koichi; Tamai, Makoto

    2017-01-01

    To evaluate the single incision laparoscopic appendectomy (SILA) using existing instruments, the 10-mm laparoscope, and glove port technique. SILA was performed on 16 patients (8 male cases, 8 female cases) between June 2012 and September 2015. A 20-mm incision was made in the umbilicus and a wound retractor was placed. A 10-mm trocar for the laparoscope and two 5-mm trocars were fixed to the three fingers of the latex gloves and it was attached to the wound retractor. Another thin forceps were inserted from right low abdomen. Average age of patients was 32.6 ± 17.7 years. Preoperative average white blood cell was 13,325 ± 4,584 /mm 3 , and average CRP was 1.81 ± 3.70 mg/dL. Preoperative body temperature was 36.8 ± 0.5°C. The mean appendix size was 9.6 ± 2.3 mm and none of the patients had an abscess on preoperative CT. The CT also revealed a fecal pellet in 5/16 (31%) of patients. Mean operation time was 66.4 ± 25.4 minutes, and minimal intraoperative bleeding was observed in all patients. Average hospital stay was 5.3 ± 1.9 days and none of the patients had complications. SILA using the 10-mm laparoscope and glove port technique may be a safe and feasible operation for mild to moderate appendicitis.

  3. [Appendicitis and gall bladder diseases as acute abdominal conditions in pregnancy].

    Science.gov (United States)

    Stukan, Maciej; Kruszewski, Wiesław Janusz; Dudziak, Mirosław; Kopiejć, Arkadiusz; Preis, Krzysztof

    2013-12-01

    Appendicitis (APP) and gall bladder diseases (GBD) are the most frequent non-obstetric indications for urgent surgery among pregnant women. The aim was to present the diagnosis, treatment and potential complications of APP and symptomatic GBD. We searched the literature for APP and GBD during pregnancy and presented the results in the form of a review article. APP symptoms among pregnant women are comparable to these in the general population. Typical clinical symptoms are present in 50-75% of cases. Laboratory tests are useful for a differential diagnosis. The imaging of choice is an ultrasonography scan, but magnetic resonance is of the highest accuracy The final diagnosis is difficult. When the surgery is delayed, the risk of appendix perforation increases and thus complications are more frequent. GBD symptoms and signs are comparable to those in the general population. The best imaging is an ultrasonography scan, and laboratory tests are important in a jaundice differential diagnosis. In cases with symptomatic GBD, a delay in surgery is associated with an increased risk of complications (pancreatitis, abortion, intrauterine death). The treatment method of choice for APP and symptomatic GBD is surgery both laparotomy and laparoscopy (preferred), which are considered relatively safe, though laparoscopy compared to laparotomy for APP can be associated with a higher risk of abortion. Untreated or delayed APP and symptomatic GBD treatment during pregnancy increases the risk of complications, both for the woman and the fetus. Diagnosis is difficult and should be based on a multidisciplinary approach to the patient. Surgery by laparotomy or laparoscopy is relatively safe.

  4. Predictive role of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios for diagnosis of acute appendicitis during pregnancy.

    Science.gov (United States)

    Yazar, Fatih Mehmet; Bakacak, Murat; Emre, Arif; Urfalıoglu, Aykut; Serin, Salih; Cengiz, Emrah; Bülbüloglu, Ertan

    2015-11-01

    Acute appendicitis (AA) is not uncommon during pregnancy but can be difficult to diagnose. This study evaluated the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in addition to conventional diagnostic indicators of the disease to diagnose AA during pregnancy. Age, gestational age, white blood cell (WBC) count, Alvarado scores, C-reactive protein (CRP), lymphocyte count, NLR and PLR were compared among 28 pregnant women who underwent surgery for AA, 35 pregnant women wrongly suspected as having AA, 29 healthy pregnant women, and 30 nonpregnant healthy women. Mean WBC counts and CRP levels were higher in women with proven AA than in those of control groups (all p < 0.05). Among all the groups, the median NLR and PLR were significantly different in women with proven AA (all p < 0.05). Receiver operating characteristic analysis was used to determine cut-off values for WBC count, CRP, lymphocyte count, NLR and PLR, and multiple logistic regression analysis showed that NLR and PLR used with routine methods could diagnose AA with 90.5% accuracy. Used in addition to routine diagnostic methods, NLR and PLR increased the accuracy of the diagnosis of AA in pregnant women. Copyright © 2015. Published by Elsevier Taiwan.

  5. Predictive role of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios for diagnosis of acute appendicitis during pregnancy

    Directory of Open Access Journals (Sweden)

    Fatih Mehmet Yazar

    2015-11-01

    Full Text Available Acute appendicitis (AA is not uncommon during pregnancy but can be difficult to diagnose. This study evaluated the neutrophil-to-lymphocyte ratio (NLR and platelet-to-lymphocyte ratio (PLR in addition to conventional diagnostic indicators of the disease to diagnose AA during pregnancy. Age, gestational age, white blood cell (WBC count, Alvarado scores, C-reactive protein (CRP, lymphocyte count, NLR and PLR were compared among 28 pregnant women who underwent surgery for AA, 35 pregnant women wrongly suspected as having AA, 29 healthy pregnant women, and 30 nonpregnant healthy women. Mean WBC counts and CRP levels were higher in women with proven AA than in those of control groups (all p < 0.05. Among all the groups, the median NLR and PLR were significantly different in women with proven AA (all p < 0.05. Receiver operating characteristic analysis was used to determine cut-off values for WBC count, CRP, lymphocyte count, NLR and PLR, and multiple logistic regression analysis showed that NLR and PLR used with routine methods could diagnose AA with 90.5% accuracy. Used in addition to routine diagnostic methods, NLR and PLR increased the accuracy of the diagnosis of AA in pregnant women.

  6. [Appendicitis in pregnancy].

    Science.gov (United States)

    Lakyová, L; Belák, J; Kudlác, M; Vajó, J; Toporcer, T; Radonak, J

    2008-10-01

    THE AIM OF THE STUDY was to highlight the problems related to acute appendicitis in pregnancy. We present our own experiences with the diagnostics and therapy of this surgical complication during gravidity. Nausea, vomiting and pain in lower right abdomen as symptoms of appendicitis are often confused with the I. trimester gravidity symptoms. The change of pain locality and the loss of somatic pain in the II. and the III. trimester cause diagnostic delay and increase the incidence of appendiceal perforation. In case of suspected appendicitis, when evaluating laboratory parameters, the common finding of leucocytosis during gravidity further complicates the differential diagnosis. In comparison to common population, ultrasonography in gravidity displays lower sensitivity and specificity. In the course of the last ten years, 9 gravid women in the age (25.6 +/- 3.9) underwent appendectomy in the 2nd surgical clinic FNLP in Kosice. This represents 0.6 percentage incidence of appendicitis of 1496 patients operated because of this diagnosis. One of the patient turned out to be a case of negative appendectomy while the rest had histologically confirmed gangrenous (5x), phlegmonous (1x) and catarrhalis appendicitis (2x). Perforation was encountered in one patient. In the physical examination dominated pain in the right hypogastrium, nausea and subfebrility. The diagnostic success of USG examination reached 40%. In all gravid patients leucocytosis was found, including a negative appendectomy. The average duration from hospitalization to operation was 38 hours. No maternal or fetal loss was noted. Correct diagnostic and early surgical intervention prevents further fetal and maternal morbidity and mortality. Physical examination is important in differential diagnosis. Leucocytosis is not a predictive marker of appendicitis. Visualization of appendix through ultrasonography is rather difficult in the third trimester.

  7. Stercoral colitis mimicking appendicitis

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    Abdelghafour Elkoundi

    2017-02-01

    Full Text Available Abstract Background Stercoral colitis is an inflammatory process involving the colonic wall related to fecal impaction. This rare condition is associated with high morbidity-mortality. Findings We report a case of a 78-year-old woman with a history of dementia under clozapine who presented a clinical and sonographic presentation of acute appendicitis. The worsening of her clinical condition prompted us to review our diagnosis and modify our approach using the CT scan which was consistent with stercoral colitis. This report concerns an atypical presentation of this condition. Conclusions The present case highlights the ability of severe forms of fecal impaction to precipitate very rare and life-threatening complications like stercoral colitis. It also points the importance of including stercoral colitis in the differential diagnosis of acute appendicitis in altered patients under anticholenergic drugs and the critical role of the CT scan as a crucial radiologic adjunct.

  8. Study of sonography sensitivity and specificity to the diagnosis of acute appendicitis in suspected patients referred to Khorramabad Ashayer hospital

    Directory of Open Access Journals (Sweden)

    mojtaba Ahmai Nejad

    2012-03-01

    Conclusion: As the study suggests, sonography before sugery can help and leads to definite diagnosis in suspected patients to appendicitis and it can prevent unnecessary surgeries, as well as it can prevent delay in treatment and related complications .

  9. [Chronic appendicitis. A case report].

    Science.gov (United States)

    Montiel-Jarquín, Alvaro José; Gómez-Conde, Eduardo; Reyes-Páramo, Pedro; Romero-Briones, Carlos; Mendoza-García, Aurelio Valentín; García-Ramírez, Ulises Noel

    2008-01-01

    The term chronic appendicitis has been used to describe any type of chronic pain that originates in the appendix, with or without inflammation. This broad category can be divided more specifically into: chronic or recurrent appendicitis and appendiceal colic pain. a 41-year-old female, suffering intestinal chronic constipation, abdominal pain, nausea, hiporexia and febricula, treated with antibiotics, vermifuges, analgesics and antispasmodics, showing a slight and partial improvement. She was suffering chronic pain in lower abdomen, mostly on the right side along a year. With these symptoms, she underwent an exploratory laparotomy, that showed chronic appendicitis. Appendix had been removed. The histopathological report corresponded to chronic appendicitis. the histopathological characteristics and the clinical manifestations of the chronic appendicitis are different from those of acute appendicitis. Criteria for chronic appendicitis include: symptoms lasting longer than 4 weeks, confirmation of chronic swelling through histopathological examination, improvement of symptoms after appendectomy. The ultrasonic images, the barium enema and the computerized helicoidal tomography could be suggestive for its diagnosis.

  10. MDCT for suspected acute appendicitis in adults: impact of oral and IV contrast media at standard-dose and simulated low-dose techniques.

    Science.gov (United States)

    Keyzer, Caroline; Cullus, Pierre; Tack, Denis; De Maertelaer, Viviane; Bohy, Pascale; Gevenois, Pierre Alain

    2009-11-01

    The objective of this study was to prospectively investigate the influence of oral, IV, and oral and IV contrast media on the information provided by MDCT at standard and simulated low radiation doses in adults suspected of having acute appendicitis. One hundred thirty-one consecutive patients (80 women, 51 men; age range, 18-87 years; mean age, 37 years) suspected of having appendicitis were randomly assigned to either ingest or not ingest iodinated contrast material. Thereafter, all patients underwent IV unenhanced and enhanced abdominopelvic MDCT with a 4 x 2.5 mm collimation at 120 kVp and 100 mAs(eff). Dose reduction corresponding to 30 mAs(eff) was simulated. Two radiologists independently read scans during separate sessions, assessed appendix visualization, and proposed a diagnosis (i.e., appendicitis or an alternative diagnosis). The final diagnosis was based on either surgical findings or clinical follow-up. Data were analyzed by factorial analysis of multiple correspondences followed by an ascending hierarchic classification method. Factorial analysis and ascending hierarchic classification revealed that, in terms of diagnostic correctness, reader influence predominated over the influence of IV and oral contrast media use and radiation dose but that correctness was also influenced by the patient's sex (p = 0.048) and was lower in cases of alternative diseases (p technique.

  11. The first imported human case of Yersinia pseudotuberculosis serotype O1 septicemia presents with acute appendicitis-like syndrome in Taiwan

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    Chung-Hsu Lai

    2014-09-01

    Full Text Available Human nonplague yersiniosis occurs more commonly in temperate regions than in tropical or subtropical regions. In Taiwan, which is located in a subtropical region of Southeast Asia, only environmental isolates and human infection of Yersinia enterocolitica were reported, but a human case of Y. pseudotuberculosis infection had not been identified. We report the first person with Y. pseudotuberculosis serotype O1 septicemia who presented with acute appendicitis-like syndrome and who was probably contracted the infection via ingestion of raw foods in a barbecue restaurant in Japan.

  12. Assessing the feasibility of mobile phones for followup of acutely ...

    African Journals Online (AJOL)

    Assessing the feasibility of mobile phones for followup of acutely unwell children presenting to village clinics in rural northern Malawi. ... Conclusions: With continued expansion of cellular network coverage and mobile ownership in Malawi, mobile phones may facilitate collection of patient outcomes for intervention ...

  13. Is laparoscopy feasible and effective for acute postoperative small ...

    African Journals Online (AJOL)

    Laparoscopic management of acute adhesive small bowel obstruction has been shown to be feasible and advantageous. However, widespread acceptance and application is still not observed. We describe the case report of a 58-year-old male who presented with signs and symptoms of small bowel obstruction status ...

  14. Discriminating between simple and perforated appendicitis

    NARCIS (Netherlands)

    Bröker, Mirelle E. E.; van Lieshout, Esther M. M.; van der Elst, Maarten; Stassen, Laurents P. S.; Schepers, Tim

    2012-01-01

    Several studies have been performed in order to diagnose an acute appendicitis using history taking and laboratory investigations. The aim of this study was to create a model for the identification of a perforated appendicitis. All consecutive patients who have undergone an appendectomy in the

  15. Infantile perforated appendicitis: A forgotten diagnosis

    Directory of Open Access Journals (Sweden)

    Katherine W. Gonzalez

    2015-04-01

    Full Text Available Acute appendicitis in the infant is a rare surgical diagnosis despite its frequency in older patients. The clinical presentation is often vague and can be misleading. We present the successful diagnosis and treatment of a 3 month old female with perforated appendicitis.

  16. Discriminating between simple and perforated appendicitis

    NARCIS (Netherlands)

    M.E.E. Bröker (Mirelle); E.M.M. van Lieshout (Esther); M. van der Elst (Maarten); L.P. Stassen (Laurents); T. Schepers (Tim)

    2012-01-01

    textabstractBackground: Several studies have been performed in order to diagnose an acute appendicitis using history taking and laboratory investigations. The aim of this study was to create a model for the identification of a perforated appendicitis. Methods: All consecutive patients who have

  17. Appendicitis, appendectomie en de wet van Murphy

    NARCIS (Netherlands)

    Heij, H. A.; van Lieburg, M. J.

    2016-01-01

    Non-surgical treatment of acute phlegmonous appendicitis has been receiving increasing attention in recent years, representing a reversal of policy. The appendectomy came into vogue at the beginning of the 20th century. It is true that prompt surgical intervention in all patients with appendicitis

  18. Perforated appendicitis presenting as a thigh abscess: A lethal ...

    African Journals Online (AJOL)

    Typical cases of acute appendicitis have excellent treatment outcomes, if managed appropriately.1 We discuss an unusual case of perforated retrocaecal appendicitis that presented as a right thigh abscess without prominent abdominal symptoms, which highlights the lethal nature of advanced appendicitis even when ...

  19. Diagnostic Accuracy of MRI Versus CT for the Evaluation of Acute Appendicitis in Children and Young Adults.

    Science.gov (United States)

    Kinner, Sonja; Pickhardt, Perry J; Riedesel, Erica L; Gill, Kara G; Robbins, Jessica B; Kitchin, Douglas R; Ziemlewicz, Timothy J; Harringa, John B; Reeder, Scott B; Repplinger, Michael D

    2017-10-01

    Appendicitis is frequently diagnosed in the emergency department, most commonly using CT. The purpose of this study was to compare the diagnostic accuracy of contrast-enhanced MRI with that of contrast-enhanced CT for the diagnosis of appendicitis in adolescents when interpreted by abdominal radiologists and pediatric radiologists. Our study included a prospectively enrolled cohort of 48 patients (12-20 years old) with nontraumatic abdominal pain who underwent CT and MRI. Fellowship-trained abdominal and pediatric radiologists reviewed all CT and MRI studies in randomized order, blinded to patient outcome. Likelihood for appendicitis was rated on a 5-point scale (1, definitely not appendicitis; 5, definitely appendicitis) for CT, the unenhanced portion of the MRI, and the entire contrast-enhanced MRI study. ROC curves were generated and AUC compared for each scan type for all six readers and then stratified by radiologist type. Image test characteristics, interrater reliability, and reading times were compared. Sensitivity and specificity were 85.9% (95% CI, 76.2-92.7%) and 93.8% (95% CI, 89.7-96.7%) for unenhanced MRI, 93.6% (95% CI, 85.6-97.9%) and 94.3% (95% CI, 90.2-97%) for contrast-enhanced MRI, and 93.6% (95% CI, 85.6-97.9%) and 94.3% (95% CI, 90.2-97%) for CT. No difference was found in the diagnostic accuracy or interpretation time when comparing abdominal radiologists to pediatric radiologists (CT, 3.0 min vs 2.8 min; contrast-enhanced MRI, 2.4 min vs 1.8 min; unenhanced MRI, 1.5 min vs 2.3 min). Substantial agreement between abdominal and pediatric radiologists was seen for all methods (κ = 0.72-0.83). The diagnostic accuracy of MRI to diagnose appendicitis was very similar to CT. No statistically significant difference in accuracy was observed between imaging modality or radiologist subspecialty.

  20. Surgical audit: A prospective study of the morbidity and mortality of acute appendicitis.

    Science.gov (United States)

    Malatani, T S; Latif, A A; Al-Saigh, A; Cheema, M A; Abu-Eshy, S

    1991-03-01

    Between March and September 1989, acute apendicitis was clinically diagnosed in 317 patients who were studied as part of a prospective surgical audit. The study was designed to determine the accuracy of diagnosis, comparison of the macroscopic appearance of the appendix at operation, and subsequent histopathology and complications associated with the morbidity and mortality of emergency appendectomy. The clinical diagnosis was correct in 278 patients (88%). Thirty-nine (12%) of the patients had a negative laparotomy. There was no mortality, and wound infection was the source of increased morbidity in 37 (12%) patients. The highest incidence of wound infection was among those who had pus in the peritoneum (20%) or had a perforated or gangrenous appendix (25%). When the macroscopic appearance of the appendix was compared with the subsequent histopathological findings, a false positive error of 7% and a false negative error of 42% was found. During appendectomy the gross appearance of the appendix must be carefully noted so that a meticulous surgical technique can be complemented by appropriate antibiotic prophylaxis against wound infection, started at the time of surgery.

  1. Appendicitis during pregnancy with a normal MRI.

    Science.gov (United States)

    Thompson, Matthew M; Kudla, Alexei U; Chisholm, Chris B

    2014-09-01

    Abdominal pain frequently represents a diagnostic challenge in the acute setting. In pregnant patients, the gravid abdomen and concern for ionizing radiation exposure further limit evaluation. If undiagnosed, appendicitis may cause disastrous consequences for the mother and fetus. We present the case of a pregnant female who was admitted for right lower quadrant abdominal pain. Advanced imaging of the abdomen and pelvis was interpreted to be either indeterminate or normal and a diagnosis of acute appendicitis was made on purely clinical grounds. This patient's management and a literature review of diagnostic techniques for acute appendicitis during pregnancy are discussed.

  2. Appendicitis (For Parents)

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Appendicitis KidsHealth / For Parents / Appendicitis What's in this article? ... the easier it will be to treat. About Appendicitis The appendix is a small finger-like organ ...

  3. The impact of disease severity, age and surgical approach on the outcome of acute appendicitis in children

    NARCIS (Netherlands)

    van den Boom, A. L.; Gorter, R. R.; van Haard, P. M. M.; Doornebosch, P. G.; Heij, H. A.; Dawson, I.

    2015-01-01

    Although a national guideline has been implemented, the optimal approach for appendectomy in children remains subject of debate in the Netherlands. Opponents of laparoscopy raise their concerns regarding its use in complex appendicitis as it is reported to be associated with an increased incidence

  4. Appendicitis in University of Port Harcourt Teaching Hospital, Nigeria

    African Journals Online (AJOL)

    Background: Acute appendicitis is the most common cause of acute abdomen worldwide with increasing incidence in developing countries. The diagnosis is mainly clinical and wound infection remains the most common post-operative complication. Objective: To determine the pattern of presentation of acute appendicitis.

  5. The value of pancreatic stone protein in predicting acute appendicitis in patients presenting at the emergency department with abdominal pain

    OpenAIRE

    Tschuor, Christoph; Raptis, Dimitri Aristotle; Limani, Përparim; Bächler, Thomas; Oberkofler, Christian Eugen; Breitenstein, Stefan; Graf, Rolf

    2012-01-01

    Abstract Background Pancreatic Stone Protein (PSP) is a protein naturally produced mainly in the pancreas and the gut. There is evidence from experimental and clinical trials that blood PSP levels rise in the presence of inflammation or infection. However, it is not known whether PSP is superior to other established blood tests (e.g. White Blood Count, Neutrophils or C - reactive protein) in predicting appendicitis in patients presenting with abdominal pain and a clinical suspicion of appendi...

  6. A Cohort Study of Preoperative Single Dose Versus Four Doses of Antibiotics for Patients With Non-Complicated Acute Appendicitis

    Directory of Open Access Journals (Sweden)

    Salah H. Al Janaby

    2017-02-01

    Full Text Available Objective: To Test the efficacy of single preoperative dose of Cefotaxime 1gm and Metronidazole 500mg in reducing the surgical site infections (SSIs after open appendectomy in patients with non-complicated appendicitis (NCA Place and Duration of Study: Al Hilla General Teaching Hospital, Babel Governorate-Iraq, from January 2013 to January 2014. Patients & Methods: 100 patients, who underwent appendectomy for NCA and fulfilled the selection criteria, were randomized into two groups. The patients in group A received a single dose of pre-operative antibiotics (Cefotaxime sodium and metronidazole, while the group B patients received three more dose of the same antibiotics postoperatively. Patients of both groups were followed-up for 30 days to assess the postoperative infective complications. Results: Group A had 48, while group B comprised of 52 patients. The groups were comparable in the baseline characteristics. Statistically, P value in rates of SSIs between both the groups was 0.9182. None of the patients developed intra-abdominal collection. Conclusion: Single dose of pre-operative antibiotics (Cefotaxime and metronidazole was sufficient in reducing the SSIs after appendectomy for NPA. Postoperative antibiotics did not add an appreciable clinical benefit in these patients. Key words: Preoperative antibiotics, Appendectomy, Surgical site infection, Non-complicated appendicitis Abbreviations: SSI: Surgical Site Infection, NCA: non-complicated appendicitis CDC Center of Disease Control.

  7. Scrotal absceso following an appendicitis

    Directory of Open Access Journals (Sweden)

    León Hernández Angélica,

    2014-07-01

    Full Text Available Appendicitis is the most common cause of acute abdomen in children; approximately one third of all cases present with appendiceal perforation at the time of surgery. Some of postoperative complications in this condition are abscesses. In unusual places such as the scrotum however, for an intraabdominal event to cause a scrotal abscess, fluid displacement requires the presence of a patent processus vaginalis. We report the case of a child with perforated appendix followed by a scrotum abscess owing to a permeable vaginal canal. The abscess was and the patient wes and treatment was performed based triple scheme antibiotics, evolving satisfactorily. Key words: appendicitis, postoperative complications, residual abscess, inguinal canal.

  8. Role of Emergency Magnetic Resonance Imaging for the Workup of Suspected Appendicitis in Pregnant Women.

    Science.gov (United States)

    Amitai, Michal M; Katorza, Eldad; Guranda, Larisa; Apter, Sara; Portnoy, Orith; Inbar, Yael; Konen, Eli; Klang, Eyal; Eshet, Yael

    2016-10-01

    Pregnant women with acute abdominal pain pose a diagnostic challenge. Delay in diagnosis may result in significant risk to the fetus. The preferred diagnostic modality is magnetic resonance imaging (MRI), since ultrasonography is often inconclusive, and computed tomography (CT) would expose the fetus to ionizing radiation. To describe the process in setting up an around-the-clock MRI service for diagnosing appendicitis in pregnant women and to evaluate the contribution of abdominal MR in the diagnosis of acute appendicitis. We conducted a retrospective study of consecutive pregnant women presenting with acute abdominal pain over a 6 year period who underwent MRI studies. A workflow that involved a multidisciplinary team was developed. A modified MRI protocol adapted to pregnancy was formulated. Data regarding patients' characteristics, imaging reports and outcome were collected retrospectively. 49 pregnant women with suspected appendicitis were enrolled. Physical examination was followed by ultrasound: when positive, the patients were referred for MR scan or surgery treatment; when the ultrasound was inconclusive, MR scan was performed. In 88% of women appendicitis was ruled out and surgery was prevented. MRI diagnosed all cases with acute appendicitis and one case was inconclusive. The overall statistical performance of the study shows a negative predictive value of 100% (95%CI 91.9-100%) and positive predictive value of 83.3% (95%CI 35.9-99.6%). Creation of an around-the-clock imaging service using abdominal MRI with the establishment of a workflow chart using a dedicated MR protocol is feasible. It provides a safe way to rule out appendicitis and to avoid futile surgery in pregnant women.

  9. Antibiotika som primær behandling af appendicitis

    DEFF Research Database (Denmark)

    Hupfeld, Line; Pommergaard, Hans-Christian; Burcharth, Jakob

    2014-01-01

    Acute appendicitis has traditionally been treated surgically. Conservative approach with antibiotic treatment has been suggested as an alternative to the surgical procedure. The available studies on surgery versus antibiotics may indicate the safe use of conservative treatment for uncomplicated...... appendicitis, but the available studies are typically of low quality. Thus, further studies are needed to clarify the role of conservative treatment, and in the meantime appendectomy remains the standard treatment for acute appendicitis....

  10. Apendicite aguda isquêmica em coelhos: novo modelo com estudo histopatológico Acute ischaemic appendicitis in rabbits: new model with histopathological study

    Directory of Open Access Journals (Sweden)

    Fernando Costa Nunes

    2005-10-01

    Full Text Available OBJETIVOS: Avaliar a isquemia parcial ou total, através da ligadura com fio inabsorvível dos vasos do mesoapêndice do apêndice vermiforme de coelhos, bem como a obstrução mecânica, através da ligadura com fio inabsorvível da base do apêndice vermiforme, a 1 cm do ceco. Avaliar a histologia do apêndice ( normal e acometido . Estudar a flora bacteriana residente no apêndice vermiforme ( normal e acometido e do exsudato peritoneal. MÉTODOS: Foram utilizados 72 coelhos ( "Oryctogalus cuniculos" , machos da linhagem Nova Zelândia, com peso médio de 3,000 gramas. Foram divididos em grupos: piloto ( A , flora bacteriana ( B , controle ( H e experimento ( C, D, E, F e G com períodos de observação de 96 horas e 192 horas. Fez-se a ligadura dos vasos do mesoapêndice, com fio inabsorvível nos grupos ( D, E, F e G e da base do apêndice vermiforme a 1 cm do ceco, no grupo ( C . No grupo experimento (D,E,F e G foi praticado o modelo isquêmico. No grupo experimento ( C foi realizada a obstrução mecânica e no grupo controle ( H foi feita somente a simulação da cirurgia. RESULTADOS: No grupo controle ( H , não ocorreu apendicite aguda. No grupo experimento ( C,D,E,F, e G ocorreu apendicite aguda. CONCLUSÃO: O procedimento utilizado causa apendicite aguda com alterações anatomopatológicas distintas. A bactéria residente encontrada na flora fisiológica do suco entérico do apêndice vermiforme e no exsudato peritoneal foi a Escherichia coli.PURPOSE: To evaluate partial or total ischemia, through ligature with an unabsorbed thread of vessels from the vermiform appendix of rabbits, as well as the mechanical obstruction, through ligature with an unabsorbed thread at the basis of the vermiform appendix, at 1 cm from the cecum, of the acute appendicitis disease. To evaluate the histology of the appendix ( normal and affected . To study the bacterium flora resident in the vermiform appendix (normal and affected and the exudates

  11. C-reactive protein and white blood cell count do not improve clinical decision-making in acute appendicitis

    DEFF Research Database (Denmark)

    Tind, Sofie; Lassen, Annmarie Touborg; Zimmermann-Nielsen, Erik

    2015-01-01

    . However, their influence on diagnostic decision-making has not previously been investigated. The aim of the present study was to investigate if the results of CRP and leucocytes had any positive or negative influence on the decision-making of surgeons handling patients with suspected AA. METHODS...... counts did not influence clinical decision-making....... appendicitis on histology. The surgeons changed their diagnosis in nine cases after assessing blood samples. The changes in the proportion of correct diagnoses, sensitivity, specificity and predictive values after assessing blood samples were not significant. CONCLUSIONS: The results of CRP and leucocyte...

  12. Ultrasound Accuracy in Diagnosing Appendicitis in Obese Pediatric Patients.

    Science.gov (United States)

    Love, Bryan E; Camelo, Monica; Nouri, Sarvenaz; Kriger, Diego; Ludi, Daniel; Nguyen, Henry

    2017-10-01

    The use of ultrasound to diagnose appendicitis in pediatric patients has been growing with the improvement of ultrasound technology and operator skills, but its utility in the increasingly obese pediatric population has not been thoroughly investigated. A retrospective review of all pediatric (≤18 years old) patients with appendicitis who were admitted at a single hospital from 2014 to 2016 was conducted. Patients were stratified into body mass index (BMI) percentile categories based on the centers for disease control guidelines. Comparisons were then made. There were 231 patients with an average BMI percentile of 72.6; 99 (42.9%) who had an ultrasound, of which 54 (54.5%) were positive for acute appendicitis, whereas 43 (43.4%) were nondiagnostic. In patients who had a nondiagnostic ultrasound, 37 had a CT demonstrating acute appendicitis. These were compared with 123 patients who had CT alone demonstrating acute appendicitis. The CT-only group was older (12 vs 9, P appendicitis.

  13. Ultrasound in the diagnosis of appendicitis: a plea for caution ...

    African Journals Online (AJOL)

    Background/Objectives: Acute appendicitis is one of the most frequent causes of acute abdomen. The clinical diagnosis is based on the case history and the physical examination. However, in some cases the typical clinical symptoms are equivocal or misleading at which time, making the diagnosis of appendicitis may be ...

  14. Summer Appendicitis | Fares | Annals of Medical and Health ...

    African Journals Online (AJOL)

    Acute appendicitis has been reported to be present throughout the year, but some particular months are associated with higher incidences. The aim of this study was designed to review previous studies and analyze the current knowledge and controversies related to seasonal variability of acute appendicitis, to examine ...

  15. appendicitis in university of port harcourt teaching hospital, nigeria

    African Journals Online (AJOL)

    2012-10-01

    Oct 1, 2012 ... seen mostly in perforated appendix (4). This study was carried out to determine the pattern of presentation of acute appendicitis in UPTH. MATERIALS AND METHODS. This was a retrospective study of all patients with histologically confirmed acute appendicitis seen at. UPTH over a two-year period (from ...

  16. Enterobius vermicularis: a rare cause of appendicitis.

    Science.gov (United States)

    Gialamas, Eleftherios; Papavramidis, Theodossis; Michalopoulos, Nick; Karayannopoulou, Georgia; Cheva, Angeliki; Vasilaki, Olga; Kesisoglou, Isaak; Papavramidis, Spiros

    2012-01-01

    Although appendicitis is one of the most common causes of emergency surgery, parasites are rarely found associated with inflammation of the appendix. The aim of this study is to establish the prevalence of Enterobius vermicularis in surgically removed appendices, as well as to determine its possible role in the pathogenesis of appendicitis. A retrospective analysis of all the appendices removed during the last 20 years at a tertiary university hospital. Appendices removed during the course of another intra-abdominal procedure were excluded from the study. All 1085 surgical specimens removed from patients with clinical appendicitis were evaluated. Enterobius vermicularis was found in seven appendices (0.65%) with clinical symptoms of appendicitis. The parasite was most frequently identified in appendices without pathological changes (6/117). There was no case of chronic appendicitis presenting E. vermicularis infestation, while the parasite was rarely related to histological changes of acute appendicitis (1/901). The results suggest that the presence of E. vermicularis in the appendix might cause appendiceal pain (colic), but can rarely be associated with pathologic findings of acute appendicitis.

  17. Utility of Immature Granulocyte Percentage in Pediatric Appendicitis

    Science.gov (United States)

    Mathews, Eleanor K.; Griffin, Russell L.; Mortellaro, Vincent; Beierle, Elizabeth A.; Harmon, Carroll M.; Chen, Mike K.; Russell, Robert T.

    2014-01-01

    Background Acute appendicitis is the most common cause of abdominal surgery in children. Adjuncts are utilized to help clinicians predict acute or perforated appendicitis, which may affect treatment decisions. Automated hematologic analyzers can perform more accurate automated differentials including immature granulocyte percentages (IG%). Elevated IG% has demonstrated improved accuracy for predicting sepsis in the neonatal population than traditional immature to total neutrophil count (I/T) ratios. We intended to assess the additional discriminatory ability of IG% to traditionally assessed parameters in the differentiation between acute and perforated appendicitis. Materials and Methods We identified all patients with appendicitis from July 2012 to June 2013 by ICD-9 code. Charts were reviewed for relevant demographic, clinical, and outcome data, which were compared between acute and perforated appendicitis groups using Fischer’s exact and t-test for categorical and continuous variables, respectively. We utilized an adjusted logistic regression model utilizing clinical lab values to predict the odds of perforated appendicitis. Results 251 patients were included in the analysis. Those with perforated appendicitis had a higher white blood cell (WBC) count (p=0.0063), C-reactive protein (CRP) (pappendicitis. The c-statistic of the final model was 0.70, suggesting fair discriminatory ability in predicting perforated appendicitis. Conclusions IG% did not provide any additional benefit to elevated CRP and presence of left shift in the differentiation between acute and perforated appendicitis. PMID:24793450

  18. CT in the diagnosis of appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Toyama, Yoshihiro; Teraoka, Hiromichi; Matsui, Hisahiro; Itoh, Yasunori; Satoh, Gen [Ritsurin Hospital, Takamatsu, Kagawa (Japan); Ohkawa, Motoomi; Tanabe, Masatada

    1995-11-01

    In five years 13 cases of acute appendicitis were examined with CT before operation. These diagnosis were not obvious with clinical evaluation and US. CT without oral contrast material clearly depicted the abnormal appendix appendicolitis periappendiceal inflammation and abscess. Especially CT showed 4 cases of periappendiceal abscess with abnormal appendix. We think unenhanced CT without oral contrast material is useful test to diagnose appendicitis and appendiceal abscess when its diagnosis are not obvious with US. (author).

  19. Imaging of appendicitis

    Directory of Open Access Journals (Sweden)

    Himal Gajjar

    2008-12-01

    Full Text Available Appendicitis is one of the commonest causes of abdominal pain requiring surgery. Early diagnosis and management are essential to reduce morbidity and mortality. Imaging is valuable in the diagnosis of cases that are clinically atypical. Imaging also allows evaluation of the complications of appendicitis. In certain circumstances, conservative treatment of complicated appendicitis with percutaneous drainage is appropriate.

  20. Imagem radiográfica de acúmulo fecal no ceco, como sinal diagnóstico de apendicite aguda Radiographic image of fecal loading in the cecum as a diagnostic sign of acute appendicitis

    Directory of Open Access Journals (Sweden)

    Andy Petroianu

    2007-08-01

    Full Text Available OBJETIVO: Apesar de os achados radiográficos de apendicite aguda serem bem documentados, o valor da radiografia simples ainda não foi completamente determinado. O objetivo do presente estudo foi estabelecer a freqüência da associação de apendicite aguda a um sinal radiográfico caracterizado por imagem de acúmulo fecal ocupando todo o ceco. MATERIAIS E MÉTODOS: Foram realizadas radiografias simples de abdome de 100 pacientes consecutivos com apendicite aguda, comprovada por operação e exame anatomopatológico. Pesquisou-se, nas radiografias, a presença de imagem de acúmulo fecal no ceco, caracterizada por hipotransparência ocupando todo o ceco e, eventualmente, também o cólon ascendente. RESULTADOS: A imagem de acúmulo fecal no ceco foi encontrada em 97% dos doentes, independentemente de idade, sexo, cor da pele ou estádio da apendicite. CONCLUSÃO: Este estudo sugere que a presença de imagem radiográfica de acúmulo fecal no ceco pode ser um sinal útil no diagnóstico de apendicite aguda.OBJECTIVE: Although the radiological features of acute appendicitis are well documented, the value of the plain radiography has not been fully appreciated yet. The present study was aimed at determining the frequency of association between acute appendicitis and a radiological sign characterized as an image of fecal loading in the whole cecum. MATERIALS AND METHODS: Plain abdominal radiographs of 100 consecutive adult patients with acute appendicitis proved by surgery and histology were assessed. The presence of fecal loading characterized by hypotransparency in the whole cecum, and sometimes also in the ascending colon, was observed. RESULTS: The image of fecal loading in the cecum was found in 97% of cases of acute appendicitis, independently of age, gender, skin color or stage of appendicitis. CONCLUSION: The present study suggests that the presence of radiological images of fecal loading in the cecum may be a useful sign for the

  1. Appendicitis During Pregnancy with a Normal MRI

    Directory of Open Access Journals (Sweden)

    Matthew M. Thompson

    2014-09-01

    Full Text Available Abdominal pain frequently represents a diagnostic challenge in the acute setting. In pregnant patients, the gravid abdomen and concern for ionizing radiation exposure further limit evaluation. If undiagnosed, appendicitis may cause disastrous consequences for the mother and fetus. We present the case of a pregnant female who was admitted for right lower quadrant abdominal pain. Advanced imaging of the abdomen and pelvis was interpreted to be either indeterminate or normal and a diagnosis of acute appendicitis was made on purely clinical grounds. This patient’s management and a literature review of diagnostic techniques for acute appendicitis during pregnancy are discussed. [West J Emerg Med. 2014;15(6:652-654

  2. Clinical and socioeconomic factors associated with negative pediatric appendicitis.

    Science.gov (United States)

    Dubrovsky, Genia; Rouch, Josh; Huynh, Nhan; Friedlander, Scott; Lu, Yang; Lee, Steven L

    2017-10-01

    Misdiagnosing appendicitis may lead to unnecessary surgery. The study evaluates the risk factors for negative appendectomies, as well as the clinical and socioeconomic consequences of negative appendectomy across three states. Data were obtained from the California, New York, and Florida State Inpatient Databases 2005-2011. Patients (<18 years) who underwent nonincidental appendectomies (n = 156,660) were evaluated with hierarchical and multivariate negative binomial regression analyses on outcomes including hospital cost, length of stay (LOS), and associated morbidity. From 2005 to 2011, there was a decrease in the rate of negative appendicitis and perforated appendicitis, whereas the rate of true acute nonperforated appendicitis increased. Whites, females, and privately insured patients were associated with higher negative appendicitis rates, whereas those at an increased risk for perforated appendicitis were African-Americans, males, and those with public or no insurance. Compared to patients with acute nonperforated appendicitis, those with negative appendicitis have significantly higher morbidity (2.5% versus 1.3%), longer LOS (3.4 versus 1.8 d), and greater hospital costs averaged over time ($6926 versus $6492 per patient). Despite a low incidence, negative appendicitis is associated with greater morbidity, longer LOS, and higher cost than acute nonperforated appendicitis. Certain subpopulations are at higher risk for undergoing surgery for negative appendicitis, whereas others are at greater risk for presenting with perforated appendicitis. Further research is needed to understand what drives such disparities and to inform efforts to improve quality of hospital care across all groups of patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Neonatal appendicitis mimicking intestinal duplication: a case report

    Directory of Open Access Journals (Sweden)

    Saeki Isamu

    2012-09-01

    Full Text Available Abstract Introduction Acute appendicitis is a common disease in older children but rare in neonates. Case presentation We report the case of a 2-day-old Asian baby who suffered from neonatal appendicitis mimicking intestinal duplication. Laparoscopic appendectomy was successfully performed after the trans-umbilical division of adhesions, and the postoperative course was uneventful. Conclusion There are few reports describing abdominal masses caused by appendicitis mimicking intestinal duplication. The laparoscopic approach for neonatal appendicitis is considered to be a safe and useful therapeutic modality with good cosmetic results.

  4. Selective use of diagnostic laparoscopy in patients with suspected appendicitis

    NARCIS (Netherlands)

    van den Broek, W. T.; Bijnen, A. B.; van Eerten, P. V.; de Ruiter, P.; Gouma, D. J.

    2000-01-01

    BACKGROUND: Diagnostic laparoscopy has been introduced as a new diagnostic tool for patients with acute appendicitis. We performed diagnostic laparoscopy when the clinical diagnosis of appendicitis was in doubt. The aims of this study were to evaluate this strategy and to analyze the efficacy of

  5. Rectal contrast-enhanced computed tomography in the diagnosis of acute appendicitis; Tomografia computarizada con contraste rectal en el diagnostico de la apendicitis aguda

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2000-07-01

    To assess the efficacy and utility of computed tomography (CT) in the diagnosis of appendicitis, and to evaluate the reliability of CT findings in right iliac fossa in the confirmation or exclusion of this diagnosis. Over a one-year period, 152 patients presenting clinical signs of appendicitis underwent CT scans. The images were reviewed by two radiologists who considered whether the appendix was normal or enlarged and the existence of other signs of appendicitis for the purpose of determining whether or not the patient presented appendicitis. The definitive diagnoses were established by surgery or by clinical follow-up. The sensitivity of CT for the diagnosis of appendicitis was 81.8%, the specificity was 95.3%, the positive predictive value was 93.1%, the negative predictive value was 87.2% and the reliability was 89.9%. The signs of appendicitis observed were: appendicoliths (sensitivity 30.3% and specificity 98.8%), fluid collections (sensitivity 19.7%, specificity 96.5%), cecal enlargement (sensitivity 21.2%, specificity 97.7%), inflammation of pericecal fat (sensitivity 72.7%, specificity 90.7%), fascial thickening (sensitivity 48.5%, specificity 91.9%) and an appendix measuring more than 6 mm (sensitivity 78.8%, specificity 94.3%). Adenopathy and free peritoneal fluid were not significantly related to appendicitis. The presence of a normal appendix filled with air or contrast material had an elevated negative predictive value with respect to appendicitis. In 35 of the 94 cases with negative CT scans, the images suggested alternative diagnoses. CT is a highly reliable diagnostic method for appendicitis. The observation of an appendix filled with air or contrast material has an elevated negative predictive value. The presence of appendicoliths has an elevated positive predictive value. (Author) 29 refs.

  6. Oral antibiotics for perforated appendicitis is not recommended

    DEFF Research Database (Denmark)

    Alamili, Mahdi; Gögenur, Ismail; Rosenberg, Jacob

    2010-01-01

    In the majority of surgical departments in Denmark, the postoperative treatment for acute perforated appendicitis comprises three days of intravenous antibiotics. Recently, it has been proposed that such antibiotic regimen should be replaced by orally administered antibiotics. The aim of this paper...... was to give an overview of studies on acute perforated appendicitis with postoperative oral antibiotics. Five studies were found in a database search covering the 1966-2009 period. There is no evidence to support a conversion of the postoperative antibiotic regimen from intravenous to oral administration...... in patients with acute perforated appendicitis....

  7. Primary epiploic appendicitis and echography findings

    International Nuclear Information System (INIS)

    Mederos Curbelo, Orestes Noel; Da Costa Fernandez, Jose Manuel; Jequin Savariego, Esther; Ramos Hernandez, Ricardo Ulises

    2010-01-01

    This is the case of a woman aged 55 presenting with localized acute abdominal pain in right inferior quadrant of 12 hours of course, leukocytosis and peritoneal reaction. The abdominal echography findings showed a supposed epiploitis but the pain intensity and persistence determined the surgical intervention. Epiploic acute appendicitis is a infrequent affection that must to be suspected in case of acute pain in inferior abdominal quadrants and imaging studies are essential for preoperative diagnosis. (author)

  8. Appendicitis in Children: Evaluation of the Pediatric Appendicitis Score in Younger and Older Children

    Directory of Open Access Journals (Sweden)

    Martin Salö

    2014-01-01

    Full Text Available Background. This study aimed to evaluate Pediatric Appendicitis Score (PAS, diagnostic delay, and factors responsible for possible late diagnosis in children <4 years compared with older children who were operated on for suspected appendicitis. Method. 122 children, between 1 and 14 years, operated on with appendectomy for suspected appendicitis, were retrospectively analyzed. The cohort was divided into two age groups: ≥4 years (n=102 and <4 years (n=20. Results. The mean PAS was lower among the younger compared with the older patients (5.3 and 6.6, resp.; P=0.005, despite the fact that younger children had more severe appendicitis (75.0% and 33.3%, resp.; P=0.001. PAS had low sensitivity in both groups, with a significantly lower sensitivity among the younger patients. Parent and doctor delay were confirmed in children <4 years of age with appendicitis. PAS did not aid in patients with doctor delay. Parameters in patient history, symptoms, and abdominal examination were more diffuse in younger children. Conclusion. PAS should be used with caution when examining children younger than 4 years of age. Diffuse symptoms in younger children with acute appendicitis lead to delay and to later diagnosis and more complicated appendicitis.

  9. Appendicular pseudodiverticula and acute appendicitis: Our 12-year experience Pseudodivertículos apendiculares y apendicitis aguda: Nuestra experiencia en 12 años

    Directory of Open Access Journals (Sweden)

    María del Carmen Manzanares-Campillo

    2011-11-01

    Full Text Available Introduction: the presence of diverticula and their complications in the cecal appendix is an uncommon disease. We present a series of 13 patients with this condition, and perform a review of the literature. Patients and method: we carried out a retrospective study of patients undergoing appendectomy for acute appendicitis in the last twelve years in our department. The pathological examination of these episodes revealed 13 cases with a diagnosis of diverticular disease, all of them consisting of pseudodiverticula. Their clinical manifestations, laboratory results, imaging tests, and histology were analyzed, and findings were compared to those in the previous literature. Results: the incidence of diverticular disease in our setting was 13 cases (0.8% among 1634 appendectomies for acute appendicitis. Diverticulitis was found in 8 patients (61.5%, and diverticulosis (38.5% in 5. Appendicular perforation was more common in patients with diverticular disease (53.8% as compared to those without this condition (31.1%. Conclusions: complicated diverticular disease in the vermiform appendix of adult patients may result in insidious, recurrent manifestations that may confound preoperative diagnosis. A higher risk for appendicular perforation renders appendectomy the therapy of choice, even prophylactically when the condition is incidentally identified preoperatively.Introducción: la presencia de divertículos y sus complicaciones en el apéndice cecal constituyen una entidad infrecuente. Presentamos una serie de 13 pacientes con esta patología y realizamos una revisión de la literatura. Pacientes y método: realizamos un estudio retrospectivo de los pacientes apendicectomizados por apendicitis aguda en los últimos doce años en nuestro servicio. El examen anatomopatológico de estos episodios reveló el diagnóstico de 13 casos con enfermedad diverticular, todos ellos pseudodivertículos. Se analizaron la clínica, pruebas analíticas, de imagen y la

  10. Acute appendicitis in an incarcerated crural hernia: analysis of our experience Apendicitis aguda en una hernia crural incarcerada: análisis de nuestra experiencia

    Directory of Open Access Journals (Sweden)

    P. Priego

    2005-10-01

    Full Text Available Introduction: the finding of the vermiform appendix within a crural hernia (Amyand's hernia is a rare entity whose incidence is not described in the literature. Objective: the aim of this study was to report our hospital's experience in this kind of pathology. Material and methods: between 1993 and 2004, 4,572 acute appendicitis and 372 incarcerated crural hernia cases have been operated on in our hospital. We studied 6 cases of incarcerated crural hernia with vermiform appendix inside. We analyzed in retrospect the following parameters: age, sex, personal history, clinical manifestations, preoperative diagnosis, surgical technique, mean hospital stay, and outcome. Results: all patients were women with a mean age of 78.8 years. Most frequent clinical manifestations included pain and a mass in the right inguinocrural region, of variable intensity and duration. No clinical, laboratory, or radiographic signs help in reaching a correct preoperative diagnosis. General anesthesia and a crural approach are used in most surgical operations. In all cases an appendectomy was performed via the hernia sac, thus proving the presence of acute appendicitis in four of them (66.67%. A prosthetic mesh was used in 3 cases, and one case of wound infection was found. In the other cases we sutured the hernia ring using prolene. Conclusion: the finding of the appendix in an incarcerated crural hernia is a rare entity in old women that is difficult to diagnose preoperatively. Treatment includes appendectomy and herniorraphy. The use of prosthetic mesh is controversial.Introducción: la presencia del apéndice vermiforme en el interior de un saco herniario crural (hernia de Amyand constituye una entidad poco frecuente y cuya incidencia no está descrita en la literatura. Objetivo: el objetivo del trabajo es presentar la experiencia de nuestro hospital en este tipo de patología. Material y métodos: entre 1993 y 2004 se han intervenido en nuestro centro 4.572 pacientes

  11. Practical issues in treatment of appendicitis

    NARCIS (Netherlands)

    van Rossem, C.C.

    2016-01-01

    Appendicitis is a common cause of acute abdominal pain and an appendectomy is still the gold standard of treatment. In spite of the high incidence, variance in diagnostic and treatment modalities remains an issue among surgeons. In this thesis several practical issues in the diagnosis and treatment

  12. Livstruende appendicitis forårsaget af Fusobacterium necrophorum

    DEFF Research Database (Denmark)

    Hagen, Trine Langfeldt; Maeda, Yasuko; Lindberg, Jens Aage

    2014-01-01

    Fusobacterium necrophorum is a well-known cause of Lemierre's syndrome. Recent studies suggest a causative association between F. necrophorum and acute appendicitis. We present a case of a 15-year-old previously healthy girl who presented with acute non-perforated appendicitis, intra......-abdominal abscesses and thrombosis that led to omental necrosis. This resulted in a life-threatening septic shock with the need for prolonged intensive care. We suggest that F. necrophorum identified in pus from the abdomen caused this fulminant variation of appendicitis with findings similar to those seen...

  13. Funiculitis mimicking appendicitis: A rare culprit

    Directory of Open Access Journals (Sweden)

    Lindsey L. Perea

    2017-01-01

    Full Text Available Acute appendicitis is an extremely common cause for pediatric admissions, most notably presenting with right lower quadrant pain. There are few other etiologies for a young male to have pain aside from appendicitis. We present a young boy who presented with right lower quadrant abdominal pain and fevers, but was found to have funiculitis. Funiculitis, or inflammation of the spermatic cord, is a very rare condition in the pediatric population, almost always occurring in the elderly with urinary flow conditions. We share our case to remind providers the importance of a full differential diagnosis.

  14. Appendicitis in Teens

    Science.gov (United States)

    ... Español Text Size Email Print Share Appendicitis in Teens Page Content Article Body Early adolescence is prime ... with a small scar, but completely cured. Helping Teens To Help Themselves Youngsters should be encouraged to ...

  15. std::string Append

    Science.gov (United States)

    2015-10-01

    UNCLASSIFIED AD-E403 689 Technical Report ARWSE-TR-14026 STD ::STRING APPEND Tom Nealis...DATES COVERED (From – To) 4. TITLE AND SUBTITLE STD ::STRING APPEND 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6...two or more strings together while developing a C++ application is a very common task. For std ::strings, there are two primary ways to achieve the

  16. Appendicitis in pregnancy.

    Science.gov (United States)

    Pastore, Patricia A; Loomis, Dianne M; Sauret, John

    2006-01-01

    Our urban practice had two incidences of documented appendicitis in pregnancy in a 24-hour period with two unique outcomes that prompted an inquiry. Appendicitis in pregnancy is relatively rare, but it has significant morbidity and is a cause of maternal and infant mortality. Abdominal pain is the most common presenting symptom, and the consideration of multiple pathologic disorders should be entertained. Accurate diagnosis of appendicitis in pregnancy is the largest challenge since the signs and symptoms may vary depending on the trimester in which the patient presents. We undertook a systematic review of English-language articles from 1975 to 2005 using the key words "appendicitis," and "pregnancy" using MEDLINE, CINAHL, and Cochrane Controlled Trials Register databases. The accurate diagnosis of appendicitis during pregnancy requires a high level of suspicion and clinical skills, and not merely relying on the classic signs and diagnostic testing. Primary care providers play an important role in recognizing potential signs and symptoms of appendicitis in pregnancy to initiate prompt action and reduce negative maternal and fetal outcomes.

  17. Comparison of ultrasonography and computed tomography in the diagnosis of acute appendicitis; Comparacion de la ecografia y la tomografia computarizada en el diagnostico de la apendicitis aguda

    Energy Technology Data Exchange (ETDEWEB)

    Cura, J. L. del; Oleaga, L.; Grande, D.; Farina, M. A.; Isusi, M. [Hospital de Basurto. Bilbao (Spain)

    2001-07-01

    The compare the efficacy of ultrasonography and computed tomography (CT) in cases of suspected appendicitis. To study to what extent age, sex and habits of the patients, as well as the clinical context, influence the diagnostic yield of these two technique. Over a one-year period, 152 patients underwent ultrasonography and CT because of the clinical suspicion of appendicitis. The studies were carried out independently, and the results of each in terms of the presence or absence of appendicitis were unknown to the specialists performing the other. The final diagnoses were established by surgical treatment or clinical follow-up. The sensitivity of CT for the diagnosis of appendicitis was 82%, the specificity was 95%, the positive predictive value was 93%, the negative predictive value was 87% and the reliability was 90%. Ultrasonography has a sensitivity of 83%, a specificity of 97%, a positive predictive value of 95%, a negative predictive value of 88% and a reliability of 91%. Ultrasound was more efficient in patients in which there was a high clinical suspicion and in children, while the results with CT were better in patients in which the clinical diagnosis was less clear. The incidence of false negatives and positives was higher with ultrasound, while CT was more frequently able to identify a normal appendix. Sex and habits had no influence on the respective efficacies, although the performance of ultrasound was simplified in thin patients and that of CT in obese individuals. Ultrasonography and CT are highly reliable in cases of suspected appendicitis, especially when this diagnosis is conformed. Ultrasound is recommended as the technique of choice in children and in patients in which the clinical suspicion is strong. The yield of CT is somewhat greater when the clinical signs and symptoms are less clear. However, the efficacy of both techniques ultimately depends on the expertise of the specialist who interprets them. (Author) 62 refs.

  18. Appendicitis in Children: Audit of outcome in Kosti-Teaching Hospital

    African Journals Online (AJOL)

    Introduction: Appendicitis is the most common cause of the acute surgical abdomen in children. It accounts for approximately one-third of childhood hospital admissions for abdominal pain. Objectives: To audit the outcome of management of children presenting with abdominal pain suspicious of acute appendicitis. Patients ...

  19. "Post-appendectomy"A cute Appendicitis in a rural area: A surgical ...

    African Journals Online (AJOL)

    Acute appendicitis is the commonest abdominal surgical emergency worldwide. Its diagnosis is a clinical one and its treatment is removal of the inflamed appendix. In this paper, three cases of acute "postappendectomy" appendicitis are presented. The paper discusses the problems of communication between doctors and ...

  20. Impact of appendicitis during pregnancy : No delay in accurate diagnosis and treatment

    NARCIS (Netherlands)

    Aggenbach, L.; Zeeman, G. G.; Cantineau, A. E. P.; Gordijn, S. J.; Hofker, H. S.

    Background: Acute appendicitis during pregnancy may be associated with serious maternal and/or fetal complications. To date, the optimal clinical approach to the management of pregnant women suspected of having acute appendicitis is subject to debate. The purpose of this retrospective study was to

  1. Feasibility of Early Diagnosis and Treatment of Acute Chest ...

    African Journals Online (AJOL)

    Acute chest syndrome is a serious complication and one of the causes of mortality in sickle cell disease. Twenty eight year old male was admitted in our hospital with fever, severe chest pain and haemolytic crisis. He was treated with intravenous antibiotics, fluids, parenteral analgesics and blood transfusion. Severe ...

  2. Impact of appendicitis during pregnancy: no delay in accurate diagnosis and treatment.

    Science.gov (United States)

    Aggenbach, L; Zeeman, G G; Cantineau, A E P; Gordijn, S J; Hofker, H S

    2015-03-01

    Acute appendicitis during pregnancy may be associated with serious maternal and/or fetal complications. To date, the optimal clinical approach to the management of pregnant women suspected of having acute appendicitis is subject to debate. The purpose of this retrospective study was to provide recommendations for prospective clinical management of pregnant patients with suspected appendicitis. Case records of all pregnant patients suspected of having appendicitis whom underwent appendectomy at our hospital between 1990 and 2010 were reviewed. Appendicitis was histologically verified in fifteen of twenty-one pregnant women, of whom six were diagnosed with perforated appendicitis. Maternal morbidity was seen in two cases. Premature delivery occurred in two out of six cases with perforated appendicitis cases and two out of six cases following a negative appendectomy. Perinatal mortality did not occur. Both (perforated) appendicitis and negative appendectomy during pregnancy are associated with a high risk of premature delivery. Clinical presentation and imaging remains vital in deciding whether surgical intervention is indicated. We recommend to cautiously weigh the risks of delay until correct diagnosis with associated increased risk of appendiceal perforation and the risk of unnecessary surgical intervention. Based upon current literature, we recommend clinicians to consider an MRI following an inconclusive or negative abdominal ultrasound aiming to improve diagnostic accuracy to reduce the rate of negative appendectomies. Accurate and prompt diagnosis of acute appendicitis should be strived for to avoid unnecessary exploration and to aim for timely surgical intervention in pregnant women suspected of having appendicitis. Copyright © 2015. Published by Elsevier Ltd.

  3. Predictors of Nondiagnostic Ultrasound for Appendicitis.

    Science.gov (United States)

    Keller, Christine; Wang, Nancy E; Imler, Daniel L; Vasanawala, Shreyas S; Bruzoni, Matias; Quinn, James V

    2017-03-01

    Ionizing radiation and cost make ultrasound (US), when available, the first imaging study for the diagnosis of suspected pediatric appendicitis. US is less sensitive and specific than computed tomography (CT) or magnetic resonance imaging (MRI) scans, which are often performed after nondiagnostic US. We sought to determine predictors of nondiagnostic US in order to guide efficient ordering of imaging studies. A prospective cohort study of consecutive patients 4 to 30 years of age with suspected appendicitis took place at an emergency department with access to 24/7 US, MRI, and CT capabilities. Patients with US as their initial study were identified. Clinical (i.e., duration of illness, highest fever, and right lower quadrant pain) and demographic (i.e., age and sex) variables were collected. Body mass index (BMI) was calculated based on Centers for Disease Control and Prevention criteria; BMI >85th percentile was categorized as overweight. Patients were followed until day 7. Univariate and stepwise multivariate logistic regression analysis was performed. Over 3 months, 106 patients had US first for suspected appendicitis; 52 (49%) had nondiagnostic US results. Eighteen patients had appendicitis, and there were no missed cases after discharge. On univariate analysis, male sex, a yearly increase in age, and overweight BMI were associated with nondiagnostic US (p appendicitis, and it may be more efficient to consider alternatives to US first for these patients. Also, this information about the accuracy of US to diagnose suspected appendicitis may be useful to clinicians who wish to engage in shared decision-making with the parents or guardians of children regarding imaging options for children with acute abdominal pain. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Fast track pathway for perforated appendicitis.

    Science.gov (United States)

    Frazee, Richard; Abernathy, Stephen; Davis, Matthew; Isbell, Travis; Regner, Justin; Smith, Randall

    2017-04-01

    Perforated appendicitis is associated with an increased morbidity and length of stay. "Fast track" protocols have demonstrated success in shortening hospitalization without increasing morbidity for a variety of surgical processes. This study evaluates a fast track pathway for perforated appendicitis. In 2013, a treatment pathway for perforated appendicitis was adopted by the Acute Care Surgery Service for patients having surgical management of perforated appendicitis. Interval appendectomy was excluded. Patients were treated initially with intravenous antibiotics and transitioned to oral antibiotics and dismissed when medically stable and tolerating oral intake. A retrospective review of patients managed on the fast track pathway was undertaken to analyze length of stay, morbidity, and readmissions. Thirty-four males and twenty-one females with an average age of 46.8 years underwent laparoscopic appendectomy for perforated appendicitis between January 2013 and December 2014. Pre-existing comorbidities included hypertension 42%, diabetes mellitus 11%, COPD 5% and heart disease 2%. No patient had conversion to open appendectomy. Average length of stay was 2.67 days and ranged from 1 to 12 days (median 2 days). Postoperative morbidity was 20% and included abscess (6 patients), prolonged ileus (3 patients), pneumonia (1 patient), and congestive heart failure (1 patient). Five patients were readmitted for abscess (3 patients), congestive heart failure (1 patient), and pneumonia (1 patient). A fast track pathway for perforated appendicitis produced shorter length of stay and acceptable postoperative morbidity and readmission. This offers the potential for significant cost savings over current national practice patterns. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Feasibility and Inter-Rater Reliability of Physical Performance Measures in Acutely Admitted Older Medical Patients

    DEFF Research Database (Denmark)

    Bodilsen, Ann Christine; Juul-Larsen, Helle Gybel; Petersen, Janne

    2015-01-01

    OBJECTIVE: Physical performance measures can be used to predict functional decline and increased dependency in older persons. However, few studies have assessed the feasibility or reliability of such measures in hospitalized older patients. Here we assessed the feasibility and inter......-rater reliability of four simple measures of physical performance in acutely admitted older medical patients. DESIGN: During the first 24 hours of hospitalization, the following were assessed twice by different raters in 52 (≥ 65 years) patients admitted for acute medical illness: isometric hand grip strength, 4......, and 30-s chair stand were 8%, 7%, and 18%, and the SRD95% values were 22%, 17%, and 49%. CONCLUSION: In acutely admitted older medical patients, grip strength, gait speed, and the Cumulated Ambulation Score measurements were feasible and showed high inter-rater reliability when administered by different...

  6. Unexpected histopathology of acute appendicitis

    Directory of Open Access Journals (Sweden)

    Mutee Ur Rehman

    2017-01-01

    Conclusion: We concluded that because of strong malignant association, it would be recommended that all appendix specimens should inspect during and after surgery and concurrent examination of peritoneal cavity is recommended.

  7. The consequences of missing appendicitis during pregnancy.

    Science.gov (United States)

    Dasari, Papa; Maurya, Dilip Kumar

    2011-08-11

    A 23-year-old second para was admitted for severe anaemia with abdominal distension in the immediate puerperal period following a preterm delivery. She suffered from acute abdominal pain 3 days back (at 32 weeks of gestation) and was evaluated in the emergency medical department for appendicitis/cholecystitis. Abdominal ultrasound was found to be normal and she received antacids for her pain abdomen. Clinical examination the day after delivery revealed abdominal distension, guarding and rigidity. Ultrasonography revealed a normal puerperal uterus with free fluid in the abdomen which on diagnostic aspiration was pus. Emergency laparotomy showed acute suppurative appendicitis with perforation. Appendecectomy with peritoneal lavage was done. Her postoperative period was stormy with high febrile spikes and evaluation confirmed septicaemia. The organism grown on postoperative blood culture and cervical swab culture was Enterococcus fecalis sensitive to vancomycin and she received the same for 10 days and recovered.

  8. Appendicitis in Pregnancy: Presentation, Management and Complications

    Directory of Open Access Journals (Sweden)

    Abdoulhossein Davoodabadi

    2016-06-01

    Full Text Available Background Diagnosis of acute appendicitis in pregnancy is difficult. Delay operation, increase complications. Objectives This study focused on early operation on base of careful history, precise physical examination, and rational close observation and evaluates its results with conventional investigation in pregnant women suspected acute appendicitis. Materials and Methods A cross sectional study in100 pregnant women and 100 aged matched non pregnant women underwent appendectomy during Sep 2011 - Dec 2014. The data were analyzed by chi-square test through SPSS 16.0. Results Age 16 - 37 years, mean age in pregnant women and no pregnant women were24.75 ± 4.4 and 27.56 ± 6.53 years (P > 0.05, respectively. 20 - 25 years age group, were more frequent = 44%. 70% patients were gravid 1, mean hospital stay in pregnant women, and non-pregnant women were 48 ± 6 and 85.2 ± 43.19 hours (P value < 0.001. respectively. acute appendicitis was confirmed histological in non-pregnant was 72%, but In pregnant women 62%, most cases were in the third Trimester 66% (n = 41. Peri umbilical pain, with migration to the right lower quadrant, was in 75% of patients. Right-lower-quadrant pain was the most common presenting symptom. Diagnosis (62% was made on base care full history and precise physical examination and close observation of 12 ± 8 hours. there were no maternal and fetal complications related to all of the appendectomies during the all trimester up to delivery period. Conclusions There are no diagnostic laboratory findings in acute appendicitis during pregnancy. Careful history and physical examination and close observation of 12 ± 8 hours are sufficient for surgery decision making. In spite of high negative appendectomy since it has no Surgical and obstetric complication, early Appendectomy without aggressive investigation recommend.

  9. Appendicitis During Pregnancy with a Normal MRI

    OpenAIRE

    Thompson, Matthew M.; Kudla, Alexei U.; Chisholm, Chris B.

    2014-01-01

    Abdominal pain frequently represents a diagnostic challenge in the acute setting. In pregnant patients, the gravid abdomen and concern for ionizing radiation exposure further limit evaluation. If undiagnosed, appendicitis may cause disastrous consequences for the mother and fetus. We present the case of a pregnant female who was admitted for right lower quadrant abdominal pain. Advanced imaging of the abdomen and pelvis was interpreted to be either indeterminate or normal and a ...

  10. Role of non-operative management in pediatric appendicitis.

    Science.gov (United States)

    Gonzalez, Dani O; Deans, Katherine J; Minneci, Peter C

    2016-08-01

    Appendectomy is currently considered the standard of care for children with acute appendicitis. Although commonly performed and considered a safe procedure, appendectomy is not without complications. Non-operative management has a role in the treatment of both uncomplicated and complicated appendicitis. In uncomplicated appendicitis, initial non-operative management appears to be safe, with an approximate 1-year success rate of 75%. Compared to surgery, non-operative management is associated with less disability and lower costs, with no increase in the rate of complicated appendicitis. In patients with complicated appendicitis, initial non-operative management with interval appendectomy has been shown to be safe with reported success rates between 66% and 95%. Several studies suggest that initial non-operative management with interval appendectomy may be beneficial in patients with perforated appendicitis with a well-formed abscess or inflammatory mass. Recent data suggest that interval appendectomy may not be necessary after initial non-operative management of complicated appendicitis. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Prospective evaluation of the Sunshine Appendicitis Grading System score.

    Science.gov (United States)

    Reid, Fiona; Choi, Julian; Williams, Marli; Chan, Steven

    2017-05-01

    Although there is a wealth of information predicting risk of post-operative intra-abdominal collection and guiding antibiotic therapy following appendicectomy, confusion remains because of lack of consensus on the clinical severity and definition of 'complicated' appendicitis. This study aimed to develop a standardized intra-operative grading system: Sunshine Appendicitis Grading System (SAGS) for acute appendicitis that correlates independently with the risk of intra-abdominal collections. Two-hundred and forty-six patients undergoing emergency laparoscopy for suspected appendicitis were prospectively scored according to the severity of appendicitis and followed up for complications including intra-abdominal collection. After termination of the study, the SAGS score was repeated by an independent surgeon based on operation notes and intra-operative photography to determine inter-rater agreement. The primary outcome measure was incidence of intra-abdominal collection, secondary outcome measures were all complications and length of stay. SAGS score demonstrated good inter-rater agreement (kappa K w 0.869; 95% CI 0.796-0.941; P appendicitis and to independently predict the risk of intra-abdominal collection. It can therefore be used to stratify risk, guide antibiotic therapy, follow-up and standardize the definitions of appendicitis severity for future research. © 2015 Royal Australasian College of Surgeons.

  12. MRI in suspected appendicitis

    NARCIS (Netherlands)

    Leeuwenburgh, M.M.N.

    2014-01-01

    Dit proefschrift richt zich op de optimalisatie van beeldvormende diagnostiek bij patiënten met een klinische verdenking op appendicitis, waarbij het gebruik van ‘magnetic resonance imaging’ (MRI) wordt verkend. Het proefschrift omvat de resultaten van de OPTIMAP-studie (OPTimisation of IMaging

  13. Appendicitis with appendicular atresia: A rare presentation | Masood ...

    African Journals Online (AJOL)

    Acute appendicitis is the most common acute surgical condition; making appendectomy the most commonly performed emergency surgical procedure in the world. Anomalies of the appendix are relatively uncommon. However, their presence may alter the course of pre-operative diagnosis and the surgical treatment ...

  14. Feasibility of Progressive Strength Training Implemented in the Acute Ward after Hip Fracture Surgery

    DEFF Research Database (Denmark)

    Kronborg, Lise; Bandholm, Thomas; Palm, Henrik

    2014-01-01

    sample of 36 patients, 18 with a cervical and 18 with a trochanteric hip fracture (27 women and 9 men, mean (SD) age of 79.4 (8.3) years) were included between June and December 2012. INTERVENTION: A daily (on weekdays) program of progressive knee-extension strength training for the fractured limb, using......IMPORTANCE: Patients with a hip fracture lose more than 50% knee-extension strength in the fractured limb within one week of surgery. Hence, immediate progressive strength training following hip fracture surgery may be rational, but the feasibility unknown. OBJECTIVE: To examine the feasibility...... of in-hospital progressive strength training implemented in the acute ward following hip fracture surgery, based on pre-specified criteria for feasibility. DESIGN, SETTING AND PATIENTS: A prospective cohort study conducted in an acute orthopedic hip fracture unit at a university hospital. A consecutive...

  15. Achados principais de exames laboratoriais no diagnóstico de apendicite aguda: uma avaliação prospectiva Main findings in laboratory tests diagnosis of acute appendicitis: a prospective evaluation

    Directory of Open Access Journals (Sweden)

    Rafael Nunes Goulart

    2012-06-01

    Full Text Available RACIONAL: Apendicite aguda é a doença abdominal cirúrgica mais comum nas unidades de emergência. Embora o diagnóstico seja clínico, a realização de exames complementares pode ser útil na dúvida diagnóstica. OBJETIVO: Avaliar as principais alterações de exames laboratoriais em pacientes com apendicite aguda, assim como sua relação com a fase evolutiva da doença. MÉTODOS: Avaliação prospectiva de pacientes com diagnóstico de apendicite aguda submetidos ao tratamento cirúrgico. RESULTADOS: Cento e setenta e nove pacientes participaram deste estudo, a maioria do sexo masculino. A idade média foi de 26 anos. Em relação à contagem de leucócitos, 46,9% apresentavam valores BACKGROUND: Acute appendicitis is the most common surgical abdominal disease in the emergency room. Although the diagnosis is clinical the complementary tests may be useful in doubt. AIM: To evaluate the main laboratory tests in patients with acute appendicitis, as well as its relationship with the evolutionary stage of the disease. METHODS: Prospective evaluation of patients with acute appendicitis who underwent surgical treatment. RESULTS: A total of 179 patients participated in this study, most were male. The mean age was 26 years. For leukocyte count 46.9% had values ​​<15.000mm3. The mean percentage of polymorphonuclear cells was 81,7%, 1,2% of sticks, 1% eosinophils, lymphocytes 12,8% and 2,9% monocytes. C-reactive protein was required for 54 patients. It was <10 mg/dl in 19, between 10 and 50 mg/dl in 24 and greater than or equal to 50 mg/dl in 11. Regarding the evolutionary phase 64% patients had early stage (stages 1 and 2, 16,2% stage 3 and 35 stage 4. A total of 57% of patients with white blood cell count greater than or equal to 20.000/mm3 had appendicular perforation (p<0,05. The percentage of polymorphonuclear leukocytes from patients with early stages was lower than the later stages (79,8% and 85,1%, respectively, with p<0,05. Patients

  16. Chronic appendicitis in a patient with 15 years abdominal pain

    Directory of Open Access Journals (Sweden)

    bizhan Khorasani

    2007-04-01

    Full Text Available Khorasani B1, Gholizadeh Pasha A2 1. Assistant professor, Department of surgery, Faculty of medicine, Tehran University of rehabilitation 2. Assistant professor, Department of surgery, Faculty of medicine, Babol University of medical sciences Abstract Background: Acute appendicitis is a completely known disease but for many physicians chronic appendicitis is unknown and some of them don believe in it. Although the number of people suffer from chronic appendicitis is much fewer than those who suffer from acute appendicitis, we shouldn ignore it. Clinical symptoms for these patients are chronic, longtime and recurrent abdominal pain, which is usually in the right lower quadrant of the abdomen. In the Para clinical examinations there isn any considerable pathological problem (in urine, stool, and sonography of the abdomen and pelvis. By recognizing appendicitis and appendectomy, the symptoms will be vanished and the patients will recover. Case presentation: The case was a 57-year-old man who has complained from chronic abdominal pain in the RLQ area since 15years ago. No pathological problem had been found in all diagnostic process. Conclusion: The problem was diagnosed as the chronic appendicitis and he underwent the appendectomy by laparoscopic procedure and was completely recovered.

  17. Feasibility and effectiveness of circuit training in acute stroke rehabilitation.

    Science.gov (United States)

    Rose, Dorian; Paris, Trevor; Crews, Erin; Wu, Samuel S; Sun, Anqi; Behrman, Andrea L; Duncan, Pamela

    2011-02-01

    Task-specificity, repetition and progression are key variables in the acquisition of motor skill however they have not been consistently implemented in post-stroke rehabilitation. To evaluate the effectiveness of a stroke rehabilitation plan of care that incorporated task-specific practice, repetition and progression to facilitate functional gain compared to standard physical therapy for individuals admitted to an inpatient stroke unit. Individuals participated in either a circuit training (CTPT) model (n = 72) or a standard (SPT) model (n = 108) of physical therapy, 5 days/week. Each 60 minute circuit training session, delivered according to severity level, consisted of four functional mobility tasks. Daily exercise logs documented both task repetition and progression. The CTPT model was successfully implemented in an acute rehabilitation setting. The CTPT group showed a significantly greater improved change in gait speed from hospital admission to discharge than the SPT group (0.21 ± 0.25 m/sec vs. 0.13 ± 0.22 m/sec; p = 0.03). The difference between groups occurred primarily among those who were ambulatory upon admission. There were no significant differences between the two cohorts at 90 days post-stroke as measured by the FONE-FIM, SF-36 and living location. Therapy focused on systematically progressed functional tasks can be successfully implemented in an inpatient rehabilitation stroke program. This circuit-training model resulted in greater gains in gait velocity over the course of inpatient rehabilitation compared to the standard model of care. Community-based services following hospital discharge to maintain these gains should be included in the continuum of post-stroke care.

  18. Evaluation of MRI for the diagnosis of appendicitis during pregnancy when ultrasound is inconclusive.

    Science.gov (United States)

    Vu, Lan; Ambrose, Devon; Vos, Patrick; Tiwari, Pari; Rosengarten, Mark; Wiseman, Sam

    2009-09-01

    To retrospectively evaluate the diagnostic performance and clinical utility of magnetic resonance imaging (MRI) in pregnant patients suspected of having acute appendicitis, when an ultrasound study generated an inconclusive result. The medical records of 19 consecutive women who underwent abdominal and pelvic MRI at a tertiary care referral center (St. Paul's Hospital, Vancouver, Canada), as part of the work up of clinically suspected acute appendicitis, were retrospectively reviewed. MRI was carried out when ultrasound findings were inconclusive. MRI findings were reviewed and compared with surgical findings and clinical follow-up data including pregnancy outcome. One of the 19 patients (5.3%) in the study cohort had an appendicitis diagnosed by MRI that was confirmed at operation and by specimen histology. The remaining study patients were diagnosed as not having appendicitis by MRI. These patients were followed until delivery, which was uneventful for all but one patient who was found to have appendicitis during Cesarean section. Overall, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MRI for the diagnosis of appendicitis during pregnancy was 50.0%, 100%, 100%, 94.4%, and 94.7%, respectively. In three patients (16.7%) with no MRI evidence of appendicitis, MRI identified an alternative etiology for their abdominal pain (two patients diagnosed with ovarian cysts, one patient diagnosed with a uterine fibroid). MRI represents a useful diagnostic test for acute appendicitis in pregnant women, and decreases the need for an emergency operation. Its high negative predictive value makes MRI useful for ruling out appendicitis in pregnant patients who have an inconclusive ultrasound. However, the low sensitivity observed in this study suggests that MRI, like other imaging modalities, is not perfect, and may miss an acute appendicitis diagnosis. Thus, future prospective clinical study of MRI as a diagnostic test for the

  19. Enterobius vermicularis causing symptoms of appendicitis in Nepal.

    Science.gov (United States)

    Sah, Shatrughan Prasad; Bhadani, Punam Prasad

    2006-07-01

    This study set out to determine the prevalence of Enterobius vermicularis in surgically removed appendices and to assess the possible relation of the parasite to acute appendicitis. All 624 surgically removed appendices received in the Department of Pathology, BPKIHS, Dharan, Nepal during 2(1/2) years (August 1999-January 2002) were examined. E. vermicularis was identified in nine (1.62%) appendices from the patients with a clinical diagnosis of appendicitis. The parasite was most frequently seen in histologically normal appendices (6/71) and was rarely associated with histological change of acute appendicitis (3/539). No cases of E. vermicularis infestation occurred in appendices showing chronic inflammation or removed during the course of other surgical procedures. E. vermicularis was found more frequently in uninflamed and histologically normal appendices (8.45%) than those which were inflamed with histopathologic changes of acute appendicitis (0.56%). It may be a cause of symptoms resembling acute appendicitis although the mechanism for this does not involve mucosal invasion by the parasite.

  20. Hyperbilirubinaemia: its utility in non-perforated appendicitis.

    Science.gov (United States)

    Sandstrom, Anna; Grieve, David A

    2017-07-01

    The diagnosis of acute appendicitis is made using clinical findings and investigations. Recent studies have suggested that serum bilirubin, a cheap and simple biochemical test, is a positive predictor in the diagnosis of appendiceal perforation and may be more specific than C-reactive protein (CRP) and white cell count (WCC). The aim of this study was to investigate the utility of the serum bilirubin level in patients with suspected acute but non-perforative appendicitis. A retrospective chart review of 213 patients who presented with suspected appendicitis in a 6-month period to Nambour General Hospital was performed. Serum bilirubin, WCC and CRP were recorded and analysed as to their utility in relation to the final diagnosis. A total of 196 patients underwent an appendicectomy and 41 of these were negative. The specificity of hyperbilirubinaemia for appendicitis overall was 0.83 with a positive predictive value (PPV) of 0.86, compared with CRP (specificity 0.40, PPV 0.75) and WCC (specificity 0.67, PPV 0.85). The area under the receiver operating characteristic curve for bilirubin was 0.6289 compared to 0.6171 for CRP and 0.7219 for WCC. A subgroup analysis of those with complicated appendicitis demonstrated a PPV for bilirubin of 0.66 compared to 0.58 for WCC and 0.34 for CRP in agreement with the literature. Subgroup analysis of hyperbilirubinaemia in simple appendicitis demonstrated a PPV of 0.81 compared to CRP (0.71) and WCC (0.82). Bilirubin had a higher specificity than CRP and WCC overall in patients with appendicitis. Hyperbilirubinaemia had a high PPV in patients with simple appendicitis. © 2015 Royal Australasian College of Surgeons.

  1. Intussusception of the appendix mimicking appendicitis during pregnancy: a case report.

    Science.gov (United States)

    Fylstra, Donald L; Toussaint, William N; Anis, Munazza

    2009-05-01

    Intussusception occurs when a segment of bowel and its associated mesentery telescopes into the lumen of the adjacent distal bowel. Appendiceal intussusception is a rare form of ileocoloc intussusception, is rarely diagnosed preoperatively, can mimic appendicitis and has not been previously reported during pregnancy. A 31-year-old gravid woman at 27 1/7 weeks' gestation presented with symptoms suggestive of acute appendicitis and was found at laparoscopy to have complete appendiceal intussusception. The list of causes of abdominal pain in pregnancy is very long, but the presence of right-sided abdominal tenderness with guarding and rebound are highly suggestive of acute appendicitis. Regardless of preoperative imaging, because the morbidity, and even mortality, from appendicitis is the morbidity of delay, early surgical intervention is recommended. This is a case of complete appendiceal intussusception mimicking acute appendicitis, but the treatment of both conditions is appendectomy.

  2. A Rare Case: Appendectomy After Connected Stump Appendicitis Perforation of the Cecum

    Directory of Open Access Journals (Sweden)

    Berke Manoglu

    2016-01-01

    Full Text Available Stump appendicitis is a rare complication after appendectomy . Stump appendicitis made of incomplete appendectomy after a rest appendix tissue develops as a result of the inflammation. Admitted to the emergency department with acute abdomen and a history of appendectomy in patients with a history of current pain in the right lower quadrant , especially that of the patient must be evaluated in terms of stump appendicitis. The fact that the earlier story appendectomy patients , causing a delay in diagnosis and increasing the morbidity Cecal perforation was offered an advanced case of delayed depending on the stump appendicitis in this article.

  3. Sequence variant at 4q25 near PITX2 associates with appendicitis

    NARCIS (Netherlands)

    Kristjansson, R.P.; Benonisdottir, S.; Oddsson, A.; Galesloot, T.E.; Thorleifsson, G.; Aben, K.K.H.; Davidsson, O.B.; Jonsson, S.; Arnadottir, G.A.; Jensson, B.O.; Walters, G.B.; Sigurdsson, J.K.; Sigurdsson, S.; Holm, H.; Arnar, D.O.; Thorgeirsson, G.; Alexiusdottir, K.; Jonsdottir, I.; Thorsteinsdottir, U.; Kiemeney, L.A.L.M.; Jonsson, T.; Gudbjartsson, D.F.; Rafnar, T.; Sulem, P.; Stefansson, K.

    2017-01-01

    Appendicitis is one of the most common conditions requiring acute surgery and can pose a threat to the lives of affected individuals. We performed a genome-wide association study of appendicitis in 7,276 Icelandic and 1,139 Dutch cases and large groups of controls. In a combined analysis of the

  4. Mimicry of Appendicitis Symptomatology in Congenital Anomalies and Diseases of the Genitourinary System and Pregnancy

    Science.gov (United States)

    Dalpiaz, Amanda; Gandhi, Jason; Smith, Noel L.; Dagur, Gautam; Schwamb, Richard; Weissbart, Steven J.; Khan, Sardar Ali

    2017-01-01

    Introduction Appendicitis is a prevailing cause of acute abdomen, but is often difficult to diagnose due to its wide range of symptoms, anatomical variations, and developmental abnormalities. Urological disorders of the genitourinary tract may be closely related to appendicitis due to the close proximity of the appendix to the genitourinary tract. This review provides a summary of the urological complications and simulations of appendicitis. Both typical and urological symptoms of appendicitis are discussed, as well as recommended diagnostic and treatment methods. Methods Medline searches were conducted via PubMed in order to incorporate data from the recent and early literature. Results Urological manifestations of appendicitis affect the adrenal glands, kidney, retroperitoneum, ureter, bladder, prostate, scrotum, and penis. Appendicitis in pregnancy is difficult to diagnose due to variations in appendiceal position and trimester-specific symptoms. Ultrasound, CT, and MRI are used in diagnosis of appendicitis and its complications. Treatment of appendicitis may be done via open appendectomy or laparoscopic appendectomy. In some cases, other surgeries are required to treat urological complications, though surgery may be avoided completely in other cases. Conclusion Clinical presentation and complications of appendicitis vary among patients, especially when the genitourinary tract is involved. Appendicitis may mimic urological disorders and vice versa. Awareness of differential diagnosis and proper diagnostic techniques is important in preventing delayed diagnosis and possible complications. MRI is recommended for diagnosis of pregnant patients. Ultrasound is preferred in patients exhibiting typical symptoms. PMID:28413377

  5. Mimicry of Appendicitis Symptomatology in Congenital Anomalies and Diseases of the Genitourinary System and Pregnancy.

    Science.gov (United States)

    Dalpiaz, Amanda; Gandhi, Jason; Smith, Noel L; Dagur, Gautam; Schwamb, Richard; Weissbart, Steven J; Khan, Sardar Ali

    2017-01-01

    Appendicitis is a prevailing cause of acute abdomen, but is often difficult to diagnose due to its wide range of symptoms, anatomical variations, and developmental abnormalities. Urological disorders of the genitourinary tract may be closely related to appendicitis due to the close proximity of the appendix to the genitourinary tract. This review provides a summary of the urological complications and simulations of appendicitis. Both typical and urological symptoms of appendicitis are discussed, as well as recommended diagnostic and treatment methods. Medline searches were conducted via PubMed in order to incorporate data from the recent and early literature. Urological manifestations of appendicitis affect the adrenal glands, kidney, retroperitoneum, ureter, bladder, prostate, scrotum, and penis. Appendicitis in pregnancy is difficult to diagnose due to variations in appendiceal position and trimester-specific symptoms. Ultrasound, CT, and MRI are used in diagnosis of appendicitis and its complications. Treatment of appendicitis may be done via open appendectomy or laparoscopic appendectomy. In some cases, other surgeries are required to treat urological complications, though surgery may be avoided completely in other cases. Clinical presentation and complications of appendicitis vary among patients, especially when the genitourinary tract is involved. Appendicitis may mimic urological disorders and vice versa. Awareness of differential diagnosis and proper diagnostic techniques is important in preventing delayed diagnosis and possible complications. MRI is recommended for diagnosis of pregnant patients. Ultrasound is preferred in patients exhibiting typical symptoms.

  6. Composition of the cellular infiltrate in patients with simple and complex appendicitis.

    Science.gov (United States)

    Gorter, Ramon R; Wassenaar, Emma C E; de Boer, Onno J; Bakx, Roel; Roelofs, Joris J T H; Bunders, Madeleine J; van Heurn, L W Ernst; Heij, Hugo A

    2017-06-15

    It is now well established that there are two types of appendicitis: simple (nonperforating) and complex (perforating). This study evaluates differences in the composition of the immune cellular infiltrate in children with simple and complex appendicitis. A total of 47 consecutive children undergoing appendectomy for acute appendicitis between January 2011 and December 2012 were included. Intraoperative criteria were used to identify patients with either simple or complex appendicitis and were confirmed histopathologically. Immune histochemical techniques were used to identify immune cell markers in the appendiceal specimens. Digital imaging analysis was performed using Image J. In the specimens of patients with complex appendicitis, significantly more myeloperoxidase positive cells (neutrophils) (8.7% versus 1.2%, P simple appendicitis. In contrast, fewer CD8+ T cells (0.4% versus 1.3%, P = 0.016), CD20 + cells (2.9% versus 9.0%, P = 0.027), and CD21 + cells (0.2% versus 0.6%, P = 0.028) were present in tissue from patients with complex compared to simple appendicitis. The increase in proinflammatory innate cells and decrease of adaptive cells in patients with complex appendicitis suggest potential aggravating processes in complex appendicitis. Further research into the underlying mechanisms may identify novel biomarkers to be able to differentiate simple and complex appendicitis. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. The Heidelberg Appendicitis Score Predicts Perforated Appendicitis in Children.

    Science.gov (United States)

    Boettcher, Michael; Günther, Patrick; Breil, Thomas

    2017-10-01

    In the future, surgical management of pediatric appendicitis might become limited to nonperforating appendicitis. Thus, it becomes increasingly important to differentiate advanced from simple appendicitis and to predict perforated appendicitis among a group of children with right-sided abdominal pain, which was the aim of this study. An institutionally approved, single-center retrospective analysis of all patients with appendectomy from January 2009 to December 2010 was conducted. All diagnostic aspects were evaluated to identify predictors and differentiators of perforated appendicitis. In 2 years, 157 children suffered from appendicitis. Perforation occurred in 47 (29.9%) of the patients. C-reactive protein (CRP) levels higher than 20 mg/dL ( P = .037) and free abdominal fluid on ultrasonography ( P = .031) are the most important features to differentiate perforated from simple appendicitis. Moreover, all children with perforation had a positive Heidelberg Appendicitis Score (HAS). A negative HAS excludes perforation in all cases (negative predictive value = 100%). Perforated appendicitis can be ruled out by the HAS. In a cohort with right-sided abdominal pain, perforation should be considered in children with high CRP levels and free fluids or abscess formation on ultrasound.

  8. Oral antibiotics for perforated appendicitis is not recommended

    DEFF Research Database (Denmark)

    Alamili, Mahdi; Gögenur, Ismail; Rosenberg, Jacob

    2010-01-01

    In the majority of surgical departments in Denmark, the postoperative treatment for acute perforated appendicitis comprises three days of intravenous antibiotics. Recently, it has been proposed that such antibiotic regimen should be replaced by orally administered antibiotics. The aim of this paper...... was to give an overview of studies on acute perforated appendicitis with postoperative oral antibiotics. Five studies were found in a database search covering the 1966-2009 period. There is no evidence to support a conversion of the postoperative antibiotic regimen from intravenous to oral administration...

  9. Profiles of US and CT imaging features with a high probability of appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Randen, A. van; Lameris, W. [University of Amsterdam, Department of Radiology, Academic Medical Center, Amsterdam (Netherlands); University of Amsterdam, Department of Surgery, Academic Medical Center, Amsterdam (Netherlands); Es, H.W. van [St Antonius Hospital, Department of Radiology, Nieuwegein (Netherlands); Hove, W. ten; Bouma, W.H. [Gelre Hospitals, Department of Surgery, Apeldoorn (Netherlands); Leeuwen, M.S. van [University Medical Centre, Department of Radiology, Utrecht (Netherlands); Keulen, E.M. van [Tergooi Hospitals, Department of Radiology, Hilversum (Netherlands); Hulst, V.P.M. van der [Onze Lieve Vrouwe Gasthuis, Department of Radiology, Amsterdam (Netherlands); Henneman, O.D. [Bronovo Hospital, Department of Radiology, The Hague (Netherlands); Bossuyt, P.M. [University of Amsterdam, Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Academic Medical Center, Amsterdam (Netherlands); Boermeester, M.A. [University of Amsterdam, Department of Surgery, Academic Medical Center, Amsterdam (Netherlands); Stoker, J. [University of Amsterdam, Department of Radiology, Academic Medical Center, Amsterdam (Netherlands)

    2010-07-15

    To identify and evaluate profiles of US and CT features associated with acute appendicitis. Consecutive patients presenting with acute abdominal pain at the emergency department were invited to participate in this study. All patients underwent US and CT. Imaging features known to be associated with appendicitis, and an imaging diagnosis were prospectively recorded by two independent radiologists. A final diagnosis was assigned after 6 months. Associations between appendiceal imaging features and a final diagnosis of appendicitis were evaluated with logistic regression analysis. Appendicitis was assigned to 284 of 942 evaluated patients (30%). All evaluated features were associated with appendicitis. Imaging profiles were created after multivariable logistic regression analysis. Of 147 patients with a thickened appendix, local transducer tenderness and peri-appendiceal fat infiltration on US, 139 (95%) had appendicitis. On CT, 119 patients in whom the appendix was completely visualised, thickened, with peri-appendiceal fat infiltration and appendiceal enhancement, 114 had a final diagnosis of appendicitis (96%). When at least two of these essential features were present on US or CT, sensitivity was 92% (95% CI 89-96%) and 96% (95% CI 93-98%), respectively. Most patients with appendicitis can be categorised within a few imaging profiles on US and CT. When two of the essential features are present the diagnosis of appendicitis can be made accurately. (orig.)

  10. Antibiotics-first strategy for uncomplicated acute appendicitis in adults is associated with increased rates of peritonitis at surgery. A systematic review with meta-analysis of randomized controlled trials comparing appendectomy and non-operative management with antibiotics.

    Science.gov (United States)

    Podda, Mauro; Cillara, Nicola; Di Saverio, Salomone; Lai, Antonio; Feroci, Francesco; Luridiana, Gianluigi; Agresta, Ferdinando; Vettoretto, Nereo

    2017-10-01

    Acute appendicitis is the most common surgical diagnosis in young patients, with lifetime prevalence of about 7%. Debate remains on whether uncomplicated AA should be operated or not. Aim of this meta-analysis of randomized controlled trials was to assess current evidence on antibiotic treatment for uncomplicated AA compared to standard surgical treatment. Systematic literature search was performed using PubMed, EMBASE, Medline, Google Scholar and Cochrane Central Register of Controlled Trials databases for randomized controlled trials comparing antibiotic therapy (AT) and surgical therapy-appendectomy (ST) for uncomplicated AA. Trials were reviewed for primary outcome measures: treatment efficacy based on 1 year follow-up, recurrence at 1 year follow-up, complicated appendicitis with peritonitis identified at the time of surgical operation and post-intervention complications. Secondary outcomes were length of hospital stay and period of sick leave. Five RCTs comparing AT and ST qualified for inclusion in meta-analysis, with 1.351 patients included: 632 in AT group and 719 in ST group. Higher rate of treatment efficacy based on 1 year follow-up was found in ST group (98.3% vs 75.9%, P appendicitis with peritonitis identified at time of surgical operation was higher in AT group (19.9% vs 8.5%, P = 0.02). No statistically significant differences were found when comparing AT and ST groups for the outcomes of overall post-intervention complications (4.3% vs 10.9%, P = 0.32), post-intervention complications based on the number of patients who underwent appendectomy (15.8% vs 10.9%, P = 0.35), length of hospital stay (3.24 ± 0.40 vs 2.88 ± 0.39, P = 0.13) and period of sick leave (8.91 ± 1.28 vs 10.27 ± 0.24, P = 0.06). With significantly higher efficacy and low complication rates, appendectomy remains the most effective treatment for patients with uncomplicated AA. The subgroups of patients with uncomplicated AA where antibiotics can be more

  11. Diagnosis of appendicitis in pregnancy.

    Science.gov (United States)

    Freeland, Michael; King, Erin; Safcsak, Karen; Durham, Rodney

    2009-12-01

    The diagnosis of appendicitis in pregnant patients is challenging. The records of pregnant patients with suspected appendicitis were reviewed. Forty-seven patients with suspected appendicitis were identified. Twenty-four patients did not undergo surgery. Twenty-three patients had ultrasound (US), none of which visualized the appendix. Seventeen patients were followed up clinically and improved. Six patients had a negative computed tomography (CT) and none required surgery. Twenty-three patients underwent surgery for presumed appendicitis. Three patients had no imaging. Twelve patients had US only; US was positive in 5 patients and all had appendicitis. Seven patients who underwent surgery had a nondiagnostic US. One patient had appendicitis. Seven patients had a positive CT and appendicitis at surgery. One patient had a positive US and magnetic resonance imaging, and had appendicitis. A total of 43 patients had US, of which 86% were nondiagnostic. Six US were read as positive and all patients had appendicitis. Thirteen patients had CT with no false-positive or false-negative results. US, when read as positive, requires no further confirmatory test other than surgery. If US is nondiagnostic, further imaging may avoid a negative appendectomy.

  12. MRI imaging in pediatric appendicitis

    Directory of Open Access Journals (Sweden)

    Robin Riley

    2018-04-01

    Full Text Available An 8-year-old male presents with two days of abdominal pain and emesis. Computed tomography was concerning for obstruction or reactive ileus with an apparent transition point in the right lower quadrant, possibly due to Crohn's. Magnetic resonance imaging was concerning for perforated appendicitis. As demonstrated by this case MRI can be as sensitive as CT in detecting pediatric appendicitis [2]. We recommend using MRI instead of CT to diagnose appendicitis to avoid ionizing radiation and increased cancer risk in the pediatric population. Keywords: Computer tomography, Magnetic resonance imaging, Pediatric appendicitis

  13. Amplified hearing device use in acute care settings for patients with hearing loss: A feasibility study.

    Science.gov (United States)

    Kimball, Amber R; Roscigno, Cecelia I; Jenerette, Coretta M; Hughart, Kimberly M; Jenkins, Wendy W; Hsu, Wesley

    2017-11-10

    The objective of this study was to assess the feasibility of using amplified hearing devices (AHD) in acute care settings for patients with hearing loss. Secondary objectives include patient and nurse satisfaction, and nursing perceived productivity. Twenty-five adult hard of hearing patients and 15 nurses were evaluated. Patients with a perceived hearing handicap were identified through the Hearing Handicap for the Elderly Screening Version. Patient and staff nurse surveys were used to assess for satisfaction with using the AHD. Nurses were surveyed to evaluate whether they felt the AHD made patient communication more efficient and effective. Twenty-four patients expressed satisfaction with the AHD and would use it in future hospitalizations. Nurses also reported satisfaction, perceived improvement of patient communication and decreased time spent communicating with patients. Results demonstrate the feasibility of using an AHD in acute care inpatient settings where elderly hard of hearing patients are common. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Diabetes increases the risk of an appendectomy in patients with antibiotic treatment of noncomplicated appendicitis.

    Science.gov (United States)

    Tsai, Ming-Chieh; Lin, Herng-Ching; Lee, Cha-Ze

    2017-07-01

    This retrospective cohort study examined whether diabetic patients have a higher risk for recurrent appendicitis during a 1-year follow-up period after successful antibiotic treatment for patients with acute uncomplicated appendicitis than nondiabetic patients using a population-based database. We included 541 appendicitis patients who received antibiotic treatment for acute appendicitis. We individually tracked each patient for a 1-year period to identify those who subsequently underwent an appendectomy during the follow-up period. Cox proportional hazard regressions suggested that the adjusted hazard ratio of an appendectomy during the 1-year follow-up period was 1.75 for appendicitis patients with diabetes than appendicitis patients without diabetes. We found that among females, the adjusted hazard ratio of an appendectomy was 2.18 for acute appendicitis patients with diabetes than their counterparts without diabetes. However, we failed to observe this relationship in males. We demonstrated a relationship between diabetes and a subsequent appendectomy in females who underwent antibiotic treatment for noncomplicated appendicitis. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Imaging of appendicitis in adults; Bildgebung der Appendizitis beim Erwachsenen

    Energy Technology Data Exchange (ETDEWEB)

    Karul, M.; Berliner, C.; Keller, S.; Yamamura, J. [University Medical Center Hamburg-Eppendorf, Hamburg (Germany). Dept. of Diagnostic and Interventional Radiology; Tsui, T.Y. [University Medical Center Hamburg-Eppendorf, Hamburg (Germany). Dept. of General, Visceral- and Thoracic Surgery

    2014-06-15

    Three imaging modalities are available for the diagnosis of acute appendicitis: ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). Transabdominal ultrasound should be the first-line imaging test. Abdominal CT is superior to US and is required immediately in patients with atypical clinical presentation of appendicitis and suspected perforation. However, low-dose unenhanced CT is equal to standard-dose CT with intravenous contrast agents in the detection of five signs of acute appendicitis (thickened appendiceal wall more than 2 mm, cross-sectional diameter greater than 6 mm, periappendicitis, abscess, and appendicolith). MRI is necessary in pregnant women and young adults. This review illustrates the principles of state-of-the-art imaging techniques and their clinical relevance. (orig.)

  16. Urinary biomarkers in pediatric appendicitis.

    Science.gov (United States)

    Salö, Martin; Roth, Bodil; Stenström, Pernilla; Arnbjörnsson, Einar; Ohlsson, Bodil

    2016-08-01

    The diagnosis of pediatric appendicitis is still a challenge, resulting in perforation and negative appendectomies. The aim of this study was to evaluate novel biomarkers in urine and to use the most promising biomarkers in conjunction with the Pediatric Appendicitis Score (PAS), to see whether this could improve the accuracy of diagnosing appendicitis. A prospective study of children with suspected appendicitis was conducted with assessment of PAS, routine blood tests, and measurements of four novel urinary biomarkers: leucine-rich α-2-glycoprotein (LRG), calprotectin, interleukin 6 (IL-6), and substance P. The biomarkers were blindly determined with commercial ELISAs. Urine creatinine was used to adjust for dehydration. The diagnosis of appendicitis was based on histopathological analysis. Forty-four children with suspected appendicitis were included, of which twenty-two (50 %) had confirmed appendicitis. LRG in urine was elevated in children with appendicitis compared to children without (p appendicitis compared to those with phlegmonous appendicitis (p = 0.003). No statistical significances between groups were found for calprotectin, IL-6 or substance P. LRG had a receiver operating characteristic area under the curve of 0.86 (95 % CI 0.79-0.99), and a better diagnostic performance than all routine blood tests. LRG in conjunction with PAS showed 95 % sensitivity, 90 % specificity, 91 % positive predictive value, and 95 % negative predictive value. LRG, adjusted for dehydration, is a promising novel urinary biomarker for appendicitis in children. LRG in combination with PAS has a high diagnostic performance.

  17. The ectopic appendicolith from perforated appendicitis as a cause of tubo-ovarian abscess

    Energy Technology Data Exchange (ETDEWEB)

    Vyas, Rajashree C.; Sides, Corey; Klein, Deborah J. [University of Rochester Medical Center, Rochester, NY (United States); Reddy, Sireesha Y. [University of Rochester, Obstetrics and Gynecology, Rochester, NY (United States); Santos, Mary C. [University of Rochester, Pediatric Surgery, Rochester, NY (United States)

    2008-09-15

    Acute appendicitis is a common surgical cause of abdominal pain in the pediatric population. History and physical examination are atypical in up to a third of patients. Known potential complications of untreated or delayed management of acute appendicitis include appendiceal perforation, periappendiceal abscess formation, peritonitis, bowel obstruction and rarely septic thrombosis of mesenteric vessels. We report an unusual complication of perforated appendicitis. A tubo-ovarian abscess developed secondary to appendicolith migration into the right fallopian tube in a patient who had undergone interval laparoscopic appendectomy for perforated appendicitis. The retained appendicolith was visualized within the obstructed and dilated fallopian tube on contrast-enhanced CT. We discuss the CT imaging features of this unusual complication of perforated appendicitis. (orig.)

  18. The ectopic appendicolith from perforated appendicitis as a cause of tubo-ovarian abscess

    International Nuclear Information System (INIS)

    Vyas, Rajashree C.; Sides, Corey; Klein, Deborah J.; Reddy, Sireesha Y.; Santos, Mary C.

    2008-01-01

    Acute appendicitis is a common surgical cause of abdominal pain in the pediatric population. History and physical examination are atypical in up to a third of patients. Known potential complications of untreated or delayed management of acute appendicitis include appendiceal perforation, periappendiceal abscess formation, peritonitis, bowel obstruction and rarely septic thrombosis of mesenteric vessels. We report an unusual complication of perforated appendicitis. A tubo-ovarian abscess developed secondary to appendicolith migration into the right fallopian tube in a patient who had undergone interval laparoscopic appendectomy for perforated appendicitis. The retained appendicolith was visualized within the obstructed and dilated fallopian tube on contrast-enhanced CT. We discuss the CT imaging features of this unusual complication of perforated appendicitis. (orig.)

  19. Appendicitis in pregnancy: an ongoing diagnostic dilemma.

    Science.gov (United States)

    Brown, J J S; Wilson, C; Coleman, S; Joypaul, B V

    2009-02-01

    Appendicitis in pregnancy (AIP) is the most common nonobstetric cause of an acute abdomen requiring surgical intervention. Diagnostic difficulties arising from gestational symptoms compound the risk of foetal loss after negative appendicectomy and exponentially increase the risk to mother and foetus with delay in genuine cases. In this article, we investigate the symptoms and signs of AIP and attempt to identify consistent clinical features and review the role of imaging in diagnosis. MEDLINE and PubMed were searched for case-control studies recording preoperative symptoms/signs suggestive of AIP, as well as appendiceal pathology. Combined likelihood and odds ratios (OR) were created for clinical features across homogenous papers. Papers examining the use of laparoscopy, ultrasound (US), computerized tomography (CT) and magnetic resonance imaging (MRI) were assessed qualitatively. Seven papers met the inclusion criteria for the analysis of consistent clinical features (450 patients). The only symptoms or signs significantly associated with a diagnosis of appendicitis were nausea (OR: 2.21, 95%CI: 1.34-3.66), vomiting (OR: 0.82-15.6 range) and peritonism (OR: 1.80, 95%CI: 1.06-3.04). US, CT and MRI have all been used to successfully diagnose AIP. Laparoscopic appendicectomy has been safely undertaken in pregnancy. Appendicitis will continue to challenge the diagnostic acumen of surgeons. Whilst useful, consensus regarding the safety of laparoscopy, CT and MRI in pregnancy is yet to be achieved.

  20. Appendicitis/diverticulitis: diagnostics and conservative treatment.

    Science.gov (United States)

    Kruis, Wolfgang; Morgenstern, Julia; Schanz, Stefan

    2013-01-01

    Appendicitis and diverticulitis are very common entities that show some similarities in diagnosis and course of disease. Both are widely believed to be simple clinical diagnoses, which is in contrast to scientific evidence. An accurate diagnosis has to describe not only the initial detection, but particularly the severity of the disease. It is based mainly on cross-sectional imaging by ultrasound (US) and computed tomography (CT). Appendectomy is the standard treatment for acute appendicitis and is mandatory in complicated cases. Antibiotic therapy is similarly effective in uncomplicated appendicitis, but long-term results are not sufficiently known. Treatment of diverticulitis is related to the disease status. Complications such as perforation and bleeding require intervention. Uncomplicated diverticulitis as graded by US or CT are subject to conservative management, in the form of outpatient or hospital care. It is an unresolved debate as to whether antibiotic treatment offers benefits. Mesalazine seems at least to improve pain. The real challenge is treatment of recurrent diverticulitis. Lifestyle measures such as nutritional habits and physical activity are found to influence diverticular disease. Besides immunosuppression, obesity is a significant risk factor for complicated diverticulitis. Whether any medication such as chronic antibiotics, probiotics or mesalazine offers benefits is unclear. The indication for sigmoid resection has changed; it is no longer given by the number of attacks, but rather by structural changes as depicted by cross-sectional imaging. Copyright © 2013 S. Karger AG, Basel.

  1. Pericarditis as complication of appendicitis.

    NARCIS (Netherlands)

    Tan, E.C.T.H.; Rieu, P.N.M.A.; Nijveld, A.; Backx, A.P.C.M.; Meis, J.F.G.M.; Severijnen, R.S.V.M.

    2004-01-01

    Pericarditis as a complication of appendicitis is a rare event. In a 25-year period we encountered two pediatric cases with this severe complication due to (a)typical presentation of appendicitis resulting in small bowel obstruction, intraabdominal abscesses, constrictive pericarditis, and purulent

  2. Conservative approach versus urgent appendectomy in surgical management of acute appendicitis with abscess or phlegmon Resultados del tratamiento conservador inicial y de la cirugía urgente en la apendicitis aguda evolucionada

    Directory of Open Access Journals (Sweden)

    J. M. Aranda-Narváez

    2010-11-01

    Full Text Available Background: Surgical management of acute appendicitis with appendiceal abscess or phlegmon remains controversial. We studied the results of initial conservative treatment (antibiotics and percutaneous drainage if necessary, with or without interval appendectomy compared with immediate surgery. Methods: We undertook an observational, retrospective cohort study of patients with a clinical and radiological diagnosis of acute appendicitis with an abscess or phlegmon, treated in our hospital between January 1997 and March 2009. Patients younger than 14, with severe sepsis or with diffuse peritonitis were excluded. A study group of 15 patients with acute appendicitis complicated with an abscess or phlegmon underwent conservative treatment. A control group was composed of the other patients, who all underwent urgent appendectomy, matched for age and later randomized 1:1. The infectious risk stratification was established with the National Nosocomial Infections Surveillance System (NNIS index. Dependent variables were hospital stay and surgical site infection. Analysis was with SPSS, with p Introducción: Existe controversia acerca del tratamiento idóneo de la apendicitis aguda evolucionada en forma de absceso o flemón. Realizamos un estudio para la evaluación de resultados del tratamiento conservador inicial (antibiótico y drenaje percutáneo si se precisa, con/sin apendicectomía diferida y del tratamiento quirúrgico urgente. Método: Estudio observacional analítico de cohortes retrospectivas. Criterios de inclusión: pacientes con diagnóstico clínico y radiológico de apendicitis aguda evolucionada en forma de absceso o flemón, tratados en nuestro hospital entre enero 1997 y marzo 2009, excluyendo pacientes pediátricos, con sepsis grave o peritonitis difusa. En 15 pacientes con apendicitis complicada con absceso o flemón (cohorte de estudio se indicó tratamiento conservador inicial. El grupo control se obtuvo del resto de pacientes (en

  3. Imaging the child with right lower quadrant pain and suspected appendicitis: current concepts

    Energy Technology Data Exchange (ETDEWEB)

    Sivit, Carlos J. [Departments of Radiology and Pediatrics, Rainbow Babies and Childrens Hospital of the University Hospitals of Cleveland and Case Western Reserve School of Medicine, Euclid Avenue, 11100, 44106-5056, Cleveland, OH (United States)

    2004-06-01

    Acute appendicitis is the most common condition presenting with right lower quadrant pain requiring acute surgical intervention in childhood. The clinical diagnosis of acute appendicitis is often not straightforward and can be challenging. Approximately one-third of children with the condition have atypical clinical findings and are initially managed non-operatively. Complications usually result from perforation and include abscess formation, peritonitis, sepsis, bowel obstruction and death. Cross-sectional imaging with sonography and computed tomography (CT) have proven useful for the evaluation of suspected acute appendicitis in children. The principal advantages of sonography are its lower cost, lack of ionizing radiation, and ability to precisely delineate gynecologic disease. The principal advantages of CT are its operator independency with resultant higher diagnostic accuracy, enhanced delineation of disease extent in perforated appendicitis, and improved patient outcomes including decreased negative laparotomy and perforation rates. (orig.)

  4. Complicated appendicitis: Analysis of risk factors in children | Singh ...

    African Journals Online (AJOL)

    Background: Acute appendicitis (AA) is the most common surgical emergency in childhood. The risk of rupture is negligible within the first 24 h, climbing to 6% after 36 h from the onset of symptoms. Because of difficulty in accurate diagnosis of AA a significant number of children still are being managed when it is already ...

  5. Uncommon mimics of appendicitis: Giant mucocele | Zahid | Pan ...

    African Journals Online (AJOL)

    Appendiceal mucocele is an infrequent but well recognized entity that can present with a variety of clinical syndromes or can be asymptomatic and discovered incidentally. A 55 years old patient was admitted in the emergency department for acute right lower quadrant pain. A diagnosis of appendicitis was made.

  6. The controversy of parasitic infection in pediatric appendicitis: a ...

    African Journals Online (AJOL)

    undergone surgical therapy for a diagnosis of acute appendicitis over a period of 8 years from January 2001 ... multiple locations in the gastrointestinal tract, including the appendix. Its most common manifestation is perianal .... amputation of the appendix [3–28]. Parasitic infection of the appendix was found to be associated ...

  7. Elderly versus young patients with appendicitis 3 years experience ...

    African Journals Online (AJOL)

    Elderly group of patients had perforated appendix in 16 cases (69.5%) while in group II patients eight cases (20%) had perforated appendix. Conclusion: Acute appendicitis in the elderly remains a challenge for practicing surgeons and continues to be associated with high morbidity and mortality. Results might improve with ...

  8. Appendicitis in diabetic pregnancy--case report.

    Science.gov (United States)

    Zawiejska, Agnieszka; Radzicka, Sandra; Wender-Ozegowska, Ewa; Banach, Arkadiusz; Brazert, Jacek

    2012-03-01

    We present a case report of a 22-year-old pregnant patient with type 1 diabetes mellitus diagnosed with an appendicitis at 21st week of gestation, who underwent laparotomy and appendectomy. In later pregnancy she required treatment for recurrent urinary tract infections and nephrolithiasis. Despite having several risk factors for an unfavorable perinatal outcome, she had caesarean section performed at term and delivered a healthy full-term newborn. In this patient, we also discuss clinical conundrum of pregnancy complicated with several conditions that may manifest with acute abdominal symptoms and perioperative care for a pregnant woman with type 1 diabetes..

  9. Dual-source computed tomography in patients with acute chest pain: feasibility and image quality

    Energy Technology Data Exchange (ETDEWEB)

    Schertler, Thomas; Scheffel, Hans; Frauenfelder, Thomas; Desbiolles, Lotus; Leschka, Sebastian; Stolzmann, Paul; Marincek, Borut; Alkadhi, Hatem [University Hospital Zurich, Department of Medical Radiology, Institute of Diagnostic Radiology, Zurich (Switzerland); Seifert, Burkhardt [University of Zurich, Department of Biostatistics, Zurich (Switzerland); Flohr, Thomas G. [Computed Tomography CTE PA, Siemens Medical Solutions, Forchheim (Germany)

    2007-12-15

    The aim of this study was to determine the feasibility and image quality of dual-source computed tomography angiography (DSCTA) in patients with acute chest pain for the assessment of the lung, thoracic aorta, and for pulmonary and coronary arteries. Sixty consecutive patients (32 female, 28 male, mean age 58.1{+-}16.3 years) with acute chest pain underwent contrast-enhanced electrocardiography-gated DSCTA without prior beta-blocker administration. Vessel attenuation of different thoracic vascular territories was measured, and image quality was semi-quantitatively analyzed by two independent readers. Image quality of the thoracic aorta was diagnostic in all 60 patients, image quality of pulmonary arteries was diagnostic in 59, and image quality of coronary arteries was diagnostic in 58 patients. Pairwise intraindividual comparisons of attenuation values were small and ranged between 1{+-}6 HU comparing right and left coronary artery and 56{+-}9 HU comparing the pulmonary trunk and left ventricle. Mean attenuation was 291{+-}65 HU in the ascending aorta, 334{+-}93 HU in the pulmonary trunk, and 285{+-}66 HU and 268{+-}67 HU in the right and left coronary artery, respectively. DSCTA is feasible and provides diagnostic image quality of the thoracic aorta, pulmonary and coronary arteries in patients with acute chest pain. (orig.)

  10. Dual-source computed tomography in patients with acute chest pain: feasibility and image quality

    International Nuclear Information System (INIS)

    Schertler, Thomas; Scheffel, Hans; Frauenfelder, Thomas; Desbiolles, Lotus; Leschka, Sebastian; Stolzmann, Paul; Marincek, Borut; Alkadhi, Hatem; Seifert, Burkhardt; Flohr, Thomas G.

    2007-01-01

    The aim of this study was to determine the feasibility and image quality of dual-source computed tomography angiography (DSCTA) in patients with acute chest pain for the assessment of the lung, thoracic aorta, and for pulmonary and coronary arteries. Sixty consecutive patients (32 female, 28 male, mean age 58.1±16.3 years) with acute chest pain underwent contrast-enhanced electrocardiography-gated DSCTA without prior beta-blocker administration. Vessel attenuation of different thoracic vascular territories was measured, and image quality was semi-quantitatively analyzed by two independent readers. Image quality of the thoracic aorta was diagnostic in all 60 patients, image quality of pulmonary arteries was diagnostic in 59, and image quality of coronary arteries was diagnostic in 58 patients. Pairwise intraindividual comparisons of attenuation values were small and ranged between 1±6 HU comparing right and left coronary artery and 56±9 HU comparing the pulmonary trunk and left ventricle. Mean attenuation was 291±65 HU in the ascending aorta, 334±93 HU in the pulmonary trunk, and 285±66 HU and 268±67 HU in the right and left coronary artery, respectively. DSCTA is feasible and provides diagnostic image quality of the thoracic aorta, pulmonary and coronary arteries in patients with acute chest pain. (orig.)

  11. MR imaging in cases of antenatal suspected appendicitis--a meta-analysis.

    Science.gov (United States)

    Blumenfeld, Yair J; Wong, Amy E; Jafari, Anahita; Barth, Richard A; El-Sayed, Yasser Y

    2011-03-01

    Appendicitis is the most common surgical emergency in pregnancy. Acute appendicitis is often difficult to diagnose clinically, and concerns regarding antenatal CT imaging limit its use resulting in high false negative rates at laparotomy. MRI has recently been reported as a reasonable alternative to CT imaging in cases of suspected appendicitis. Our objective was to perform a meta-analysis of recently published data regarding the utility of MR imaging in cases of antenatal suspected acute appendicitis. We searched the PubMed database using keywords 'MRI', 'appendicitis', and 'pregnancy'. Five case series describing the role of MRI in cases of antenatal appendicitis were included. The sensitivity, specificity, positive, and negative predictive values were calculated. Two hundred twenty-nine patients were included in the study. In the first analysis in which non-diagnostic scans were excluded, the sensitivity, specificity, positive and negative predictive values of MRI for diagnosing appendicitis were 95.0%, 99.9%, 90.4%, and 99.5%, respectively. In the second analysis, which included non-diagnostic scans, the sensitivity, specificity, positive and negative predictive values were 90.5%, 98.6%, 86.3%, and 99.0%, respectively MR imaging may be useful in cases of suspected antenatal appendicitis. Data are still limited and larger prospective studies are necessary to confirm this finding.

  12. Left and right atrial feature tracking in acute myocarditis: A feasibility study

    International Nuclear Information System (INIS)

    Dick, Anastasia; Schmidt, Björn; Michels, Guido; Bunck, Alexander C.; Maintz, David; Baeßler, Bettina

    2017-01-01

    Purpose: The present study aims at evaluating the feasibility and reproducibility of cardiac magnetic resonance (CMR) feature tracking (FT) derived strain and strain rate (SR) parameters of the left and right atrium (LA, RA) in patients with acute myocarditis as well as their potential to detect diastolic dysfunction. In addition, the diagnostic value of LA and RA strain parameters in the setting of acute myocarditis is investigated. Methods: CMR cine data of 30 patients with CMR-positive acute myocarditis were retrospectively analyzed. 25 age- and gender-matched healthy individuals served as a control. Analysis of longitudinal strain and SR of both atria was performed in two long-axis views using a dedicated FT-software. LA and RA deformation was analyzed including reservoir function (total strain [ε s ], peak positive SR [SR s ]), conduit function (passive strain [ε e ], peak early negative SR [SR e ]) and booster pump function (active strain [ε a ], peak late negative SR [SR a ]). Intra- and inter-observer reproducibility was assessed for all strain and SR parameters using Bland-Altman analyses, intra-class correlation coefficients (ICCs) and coefficients of variation (CV). Results: FT analyses of both atria were feasible in all patients and controls. Reproducibility was good for reservoir and conduit function parameters and moderate for booster pump function parameters. Myocarditis patients demonstrated an impaired LA reservoir and conduit function when compared to healthy controls (LA ε s : 32 ± 17 vs. 46 ± 13, p = 0.019; LA SR s : 1.5 ± 0.5 vs. 1.8 ± 0.5, p = 0.117; LA SR e : −1.3 ± 0.5 vs. −1.9 ± 0.5, p < 0.001), while LA booster pump function was preserved. In logistic regression and ROC-analyses, LA SR e proved to be the best independent predictor of acute myocarditis (AUC 0.80), and using LA SR e with a cut-off of −1.6 s −1 resulted in a diagnostic sensitivity of 83% and a specificity of 80%. Changes in RA phasic function parameters

  13. Feasibility and Diagnostic Value of Cardiovascular Magnetic Resonance Imaging After Acute Ischemic Stroke of Undetermined Origin.

    Science.gov (United States)

    Haeusler, Karl Georg; Wollboldt, Christian; Bentheim, Laura Zu; Herm, Juliane; Jäger, Sebastian; Kunze, Claudia; Eberle, Holger-Carsten; Deluigi, Claudia Christina; Bruder, Oliver; Malsch, Carolin; Heuschmann, Peter U; Endres, Matthias; Audebert, Heinrich J; Morguet, Andreas J; Jensen, Christoph; Fiebach, Jochen B

    2017-05-01

    Etiology of acute ischemic stroke remains undetermined (cryptogenic) in about 25% of patients after state-of-the-art diagnostic work-up. One-hundred and three patients with magnetic resonance imaging (MRI)-proven acute ischemic stroke of undetermined origin were prospectively enrolled and underwent 3-T cardiac MRI and magnetic resonance angiography of the aortic arch in addition to state-of-the-art diagnostic work-up, including transesophageal echocardiography (TEE). We analyzed the feasibility, diagnostic accuracy, and added value of cardiovascular MRI (cvMRI) compared with TEE for detecting sources of stroke. Overall, 102 (99.0%) ischemic stroke patients (median 63 years [interquartile range, 53-72], 24% female, median NIHSS (National Institutes of Health Stroke Scale) score on admission 2 [interquartile range, 1-4]) underwent cvMRI and TEE in hospital; 89 (86.4%) patients completed the cvMRI examination. In 93 cryptogenic stroke patients, a high-risk embolic source was found in 9 (8.7%) patients by cvMRI and in 11 (11.8%) patients by echocardiography, respectively. cvMRI and echocardiography findings were consistent in 80 (86.0%) patients, resulting in a degree of agreement of κ=0.24. In 82 patients with cryptogenic stroke according to routine work-up, including TEE, cvMRI identified stroke etiology in additional 5 (6.1%) patients. Late gadolinium enhancement consistent with previous myocardial infarction was found in 13 (14.6%) out of 89 stroke patients completing cvMRI. Only 2 of these 13 patients had known coronary artery disease. Our study demonstrated that cvMRI was feasible in the vast majority of included patients with acute ischemic stroke. The diagnostic information of cvMRI seems to be complementary to TEE but is not replacing echocardiography after acute ischemic stroke. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01917955. © 2017 American Heart Association, Inc.

  14. Concurrent interstitial ectopic pregnancy and appendicitis: a case report.

    Science.gov (United States)

    Biggs, R Lee; Magann, Everett F; O'Boyle, John D

    2008-05-01

    Concurrent ectopic pregnancy and acute appendicitis is rarely encountered. Since 1960, only 22 cases have been reported. No case of concurrent interstitial ectopic pregnancy and appendicitis has ever been reported. A 24-year-old, African American woman, gravida 4, para 3, had a right interstitial ectopic pregnancy. She was managed as an inpatient with parenteral methotrexate and her beta-human chorionic gonadotropin level decreased appropriately. She was discharged 3 days after treatment but subsequently returned with right lower quadrant pain, nausea, vomiting and fever. The patient underwent laparoscopy with removal of a suppurative appendix. A stable interstitial ectopic pregnancy was visualized and left in situ. The discipline to consider concomitant abdominal pathology is paramount. The perceived rarity of an ectopic pregnancy and appendicitis should not obscure a thorough clinical evaluation.

  15. ABDX A Decision Support System for the Management of Acute Abdominal Pain. Version 3.0. Programmer’s Manual

    Science.gov (United States)

    1989-10-31

    c. pelvic inflammatory disease d. diverticulitis a. Ectopic Pregnancy see ECTOPIC PREGNANCY. If an adnexal mass is palpated and there is a...to do so could be catastrophic. b. Acute appendicitis see APPENDICITIS. c. Pelvic inflammatory disease see PID. d. Diverticulitis most commonly...threatened/incomplete abortion e. endometriosis f. diverticulitis a. Pelvic inflammatory disease see PID b. Acute appendicitis see APPENDICITIS

  16. Appendicitis during Pregnancy: The Clinical Experience of a Secondary Hospital

    Science.gov (United States)

    Jung, Soo Jung; Kim, Jun Hyun; Kong, Pil Sung; Kim, Kyung Ha; Bae, Sung Woo

    2012-01-01

    Purpose Appendicitis is the most common condition leading to an intra-abdominal operation for a non-obstetric problem in pregnancy. The aim of this study was to examine our experience and to analyze the clinical characteristics and the pregnancy outcomes for appendicitis during pregnancy that was reported in Korea. Methods We reported 25 cases of appendicitis during pregnancy that were treated at Good Moonhwa Hospital from January 2004 to March 2010. We also analyzed appendicitis during pregnancy reported in Korea between 1970 and 2008 by a review of journals. Results The incidence of acute appendicitis during pregnancy was one per 568 deliveries. The mean age was 27.92 years old, the gestational stage at the onset of symptoms was the first trimester in 10 patients (40%), the second trimester in 14 patients (56%), and the third trimester in 1 patient (4%). Among the 25 cases, 21 were treated with an open appendectomy and 4 with laparoscopic appendectomies. The postoperative complications were 2 wound infections and 1 spontaneous abortion. Conclusion Our experience demonstrated that appendectomies on pregnant patients can be successfully performed at secondary hospitals. PMID:22816059

  17. Nutritional immunomodulation in critically ill children with acute lung injury: feasibility and impact on circulating biomarkers.

    Science.gov (United States)

    Jacobs, Brian R; Nadkarni, Vinay; Goldstein, Brahm; Checchia, Paul; Ayad, Onsy; Bean, Judy; DeMichele, Stephen

    2013-01-01

    Respiratory failure caused by acute lung injury or acute respiratory distress syndrome is associated with significant morbidity in children. Enteral nutrition enriched with eicosapentaenoic acid, γ-linolenic acid and antioxidants (eicosapentaenoic acid + γ-linolenic acid) can safely modulate plasma phospholipid fatty acid profiles, reduce inflammation, and improve clinical outcomes in adults. There is little information regarding the use of enteral eicosapentaenoic acid + γ-linolenic acid to modulate plasma phospholipid fatty acid profiles in children. We sought to determine if continuous feeding of enteral nutrition containing eicosapentaenoic acid, γ-linolenic acid, and antioxidants was feasible in critically ill children with acute lung injury or acute respiratory distress syndrome. We further evaluated the impact of such an approach on the alteration of plasma phospholipid fatty acid concentrations. Prospective, blinded, randomized, controlled, multicenter trial. PICU. Twenty-six critically ill children (age 6.2 ± 0.9 yr, PaO2/FIO2 185 ± 15) with the diagnosis of acute lung injury or acute respiratory distress syndrome. Mechanically ventilated children received either eicosapentaenoic acid + γ-linolenic acid or a standard pediatric enteral formula. Clinical, biochemical, plasma fatty acid, and safety data were assessed at baseline, study days 4 and 7. At baseline, there were no significant differences in the two study groups. Both groups met enteral feeding goals within 30 hrs and had similar caloric delivery. There were no differences in formula tolerance as measured by serum chemistries, liver and renal function, and hematology studies after 7 days of feeding either eicosapentaenoic acid + γ-linolenic acid or pediatric enteral formula. On study day 4 and 7, plasma phospholipid fatty acid profiles in the eicosapentaenoic acid + γ-linolenic acid group showed a significant increase in anti-inflammatory circulating markers. Providing enteral nutrition

  18. Risk of appendicitis in patients with incidentally discovered appendicoliths.

    Science.gov (United States)

    Khan, Muhammad Sohaib; Chaudhry, Mustafa Belal Hafeez; Shahzad, Noman; Tariq, Marvi; Memon, Wasim Ahmed; Alvi, Abdul Rehman

    2018-01-01

    An appendicolith-related appendiceal obstruction leading to appendicitis is a commonly encountered surgical emergency that has clear evidence-based management plans. However, there is no consensus on management of asymptomatic patients when appendicoliths are found incidentally. The objective of this study was to determine the risk of appendicitis in patients with an incidental finding of the appendicolith. A retrospective matched cohort study of patients with appendicolith discovered incidentally on computed tomographic scan from January 2008 to December 2014 at our institution was completed. The size and position of the appendicolith were ascertained. The study group was matched by age and gender to a control group. Both groups were contacted and interviewed regarding development of appendicitis. In total, 111 patients with appendicolith were successfully contacted and included in the study. Mean age was found to be 38 ± 15 y with 36 (32%) of the study population being females. Mean length of appendix was 66 ± 16 mm, and mean width was 5.8 ± 0.9 mm. Mean size of the appendicolith was 3.6 ± 1.1 mm (1.4-7.8 mm). Fifty-eight percent of appendicoliths was located at the proximal end or whole of appendix, 31% at mid area, and 11% at the distal end of appendix. All patients of the study and control groups were contacted, and at a mean follow-up of 4.0 ± 1.7 y, there was no occurrence of acute appendicitis in either group. Patients with incidentally discovered appendicolith on radiological imaging did not develop appendicitis. Hence, the risk of developing acute appendicitis for these patients does not seem higher than the general population. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Outcomes of the patients diagnosed incidentally appendicitis during cesarean section.

    Science.gov (United States)

    Kulhan, Mehmet; Kulhan, Nur Gozde; Nayki, Umit; Nayki, Cenk; Ulug, Pasa; Ata, Nahit; Toklucu, Hulya

    2017-01-01

    Appendicitis is the most common condition leading to an intraabdominal operation for a non obstetric problem in pregnancy and diagnosis of appendicitis is complicated by the physiologic and anatomic changes that occur during pregnancy. Although a surgical procedure carries the risk of fetal loss or preterm delivery, delay in diagnosis also increases the risk of complications in both mother and fetus. In this report we present our experience and analyze clinical characteristic and the pregnancy outcomes of appendicitis diagnosed incidentally during cesarean in the third trimester. The study population consisted of 23 pregnant women who were diagnosed incidentally with appendicitis during cesarean at Erzincan University Hospital between 2015 and 2016. Appendectomy was performed on 23 patients during a caesarean section performed for any reason. The mean dia-meter of appendix was 7.82 ± 1.85 mm. The mean operation time was 67.39 ± 18.94 SD and antibiotic therapy was given to all patients. Postoperative complications were noted in 4 (17.4%) patients. Wound infection was seen in 4 (17.4%) patients, the other 19 patients revealed no postoperative complications. The mean of APGAR score of newborns in the postoperative period was 8.26 ± 0.86 SD and no complications were observed in both mothers and newborns. Histopathology of the specimen confirmed acute appendicitis in 23 (100%) cases. Acute appendicitis is a challenging diagnosis in the pregnant patient; however, early surgical intervention should be performed with any suspicion. The type of surgery depends on the surgeon's preference and experience.

  20. 99mTc-labeled monoclonal antibodies against granulocytes (BW 250/183) for the detection of appendicitis

    International Nuclear Information System (INIS)

    Overbeck, B.; Briele, B.; Hotze, A.; Biersack, H.J.; Kania, U.; Vogel, J.; Lange, L.; Ott, G.

    1992-01-01

    Scintigraphy with 99m Tc-labeled anti-granulocyte antibodies (AGAb) was performed in 50 patients with suspected appendicitis. Sequential and static imaging as well as SPECT of the pelvis and abdomen was performed 2 hp.i. In all patients the diagnosis was confirmed either histologically or by long-term follow-up. 13 patients had histologically proven acute appendicitis. In 11 patients the appendix scan had been positive and in 2 patients the scan had shown no significant tracer uptake in the right lower abdomen. The remaining 37 patients turned out not to have acute appendicitis. 29 out of these patients had negative and 3 had positive scan findings. In 5 patients the scan was equivocal. Out of these patients 2 had pathologic findings on the left side of the abdomen which turned out to be acute diverticulitis in one patient and acute peritonitis in the other. The remaining 3 patients with unclear scintigraphic findings had no acute appendicitis. Scintigraphy with AGAb is fast and easy to perform and thus superior to cell labeling methods for diagnosing acute appendicitis. Sensitivity for the diagnosis of acute appendicitis was 85% with a specifitiy of 91%. Chronic or scarred non-granulocytic appendicitis - in which there is often no definite indication for surgery - was negative in our study expect for two cases. (orig.) [de

  1. The challenging ultrasound diagnosis of perforated appendicitis in children: constellations of sonographic findings improve specificity.

    Science.gov (United States)

    Tulin-Silver, Sheryl; Babb, James; Pinkney, Lynne; Strubel, Naomi; Lala, Shailee; Milla, Sarah S; Tomita, Sandra; Fefferman, Nancy R

    2015-06-01

    Rapid and accurate diagnosis of appendicitis, particularly with respect to the presence or absence of perforation, is essential in guiding appropriate management. Although many studies have explored sonographic findings associated with acute appendicitis, few investigations discuss specific signs that can reliably differentiate perforated appendicitis from acute appendicitis prior to abscess formation. The purpose of our study was to identify sonographic findings that improve the specificity of US in the diagnosis of perforated appendicitis. Our assessment of hepatic periportal echogenicity, detailed analysis of intraperitoneal fluid, and formulation of select constellations of sonographic findings expands upon the literature addressing this important diagnostic challenge. We retrospectively reviewed 116 abdominal US examinations for evaluation of abdominal pain in children ages 2 to 18 years from January 2008 to September 2011 at a university hospital pediatric radiology department. The study group consisted of surgical and pathology proven acute appendicitis (n = 51) and perforated appendicitis (n = 22) US exams. US exams without a sonographic diagnosis of appendicitis (n = 43) confirmed by follow-up verbal communication were included in the study population as the control group. After de-identification, the US exams were independently reviewed on a PACS workstation by four pediatric radiologists blinded to diagnosis and all clinical information. We recorded the presence of normal or abnormal appendix, appendicolith, appendiceal wall vascularity, thick-walled bowel, dilated bowel, right lower quadrant (RLQ) echogenic fat, increased hepatic periportal echogenicity, bladder debris and abscess or loculated fluid. We also recorded the characteristics of intraperitoneal fluid, indicating the relative quantity (number of abdominal regions) and quality of the fluid (simple fluid or complex fluid). We used logistic regression for correlated data to evaluate

  2. Laparoscopic treatment of perforated appendicitis

    Science.gov (United States)

    Lin, Heng-Fu; Lai, Hong-Shiee; Lai, I-Rue

    2014-01-01

    The use of laparoscopy has been established in improving perioperative and postoperative outcomes for patients with simple appendicitis. Laparoscopic appendectomy is associated with less wound pain, less wound infection, a shorter hospital stay, and faster overall recovery when compared to the open appendectomy for uncomplicated cases. In the past two decades, the use of laparoscopy for the treatment of perforated appendicitis to take the advantages of minimally invasiveness has increased. This article reviewed the prevalence, approaches, safety disclaimers, perioperative and postoperative outcomes of the laparoscopic appendectomy in the treatment of patients with perforated appendicitis. Special issues including the conversion, interval appendectomy, laparoscopic approach for elderly or obese patient are also discussed to define the role of laparoscopic treatment for patients with perforated appendicitis. PMID:25339821

  3. Feasibility of progressive strength training implemented in the acute ward after hip fracture surgery.

    Directory of Open Access Journals (Sweden)

    Lise Kronborg

    Full Text Available Patients with a hip fracture lose more than 50% knee-extension strength in the fractured limb within one week of surgery. Hence, immediate progressive strength training following hip fracture surgery may be rational, but the feasibility unknown.To examine the feasibility of in-hospital progressive strength training implemented in the acute ward following hip fracture surgery, based on pre-specified criteria for feasibility.A prospective cohort study conducted in an acute orthopedic hip fracture unit at a university hospital. A consecutive sample of 36 patients, 18 with a cervical and 18 with a trochanteric hip fracture (27 women and 9 men, mean (SD age of 79.4 (8.3 years were included between June and December 2012.A daily (on weekdays program of progressive knee-extension strength training for the fractured limb, using ankle weight cuffs in 3 sets of 10 repetition maximum loadings.The primary outcome was the change in training load (kg during the knee-extension strength training. The secondary outcomes were changes in hip fracture-related pain and maximal isometric knee-extension strength.The strength training was commenced at a mean of 2.4 (0.7 days after surgery. The training loads (kilograms lifted increased from 1.6 (0.8 to 4.3 (1.7 kg over 4.3 (2.2 training sessions (P<.001. The maximal isometric knee-extension strength of the fractured limb increased from 0.37 (0.2 to 0.61 (0.3 Nm/kg (P<.001, while the average strength deficit in the fractured limb decreased from 50% to 32% (% non-fractured, P<.001. Only 3 of 212 sessions were not performed because of severe hip fracture-related pain.Progressive knee-extension strength training of the fractured limb commenced in the acute ward seems feasible, and may reduce strength asymmetry between limbs without hip pain interfering. The clinical efficacy needs confirmation in a randomized controlled design.ClinicalTrials.gov ID: NCT01616030.

  4. Outcomes of Antibiotic Therapy for Uncomplicated Appendicitis in Pregnancy.

    Science.gov (United States)

    Joo, Jeong Il; Park, Hyoung-Chul; Kim, Min Jeong; Lee, Bong Hwa

    2017-12-01

    The aim of the present study is to determine the feasibility and safety of antibiotics for uncomplicated simple appendicitis in pregnancy. We conducted a 6-year prospective observational study on 20 pregnant women in whom uncomplicated simple appendicitis (appendiceal diameter ≤11 mm and with no signs of appendicoliths, perforation, or abscess) was radiologically verified and managed with a 4-day course of antibiotics. Treatment failure rate, defined as the need for an appendectomy during hospitalization and recurrence in the follow-up period (median 25 months), and maternal or fetal complications during the pregnancy were evaluated. Mean age of patients was 33.4 years, and gestational age was 17.8 weeks. Three patients failed to respond to antibiotic therapy during hospitalization and underwent subsequent appendectomy (2 suppurative and 1 perforated appendicitis). There was 1 wound infection postoperatively. During follow-up, 2 patients during their ongoing pregnancy experienced recurrence at 3 and 6 months post-treatment, and a new course of antibiotics was determined. Patients also experienced recurrence at 8 and 10 months post-treatment and underwent appendectomy. Treatment failure occurred in 5 patients (25%) with no fetal complications during the pregnancy. Antibiotic therapy for uncomplicated appendicitis in pregnancy may be a feasible treatment option without severe maternal and fetal complications. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Apendicite aguda no ciclo gravídico-puerperal: um estudo de 13 casos Acute appendicitis in the gravidic-puerperal cycle: a study of 13 cases

    Directory of Open Access Journals (Sweden)

    Expedito Fernandes Gurgel

    1998-05-01

    Full Text Available Descrevemos 13 casos de apendicite no ciclo gravídico-puerperal, atendidos na Maternidade Escola Januário Cicco em Natal, no período de 8 anos (jan/89 a dez/96. Todos os casos foram avaliados por uma equipe de obstetras e cirurgiões e a decisão de executar a apendicectomia foi tomada conjuntamente. Onze pacientes eram gestantes (4 no 1º trimestre, 6 no 2º e 1 no 3º e 2 puérperas. A incidência foi 1/3.422 partos, a idade das gestantes variou entre 18 e 30 anos, sendo a maioria nulíparas. No quadro clínico a queixa mais freqüente foi a dor abdominal forte ou moderada, localizada em todo o abdome. A incisão de Rock Daves foi a de eleição, exceto no caso em que a paciente era assintomática e a apendicite foi um achado durante uma cesárea. O apêndice estava roto em 6 casos e dentre eles, 2 apresentaram abscesso de parede abdominal e 1 paciente abortou. Em 9 gestantes a gravidez evoluiu sem intercorrências, culminando com partos a termo. Não houve complicações nas pacientes operadas no puerpério ou naquela apendicectomizada durante a cesárea. Constatou-se associação positiva entre a incidência de perfuração do apêndice e o aumento do intervalo de tempo do início da dor ao ato cirúrgico. Foi observado um aumento da incidência de perfuração quando a dor se expandia por todo o abdome. A precocidade diagnóstica e terapêutica é fundamental no prognóstico destas pacientes.The present study describes 13 cases of appendicitis in the gravidic-puerperal cycle, at the Maternidade Escola Januário Cicco, from Jan/89 to Dec/96. The cases were assisted by a team of obstetricians and surgeons. Eleven patients were pregnant (4 in the 1st trimester, 6 in the 2nd and 1 in the 3rd and 2 were in the puerperal period. The incidence was 1/3.422; the age ranged from 18 to 30 years and the majority was nulliparous. The most frequent symptom was abdominal pain (intense or moderate. The appendix was perforated in 6 cases, 2 of them with

  6. Second date appendectomy: Operating for failure of nonoperative treatment in perforated appendicitis.

    Science.gov (United States)

    Lotti, Marco

    2017-06-01

    Nonoperative treatment of acute appendicitis is embraced by many surgical teams, driven by low to moderate quality randomized studies that support noninferiority of antibiotics versus appendectomy for treatment of acute uncomplicated appendicitis. Several flaws of these studies have emerged, especially in the recruitment strategy and in the diagnostic criteria that were used. The growing confidence given to antibiotics, together with the lack of reliable criteria to distinguish between uncomplicated and perforated appendicitis, exposes patients with perforated appendicitis to the likelihood to be treated with antibiotics instead of surgery. Among them, those patients who experience a temporary relief of symptoms due to antibiotics, followed by early recurrence of disease when antibiotics are discontinued, are likely to undergo appendectomy at their second date. Second date appendectomy, i.e. the removal of the appendix when acute inflammation relapses within the scar of a previously unhealed perforated appendicitis, is the unwanted child of the nonoperative treatment and a new challenge for both the surgeon and the patient. Between June and July 2016, two patients were readmitted and operated for failure of nonoperative treatment with antibiotics. A video is presented, which focuses on the different anatomic presentation and technical challenges between prompt and second date laparoscopic appendectomy. When proposing nonoperative treatment for acute appendicitis, surgeons should be aware and inform their patients that if the appendix is perforated and an incomplete healing and early recurrence occur, a second date appendectomy could be a more challenging operation compared to a prompt appendectomy. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Single institution and statewide performance of ultrasound in diagnosing appendicitis in pregnancy.

    Science.gov (United States)

    Drake, Frederick T; Kotagal, Meera; Simmons, LaVone E; Parr, Zoe; Dighe, Manjiri K; Flum, David R

    2015-04-01

    Assess the performance of ultrasound (US) in pregnant patients presenting with acute abdominal pain concerning for appendicitis. Descriptive analysis of pregnant patients who underwent an US for acute abdominal pain over a 6-year period using data from a statewide quality improvement collaborative and a single center. Statewide, 131 pregnant patients underwent an appendectomy and 85% had an US. In our single-center case series, 49 pregnant patients underwent an US for acute abdominal pain and four patients had appendicitis (8%). Of those, three were definitively diagnosed with US. The appendix was visualized by US in five patients (3 appendicitis/2 normal). Mean gestational age was 11 weeks for visualization of the appendix versus 20 weeks for non-visualization (p appendicitis in pregnant women, especially in the first trimester, and often contributes to definitive disposition. US performed less well in excluding appendicitis; however, in certain clinical settings, providers appeared to trust US findings. From these results, we developed a multidisciplinary imaging pathway for pregnant patients who present with acute abdominal pain concerning for appendicitis.

  8. MRI for clinically suspected pediatric appendicitis: an implemented program

    Energy Technology Data Exchange (ETDEWEB)

    Moore, Michael M.; Gustas, Cristy N.; Choudhary, Arabinda K.; Methratta, Sosamma T.; Hulse, Michael A.; Eggli, Kathleen D.; Boal, Danielle K.B. [Penn State Milton S. Hershey Medical Center, Department of Radiology, Mail Code H066, 500 University Drive, P.O. Box 850, Hershey, PA (United States); Geeting, Glenn [Penn State Milton S. Hershey Medical Center, Department of Emergency Medicine, Hershey, PA (United States)

    2012-09-15

    Emergent MRI is now a viable alternative to CT for evaluating appendicitis while avoiding the detrimental effects of ionizing radiation. However, primary employment of MRI in the setting of clinically suspected pediatric appendicitis has remained significantly underutilized. To describe our institution's development and the results of a fully implemented clinical program using MRI as the primary imaging evaluation for children with suspected appendicitis. A four-sequence MRI protocol consisting of coronal and axial single-shot turbo spin-echo (SS-TSE) T2, coronal spectral adiabatic inversion recovery (SPAIR), and axial SS-TSE T2 with fat saturation was performed on 208 children, ages 3 to 17 years, with clinically suspected appendicitis. No intravenous or oral contrast material was administered. No sedation was administered. Data collection includes two separate areas: time parameter analysis and MRI diagnostic results. Diagnostic accuracy of MRI for pediatric appendicitis indicated a sensitivity of 97.6% (CI: 87.1-99.9%), specificity 97.0% (CI: 93.2-99.0%), positive predictive value 88.9% (CI: 76.0-96.3%), and negative predictive value 99.4% (CI: 96.6-99.9%). Time parameter analysis indicated clinical feasibility, with time requested to first sequence obtained mean of 78.7 +/- 52.5 min, median 65 min; first-to-last sequence time stamp mean 14.2 +/- 8.8 min, median 12 min; last sequence to report mean 57.4 +/- 35.2 min, median 46 min. Mean age was 11.2 +/- 3.6 years old. Girls represented 57% of patients. MRI is an effective and efficient method of imaging children with clinically suspected appendicitis. Using an expedited four-sequence protocol, sensitivity and specificity are comparable to CT while avoiding the detrimental effects of ionizing radiation. (orig.)

  9. Laparoscopic appendicectomy for suspected mesh-induced appendicitis after laparoscopic transabdominal preperitoneal polypropylene mesh inguinal herniorraphy

    Directory of Open Access Journals (Sweden)

    Jennings Jason

    2010-01-01

    Full Text Available Laparoscopic inguinal herniorraphy via a transabdominal preperitoneal (TAPP approach using Polypropylene Mesh (Mesh and staples is an accepted technique. Mesh induces a localised inflammatory response that may extend to, and involve, adjacent abdominal and pelvic viscera such as the appendix. We present an interesting case of suspected Mesh-induced appendicitis treated successfully with laparoscopic appendicectomy, without Mesh removal, in an elderly gentleman who presented with symptoms and signs of acute appendicitis 18 months after laparoscopic inguinal hernia repair. Possible mechanisms for Mesh-induced appendicitis are briefly discussed.

  10. Feasibility and Acute Toxicity of Hypofractionated Radiation in Large-breasted Patients

    Energy Technology Data Exchange (ETDEWEB)

    Dorn, Paige L., E-mail: pdorn@radonc.uchicago.edu [Department of Radiation and Cellular Oncology, University of Chicago Hospitals, Chicago, IL (United States); Corbin, Kimberly S.; Al-Hallaq, Hania; Hasan, Yasmin; Chmura, Steven J. [Department of Radiation and Cellular Oncology, University of Chicago Hospitals, Chicago, IL (United States)

    2012-05-01

    Purpose: To determine the feasibility of and acute toxicity associated with hypofractionated whole breast radiation (HypoRT) after breast-conserving surgery in patients excluded from or underrepresented in randomized trials comparing HypoRT with conventional fractionation schedules. Methods and Materials: A review was conducted of all patients consecutively treated with HypoRT at University of Chicago. All patients were treated to 42.56 Gy in 2.66 Gy daily fractions in either the prone or supine position. Planning was performed in most cases using wedges and large segments or a 'field-in-field' technique. Breast volume was estimated using volumetric measurements of the planning target volume (PTV). Dosimetric parameters of heterogeneity (V105, V107, V110, and maximum dose) were recorded for each treatment plan. Acute toxicity was scored for each treated breast. Results: Between 2006 and 2010, 78 patients were treated to 80 breasts using HypoRT. Most women were overweight or obese (78.7%), with a median body mass index of 29.2 kg/m{sup 2}. Median breast volume was 1,351 mL. Of the 80 treated breasts, the maximum acute skin toxicity was mild erythema or hyperpigmentation in 70.0% (56/80), dry desquamation in 21.25% (17/80), and focal moist desquamation in 8.75% (7/80). Maximum acute toxicity occurred after the completion of radiation in 31.9% of patients. Separation >25 cm was not associated with increased toxicity. Breast volume was the only patient factor significantly associated with moist desquamation on multivariable analysis (p = 0.01). Patients with breast volume >2,500 mL experienced focal moist desquamation in 27.2% of cases compared with 6.34% in patients with breast volume <2,500 mL (p = 0.03). Conclusions: HypoRT is feasible and safe in patients with separation >25 cm and in patients with large breast volume when employing modern planning and positioning techniques. We recommend counseling regarding expected increases in skin toxicity in women

  11. Perforated appendicitis with purulent peritonitis in the third semester of pregnancy

    Directory of Open Access Journals (Sweden)

    Sparić Radmila

    2005-01-01

    Full Text Available Acute appendicitis is the most common non-obstetric reason of abdominal pain in the pregnancy, causing significant increase of maternal and fetal morbidity and mortality. This is a case report of a patient in the third trimester of pregnancy in whom perforated appendicitis caused purulent peritonitis. She was operated as an emergency case and cesarean section was performed. After the surgery and antibiotic administration according to drug susceptibility test, her postoperative course was uneventful. Delayed diagnosis of the acute appendicitis leads to increased rate of appendicular perforation, with numerous maternal and fetal complications. In cases of suspected appendicitis during pregnancy, surgical exploration is indicated, either by laparoscopy or laparotomy. Laparotomy is the method of choice in cases after 20 weeks of pregnancy and whenever signs of diffuse peritonitis are present.

  12. Appendicitis-like clinical image elicited by Enterobius vermicularis: case report and review of the literature.

    Science.gov (United States)

    Vleeschouwers, W; Hofman, Ph; Gillardin, J P; Meert, V; Van Slycke, S

    2013-01-01

    A 17-year-old female patient presented with the clinical features of an acute appendicitis. During laparoscopic exploration a macroscopically normal appendix was found. Since there were no intra-abdominal abnormalities found, the appendix was resected. Anatomopathology demonstrated Enterobius vermicularis, a pinworm infecting only humans, and mostly living in the caecum. This parasite is responsible for possibly the most common helminthic infection in the developed world. Its role in the pathogenesis of acute appendicitis is controversial, but more recent studies indicate a stronger association between enterobiasis and appendicitis. Often, enterobius mimics appendicitis by obstructing the lumen of the appendix, thereby causing appendiceal colic. This case report stresses the importance of microscopic examination of all appendectomy resection specimens. In case of enterobius infestation, systemic therapy of patient and family is necessary.

  13. Left and right atrial feature tracking in acute myocarditis: A feasibility study

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    Dick, Anastasia, E-mail: anastasia-dick@web.de [Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne (Germany); Schmidt, Björn, E-mail: bjoernschmidt1989@gmx.de [Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne (Germany); Michels, Guido, E-mail: guido.michels@uk-koeln.de [Department III of Internal Medicine, Heart Centre, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne (Germany); Bunck, Alexander C., E-mail: alexander.bunck@uk-koeln.de [Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne (Germany); Maintz, David, E-mail: david.maintz@uk-koeln.de [Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne (Germany); Baeßler, Bettina, E-mail: bettina.baessler@uk-koeln.de [Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne (Germany)

    2017-04-15

    Purpose: The present study aims at evaluating the feasibility and reproducibility of cardiac magnetic resonance (CMR) feature tracking (FT) derived strain and strain rate (SR) parameters of the left and right atrium (LA, RA) in patients with acute myocarditis as well as their potential to detect diastolic dysfunction. In addition, the diagnostic value of LA and RA strain parameters in the setting of acute myocarditis is investigated. Methods: CMR cine data of 30 patients with CMR-positive acute myocarditis were retrospectively analyzed. 25 age- and gender-matched healthy individuals se