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Sample records for acute appendicitis retrospective

  1. [Treatment of acute appendicitis: Retrospective analysis].

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    Menclová, K; Traboulsi, E; Nikov, A; Hána, L; Rousek, M; Ryska, M

    Acute appendicitis is the most common cause of intra-abdominal emergency surgery worldwide. The approach to its treatment keeps changing. The number of acute appendectomies has been decreasing. Many patients are treated conservatively with success. Our study compares conservative and surgical treatment of acute appendicitis, including its complications in our department. We retrospectively analyzed the group of 117 patients hospitalized with the clinical diagnosis of acute appendicitis. We distinguished patients with complicated and uncomplicated appendicitis, and patients operated and treated conservatively. We evaluated complication rates and recurrences of the disease, respectively, in 1-year follow-up. The Student t test and Fishers exact test were used for the statistical analysis. In 2012 we hospitalized 117 patients with acute appendicitis: 83 patients (71%) for uncomplicated and 34 (29%) for complicated appendicitis. 41% of patients with complicated and 13% with uncomplicated appendicitis (p=0.02) were treated conservatively. Conservative treatment or laparoscopic surgery, respectively, were used more often in women ( p0.001). There was no failure of conservative treatment. Perioperative morbidity was 13%. No patient died. 6 patients (24%) of the conservatively treated group were hospitalized in the subsequent year for recurrent problems. 4 (16%) were reoperated. The rate of negative appendectomy (negative pathological findings) was 11%. The hospitalization time was shorter in patients treated conservatively or using laparoscopy, respectively, compared to the group of patients undergoing appendectomy. In the modern era of available complementary examinations and a broad spectrum of antibiotics the conservative approach is favoured as a treatment of complicated appendicitis. Conservative treatment of uncomplicated appendicitis is an option, but not the method of choice. Routine elective appendectomy after successful conservative treatment is groundless

  2. Acute Appendicitis

    DEFF Research Database (Denmark)

    Tind, Sofie; Qvist, Niels

    2017-01-01

    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...... peritoneal fluid cultivation. CONCLUSION: There was a low concordance in clinical and histopathological diagnoses of the different grades of appendicitis. Perioperative cultivation of the peritoneal fluid as a standard should be further examined. The potential could be a reduced postoperative antibiotic use...

  3. Single-port laparoscopic surgery in acute appendicitis: retrospective comparative analysis for 618 patients.

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    Kang, Byung Mo; Hwang, Ji Woong; Ryu, Byoung Yoon

    2016-11-01

    Transumbilical single-port laparoscopic appendectomy (SPLA) is a promising procedure that features less pain, faster recovery of postoperative bowel function and superior cosmetic results. We performed a retrospective comparative analysis of SPLA versus conventional laparoscopic surgery (CLA) to evaluate the safety and efficacy in acute appendicitis. From December 2008 to November 2013, laparoscopic surgery was performed on 636 patients with acute appendicitis at the Department of Surgery, Chuncheon Sacred Heart Hospital. Under approval of Institutional Review Board, data concerning baseline characteristics, operative outcomes, postoperative complications and postoperative functional recovery were compared between both procedures. After exclusion of 18 patients, 618 patients treated for acute appendicitis were included. SPLA was performed in 375 patients and CLA in 243 patients. Complicated appendicitis was more prevalent in the CLA group (26.3 %) than in the SPLA group (17.1 %) (p = 0.005). There was no difference between groups in operation time (p = 0.235), postoperative duration of hospital stay (p = 0.672) and readmission rate (p = 0.688). The rate of postoperative complications was similar in both groups (10.7 % in SPLA vs. 11.1 % in CLA, p = 0.862). In subgroup analysis of complicated appendicitis, more patients needed conversion to open surgery in the SPLA group (15.6 vs. 1.6 %, p = 0.005). In uncomplicated appendicitis, SPLA can be performed safely and efficiently. However, more selective indication for SPLA should be applied in cases of complicated appendicitis because of the greater risk of open conversion.

  4. 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.

  5. Acute appendicitis in pregnancy

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    Ortiz-Gualdrón César Augusto

    2012-01-01

    Acute appendicitis is the most common non-obstetric surgery pathology in pregnancy, itsincidence can be varied and occurs at a higher rate during the first and second trimesterof gestation. Its diagnosis is difficult and can be confused by the anatomical andphysiological changes during pregnancy, which alter their clinical presentation. Commonsymptoms are abdominal located pain, vomiting and nausea. The diagnosis is mainlyclinical, but laboratory tests and additional imaging help confirm or r...

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

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    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.

  7. Conservative treatment in acute appendicitis

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    G R Paudel

    2010-12-01

    Full Text Available INTRODUCTION: Acute appendicitis is one of the commonest surgical problems and appendectomy is one of the most commonly done operations in the emergency world wide. Though there have been occasional reports with conservative treatment in acute appendicitis, it is not being practiced as a routine. METHODS: All patients between ten to sixty years of age admitted at BPKIHS with the diagnosis of acute appendicitis over a period of one year were enrolled in the study. After taking informed consent the patients were managed conservatively. Those who did not respond to antibiotics within 24 hours were operated. Total hospital stay and complications were recorded and they were followed up at first week, sixth week and sixth month. The success rate, conversion rate, recurrence rate and morbidity and mortality pattern were assessed as the final outcome of conservative treatment of acute appendicitis. RESULTS: A total of 96 patients (48 males and 48 females underwent conservative treatment. The conservative treatment was successful in 79 (82.3% cases and failed in 11 (11.4% cases, which included: conversion to appendectomy during conservative treatment period 4 (4.2% cases, recurrence 7 (7.3% cases. There was no mortality in this study. CONCLUSION: Acute appendicitis can be treated successfully with conservative (antibiotics treatment with a short hospital stay. Though there is a risk of recurrence in some cases, all the complications after appendectomy can be eliminated with the conservative treatment. Keywords: acute appendicitis, appendicular lump, conservative management

  8. Challenges in uncomplicated acute appendicitis

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    Fernando Resende; Ana Beatriz Almeida; Jose Costa Maia; Renato Bessa Melo

    2016-01-01

    Acute appendicitis is one of the most common abdominal emergencies requiring surgery. It still represents, however, a challenging diagnosis. In order to facilitate this process, several scoring systems were developed, namely, the Alvarado score, acute inflammatory response and Raja Isteri Pengiran Anak Saleha Appendicitis scores, which are the most used in clinical practice. This clinical condition encompasses a wide spectrum of clinical presentations, from the uncomplicated form to the one with diffuse peritonitis. Treatment of uncomplicated acute appendicitis remains a matter of discussion. Although appen-dectomy has been regarded as the gold-standard, conservative management with antibi-otics is gaining more and more acceptance. The approach to appendectomy constitutes another controversial issue, namely, its performance through an open or a laparoscopic approach, which seems to be establishing itself, in some centers, as the standard of care. With this paper, we intend to give some insight on the aforementioned topics, through a review of the available literature on uncomplicated appendicitis.

  9. 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.

  10. 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.

  11. How to diagnose acute appendicitis

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

    2016-01-01

    Acute appendicitis (AA) is a common abdominal emergency with a lifetime prevalence of about 7 %. As the clinical diagnosis of AA remains a challenge to emergency physicians and surgeons, imaging modalities have gained major importance in the diagnostic work-up of patients with suspected AA in order...... appendicitis (AA). • Primary US for AA diagnosis will decrease ionizing radiation and cost. • Sensitivity of US to diagnose AA is lower than of CT/MRI. • Non-visualization of the appendix should lead to clinical reassessment. • Complementary MRI or CT may be performed if diagnosis remains unclear....

  12. Diagnostic Value of Mean Platelet Volume in Acute Appendicitis

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    Turgay Kilic

    2014-12-01

    Full Text Available Aim: The diagnosis of acute appendicitis for patients referred to the emergency department with the complaint of abdominal pain remains challenging. In this study, we investigated the diagnostic value of mean platelet volume in acute appendicitis. Material and Method: This clinical research study was performed retrospectively and included patients referred to the emergency department between January 1 and December 31, 2013, with the complaint of abdominal pain and were then discharged without a specific diagnosis in comparison to patients with a proven diagnosis of acute appendicitis. Control patients were selected using a randomization method from among patients of the same age and gender as acute appendicitis patients. The acute appendicitis group was subdivided into complicated and noncomplicated cases according to the pathology results. The Mann-Whitney U test for continuous variables and the chi-square test for categorical data were used. Results: This clinical research study was performed with 316 acute appendicitis patients and an equal number of control patients; 188 of the patients were male. Among the acute appendicitis patients, 67 presented with complicated acute appendicitis and 249 with noncomplicated acute appendicitis. The median mean platelet volume of the acute appendicitis versus control patients was 8.03 fL (IQR: 1.86; min: 5.53, max: 14.40 and 8.10 fL (IQR: 1.38; min: 5.70, max: 13.90, respectively (p=0.193. The platelet counts in the complicated and noncomplicated groups were 235 K/µL (IQR: 70; min: 116, max: 649 and 261 K/µL (IQR: 87; min: 124, max: 537, respectively (p

  13. Evaluation of scoring systems in predicting acute appendicitis in children.

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    Macco, Sven; Vrouenraets, Bart C; de Castro, Steve M M

    2016-12-01

    Acute appendicitis can be difficult to diagnose, especially in children. Appendicitis scoring systems have been developed as a diagnostic tool to improve the decision-making process in patients with suspected acute appendicitis. This study evaluates the Appendicitis Inflammatory Response score, Alvarado score, and Pediatric Appendicitis Score in children suspected of acute appendicitis. Data were collected retrospectively. All children younger than 18 years suspected of acute appendicitis who presented to the emergency department between January 2006 and June 2014 were included in this study. Variables were registered to evaluate 3 different appendicitis scoring systems. The diagnostic performance of the 3 scores was analyzed using the area under the receiver-operating curve and by calculating the diagnostic performances at different cut-off points. The present study included 747 consecutive children. There were 399 boys (53%) and 348 girls (47%) with a mean age of 11 years (range, 1-17 years). In total, 269 children (36%) were diagnosed with acute appendicitis. The area under the receiver-operating curve of the Appendicitis Inflammatory Response score was 0.90, the Alvarado score was 0.87, and the Pediatric Appendicitis Score was 0.82 (P Appendicitis Inflammatory Response score were better at predicting an acute appendicitis than that of the Alvarado score and Pediatric Appendicitis Score. In children with a low-risk acute appendicitis, false negative rates of 14% for the Appendicitis Inflammatory Response, 7% for the Alvarado, and 18% for the Pediatric Appendicitis Score were measured. In this study, the Appendicitis Inflammatory Response score had the highest discriminating power and outperformed the Alvarado score and Pediatric Appendicitis Score in predicting acute appendicitis in children. Excluding acute appendicitis safely in children with the scoring systems still remains uncertain. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Abdominal actinomycosis mimicking acute appendicitis.

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    Conrad, Robert Joseph; Riela, Steven; Patel, Ravi; Misra, Subhasis

    2015-01-01

    A 52-year-old Hispanic woman presented to the emergency department, reporting worsening sharp lower right quadrant abdominal pain for 3 days. CT of the abdomen and pelvis showed evidence of inflammation in the peritoneal soft tissues adjacent to an enlarged and thick-walled appendix, an appendicolith, no abscess formation and a slightly thickened caecum consistent with acute appendicitis. During laparoscopic appendectomy, the caecum was noted to be firm, raising suspicion of malignancy. Surgical oncology team was consulted and open laparotomy with right hemicolectomy was performed. Pathology reported that the ileocaecal mass was not a malignancy but was, rather, actinomycosis. The patient was discharged after 10 days of intravenous antibiotics in the hospital, with the diagnosis of abdominal actinomycosis. Although the original clinical and radiological findings in this case were highly suggestive of acute appendicitis, abdominal actinomycosis should be in the differential for right lower quadrant pain as it may be treated non-operatively.

  15. Sonography in the diagnosis of acute appendicitis

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    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.

  16. 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.

  17. Appendiceal endometriosis differentially diagnosed from acute appendicitis

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    Gastón Astroza; Victor Faundes; René Nanjarí; Marcelo Fleiderman; Carlos Rodriguez

    2010-01-01

    @@ Endometriosis is a common disease in premenopausal women involving pelvic organs specially. However endometriosis that affects the appendix is rarely seen except appendiceal endometriosis that mimics acute appendicitis. In a patient with acute appendicitis we diagnosed and operated on, histopathological examination of the appendix revealed appendiceal endometriosis which caused symptoms.

  18. Acute Appendicitis in Infants. A Case Report

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    Sergio Luis González López

    2013-04-01

    Full Text Available Acute appendicitis is more common in school-age children, but it rarely occurs in infants. The younger the patient, the fastest the course of the disease. In addition, there are greater risks of complications. A case of a nine-month-old infant, admitted to the pediatric hospital with fever and diarrhea, is presented. After several tests, he underwent surgery. Peritonitis caused by acute gangrenous appendicitis was diagnosed. While the patient was in the intensive care unit, he suffered a septic shock and acute multiple organ failure. As a result, he died 24 hours later. The biopsy confirmed the diagnosis of acute gangrenous appendicitis. Acute appendicitis is a disease that must be considered by doctors who treat infants with fever, diarrhea and abdominal pain related to irritability. Thus, an early diagnosis of the disease as well as the implementation of an appropriate surgical treatment can be performed.

  19. Can fruit seeds and undigested plant residuals cause acute appendicitis

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    Omer Engin; Mehmet Yildirim; Savas Yakan; Gulnihal Ay Coskun

    2011-01-01

    Objective:To investigate the relation between fruit seeds, plants residuals and appendicitis. Methods: Among cases that underwent appendectomy, the appendicitis cases having fruit seeds and undigested plant residuals in their etiology were examined retrospectively. Also, histopathological features, age, sex, and parameters of morbidity and mortality were used. Results: Fruit seed was found in one case(0.05%) with presence of pus in appendix lumen, undigested plant residuals in 7 cases(0.35%). It was determined that there were appendix inflammation in 2 of the plant residuals cases, while there were obstruction and lymphoid hyperplasia in the appendix lumen of5 cases. No mortality was observed.Conclusions: The ratio of acute appendicitis caused by plants is minimal among all appendectomised patients, but avoidence of eating undigested fruit seeds and chewing plants well may help to prevent appendicitis.

  20. A rare presentation of an acute appendicitis

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    Kordzadeh, Ali; Lorenzi, Bruno; Kalyan, Jiten P.; Hanif, Muhammad A.; Charalabopoulos, Alexandros

    2017-01-01

    Paraumbilical hernia sac usually contains omentum, bowel loop and rarely appendicular epiploicae, metastatic deposits and vermiform appendix. Presentation of acute appendicitis in a paraumbilical hernia is rare and limited to few case reports in the literature. Herein, we would like to report a case of a successfully treated acute appendicitis presenting in a paraumbilical hernia in an 84-year-old lady with 6-month follow-up. PMID:28096326

  1. [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.

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

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    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.

  3. Acute amebic appendicitis: report of a rare case.

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    Singh, Naorem Gopendro; Mannan, A A S Rifat; Kahvic, Mirza

    2010-01-01

    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.

  4. Outpatient surgery for acute uncomplicated appendicitis

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    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.

  5. 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

  6. 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

  7. 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.

  8. Imaging Acute Appendicitis: State of the Art

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    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.

  9. Perforation rate in acute appendicitis: association with different risk facotrs

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    B. Khorasani

    2006-08-01

    Full Text Available Background: The early diagnosis of acute appendicitis before progression to gangrene or abscess formation is recognized as important to minimize morbidity from this common disease process. The aim of this study was to assess the value of different risk factors in the diagnosis of perforation. Methods: This descriptive-analytic and retrospective study was conducted to investigate epidemiological characteristics in patients with perforated and non-perforated appendicitis. A series of 1311 patients who were operated on for acute appendicitis between years 1380-1382 in Shahid Beheshti and Yahya-nejad hospitals were reviewed.. Data gathered included age at operation, gender, care sought prior to admission for appendectomy including antibiotic and analgesic therapy, time of presentation in the year, duration of symptoms, signs and symptoms at the time of admission, and the patient’s living area. Results: One hundred twenty one of 1311 patients (9% had perforated appendicitis and 1190 patients (91% had unperforated appendicitis. Presentation and referral in the first 6-month was associated with higher perforation rate. Patients from rural area showed a higher rate of perforations. The perforation rate was significantly higher in elderly patients (>65 year. When the duration of symptoms was more than 12 hours at presentation, the risk of perforation showed a five-fold increase. 30.7% of perforated cases had used antibiotic or sedative before referring to the hospital. Conclusion: Appendiceal perforation continues to be a complication in patients with acute appendicitis and increased in the frequency as the age of the patients increase and the duration of symptoms lengthen. We also found that the perforation rate is higher in patients from rural area and in whom present in the first 6-month of the year, a finding that was not reported so far.

  10. Extraintestinal heterotopic gastric tissue simulating acute appendicitis

    Institute of Scientific and Technical Information of China (English)

    Elizabeth Bender; Steven P Schmidt

    2008-01-01

    We describe the case of a 68-year-old otherwise healthy male who presented to our emergency room with signs and symptoms of acute appendicitis. Exploratory surgery revealed a normal appendix. Further examination revealed an enlarged lymph node-like mass of tissue near the appendix, in the ileocecal mesentery. This mass was removed and was found to be inflamed heterotopic gastric tissue. Although reports of heterotopic gastric tissue in the literature are common, we believe that this case represents the first report of inflamed heterotopic gastric tissue simulating appendicitis.

  11. 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.

  12. Can fruit seeds and undigested plant residuals cause acute appendicitis

    Directory of Open Access Journals (Sweden)

    Omer Engin

    2011-04-01

    Conclusions: The ratio of acute appendicitis caused by plants is minimal among all appendectomised patients, but avoidence of eating undigested fruit seeds and chewing plants well may help to prevent appendicitis.

  13. Acute amebic appendicitis: Report of a rare case

    Directory of Open Access Journals (Sweden)

    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.

  14. Ultrasonography in the diagnosis of acute appendicitis

    Directory of Open Access Journals (Sweden)

    Luciano Augusto Botter

    2005-09-01

    Full Text Available Objective: To evaluate the role of sonography in diagnosis ofacute appendicitis, with an emphasis on early evolution cases.Methods: From 240 cases with the diagnosis of appendicitis, aretrospective study of 149 patients submitted to appendicectomyat the Hospital Israelita Albert Einstein, in 2002, was carried out.The appendix of these 149 patients was visualized in apreoperative sonography and the diagnosis was confirmed byhistological examination. Patients were distributed into twogroups - initial and advanced - according to the measure of thelargest external diameter of the appendix. The statistical dataanalysis included demographic information (sex and age anddirect and indirect signs of acute appendicitis. Results: Therewere more cases of acute appendicitis in the groups aged 10-30years, mean age of 18.3 years in the initial group and 26.4 yearsin the advanced group. There was no statistically significantdifference regarding sex. The advanced group presented 4.5%of false-positive results and the initial group, 23.1%. Among thedirect signs, non-compressibility of the appendix stood out andwas observed in more than half cases; with regard to indirectsigns, hyperechogenicity of periappendiceal tissues wasobserved in up to 75% of cases in both groups. Conclusion: Therewas a statistically significant difference in false-positive cases,which were more often observed in the initial group. Therefore,sonographic follow-up is recommended in these cases.

  15. 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 appendicitis cases. CT findings suggestive of appendiceal diverticulitis included the absence of fluid collection in the appendix (84% vs 12%, P appendicitis. PMID:25852277

  16. Case Report and Management of Suspected Acute Appendicitis in Pregnancy

    OpenAIRE

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

    2011-01-01

    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 a...

  17. Acute leukemic appendicitis in a patient with acute promyelocytic leukemia

    Directory of Open Access Journals (Sweden)

    Hatim Karachiwala

    2012-01-01

    Full Text Available Leukemic and lymphomatous infiltration of the appendix is a rare complication. We present the case of a 31-year-old male with acute promyelocytic leukemia who developed acute abdomen on day 11 of induction chemotherapy with idarubicin and cytarabine. After appropriate work-up, a clinical diagnosis of acute appendicitis was made. Despite severe pancytopenia, he successfully underwent laparoscopic appendectomy. The final pathology revealed leukemic infiltration of the appendix. It is hypothesized that the leukemic infiltration may play a role in the development of acute appendicitis. Further, this case demonstrates the need to maintain a high index of suspicion and prompt surgical intervention for surgical pathologies in neutropenic patients.

  18. Gallbladder Volvulus Presenting as Acute Appendicitis

    Directory of Open Access Journals (Sweden)

    Zachary Bauman

    2015-01-01

    Full Text Available We encountered a case of gallbladder volvulus in an 88-year-old thin female in which the initial presentation was more consistent with that of acute appendicitis. After complete work-up, including physical exam, lab work, and computed tomography, the definite diagnosis of gallbladder volvulus was not made until intraoperative visualization was obtained. Gallbladder volvulus is a rare but serious condition, which requires a high clinical suspicion so prompt surgical intervention can be undertaken.

  19. Acute appendicitis diagnosis using artificial neural networks.

    Science.gov (United States)

    Park, Sung Yun; Kim, Sung Min

    2015-01-01

    Artificial neural networks is one of pattern analyzer method which are rapidly applied on a bio-medical field. The aim of this research was to propose an appendicitis diagnosis system using artificial neural networks (ANNs). Data from 801 patients of the university hospital in Dongguk were used to construct artificial neural networks for diagnosing appendicitis and acute appendicitis. A radial basis function neural network structure (RBF), a multilayer neural network structure (MLNN), and a probabilistic neural network structure (PNN) were used for artificial neural network models. The Alvarado clinical scoring system was used for comparison with the ANNs. The accuracy of the RBF, PNN, MLNN, and Alvarado was 99.80%, 99.41%, 97.84%, and 72.19%, respectively. The area under ROC (receiver operating characteristic) curve of RBF, PNN, MLNN, and Alvarado was 0.998, 0.993, 0.985, and 0.633, respectively. The proposed models using ANNs for diagnosing appendicitis showed good performances, and were significantly better than the Alvarado clinical scoring system (p < 0.001). With cooperation among facilities, the accuracy for diagnosing this serious health condition can be improved.

  20. 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.

  1. 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.

  2. 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.

  3. 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.)

  4. 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

  5. Acute appendicitis in a premature baby

    Energy Technology Data Exchange (ETDEWEB)

    Beluffi, Giampiero; Alberici, Elisa [Department of Radiodiagnosis, Section of Paediatric Radiology, IRCCS Policlinico S. Matteo, Piazzale Golgi 2, 27100 Pavia PV (Italy)

    2002-07-01

    A case of acute appendicitis in a premature baby in whom diagnosis was suggested on plain films of the abdomen is presented. In this baby air in a hollow viscus suspected of being an enlarged appendix was the clue to diagnosis. The diagnostic dilemma of this rare and life-threatening condition in premature babies and newborns is underlined. The relevance of different imaging modalities and of different findings in this age group is discussed. Awareness of this rare condition and possible differential diagnosis in newborns and premature babies is stressed. (orig.)

  6. 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

  7. Antibiotic Duration After Laparoscopic Appendectomy for Acute Complicated Appendicitis

    NARCIS (Netherlands)

    Rossem, C.C. van; Schreinemacher, M.H.; Geloven, A.A. van; Bemelman, W.A.; Goor, H. van; Knaapen, L.

    2016-01-01

    IMPORTANCE: Optimal duration of antibiotic treatment to reduce infectious complications after an appendectomy for acute complicated appendicitis remains unclear. OBJECTIVE: To investigate the effect of antibiotic duration on infectious complications after laparoscopic appendectomy for acute complica

  8. Acute appendicitis in a femoral hernia

    Directory of Open Access Journals (Sweden)

    Zdravković Darko

    2007-01-01

    Full Text Available INTRODUCTION Acute appendicitis in a femoral hernia is an uncommon condition that can be serious. Complications are more frequent if the diagnosis is delayed and surgery is not performed on time. CASE REPORT We present a 71-year-old man with a painful swollen mass. The patient presented with fatigue and loss of appetite, while body temperature was normal. The abdomen was not painful, and peristaltic was normal. All laboratory findings were normal. After anamnesis and physical examination, the presumed diagnosis was incarcerated femoral hernia and the patient was sent to the operating room. Intraoperative findings revealed an incarcerated femoral hernia within a phlegmonous inflammated appendix. Appendectomy and McVay hernioplastics were done. The postoperative course was without complications. CONCLUSION It is very important to bear in mind that right femoral hernia with signs of incarceration and inflammation may contain an acutely inflamed appendix. Delayed diagnosis and misdiagnosis cause greater morbidity and mortality.

  9. Acute chylous ascites mimicking acute appendicitis in a patient with pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Emily K Smith; Edmund Ek; Daniel Croagh; Lavinia A Spain; Stephen Farrell

    2009-01-01

    We report a case of acute chylous peritonitis mimicking acute appendicitis in a man with acute on chronic pancreatitis. Pancreatitis, both acute and chronic, causing the development of acute chylous ascites and peritonitis has rarely been reported in the English literature. This is the fourth published case of acute chylous ascites mimicking acute appendicitis in the literature.

  10. 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.

  11. 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.

  12. 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 ...

  13. Laparoscopic appendicectomy for complicated appendicitis: is it safe and justified?: A retrospective analysis.

    Science.gov (United States)

    Khiria, Lakshman S; Ardhnari, Ramesh; Mohan, Narshimhan; Kumar, Palaniappan; Nambiar, Rajesh

    2011-06-01

    Although laparoscopic appendectomy has some advantages over open appendectomy, the literature suggests conflicting results regarding postoperative complications for complicated appendicitis. A retrospective review of patients with complicated appendicitis managed surgically at Meenakshi Mission Hospital and Research Center, Madurai, Tamilnadu, India was undertaken. A total of 497 patients were admitted with acute appendicitis and operated during the study period of 10 years from January 1999 to July 2009, out of which 119 (24%) patients had complicated appendicitis whereas 378 (76%) had uncomplicated acute appendicitis. The mean age of patients included in the study was 33.42 years (range, 4 to 80 y) with a male: female ratio of 2:1. Ninety-nine patients (83.19%) underwent laparoscopic appendicectomy and 1 patient underwent laparoscopic-assisted right hemicolectomy for suspected mass lesion of the cecum. Eleven patients (9.24%) underwent open appendicectomy because of preoperative clinical features of peritonitis in 10 patients and mass in 1 patient. Seven patients (5.88%) had conversion from laparoscopic to open procedure. The overall mean operating time was 68 minutes (25 to 180 min). For laparoscopic appendicectomy, 66 minutes (25 to 180 min), for open appendicectomy 76 minutes (50 to 110 min), for lap to open conversion 85 minutes (40 to 135 min), and for drainage procedure 67 minutes (60 to 75 min). A total of 28 patients developed complication in the form of wound infection (7), pneumonia (8), intra-abdominal abscess (11), and enterocutaneous fistula (2) after percutaneous drainage of intra-abdominal collection. All were managed conservatively and no mortality occurred. The morbidity rates, particularly for intra-abdominal abscesses and wound infection were less for laparoscopic appendectomy in complicated appendicitis than those reported in the literature for open appendectomy, whereas operating times and hospital stays were similar.

  14. [Change in pancreatic exocrine function in acute appendicitis].

    Science.gov (United States)

    Ivanov, Iu A

    1979-10-01

    In order to study changes in the functional state of the pancreas 1572 investigations of the blood and urine amylase, atoxylresistant lipase of the blood serum before operation were performed in different postoperative periods in 131 patients with acute appendicitis. The enzyme activity was established to increase, especially in destructive forms of appendicitis and in elderly patients.

  15. Schistosomiasis: A Rare Cause of Acute Appendicitis

    Directory of Open Access Journals (Sweden)

    Faten Limaiem

    2015-06-01

    Full Text Available Schistosomiasis is a water-borne trematode infestation and is one of the most widespread parasitic diseases in the world. Schistosomiasis can affect any organ, but is rare in the appendix. In this paper, the authors report a new case of appendicular schistosomiasis that was incidentally discovered in a 27-year-old male patient from Mali who underwent appendectomy for acute appendicitis. Appendectomy specimens removed from patients with appendicular schistosomiasis often appear macroscopically normal, but histopathological analysis of these cases confirms the diagnosis by revealing schistosomal eggs. The authors strongly recommend that all appendectomy specimens be examined histopathologically regardless of whether the specimens are macroscopically normal. [J Interdiscipl Histopathol 2015; 3(2.000: 78-80

  16. 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.)

  17. [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

    2017-02-18

    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 © 2017. Publicado por Elsevier España, S.L.U.

  18. 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...

  19. Solitary caecum diverticulitis mimicking acute appendicitis.

    Science.gov (United States)

    Hot, Semih; Eğin, Seracettin; Gökçek, Berk; Yeşiltaş, Metin; Alemdar, Ali; Akan, Arzu; Karahan, Servet Rüştü

    2015-12-01

    Solitary cecum diverticulum is a benign formation, but it can be complicated with inflammation, perforation and bleeding. Cecum diverticulitis (CD) is the most common complication of caecal diverticulum and it has the highest incidence among Asians, but it is a rare condition in the western world. The incidence of colonic diverticular disease can vary according to national origin, cultural structure and nutritional habits. CD is not common in our country, but it is an important situation because of its clinical similarity with the commonly seen acute right side abdominal diseases like acute appendicitis. Preoperative diagnosis is difficult, and hence, the actual frequency is not known. The treatment of CD can vary from medical therapy to right hemi colectomy. In this study, we presented ten CD cases on whom surgical resection was performed in our surgery unit during the last 8 years. Our purpose was to increase the awareness of surgeons about this situation, and so, make them pay attention for not having their first experience in the operating room.

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

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    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.

  1. Value of ultrasonography in the diagnosis of acute appendicitis

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    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.

  2. Simultaneous Acute Cholecystitis and Acute Appendicitis Treated by a Single Laparoscopic Operation

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    Jonas P. DeMuro

    2012-01-01

    Full Text Available While acute appendicitis and acute cholecystitis are both common, they are only rarely seen simultaneously. The clinical presentation and hospital course of a 45-year-old female with concurrent acute appendicitis and acute cholecystitis is presented. The laparoscopic approach is ideal for dealing with multiple, simultaenous abdominal pathologies.

  3. Simultaneous Acute Cholecystitis and Acute Appendicitis Treated by a Single Laparoscopic Operation

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    DeMuro, Jonas P.

    2012-01-01

    While acute appendicitis and acute cholecystitis are both common, they are only rarely seen simultaneously. The clinical presentation and hospital course of a 45-year-old female with concurrent acute appendicitis and acute cholecystitis is presented. The laparoscopic approach is ideal for dealing with multiple, simultaenous abdominal pathologies.

  4. Laparoscopic management of acute appendicitis in situs inversus

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    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.

  5. Postoperative antibiotic use and the incidence of intra-abdominal abscess in the setting of suppurative appendicitis: a retrospective analysis.

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    Bae, Esther; Dehal, Ahmed; Franz, Vanessa; Joannides, Michael; Sakis, Nicholas; Scurlock, Joshua; Nguyen, Patrick; Hussain, Farabi

    2016-12-01

    Although guidelines exist for postoperative antibiotic use in acute appendicitis that is perforated, gangrenous, or simple/uncomplicated, there are less data about its use in suppurative appendicitis. Here, we targeted this subgroup of patients to determine whether postoperative antibiotic administration affects incidence of intra-abdominal abscess formation. We retrospectively examined 1,192 patients who underwent laparoscopic appendectomy for acute appendicitis at Kaiser Permanente Fontana Hospital between August 2010 and August 2013. Suppurative appendicitis was described for 143 (12%) patients. Fifty-two patients received postoperative antibiotics for at least 1 week on discharge home, 91 did not. Of 143 patients with suppurative appendicitis, 1 (1.9%) who received postoperative antibiotics came back with an intra-abdominal abscess within 1 month. Of the 91 patients in the no antibiotic group, 1 (1.1%) came back with an intra-abdominal abscess. The administration of postoperative antibiotic in the setting of suppurative appendicitis has no effect on the rate of intra-abdominal abscess formation. Routine postoperative antibiotics may not be necessary in this patient population, and more evidence is needed to justify its use. Copyright © 2016 Elsevier Inc. All rights reserved.

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

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    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

  7. Study of 150 cases of acute appendicitis in children

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    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%

  8. Acute Appendicitis: An Extracolonic Manifestation of Clostridium difficile Colitis

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    Ali Ridha

    2017-01-01

    Full Text Available The current report is the case of a 30-year-old male patient who presented with symptomatology suggestive of appendicitis. However, careful history-taking and laboratory tests led to the diagnosis of Clostridium difficile colitis, resulting in successful nonsurgical management of this patient. Although both appendicitis and C. difficile colitis are common conditions, they are rarely diagnosed concurrently. This is reflected by paucity of literature describing this manifestation. Given this current presentation, the authors contend that the manifestation of extracolonic colitis within the appendix is possibly underdiagnosed or misdiagnosed as an acute appendicitis and thus potentially results in unnecessary surgical intervention. This report reminds physicians to consider the medical approach to managing acute appendicitis given the possibility of underlying C. difficile colitis as the causative factor.

  9. Acute Appendicitis Complicated by Pylephlebitis: A Case Report

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    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.

  10. 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.

  11. 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.

  12. Appendiceal taeniasis presenting like acute appendicitis.

    Science.gov (United States)

    Sartorelli, Alesso Cervantes; da Silva, Márcia Guimarães; Rodrigues, Maria Aparecida Marchesan; da Silva, Reinaldo José

    2005-09-01

    A case of parasitic appendicitis caused by Taenia sp. in a 28-year-old woman from Brazil is reported. Histopathological data and a description of the helminthe found in the appendix lumen are presented.

  13. 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.

  14. Acute neonatal appendicitis: a diagnosis to consider in abdominal sepsis.

    Science.gov (United States)

    Arias-Llorente, R P; Flórez-Díez, P; Oviedo-Gutiérrez, M; Suárez-Rodríguez, M; Costa-Romero, M; Solís-Sánchez, G; García-López, E

    2014-01-01

    Appendicitis in the neonatal period is extremely rare. Its low incidence together with non-specific clinical symptoms often mean the diagnosis is delayed, leading to increased rates of peritonitis and mortality. We report the case of a 33-week premature infant, small for gestational age (1180 g at birth), clinically stable and receiving exclusive enteral feeding, who presented clinical manifestations of necrotizing enterocolitis at 14 days of life. Acute phase reactants were elevated and abdominal radiography showed pneumoperitoneum. Laparotomy revealed acute perforated appendicitis without intestinal involvement and purulent fluid in the peritoneum, for which appendectomy was performed. Neonatal acute appendicitis should be considered in the differential diagnosis of abdominal sepsis since early diagnosis and treatment significantly reduce associated morbidity and mortality.

  15. Appendiceal diverticulitis and acute appendicitis: differences and similarities

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    Irene Lobo-Machín

    2014-08-01

    Full Text Available Introduction: Acute appendiceal diverticulitis is an unusual cause of acute abdomen, considered clinically indistinguishable from acute appendicitis. Material and methods: 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. Results: Mean age at presentation was lower in acute appendicitis (37.24 ± 19.98 vs. 54.81 ± 17.55 years, p < 0.001, with significant differences between men (33.33 ± 15.89 vs. 57 ± 18.02 years, p < 0.001 but not between women (41.76 ± 24.87 vs. 50.44 ± 16.69 years, p = 0.34. In the 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. Conclusions: 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.

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

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    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.

  17. [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.

  18. Diagnostic Performance on Low Dose Computed Tomography For Acute Appendicitis Among Attending and Resident Radiologists

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    Chang

    2016-01-01

    Full Text Available Background Low-dose computed tomography (LDCT techniques can reduce exposure to radiation. Several previous studies have shown that radiation dose reduction in LDCT does not decrease the diagnostic performance for appendicitis among attending radiologists. But, the LDCT diagnostic performance for acute appendicitis in radiology residents with variable training levels has not been well discussed. Objectives To compare inter-observer and intra-observer differences of diagnostic performance on non-enhanced LDCT (NE-LDCT and contrast-enhanced standard dose CT (CE-SDCT for acute appendicitis among attending and resident radiologists. Patients and Methods This retrospective study included 101 patients with suspected acute appendicitis who underwent NE-LDCT and CE-SDCT. The CT examinations were interpreted and recorded on a five-point scale independently by three attending radiologists and three residents with 4, 1 and 1 years of training. Diagnostic performance for acute appendicitis of all readers on both examinations was represented by area under receiver operating characteristic (ROC curves. Inter-observer and intra-observer AUC values were compared using Jackknife FROC software on both modalities. The diagnostic accuracy of each reader on NE-LDCT was compared with body mass index (BMI subgroups and noise using independent T test. Results Diagnostic performances for acute appendicitis were not statistically different for attending radiologists at both examinations. Better performance was noted on the CE-SDCT with a borderline significant difference (P = 0.05 for senior radiology resident. No statistical difference of AUC values was observed between attending radiologists and fourth year resident on both examinations. Statistically significant differences of AUC values were observed between attending radiologists and first year residents (P = 0.001 ~ 0.018 on NE-LDCT. Diagnostic accuracies of acute appendicitis on NE-LDCT for each reader were not

  19. Simultaneous acute appendicitis and pseudomembranous colitis in a pediatric patient.

    Science.gov (United States)

    Vidrine, Steven R; Cortina, Chandler; Black, Marissa; Vidrine, Steven B

    2012-01-01

    Acute appendicitis is a common cause for pediatric surgery, with an increasing incidence as this population ages. Pseudomembranous colitis (PMC) from Clostridum difficle is being seen more frequently in pediatric patients, especially after treatment with antibiotics and in those with Hirschsprung's disease. Only three prior cases of appendicitis associated with PMC have been described in the literature, and all of them occurred in adult patients. Here, we describe the first documented pediatric case: a 16-year-old female who developed acute appendicitis while concomitantly being treated for suspected pseudomembranous colitis. We concur with previous authors that there may be an association between these two pathologies; furthermore, this association may not always be clinically apparent and may be both under-diagnosed and under-reported.

  20. Appendicitis

    Science.gov (United States)

    ... of lymph nodes in the intestines, or even parasites. Once the appendix is blocked, it becomes inflamed ... of appendicitis can happen in other illnesses (like kidney stones, pneumonia, and urinary tract infections). That's why ...

  1. Torsion of an Epiploic Appendix Pretending as Acute Appendicitis

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    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

  2. Acute appendicitis following endoscopic mucosal resection of cecal adenoma.

    Science.gov (United States)

    Nemoto, Yukako; Tokuhisa, Junya; Shimada, Nagasato; Gomi, Tatsuya; Maetani, Iruru

    2015-07-21

    Endoscopic mucosal resection (EMR) allows the removal of flat or sessile lesions, laterally spreading tumors, and carcinoma of the colon or the rectum limited to the mucosa or the superficial submucosa. Acute appendicitis is the most common abdominal emergency requiring emergency surgery, and it is also a rare complication of diagnostic colonoscopy and therapeutic endoscopy, including EMR. In the case presented here, a 53-year-old female underwent colonoscopy due to a positive fecal occult blood test and was diagnosed with cecal adenoma. She was referred to our hospital and admitted for treatment. The patient had no other symptoms. EMR was performed, and 7 h after the surgery, the patient experienced right -lower abdominal pain. Laboratory tests performed the following day revealed a WBC count of 16000/mm(3), a neutrophil count of 14144/mm(3), and a C-reactive protein level of 2.20 mg/dL, indicating an inflammatory response. Computed tomography also revealed appendiceal wall thickening and swelling, so acute appendicitis following EMR was diagnosed. Antibiotics were initiated leading to total resolution of the symptoms, and the patient was discharged on the sixth post-operative day. Pathological analysis revealed a high-grade cecal tubular adenoma. Such acute appendicitis following EMR is extremely rare, and EMR of the cecum may be a rare cause of acute appendicitis.

  3. Ileocecocolic Intussusception Induced by Acute Appendicitis: A Case Report

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    Jo, Bang Sil; Kim, Min Jeong; Jang, Kyung Mi; Lee, Hyun; Jeon, Eui Yong; Lee, Kwan Seop; Lee, Yul [Hallym University Sacred Heart Hospital, Anyang (Korea, Republic of)

    2009-09-15

    Intussusception is a rare disease in adults. Moreover, appendiceal disease is very rarely the leading cause of adult intussusception. We report a case in which ileocecocolic intussusception is secondary to an acute appendicitis in an adult, and describe the radiologic, clinical, and pathologic findings.

  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. Characteristics of mesenteric lymphadenitis in comparison with those of acute appendicitis in children.

    Science.gov (United States)

    Gross, Itai; Siedner-Weintraub, Yael; Stibbe, Shir; Rekhtman, David; Weiss, Daniel; Simanovsky, Natalia; Arbell, Dan; Hashavya, Saar

    2017-02-01

    Mesenteric lymphadenitis (ML) is considered as one of the most common alternative diagnosis in a child with suspected acute appendicitis (AA). In this retrospective study, patients diagnosed with ML (n = 99) were compared in terms of demographic, clinical, and laboratory findings to patients diagnosed with AA (n = 102). This comparison was applied for both lymph nodes smaller and larger than 10 mm. When compared to patients with AA, patients with ML had significantly longer duration of symptoms prior to emergency department (ED) presentation (2.4 ± 2.6 vs 1.4 ± 1.4 days, P = 0.002) and multiple ED presentations (1.3 ± 0.7 vs 1.05 ± 0.3, P appendicitis. • Despite its prevalence, only few studies addressed the clinical characteristics of this clinical entity and their comparison with acute appendicitis. What is New: • Mesenteric lymphadenitis and acute appendicitis could be differentiated by multiple clinical and laboratory parameters. • No significant difference was found between those presenting with small and large lymph nodes.

  6. 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.

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

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    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.

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

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    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

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    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. Unenhanced MR Imaging in adults with clinically suspected acute appendicitis

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    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.

  11. C-Reactive protein is an independent surgical indication marker for appendicitis: a retrospective study

    Science.gov (United States)

    Yokoyama, Shozo; Takifuji, Katsunari; Hotta, Tsukasa; Matsuda, Kenji; Nasu, Toru; Nakamori, Mikihito; Hirabayashi, Naoki; Kinoshita, Hiroyuki; Yamaue, Hiroki

    2009-01-01

    Background This study is an attempt to clarify the role of C-reactive protein (CRP) as a surgical indication marker for appendicitis. Methods One hundred and fifty patients who underwent appendectomies and had pathologically confirmed appendicitis were reviewed between May 1, 1999 and September 31, 2007. The correlation between preoperative clinical factors and the actual histological severity, and identify surgical indication markers were assessed by univariate and multivariate analyses. Results Univariate analysis showed that only the CRP level significantly differ between the surgical treatment necessary group (gangrenous appendicitis) and the possible non-surgical treatment group (catarrhalis and phlegmonous appendicitis). Multivariate analysis indicated only the CRP level to be a surgical indication marker for acute appendicitis. The receiver-operating characteristic (ROC) curve indicated that the cutoff value of CRP for surgical indication of appendicitis is 4.95 mg/dl. Conclusion Only the CRP level is consistent with the severity of appendicitis, and considered to be a surgical indication marker for acute appendicitis. PMID:19878592

  12. C-Reactive protein is an independent surgical indication marker for appendicitis: a retrospective study

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    Nakamori Mikihito

    2009-10-01

    Full Text Available Abstract Background This study is an attempt to clarify the role of C-reactive protein (CRP as a surgical indication marker for appendicitis. Methods One hundred and fifty patients who underwent appendectomies and had pathologically confirmed appendicitis were reviewed between May 1, 1999 and September 31, 2007. The correlation between preoperative clinical factors and the actual histological severity, and identify surgical indication markers were assessed by univariate and multivariate analyses. Results Univariate analysis showed that only the CRP level significantly differ between the surgical treatment necessary group (gangrenous appendicitis and the possible non-surgical treatment group (catarrhalis and phlegmonous appendicitis. Multivariate analysis indicated only the CRP level to be a surgical indication marker for acute appendicitis. The receiver-operating characteristic (ROC curve indicated that the cutoff value of CRP for surgical indication of appendicitis is 4.95 mg/dl. Conclusion Only the CRP level is consistent with the severity of appendicitis, and considered to be a surgical indication marker for acute appendicitis.

  13. WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis.

    Science.gov (United States)

    Di Saverio, Salomone; Birindelli, Arianna; Kelly, Micheal D; Catena, Fausto; Weber, Dieter G; Sartelli, Massimo; Sugrue, Michael; De Moya, Mark; Gomes, Carlos Augusto; Bhangu, Aneel; Agresta, Ferdinando; Moore, Ernest E; Soreide, Kjetil; Griffiths, Ewen; De Castro, Steve; Kashuk, Jeffry; Kluger, Yoram; Leppaniemi, Ari; Ansaloni, Luca; Andersson, Manne; Coccolini, Federico; Coimbra, Raul; Gurusamy, Kurinchi S; Campanile, Fabio Cesare; Biffl, Walter; Chiara, Osvaldo; Moore, Fred; Peitzman, Andrew B; Fraga, Gustavo P; Costa, David; Maier, Ronald V; Rizoli, Sandro; Balogh, Zsolt J; Bendinelli, Cino; Cirocchi, Roberto; Tonini, Valeria; Piccinini, Alice; Tugnoli, Gregorio; Jovine, Elio; Persiani, Roberto; Biondi, Antonio; Scalea, Thomas; Stahel, Philip; Ivatury, Rao; Velmahos, George; Andersson, Roland

    2016-01-01

    Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued. In July 2015, during the 3rd World Congress of the WSES, held in Jerusalem (Israel), a panel of experts including an Organizational Committee and Scientific Committee and Scientific Secretariat, participated to a Consensus Conference where eight panelists presented a number of statements developed for each of the eight main questions about diagnosis and management of AA. The statements were then voted, eventually modified and finally approved by the participants to The Consensus Conference and lately by the board of co-authors. The current paper is reporting the definitive Guidelines Statements on each of the following topics: 1) Diagnostic efficiency of clinical scoring systems, 2) Role of Imaging, 3) Non-operative treatment for uncomplicated appendicitis, 4) Timing of appendectomy and in-hospital delay, 5) Surgical treatment 6) Scoring systems for intra-operative grading of appendicitis and their clinical usefulness 7) Non-surgical treatment for complicated appendicitis: abscess or phlegmon 8) Pre-operative and post-operative antibiotics.

  14. Fecal loading in the cecum as a new radiological sign of acute appendicitis

    Institute of Scientific and Technical Information of China (English)

    Andy Petroianu; Luiz Ronaldo Alberti; Renata Indelicato Zac

    2005-01-01

    AIM: Although the radiological features of acute appendicitis have been well documented, the value of plain radiography has not been fully appreciated. The aim of this study was to determine the frequency of the association of acute appendicitis with images of fecal loading in the cecum.METHODS: Plain abdominal radiographs of 400 patients operated upon for acute appendicitis (n = 100), acute cholecystitis (n = 100), right acute pelvic inflammatory disease (n = 100) and right nephrolithiasis (n = 100)were assessed. The presence of fecal loading was recorded and the sensitivity and specificity of this sign for acute appendicitis were calculated.RESULTS: The presence of fecal loading in the cecum occurred in 97 patients with acute appendicitis, 13 patients with acute cholecystitis, 12 patients with acute inflammatory pelvic disease and 19 patients with nephrolithiasis. The sensitivity of this sign for appendicitis was 97% and its specificity to this disease was 85.3%. Its positive predictive value for appendicitis was 68.7%; however, its negative predictive value for appendicitis was 98.8%.CONCLUSION: The present study suggests that the presence of radiological images of fecal loading in the cecum may be a useful sign of acute appendicitis, and the absence of this sign probably excludes this disease.This is the first description of fecal loading as a radiological sign for acute appendicitis.

  15. [Immunotherapy for the treatment of acute appendicitis in children].

    Science.gov (United States)

    Bulanova, A A; Akhanzaripov, Z A

    1994-08-01

    The immune status was studied during the development of the disease in 182 children who were operated on for acute appendicitis. T lymphocytes and their subpopulations circulating in the blood, as well as B lymphocytes, immunoglobulins A, M, G, and immune complexes were determined. The character of changes of these values before the operation and in various postoperative periods were determined. The effect of complex treatment, including T-activin, on the clinical and immunological parameters in children with acute appendicitis was appraised. Analysis of the results showed that a transitory immunodepressive state forms in children with the disease, which is more marked in the destructive form, with normalization of the main values of cell-mediated and humoral immunity by the 7th day after appendectomy. In a complicated course of acute appendicitis the state of immunodeficiency is torpid in character and does not return to normal values even after clinical recovery, i.e. before discharge from the clinic. Inclusion of the immunostimulating agent T-activin into the complex treatment of patients with appendicitis ensures a more rapid involution of the main clinical manifestations of the disease. The therapeutic effect was most pronounced in destructive appendicitis: after 3 days of treatment the pain syndrome was encountered twice less frequently and intestinal paresis more than twice less frequently in these patients, and the term of hospital stay (8.8 +/- 0.4 days) was less shorter than for children of the control group (12.2 +/- 1.9 days) who did not receive T-activin in the therapeutic complex.

  16. Laparoscopic appendectomy in surgical treatment of acute appendicitis

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    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. Does breast feeding provide protection against acute appendicitis? A case-control study.

    Science.gov (United States)

    Alves, João Guilherme Bezerra; Figueiroa, José Natal; Barros, Isabela

    2008-10-01

    Breast feeding stimulates a more tolerant lymphoid tissue at the base of the appendix and this could provide protection against acute appendicitis. Two studies reported that children and adolescents with appendicitis were less likely to have been breast fed. In a case-control study of 200 children with histologically confirmed acute appendicitis matched by 200 siblings with the same sex and difference age - up to three-year-old - we found breast feeding in at least the first two months of life and for more than four months provides protection against acute appendicitis. These findings suggesting that breast feeding may possibly give protection against the development of appendicitis.

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

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    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.

  19. Abdominal Pain in the Female Patient: A Case of Concurrent Acute Appendicitis and Ruptured Endometrioma

    Science.gov (United States)

    Louis, Martine A.; Lin, Elizabeth; Baek, Ji Yoon; Andoni, Alda; Wang, Xiao Hui

    2016-01-01

    General surgeons are often asked to evaluate acute abdominal pain which has an expanded differential diagnosis in women of childbearing age. Acute appendicitis accounts for many surgical emergencies as a common cause of nongynecologic pelvic pain. In some rare instances, acute appendicitis has been shown to occur simultaneously with a variety of gynecologic diseases. We report a case of concurrent acute appendicitis and ruptured ovarian endometrioma. PMID:28097032

  20. The activity of granulocyte alpha-amylase in acute appendicitis.

    Science.gov (United States)

    Zakrzewska, I; Gajda, R

    1994-01-01

    The activity of alpha-amylase was measured in isolated granulocytes, serum and urine of 35 patients with acute appendicitis. The measurements were performed before operation and on the 7th day after operation. Slightly increased activity of alpha-amylase was found in the serum and urine of 15 patients. On the 7th day after operation the activity of this enzyme reached normal value. The activity of granulocyte alpha-amylase was elevated in 22 patients. In 2 of them the increased activity still maintained on the 7th day after operation. Positive correlation between the serum and granulocyte alpha-amylase activities was found. These observations allow to conclude that granulocytes are the source of increased alpha-amylase activity in the serum of patients with acute appendicitis.

  1. STUDY OF INTRAOPERATIVELY AND HISTOLOGICALLY NEGATIVE CASES IN CLINICALLY DIAGNOSED CASES OF ACUTE APPENDICITIS

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    Muralidhar Manga

    2016-07-01

    Full Text Available BACKGROUND Acute appendicitis remains the most common cause of acute abdomen requiring surgical intervention. Diagnosis of appendicitis is done on clinical grounds. The aetiology and pathogenesis of appendicitis are poorly understood. The cause of pain in the cases with clinical diagnosis of acute appendicitis but intraoperatively normal looking appendix remains controversial. The present study aims at determining the cause of pain in these cases by combining routine histopathology, IHC to investigate the status of the enteric nervous system in normal and inflamed appendices. MATERIALS AND METHODS In the present study, 694 patients who underwent appendicectomy with diagnosis of acute appendicitis were included. In 89 cases, there were no signs of inflammation intraoperatively. These appendix specimens were followed by histopathological examination by H&E staining. 69 out of 89 specimens did not have signs of inflammation in histological examination by H&E staining. Cases which are diagnosed as acute appendicitis but histologically negative in H&E staining are taken as study cases. 49 acute appendicitis cases- histologically positive acute appendicitis (HPAA and 20 appendices from right hemicolectomy specimens were taken as controls. All these specimens were subjected to; 1 Routine Haematoxylin & Eosin staining. 2 Toluidine blue stain for mast cell evaluation. 3 Immunohistochemistry by S-100 stain for evaluating size and number of the ganglia. OBSERVATION The mean mast cell count was more in the histologically negative acute appendicitis group when compared to histologically positive acute appendicitis and control group. The mean size and number of the ganglia were more in the histologically negative acute appendicitis group when compared to histologically positive acute appendicitis and control groups. CONCLUSION Neuronal hypertrophy and mast cells may play a role in the pathogenesis of “appendicitis like pain” in patients with

  2. Acute suppurative appendicitis with Blastocystis hominis

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    Poppy M Lintong

    2012-10-01

    Full Text Available Blastocystis hominis (B. hominis is an anaerobic protozoan parasite, which lives in human and animal ’s intestines. It is commonly found in the tropical area. The parasite is low pathogen and its infection causes gastrointestinal disease with diarrhea symptom as reported from many studies. B. hominis is rarely seen in tissue section. The clinical diagnoses are usually confirmed with the microscopic examination of the stool, which can directly detect the parasite through trichrom stain and Kinyoun acid fast technique. We reported a case of 52 years old man with abdominal pain and suspected as perforated appendicitis and tumor of appendix as the differential diagnosis. The macroscopic features of the appendix mass were 7 cm in length and 1.5-2.5 cm in diameter. The cut section showed a widening of the appendix lumen, and the distal part filled with a gelatinous mass. The microscopic examination with HE stain showed the infiltration of PMN inflammatory cells in the muscle layer of the appendix and foci of a number of round structures in the sub mucosal layer known as B. hominis. Some authors reported results from the endoscopy and biopsy examinations that B. hominis does not infiltrate in the intestinal mucosa; nevertheless, in this case we found the infiltration of the parasite towards the mucosal and sub mucosal layers of the appendix.

  3. The platelet indices in pediatric patients with acute appendicitis

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    Yunus Yilmaz

    2015-06-01

    Full Text Available Background: The diagnosis of Acute Appendicitis (AA remains a problem in pediatric population. It has been suggested that Mean Platelet Volume (MPV is lower in the patients with AA. The purpose of this study was to investigate the diagnostic value of platelet indices in pediatric AA cases. Methods: A retrospective case-controlled study was designed: 224 subjects were included in this study. All patients had been operated on in division of pediatric surgery at the Kars Government Hospital with the preliminary diagnosis of AA. 204 and 20 of these patients were pathologically diagnosed as AA (group 1 and normal appendix vermiformis (group 2, respectively. Platelet indices had been studied in the biochemistry laboratory of the hospital, before the surgery. Results: In group 1, platelet count, mean platelet volume, plateletcrit and platelet distribution width were 305 +/- 94x103/ and micro;L; 7.37 +/- 0.90 fL; 0,220 +/- 0.057 % and 16.3 +/- 0.5%, respectively. In group 2, platelet count, mean platelet volume, plateletcrit and platelet distribution width were 283 +/- 85 103/ and micro;L; 7.60 +/- 1.24 fL; 0.208 +/- 0.045 % and 16.4 +/- 0.7%, respectively. There was no statistically significant difference between the groups studied with regard to platelet indices (P>0.05. Conclusions: Our study showed that platelet indices have no diagnostic value in the diagnosis of AA at pediatric age group. [Int J Res Med Sci 2015; 3(6.000: 1388-1391

  4. Acute appendicitis in acute leukemia and the potential role of decitabine in the critically ill patient

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    Deepti Warad

    2015-01-01

    Full Text Available Acute appendicitis in children with acute leukemia is uncommon and often recognized late. Immunocompromised host state coupled with the importance of avoiding treatment delays makes management additionally challenging. Leukemic infiltration of the appendix though rare must also be considered. Although successful conservative management has been reported, surgical intervention is required in most cases. We present our experience with acute appendicitis in children with acute leukemia and a case of complete remission of acute myeloid leukemia with a short course of decitabine. Decitabine may serve as bridging therapy in critically ill patients who are unable to undergo intensive chemotherapy.

  5. Conservative treatment in uncomplicated acute appendicitis: reassessment of practice safety.

    Science.gov (United States)

    Steiner, Zvi; Buklan, Genady; Stackievicz, Rodica; Gutermacher, Michael; Litmanovitz, Ita; Golani, Guy; Arnon, Shmuel

    2017-04-01

    The success rate of conservative treatment for children with uncomplicated appendicitis was prospectively evaluated among 197 children. All who received intravenous antibiotics for 3-5 days, and if symptoms resolved, were discharged home on oral antibiotics for 5 days. Failure rate, symptoms, laboratory signs, and sonographic findings were evaluated for prognostic markers of treatment failure. Children were followed for 18 months. The success rate of conservative treatment was 87%, with shorter hospital stays compared to children who eventually needed surgery (72 [60-84] vs. 84 h [72-126], P = 0.001). Vomiting and/or nausea and intraluminal fluid on sonography were the only prognostic signs of failed treatment (P = 0.028 and P = 0.0001, respectively). After multi-regression analysis, intraluminal fluid was the only prognostic sign for failed treatment (odds ratio = 10.2; 95% CI 3.3-31.8, P = 0.001). Patients who failed conservative treatment were successfully operated without significant morbidity. Pathology findings were compatible with acute or subacute inflammation in 94% of operated AA, with no perforated appendices. When applying rigorous criteria for children with uncomplicated appendicitis, a high success rate can be achieved with conservative treatment. Those who fail conservative treatment have a benign medical course without serious complications. Intraluminal fluid may increase risk for conservative treatment failure. What is Known: • Conservative treatment in uncomplicated acute appendicitis is a reasonable alternative to appendectomy. What is New: • Using rigorous criteria for conservative treatment in uncomplicated acute appendicitis is safe and feasible. • Intraluminal fluid should be considered a contraindication to conservative treatment.

  6. Computed Tomography Diagnosis Utilizing Compressed Image Data: An ROC Analysis Using Acute Appendicitis as a Model

    OpenAIRE

    2002-01-01

    Using receiver-operating characteristic (ROC) methodology, the ability to diagnose acute appendicitis with computed tomography (CT) images displayed at varying levels of lossy compression was evaluated. Nine sequential images over the ileocecal region were obtained from 53 consecutive patients with right lower quadrant pain who were clinically suspected to have acute appendicitis. Thirty were proven surgically to have acute appendicitis, alternative diagnoses confirmed in 23. The image sets w...

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

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    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.

  8. The Diagnostic Value of D-dimer, Procalcitonin and CRP in Acute Appendicitis

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    Bulent Kaya, Baris Sana, Cengiz Eris, Koray Karabulut, Orhan Bat, Riza Kutanis

    2012-01-01

    Full Text Available BACKGROUND: The early diagnosis of acute abdomen is of great importance. To date, several inflammatory markers have been used for the diagnosis of acute abdominal conditions, including acute appendicitis. The aim of this study was to evaluate the diagnostic utility of D-dimer, Procalcitonin (PCT and C-reactive protein (CRP measurements in the acute appendicitis.METHODS: This prospective study was conducted between March 1st, 2010 and July 1st, 2011. In this period, seventy-eight patients were operated with the diagnosis of acute appendicitis, and D-dimer, PCT and CRP levels of the patients were measured. The patients were grouped as phlegmonous appendicitis (Group 1, gangrenous appendicitis (Group 2, perforated appendicitis (Group 3 and negative appendectomy (Group 4 according to the surgical findings and histopathological results.RESULTS: Of 78 patients, 54 (69.2 % were male and 24 (30.8 % were female, and the mean age was 25.4 ± 11.1 years (range, 18 to 69 years. 66 (84.6 % patients had increased leukocyte count (white blood cell count. The PCT values were higher than the upper normal limit in 20 (25.6% patients, followed by D-dimer in 22 (28.2 % patients and CRP in 54 (69.2 % patients. The diagnostic value of leukocyte count and CRP in acute appendicitis was higher than that of the other markers, whereas leukocyte count showed very low specificity. CRP values were higher in perforated appendicitis when compared with the phlegmonous appendicitis (p<0.05. However, PCT and D-dimer showed lower diagnostic values (26% and 31%, respectively.CONCLUSION: An increase in CRP levels alone is not sufficient to make the diagnosis of acute appendicitis. However, CRP levels may differentiate between phlegmonous appendicitis and perforated appendicitis. Due to their low sensitivity and diagnostic value, PCT and D-dimer are not better markers than CRP for the diagnosis of acute appendicitis.

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

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    Karakas, S.P.; Guelfguat, M.; Springer, S.; Singh, S.P. [Department of Radiology, Schneider Children' s Hospital, Long Island Jewish Medical Center and the Long Island Campus of the Albert Einstein College of Medicine, New Hyde Park, NY, 11042 (United States); Leonidas, J.C. [Department of Radiology, Schneider Children' s Hospital, Long Island Jewish Medical Center and the Long Island Campus of the Albert Einstein College of Medicine, New Hyde Park, NY, 11042 (United States); Department of Radiology, Schneider Children' s Hospital, 270-05 76th Avenue, New Hyde Park, NY, 11042 (United States)

    2000-02-01

    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

  10. CLINICAL EVALUATION AND ROLE OF USG IN PATIENTS OF ACUTE APPENDICITIS IN A RURAL HOSPITAL

    Directory of Open Access Journals (Sweden)

    Sandesh

    2014-12-01

    Full Text Available INTRODUCTION: Acute appendicitis is the commonest emergency met in surgical practice. The clinical features sometimes being non-specific and list of differential diagnosis is too long. Diagnosis being particularly difficult in females due to associated gynaecological and obstetric conditions. The aim is to reduce unnecessary laparotomies and incidence of appendiceal perforation which is associated with significant post-operative morbidity. Reported approaches to achieve this objective include emergency laparotomy, Ultrasonography (USG, scoring system, CT scan etc. In peripheral areas USG remains most widely available and preliminary investigative for establishing definitive diagnosis in addition to clinical suspicion. AIM: Clinical evaluation and role of ultrasonography in patients of acute appendicitis in a rural hospital. OBJECTIVES: To study clinical profile of acute appendicitis. Role of USG in diagnosis of acute appendicitis. METHODS: 50 patients of acute abdomen suspected to have acute appendicitis, of all age groups and both sexes, admitted with cardinal features of acute appendicitis like pain in abdomen (Right iliac fossa, vomiting, and fever were included in this study. Patients were studied according to the Proforma. Surgeons made a final clinical diagnosis on the basis of clinical impression and USG information. All the patients diagnosed as acute appendicitis (without any lump formation in RIF were treated surgically and diagnosis was confirmed histopathologically. Acute appendicitis was studied with special reference to clinical findings and ultrasonographic findings. Use of ultrasonography in the diagnosis of acute appendicitis was evaluated. CONCLUSION: USG remains most cost effective, efficient and valuable investigation for acute appendicitis in rural settings. The use of USG in suspected acute appendicitis should be complement to but not replacing clinical assessment.

  11. Contrast-enhanced power Doppler US in the diagnosis of acute appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Incesu, L.; Yazicioglu, A.K.; Selcuk, M.B.; Ozen, N

    2004-05-01

    Introduction/objective: To determine the value of power Doppler (PD) ultrasonography (US) and contrast-enhanced power Doppler (CEPD) US in the diagnosis of acute appendicitis and the prediction of histopathologic stages. Methods and material: 50 patients with suspected acute appendicitis were evaluated by the same radiologist with PD US and CEPD US. Air micro bubbles stabilized by a granulate of 'galactose and palmitic acid' were used as a contrast medium for sonography with the concentration of 400 mg/ml. PD US and CEPD US results were later correlated with the surgical and histopathologic findings. PD US and CEPD US findings were considered positive for appendicitis; if there was depiction of hyperemia in the wall of the appendix or if there was depiction of prominent peripheral vascularity when compared with normal soft tissues; and negative if both hyperemia and peripheral hyperemia were not prominent. Results and discussions: Of the 50 patients, 35 patients had histopathologically proven acute appendicitis. CEPD US showed prominent hyperemia in the appendiceal vessels or feeding vessels of the inflamed appendix, and resistance index (RI) calculations were easier. There was statistically significant difference between mean RI values of the normal appendix, suppurative appendicitis and gangrenous appendicitis. PD US has accuracy of 80%, sensitivity of 74% and CEPD US has 98%, and 100% in the diagnosis of acute appendicitis. CEPD US identified 100% of suppurative appendicitis and gangrenous appendicitis. Conclusion: CEPD US is a promising method in the diagnosis of acute appendicitis and determination of the inflammation stage.

  12. [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

    2017-01-03

    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.

  13. [Acute appendicitis: clinico-diagnostic and therapeutic considerations].

    Science.gov (United States)

    Carditello, A; Bartolotta, M; Bonavita, G; Lentini, B; Sturniolo, G

    1985-04-01

    Since january 1970-december 1982, 58 patients underwent emergently appendectomy for acute appendicitis. 31 (53,4 percent) where males; the average age was 21 +/- 2,3 years (M +/- SEM). The duration of symptoms ranged from 1-6 hours (10,3 percent of cases) to over 48 hours, before the hospital admission (15,4 percent of cases). 27 patients (46,5 percent) had a clinical examination at home by a physician. 21 patients (36,4 percent) came to hospital emergency unit without previous physical examination; 10 (17,2 percent) were transferred from other departments. In 6,9 percent of cases was present a perforated appendicitis with peritonitis. During operation, in 50 percent of patients was performed a therapeutic peritoneal lavage. In 63,7 percent of cases multiple drains were placed in peritoneal cavity. In all patients was effected postoperative antibiotic profilaxis. The mortality rate was 3,4 percent. General complications were observed more in patients with perforated appendicitis. This review suggests the following remarcable data: morbidity of this disease is still high; the physical examination is more important than laboratory work (especially in the elderly patients, which are often immunodepressed and in children, with leucocitosis-lack at hospital admission); early surgery is the most important factor to the improvement of prognosis in these cases and the results of surgical treatment are improved by large vertical incisions, peritoneal lavage and application of multiple intracavitary drains.

  14. 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.

  15. Are acute exacerbations of chronic inflammatory appendicitis triggered by coprostasis and/or coproliths?

    Institute of Scientific and Technical Information of China (English)

    George Sgourakis; Georgios C Sotiropoulos; Ernesto P Molmenti; Charis Eibl; Stylianous Bonticous; Jurgen Moege; Christoph Berchtold

    2008-01-01

    AIM:To examine the role of coprostasis and coproliths in recurrent appendicitis.METHODS:We evaluated four hundred and twentyseven consecutive pathology reports of all appendectomy specimens from January 2003 to December 2004.Findings were categorised as showing acute append icitis,acute recurrent appendicitis,subacute recurrentappendicitis,chronic appendicitis,or appendices without inflammation.All patients had presented with acute right lower quadrant pain.In 94 instances,there was a history of recurrent similar episodes in the past.RESULTS:Of the 427 histology reports,294 were interpreted as showing acute appendicitis,56 acute recurrent appendicitis,34 subacute recurrent appen-dicitis,28chronic appendicitis,and 15 non-inflamed appendices.Coprostasis was observed in 58 patients (13.58%) and the presence of coprolith in 6 (1.4%).Coprostasis,and age,were among the predictors in the final model.CONCLUSION:Coprostasis but not coproliths seems to be a contributing factor to acute exacerbations of chronic inflammatory appendicitis.

  16. 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.

  17. 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.)

  18. Laparoscopic appendectomy for complicated acute appendicitis does not result in increased surgical complications

    Directory of Open Access Journals (Sweden)

    Yueh-Ming Lin

    2012-07-01

    Conclusion: This study demonstrated no increase in surgical complications after LA in patients with complicated acute appendicitis when compared with those who had uncomplicated disease. Therefore, LA may be considered the first-choice treatment option for both uncomplicated and complicated acute appendicitis.

  19. A rare cause of acute abdomen in adults: Parasitic infection-related acute appendicitis.

    Science.gov (United States)

    Küpeli, Aydın Hakan; Özdemir, Murat; Topuz, Sezgin; Sözütek, Alper; Paksoy, Tuğba

    2015-01-01

    Ascaris lumbricoides is a common parasitic disease all over the world, especially in less developed countries. Acute appendicitis related to parasitic infection is a rare condition. Parasitic infections should be kept in mind in patients who are admitted to the emergency department with acute abdomen, especially in endemic areas.

  20. Research of Ultrasound Diagnosis for Acute Appendicitis%超声对急性阑尾炎诊断价值的研究

    Institute of Scientific and Technical Information of China (English)

    尤焕焕

    2015-01-01

    目的通过急性阑尾炎的超声图像表现,探讨急性阑尾炎的超声诊断价值。方法搜集本院2011年2月~2014年3月手术病例证实的50例急性阑尾炎的临床和超声资料,回顾性分析超声图像特征对急性阑尾炎的诊断价值。结果本组50例急性阑尾炎的超声诊断正确者48例,诊断准确率为96%,其中单纯性阑尾炎10例,化脓性阑尾炎32例,坏疽性阑尾炎5例,1例为回盲部肿瘤。结论超声图像特征对急性阑尾炎的诊断准确率高,已经成为疑似急性阑尾炎患者的最为行之有效的方法。%Objective The sonographic findings of acute appendicitis, To explore the value of ultrasound in the diagnosis of acute appendicitis. Methods Col ect the clinical and ultrasound date of 50 cases of confirmed by operation, a retrospective analysis of the ultrasonographic charateristics of value in the diagnosis of acute appendicitis. Results 48 cases of true ultrasound diagnosis in this group of 50 cases of acute appendicitis, the diagnostic accuracy was 96%, among 13 patients with simple appendicitis, 32cases of suppurative appendicitis, 5 cases of gangrenous appendicitis, 1 cases of ileocecal tumor. Conclusion Ultrasonography in the diagnosis of acute appendicitis rate has become the most ef ective method for the patients with suspected acute appendicitis.

  1. Acute Appendicitis and Pneumatosis in a Duplicated Appendix With Schistosoma Remnants.

    Science.gov (United States)

    Handra-Luca, Adriana; Bisseret, Damien; Dragoescu, Ema

    2016-02-01

    Appendiceal pneumatosis is rare, reported either in the context of acute appendicitis or enterocolitis. Here, we report the case of an elderly adult in whom the acute appendicitis was associated with pneumatosis and occurred in the context of a malformed appendix with pathogenic organism remnants. A 72-year-old man presented with abdominal pain 3 weeks after posttraumatic dorsolumbar surgery. The computed tomography scan showed acute appendicitis and 2 diverticula. On microscopy, the appendix showed acute appendicitis along with a Cave-Wallbridge type A duplication. In addition, several optically clear spaces were observed in the entire appendiceal wall consistent with pneumatosis of the appendix. Focally, calcified structures suggesting pathogenic organisms such as Schistosoma were noted as well. In conclusion, we report a case of appendiceal pneumatosis occurring in the context of acute appendicitis in a duplicated appendix, with presence of calcified structures suggestive of pathogenic organisms.

  2. 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

    2016-03-01

    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.

  3. Appendicitis presenting as the first manifestation of colorectal carcinoma: a 13-year retrospective study.

    Science.gov (United States)

    Shine, Rebecca J; Zarifeh, Abigail; Frampton, Chris; Rossaak, Jeremy

    2017-07-21

    Appendicitis in older adults may present as the first sign of underlying colorectal cancer. We aim to determine whether there was a difference in the rate of diagnosis of colorectal carcinoma for patients ≥45 years following a presentation with appendicitis, compared with New Zealand standardised rates. Retrospective study of patients ≥45 years with a confirmed diagnosis of appendicitis from 2003 to 2015 inclusive. The rate of colorectal carcinoma diagnosed during the 36-month follow-up period was calculated and compared to standardised rates, as per the New Zealand cancer registry. Six hundred and twenty-nine patients were included for analysis, 15 had a diagnosis of colorectal cancer in the follow-up period. Patients ≥45 years had a 6.3-fold (CI 3.6-10.2) increased risk of colorectal carcinoma than predicted given the population demographics. Those patients aged between 45-60 years had a 17-fold (95% CI 8-32.2) increased standardised risk ratio. This is the first study of its kind conducted in Australasia. This study found patients ≥45 years who present with appendicitis have significantly increased risk of underlying colorectal cancer. Until further research is conducted the authors recommend clinicians consider colonic investigation for older adults following a diagnosis of appendicitis.

  4. 多层螺旋CT在急性阑尾炎诊断中的价值%Multislice CT Value in the Diagnosis of Acute Appendicitis

    Institute of Scientific and Technical Information of China (English)

    冯彦琦

    2014-01-01

    目的:探讨MSCT在临床诊断急性阑尾炎中的应用价值。方法回顾性分析67例急性阑尾炎的临床表现、CT扫描特征和手术病理资料。结果67例经手术、病理证实的急性阑尾炎中,单纯性阑尾炎15例,阑尾炎并阑尾周围炎33例,坏疽性阑尾炎8例,阑尾穿孔并周围脓肿例11例。结论急性阑尾炎有典型的 CT表现, MSCT在三维重建及图像后处理技术能从多角度显示阑尾及其周围情况,在急性阑尾炎的诊断、术前病理分型、鉴别诊断及治疗方案的拟定中有较高的临床应用价值。%Objective To investigate the value of MSCT in the clinical diagnosis of acute appendicitis. Methods A retrospective analysis of 67 cases of acute appendicitis, the clinical manifestation, CT scanning features and surgical pathology. Results 67 cases were confirmed by operation and pathology, acute appendicitis, 15 cases were simple appendicitis, appendicitis and appendiceal inflammation around 33 cases, 8 cases of gangrenous appendicitis, and perforated appendicitis abscess cases around 11. Conclusion Acute appendicitis has the typical CT manifestations, MSCT in 3D reconstruction and image post-processing technology can display the appendix and the sur ounding situation from various angles, in the diagnosis of acute appendicitis, preoperative pathological classification, dif erential diagnosis and treatment of the proposed high clinical application value.

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

    OpenAIRE

    Daisuke Ito; Shojirou Hata; Shimizu Seiichiro; Kaoru Kobayashi; Masanori Teruya; Michio Kaminishi

    2014-01-01

    INTRODUCTION: Outside of these high-risk regions, acute amebic appendicitis is considerably rarer and the mortality rate is much higher than with non-amebic appendicitis. PRESENTATION OF CASE: A 31-year-old woman presented with fever and right lower abdominal pain with no history of traveling abroad or sexual infection. Computed tomography revealed a dilated appendix and thickened cecal and ascending colon walls. She underwent an appendectomy for appendicitis. Owing to a lack of symptom re...

  6. Accurate diagnosis of acute abdomen in FMF and acute appendicitis patients: how can we use procalcitonin?

    Science.gov (United States)

    Kisacik, Bunyamin; Kalyoncu, Umut; Erol, M Fatih; Karadag, Omer; Yildiz, Mustafa; Akdogan, Ali; Kaptanoglu, Bugra; Hayran, Mutlu; Ureten, Kemal; Ertenli, Ihsan; Kiraz, Sedat; Calguneri, Meral

    2007-12-01

    This study was conducted to define the value of procalcitonin (PCT) levels in the differential diagnosis of abdominal familial Mediterranean fever (FMF) attacks from acute appendicitis. From October 2006 to January 2007, 28 FMF (12 males, 16 females) patients with acute abdominal attacks and 34 patients (18 males) with acute abdomen who underwent operation with the clinical diagnosis of acute appendicitis were consecutively enrolled in this study. FMF patients with concurrent infectious diseases were excluded. PCT values were measured by an immunofluorescent method using the B.R.A.H.M.S. PCT kit (B.R.A.H.M.S. Diagnostica, Berlin, Germany). Erythrocyte sedimentation rate (ESR), C-reactive proteins (CRP) and leucocyte levels were also noted. Mean disease duration in FMF patients was 9.6 +/- 8.1 years (range 2-33 years) and all were on colchicine therapy with a mean colchicine dosage of 1.2 +/- 0.4 mg/day. Among the operated patients, 5 were excluded: 3 patients had normal findings and 2 had intestinal perforation (PCT levels were 2.69 and 4.93 ng/ml, respectively) at operative and pathologic evaluation. There were no significant differences between the two groups with respect to gender and age (p was not significant (NS) for all). Acute phase reactants and PCT levels were increased in patients with FMF compared to patients with acute appendicitis (0.529[0.12 +/- 0.96] vs 0.095 [0.01-0.80] p FMF patients compared to 62% (18/29) of acute appendicitis patients (p FMF attacks from acute appendicitis, though it should not supplant more conventional investigations.

  7. 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/

  8. 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

  9. Ultrasonography Manifestation of Acute Appendicitis%急性阑尾炎的超声表现

    Institute of Scientific and Technical Information of China (English)

    刘晓芳

    2016-01-01

    目的:探讨急性阑尾炎的超声表现。方法收集我2014年6月~2014年12月通过超声检查诊断为急性阑尾炎患者66例影像表现进行分析。结果46例患者为急性单纯阑尾炎,急性化脓性阑尾炎10例,急性坏疽性阑尾炎10例。结论超声检查诊断急性阑尾炎精准,方便快捷,无创,能在临床的诊断及手术时提供重要的依据。%Objective To investigate the ultrasonographic features of acute appendicitis.Methods Selected the imaging findings of 66 patients with acute appendicitis who were diagnosed as acute appendicitis by ultrasound examination from June 2014 to December 2014 were collected and analyzed.Results 46 patients with acute simple appendicitis, 10 cases of acute suppurative appendicitis, 10 cases of acute gangrenous appendicitis. Conclusion Ultrasound diagnosis of acute appendicitis is accurate,convenient, non-invasive, can provide an important basis for clinical diagnosis and surgery.

  10. Diagnosing acute appendicitis using a nonoral contrast CT protocol in patients with a BMI of less than 25.

    Science.gov (United States)

    Ramalingam, Vijay; Bates, David D B; Buch, Karen; Uyeda, Jennifer; Zhao, Kathy M; Storer, Lindsey A; Roberts, Marisa B; Lebedis, Christina A; Soto, Jorge A; Anderson, Stephan W

    2016-10-01

    The objective of this study was to compare the accuracy for the diagnosis of appendicitis in patients presenting to the emergency department (ED) with acute, nontraumatic abdominal pain and a body mass index (BMI) of less than 25 before and after the implementation of a nonoral contrast computed tomography (CT) protocol with intravenous contrast. The IRB approved this HIPAA-compliant retrospective study; informed consent was waived. This study included 736 adult patients with a BMI of less than 25 presenting to our ED with acute, nontraumatic abdominal pain over two distinct 6-month time periods. An oral and intravenous contrast-enhanced protocol was utilized in the first cohort (group A), and an intravenous contrast-enhanced protocol without oral contrast was utilized in the second cohort (group B). Three abdominal fellowship-trained readers retrospectively reviewed all CT studies and electronic medical records, including surgical/pathology reports that served as reference standards. Group A consisted of 359 patients; 41 patients had surgically proven appendicitis. The sensitivity and specificity of the readers for diagnosing appendicitis in group A ranged from 95.2-100 and 98.1-99.5 %, respectively. Group B consisted of 372 patients; 39 had surgically proven appendicitis. The sensitivity and specificity of the readers in group B ranged from 92.0-100 and 98.6-100 %, respectively. There were no statistically significant differences in sensitivity or specificity for CT scans performed in groups A and B. In patients with a BMI of less than 25, an intravenous contrast-enhanced CT protocol without oral contrast demonstrates similar accuracy to an intravenous contrast-enhanced protocol with oral contrast for diagnosing acute appendicitis.

  11. Isolated submucosal lipomatosis of appendix mimicking acute appendicitis: computed tomography findings

    Directory of Open Access Journals (Sweden)

    Şükrü Şanlı

    2014-03-01

    Full Text Available Acute appendicitis is one of the more common surgical emergencies, and it is one of the most common causes of acute abdominal pain. Intestinal lipomatosis is a rare condition particularly the isolated form of lipomatosis of the appendix which may mimic or present as an acute appendicitis, that frequently requires the surgical exploration.In this paper, we report computed tomography findings of a case wıth isolated form of submucosal lipomatosis of appendix.

  12. Typhoid Fever and Acute Appendicitis: A Rare Association Not Yet Fully Formed

    Directory of Open Access Journals (Sweden)

    Daniel J. Sartori

    2017-08-01

    Full Text Available Infections caused by foodborne enteric pathogens including typhoidal and non-typhoidal Salmonella species can mimic symptoms of acute appendicitis. The association between such bacterial pathogens and pathology-proven acute appendicitis has been described, but this link is poorly understood. Here we describe a case of a young man with typhoid fever presenting with histology-proven acute appendicitis requiring urgent appendectomy, and provide a brief review of relevant literature to prompt more widespread recognition of this rare cause of a common surgical emergency.

  13. Asymptomatic early acute appendicitis initiated and diagnosed during colonoscopy: A case report

    Institute of Scientific and Technical Information of China (English)

    Michelle Petro; Anil Minocha

    2005-01-01

    Colonoscopic diagnosis of asymptomatic early acute appendicitis is exceedingly rare. Although obstruction of the lumen due to various causes is believed to be the most common physiologic mechanism of acute appendicitis, all of the previously documented cases in the literature have only shown a patent appendiceal lumen with pus flowing into the cecum. We present the case of a patient undergoing colonoscopy for colorectal cancer evaluation with no abdominal symptoms. An obstructed, swollen appendix was seen. The process was probably initiated during the colonoscopy, documenting perhaps the earliest stage of acute appendicitis for the first time. Endoscopic, CT and microscopic documentation of the case is also presented.

  14. Macroamylasemia in a patient with acute appendicitis: a case report.

    Science.gov (United States)

    Um, J W; Kim, K H; Kang, M S; Choe, J H; Bae, J W; Hong, Y S; Suh, S O; Kim, Y C; Whang, C W; Kim, S M

    1999-12-01

    Macroamylasemia is a condition of persistent, elevated serum amylase activity with no apparent clinical symptoms of a pancreatic disorder. In Korea, however, no such case has been reported to date. We report a case of a 17-year-old female diagnosed with macroamylasemia and acute appendicitis. One day earlier, she developed epigastric and right lower quadrant abdominal pain. She was characterized by high level of serum amylase, but normal lipase. Amylase isoenzyme analysis demonstrated increased fraction of salivary type and follow-up amylase level was persistently increased. Immunofixation disclosed the macroamylase binding with an immunoglobulin, consisting of IgA and kappa chain. The patient was treated by appendectomy, and the abdominal pain subsided.

  15. 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.

  16. Meralgia Paresthetica as a Presentation of Acute Appendicitis in a Girl With Acute Lymphoblastic Leukemia.

    Science.gov (United States)

    Nishimura, Miho; Kodama, Yuichi; Fukano, Reiji; Okamura, Jun; Ogaki, Kippei; Sakaguchi, Yoshihisa; Migita, Masahiro; Inagaki, Jiro

    2015-04-01

    A 7-year-old girl with Philadelphia chromosome-positive acute lymphoblastic leukemia developed recurrent fever and meralgia paresthetica (MP) during chemotherapy, which resolved after administration of antibiotics. Five months after the onset of these symptoms, enhanced computed tomography showed a periappendiceal abscess extending into the psoas muscle. The cause of her fever and MP was thought to be appendicitis, which probably developed during induction chemotherapy but did not result in typical abdominal pain. Patients with recurrent fever and MP should be evaluated by imaging examinations including computed tomography to search for appendicitis.

  17. A case of acute appendicitis in a patient with crossed renal ectopia

    Institute of Scientific and Technical Information of China (English)

    Ulvi Meral; Murat Zor; Orhan Ureyen; Nisa Cem Oren; Hilmi Gungor

    2016-01-01

    Crossed renal ectopia is a rare anomaly in urological clinical practice. Patients with this anomaly are usually asymptomatic. Herein, we reported a case of acute appendicitis in a patient with crossed renal ectopia. A 22-year-old man with abdominal pain admitted to the emergency department. His physical examination revealed muscular defense and painful mass at the lower quadrant. Abdominal ultrasonography revealed crossed renal ectopia with no sign of stones and acute appendicitis. Tomography confirmed crossed renal ectopia but not acute appendicitis. On-going clinical symptoms lead to surgical intervention and acute appendicitis diagnosis. The patient was treated with appendectomy with no perioperative complications. Appendectomy is a common surgical procedure in surgical clinical practice. Acute abdominal pain must be managed carefully in patients with unusual anatomy. Also surgeons should be aware of ectopic organs in surgical procedures, to avoid iatrogenic intraoperative injuries.

  18. Ischemia-modified albumin as a predictor of the severity of acute appendicitis.

    Science.gov (United States)

    Kılıç, Murat Özgür; Güldoğan, Cem Emir; Balamir, İlhan; Tez, Mesut

    2017-01-01

    The early prediction of gangrenous/perforated appendicitis is of great importance for the surgical planning, further treatments, and predicting the course of disease. Ischemia-modified albumin (IMA) was previously reported as a biomarker of various ischemia-based diseases. Our aim is to determine the predictive value of serum IMA in the severity of acute appendicitis. Sixty-two patients who underwent urgent appendectomy were included in the study. Plasma level of IMA was measured after diagnosis and before treatment. All patients were classified as noncomplicated (acute) appendicitis and complicated (gangrenous/perforated) appendicitis according to histopathological findings, and comparisons were made between the groups. The data of 62 patients with a mean age of 30.1 years were statistically evaluated. The pathological diagnoses were acute appendicitis in 33 (53.2%), and gangrenous/perforated appendicitis in 29 (46.8%) patients. There were significant differences in computed tomography (CT) findings (P = .031) and IMA (P = .012) levels between the groups. A strong positive correlation between IMA levels and CT findings was also found (Spearman ρ = +0.688, P = .003). The IMA can be considered as a novel and useful marker to distinguish gangrenous/perforated appendicitis from noncomplicated appendicitis. The correlation of IMA with CT findings also enhances the predictive value of IMA. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Histopathological Feature of Acute Appendicitis in Kerman-Iran from 1997 to 2003

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    Fatemeh Nabipour

    2005-01-01

    Full Text Available Acute appendicitis is one of the most common surgical conditions that affect about seven percent of the population. The histopathologic stages of appendicitis are important to regarding prognosis. To evaluate pathologic features of appendix after operation, this study was designed. 2753 appendices specimen that had been received to department of pathology of two major hospitals in Kerman-Iran during five years periods were reviewed by two pathologist and classification was performed by followed: Normal, early acute, acute, suppurative or purulent, gangrenous and perforated appendicitis. There were 54.6% males, the average age of patients was 24.9+/-13.3 (mean+/-SD, that 76.6% was under 30 years old. 34.2% of reports were normal histopathologically. The accuracy rate of acute appendicitis was 65.8%. Perforation observed to 0.8%. There was significant difference between sex and stage of development of appendicitis. Seasonal incidence was difference in various histopathology views, significantly. Finally, acute appendicitis was more frequent in men than women and was increase by age specially 19-30 years. Our results showed appendicitis was more frequent and higher in stage at winter.

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

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    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

  1. 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.

  2. 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.

  3. De Garengeot’s Hernia; Acute Appendicitis In An Incarcerated Femoral Hernia

    Directory of Open Access Journals (Sweden)

    Kokoszka Maciej

    2015-07-01

    Full Text Available Acute appendicitis and incarcerated femoral hernia belong to relatively well known surgical diseases with regard to diagnostic workup and treatment. de Garengeot’s hernia is an entity involving concurrent occurrence of both the above mentioned problems.

  4. Clinical value of CT in diagnosis of acute appendicitis%急性阑尾炎的CT诊断及临床应用价值

    Institute of Scientific and Technical Information of China (English)

    唐俊军; 黄宗良; 王国良

    2015-01-01

    目的 提高对CT在急性阑尾炎诊断中重要性的认识.方法 回顾性分析经手术病理证实的87例急性阑尾炎的CT表现.结果 87例急性阑尾炎中,单纯性阑尾炎45例,阳性40例,阴性5例;化脓性阑尾炎28例,坏疽穿孔性阑尾炎7例,阑尾周围脓肿7例均出现相应的CT表现.CT表现为阑尾肿大,管径增粗,阑尾壁不同程度水肿,同时可合并周围炎性渗出或脓肿形成.结论 CT对急性阑尾炎的诊断及临床应用有很大的价值.%Objective To enhance the application value of CT in diagnosis of acute appendicitis. Methods CT findings of 87 cases with acute appendicitis confirmed by surgery and pathology were retrospectively analyzed. Results There were 87 cases of acute appendicitis,45 cases of simple appendicitis,28 cases of suppurative appendicitis,7 cases of gangrenous appendicitis,7 cases of appendiceal abscess. CT findings of 5 cases of simple appendicitis were negative. CT showed swelling of the appendix,edema of the appendix wall and the abscess of the appendix. Conclusion CT imaging is of great value in the diagnosis of acute appendicitis.

  5. 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.

  6. 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

    2017-09-11

    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.

  7. 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.

  8. The utility of acoustic radiation force impulse imaging in diagnosing acute appendicitis and staging its severity

    Science.gov (United States)

    Göya, Cemil; Hamidi, Cihad; Okur, Mehmet Hanifi; İçer, Mustafa; Oğuz, Abdullah; Hattapoğlu, Salih; Çetinçakmak, Mehmet Güli; Teke, Memik

    2014-01-01

    PURPOSE The aim of this study was to investigate the feasibility of using acoustic radiation force impulse (ARFI) imaging to diagnose acute appendicitis. METHODS Abdominal ultrasonography (US) and ARFI imaging were performed in 53 patients that presented with right lower quadrant pain, and the results were compared with those obtained in 52 healthy subjects. Qualitative evaluation of the patients was conducted by Virtual Touch™ tissue imaging (VTI), while quantitative evaluation was performed by Virtual Touch™ tissue quantification (VTQ) measuring the shear wave velocity (SWV). The severity of appendix inflammation was observed and rated using ARFI imaging in patients diagnosed with acute appendicitis. Alvarado scores were determined for all patients presenting with right lower quadrant pain. All patients diagnosed with appendicitis received appendectomies. The sensitivity and specificity of ARFI imaging relative to US was determined upon confirming the diagnosis of acute appendicitis via histopathological analysis. RESULTS The Alvarado score had a sensitivity and specificity of 70.8% and 20%, respectively, in detecting acute appendicitis. Abdominal US had 83.3% sensitivity and 80% specificity, while ARFI imaging had 100% sensitivity and 98% specificity, in diagnosing acute appendicitis. The median SWV value was 1.11 m/s (range, 0.6–1.56 m/s) for healthy appendix and 3.07 m/s (range, 1.37–4.78 m/s) for acute appendicitis. CONCLUSION ARFI imaging may be useful in guiding the clinical management of acute appendicitis, by helping its diagnosis and determining the severity of appendix inflammation. PMID:25323836

  9. Acute primary haemorrhagic omental torsion mimicking perforated appendicitis: an unorthodox surgical paradox.

    Science.gov (United States)

    Rehman, Abdul

    2014-08-01

    Acute primary haemorrhagic omental torsion is an atypical and deceptive cause of acute abdomen that could closely mimic a myriad of intra-abdominal catastrophes, especially perforated appendicitis. The author reports a 30 years man who had presented with gradually worsening right-sided abdominal pain of 2 days duration. Laboratory work-up and abdominal radiographs were inconclusive. Abdominal sonography detected presence of free fluid in the pelvic cul-de-sac. Based on clinical and sonographic findings, presumptive diagnosis of perforated appendicitis was made and the patient was explored through extended Rockey-Davis incision. About 500 - 700 ml of dark-coloured blood (haemoperitoneum) was present in the peritoneal cavity and the pelvis secondary to acute haemorrhagic omental torsion. The appendix was grossly normal. Omentectomy and prophylactic appendicectomy resulted in uneventful recovery of the patient. Acute primary omental torsion is an uncommon pathology that must be kept in mind during differential diagnosis of acute abdomen, especially acute or perforated appendicitis.

  10. Enterobius Vermicularis infection of the appendix as a cause of acute appendicitis in a Greek adolescent: a case report

    OpenAIRE

    Efraimidou, Eleni; Gatopoulou, Anthia; Stamos, Charilaos; Lirantzopoulos, Nikolaos; Kouklakis, George

    2008-01-01

    Gastrointestinal infection due to Enterobius vermicularis occurs worldwide and is considered to be the most common helminth infection. The simple presence of E. vermicularis in the appendix usually produces symptoms of acute appendicitis. The association of this parasitic infestation with acute appendicitis varies from 0.2%–41.8% worldwide. We present a case of a 15 year old female with enterobiasis of appendix presented with clinical features of acute appendicitis. The appendix was surgicall...

  11. Acute isolated appendicitis due to Aspergillus carneus in a neutropenic child with acute myeloid leukemia.

    Science.gov (United States)

    Decembrino, Nunzia; Zecca, Marco; Tortorano, Anna Maria; Mangione, Francesca; Lallitto, Fabiola; Introzzi, Francesca; Bergami, Elena; Marone, Piero; Tamarozzi, Francesca; Cavanna, Caterina

    2016-01-01

    We describe a case of isolated acute appendicitis due to Aspergillus carneus in a neutropenic child with acute myeloid leukemia (AML) treated according to the AIEOP AML 2002/01 protocol. Despite prophylaxis with acyclovir, ciprofloxacin and fluconazole administered during the neutropenic phase, 16 days after the end of chemotherapy the child developed fever without identified infective foci, which prompted a therapy shift to meropenem and liposomial amphotericin B. After five days of persisting fever he developed ingravescent abdominal lower right quadrant pain. Abdominal ultrasound was consistent with acute appendicitis and he underwent appendectomy with prompt defervescence. PAS+ fungal elements were found at histopathology examination of the resected vermiform appendix, and galactomannan was low positive. A. carneus, a rare species of Aspergillus formerly placed in section Flavipedes and recently considered a member of section Terrei, was identified in the specimen. Treatment with voriconazole was promptly started with success. No other site of Aspergillus localization was detected. Appendicitis is rarely caused by fungal organisms and isolated intestinal aspergillosis without pulmonary infection is unusual. To our knowledge, this is the first report of infection due to A. carneus in a child and in a primary gastrointestinal infection.

  12. Discovery and validation of urine markers of acute pediatric appendicitis using high accuracy mass spectrometry

    Science.gov (United States)

    Kentsis, Alex; Lin, Yin Yin; Kurek, Kyle; Calicchio, Monica; Wang, Yan Yan; Monigatti, Flavio; Campagne, Fabien; Lee, Richard; Horwitz, Bruce; Steen, Hanno; Bachur, Richard

    2015-01-01

    Study Objective Molecular definition of disease has been changing all aspects of medical practice, from diagnosis and screening to understanding and treatment. Acute appendicitis is among many human conditions that are complicated by the heterogeneity of clinical presentation and shortage of diagnostic markers. Here, we sought to profile the urine of patients with appendicitis with the goal of identifying new diagnostic markers. Methods Candidate markers were identified from the urine of children with histologically proven appendicitis by using high accuracy mass spectrometry proteome profiling. These systemic and local markers were used to assess the probability of appendicitis in a blinded, prospective study of children being evaluated for acute abdominal pain in our emergency department. Tests of performance of the markers were evaluated against the pathologic diagnosis and histologic grade of appendicitis. Results Test performance of 57 identified candidate markers was studied in 67 patients, with median age of 11 years, 37% of whom had appendicitis. Several exhibited favorable diagnostic performance, including calgranulin A (S100-A8), α-1-acid glycoprotein 1 (orosomucoid), and leucine-rich α-2-glycoprotein (LRG), with the ROC AUC and values of 0.84 (95 % CI 0.72-0.95), 0.84 (0.72-0.95), and 0.97 (0.93-1.0), respectively. LRG was enriched in diseased appendices and its abundance correlated with severity of appendicitis. Conclusions High accuracy mass spectrometry urine proteome profiling allowed identification of diagnostic markers of acute appendicitis. Usage of LRG and other identified biomarkers may improve the diagnostic accuracy of clinical evaluations of appendicitis. PMID:19556024

  13. 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.)

  14. 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.

  15. [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.

  16. Overview and diagnosis of acute appendicitis in children.

    Science.gov (United States)

    Glass, Charity C; Rangel, Shawn J

    2016-08-01

    Appendicitis represents the most common abdominal surgical emergency in the pediatric age group. Despite being a relatively common condition, the diagnosis of appendicitis in children can prove to be challenging in many cases. The goal of this article is to review the predictive utility for presenting signs and symptoms, laboratory tests, and imaging studies in the diagnostic work-up of appendicitis. Furthermore, we sought to explore the predictive utility of composite measures based on multiple sources of diagnostic information, as well as the utility of clinical pathways as a means to streamline the diagnostic process. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Does elevated urinary 5-hydroxyindole acetic acid level predict acute appendicitis in children?

    Science.gov (United States)

    Bosak Versic, Ana; Glavan, Nedeljka; Bukvic, Nado; Tomasic, Zlatko; Nikolic, Harry

    2016-12-01

    Acute appendicitis is the most common abdominal surgical emergency in children, and appendectomy is the most frequent acute abdominal operation. Prompt diagnosis and surgical treatment are required to reduce the risk of perforation and prevent complications, especially in small children. Enterochromaffin cells that contain large amounts of serotonin are mostly located in the distal appendix. Serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) could therefore be a marker for acute appendicitis. We tested urinary 5-HIAA concentrations in spot urine samples from children with acute appendicitis. We enrolled 93 patients who underwent surgery for suspicion of acute appendicitis. The diagnosis was made intraoperatively and confirmed histopathologically. Additionally, urine samples from 102 healthy children were collected as controls. Their 5-HIAA was measured using high-performance liquid chromatography. Acute appendicitis was diagnosed in 81 patients, whereas there were other explanations for abdominal pain in the remaining 12 patients in the non-appendicitis group. The control group comprised 102 healthy children. Considering the median of all measured 5-HIAA values as the cut-off, we analysed the proportions of patients with elevated values in all the groups. Our analysis showed that statistically there was no significant difference in the distribution of percentages among the groups. The area under the curve for 5-HIAA was 0.55 (95% CI 0.47 to 0.62) with sensitivity and specificity 60.4% and 48.9%, respectively. Urine 5-HIAA concentration measured in spot samples is not a reliable method for diagnosing acute appendicitis in children. 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/.

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

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    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

  19. 86例急性阑尾炎的超声诊断%In 86 Cases the Ultrasound Diagnosis of Acute Appendicitis

    Institute of Scientific and Technical Information of China (English)

    张丽

    2013-01-01

      目的探讨急性阑尾炎的超声诊断价值。方法运用高频及低频超声对经手术病理证实的86例急性阑尾炎的超声声像图进行回顾性分析。结果根据86例急性阑尾炎的超声声像图特征,归纳为4种类型,单纯性阑尾炎46例,化脓性阑尾炎22例,坏疽及穿孔性阑尾炎8例,阑尾周围脓肿形成10例。结论急性阑尾炎有多种超声表现,熟悉这些表现有助于提高超声诊断的准确性。%  Objective Explore the value of ultrasound in the diagnosis of acute appendicitis. Methods Application of high frequency and low frequency ultrasound on confirmed by operation and pathology of 86 patients with acute appendicitis ultrasound were retrospectively analyzed. Results Based on 86 cases of acute appendicitis ultrasonography characteristics, grouped into 4 types, 46 cases of simple appendicitis, 22 cases of suppurative appendicitis, 8 cases of gangrenous and perforated appendicitis, 10 cases of appendiceal abscess formation. Conclusion Acute appendicitis with multiple ultrasonic manifestations, familiar with these performance contributes to improve the diagnostic accuracy of ultrasound.

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

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    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.

  1. Volume-outcome relation for acute appendicitis: evidence from a nationwide population-based study.

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    Po-Li Wei

    Full Text Available BACKGROUND: Although procedures like appendectomy have been studied extensively, the relative importance of each surgeon's surgical volume-to-ruptured appendicitis has not been explored. The purpose of this study was to investigate the rate of ruptured appendicitis by surgeon-volume groups as a measure of quality of care for appendicitis by using a nationwide population-based dataset. METHODS: We identified 65,339 first-time hospitalizations with a discharge diagnosis of acute appendicitis (International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM codes 540, 540.0, 540.1 and 540.9 between January 2007 and December 2009. We used "whether or not a patient had a perforated appendicitis" as the outcome measure. A conditional (fixed-effect logistic regression model was performed to explore the odds of perforated appendicitis among surgeon case volume groups. RESULTS: Patients treated by low-volume surgeons had significantly higher morbidity rates than those treated by high-volume (28.1% vs. 26.15, p<0.001 and very-high-volume surgeons (28.1% vs. 21.4%, p<0.001. After adjusting for surgeon practice location, and teaching status of practice hospital, and patient age, gender, and Charlson Comorbidity Index, and hospital acute appendicitis volume, patients treated by low-volume surgeons had significantly higher rates of perforated appendicitis than those treated by medium-volume surgeons (OR = 1.09, p<0.001, high-volume surgeons (OR = 1.16, p<0.001, or very-high-volume surgeons (OR = 1.54, p<0.001. CONCLUSION: Our study suggested that surgeon volume is an important factor with regard to the rate of ruptured appendicitis.

  2. An unusual manifestation of acute appendicitis with left flank pain

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    Roland Talanow, MD, PhD

    2008-08-01

    Full Text Available The author presents a case with an unusual presentation of early appendicitis. The patient presented initially with left sided flank pain. Workup for nephrolithiasis, including non-contrast CT of the abdomen and pelvis was negative for renal stones or hydronephrosis. After discharge, the patient presented one week later in the ED with right lower quadrant pain. Contrast enhanced CT of the abdomen revealed perforated appendicitis.

  3. Fibromatosis of the cecum presenting with acute appendicitis: a case report

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    Toydemir T

    2011-12-01

    Full Text Available Toygar Toydemir1, Gökhan Ertuğrul21Istanbul Surgery Hospital, Department of General Surgery, Nisantasi-Istanbul, 2Atatürk State Hospital, Department of General Surgery, Düzce, TurkeyAbstract: Although acute appendicitis is a common clinical condition in general surgical practice, <1% of them are associated with malignancies. Appendiceal carcinoids make up most of those malignancies and acute appendicitis cases associated with benign cecal neoplasias are very uncommon. In this study, a 25-year-old female patient who presented with distinct acute appendicitis symptoms is reported. The patient was operated on via open technique. Exploration revealed an appendix with advanced edema and hyperemia. While the cecum was observed to be normal, a solid mass of 2.5 cm diameter was palpated in the appendiceal base. Following the ileocecal resection, histopathological examination revealed the mass as a fibromatosis. The goals of this report are to remind health care professionals that some very rare etiologies may be involved in acute appendicitis diagnosis and treatment, and to underscore the place of laparoscopic approach and preoperative computed tomography in this disease.Keywords: acute appendicitis, fibromatosis, laparoscopy, preoperative computed tomography

  4. 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.

  5. ACUTE APPENDICITIS SECONDARY TO ENTEROBIUS VERMICULARIS INFESTATION IN A YOUNG FEMALE: A CASE REPORT

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    Kumar Premjeet

    2014-05-01

    Full Text Available Gastrointestinal infection due to enterobius vermicularis occurs worldwide and is considered to be the most common helminth infection. The simple presence of enterobius vermicularis in the appendix usually produces symptoms of acute appendicitis. Acute appendicitis due to enterobius vermicularis is very rare, affecting mostly children. The association of this parasitic infestation with acute appendicitis varies from 0.2%–41.8% worldwide. Whether pinworms cause inflammation of the appendix or just appendiceal colic has been a matter of controversy. We present a case of an 18 year old female with enterobiasis of appendix presented with clinical features of acute appendicitis. The appendix was surgically removed and the specimen was pathologically diagnosed to contain of enterobius vermicularis in non-inflamed and histologically mild mononuclear cell infiltrated appendix. One should keep in mind that the clinical signs of intestinal parasite infection may mimic acute appendicitis, although rare. A careful evaluation of symptoms such as pruritus ani, or eosinophilia on laboratory examination, could prevent unnecessary appendectomies.

  6. Limits and advantages of abdominal ultrasonography in children with acute appendicitis syndrome

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    Valentina Pastore

    2014-01-01

    Full Text Available Background: Graded compression ultrasonography (US has become the most popular technique used in suspected appendicitis and in our prospective study, we have evaluated its contribution to the diagnosis of acute appendicitis during the period 2010-2013. Materials and Methods: Four hundred and eighty children underwent urgent abdominal suspected of having acute appendicitis. Patients were divided into operated groups; (220 patients and non-operated (260 patients the final diagnosis was established on histopathological findings in the first group and on the phone interview in the second one. US was the sole imaging modality in all the non-operated patients and in 203 out of 220 operated ones. Seven children in the operated group underwent CT, while a second US was performed in 10 patients. Results: Acute appendicitis was confirmed in 188 operated patients while no one in the non-operated group returned to the hospital or was operated for appendicitis. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 79%, 78%, 95%, 39% and 79%, respectively. Negative appendectomy and perforation rates were 14% and 8%. Seventeen children in the operated group required a second diagnostic imaging: 7 CTs and 10 USs. All the seven CTs were consistent with appendicitis and 6 out of 10 USs showed ecographic signs of appendicitis. Conclusion: Our results support routine US in all the children with suspected appendicitis because it helps in reducing negative appendectomy and perforation rate. Moreover, a negative US does not justify a subsequent and immediate CT because clinical re-evaluation and a second US can clarify the diagnosis.

  7. 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.)

  8. [Acute appendicitis. Surgical and non-surgical treatment].

    Science.gov (United States)

    Souza-Gallardo, Luis Manuel; Martínez-Ordaz, José Luis

    2017-01-01

    Appendicitis represents a common disease for the surgeon with a relative risk between 7-8%. It was thought that if more time passed between diagnosis and treatment, the risk for complications, such as perforation or abscess formation, was higher; nevertheless; the evolution is variable, making necessary the development of different strategies such as antibiotic use only, interval surgery or endoscopic treatment. The purpose of this study is to make a revision in the management of appendicitis comparing conservative and surgical treatment. It is known that traditional management of appendicitis is appendectomy with a complication rate of 2.5% to 48%. Nowadays, laparoscopy is the approach of choice by many surgeons and there have proposed new invasive techniques such as endoscopic treatment with the use of prosthesis and ambulatory surgery. Antibiotic use is essential in the management of appendicitis. Its use as the only strategy to treat this disease has the purpose of lowering costs and diminishing complications related to surgery or the resection of the organ. We conclude that the ideal management of appendicitis remains controversial and it will depend of the clinical characteristics of each patient and the resources available.

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

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    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.

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

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    Ito, Daisuke; Hata, Shojirou; Seiichiro, Shimizu; Kobayashi, Kaoru; Teruya, Masanori; Kaminishi, Michio

    2014-01-01

    INTRODUCTION Outside of these high-risk regions, acute amebic appendicitis is considerably rarer and the mortality rate is much higher than with non-amebic appendicitis. PRESENTATION OF CASE A 31-year-old woman presented with fever and right lower abdominal pain with no history of traveling abroad or sexual infection. Computed tomography revealed a dilated appendix and thickened cecal and ascending colon walls. She underwent an appendectomy for appendicitis. Owing to a lack of symptom resolution, we performed a pathologic examination of the appendix again that revealed multiple Entamoeba histolytica trophozoites; the serum amebic antibody was positive. She was treated postoperatively with metronidazole for amebiasis and discharged on postoperative day 12. DISCUSSION The mortality rate and frequency of severe postoperative intraabdominal complications were higher in the Japanese literature (1995–2013) (25% and 33%, respectively) than in other developed countries (3.3% and 19.4%, respectively). Japan is a low-risk area for amebiasis; many physicians fail to consider amebiasis in the differential diagnosis of acute abdomen. It is important to conduct further examinations, including those for amebiasis, when appendectomy does not resolve acute appendicitis. 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. PMID:25460473

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

    Science.gov (United States)

    Ito, Daisuke; Hata, Shojirou; Seiichiro, Shimizu; Kobayashi, Kaoru; Teruya, Masanori; Kaminishi, Michio

    2014-01-01

    Outside of these high-risk regions, acute amebic appendicitis is considerably rarer and the mortality rate is much higher than with non-amebic appendicitis. A 31-year-old woman presented with fever and right lower abdominal pain with no history of traveling abroad or sexual infection. Computed tomography revealed a dilated appendix and thickened cecal and ascending colon walls. She underwent an appendectomy for appendicitis. Owing to a lack of symptom resolution, we performed a pathologic examination of the appendix again that revealed multiple Entamoeba histolytica trophozoites; the serum amebic antibody was positive. She was treated postoperatively with metronidazole for amebiasis and discharged on postoperative day 12. The mortality rate and frequency of severe postoperative intraabdominal complications were higher in the Japanese literature (1995-2013) (25% and 33%, respectively) than in other developed countries (3.3% and 19.4%, respectively). Japan is a low-risk area for amebiasis; many physicians fail to consider amebiasis in the differential diagnosis of acute abdomen. It is important to conduct further examinations, including those for amebiasis, when appendectomy does not resolve acute appendicitis. 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. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  12. Routine Ultrasound and Limited Computed Tomography for the Diagnosis of Acute Appendicitis

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    Wiersma, Fraukje; Bakker, Rutger F. R.; Merkus, Jos W. S.; Breslau, Paul J.; Hamming, Jaap F.

    2010-01-01

    Background Acute appendicitis continues to be a challenging diagnosis. Preoperative radiological imaging using ultrasound (US) or computed tomography (CT) has gained popularity as it may offer a more accurate diagnosis than classic clinical evaluation. The optimal implementation of these diagnostic modalities has yet to be established. The aim of the present study was to investigate a diagnostic pathway that uses routine US, limited CT, and clinical re-evaluation for patients with acute appendicitis. Methods A prospective analysis was performed of all patients presenting with acute abdominal pain at the emergency department from June 2005 until July 2006 using a structured diagnosis and management flowchart. Daily practice was mimicked, while ensuring a valid assessment of clinical and radiological diagnostic accuracies and the effect they had on patient management. Results A total of 802 patients were included in this analysis. Additional radiological imaging was performed in 96.3% of patients with suspected appendicitis (n = 164). Use of CT was kept to a minimum (17.9%), with a US:CT ratio of approximately 6:1. Positive and negative predictive values for the clinical diagnosis of appendicitis were 63 and 98%, respectively; for US 94 and 97%, respectively; and for CT 100 and 100%, respectively. The negative appendicitis rate was 3.3%, the perforation rate was 23.5%, and the missed perforated appendicitis rate was 3.4%. No (diagnostic) laparoscopies were performed. Conclusions A diagnostic pathway using routine US, limited CT, and clinical re-evaluation for patients with acute abdominal pain can provide excellent results for the diagnosis and treatment of appendicitis. PMID:20582544

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

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    Alexander Swidsinski

    2012-01-01

    Full Text Available Background/Aim: To investigate the geographic occurrence of mucosa-invading Fusobacteria in acute appendicitis. Patients and Methods: 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. Results: 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%. Conclusions: Acute appendicitis is a polymicrobial infectious disease in which F. nucleatum and other Fusobacteria play a key role.

  14. Non-Complicated Acute Appendicitis in Adults Treated Successfully by Conservative Treatment without Recurrences.

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    Charalampopoulos, Anestis; Dimopoulos, Ioannis; Koliakos, Nikolaos; Kopanakis, Konstantinos; And, Theodoros Liakakos

    2017-01-01

    Backround: Surgical treatment of appendicitis remains the standard treatment, but many cases respond conservatively. Our purpose was the clarification of the clinical, laboratory and imaging characteristics of uncomplicated cases undergoing successful conservative treatment without recurrence. Methods: 105 adult patients (66 female, 39 male) with non-complicated acute appendicitis. Symptom duration, clinical abdominal examination, body temperature, inflammatory markers, imaging studies results and in-hospital treatment were recorded. No patient had a previous episode of appendicitis. Results: Duration of symptoms was 2 hours-3 days. Abdominal examination was compatible with appendicitis and findings were localized in the lower right quadrat. The majority (85.7%) had no or low fever ( 37.4 C). All had leukocytosis (range: 10.000-22.900 WBC/L, mean 14.370'+-2.900 WBC/L), 3 patients 20.000 WBC/L. All had CRP 3.36 mg/L (mean 46.8'+-40.5 mg/L), and 3 150 mg/L. U/S was performed on 95 patients (combined with transvaginal U/S in 19 females) with positive findings of acute appendicitis in 91 (91/95, 95.7%). When faced with inconclusive findings, CT was performed (13 patients) and MRI on one pregnant. In-hospital conservative treatment lasted 1-10 days, overstay was 1-2 days following clinic-laboratory regression. Outpatient, antibiotic treatment followed discharge in 27 patients. Conclusions: Young patients with non-complicated acute appendicitis and short symptom duration, without rare etiologic pathologies, are candidates for conservative treatment. Diagnosis of non-complicated acute appendicitis is based on combining clinical signs, positive inflammatory markers and imaging studies, excluding complicated cases, generalized peritonitis and sepsis. The inflammation seems self-limited, while the role of anti-inflammatory drugs remains obscure. AA = Acute Appendicitis, un-AA = Uncomplicated AA, cAA = Complicated Acute Appendicitis, WBC = White Blood Cells, CRP = C

  15. Septic thrombophlebitis of the porto-mesenteric veins as a complication of acute appendicitis

    Institute of Scientific and Technical Information of China (English)

    Yeon Soo Chang; Sun Young Min; Sun Hyung Joo; Suk-Hwan Lee

    2008-01-01

    Pylephlebitis, a rare complication of acute appendicitis,is defined as thrombophlebitis of the portal venous system. Pylephlebitis usually occurs due to secondary infection in the region drained into the portal system.We report a case of pylephlebitis caused by acute appendicitis. The patient was transferred from a private clinic 1 wk after appendectomy with the chief complaints of high fever and abdominal pain. He was diagnosed with pylephlebitis of the portal vein and superior mesenteric vein by CT-scan. The patient was treated with antibiotics and anticoagulation therapy,and discharged on the 25th day and follow-up CT scan showed a cavernous transformation of portal thrombosis.

  16. 18F-FDG PET/CT Scan Can Predate Clinical Presentation in Acute Appendicitis.

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    Ali, Syed Zama; Yin, Loi Hoi; Kin, Khor Lih; Sinha, Arvind Kumar; Poon, Li Mei

    2017-09-01

    Acute appendicitis is a clinical diagnosis typically presenting with right lower quadrant pain. We describe the case of an asymptomatic 53-year-old man with stage 2A diffuse large B-cell lymphoma, who underwent F-FDG PET/CT at the completion of chemotherapy. The scan showed complete lymphomatous disease remission. Incidentally, there was increased FDG uptake in a tubular structure adjacent to the cecum. Clinical examination was negative. Subsequently, the patient presented 6 days later with typical acute appendicitis symptoms. This case is interesting wherein increased FDG uptake in the appendix predated the appearance of clinical symptoms.

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

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    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.

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

    DEFF Research Database (Denmark)

    Andersson, Manne; Rubér, Marie; Ekerfelt, Christina;

    2014-01-01

    , 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. Role of clinical judgment and tissue harmonic imaging ultrasonography in diagnosis of paediatric acute appendicitis

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    Zakaria Ossama

    2011-11-01

    Full Text Available Abstract Background Appendicitis is the most common surgical emergency in children; yet, diagnosis of equivocal presentations continues to challenge clinicians. Aim The objective of this study was to investigate the hypothesis that the use of a modified clinical practice and harmonic ultrasonographic grading scores (MCPGS may improve the accuracy in diagnosing acute appendicitis in the pediatric population. Patients & Methods Main outcome measures Sensitivity, specificity, and accuracy of the modified scoring system. Five hundred and thirty patients presented with suspected diagnosis of acute appendicitis during the period from December 2000 to December 2009 were enrolled in this study. Children's data that have already been published of those who presented with suspected diagnosis of acute appendicitis- to whom a special clinical practice grading scores (CPGS incorporating clinical judgment and results of gray scale ultrasonography (US was applied- were reviewed and compared to the data of 265 pediatric patients with equivocal diagnosis of acute appendicitis (AA, to whom a modified clinical practice grading scores (MCPGS was applied. Statistical analyses were carried out using Z test for comparing 2 sample proportions and student's t-test to compare the quantitative data in both groups. Sensitivity and specificity for the 2 scoring systems were calculated using Epi-Info software. Results The Number of appendectomies declined from 200 (75.5% in our previous CPGS to 187 (70.6% in the MCPGS (P > 0.05. Specificity was significantly higher when applying MCPGS (90.7% in this study compared to 70.47% in our previous work when CPGS was applied (P P Conclusions MCPGS tends to help in reduce the numbers of avoidable and unnecessary appendectomies in suspected cases of pediatric acute appendicitis that may help in saving hospital resources.

  20. MSCT在无典型临床表现阑尾炎诊断中的应用%Helical CT scanning in the diagnosis of acute appendicitis without typica clinical features

    Institute of Scientific and Technical Information of China (English)

    吴丽卓; 王景宇; 王淑清

    2011-01-01

    Objective To investigate the value of helical CT in diagnosis of appendicitis with atypical clinical feature .MethodsHelical CT manifestations of 64 cases of appendicitis which were not initially considered on clinical presentation confirmed surgically and pathologically were retrospectively analyze .Results Helical CT findings of appendicitis included ;23cases of dissect abnormal ap-pendicitis (36.0 %)(7cases of pelvic appendicitis ,10cases of retro-peritoneal appendicitis ,6cases of superior position appendicitis ) ; 15cases of the infant acute appendicitis (23.0 % ) ; 26cases of the senior citizen acute appendicitis (41.0% ) .Conclusion MSCT has important significance to the diagnosis and the differential diagnosis of appendicitis and its complications atipica appendicitis .%目的 探讨MSCT扫描在临床表现不典型阑尾炎诊断中的价值.方法 回顾性分析64例特殊类型阑尾炎的临床表现、CT扫描特征和手术资料.结果 64例经手术、病理证实的急性阑尾炎中,CT诊断与手术相符者57例,诊断符合率89.0%.CT扫描诊断为解剖异常阑尾23例(36.0%)(盆腔阑尾7例,腹膜后位阑尾10例,肝下阑尾6例);小儿急性阑尾炎15例(23.0%);老年人急性阑尾炎26例(41.0%).结论 MSCT扫描对临床表现不典型阑尾炎的诊断,具有较高的临床价值.

  1. Volume-Outcome Relation for Acute Appendicitis: Evidence from a Nationwide Population-Based Study

    Science.gov (United States)

    Wei, Po-Li; Liu, Shih-Ping; Keller, Joseph J.; Lin, Herng-Ching

    2012-01-01

    Background Although procedures like appendectomy have been studied extensively, the relative importance of each surgeon's surgical volume-to-ruptured appendicitis has not been explored. The purpose of this study was to investigate the rate of ruptured appendicitis by surgeon-volume groups as a measure of quality of care for appendicitis by using a nationwide population-based dataset. Methods We identified 65,339 first-time hospitalizations with a discharge diagnosis of acute appendicitis (International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes 540, 540.0, 540.1 and 540.9) between January 2007 and December 2009. We used “whether or not a patient had a perforated appendicitis” as the outcome measure. A conditional (fixed-effect) logistic regression model was performed to explore the odds of perforated appendicitis among surgeon case volume groups. Results Patients treated by low-volume surgeons had significantly higher morbidity rates than those treated by high-volume (28.1% vs. 26.15, pappendicitis volume, patients treated by low-volume surgeons had significantly higher rates of perforated appendicitis than those treated by medium-volume surgeons (OR = 1.09, pappendicitis. PMID:23300703

  2. 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

  3. [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.

  4. B-ultrasound diagnosis characteristics of acute appendicitis%急性阑尾炎B超诊断特点分析

    Institute of Scientific and Technical Information of China (English)

    曾茜; 邹亚卓

    2013-01-01

    目的探讨急性阑尾炎的B超诊断特点。方法选取本院2009年12月~2010年12月收治的疑似急性阑尾炎患者89例。全部进行B超检查,对B超诊断特点进行回顾性总结分析。结果本组患者经病理检查急性阑尾炎阳性66例(其中单纯性阑尾炎患者32例,化脓性阑尾炎患者15例,坏疽性阑尾炎患者12例,阑尾周围脓肿患者7例),急性阑尾炎阴性23例;经B超检查急性阑尾炎阳性64例,急性阑尾炎阴性25例。B超检查急性阑尾炎检查率为71.91%,敏感度为92.42%,特异度为86.96%,准确度为91.01%。结论 B超在急性阑尾炎的临床诊断上具有方便、快捷、特异性强、结果可靠的特点,可以更好的辅助医师进行临床诊断,早期确定治疗方案,为急性阑尾炎诊断、治疗提供了客观依据,值得临床推广使用。%Objective To explore B-ultrasound diagnosis characteristics of acute appendicitis. Methods 89 cases of suspected acute appendicitis were selected in our hospital from December 2009 to Decembe2010.All the patients were given B-ultrasound diagnosis,retrospectively analyzed B-ultrasound diagnosis characteristics. Results 66 cases checked by pathological examination were acute appendicitis positive(32 cases had simple appendicitis,15 cases had suppurative appendicitis,12 cases had gangrenous appendicitis,7 cases had appendiceal abscess),acute appendicitis negative had 23 cases;64 cases checked by B-ultrasound diagnosis were acute appendicitis positive,25 cases were acute appendicitis negative. B-ultrasound diagnosed acute appendicitis,the examination rate was 71.91%,sensitivity was 92.42%,specificity was 86.96%,accuracy was 91.01% . Conclusion B ultrasound in the clinical diagnosis of acute appendicitis is convenient,fast,specificity and reliable. It can better assist physicians for clinical diagnosis,it can provide an objective basis for acute appendicitis diagnosis in early identification

  5. Relief of abdominal pain by morphine without altering physical signs in acute appendicitis

    Institute of Scientific and Technical Information of China (English)

    YUAN Yong; CHEN Jia-yong; GUO Hao; ZHANG Yi; LIANG Dao-ming; ZHOU Dong; ZHAO Hui; LIN Feng

    2010-01-01

    Background Abdominal pain is a common symptom among patients with acute appendicitis, yet these patients havelong been denied relief from suffering because of widespread misconceptions associated with the use of opioids. Wedetermined whether morphine hydrochloride masked the physical signs in adults with acute appendicitis and assessedthe efficacy of morphine in relieving abdominal pain.Methods A prospective, double-blind, placebo controlled, clinical trial was conducted with 106 adult patients between16 and 70 years old with acute appendicitis. Patients were randomly divided into a morphine group (n=54) or a normalsaline group (n=52). All patients presented with acute abdominal pain with onset within 3 days. The morphine groupreceived hypodermic injection of morphine (0.15 mg/kg; maximum 20 mg) and the control group members were given anequivalent volume of normal saline solution. The clinical symptoms, physical signs, and patients' cooperation duringphysical examination were assessed before and after 30 minutes of morphine or normal saline administration.Results Abdominal pain was significantly relieved and the patients' cooperation was improved in the morphine groupafter 30 minutes treatment compared with the control group and before morphine administration (P0.05).Conclusions Morphine relieved abdominal pain and improved the patients' cooperation for treatment and care.Furthermore, the morphine did not mask the physical signs of acute appendicitis.

  6. Systemic Mastocytosis Presenting as Acute Appendicitis: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Syed A. Akbar

    2013-03-01

    Full Text Available Systemic mastocytosis is characterized by abnormal growth and accumulation of mast cells in various organs. Gastrointestinal (GI symptoms are common disease manifestations in this disease and can significantly impair the quality of life. Signs of GI systemic mastocytosis include steatorrhea, malabsorption, hepatomegaly, splenomegaly, portal hypertension, and ascites. Acute appendicitis as a presenting feature in systemic mastocytosis has not been reported in the literature previously. In this report, we discuss the case of a female patient with systemic mastocytosis (c-KIT D816V (+ who was admitted for right-sided acute abdominal pain. Laboratory study revealed an normal white blood cell count with eosinophilia and an elevated serum tryptase level of 23 μg/l. CT of the abdomen and pelvis showed an enlarged appendix of 12 mm in diameter, with minimal wall enhancement. Laparoscopic appendectomy was performed. The appendix was found to be hyperemic and firm, and it was densely adherent to the posterior cecum, the surrounding peritoneal wall, and the overlying mesenteric fat. Pathology revealed acute appendicitis with greater than 30 mast cells per high-power field by immunoperoxidase studies with mast cell tryptase and CD117. The patient subsequently improved and was discharged home. This case is the first reported case with a histological diagnosis of acute appendicitis resulting from mast cell infiltration. Physicians should be aware of acute appendicitis as a manifestation of systemic mastocytosis. Prompt diagnosis and management may prevent potentially fatal complications of appendiceal perforation and peritonitis.

  7. 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

  8. [Acute appendicitis and coinfection with enterobiasis and taeniasis: a case report].

    Science.gov (United States)

    Çallı, Gülhan; Özbilgin, Mücahit; Yapar, Nur; Sarıoğlu, Sülen; Özkoç, Soykan

    2014-01-01

    Parasites are rarely associated with inflammation of the appendix. Generally, parasites cause acute abdominal pain via blocking the gut lumen. In this article, we presented a case of appendicitis where Enterobius vermicularis was detected in the surgical specimen and Taenia was detected in the stool. A 31 year old male patient was admitted to the emergency room with severe abdominal pain, which has begun two days ago. On physical examination, tenderness was positive on palpation of the right lower abdominal quadrant and the patient was operated on with the diagnosis of acute appendicitis. Histopathological examination of the patient's appendectomy material revealed numerous parts of parasites resembling Enterobius vermicularis and slight mucosal erosion. On parasitological examination of the patient's stool, Taenia eggs and adult forms were determined. Antiparasitic therapy was started with niclosamide for taeniasis and albendazole for enterobiasis. Parasitic infections can mimic acute appendicitis clinically. Radiological and laboratory findings do not help to distinguish the diagnosis of acute appendicitis. In the histopathological examination of the appendix, the findings of acute inflammation of the appendix wall may not be defined. For patients with normal histopathological examination, screening for parasites should be done, and anti-parasitic treatment should be started after appendectomy.

  9. 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

  10. Evaluation of Tc-99m leukocyte scan in the diagnosis of acute appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Butler, J.A.; Marcus, C.S.; Henneman, P.L.; Inkelis, S.H.; Wilson, S.E.

    1987-05-01

    A new /sup 99m/Tc Microlite leukocyte scan was performed in 38 patients to assess its value in the diagnosis of acute appendicitis. Autologous leukocytes are labeled with /sup 99m/Tc by inducing phagocytosis of /sup 99m/Tc albumin microcolloid particles. The advantages of this test over the standard indium-111 scan include superior imaging capability, a marked reduction (greater than 75%) in the radiation dose, and performance of the test including labeling, in less than 3 hr. Imaging is performed at 5-90 min postinjection of labeled cells. There were 19 male and 19 female patients with ages ranging from 10 to 80 years, in whom the diagnosis of appendicitis was indeterminate on clinical examination. Of the 13 of the 38 patients (34%) who came to surgery 12 had acute appendicitis. The WBC scan correctly identified 10 of the 12 cases of appendicitis. There were two false-negative studies. In the nonoperative group of 25 patients admitted for observation, 21 studies were reported as negative and four identified other sites of inflammation. All patients with a negative study have remained asymptomatic on follow-up. With a sensitivity of 83% (10/12) and a specificity of 100% (26/26) the /sup 99m/Tc leukocyte scan provides a rapid and highly accurate method for diagnosis of appendicitis in this preliminary study of patients with equivocal clinical exams.

  11. 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.

  12. Duplicate Appendix With Acute Ruptured Appendicitis: A Case Report

    OpenAIRE

    Nazir, Sharique; Bulanov, Alex; Ilyas, Mohammed Iyoob Mohammed; Jabbour, Ibrahim I.; Griffith, Larry

    2015-01-01

    Duplication of the appendix is a rare congenital anomaly that, in adults, is most often found incidentally during surgery for other reasons. Appendicitis in the duplicated appendix is very rare and has been reported less than 10 times in the medical literature. We describe a 33-year-old woman with worsening periumbilical pain, nausea, vomiting, and fever. Physical examination showed localized peritonitis in the right lower quadrant. She had an elevated white blood cell count with neutrophilia...

  13. Computed Tomography (CT) Findings of a Diagnostic Dilemma: Atypically Located Acute Appendicitis

    Science.gov (United States)

    Evrimler, Sehnaz; Okumuser, Irfan; Unal, Nermin

    2016-01-01

    Summary Background Acute appendicitis is an emergent surgically treated disease generally represented by right lower abdominal pain. The most common location of the appendix is descending intraperitoneal. However, it can also show atypical locations such as inguinal canal, femoral canal, subhepatic, retrocecal, intraperitoneal abdominal midline and left side in situs inversus or intestinal malrotation patients. Atypical location can lead to atypical clinical presentations. Ultrasonography is the first choice modality for imaging. However, it can be insufficient for demonstration of the appendix. Therefore, computed tomography (CT) is needed for further examination. We aim to review the CT findings of atypically located acute appendicitis with cases and remind the clinicians and radiologists the importance of the prompt diagnosis. Case Report We presented five atypically-located appendix cases, including four with acute appendicitis that presented to our emergency department with acute abdominal pain. Two of the acute appendicitis cases had normal, the other two had elevated white blood cell count, but all of them had elevated CRP. Ultrasonography imaging was performed as a first-line imaging modality. Because of the inconclusive results of both clinical-laboratory findings and ultrasonography, CT imaging was performed. Abdominal CT demonstrated all of the atypically localised appendices successfully, which were left-sided in a malrotated patient, retrocecal, subhepatic, retrocecal ascending, intraperitoneal abdominal midline localised. Conclusıons Atypically located acute appendicitis can show atypical presentation and result in misdiagnosis. If ultrasonograpgy is inconclusive, we suggest abdominal CT in such confusing, complicated cases, because misdiagnosis or delay in the right diagnosis can result in complications and increased morbidity and mortality rates. PMID:28058072

  14. 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

    PURPOSE: Aim of the study was to describe changes in the epidemiology of acute appendicitis in Danish children between 0-19 years of age for the period 1996-2004. METHODS: The study was based on discharge diagnoses taken from the Danish National Patient Registry of all 28 274 patients with a diag...

  15. Acute Appendicitis as Complication of Colon Transit Time Study; A Case Report.

    Science.gov (United States)

    Ghahramani, Leila; Roshanravan, Reza; Khodaei, Shahin; Rahimi Kazerooni, Salar; Moslemi, Sam

    2015-07-01

    Colon transit time study with radio opaque markers is a simple method for assessment of colon motility disorder in patients with chronic idiopathic constipation. We report a case of acute appendicitis that was induced by impaction of radio opaque markers after colon transit time study. We think that this case report is first significant complication of colon transit time study until now.

  16. Descending colon interposition in a patient presenting with abdominal pain and acute appendicitis

    Directory of Open Access Journals (Sweden)

    Eiref SD

    2010-09-01

    Full Text Available Interposition of the descending colon between the kidney and the psoas major muscle is a rare hindgut anatomic variant. Presented herein is a case of descending colon interposition in a patient admitted with abdominal pain and acute appendicitis. Internal hernia was ruled out by laparoscopy.

  17. A young man with concurrent acute appendicitis and incarcerated right indirect inguinal hernia

    Directory of Open Access Journals (Sweden)

    Ditsatham C

    2016-01-01

    Full Text Available Chagkrit Ditsatham, Areewan Somwangprasert, Kirati Watcharachan, Phanchaporn Wongmaneerung Division of Head, Neck, and Breast, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Objective: Acute appendicitis and incarcerated hernia rarely present in the same episode. Our study reports patient presentation, diagnosis method, and treatment of an unusual case at the Chiang Mai University Hospital. Method: Case report. Result: A 20-year-old man visited the Chiang Mai University Hospital with right lower quadrant pain and a right groin mass which could not be reduced. The computerized tomography scan showed acute appendicitis and omentum in the hernia sac. Operative treatment was an appendectomy and herniorrhaphy. The treatment was successful, and the patient was discharged from our hospital without any complications. Conclusion: Concurrent acute appendicitis and incarcerated hernia are very rare, but should be kept in mind if a patient presents with right lower quadrant pain and a right groin mass. Further investigation may be helpful if the diagnosis is uncertain. Operative priority treatment depends on each individual case. Keywords: combined acute appendicitis and incarcerated inguinal hernia

  18. The impact of diagnostic delay on the course of acute appendicitis

    NARCIS (Netherlands)

    V.C. Cappendijk; F.W.J. Hazebroek (Frans)

    2000-01-01

    textabstractBACKGROUND: The diagnosis of acute appendicitis is often delayed, which may complicate the further course of the disease. AIMS: To review appendectomy cases in order to determine the incidence of diagnostic delay, the underlying factors, and impact on the co

  19. 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.

  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. Changes in appetite hormone (ghrelin) levels of saliva and serum in acute appendicitis cases before and after operation.

    Science.gov (United States)

    Cetinkaya, Ziya; Aydin, Suleyman; Cerrahoglu, Yusuf Z; Ayten, Refik; Erman, Fazilet; Aygen, Erhan

    2009-02-01

    This study was designed to measure the levels of serum and saliva ghrelin concentrations before and after surgery in an attempt to clarify whether this hormone plays any significant roles in acute appendicitis and cholelithiasis patients when compared with healthy controls. Samples were obtained from 20 patients with appendicitis, 10 patients with cholelithiasis before and after operation, and 16 healthy controls. The levels of ghrelin (acylated) were measured by means of a RIA assay. The results revealed that preoperative levels of ghrelin in saliva and serum were significantly decreased with respect to post-op in patients undergoing appendectomy, and control levels. This was also the case when the preoperative ghrelin concentrations in patients with appendicitis were compared with those having choelithiasis. Taken together, decreased ghrelin concentration in preoperative appendicitis might be a causative factor for the "loss of appetite" observed in an acute inflammatory condition such as acute appendicitis. However, further studies are necessary to reveal the exact mechanisms behind this observation.

  2. Total leucocyte count, C-reactive protein and neutrophil count: Diagnostic Aid in acute appendicitis

    Directory of Open Access Journals (Sweden)

    Shafi Sheikh

    2009-01-01

    Full Text Available Background/Aim: Acute appendicitis is one of the most common acute intraabdominal affections seen in surgical departments, which can be treated easily if an accurate diagnosis is made in time. Otherwise, delay in diagnosis and treatment can lead to diffuse peritonitis. Materials and Methods: A study was conducted on 110 patients who were operated for acute appendicitis to determine the role and predictive value of the total leucocyte count (TLC, C-reactive protein (CRP and percentage of neutrophil count in the diagnosis of acute appendicitis. Preoperative TLC, CRP and percentage of neutrophil count were determined and were compared with the results of the histopathology of the removed appendix. Results: Of all the patients studied, 92 had histopathologically positive appendicitis. The TLC was found to be significantly high in 90 patients who proved to have acute appendicitis, whereas CRP was high in only 88 patients and neutrophil percentage was raised in 91; four had a normal CRP level. Thus, TLC had a sensitivity, specificity and positive predictive value of 97.82%, 55.55% and 91.8%, respectively. CRP had a sensitivity, specificity and positive predictive value of 95.6%, 77.77% and 95.6% respectively. Percentage of neutrophil count had a sensitivity, specificity and positive predictive value of 98.9%, 38.88% and 89.21%, respectively. When used in combination, there was a marked improvement in the specificity and the positive predictive value to 88.04% and 98.7%, respectively. Conclusion: The inflammatory markers, i.e., TLC, CRP and neutrophil count can be helpful in the diagnosis when measured together as this increases their specificity and positive predictive value.

  3. [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.

  4. Assessing Murphy Sequence as a Clinical Element in Acute Appendicitis Diagnosis

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    Andy Rocha Quintana

    2011-04-01

    Full Text Available Background: at present, the presence or lack of agreement between clinical diagnosis and evidence when exploring the abdominal cavity and performing excision of the pathological piece in cases of acute appendicitis, has become an increasingly contested issue. Objective: to characterize the presentation of Murphy Sequence in patients who underwent acute appendicitis surgery. Methods: descriptive study on a case series of patients who underwent acute appendicitis surgery in the General University Hospital of Cienfuegos between March and September 2006. Variables analyzed: age, sex, skin color, evolution duration and order of appearance of symptoms, presentation of Murphy Sequence, complementary tests and pathological diagnosis. Results: the average age for cases where Murphy Sequence was not presented was 34 years old, predominantly brown skinned males. The sequence was not completed in 96, 8% of cases, mainly those found in catarrhal stage. Laparoscopy was not performed in 69.7% of patients and, within this group, 97.7% of patients did not complete the sequence. In 51.9% of the cases, the first symptom was epigastric pain that then moved to the right iliac fossa. A broad spectrum of values of white blood cells was found in cases of catarrhal appendicitis. Conclusions: in 96.8% of cases Murphy Sequence was absent. Even in cases of long evolutions, these symptoms were not related to the disease stages.

  5. Spontaneous chylous peritonitis mimicking acute appendicitis: A case report and review of literature

    Institute of Scientific and Technical Information of China (English)

    Fu-Chi Fang; Sheng-Der Hsu; Chuang-Wei Chen; Teng-Wei Chen

    2006-01-01

    Acute abdominal pain with signs and symptoms of peritonitis due to sudden extravasation of chyle into the peritoneal cavity is a rare condition that is often mistaken for other disease processes. The diagnosis is rarely suspected preoperatively. We report a case of spontaneous chylous peritonitis that presented with typical symptoms of acute appendicitis such as intermittent fever and epigastric pain radiating to the lower right abdominal quadrant before admission.

  6. Neuronal hypertrophy and mast cells in histologically negative, clinically diagnosed acute appendicitis: a quantitative immunophenotypical analysis.

    Science.gov (United States)

    Amber, Safeena; Mathai, Alka Mary; Naik, Ramadas; Pai, Muktha R; Kumar, Suneet; Prasad, Keerthana

    2010-03-01

    In about 20-25% of appendicectomies performed for clinically suspected acute appendicitis, definite morphological changes are lacking on histopathological examination. The present study was done to investigate whether any changes in neurons and mast cells could be detected in patients presenting with clinical acute appendicitis but found to have normal appendix at histopathology. A descriptive study was conducted on 50 appendix specimens which were categorized as histology-positive acute appendicitis (HPAA), clinically acute appendicitis but histologically negative (HNAA), appendices resected for other causes and appendices from forensic autopsy. A morphometric and quantitative evaluation of nerve fibers and ganglion plexus and its relation to mast cell density were studied. All sections were subjected to hematoxylin and eosin stain, toluidine blue stain, S 100 protein and neuron specific enolase (NSE) immunostaining and a quantitative image analysis system. Mucosal and submucosal neuronal components highlighted by NSE and S100 immunostaining observed in cases of HNAA were comparable to cases of HPAA. With S 100 immunostaining in HNAA cases, the increase in number and size of myentric neuronal plexus were mild in 40% (10/25) cases, moderate in 40% (10/25) and marked in 20% (5/25) cases as compared to 66.7% (10/15) cases of HPAA showing moderate and 33.3% (5/15) cases showing marked increase (p = 0.018). The mean mast cell count was highest in the HNAA cases (2.74) in all the four layers as compared to the HPAA (1.85) and control group (2.05). There was no difference in the relationship of the size of ganglion cells and the mast cell concentration. Neuronal hypertrophy and mast cells may play a role in the pathogenesis of appendicitis-like pain in patients with histologically normal appendices.

  7. Could an abdominal drainage be avoided in complicated acute appendicitis? Lessons learned after 1300 laparoscopic appendectomies.

    Science.gov (United States)

    Schlottmann, Francisco; Reino, Romina; Sadava, Emmanuel E; Campos Arbulú, Ana; Rotholtz, Nicolás A

    2016-12-01

    Complicated appendicitis (CA) may be a risk factor for postoperative intra-abdominal abscess formation (IAA). In addition, several publications have shown an increased risk of postoperative collection after laparoscopic appendectomy. Most surgeons prefer to place a drain to collect contaminated abdominal fluid to prevent consequent abscess formation. We aimed to evaluate the utility of placing an intra-abdominal drain in laparoscopic appendectomy for complicated acute appendicitis. From January 2005 to June 2015 all charts of consecutive patients who underwent laparoscopic appendectomy for CA were revised. CA was defined as a perforated appendix with associated peritonitis. The sample was divided into two groups, G1: intra-abdominal drain and G2: no drain. Demographics, operative factors and 30-day postoperative complications were analyzed. In the study period 1300 laparoscopic appendectomies were performed. Laparoscopic findings showed that 17.3% of the surgeries were for complicated acute appendicitis (225 patients). Fifty-six patients (25%) were in G1 and 169 patients (75%) in G2. No significant differences in clinical presentation and demographics were found (p: NS). G1 had an increased conversion rate (G1: 19.6% vs. G2: 7.1%; p: 0.007). No differences were found in the overall morbidity (G1: 32.1% vs. G2: 21.3%, p: NS). The rate of postoperative IAA was 14.2% in G1 and 8.9% in G2 (p: NS). Length of stay was higher in G1 (G1: 5.2 days vs. G2 2.9 days, p: 0.001). There was no mortality in either group. The placement of intra-abdominal drain in complicated acute appendicitis may not present benefits and may even lengthen hospital stay. These observations suggest that there is no need of using a drain in laparoscopic appendectomy for complicated acute appendicitis. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  8. Biomarkers of acute appendicitis: systematic review and cost-benefit trade-off analysis.

    Science.gov (United States)

    Acharya, Amish; Markar, Sheraz R; Ni, Melody; Hanna, George B

    2017-03-01

    Acute appendicitis is the most common surgical emergency and can represent a challenging diagnosis, with a negative appendectomy rate as high as 20 %. This review aimed to evaluate the clinical utility of individual biomarkers in the diagnosis of appendicitis and appraise the quality of these studies. A systematic review of the literature between January 2000 and September 2015 using of PubMed, OvidMedline, EMBASE and Google Scholar was conducted. Studies in which the diagnostic accuracy, statistical heterogeneity and predictive ability for severity of several biomarkers could be elicited were included. Information regarding costs and process times was retrieved from the regional laboratory. European surgeons blinded to these reviews were independently asked to rank which characteristics of biomarkers were most important in acute appendicitis to inform a cost-benefit trade-off. Sensitivity testing and the QUADAS-2 tool were used to assess the robustness of the analysis and study quality, respectively. Sixty-two studies met the inclusion criteria and were assessed. Traditional biomarkers (such as white cell count) were found to have a moderate diagnostic accuracy (0.75) but lower costs in the diagnosis of acute appendicitis. Conversely, novel markers (pro-calcitonin, IL 6 and urinary 5-HIAA) were found to have high process-related costs including analytical times, but improved diagnostic accuracy. QUADAS-2 analysis revealed significant potential biases in the literature. When assessing biomarkers, an appreciation of the trade-offs between the costs and benefits of individual biomarkers is needed. Further studies should seek to investigate new biomarkers and address concerns over bias, in order to improve the diagnosis of acute appendicitis.

  9. The role of neutrophil lymphocyte ratio to leverage the differential diagnosis of familial Mediterranean fever attack and acute appendicitis.

    Science.gov (United States)

    Kucuk, Adem; Erol, Mehmet Fatih; Senel, Soner; Eroler, Emir; Yumun, Havvanur Alparslan; Uslu, Ali Ugur; Erol, Asiye Mukaddes; Tihan, Deniz; Duman, Ugur; Kucukkartallar, Tevfik; Solak, Yalcin

    2016-03-01

    Familial Mediterranean fever (FMF) is an autosomal recessive disorder characterized by attacks of fever and diffuse abdominal pain. The primary concern with this presentation is to distinguish it from acute appendicitis promptly. Thus, we aimed to evaluate the role of neutrophil lymphocyte ratio (NLR) to leverage the differential diagnosis of acute FMF attack with histologically proven appendicitis. Twenty-three patients with histologically confirmed acute appendicitis and 88 patients with acute attack of FMF were included in the study. NLR, C-reactive protein and other hematologic parameters were compared between the groups. Neutrophil to lymphocyte ratio was significantly higher in patients with acute appendicitis compared to the FMF attack group (8.24 ± 6.31 vs. 4.16 ± 2.44, p = 0.007). The performance of NLR in diagnosing acute appendicitis with receiver operating characteristic analysis with a cut-off value of 4.03 were; 78% sensitivity, 62% specificity, and area under the curve 0.760 (95% confidence interval, 0.655 to 0.8655; p < 0.001). This study showed that NLR, the simple and readily available inflammatory marker may have a useful role in distinguishing acute FMF attack from acute appendicitis.

  10. 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.

  11. BACTERIAL PATTERN OF APPENDIX IN ACUTE AND CHRONIC APPENDICITIS WITH ITS CLINICAL CORRELATION

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    Surajit

    2016-02-01

    Full Text Available BACKGROUND Acute appendicitis is a common, sometimes confusing and often treacherous cause of acute abdomen at all ages. The only way to reduce morbidity and to prevent mortality is to perform appendicectomy before perforation or gangrene occurs. As appendicectomy is a very common practice, it is essential to know in detail the various etiological factors that precipitate appendicitis. Bacterial invasion being a very common cause makes it imperative that we have a clear picture of the bacterial pattern of appendix in acute and recurrent appendicitis and to correlate this with clinical findings. A proper idea of bacterial flora of appendix thus helps us not only to prevent postoperative complication, but also to impart effective conservative treatment by pinpointing sensitive drugs. AIMS AND OBJECTIVES Knowledge of bacterial flora of appendix also has socio-economic benefits through low rates of post-operative complications, reduced hospital stay and also reduced indiscriminate use of multiple costly drugs. The aim of this study is to establish the bacterial profile in acute as well as recurrent appendicitis and to correlate the findings with the severity of the disease. MATERIALS AND METHODS This study was conducted on 90 patients irrespective of age and sex who attended the emergency and OPD during the course of the work with symptoms suggestive of appendicitis. Following appendicectomy, each of the specimens was cut into two pieces. One was sent for histopathological examination and other was sent for bacterial culture. RESULT The commonest bacteria isolated were Escherichia coli in 67.78% cases, which is a facultative anaerobe and it was closely accompanied by Klebsiella species in 47.78% cases. Other isolates that were recorded included Staphylococcus aureus in 3.33% cases with Pseudomonas aeruginosa and Proteus species in 2.22% cases each. Mixed infections were seen in phlegmonous, gangrenous and perforative appendicitis. Bacteroides

  12. The epidemiology of acute appendicitis in California: racial, gender, and seasonal variation.

    Science.gov (United States)

    Luckmann, R; Davis, P

    1991-09-01

    The incidence of acute appendicitis has been reported to vary substantially by country, geographic region, race, sex, season, and occupation, but the reasons for this variation are unknown. We evaluated several risk factors for appendicitis by analyzing data from hospital discharge abstracts on all cases of acute appendicitis treated surgically in nonfederal hospitals in California from 1983 to 1986 (N = 102,546). Comparison of age and sex-specific incidence rates for four racial/ethnic groups (white, Hispanic, black, and Asian/other) revealed rates in blacks and the Asian/other group one-half or less of the rates for whites and Hispanics between the ages of 5 and 29 years. Incidence rates in males were higher than rates in females in all racial/ethnic groups for most ages (RR = 1.1-1.7). Seasonal variation in incidence was modest. Peak rates occurred in July, August, and September, and the lowest rates occurred in December. Hypotheses about the etiology of appendicitis must account for substantial racial/ethnic, gender, age variation, and modest seasonal variation in the incidence.

  13. 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.

  14. 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

  15. Incidence and case fatality rates for acute appendicitis in California. A population-based study of the effects of age.

    Science.gov (United States)

    Luckmann, R

    1989-05-01

    In 1984, 24,794 appendectomies and abscess drainage procedures were performed for acute appendicitis in California hospitals. Analysis of hospital discharge abstracts revealed age- and sex-specific incidence rates and in-hospital case fatality rates for acute appendicitis lower than previously reported. In persons aged 60 years and older, the case fatality rate for nonperforating appendicitis with appendectomy was 0.7% and for perforating appendicitis and abscess 2.4%. Surgery was delayed beyond the day of admission in 21% of persons aged 40-59 years, 29% of persons aged 60-79 years, and 47% of persons aged 80 years and over. The proportion of cases with perforation increased from 22% to 75% between ages 20 and 80 years. The population incidence of perforating appendicitis changed little after age 20 years, while the incidence of nonperforating cases declined sharply. The high proportion of appendicitis cases with perforation among the elderly may be due to the decreased incidence of nonperforating appendicitis in the elderly and not to a greater propensity for perforation, as previously proposed. Most elderly in California receive timely surgery for appendicitis and tolerate it better than previously reported. Diminished tolerance for intra-abdominal infection may be the primary determinant of the increase in case fatality with age.

  16. Ultrasonic Direct and Indirect Signs of Acute Appendicitis-diagnostic Value%超声直接与间接征象对急性阑尾炎分型的诊断价值

    Institute of Scientific and Technical Information of China (English)

    张爱红; 申国升

    2013-01-01

      目的:通过超声的直接和间接征象,探讨急性阑尾炎分型的诊断价值.方法:回顾性分析106例经手术和病理证实的急性阑尾炎的声像图,根据其直接和间接征象进行超声分型,并与病理对照.结果:超声分型诊断符合率,急性单纯性阑尾炎83.3%(25/30),急性化脓性阑尾炎91.9%(57/62),坏疽性阑尾炎85.7%(12/14).结论:超声直接和间接征象能较确切的反映不同类型的急性阑尾炎,正确认识这些征象,有助于对急性阑尾炎的分型作出诊断.%Objective: By the direct and indirect signs of the ultrasound,g enotyping diagnostic value of acute appendicitis. Method: A retrospective analysis of 106 cases of surgically and pathologically confirmed acute appendicitis,ultrasonography,ultrasound type,in accordance with its direct and indirect signs and pathology.Result: Ultrasound Diagnostic Classification coincidence rate of acute simple appendicitis was 83.3%(25/30), acute suppurative appendicitis was 91.9%(57/62),gangrenous appendicitis was 85.7%(12/14).Conclusion: Ultrasonography is the direct and indirect signs of the exact reflection of the different types of acute appendicitis,the correct understanding of these signs will help make a diagnosis of acute appendicitis typing.

  17. MODIFIED ALVARADO’S SCORE: A DIAGNOSTIC TOOL FOR ACUTE APPENDICITIS

    Directory of Open Access Journals (Sweden)

    Chandrashekar

    2014-04-01

    Full Text Available BACKGROUND: Alvarado score is simple and can be instituted easily as this scoring is clinical, non-invasive and can be used to support diagnosis of acute appendicitis. Alvarado system combined with ultrasound can be used as a cheap and inexpensive way to confirming acute appendicitis and reducing negative appendicectomy rate. METHODS: The patients on admission were evaluated on the basis of Alvarado scoring. In this study we used a slightly modified version of Alvarado score by excluding one lab finding – shift to the neutrophils maturation. (Score 1, instead patients were subjected to ultrasonography of abdomen. CONCLUSION: Alvarado scoring system is dynamic allowing observation and critical reevaluation of evolution of clinical picture.

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

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    Pinto, Antonio [Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Piazza delle Cliniche no 2, 90127 Palermo (Italy)]. E-mail: pinto@neomedia.it; Di Raimondo, Domenico [Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Piazza delle Cliniche no 2, 90127 Palermo (Italy); Tuttolomondo, Antonino [Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Piazza delle Cliniche no 2, 90127 Palermo (Italy); Fernandez, Paola [Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Piazza delle Cliniche no 2, 90127 Palermo (Italy); Caronia, Aurelio [Dipartimento di Biotecnologie Mediche - Sezione di Radiologia, University of Palermo, Via del Vespro no 129, 90127 Palermo (Italy); Lagalla, Roberto [Dipartimento di Biotecnologie Mediche - Sezione di Radiologia, University of Palermo, Via del Vespro no 129, 90127 Palermo (Italy); Arnao, Valentina [Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Piazza delle Cliniche no 2, 90127 Palermo (Italy); Law, Robert L. [Department of Radiology, Frenchay Hospital, Bristol (United Kingdom); Licata, Giuseppe [Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Piazza delle Cliniche no 2, 90127 Palermo (Italy)

    2007-05-15

    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.

  19. Comparative analysis between single incision and conventional laparoscopic appendectomy for acute appendicitis

    OpenAIRE

    Sreeram Sateesh; Harsha Subraj; Gangaiahgari Mahesh; Pasupuleti Sreenivasa Rao

    2014-01-01

    Appendicitis is an acute inflammatory condition of appendix. Since it is a surgical emergency, needs early diagnosis and treatment strategies which include clinical examination, followed by Laboratory investigations and Imaging studies. The scoring systems like Alvarado score have been considered for better diagnosis. In most studies surgery has been reported as the best modality of treatment. Several studies clearly mentioned the impact of various surgical procedures which include Open appen...

  20. De Garengeot's hernia: acute appendicitis in a femoral hernia. Case report and literature overview.

    Science.gov (United States)

    Snoekx, R; Geyskens, P

    2014-01-01

    Migration of the appendix vermiformis into a femoral hernia is also known as De Garengeot's hernia. We report the case of an elderly patient who was diagnosed with an acute appendicitis within a strangulated femoral hernia sac. Emergency incision and abscess drainage was performed, followed by delayed laparoscopic appendectomy and herniorraphy. Both procedures were uneventful and the patient fully recovered. Although exceedingly rare, the surgeon needs to be aware of this entity to prevent a delay in diagnosis with potentially serious adverse events.

  1. [Early oral feeding versus classic oral feeding after appendicectomy for acute appendicitis].

    Science.gov (United States)

    Kassi Assamoi, B F; Yenon, K S; Lebeau, R; Traore, M; Akpa-Bedi, E; Kouassi, J C

    2010-01-01

    The appendectomies for acute appendicitis are the most frequent surgical interventions (43.6%) in our service. The recent studies demonstrated the feasibility and the economical gain of the early oral feeding vs. classic oral feeding, after elective digestive surgery. We wanted to spread these results therefore to the appendectomy for acute appendicitis. It is about a prospective survey carrying on 110 patients also left in two groups, and comparing the classic postoperative oral feeding vs. the early postoperative oral feeding on one year. The two groups were comparable and the studied parameters were : the length of the postoperative ileus, the hospitable morbidity, the length of the hospitalization and the cost of the hold in charge. The length of the postoperative ileus was not different in the two groups as well as the morbidity. The difference of the median length of hospitalization in the two groups was not meaningful. The cost of the hold in charge was meaningfully more elevated in the group with classic postoperative feeding. In conclusion, the early postoperative oral feeding in our survey doesn't reduce the length of the postoperative ileus and don't drag a morbidity anymore that the classic oral feeding. However if it doesn't shorten the length of the hospitalization, it drags a reduction of the cost of the hold in charge. There is a gain therefore precociously to nourish the patients after appendectomy for acute appendicitis.

  2. Acute appendicitis presenting with abdominal wall and right groin abscess: A case report

    Institute of Scientific and Technical Information of China (English)

    Mustafa Yildiz; Ahmet Sevki Karakayali; Saadet Ozer; Hilal Ozer; Aydin Demir; Bugra Kaptanoglu

    2007-01-01

    We report a case of right lower abdominal wall and groin abscess resulting from acute appendicitis. The patient was an 27-year-old man who had no apparent abdominal signs and was brought to the hospital due to progressive painful swelling of right lower abdomen and the groin for 10 d. Significant inflammatory changes of soft tissue involving the right lower trunk were noted without any apparent signs of peritonitis. Laboratory results revealed leukocytosis. Abdominal ultrasonography described the presence of abscess at right inguinal site also communicating with the intraabdominal region. Right inguinal exploration and laparotomy were performed and about 250 mL of pus was drained from the subcutaneous tissue and preperitoneal space. No collection of pus was found intraabdominally and subserous acute appendicitis was the cause of the abscess. The patient fully recovered at the end of the second post-operation week. This case reminds us that acute appendicitis may have an atypical clinical presentation and should be treated carefully on an emergency basis to avoid serious complications.

  3. 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.

    2015-01-01

    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 p

  4. 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

  5. Optimizing imaging in suspected appendicitis (OPTIMAP-study: A multicenter diagnostic accuracy study of MRI in patients with suspected acute appendicitis. Study Protocol

    Directory of Open Access Journals (Sweden)

    Bossuyt Patrick MM

    2010-10-01

    Full Text Available Abstract Background In patients with clinically suspected appendicitis, imaging is needed to substantiate the clinical diagnosis. Imaging accuracy of ultrasonography (US is suboptimal, while the most accurate technique (CT is associated with cancer related deaths through exposure to ionizing radiation. MRI is a potential replacement, without associated ionizing radiation and no need for contrast medium administration. If MRI is proven to be sufficiently accurate, it could be introduced in the diagnostic pathway of patients with suspected appendicitis, increasing diagnostic accuracy and improving clinical outcomes, without the risk of radiation induced cancer or iodinated contrast medium-related drawbacks. The multicenter OPTIMAP study was designed to estimate the diagnostic accuracy of MRI in patients with suspected acute appendicitis in the general population. Methods/Design Eligible for this study are consecutive patients presenting with clinically suspected appendicitis at the emergency department in six centers. All patients will undergo imaging according to the Dutch guideline for acute appendicitis: initial ultrasonography in all and subsequent CT whenever US does not confirm acute appendicitis. Then MRI is performed in all patients, but the results are not used for patient management. A final diagnosis assigned by an expert panel, based on all available information including 3-months follow-up, except MRI findings, is used as the reference standard in estimating accuracy. We will calculate the sensitivity, specificity, predictive values and inter-observer agreement of MRI, and aim to include 230 patients. Patient acceptance and total imaging costs will also be evaluated. Discussion If MRI is found to be sufficiently accurate, it could replace CT in some or all patients. This will limit or obviate the ionizing radiation exposure associated risk of cancer induction and contrast medium induced nephropathy with CT, preventing the burden and

  6. [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

  7. 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 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.

  8. Perforated appendicitis masquerading as acute pancreatitis in a morbidly obese patient.

    Science.gov (United States)

    Forster, Michael-J; Akoh, Jacob-A

    2008-03-21

    Diagnosis and treatment of common conditions in morbidly obese patients still pose a challenge to physicians and surgeons. Sometimes too much reliance is put on investigations that can lead to a misdiagnosis. This case demonstrates an obese woman admitted under the medical team with a presumed diagnosis of pneumonia, who was later found to have an acute abdomen and raised amylase, which led to an assumed diagnosis of pancreatitis. She died within 24 h of admission and post mortem confirmed the cause of death as systemic sepsis due to perforated appendicitis, with no evidence of pancreatitis. Significantly elevated serum amylase level may occur in non-pancreatitic acute abdomen.

  9. Perforated appendicitis masquerading as acute pancreatitis in a morbidly obese patient

    Institute of Scientific and Technical Information of China (English)

    Michael J Forster; Jacob A Akoh

    2008-01-01

    Diagnosis and treatment of common conditions in morbidly obese patients still pose a challenge to physicians and surgeons. Sometimes too much reliance is put on investigations that can lead to a misdiagnosis. This case demonstrates an obese woman admitted under the medical team with a presumed diagnosis of pneumonia, who was later found to have an acute abdomen and raised amylase, which led to an assumed diagnosis of pancreatitis. She died within 24 h of admission and post mortem confirmed the cause of death as systemic sepsis due to perforated appendicitis, with no evidence of pancreatitis. Significantly elevated serum amylase level may occur in non-pancreatitic acute abdomen.

  10. 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.

  11. Acute Appendicitis in an Incarcerated Femoral Hernia: A Case of De Garengeot Hernia

    Directory of Open Access Journals (Sweden)

    Kiyoko Ebisawa

    2009-11-01

    Full Text Available Appendicitis and incarcerated hernia are frequently encountered reasons of emergency surgery for acute abdomen. The treatment in early stages of each condition is generally simple, but when these conditions are combined, the symptoms become slightly complicated, obscuring specific symptoms. Especially the lack of symptoms for appendicitis leads to delayed diagnosis, resulting in high morbidity. Amyand hernia, which contains appendix in its inguinal hernia sac, is perhaps more familiar to the general surgeons than De Garengeot hernia, which is an incarcerated femoral hernia with an appendix in its sac. We report the case of a 90-year-old female with incarcerated femoral hernia who underwent emergency hernioplasty only to reveal an inflamed appendix in its sac. The patient underwent both appendectomy and hernia repair simultaneously with synthetic mesh and was discharged on postoperative day 7 without any complications. We will also discuss the physical and radiological findings of De Garengeot hernia.

  12. Benign multicystic mesothelioma of peritoneum complicating acute appendicitis in a man: a case report.

    Science.gov (United States)

    Occhionorelli, Savino; Tartarini, Daniela; Pascale, Giovanni; Maccatrozzo, Stefano; Stano, Rocco; Vasquez, Giorgio

    2016-02-27

    Benign multicystic mesothelioma is a rare pathology. Few cases are reported in the medical literature and acute presentation is extremely uncommon. We describe an acute clinical presentation of the neoplasm that revealed itself with signs and symptoms attributable to acute appendicitis in a 41-year-old white man. Abdominal echography and computed tomography scans demonstrated the presence of a mass in direct contiguity with cecal fundus, but diagnosis remained unclear. Our patient underwent surgery and complete removal of the neoplasm. Only a definitive histological examination defined the nature of the lesion. No signs of relapse were demonstrated 1 year after the operation. We showed that an acute presentation of a benign neoplasm represents a diagnostic and therapeutic challenge for the surgeon, because of the difficult differential diagnosis that acute presentation can sometimes pose and the trouble that an emergence treatment can imply.

  13. 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.)

  14. 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

  15. 急性阑尾炎术后并发症的防治%Prevention and Treatment of Acute Appendicitis Postoperative Complications

    Institute of Scientific and Technical Information of China (English)

    景玉萍

    2013-01-01

    Objective To observe the prevention and treatment of complications of acute appendicitis. Methods:a retrospective analysis of the clinical data of 800 patients with acute appendicitis patients in our hospital from 2007 January to 2012 December were analyzed. Results:suppurative appendicitis in 300 cases, incision infection in 10 cases, the complication rate was 3.3%;80 cases of appendiceal abscess, a total of 15 cases of complications, the incidence of complications was 18.8%. Conclusion:the early diagnosis of acute appendicitis, timely operation are the key to prevent operation incision infection.%目的:观察急性阑尾炎术后并发症的防治。方法回顾性分析我院自2007年1月~2012年12月收治的800例急性阑尾炎患者的临床资料。结果单纯性化脓性阑尾炎300例,并发切口感染10例,并发症发生率为3.3%;阑尾脓肿80例,并发症发生总数15例,并发症发生率为18.8%。结论对急性阑尾炎的早期诊断、及时手术是预防手术切口感染的关键。

  16. Comparative analysis between single incision and conventional laparoscopic appendectomy for acute appendicitis

    Directory of Open Access Journals (Sweden)

    Sreeram Sateesh

    2014-08-01

    Full Text Available Appendicitis is an acute inflammatory condition of appendix. Since it is a surgical emergency, needs early diagnosis and treatment strategies which include clinical examination, followed by Laboratory investigations and Imaging studies. The scoring systems like Alvarado score have been considered for better diagnosis. In most studies surgery has been reported as the best modality of treatment. Several studies clearly mentioned the impact of various surgical procedures which include Open appendectomy (OA, Conventional laparoscopic appendectomy (CLA and Single incision laparoscopic appendectomy (SILA. Hence, the present study is carried in an aim to assess and compare the merits and demerits between the surgical procedures Like SILA and CLA. The patients were randomly selected from the surgical department (NMCH who presented with acute pain abdomen and diagnosed as acute appendicitis. 50 patients were enrolled in the study after fulfilling the inclusion and exclusion criteria. The various demographic variables have been studied between the surgical procedures to demonstrate their impact, which include wound infection rate, pain scores at 24 and 48hrs, the amount of time period for surgery in minutes, patient satisfaction scores and post-operative stay tenure at the hospital in days. The laparoscopic hand instruments used in both techniques are similar, except covidien port which was reused in SILA, following gas sterilization to reduce the cost. Findings reveal that the pain score was significantly lower in SILA than CLA group. The procedure time is comparatively more in SILA than CLA group. Patients had significant satisfaction score in SILA measured at 6 weeks after appendectomy. However the post operative stay, wound infection rate was almost similar in both the groups. There was no conversion to open Appendectomy performed in either of these groups. Results also clearly suggest that the SILA procedure is the safe, alternative and effective

  17. First case of villous adenoma of the appendix leading to acute appendicitis presenting as strangulated femoral hernia: changes in management owing to concurrent adenoma.

    Science.gov (United States)

    Suppiah, A; Barandiaran, J; Morgan, R; Perry, E P

    2008-02-01

    A 78-year-old lady presented with signs and symptoms of a strangulated femoral hernia. Peri-operatively she was found to have appendicitis within the hernia sac. Appendicectomy and non-mesh hernia repair were performed. Histology revealed acute inflammation and a villous adenoma of the appendix. Villous adenomas of the vermiform appendix are extremely rare tumours of the gastrointestinal tract. This is the first case combining two very rare pathologies--acute appendicitis presenting as strangulated femoral hernia and villous adenoma of the appendix. Early diagnosis and surgery are required to avoid high morbidity of perforated appendicitis within a femoral hernia. First, we discuss the diagnosis and surgical treatment of acute appendicitis within a femoral hernia. Second, the presence of an adenoma changes the aetiology of appendicitis. More importantly, changes in surgical management of acute appendicitis presenting as a strangulated femoral hernia owing to a co-existing adenoma are discussed.

  18. In-hospital Surgical Delay Does Not Increase the Risk for Perforated Appendicitis in Children: A Single-center Retrospective Cohort Study.

    Science.gov (United States)

    Almström, Markus; Svensson, Jan F; Patkova, Barbora; Svenningsson, Anna; Wester, Tomas

    2017-03-01

    To investigate the correlation between in-hospital surgical delay before appendectomy for suspected appendicitis and the finding of perforated appendicitis in children. All children undergoing acute appendectomy for suspected acute appendicitis at Karolinska University Hospital, Stockholm, Sweden from 2006 to 2013 were reviewed for the exposure of surgical delay. Primary endpoint was the histopathologic finding of perforated appendicitis. The main explanatory variable was in-hospital surgical delay, using surgery within 12 hours as reference. Secondary endpoints were postoperative wound infection, intra-abdominal abscess, reoperation, length of hospital stay, and readmission. To adjust for selection bias, a logistic regression model was created to estimate odds ratios for the main outcome measures. Missing data were replaced using multiple imputation. The study comprised 2756 children operated for acute appendicitis. Six hundred sixty-one (24.0%) had a histopathologic diagnosis of perforated appendicitis. In the multivariate logistic regression analysis, increased time to surgery was not associated with increased risk of histopathologic perforation. There was no association between the timing of surgery and postoperative wound infection, intra-abdominal abscess, reoperation, or readmission. In-hospital delay of acute appendectomy in children was not associated with an increased rate of histopathologic perforation. Timing of surgery was not an independent risk factor for postoperative complications. The results were not dependent on the magnitude of the surgical delay. The findings are analogous with previous findings in adults and may aid the utilization of available hospital- and operative resources.

  19. Diagnosis and management of acute appendicitis. EAES consensus development conference 2015.

    Science.gov (United States)

    Gorter, Ramon R; Eker, Hasan H; Gorter-Stam, Marguerite A W; Abis, Gabor S A; Acharya, Amish; Ankersmit, Marjolein; Antoniou, Stavros A; Arolfo, Simone; Babic, Benjamin; Boni, Luigi; Bruntink, Marlieke; van Dam, Dieuwertje A; Defoort, Barbara; Deijen, Charlotte L; DeLacy, F Borja; Go, Peter Mnyh; Harmsen, Annelieke M K; van den Helder, Rick S; Iordache, Florin; Ket, Johannes C F; Muysoms, Filip E; Ozmen, M Mahir; Papoulas, Michail; Rhodes, Michael; Straatman, Jennifer; Tenhagen, Mark; Turrado, Victor; Vereczkei, Andras; Vilallonga, Ramon; Deelder, Jort D; Bonjer, Jaap

    2016-11-01

    Unequivocal international guidelines regarding the diagnosis and management of patients with acute appendicitis are lacking. The aim of the consensus meeting 2015 of the EAES was to generate a European guideline based on best available evidence and expert opinions of a panel of EAES members. After a systematic review of the literature by an international group of surgical research fellows, an expert panel with extensive clinical experience in the management of appendicitis discussed statements and recommendations. Statements and recommendations with more than 70 % agreement by the experts were selected for a web survey and the consensus meeting of the EAES in Bucharest in June 2015. EAES members and attendees at the EAES meeting in Bucharest could vote on these statements and recommendations. In the case of more than 70 % agreement, the statement or recommendation was defined as supported by the scientific community. Results from both the web survey and the consensus meeting in Bucharest are presented as percentages. In total, 46 statements and recommendations were selected for the web survey and consensus meeting. More than 232 members and attendees voted on them. In 41 of 46 statements and recommendations, more than 70 % agreement was reached. All 46 statements and recommendations are presented in this paper. They comprise topics regarding the diagnostic work-up, treatment indications, procedural aspects and post-operative care. The consensus meeting produced 46 statements and recommendations on the diagnostic work-up and management of appendicitis. The majority of the EAES members supported these statements. These consensus proceedings provide additional guidance to surgeons and surgical residents providing care to patients with appendicitis.

  20. Conservative treatment and nursing of acute appendicitis%阑尾炎的保守治疗和护理

    Institute of Scientific and Technical Information of China (English)

    董桂霞

    2013-01-01

    Objective:To explore the method of appendicitis in conservative treatment and effective nursing measures. Methods:a retrospective analysis of our hospital for conservative treatment of 90 cases of acute appendicitis in patients with clinical data, conservative treatment with combination of TCM and Western medicine, and the comprehensive nursing measures. Results:90 patients were cured, 1 cases turned to operation without treatment, among them, 63 cases of conservative treatment after 7 days cure, 27 cases were cured with conservative treatment for 14 days;the average hospital stay was 7.1 days. Conclusion:application of conservative treatment of integrated traditional Chinese and Western medicine, not only eliminates the operation on the patients with fear, and avoid serious complications caused by operation and anesthesia. Nursing science, system contributes to acute appendicitis in conservative treatment of patients, shorten the hospitalization time, reduce the economic burden.%目的:探讨阑尾炎保守治疗的方法及有效护理措施。方法:回顾性分析我院行保守治疗的90例急性阑尾炎患者临床资料,采用中西医结合的保守治疗方法,并采用综合护理措施。结果90例患者均痊愈出院,无1例转为手术治疗,其中,63例保守治疗7日后痊愈,27例保守治疗14天后痊愈;平均住院时间为7.1天。结论应用中西医结合的保守治疗,既消除了患者对手术的恐惧,又避免了手术和麻醉带来的严重并发症。科学、系统的护理措施有助于急性阑尾炎保守治疗患者的痊愈,缩短患者住院时间,降低经济负担。

  1. The significance of urinary beta-2 microglobulin level for differential diagnosis of familial Mediterranean fever and acute appendicitis.

    Science.gov (United States)

    Ugan, Yunus; Korkmaz, Hakan; Dogru, Atalay; Koca, Yavuz Savas; Balkarlı, Ayse; Aylak, Firdevs; Tunc, Sevket Ercan

    2016-07-01

    The clinical and laboratory parameters widely used are not specific to discriminate the abdominal pain due to FMF attack from that of acute appendicitis. The present study aims to investigate the urinary beta-2 microglobulin (U-β2M) level as a potential parameter to identify these two diseases mimicking each other. A total of 51 patients with established FMF diagnosis due to Tel Hashomer criteria on colchicine treatment (1-1.5 mg/day), 15 patients with acute appendicitis who had appropriate clinical picture and were also supported pathologically after the surgery, and 20 healthy controls were enrolled in the study. Of the 51 patients with FMF, 25 were at an attack period, while remaining 26 were not. For the diagnosis of acute attack, as well as physical examination, laboratory tests including white blood cell count, C-reactive protein, and erythrocyte sedimentation rate were performed. From urine specimens U-β2M, microalbumin, and N-acetyl glucosaminidase (U-NAG) were measured. U-β2M levels were significantly higher in acute appendicitis group compared to FMF attack, FMF non-attack, and control groups (p < 0.001, p < 0.001, and p < 0.001, respectively). U-NAG and microalbuminuria were significantly higher in acute appendicitis, FMF attack, and FMF non-attack groups compared to controls (U-NAG p < 0.001, p = 0.016, p = 0.004, microalbuminuria p < 0.001, p < 0.001, p < 0.001, respectively). Microalbuminuria was significantly higher in acute appendicitis group compared to the FMF attack group (p = 0.004). Determination of U-β2M levels may be helpful for differential diagnosis of peritonitis attacks of FMF patients on colchicine treatment and acute appendicitis. However, this finding should be substantiated with other studies.

  2. Localized pseudomembranous colitis in the cecum and ascending colon mimicking acute appendicitis.

    Science.gov (United States)

    Chyung, Ju Won; Shin, Dong Gue

    2013-05-27

    A 61-year-old male was admitted to our hospital due to right lower abdominal pain and watery diarrhea for 3 d. Beginning 3 wk before he arrived in our hospital, he took 3(rd)-generation cephalosporin (cefixime) for 2 wk due to chronic left ear otitis media. Colonoscopic examination revealed yellowish patches of ulcerations and swelling covered with thick serosanguineous exudate in the cecum and ascending colon. After 7 d of oral metronidazole treatment, his symptoms completely disappeared. We report a case of localized pseudomembranous colitis in the cecum and ascending colon mimicking acute appendicitis associated with cefixime.

  3. Enterobius Vermicularis infection of the appendix as a cause of acute appendicitis in a Greek adolescent: a case report.

    Science.gov (United States)

    Efraimidou, Eleni; Gatopoulou, Anthia; Stamos, Charilaos; Lirantzopoulos, Nikolaos; Kouklakis, George

    2008-12-06

    Gastrointestinal infection due to Enterobius vermicularis occurs worldwide and is considered to be the most common helminth infection. The simple presence of E. vermicularis in the appendix usually produces symptoms of acute appendicitis. The association of this parasitic infestation with acute appendicitis varies from 0.2%-41.8% worldwide. We present a case of a 15 year old female with enterobiasis of appendix presented with clinical features of acute appendicitis. The appendix was surgically removed and the specimen was pathologically diagnosed to contain of E. vermicularis in non-inflamed and histologically normal appendix. Even if this condition is not uncommon in the Greek population, to the best of our knowledge this is the first report presented in the English literature.

  4. 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.

  5. 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.

  6. 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.)

  7. The value of ultrasonography in early diagnosis of acute appendicitis%超声检查在急性阑尾炎早期诊断中的价值

    Institute of Scientific and Technical Information of China (English)

    牛子长; 温雪娟; 王小英; 周迎莉

    2012-01-01

    Objective To explore the value of ultrasonography in early diagnosis of acute appendicitis. Methods The clinical date of 118 cases with acute appendicitis analyzed retrospectively. Results There were 118 cases of acute appendicitis, the diagnose accordance rate was 92. 4% , including 28 cases of acute simple appendicitis, the diagnose accordance rate was 85. 7% , 62 cases of acute purulent appendicitis, the diagnosis accordance rate was 96.7% , 16 cases of acute necrosis appendicitis, the diagnosis accordance rate was 93. 6% , 12 cases of blending lump appendicitis, the diagnosis accordance rate was 83. 3%. Conclusion Ultrasonography in early diagnosis of acute appendicitis have a higher value, by combining syndromes history, physical examination, development observation and laboratory medical report and ultrasonic examination can improve diagnosis rate obviously.%目的 探讨超声检查在急性阑尾炎早期诊断中的价值.方法 回顾性分析118例急性阑尾炎患者的临床资料.结果 急性阑尾炎118例,超声诊断符合率92.4%;其中急性单纯性阑尾炎28例,诊断符合率85.7%;急性化脓性阑尾炎62例,诊断符合率96.7%;急性坏疽性阑尾炎16例,诊断符合率93.6%.混合包块型阑尾炎12例,诊断符合率83.3%.结论 超声检查在急性阑尾炎的早期诊断中有较高的价值,结合病史、查体、动态观察及实验室检查可明显提高诊断率.

  8. 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.

  9. Impact of outpatient management following appendectomy for acute appendicitis: An ACS NSQIP-P analysis.

    Science.gov (United States)

    Litz, Cristen N; Stone, Laurie; Alessi, Roberta; Walford, Nebbie E; Danielson, Paul D; Chandler, Nicole M

    2017-06-30

    In 2012, a same-day discharge protocol following appendectomy for acute appendicitis was initiated. Our objective was to determine the success of the protocol by reviewing the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) outcomes following protocol development. The 2015 NSQIP-P Participant Use Data File was queried to identify patients with acute appendicitis who underwent appendectomy. Outcomes were compared to institutional outcomes. There were 154 institutional patients and 4973 from NSQIP-P centers. Institutional rate of outpatient management was higher compared to NSQIP-P (84% vs 48%, ppp=0.2), deep (0.6% vs 0.1%, p=0.17) or organ/space surgical site infections (1.3% vs 0.7%, p=0.31). The incidences of other complications (1.3% vs 0.6%, p=0.26) and 30-day readmissions (3.2% vs 2.6%, p=0.61) were similar. Outpatient management following appendectomy in children is possible with low morbidity and readmission rates. Comparison with other NSQIP-Pediatric centers suggests an opportunity to generalize this practice with considerable savings to the health care system. Prognosis study, level II. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Outcomes after laparoscopic treatment of complicated versus uncomplicated acute appendicitis: a prospective, comparative trial.

    Science.gov (United States)

    Malagon, Antonio M; Arteaga-Gonzalez, Ivan; Rodriguez-Ballester, Lucrecia

    2009-12-01

    Laparoscopic treatment of simple acute appendicitis (AA) is a safe procedure; however, there are doubts about its safety in cases of complicated AA. The aim of this study was to determine the differences in results of laparoscopic treatment between cases of complicated versus simple AA. We prospectively included all patients treated for suspected AA by two surgeons of our service between May 2002 and May 2007. Of 221 patients, 20 were excluded from the study because the laparoscopic approach was not possible; 116 of 201 had uncomplicated AA, 57 complicated AA, 12 gynecologic ethiology, 11 negative appendectomy, and 5 other causes; patients without acute appendicitis were also excluded from the study. In all cases, laparoscopy was the first treatment option. The following variables were considered: mean surgical time, reconversions, emergency readmissions, emergency reinterventions or invasive procedures, mean postoperative hospital stay, and postoperative complications (i.e., infectious or noninfectious). Our results showed statistically significantly worse results, in terms of surgical time, postoperative stay, reconversions, and infectious complications, for patients with complicated versus uncomplicated AA; however, no differences were observed regarding noninfectious complications, emergency readmissions, and emergency reinterventions or invasive procedures. We consider that laparoscopic treatment of complicated AA may be safely used, despite worse results than in cases of simple AA, since the differences in numbers of severe postoperative complications requiring emergency readmission, reintervention, or invasive procedures were not statistically significant.

  11. Barium appendicitis: A single institution review in Japan

    Science.gov (United States)

    Katagiri, Hideki; Lefor, Alan Kawarai; Kubota, Tadao; Mizokami, Ken

    2016-01-01

    AIM To review clinical experience with barium appendicitis at a single institution. METHODS A retrospective review of patients admitted with a diagnosis of acute appendicitis, from January 1, 2013 to December 31, 2015 was performed. Age, gender, computed tomography (CT) scan findings if available, past history of barium studies, pathology, and the presence of perforation or the development of complications were reviewed. If the CT scan revealed high density material in the appendix, the maximum CT scan radiodensity of the material is measured in Hounsfield units (HU). Barium appendicitis is defined as: (1) patients diagnosed with acute appendicitis; (2) the patient has a history of a prior barium study; and (3) the CT scan shows high density material in the appendix. Patients who meet all three criteria are considered to have barium appendicitis. RESULTS In total, 396 patients were admitted with the diagnosis of acute appendicitis in the study period. Of these, 12 patients (3.0%) met the definition of barium appendicitis. Of these 12 patients, the median CT scan radiodensity of material in the appendix was 10000.8 HU, ranging from 3066 to 23423 HU (± 6288.2). In contrast, the median CT scan radiodensity of fecaliths in the appendix, excluding patients with barium appendicitis, was 393.1 HU, ranging from 98 to 2151 HU (± 382.0). The CT scan radiodensity of material in the appendices of patients with barium appendicitis was significantly higher than in patients with nonbarium fecaliths (P < 0.01). CONCLUSION Barium appendicitis is not rare in Japan. Measurement of the CT scan radiodensity of material in the appendix may differentiate barium appendicitis from routine appendicitis.

  12. Pediatric case of acute right-sided abdominal pain: diagnosis is not always appendicitis

    Directory of Open Access Journals (Sweden)

    Elgharbawy F

    2017-06-01

    Full Text Available Fawzia Elgharbawy,1 Khalil Salameh,1 Talal Al Rayes,2 Ibtihal S Abdelgadir3 1Pediatrics Division, Al Wakra Hospital, 2Hamad Medical Corporation, 3Sidra Medical and Research Centre, Doha, Qatar Abstract: Omental infarction (OI is a rare cause of acute abdominal pain occurring in 0.1% of children, which is typically diagnosed during surgery for suspected appendicitis. We present the case of a 7-year-old Pakistani girl. She presented with acute, severe, progressive, right-sided abdominal pain, which was present for 12 hours before presentation. No constitutional symptoms such as fever, anorexia, nausea or vomiting were present. Clinical examination revealed an adequately growing child following the 50th centile. She had severe generalized abdominal tenderness with rebound tenderness and guarding, mainly on the right lower abdominal quadrant, with all other system examinations normal. She had mildly increased inflammatory markers, and her initial abdominal ultrasound scan result was within normal limits. She had laparoscopic surgery following a diagnosis of suspected acute appendicitis; however, an intraoperative diagnosis of OI was made. This was later confirmed by histopathology. This case report highlights the importance of including OI in the differential diagnosis list of acute abdominal pain in children, in addition to the importance of computed tomography (CT as the gold standard tool to aid diagnosis. In the presence of typical symptoms and signs of OI, a CT scan can assist and guide the management of similar cases. This course of action is suggested for the reason that OI typically runs a self-limited course and conservative care may be the most appropriate recommended course of action. Consequently, unnecessary operations could be avoided due to the diagnosis confirmation of studying images. Keywords: omentum, infarction, abdominal pain, child

  13. A hybrid decision support model to discover informative knowledge in diagnosing acute appendicitis

    Directory of Open Access Journals (Sweden)

    Son Chang Sik

    2012-03-01

    Full Text Available Abstract Background The aim of this study is to develop a simple and reliable hybrid decision support model by combining statistical analysis and decision tree algorithms to ensure high accuracy of early diagnosis in patients with suspected acute appendicitis and to identify useful decision rules. Methods We enrolled 326 patients who attended an emergency medical center complaining mainly of acute abdominal pain. Statistical analysis approaches were used as a feature selection process in the design of decision support models, including the Chi-square test, Fisher's exact test, the Mann-Whitney U-test (p Results Of 55 variables, two subsets were found to be indispensable for early diagnostic knowledge discovery in acute appendicitis. The two subsets were as follows: (1 lymphocytes, urine glucose, total bilirubin, total amylase, chloride, red blood cell, neutrophils, eosinophils, white blood cell, complaints, basophils, glucose, monocytes, activated partial thromboplastin time, urine ketone, and direct bilirubin in the univariate analysis-based model; and (2 neutrophils, complaints, total bilirubin, urine glucose, and lipase in the multivariate analysis-based model. The experimental results showed that the model with univariate analysis (80.2%, 82.4%, 78.3%, 76.8%, 83.5%, and 80.3% outperformed models using multivariate analysis (71.6%, 69.3%, 73.7%, 69.7%, 73.3%, and 71.5% with entry and removal criteria of 0.01 and 0.05; 73.5%, 66.0%, 80.0%, 74.3%, 72.9%, and 73.0% with entry and removal criteria of 0.05 and 0.10 in terms of accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and area under ROC curve, during a 10-fold cross validation. A statistically significant difference was detected in the pairwise comparison of ROC curves (p p Conclusions The decision model developed in this study can be applied as an aid in the initial decision making of clinicians to increase vigilance in cases of suspected acute

  14. Diagnostic value of maximal-outer-diameter and maximalmural- thickness in use of ultrasound for acute appendicitis in children

    Institute of Scientific and Technical Information of China (English)

    Bo-Kyung Je; Sung-Bum Kim; Seung Hwa Lee; Ki Yeol Lee; Sang Hoon Cha

    2009-01-01

    AIM: To evaluate the maximal-outer-diameter (MOD) and the maximal-mural-thickness (MMT) of the appendix in children with acute appendicitis and to determine their optimal cut-off values to diagnose acute appendicitis. METHODS: In total, 164 appendixes from 160 children between 1 and 17 years old (84 males, 76 females; mean age, 7.38 years) were examined by high-resolution abdominal ultrasound for acute abdominal pain and the suspicion of acute appendicitis. We measured the MOD and the MMT at the thickest point of the appendix. Patients were categorized into two groups according to their medical records: patients who had surgery (surgical appendix group) and patients who did not have surgery (non-surgical appendix group). Data were analyzed by MedCalc v.9.3. The rank sum test (Mann-Whitney test) was used to evaluate the difference in the MOD and the MMT between the two groups. ROC curve analysis was used to determine the optimal cut-off value of the MOD and the MMT on diagnosis of acute appendicitis.RESULTS: There were 121 appendixes (73.8%) in the non-surgical appendix group and 43 appendixes (26.2%) in the surgical appendix group. The median 26.2%) in the surgical appendix group. The median MOD differed significantly between the two groups (0.37 cm vs 0.76 cm, P 0.57 cm (sensitivity 95.4%, specificity 93.4%) and > 0.22 cm (sensitivity 90.7%, specificity 79.3%), respectively. CONCLUSION: The MOD and the MMT are reliable criteria to diagnose acute appendicitis in children. An MOD > 0.57 cm and an MMT > 0.22 cm are the optimal criteria.

  15. 64排螺旋CT重建技术在急性阑尾炎诊断中的应用价值%application of 64-Slice Spiral CT Reconstruction Technique in diagnosis of acute appendicitis

    Institute of Scientific and Technical Information of China (English)

    任春慧; 冯华; 梁爽; 曲世巍

    2013-01-01

    Objective To investigate the effectiveness of 64-slice spiral CT reconstruction technique in diagnosis of acute appendicitis. Methods Retrospective analysis of 64-slice spiral CT scan images was performed on 60 patients who underwent abdominal 64-slice spiral CT scans and were confirmed through clinical pathology as acute appendicitis sufferers. After multi-planar and curve reconstruction of all the images in the workstation, observation and analysis of appendicitis were made on the size, morphology and surrounding changes. Results Among 60 patients with acute appendicitis, 21 cases were found acute simple appendicitis, 32 superlative appendicitis, 5 appendiceal abscess, 2 appendiceal perforation. Two kinds of features - direct and indirect features could be gained from 64-slice spiral CT findings. Direct features include thickened and enlarged appendicitis(diameter> 6 mm), thickened wall of the appendicitis, appendicitis calculus. Indirect features included inflammation, abscess or inflammatory mass around the appendicitis, free intraperitoneal gas and swelling local lymph nodes. Conclusion Acute appendicitis had typical features in its CT iamges. Application of 64-slice spiral CT reconstruction techniques could have a better reveal of appendicitis and its surrounding circumstances, which significantly improved the diagnosis of appendicitis and was of great application value.%  目的探讨64排螺旋CT重建技术在急性阑尾炎诊断中的应用价值。方法对60例经临床病理证实的急性阑尾炎患者的64排螺旋CT扫描资料进行回顾性分析,所有患者行全腹部64排螺旋平扫,所得图像在工作站进行多平面及曲面重建,对阑尾的大小、形态及周围改变进行观察分析。结果60例资料中,急性单纯性阑尾炎21例、化脓性阑尾炎32例、阑尾脓肿5例、阑尾穿孔2例。64排螺旋CT直接征象为阑尾增粗、增大(直径>6 mm),阑尾壁增厚,阑尾结石;间接征象

  16. 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.

  17. Acute appendicitis: Is removal of a normal appendix still existing and can we reduce its rate?

    Directory of Open Access Journals (Sweden)

    Khairy Gamal

    2009-01-01

    Full Text Available Background/Aim: To determine the incidence of negative appendectomies and to identify factors that may reduce the risk of having the normal appendices removed surgically. Design: Cross-sectional study. Setting: College of Medicine and King Khalid University Hospital, Riyadh, Saudi Arabia. Materials and Methods: The surgical and histological data of 852 patients who underwent appendicectomy were reviewed. All incidental or interval appendicectomies were excluded. Only patients who were admitted and whose appendices were removed and subjected to histology were included (585 patients. The data on patients who had a normal appendix on histology further analyzed to include demographics, specific investigations, operative findings of the appendix and additional operative findings that need other surgical procedures. Results: A normal appendix was removed in 54 (9.2% of the patients. Only 5.5% of those patients had a computed tomography (CT scan preoperatively and 3.7% had diagnostic laparoscopy. In 21 patients, additional operative and histological findings were obtained that might have caused the right lower abdominal pain. Conclusion: In spite of the advances in the diagnostic and imaging techniques, the rates of negative findings on appendicectomy have not decreased much. Clinical judgment is still the most important factor in the management of patients with suspected acute appendicitis. The routine use of CT scan or diagnostic laparoscopy for all patients who are suspected to have appendicitis is neither cost-effective nor safe.

  18. INCIDENCE, RISK FACTORS AND COMPLICATIONS OF ACUTE PERFORATED AND NON - PERFORATED APPENDICITIS IN A RURAL SETUP OF ANDHRA PRADESH

    Directory of Open Access Journals (Sweden)

    Anil Kumar

    2015-05-01

    Full Text Available Appendicitis is one of the most common surgical emergencies. The incidence of appendicitis and chances of complication in the form of perforation are dependent on both the patients and non - patient factors . There are various studies conducted to address this problem, but there are no studies conducted to look in to the incidence of appendicitis in east Godavari district of Andhra Pradesh. Our study was aimed to bridge thi s gap. METHOD S AND MATERIALS: this was a retrospective study, patient data from 2009 - 2014 was analyzed and the age, distance from hospital, educational and socioeconomic background of the patients was collected. The duration between first appearance of sy mptoms and hospitalization was recorded. The incidence of post - op complication was also recorded. RESULTS: T he incidence of perforation was 15% in our study population, most of the patients were from low socioeconomic group and having income less than 5000 /month. The middle age group between 30 - 40 years was commonly affected by the appendicitis. The time laps between appearance of symptoms and hospitalization was found to be a predominant factor in the perforation. Surgical site infection was most common co mplication in the patients treated. CONCLUSION: T he incidence of perforation is still high and the time laps between first appearance of symptoms and hospitalization is a major determinant of perforation or complication in the appendicitis.

  19. 急性阑尾炎超声鉴别及漏误诊分析%Application of Ultrasound for Differential Diagnosis in Acute Appendicitis and the Analysis of Reasons for Missed Diagnosis and Misdiagnosis

    Institute of Scientific and Technical Information of China (English)

    贾莉; 宗华凤; 王希春; 温爽; 宋涛

    2013-01-01

    目的 探讨超声在急性阑尾炎鉴别诊断中的应用及漏误诊原因,进一步提高诊断准确率.方法 回顾性分析103例临床疑似急性阑尾炎声像图表现,对照手术病理.结果 急性阑尾炎93例,超声确诊84例,漏诊7例,误诊2例,超声诊断敏感度90.3%、特异性90.0%、准确性90.3%、漏诊率7.5%、误诊率2.2%.非急性阑尾炎10例,超声确诊9例,误诊1例,超声鉴别诊断准确率90.0% (9/10).结论 急性阑尾炎超声鉴别诊断具有重要价值,密切结合临床拓宽超声检查思路是减少漏误诊的关键.%Objective To investigate the value of ultrasound for differential diagnosis in acute appendicitis, and to summarize the reasons of missed diagnosis and misdiagnosis, so as to further improve the diagnostic accuracy. Methods The sonograma of 103 cases suspected clinically as acute appendicitis were retrospectively analyzed and compared with operation and pathology. Results Totally 93 cases of acute appendicitis were proved. 84 cases were diagnosed correctly by preoperative ultrasound, 7 cases were missed diagnosed, 2 cases were misdiagnosed. The sensitivities, specificities, accuracies, missed diagnosis rate and misdiagnosis rate of ultrasound in the diagnosis of acute appendicitis were 90. 3% , 90. 0% , 90. 3% , 7. 5% and 2. 2% , respectively. Ten cases of non - acute appendicitis were proved. 9 cases were diagnosed correctly by ultrasound, and 1 cases were misdiagnosed. The differential diagnosis concordance rate was 90.0% (9/10) in non -acute appendicitis. Conclusion Ultrasound has important value for differential diagnosis of acute appendicitis. Marriage with clinic and broadening the ultrasound examination ideas are the keys of reducing missed diagnosis and misdiagnosis.

  20. Evaluation of modified Alvarado score in the diagnosis of acute appendicitis

    Directory of Open Access Journals (Sweden)

    Abhinandan B. Vandakudri

    2016-01-01

    Results: The result of the study showed that high scores in men and children (7-9 had a sensitivity of 92.3% and 83.3% respectively, whereas in females it had a sensitivity of 72.7%. The score (5-6 in males and females had a sensitivity of 57% and 50% respectively. Conclusions: The high scores in modified Alvarado score is dependable aid in the early diagnosis of acute appendicitis in men and children but it's not true as far as women are considered. Ultrasonography of abdomen is a useful tool in avoiding negative appendicectomy rates particularly in females. [Int J Res Med Sci 2016; 4(1.000: 84-88

  1. 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...... 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......%. Of the 21 predictive factors for acute appendicitis 11 were significant (p 10 x 10[9]/1), migration of pain to the right lower quadrant, gradual onset of pain, increasing intensity of pain, pain aggravated by movement, pain aggravated by coughing, anorexia, vomiting...

  2. The features of physical diagnosis for acute appendicitis in children%小儿急性阑尾炎的检体诊断特征分析

    Institute of Scientific and Technical Information of China (English)

    雷学锋; 柳良好; 刘丹丹; 鲍俏; 张刚

    2016-01-01

    目的:探讨不同年龄段的小儿急性阑尾炎腹部检体诊断特点。方法将手术证实的431例小儿急性阑尾炎患儿分为新生儿组、婴幼儿组、学龄前组、学龄期组,对各组检体情况进行回顾性分析,总结其各自特点。结果新生儿组3例(0.70%)以腹胀、精神差、肠鸣音改变等为主,婴幼儿组31例(7.19%)以叩痛、减速带试验阳性、反跳痛等为主,学龄前组162例(37.59%)以叩痛、反跳痛、肠鸣音改变等为主,学龄期组235例(54.52%)以叩痛、减速带试验阳性、反跳痛等为主。结论各年龄段小儿急性阑尾炎的腹部检体诊断特点不相同,细致、准确的检体可提供重要诊断依据。%Objective To investigate the features of physical diagnosis for acute appendicitis in the children of different age periods. Methods Four hundred and thirty⁃one cases with acute appendicitis ( postoperative diagnosis) were enrolled in this study,and divided into newborn,infant,preschool,and school age⁃groups. The clinical physical diagnosis of each group was retrospectively analyzed to summarize the features. Results Three newborns ( accounting for about 0. 70%) were characterized by abdominal distention,bad spirit, weak bowel sounds, and so on. Thirty⁃one infants′ ( 7. 19%) physical diagnosis were mainly percussion pain,positive speed humps test,rebound tenderness.The features of preschool group (162 cases,37. 59%) were mainly percussion pain, rebound tenderness, bowel sounds changing. The features of school age group (235 cases,54.52%) were principally percussion pain,speed humps test positive,rebound tenderness. Conclusions There are discrepancies between four age⁃groups in the features of acute appendicitis.Detailed and accurate physical diagnosis can provide important diagnostic evidences of acute appendicitis in children.

  3. 28例急性阑尾炎CT诊断与临床诊断对照分析%CT diagnosis and clinical diagnosis of acute appendicitis control analysis

    Institute of Scientific and Technical Information of China (English)

    黄秋林

    2014-01-01

    Objective CT in the diagnosis of acute appendicitis and its clinical significance.Methods Retrospective analysis of CT scan data of our hospital in 2009-2012 were 28 cases of atypical clinical manifestations in patients with acute appendicitis and other similar clinical manifestations of disease in patients with acute appendicitis, CT diagnostic results with the results of the surgery, pathology or clinical fol ow-up control.Results CT diagnosis of acute appendicitis in 24 cases, 21 cases as true positive, 3 were false-positive diagnosis of acute appendicitis four cases.Conclusion CT in the diagnosis of acute appendicitis with high accuracy, specificity and sensitivity, and timely identification of other diseases other than appendicitis, is of great significance to the clinical treatment options.%目的:探讨CT检查对急性阑尾炎的诊断及临床意义。方法回顾性分析我院2009-2012年收治的28例临床表现不典型的急性阑尾炎患者及其他疾病临床表现类似急性阑尾炎患者的CT检查资料、CT诊断结果与手术、病理或临床随访结果对照。结果 CT诊断急性阑尾炎24例,21例为真阳性,3例为假阳性,未诊断急性阑尾炎4例。结论 CT检查对急性阑尾炎的诊断具有较高的准确度、特异度及敏感度,而且能及时地发现除阑尾炎以外的其他病变,对临床治疗方案的选择具有重要意义。

  4. Acute appendicitis: should the laparoscopic approach be proposed as the gold standard? Six-year experience in an Emergency Surgery Unit

    Science.gov (United States)

    GUERCIO, G.; AUGELLO, G.; LICARI, L.; DAFNOMILI, A.; RASPANTI, C.; BAGARELLA, N.; FALCO, N.; ROTOLO, G.; FONTANA, T.; PORRELLO, C.; GULOTTA, G.

    2016-01-01

    Acute appendicitis is common in an Emergency Surgery Unit. Although the laparoscopic approach is a method accepted for its treatment, no strong data are available for determining how many procedures must an experienced surgeon carry out for obtaining all the advantages of this technique and if this approach can become the gold standard in the activity of a general emergency unit with senior surgeons variously skilled on the basic laparoscopy. 142 patients that underwent appendectomy (90 laparoscopic, 52 conventional) for acute appendicitis were enrolled in this institutional retrospective cohort study. The surgeons were classified with a descriptor-based grading and divided in two groups regarding the skill. The only relevant result of our study was the significant reduction of conversion rate in case of laparoscopic approach. No strong differences were found concerning the duration of the procedure and the hospital stay between the two groups. The rate of complications were very low in both groups. In conclusion, the experienced surgeons can easily perform a laparoscopic approach independently from the specific skill in this approach. PMID:27938536

  5. 急性阑尾炎术后切口感染的防治%Prevention of wound infection after acute appendicitis

    Institute of Scientific and Technical Information of China (English)

    张崇广; 王文江

    2016-01-01

    目的:探讨综合措施预防急性阑尾炎术后切口感染的效果。方法选取2008年1月~2014年12月我院接受急性阑尾炎手术患者363例作为研究对象,从术前刷手、皮肤消毒等到术中操作以及术后围手术期处理的各个环节进行回顾性分析。结果本组患者仅发生切口感染3例,感染发生率为0.8%。结论采取综合方法预防阑尾术后切口感染,明显降低切口感染率,效果满意。%Objective To explore effective comprehensive measures of acute appendicitis postoperative infection prevention.Methods 363 cases of acute appendicitis from preoperative surgical scrub,skin disinfection until surgery operations and all aspects of perioperative treatment were analyzed retrospectively.Results Wound infection occurred in this group only three cases,the infection rate was 0.8%.Conclusion We take an integrated approach to the prevention of wound infection after appendectomy,signiifcantly reduced wound infection rate,results were satisfactory.

  6. Stump Appendicitis: A Clinical Enigma.

    Science.gov (United States)

    Çiftci, F; Abdurrahman, I; Tatar, Z

    2015-01-01

    Appendectomy is one of the most frequently performed operations. Stump appendicitis, as a postoperative complication of appendectomy, is inflammation of the remnant residue when an incomplete excision occurs. We present a patient with stump appendicitis who had been operated on, laparoscopically, for acute appendicitis 6 months before. The patient was diagnosed with acute appendicitis, underwent surgery, and was discharged on postoperative day 3 without complications. Stump appendicitis is a rare cause of acute abdominal disease but should be considered in the differential diagnosis. Ultrasonography is helpful in the diagnosis.

  7. Diagnosis and Treatment of Mucinous Appendiceal Neoplasm Presented as Acute Appendicitis

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    Ioannis Kehagias

    2016-01-01

    Full Text Available Appendiceal mucocele is a rare cause of acute abdomen. Mucinous appendiceal neoplasms represent 0.2–0.7% of all appendix specimens. The aim of this study is to report a case of a mucinous appendiceal neoplasm presented as acute appendicitis, discussing the clinical and surgical approach in the emergency setting. A 72-year-old female patient was admitted to the emergency department with a clinical examination indicative of acute abdomen. The patient underwent abdominal computed tomography scan which revealed a cystic lesion in the right iliac fossa measuring 8.3 × 5.2 × 4.1 cm, with calcified walls, and a mean density indicative of high protein content. The patient was taken to the operating room and a right hemicolectomy was performed. The postoperative course was unremarkable. The histopathological examination revealed a low-grade mucinous appendiceal neoplasm with negative regional lymph nodes. Ultrasound and CT are useful in diagnosing appendiceal mucocele and synchronous cancers in the emergency setting. The initial operation should include appendectomy and resection of the appendicular mesenteric fat along with any fluid collection for cytologic examination. During urgent appendectomy it is important to consider every mucocele as malignant in order to avoid iatrogenic perforation causing pseudomyxoma peritonei. Although laparotomy is recommended, the laparoscopic approach is not contraindicated.

  8. Appendicitis in Children: Evaluation of the Pediatric Appendicitis Score in Younger and Older Children

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    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. Endoloops or endostapler use in laparoscopic appendectomy for acute uncomplicated and complicated appendicitis : No difference in infectious complications.

    Science.gov (United States)

    van Rossem, Charles C; van Geloven, Anna A W; Schreinemacher, Marc H F; Bemelman, Willem A

    2017-01-01

    The most appropriate closure for the appendicular stump with either endoloops or an endostapler in laparoscopic appendectomy remains unclear and under debate because of limited and conflicting evidence. In a 2-month prospective, observational, resident-led nationwide cohort study, patients undergoing laparoscopic appendectomy for both uncomplicated and complicated appendicitis were analysed. Logistic regression analyses were performed for identifying the possible effect of stump closure type and other risk factors for infectious complications. Laparoscopic appendectomy for acute appendicitis was performed in 1369 patients in 62 hospitals; endoloops were used in 76.7 % and an endostapler in other patients. Median operating time was not different between endoloop and endostapler use (42.0 vs. 44.0 min, P = 0.243). A superficial surgical site infection was seen in 2.0 % after uncomplicated appendicitis and in 0.8 % after complicated appendicitis. The intra-abdominal abscess rate was 1.9 % after uncomplicated and 11.0 % after complicated appendicitis. No significant effect of stump closure type was observed for any infectious complication (OR 1.05; 95 % CI 0.625-1.766, P = 0.853) or an intra-abdominal abscess (OR OR 0.96; 95 % CI 0.523-1.768, P = 0.899). In multivariable analysis, complicated appendicitis was identified as the only independent risk factor for an intra-abdominal abscess (OR 6.26; 95 % CI 3.454-11.341, P < 0.001). The infectious complication rate is not influenced by the type of appendicular stump closure with either endoloops or an endostapler in this study. If technically feasible, closure with endoloops is advised for cost considerations.

  10. 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.

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

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    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

  12. Complicated acute appendicitis presenting as a rapidly progressive soft tissue infection of the abdominal wall: a case report.

    Science.gov (United States)

    Beerle, Corinne; Gelpke, Hans; Breitenstein, Stefan; Staerkle, Ralph F

    2016-12-01

    We report a case of a rare complication of acute appendicitis with perforation through the abdominal wall. The case points out that an intraabdominal origin should be considered in patients presenting with rapidly spreading soft tissue infections of the trunk. A 58-year-old European woman presented to our hospital with a 1-week history of severe abdominal pain accompanied by rapidly spreading erythema and emphysema of the lower abdomen. On admission, the patient was in septic shock with leukocytosis and elevation of C-reactive protein. Among other diagnoses, necrotizing fasciitis was suspected. Computed tomography showed a large soft tissue infection with air-fluid levels spreading through the lower abdominal wall. During the operation, we found a perforated appendicitis breaking through the fascia and causing a rapidly progressive soft tissue infection of the abdominal wall. Appendicitis was the origin of the soft tissue infection. The abdominal wall was only secondarily involved. Even though perforated appendicitis as an etiology of a rapidly progressive soft tissue infection of the abdominal wall is very rare, it should be considered in the differential diagnosis of abdominal wall cellulitis. The distinction between rapidly spreading subcutaneous infection with abscess formation and early onset of necrotizing fasciitis is often difficult and can be confirmed only by surgical intervention.

  13. Apendicite aguda: modelo experimental em coelhos Acute appendicitis: model experimental in rabbits

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    João EBRAM-NETO

    2000-04-01

    Full Text Available Com objetivo de estudar experimentalmente as diversas fases evolutivas da apendicite aguda, foram utilizados 60 coelhos (Oryctogalus cuniculus, fêmeas, da linhagem Nova Zelândia, com peso variando de 2510 a 3040 gramas. Os animais foram divididos em dois grupos denominados controle e experimento, e estes subdivididos em três subgrupos com períodos de observação de 12, 24 e 48 horas. No grupo experimento foi realizada a oclusão do lume apendicular por meio de sutura seromuscular circular a 8 cm da extremidade distal do apêndice cecal, com fio de polipropileno 4-0. No controle foi feita somente a simulação da cirurgia. Os aspectos macroscópicos (aumento do tamanho, necrose, perfuração, aderência e secreção na cavidade abdominal bem como os microscópicos do grupo experimento, evidenciaram uma progressão das alterações anatomopatológicas mostrando haver uma relação entre a intensidade dos achados histopatológicos e o tempo de observação. Conclui-se que o método utilizado causa apendicite aguda com alterações anatomopatológicas distintas, de acordo com a fase evolutiva da doença.The evolving phases of acute appendicitis were studied experimentally. Sixty female rabbits (Oryctogalus cuniculus of New Zealand lineage weighing about 2510 to 3040 g were divided in two groups: a control group and experimental group. The experimental group was divided into three subgroups for observation after 12, 24 and 48 hours of the operation, that consisted on a 4-0 polypropylene circular suture at 8 cm from the distal part of the cecal appendix. The control group was sham operated. The macroscopic exam (increase of the appendix volume, necrosis, perfuration, adherence and secretion in the abdominal cavity and the microscopic finding showed a progression in the anatomopathological alterations. There was a close relationship between the histopathological findings and time after the appendiceal obstruction. We conclude that the method

  14. Laparoscopic Appendectomy in Pregnancy With Acute Appendicitis: Single Center Experience With World Review.

    Science.gov (United States)

    Maimaiti, Abudukaiyoumu; Aierkin, Amina; Mahmood, KhanMuddassar; Apaer, Shadike; Maimaiti, Yilihamu; Yibulayin, Xiaokaiti; Li, Tao; Zhao, Jin-Ming; Tuxun, Tuerhongjiang

    2017-10-09

    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.

  15. 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.

  16. 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.

  17. MSCT重建技术在急性阑尾炎诊断及鉴别诊断中的应用%Application of MSCT Reconstruction Technique in Diagnosis and Differential Diagnosis of Acute Appendicitis

    Institute of Scientific and Technical Information of China (English)

    孙振平; 刘振元; 朱亚亮

    2014-01-01

    目的:探讨多层螺旋CT(MSCT)及重建技术在急性阑尾炎诊断及鉴别诊断中的应用价值。方法:回顾性分析57例临床拟诊急性阑尾炎病例,均行MSCT扫描,并在工作站进行MPR、CPR图像重建后综合分析CT表现,然后与临床病史及术后结果对照。结果:57例病例中,急性单纯性阑尾炎31例,急性化脓性阑尾炎9例,穿孔性阑尾炎7例,阑尾周围脓肿4例;回盲部肿瘤2例,阑尾黏液囊肿1例,大网膜囊肿1例,右侧输尿管结石1例,血管或肠管误认为阑尾1例。结论:MSCT扫描并结合MPR、CPR重建技术可明确显示阑尾及周围组织、器官的相关情况,在急性阑尾炎的诊断及鉴别诊断中有较高应用价值。%Objective:To explore the application value of multi-slice spiral CT(MSCT)and reconstruction techniques in the diagnosis and differential diagnosis of acute appendicitis.Method:A retrospective analysis of 57 clinical cases suspected acute appendicitis:scanned with multilayer spiral CT,reconstructed MPR and CPR images at workstation, then composite analyzed of CT findings,compared CT findings with clinical history and postoperative findings.Result:Among the 57 cases,31 cases of acute simple appendicitis,9 cases of acute suppurative appendicitis,7 cases of perforated appendicitis,4 cases of appendiceal abscess;ileocecal tumor in 2 cases,1 case of mucocele of the appendix,1 case of omental cyst,1 case of right ureter stones,1 case of intestinal vascular or mistaken railing tail.Conclusion:MSCT scanning combined with MPR,CPR reconstruction techniques can be clearly demonstrated appendix and surrounding tissues and organs of the relevant circumstances,in acute appendicitis diagnosis and differential diagnosis has a higher application value.

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

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    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.

  19. Lessons to be learned: a case study approach--acute appendicitis masquerading as macroamylasaemia.

    Science.gov (United States)

    Ganesh, Muniappan; Salam, Imroz

    2008-05-01

    Macroamylasaemia is a condition in which serum amylase is elevated in the presence of a low to normal urinary amylase and normal renal function. It is rare but can masquerade as other clinical disorders. Discussed here is a case report of a patient who presented initially with abdominal pain (later recognized as being due to gangrenous appendicitis) and in whom there was a very high serum amylase level, leading to an erroneous initial diagnosis and management as acute pancreatitis. The CT scan of the abdomen was normal without any evidence of pancreatitis. Subsequently, the renal amylase:creatinine clearance ratio (C(am)/C(cr)) was found to be low, being characteristic and diagnostic of macroamylasaemia; the latter was, in turn, the cause for the elevated serum amylase level. The underlying macroamylasaemia had thus masqueraded as pancreatitis. The patient underwent appendicectomy and hence made an excellent recovery. It is vitally important to recognize this condition in order to avoid both an incorrect diagnosis and inappropriate treatment/management.

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

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    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.

  1. The Role of DNA Amplification and Cultural Growth in Complicated Acute Appendicitis

    Science.gov (United States)

    Tocchioni, Francesca; Tani, Chiara; Bartolini, Laura; Moriondo, Maria; Nieddu, Francesco; Pecile, Patrizia; Azzari, Chiara; Messineo, Antonio; Ghionzoli, Marco

    2016-01-01

    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. PMID:27777701

  2. 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.)

  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...... the blood results and re-evaluate their diagnosis. The surgeon's diagnosis before and after was compared with the final diagnosis defined by surgical findings or follow-up. The gold standard was any degree of appendicitis on histology. RESULTS: A total of 226 patients were included of whom 91 (40.3%) had...

  4. The validity and reliability of iridology in the diagnosis of previous acute appendicitis as evi-denced by appendectomy

    Directory of Open Access Journals (Sweden)

    L. Frank

    2013-01-01

    Full Text Available Iridology is defined as a photographic science that identifies pathological and functional changes within organs via biomicroscopic iris assessment for aberrant lines, spots, and discolourations. According to iridology, the iris does not reflect changes  during  anaesthesia,  due  to  the  drugs inhibitory  effects  on  nerves  impulses,  and  in cases of organ removal, it reflects the pre-surgical condition.The profession of Homoeopathy is frequently associated with iridology and in a recent survey (2009  investigating  the  perceptions  of  Masters of  Technology  graduates  in  Homoeopathy  of University of Johannesburg, iridology was highly regarded as a potential additional skill requirement for assessing the health status of the patient.This  study  investigated  the  reliability  of iridology  in  the  diagnosis  of  previous  acute appendicitis, as evidenced by appendectomy. A total of 60 participants took part in the study. Thirty of the 60 participants had an appendectomy due to acute appendicitis, and 30 had had no prior history  of  appendicitis.  Each  participant’s  right iris  was  documented  by  photography  with  the use  of  a  non-mydriatic  retinal  camera  that  was reset for photographing the iris. The photographs were then randomized by an external person and no identifying data made available to the three raters.  The  raters  included  the  researcher,  who had little experience in iridology and two highly experienced  practising  iridologists.  Data  was obtained  from  the  analyses  of  the  photographs wherein  the  presence  or  absence  of  lesions (implying acute appendicitis was indicated by the raters. None of the three raters was able to show a significant  success  rate  in  identifying  correctly the  people  with  a  previous  history  of  acute appendicitis and resultant appendectomies

  5. 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...

  6. 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.)

  7. 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.

  8. 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.

  9. 小儿急性化脓性阑尾炎150例治疗分析%Clinical Analysis of Pediatric Acute Suppurative Appendicitis of 150 Cases

    Institute of Scientific and Technical Information of China (English)

    安俊军; 张生格

    2015-01-01

    Objective To summarize diagnosis and treatment of infantile suppurative appendicitis, in order to im-prove the comprehensive understanding of infantile suppurative appendicitis,reduce the occurrence of postoperative com-plications.Methods 860 cases of appendicitis in children with clinical medical records of the statistics, of which the clinical data of 150 cases of children with purulent appendicitis were retrospectively analyzed.Results All 150 cases were performed surgical treatment, 62 cases of traditional laparotomy, laparoscopic surgery in 88 cases, 2 cases of lapa-roscopic transfer laparotomy.Preoperative diagnosis and postoperative diagnosis of 138 cases of appendicitis, coincidence rate was 92.0% .Postoperative complications in 11 cases, mergers were recovered and discharged, no deaths.Conclusions Children with acute suppurative appendicitis small age of perforation rate is high, the clinician should be detailed history, careful physical examination, reasonable use of auxiliary examination, comprehensive analy-sis, as far as possible the diagnosis of early diagnosis, timely surgical treatment, reduce the incidence rate of perforation, reduce the occurrence of postoperative complications.%目的:总结小儿化脓性阑尾炎的临床诊治,提高临床医师对于小儿化脓性阑尾炎的全面认识,做到早诊断,早治疗,并减少术后并发症的发生。方法对收治的860例阑尾炎患儿临床病历资料进行统计,其中150例化脓性阑尾炎患儿的临床资料进行回顾性分析、总结。结果本组150例均行手术治疗,行传统开腹手术62例,腹腔镜手术88例,腹腔镜中转开腹2例,术后阑尾标本行病理检查:化脓性阑尾炎150例,平均就诊时间为32.5 h,临床症状表现为:腹痛、发热、恶心与呕吐、腹泻、肠梗阻、腹部压痛等,术前诊断与术后诊断均为阑尾炎者138例,符合率为92.0%。术后合并并发症11例,均痊愈出院,

  10. Polymorphisms in the IL-6 and IL-6R receptor genes as new diagnostic biomarkers of acute appendicitis: a study on two candidate genes in pediatric patients with acute appendicitis

    OpenAIRE

    Sarsu, Sevgi Büyükbeşe; Yılmaz, Şenay Görücü; Bayram, Ali; Denk, Affan; Kargun, Kürşat; Sungur, Mehmet Ali

    2015-01-01

    Background Acute appendicitis (AA) (OMIM: 107700) is an inflammatory disease which is characterized by appendiceal inflammation. Genetic and environmental factors contribute to the development of AA. Especially, multiple genetic factors appear to be promising in the explanation of etiopathogenesis of AA. IL-6 (Interleukin-6) is an inflammatory cytokine and IL-6 receptor (IL-6R) plays an important role in the immune response. IL-6 (-572G/C rs1800796) and IL-6R (1:G.154448302 T > C rs7529229) g...

  11. Acute burn during pregnancy: A retrospective study

    Directory of Open Access Journals (Sweden)

    Ezzatollah Rezaei

    2016-01-01

    Full Text Available Background & aim: The incidence of acute burn injuries in pregnant women is very low. Burn injuries during pregnancy are often associated with a high rate of fetal and maternal mortality and morbidity. In this study, we aimed to review the cases of acute burn during pregnancy and evaluate the outcome of these patients in Mashhad, Iran. Methods:This retrospective study was performed using the medical records of 48 pregnant women with thermal injuries over a 13-year period. Results: The results showed that 8 (16.7%, 27 (56.3%, and 13 (27.1% patients were in the first, second, and third trimesters of pregnancy. Moreover, 14 mothers (29.2% died, 24 (50.0% were discharged without any fetal problems, eight (16.7% had fetal death, 13 (27.1% had abortion, two (4.2% had normal vaginal delivery, and one (2.1% underwent normal caesarean section. Conclusion: The rate ofmaternal survival in the first and second trimesters was higher than the third one. In the third trimester, pregnancy termination is indicated only after fetal maturation.

  12. 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.

  13. Analysis of the features of sonogram in acute appendicitis%急性阑尾炎65例超声声像图分析

    Institute of Scientific and Technical Information of China (English)

    金亮培

    2012-01-01

    Objective To evaluate the feastures of sonogram and the diagnostic value of ultrasonography in acute appendicitis. Methods 65 cases of acute appendicitis were examined with ultrasonography. The features of sonogram overe analyzed and compared with postoperative pathology. Results The ultrasonic features of acute appendicitis were notable in 65 cases, different pathological type of appendicitis show different ultrasonographic features. Conclusion Ultrasonography has great value in the diagnosis and classification of acute appendicitis.%目的探讨急性阑尾炎的声像图特征和诊断价值。方法回顾65例急性阑尾炎的超声检查资料,分析不同病理类型急性阑尾炎的声像图特征。结果65例患者中超声检查均有明显的超声声像图改变,各型急性阑尾炎之间存在声像图区别。结论超声检查对急性阑尾炎的诊断和分型具有重要的临床价值。

  14. Summer Appendicitis

    African Journals Online (AJOL)

    hanumantp

    diet, during summer months could be contribute to the higher incidence of appendicitis ... To examine the global trends in the seasonality of appendicitis, .... Iran. Summer. [11]. 1998-2004. 1331. Italy. Summer. [12]. 1991-1998. 65,675. Canada.

  15. A young man with concurrent acute appendicitis and incarcerated right indirect inguinal hernia

    Directory of Open Access Journals (Sweden)

    Farwana M

    2016-04-01

    Full Text Available Mohammad Farwana,1 Reem Farwana,2 Ikram Nasr3 1King's College London, London, 2University of Birmingham, Birmingham, 3Guy's and St Thomas' Hospital, London, UKWe read with great interest the expert opinion of Ditsatham et al1 on an extremely interesting case. Ditsatham describes a patient who presented with both appendicitis and an indirect inguinal hernia. There is very little known on the subject of concurrent appendicitis and hernia throughout the literature. There were some aspects to the history that stood out.View original paper by Ditsatham and colleagues.

  16. Underestimated Amoebic Appendicitis among HIV-1-Infected Individuals in Japan

    Science.gov (United States)

    Kobayashi, Taiichiro; Yano, Hideaki; Murata, Yukinori; Igari, Toru; Nakada-Tsukui, Kumiko; Yagita, Kenji; Nozaki, Tomoyoshi; Kaku, Mitsuo; Tsukada, Kunihisa; Gatanaga, Hiroyuki; Kikuchi, Yoshimi; Oka, Shinichi

    2016-01-01

    ABSTRACT Entamoeba histolytica is not a common causative agent of acute appendicitis. However, amoebic appendicitis can sometimes be severe and life threatening, mainly due to a lack of awareness. Also, its frequency, clinical features, and pathogenesis remain unclear. The study subjects were HIV-1-infected individuals who presented with acute appendicitis and later underwent appendectomy at our hospital between 1996 and 2014. Formalin-fixed paraffin-embedded preserved appendix specimens were reexamined by periodic acid-Schiff (PAS) staining and PCR to identify undiagnosed amoebic appendicitis. Appendectomies were performed in 57 patients with acute appendicitis. The seroprevalence of E. histolytica was 33% (14/43) from the available stored sera. Based on the medical records, only 3 cases were clinically diagnosed as amoebic appendicitis, including 2 diagnosed at the time of appendectomy and 1 case diagnosed by rereview of the appendix after the development of postoperative complications. Retrospective analyses using PAS staining and PCR identified 3 and 3 more cases, respectively. Thus, E. histolytica infection was confirmed in 9 cases (15.8%) in the present study. Apart from a significantly higher leukocyte count in E. histolytica-positive patients than in negative patients (median, 13,760 versus 10,385 cells/μl, respectively, P = 0.02), there were no other differences in the clinical features of the PCR-positive and -negative groups. In conclusion, E. histolytica infection was confirmed in 9 (15.8%) of the appendicitis cases. However, only 3, including one diagnosed after intestinal perforation, were diagnosed before the present analyses. These results strongly suggest there is frequently a failure to detect trophozoites in routine examination, resulting in an underestimation of the incidence of amoebic appendicitis. PMID:27847377

  17. Underestimated Amoebic Appendicitis among HIV-1-Infected Individuals in Japan.

    Science.gov (United States)

    Kobayashi, Taiichiro; Watanabe, Koji; Yano, Hideaki; Murata, Yukinori; Igari, Toru; Nakada-Tsukui, Kumiko; Yagita, Kenji; Nozaki, Tomoyoshi; Kaku, Mitsuo; Tsukada, Kunihisa; Gatanaga, Hiroyuki; Kikuchi, Yoshimi; Oka, Shinichi

    2017-01-01

    Entamoeba histolytica is not a common causative agent of acute appendicitis. However, amoebic appendicitis can sometimes be severe and life threatening, mainly due to a lack of awareness. Also, its frequency, clinical features, and pathogenesis remain unclear. The study subjects were HIV-1-infected individuals who presented with acute appendicitis and later underwent appendectomy at our hospital between 1996 and 2014. Formalin-fixed paraffin-embedded preserved appendix specimens were reexamined by periodic acid-Schiff (PAS) staining and PCR to identify undiagnosed amoebic appendicitis. Appendectomies were performed in 57 patients with acute appendicitis. The seroprevalence of E. histolytica was 33% (14/43) from the available stored sera. Based on the medical records, only 3 cases were clinically diagnosed as amoebic appendicitis, including 2 diagnosed at the time of appendectomy and 1 case diagnosed by rereview of the appendix after the development of postoperative complications. Retrospective analyses using PAS staining and PCR identified 3 and 3 more cases, respectively. Thus, E. histolytica infection was confirmed in 9 cases (15.8%) in the present study. Apart from a significantly higher leukocyte count in E. histolytica-positive patients than in negative patients (median, 13,760 versus 10,385 cells/μl, respectively, P = 0.02), there were no other differences in the clinical features of the PCR-positive and -negative groups. In conclusion, E. histolytica infection was confirmed in 9 (15.8%) of the appendicitis cases. However, only 3, including one diagnosed after intestinal perforation, were diagnosed before the present analyses. These results strongly suggest there is frequently a failure to detect trophozoites in routine examination, resulting in an underestimation of the incidence of amoebic appendicitis. Copyright © 2016 Kobayashi et al.

  18. 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.

  19. Pediatric Appendicitis.

    Science.gov (United States)

    Rentea, Rebecca M; St Peter, Shawn D

    2017-02-01

    Appendicitis is one of the most common surgical pathologies in children. It can present with right lower quadrant pain. Scoring systems in combination with selective imaging and surgical examination will diagnose most children with appendicitis. Clinical pathways should be used. Most surgical interventions for appendicitis are now almost exclusively laparoscopic, with trials demonstrating better outcomes for children who undergo index hospitalization appendectomies when perforated. Nonoperative management has a role in the treatment of both uncomplicated and complicated appendicitis. This article discusses the workup and management, modes of treatment, and continued areas of controversy in pediatric appendicitis. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. 妊娠期急性阑尾炎72例临床分析%Analysis of 72 pregnant patients with acute appendicitis

    Institute of Scientific and Technical Information of China (English)

    张伊凡; 杨星海

    2011-01-01

    Objective To evaluate the clinical presentation,diagnosis,management,and outcome of acute appendicitis in pregnancy. Methods Seventy-two cases of acute appendicitis in pregnancy were retrospectively analyzed. Results There were 13 cases at 1st trimester,27 at 2nd trimester, and 12 at 3rd trimester. Forty-seven cases complained of abdominal pain in right lower quadrant, and 42 cases had tenderness in the same area. Twenty-three cases had rebound tenderness and 12 cases had myotoni-a. Thirty-one cases (43 %) had abnormal findings of ultrosound. Forty-nine cases (68 %) received surgical operations and 23 cases (32 %) were given conservative treatment. Wound infection occurred in 3 cases (6 %) and abdominal abscess in one (2 %). Nineteen cases developed threatened abortion or preterm contraction. Four cases progressed to abortion and 2 preterm delivery. Conclusion It is crucial to diagnose and manage acute appendicitis in pregnancy timely. Temporary observation is reasonable whenever the diagnosis is in doubt. Positive findings of ultrasound can confirm diagnosis. Antibiotics as conservative treatment could be applied selectively. Tocolytics has obvious effects on the patients with non-perforated appendicitis. The incidence of abortion and preterm delivery increases dramatically when appendix is perforated.%目的 探讨妊娠期急性阑尾炎的临床特点、诊治方法和术后并发症.方法 回顾性分析6年间72例妊娠期急性阑尾炎的临床资料.结果 早期妊娠合并急性阑尾炎13例,中期47例,晚期12例.右下腹痛47例,右下腹压痛42例、反跳痛23例、肌紧张12例.B型超声征象异常31例(43%).手术49例(68%),保守治愈23例(32%).术后伤口感染3例(6%),腹腔残余脓肿1例(2%).先兆流产或先兆早产19例,流产4例,早产2例.结论 妊娠期急性阑尾炎及时诊治至关重要,诊断不明确者可作短暂观察,B型超声结果阳性能够确诊.抗生素保守治疗可选择性应用.保胎治

  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. 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.

  3. Torsion of a lipoma of parietal peritoneum: a rare case mimicking acute appendicitis.

    Science.gov (United States)

    Shrestha, Binod Bade; Karmacharya, Mikesh

    2014-06-18

    Lipomas are found most often on the torso, neck, upper thighs, upper arms and armpits; they can also occur almost anywhere in the body. Parietal peritoneum lipoma is a rare intraoperative finding during abdominal surgery. We present a case of a torted, pedunculated parietal wall lipoma in the right iliac fossa that gave rise to a clinical diagnosis of appendicitis. So far only one case has been reported.

  4. Torsion of a lipoma of parietal peritoneum: a rare case mimicking acute appendicitis

    OpenAIRE

    2014-01-01

    Lipomas are found most often on the torso, neck, upper thighs, upper arms and armpits; they can also occur almost anywhere in the body. Parietal peritoneum lipoma is a rare intraoperative finding during abdominal surgery. We present a case of a torted, pedunculated parietal wall lipoma in the right iliac fossa that gave rise to a clinical diagnosis of appendicitis. So far only one case has been reported.

  5. The Value of Ultrasound in the Diagnosis of Acute Appendicitis%急性阑尾炎的超声诊断价值

    Institute of Scientific and Technical Information of China (English)

    刘世锋; 熊彩霞

    2014-01-01

    目的:探讨超声诊断急性阑尾炎的超声图像特征及价值。方法对我院160例临床怀疑急性阑尾炎的患者进行右下腹及全腹检查,观察异常改变,对其声像图特征进行总结分析。结果急性阑尾炎的超声诊断符合率为92%。结论超声对急性阑尾炎的诊断安全、快捷,给临床治疗及时提供信息,为临床提供客观的诊断依据,具有重要临床应用价值。%Objective To investigate the ultrasonic image characteristics and the value of ultrasound in the diagnosis of acute appendicitis.Methods The right lower abdomen and abdominal examination in 160 patients with clinical y suspected acute appendicitis,abnormal changes were observed,to summarize and analyze the sonographic characteristics.Results The ultrasonic diagnosis of acute appendicitis rate was 92%.Conclusion Ultrasound diagnosis of acute appendicitis is safe、fast, clinical treatment to provide timely information,to provide the objective diagnostic basis for clinic,which has important clinical value.

  6. 手术治疗急性阑尾炎的效果分析%The Effect of Surgical Treatment of Acute Appendicitis

    Institute of Scientific and Technical Information of China (English)

    杨小平

    2013-01-01

    Objective To study the ef ect of the diagnosis and treatment of acute appendicitis. Methods Observation on treatment of 150 cases of acute appendicitis operation treatment after hospitalization June 2007~June 2013 year in the internal hospital. Results:among the 150 cases of acute appendicitis patients operation was successful in 146 patients,4 patients were misdiagnosed. Conclusion the treatment of acute appendicitis operation treatment is the most ef ect,it is worthy of popularization and application.%目的:为了研究急性阑尾炎的诊断依据和治疗效果。方法观察2007年6月~2013年6月内在本院住院治疗的150例急性阑尾炎患者手术完成后的治疗效果。结果在150例急性阑尾炎患者当中有146例患者手术成功,4例患者被误诊。结论手术治疗急性阑尾炎是最具疗效的治疗方法,值得推广应用。

  7. Initial antibiotic treatment for acute simple appendicitis in children is safe: Short-term results from a multicenter, prospective cohort study

    NARCIS (Netherlands)

    Gorter, R.R.; Lee, J.H. van der; Cense, H.A.; Kneepkens, C.M.; Wijnen, M.H.W.A.; Hof, K.H. In 't; Offringa, M.; Heij, H.A.

    2015-01-01

    BACKGROUND: Initial antibiotic treatment for acute appendicitis has been shown to be safe in adults; so far, not much is known about the safety and efficacy of this treatment in children. The aims of this study were to investigate the feasibility of a randomized controlled trial (RCT) evaluating ini

  8. Abdominal-pelvic scanning parameters revisited: a case for Z-axis reduction in patients with clinical suspicion for acute appendicitis.

    Science.gov (United States)

    Patel, Darshan C; Huang, Yu-Hui; Meyer, Jonathan; Sepahdari, Amir

    2017-07-27

    The purpose of this study was to determine if CT for appendicitis can be abbreviated to begin at the top of the L2 vertebral body level and still maintain the detection rate of appendicitis and other symptomatic pathology without omitting significant incidental findings. Retrospective review of CT abdomen-pelvis exams for suspected appendicitis over a 5-month period was performed. The Z-axis scan length of the original full scans and theoretical limited scans from the top of L2 were recorded and calculated. Images were reviewed for incidental findings above the L2 vertebral body level and categorized by severity per American College of Radiology (ACR) white paper guidelines. Final diagnoses based on imaging findings were also recorded. One hundred nineteen patients (46 males, 73 females, mean age 29 ± 14) were included. Appendicitis was present in 26 cases (22%). Using a theoretical scan beginning at the top of the L2 vertebral body, none of the findings leading to diagnosis of appendicitis would have been missed. A total of 30 incidental findings were found above the L2 vertebral body. Per ACR white paper guidelines, 26 of these findings did not require additional imaging follow-up. Additional follow-up imaging was recommended for 3 of the findings above L2, and 1 right adrenal metastasis was found above L2 in a patient with previously undiagnosed NSCLC. This patient coincidentally also had appendicitis. No symptomatic pathology would have been missed had the scans begun at the top of the L2 vertebral body. Such an abbreviated scan would have resulted in a mean Z-axis reduction of 12.9 cm (30.3%). CT using abbreviated Z-axis scan length can reduce radiation dose and provide necessary imaging needed to diagnose appendicitis or other symptomatic pathology without omitting significant incidental findings.

  9. Gangrenous appendicitis presenting as acute abdominal pain in a patient on automated peritoneal dialysis: a case report

    Directory of Open Access Journals (Sweden)

    Ekart Robert

    2012-09-01

    Full Text Available Abstract Introduction Presentations of abdominal pain in patients on peritoneal dialysis deserve maximal attention and careful differential diagnosis on admittance to medical care. In this case report a gangrenous appendicitis in a patient on automated peritoneal dialysis is presented. Case presentation We report the case of a 38-year-old Caucasian man with end-stage renal disease who was on automated peritoneal dialysis and developed acute abdominal pain and cloudy peritoneal dialysate. Negative microbiological cultures of the peritoneal dialysis fluid and an abdominal ultrasonography misleadingly led to a diagnosis of culture negative peritonitis. It was decided to remove the peritoneal catheter but the clinical situation of the patient did not improve. An explorative laparotomy was then carried out; diffuse peritonitis and gangrenous appendicitis were found. An appendectomy was performed. Myocardial infarction and sepsis developed, and the outcome was fatal. Conclusion A peritoneal dialysis patient with abdominal pain that persists for more than 48 hours after the usual antibiotic protocol for peritoneal dialysis-related peritonitis should immediately alert the physician to the possibility of peritonitis caused by intra-abdominal pathology. Not only peritoneal catheter removal is indicated in patients whose clinical features worsen or fail to resolve with the established intra-peritoneal antibiotic therapy but, after 72 hours, an early laparoscopy should be done and in a case of correct indication (intra-abdominal pathology an early explorative laparotomy.

  10. 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 pregn

  11. Appendicitis in Children. Clinical, diagnostic and pathogenic factors

    OpenAIRE

    Salö, Martin

    2016-01-01

    Background: Appendicitis is the most common disease requiring abdominal surgery in children. However, the diagnosis of pediatric appendicitis is still a challenge, resulting in perforation and negative appendectomies, especially in girls and young children. Further, the pathogenesis of acute appendicitis is not known. Aim: To examine acute appendicitis in children in the aspects of evaluation of the utility of the pediatric appendicitis score (PAS) in young children and evaluate factors respo...

  12. APPENDICITIS: YOUNG ADULTS ARE SUSCEPTIBLE

    Directory of Open Access Journals (Sweden)

    Somashekhar V. Hiremath

    2016-08-01

    Full Text Available CONTEXT Appendicitis is the one of the most common emergencies of the acute abdomen encountered by the clinicians; peritonitis is the common cause due to appendicular perforation. Ultrasonography of abdomen is the preferred method of diagnosis of acute appendicitis. The study is done to diagnose acute appendicitis in a tertiary care hospital to ascertain early diagnosis prevalent in this part of the country, which might differ from other studies. AIM To ascertain prevalence, presentation and management of appendicitis in this part of India in a tertiary care government hospital with provisional diagnosis of appendicitis. MATERIAL AND METHODS Cases of acute abdomen, clinical diagnosis of acute appendicitis admitted in KIMS Hospital, Hubli, a tertiary care government hospital, from January 2014 to January 2015 for materials of this study. 100 cases have been taken for study; cases included in this study are acute appendicitis, appendicular abscess; method used is USG abdomen, a simple diagnostic tool. RESULTS In present study, 100 cases of acute abdomen with clinical diagnosis of acute appendicitis were taken and laparotomy was done for 98 cases and two cases of appendicular abscess. Youngest patient was 7 years old and oldest was 65 years. Peak incidence between 11 to 30 years of age group and male to female ratio is 3:2. Postoperative wound infection was a common complication in 21 cases and retention of urine was noticed in 7 cases, and there was a death in one case due to septicaemia. CONCLUSION Acute appendicitis is a second most common indication for early laparotomy in KIMS Hospital, Hubli, first being perforative peritonitis. Acute appendicitis is common between 11 to 30 years of age group, early diagnosis and intervention is required to prevent appendicular perforation and its complications. Diagnosis of acute appendicitis is to be done in patients presenting with atypical pain, absence of vomiting does not rule out appendicitis. Anorexia

  13. [Appendicitis in children under 3].

    Science.gov (United States)

    Baeza Herrera, C; Guido Ramires, O; González Galicia, J A; Rojas Aro, E

    1994-01-01

    There are many differences between acute appendicitis in the older child and the infants. An understanding of the under three years of age child's response to intra-abdominal infection in contrast to that of the older child and an appreciation for the supportive treatment of the child are vitally important in further lowering the morbidity of young children with acute appendicitis. The purpose of the present study was to investigate the factors contributing to the high perforation rate seen in this age group. A retrospective analysis was done in 88 patients under the age of three who underwent appendectomy. These patients ranged from 4 and 35 months in age. There were 51 (77.4%) male patients. The main complaints were fever, pain and vomiting. Duration of symptoms was more than 24 hours in 80%. Abdominal radiographs showed signs of small bowel obstruction. Peritonitis was found in the majority of the cases (90%). overall morbidity was 31.8% and mortality 1.1%. These data suggest that duration of symptoms is directly proportional to complications rate.

  14. 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.)

  15. De Garengeot's hernia: a case of acute appendicitis in a femoral hernia sac.

    Science.gov (United States)

    Tanrıkulu, Ceren Sen; Tanrıkulu, Yusuf; Akkapulu, Nezih

    2013-07-01

    The presence of an appendix vermiformis in a femoral hernia sac is called De Garengeot's hernia. It is a very rare clinical condition and requires emergency surgery. However, preoperative diagnosis of De Garengeot's hernia is difficult. Herein, we report a 58-year-old female who presented with sudden-onset painful swelling in the right groin region. Diagnosis was established based on computed tomography findings, and appendectomy with mesh-free hernia repair was performed. The postoperative period was uneventful, and the histopathologic examination of the specimen revealed gangrenous appendicitis.

  16. Liver Hemangioma Bleeding Rupture Misdiagnosed as Acute Appendicitis%肝血管瘤破裂出血误诊为急性阑尾炎

    Institute of Scientific and Technical Information of China (English)

    刘壮

    2014-01-01

    Objective To explore the clinical characteristics of liver hemangioma rupture bleeding, and evaluate its differ-ential diagnosis. Methods Retrospectively analysis of the clinical data of a case of multiple liver hemangioma rupture hemorrhage misdiagnosed as acute appendicitis was made. Results A patient with lower abdominal pain for 20 hours before admission was pri-marily diagnosed as having acute appendicitis, and underwent an emergency laparotomy. During the operation, no abnormal appen-dix was found, but a mass in liver with burst bleeding was found and the liver surface was full of millet qualitative hard nodules. Be-cause of impossible determination on the nature of the tumor, the patient was given local hemostasis therapy, and abdominal cavity was washed, then drainage tube was placed at the same time, some tissues surrounding bleeding mass was removed, and no active bleeding before abdominal closing was observed. Postoperative pathologic result of liver mass showed degeneration of liver cells, with cellulose and inflammatory cells, and reinforced CT scanning confirmed liver hemangioma rupture bleeding, but to define the cause of bleeding, a followed enquiry of history and related examinations were made before systemic lupus erythematosus (active phase) was confirmed. Gamma globulin and Methylprednisolone treatment were given and the patient was discharged after improvement. Conclusion Because of the particular position, patients with liver hemangioma (right liver lobe) rupture hemorrhage usually have atypical clinical symptoms and signs, which may be related to systemic lupus erythematosus and mistaken as acute appendicitis.%目的:探讨肝血管瘤破裂出血的临床特点及鉴别诊断要点。方法对肝多发血管瘤破裂出血误诊为急性阑尾炎1例的临床资料进行回顾性分析。结果本例因右下腹痛20 h急诊入院,按急性阑尾炎行剖腹探查术。术中探查示:阑尾未见异常,肝

  17. A retrospective analysis of acute organophosphorus poisoning ...

    African Journals Online (AJOL)

    Correspondence to: Dr. M. R. Kumar, Department of Medicine, Narayana Medical College Hospital, ... receive treatment was 5.2 ± 7.4 (range 1-48 h). ... retrospective record-based nature are the major limitations of the present study. There is a ...

  18. 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

  19. Evaluation of high mobility group box 1 protein as a presurgical diagnostic marker reflecting the severity of acute appendicitis

    Directory of Open Access Journals (Sweden)

    Wu Chuanxin

    2012-09-01

    Full Text Available Abstract Objectives To validate the role of high mobility group box-1(HMGB1 in diagnosis of acute appendicitis (AA with different pathological severity. Methods According to the pathologically diagnosis, 150 patients underwent appendectomies between Jan. 2007 and Dec, 2010 were divided into acute simple, acute suppurative and acute gangrenous appendicitis as group 1, 2 and 3, respectively. Each patient group contains 50 sex and age matched cases to make comparison with 50 healthy volunteers. The mRNA and protein expression levels of serum HMGB1 were determined by real-time quantitative PCR and enzyme linked immunosorbent assay (ELISA. Serum High-sensitivity C-reactive protein (hs-CRP levels were determined by rate nephelometric immunoassay. Results In comparison with health volunteers, relative HMGB1 mRNA levels in group 1, 2 and 3 were significantly increased 3.05 ± 0.51,8.33 ± 0.75 and 13.74 ± 1.09 folds, reflecting a tendency of augmented severity. In accordance, serum protein levels of HMGB1 were 10.97 ± 1.64, 14.42 ± 1.56 and 18.08 ± 2.41 ng/ml in 3 patient groups, which are significantly higher than that of healthy volunteers’ 5.47 ± 0.73 ng/ml. hs-CRP levels were 12.85 ± 3.41, 21.04 ± 1.98 and 31.07 ± 5.46 ng/ml in 3 patients groups compared with 2.06 ± 0.77 ng/ml in controls. The concentrations of HMGB1 and hs-CRP were both positively correlated with disease severity. Conclusion Serum HMGB1 constitutes as a valuable marker in diagnosis of AA. Positively correlated with hs-CRP level, mRNA and protein expression of HMGB1 to a certain extent reflected the severity of AA.

  20. 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

  1. 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

  2. Comparison and Efficacy of LigaSure and Rubber Band Ligature in Closing the Inflamed Cecal Stump in a Rat Model of Acute Appendicitis

    Directory of Open Access Journals (Sweden)

    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.

  3. Consideraciones actuales sobre el diagnóstico de la apendicitis aguda: Current criteria Diagnosis of acute appendicitis:

    Directory of Open Access Journals (Sweden)

    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

  4. Factors predictive of complicated appendicitis in children.

    Science.gov (United States)

    Pham, Xuan-Binh D; Sullins, Veronica F; Kim, Dennis Y; Range, Blake; Kaji, Amy H; de Virgilio, Christian M; Lee, Steven L

    2016-11-01

    The ability to predict whether a child has complicated appendicitis at initial presentation may influence clinical management. However, whether complicated appendicitis is associated with prehospital or inhospital factors is not clear. We also investigate whether hyponatremia may be a novel prehospital factor associated with complicated appendicitis. A retrospective review of all pediatric patients (≤12 y) with appendicitis treated with appendectomy from 2000 to 2013 was performed. The main outcome measure was intraoperative confirmation of gangrenous or perforated appendicitis. A multivariable analysis was performed, and the main predictors of interest were age 24 h, leukocytosis (white blood cell count >12 × 10(3)/mL), hyponatremia (sodium ≤135 mEq/L), and time from admission to appendectomy. Of 392 patients, 179 (46%) had complicated appendicitis at the time of operation. Univariate analysis demonstrated that patients with complicated appendicitis were younger, had a longer duration of symptoms, higher white blood cell count, and lower sodium levels than patients with noncomplicated appendicitis. Multivariable analysis confirmed that symptom duration >24 h (odds ratio [OR] = 5.5, 95% confidence interval [CI] = 3.5-8.9, P appendicitis. Increased time from admission to appendectomy was not a predictor of complicated appendicitis (OR = 0.8, 95% CI = 0.5-1.2, P = 0.2). Prehospital factors can predict complicated appendicitis in children with suspected appendicitis. Hyponatremia is a novel marker associated with complicated appendicitis. Delaying appendectomy does not increase the risk of complicated appendicitis once intravenous antibiotics are administered. This information may help guide resource/personnel allocation, timing of appendectomy, and decision for nonoperative management of appendicitis in children. Copyright © 2016 Elsevier Inc. All rights reserved.

  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. 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 .

  7. 妊娠期急性阑尾炎66例诊疗分析%Clinical Analysis of Diagnosis and Treatment for 66 Cases of Acute Appendicitis During Pregnancy

    Institute of Scientific and Technical Information of China (English)

    苏乃伟; 李新宁; 石群峰

    2012-01-01

    目的:探讨妊娠期急性阑尾炎的诊断及治疗方法.方法:回顾性分析66例妊娠期急性阑尾炎的临床资料,29例患者不同意手术而接受保守治疗,其中12例感染不能控制,改手术治疗,另37例入院急诊外科手术治疗.结果:66例患者顺利出院;8例患者出院后要求行人工流产术;2例患者术后流产,1例患者术后10d早产;无胎儿宫内窘迫、死胎及妊娠妇女死亡等严重并发症.结论:妊娠期急性阑尾炎的及时诊断和手术治疗,是保证临床效果及母婴安全的重要手段.但对感染症状轻、局部腹膜炎不明显、不同意手术的患者,可先予保守治疗,密切观察,治疗效果不明显时应立即手术.%Objective:To explore diagnosis and treatment of acute appendicitis during pregnancy. Methods:retrospective analysis of the clinical data of 66 cases of acute appendicitis during pregnancy,29 patients didn't agree with surgery,so received conservative treatment,and 12 cases of uncontrolled infection,change to surgical treatment,37 cases were admitted to the hospital emergency surgical treatment. Results:66 patients discharge smoothly;eight patients after discharge required abortion in obstetrics and gynecology;2 patients had the abortion,one patient was premature birth at 10 days after surgery;no serious complications such as fetal distress,stillbirth and pregnant women death. Conclusions:Important means for the safety of maternal and infant is that timely diagnosis and surgical treatment of acute appendicitis during pregnancy. If symptoms of light infection,unapparent local peritonitis,and patients don't agree with surgery,we first do conservative treatment,and closely observe. If the treatment effect is not obvious, we then immediately surgery.

  8. 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

  9. Acute appendicitis in an incarcerated crural hernia: analysis of our experience Apendicitis aguda en una hernia crural incarcerada: análisis de nuestra experiencia

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    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

  10. Imaging of acute appendicitis in children: EU versus U.S.... or US versus CT? A North American perspective

    Energy Technology Data Exchange (ETDEWEB)

    Frush, Donald P. [Duke University Medical Center, McGovern-Davison Children' s Health Center, Division of Pediatric Radiology, Department of Radiology, Box 3808 DUMC, Durham, NC (United States); Frush, Karen S. [Duke University Health System, Duke University Medical Center, Division of Pediatric Emergency Medicine, Department of Pediatrics, Durham, NC (United States); Oldham, Keith T. [Children' s Hospital of Wisconsin, Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI (United States)

    2009-05-15

    The timing, type, and technique of imaging evaluation of suspected appendicitis in children are all debated. This debate is both local and international. The fact is that choices in imaging evaluation will depend on both local and national influences, which are reasonable and to be expected. There still is a responsibility, though, for those involved with evaluation of patients with possible appendicitis to come to agreement about an appropriate diagnostic pathway that considers standards of care and available resources. (orig.)

  11. The diagnosis of acute appendicitis with the combined use of different frequency ultrasound: Analysis of 115 Cases%不同频率超声联合应用诊断急性阑尾炎115例分析

    Institute of Scientific and Technical Information of China (English)

    张辉

    2012-01-01

    目的 探讨不同频率超声联合使用在急性阑尾炎诊断中的价值.方法 回顾性分析经手术病理确诊的115例阑尾炎患者的超声声像图,分析各型阑尾炎的图像特点.结果 急性单纯性阑尾炎41例,急性化脓性阑尾炎52例,坏疽性阑尾炎13例,阑尾周围脓肿9例,各类型急性阑尾炎声像图改变具有特异性.结论 不同频率超声联合使用在急性阑尾炎诊断及分型中有其重要的临床价值.%Objective To investigate the value of the combined use of different frequency ultrasound in the diagnosis of. Acute appendicitis Methods One hundred fifteen cases with acute appendicitis underwent ultrasound and confirmed by surgical pathology. The ultrasonic characteristics were compared with the histopathological findings. Results Each type of acute appendicitis ultrasonogra-phy was specific,including41 cases of acute simple appendicitis,52 cases of acute suppurative appendicitis, 13 cases of gangrenous appendicitis,9 cases of appendiceal abscess. Conclusion It was useful to combine different frequency ultrasound in the diagnosis of a-cute appendicitis.

  12. Acute uncomplicated appendicitis study: rationale and protocol for a multicentre, prospective randomised controlled non-inferiority study to evaluate the safety and effectiveness of non-operative management in children with acute uncomplicated appendicitis

    Science.gov (United States)

    Xu, Jane; Liu, Yingrui Cyril; Adams, Susan; Karpelowsky, Jonathan

    2016-01-01

    Introduction This article presents an overview of a prospective randomised controlled non-inferiority study designed to evaluate the safety and effectiveness of non-operative management (NOM) with operative management in children with acute uncomplicated appendicitis (AUA). Here, we present the study protocol for this APRES study, a multicentre Australian study. The rationale and details of future analysis, in particular, non-inferiority calculations, cost-effectiveness, feasibility and acceptability of each intervention. Design A multicentre, prospective randomised controlled clinical trial, conducted in 2 Australian tertiary paediatric hospitals. Participants Children who meet the inclusion criteria of an age between 5 and 15 years and a clinical diagnosis of AUA will be invited to participate, and after consent will be randomised via a computer-based program into treatment groups. The study started in June 2016, and the target recruitment is 220 patients. Interventions Children in the control group will be treated with prophylactic antibiotics and appendicectomy, and those in the intervention group will be treated with antibiotic therapy alone. Primary outcome measures include unplanned or unnecessary operation and complications at 30 days. Secondary outcomes include longer term complications within 1 year, length of stay, time off work and school analgesic requirements and cost. Analysis Data analyses will be on the intention-to-treat principle using non-inferiority analysis. Analysis will include the Pearson χ2 test for categorical variables and independent sample t-test or Mann-Whitney test for continuous variables. Non-inferiority for NOM will be tested using 1-sided Wald tests with an α level of 0.05. Ethics and dissemination The research has been approved by the Human Research Ethics Committee of the Sydney Children's Hospital Network. In addition, results will be reported through academic journals, seminars and conference presentations. Trial

  13. Management of Uncomplicated Acute Appendicitis as Day Case Surgery: Feasibility and a Critical Analysis of Exclusion Criteria and Treatment Failure.

    Science.gov (United States)

    Grelpois, Gérard; Sabbagh, Charles; Cosse, Cyril; Robert, Brice; Chapuis-Roux, Emilie; Ntouba, Alexandre; Lion, Thierry; Regimbeau, Jean-Marc

    2016-11-01

    Day case surgery (DCS) for uncomplicated acute appendicitis (NCAA) is evaluated. The objective of this prospective, single-center, descriptive, nonrandomized, intention-to-treat cohort study was to assess the feasibility of DCS for NCAA with a critical analysis of the reasons for exclusion and treatment failures and a focus on patients discharged to home and admitted for DCS on the following day. From April 2013 to December 2015, NCAA patients meeting the inclusion criteria were included in the study. The primary end point was the success rate for DCS (length of stay less than 12 hours) in the intention-to-treat population (all NCAA) and in the per-protocol population (no pre- or perioperative exclusion criteria). The secondary end points were morbidity, DCS quality criteria, predictive factors for successful DCS, patient satisfaction, quality of life, and reasons for pre- or perioperative exclusion. A subgroup of patients discharged to home the day before operation was also analyzed. A total of 240 patients were included. The success rate of DCS was 31.5% in the intention-to-treat population and 91.5% in the per-protocol population. The rates of unplanned consultations, hospitalization, and reoperation were 13%, 4%, and 1%, respectively. An analysis of the reasons for DCS exclusion showed that 73% could have been modified. For the 68 patients discharged to home on the day before operation, the DCS success rate was 91%. Day case surgery is feasible in NCAA. A critical analysis of the reasons for exclusion from DCS showed that it should be possible to dramatically increase the eligible population. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  14. [The local complications of appendicitis].

    Science.gov (United States)

    Ortega León, L H; Vargas Domínguez, A; Miranda Fraga, P

    1994-01-01

    In order to find out the predisposing factors of local complications after appendectomy in two general hospitals, 268 charts of patients with acute appendicitis confirmed by surgery were reviewed. There were 142 males and 126 females. All wounds were closed and prophylactic antibiotics were not used. Sixty patients (22 per cent) developed local complications; 49 (81.7 per cent) surgical wound infection and 11 (18.3 per cent) with intra-abdominal abscess. In the wound infection group 25 per cent had complicated acute appendicitis and only one per cent non-complicated acute appendicitis. The correlation between the preoperative period and wound sepsis showed, the longer period the higher incidence of wound infection, 1.7 per cent with less than 24 hr. 11 per cent with less than 72 hr. and 78.9 per cent with more than 96 hr.

  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. 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 under

  17. Discriminating between simple and perforated appendicitis

    NARCIS (Netherlands)

    M. 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

  18. 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.

  19. Suspected appendicitis during pregnancy: prevalence and management at prince Hashem Ben AL-Hussein Hospital (Zarqa/Jordan

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    Hasan Al-Dahamsheh

    2012-09-01

    Full Text Available To evaluate the clinical picture and outcome of suspected appendicitis in pregnant women. Retrospective analytic study of 28 appendectomies performed during pregnancy for suspected appendicitis in our hospital at period April 2004 to September 2006. All files and medical records of these patients were analyzed and studied. Those including variables (demographic, clinical, laboratory and surgical outcomes data were collected retrospectively. Prevalence of appendicitis was calculated from the total number of deliveries and abortions that occurred during this period. Numbers of correct and wrong diagnosis were reported and comparison of perinatal outcome, maternal morbidity and different variables in negative and positive laparotomies performed. The prevalence of suspected appendicitis in pregnancy is 0.29%. Incidences of negative laparotomies were 36%. The most diagnostic findings for acute appendicitis were history of periumbilical pain, anorexia and Rt iliac fossa findings. Half of wrong diagnosis were related to premature labor pain or abortion. The prevalence of suspected appendicitis during pregnancy in our environment during this period was higher than the reported incidence and rate of wrong diagnosis still high. Good clinical assessment with adjunct ultrasonic examination could reduce the incidence of negative laparotomies or prevent late complication. Delay in operation leading to higher rate of maternal morbidity and adversely affect the obstetric outcome. Journal of College of Medical Sciences-Nepal,2012,Vol-8,No-1, 36-43 DOI: http://dx.doi.org/10.3126/jcmsn.v8i1.6824

  20. Apendicitis aguda en el adulto mayor, resultados del tratamiento quirúrgico en un hospital regional Acute appendicitis in the elderly and the results of surgical treatment in a regional hospital

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    Radamés Isaac Adefna Pérez

    2011-09-01

    . Methods: a retrospective, case series, descriptive and observational study was conducted from January,1, 2005 to December 31, 2008 in the "Miguel Enriquez" Clinical Surgical Hospital. All patients aged over 60 and operated on of acute appendicitis were included. Results: from all the symptoms there was predominance of abdominal pain, nauseas and vomiting. The typical pain predominated in the age group of 60-69 and according aging there was predominance of atypical pain. The figures of appendicular advanced inflammation: perforations (13.5 %, gangrene (13.5 % and suppuration (21.1 %. Global morbidity was of 28.8 %. In present series there was not mortality. Conclusions: the appendicitis in elderly shows achievements in relation to treatment and results in our institution. The atypical presentations remain with a significant morbidity. It is necessary to take actions in the area of diagnosis and surgical treatment to achieve to improve still more the results.

  1. A Feasibility Study of Smartphone-Based Telesonography for Evaluating Cardiac Dynamic Function and Diagnosing Acute Appendicitis with Control of the Image Quality of the Transmitted Videos.

    Science.gov (United States)

    Kim, Changsun; Cha, Hyunmin; Kang, Bo Seung; Choi, Hyuk Joong; Lim, Tae Ho; Oh, Jaehoon

    2016-06-01

    Our aim was to prove the feasibility of the remote interpretation of real-time transmitted ultrasound videos of dynamic and static organs using a smartphone with control of the image quality given a limited internet connection speed. For this study, 100 cases of echocardiography videos (dynamic organ)-50 with an ejection fraction (EF) of ≥50 s and 50 with EF smartphone, to which the images were transmitted from the ultrasound machine. The resolution of the transmitted echocardiography videos was reduced by approximately 20 % to increase the frame rate of transmission given the limited internet speed. The differences in diagnostic performance between the two devices when evaluating left ventricular (LV) systolic function by measuring the EF and when evaluating the presence of acute appendicitis were investigated using a five-point Likert scale. The average areas under the receiver operating characteristic curves for each reviewer's interpretations using the LCD monitor and smartphone were respectively 0.968 (0.949-0.986) and 0.963 (0.945-0.982) (P = 0.548) for echocardiography and 0.972 (0.954-0.989) and 0.966 (0.947-0.984) (P = 0.175) for abdominal ultrasonography. We confirmed the feasibility of remotely interpreting ultrasound images using smartphones, specifically for evaluating LV function and diagnosing pediatric acute appendicitis; the images were transferred from the ultrasound machine using image quality-controlled telesonography.

  2. A Novel Reporting System to Improve Accuracy in Appendicitis Imaging

    Science.gov (United States)

    Godwin, Benjamin D.; Drake, Frederick T.; Simianu, Vlad V.; Shriki, Jabi E.; Hippe, Daniel S.; Dighe, Manjiri; Bastawrous, Sarah; Cuevas, Carlos; Flum, David; Bhargava, Puneet

    2015-01-01

    OBJECTIVE The purpose of this study was to ascertain if standardized radiologic reporting for appendicitis imaging increases diagnostic accuracy. MATERIALS AND METHODS We developed a standardized appendicitis reporting system that includes objective imaging findings common in appendicitis and a certainty score ranging from 1 (definitely not appendicitis) through 5 (definitely appendicitis). Four radiologists retrospectively reviewed the preoperative CT scans of 96 appendectomy patients using our reporting system. The presence of appendicitis-specific imaging findings and certainty scores were compared with final pathology. These comparisons were summarized using odds ratios (ORs) and the AUC. RESULTS The appendix was visualized on CT in 89 patients, of whom 71 (80%) had pathologically proven appendicitis. Imaging findings associated with appendicitis included appendiceal diameter (odds ratio [OR] = 14 [> 10 vs appendicitis. In this initially indeterminate group, using the standardized reporting system, radiologists assigned higher certainty scores (4 or 5) in 21 of the 28 patients with appendicitis (75%) and lower scores (1 or 2) in five of the seven patients without appendicitis (71%) (AUC = 0.90; p = 0.001). CONCLUSION Standardized reporting and grading of objective imaging findings correlated well with postoperative pathology and may decrease the number of CT findings reported as indeterminate for appendicitis. Prospective evaluation of this reporting system on a cohort of patients with clinically suspected appendicitis is currently under way. PMID:26001230

  3. CLINICAL STUDY OF ACUTE POISONING: A RETROSPECTIVE STUDY

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    Praveen

    2014-11-01

    Full Text Available : OBJECTIVES: To determine the common agents, clinical features and outcomes of acute poisoning. MATERIALS AND METHODS: A retrospective study of patients of acute poisoning of more than 14 years age admitted through emergency with a history of intentional, self-inflicted and suicidal poisoning in SRMS-IMS from Jan 2010 to Dec 2012. RESULTS: A total of 58 cases were included with a common age of affection 16 to 25 years and male to female ratio 1.63: 1. Poisoning cases occur throughout the year with maximum prevalence in May and minimum in June. Organophosphorus was the most common poison followed by aluminium phosphide. Vomiting was the most common symptoms followed by altered sensorium. 70.68% patients were discharged, 20.68% expired and 8.62% left against medical advice. Aluminium phosphide was the most common toxin consumed by dead patients. CONCLUSION: Acute poisoning is commonly affecting young population and is caused by variety of toxin. High mortality is associated with aluminum phosphide.

  4. Malpractice in Cases of Pediatric Appendicitis.

    Science.gov (United States)

    Sullins, Veronica F; Rouch, Joshua D; Lee, Steven L

    2017-03-01

    Appendicitis is one of the most common diagnoses in children and is frequently the focus of alleged malpractice. Causes for medical malpractice claims and outcomes of disputes in pediatric patients with appendicitis are currently unknown. A retrospective database review of all medical malpractice claims concerning the diagnosis of appendicitis from 1984 to 2013 in pediatric patients was performed. Alleged claims, causes of malpractice, and outcomes were recorded and analyzed. Of the 203 included cases, failure or delays in diagnosing appendicitis are the most common causes of malpractice lawsuits and account for the majority of the largest payments to plaintiffs outcomes. Cases that ultimately went to trial resulted in defense verdicts in 67.5%. Mortality occurred in 19.9% of included cases. Timely diagnosis of appendicitis in children should be the focus of physicians across all specialties to improve patient safety and potentially reduce medicolegal liability.

  5. Scrotal absceso following an appendicitis

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    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.

  6. Acute pyelonephritis in pregnancy: an 18-year retrospective analysis.

    Science.gov (United States)

    Wing, Deborah Ann; Fassett, Michael John; Getahun, Darios

    2014-03-01

    We sought to describe the incidence of acute pyelonephritis in pregnancy, and to assess its association with perinatal outcomes in an integrated health care system. A retrospective cohort study was performed using medical records on 546,092 singleton pregnancies delivered in all Kaiser Permanente Southern California hospitals from 1993 through 2010. These medical records include the perinatal service system along with inpatient and outpatient encounter files. Adjusted odd ratios (ORs) and 95% confidence intervals (CIs) were used to estimate associations. The incidence of acute antepartum pyelonephritis was 0.5% (2894/543,430). Women with pyelonephritis in pregnancy were more likely to be black or Hispanic, young, less educated, nulliparous, initiate prenatal care late, and smoke during pregnancy. Pregnancies of women with pyelonephritis compared to those without were more likely to be complicated by anemia (26.3% vs 11.4%; OR, 2.6; 95% CI, 2.4-2.9), septicemia (1.9% vs 0.03%; OR, 56.5; 95% CI, 41.3-77.4), acute pulmonary insufficiency (0.5% vs 0.04%; OR, 12.5; 95% CI, 7.2-21.6), acute renal dysfunction (0.4% vs 0.03%; OR, 16.5; 95% CI, 8.8-30.7), and spontaneous preterm birth (10.3% vs 7.9%; OR, 1.3; 95% CI, 1.2-1.5). Most of the preterm births occurred between 33-36 weeks (9.1%). We characterize the incidence of pyelonephritis in an integrated health care system where routine prenatal screening for asymptomatic bacteriuria is employed. Maternal complications are commonly encountered and the risk of preterm birth is higher than the baseline obstetric population. Copyright © 2014 Mosby, Inc. All rights reserved.

  7. Apendicite aguda: análise institucional no manejo peri-operatório Acute appendicitis: institutional evaluation in the peri-operative managment

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    Orli Franzon

    2009-06-01

    avançado o estágio de evolução da apendicite, maior a prevalência de complicações.BACKGROUND: Acute appendicitis is one of the most common cause of acute abdomen and is responsible for high morbidity. Correct diagnosis remains a challenge, thus accurate perioperative assessment is important in planning surgical therapy. AIM: To evaluate institutional findings in perioperative workup, operative approach and adverse outcomes in patients who underwent open surgical intervention for acute appendicitis. METHOD: A prospective chart was performed of 88 adults patients undergoing open appendectomy. Variables compared were imaging methods and laboratory evaluation, pathologic findings and early complications. Statistical analysis was performed by SPSS 8.0 and EpiInfo6.0. RESULTS: Thirty patients underwent ultrassonography (56,7% females and five computorized tomography (all women. The differencial white cell count was directly related to more advanced phases regarding increased of "stabs", segmented and eosinophyls/lymphocytes decrease (P>0,005. Sixty (67% patients used antibiotic therapy and 38,33% of them had perforated appendicitis. Was found 23,8% of complications, 11,4% was wound infections and patients with perforated appendicitis. CONCLUSION: Females demand more imaging methods. The differencial white cell count in complicated appendicitis has an increment in less mature neutrophils and reduction of the eosinophils and lymphocytes. Advanced phases has increase risk of early complications mainly superficial wound infections and shows more prevalence in using.

  8. Four-year retrospective look for acute scrotal pathologies

    Science.gov (United States)

    Ayvaz, Olga Devrim; Celayir, Aysenur Cerrah; Moralioglu, Serdar; Bosnali, Oktav; Pektas, Osman Zeki; Pelin, Ahmet Koray; Caman, Sefik

    2015-01-01

    OBJECTIVE: A group of diseases in the scrotum setting forth by the sudden swelling and redness and pain consist of acute scrotal pathologies. The most common causes of acute scrotum in children are epididymitis, epididymo-orchitis, orchitis, testicular torsion, torsion of the appendix testis, incarcerated inguinal hernia and traumatic hydro/hematocele. In this study; we aim to evaulate patients with acute scrotal pathologies who were interned in our department. METHODS: All hospital data of cases who were interned at our deparment due to acute scrotum in between June 2010-June 2014 were evaluated retrospectively. Cases with incarcerated inguinal herni were excluded in this study. RESULTS: In a 4-year-period 114 cases were interned in our department with acute scrotum. Mean age of the patients was 7.6±4.577 years (min: 1m-max: 18yrs). Doppler US was performed in 112 patients to evaluate the blood flow while in 2 patients applied after normal office hours were evaluated without Doppler US and operated under emergency conditions. The patients had received diagnosis of epididymitis/epididymo-orchitis/orchitis (n=83 cases; 72.8%), testicular torsion (n=24; 21.1%), torsion of the appendix testis (n=2; 1.8%) with and traumatic hydrocele/ hematocele (n=5; 4.4%). While detorsion was performed in 18 (75%) cases with testicular torsion and orchiectomy in 6 (25%) cases. Histopathological evaluation of orchiectomy specimens revealed hemorrhagic necrosis and hemorrhagic infarction or ischemic changes. Normal testicular size and vascularity were detected in 11 (61.1%) cases with detorsioned testis as detected by follow-up Doppler US. Late orchiectomy was performed in 7 cases (38.9%) with complete atrophy due to lack of blood supply. CONCLUSION: Although Doppler US is very helpful for differential diagnosis of patients with acute scrotum who applied early period, if Doppler US will lead to a waste of time, direct surgery without delay will reduce the risk of testicular loss. PMID

  9. Recurrent epiploic appendagitis mimicking appendicitis and cholecystitis

    Science.gov (United States)

    Hearne, Christopher B.; Taboada, Jorge

    2017-01-01

    Epiploic appendagitis (EA) is a rare cause of acute abdominal pain caused by inflammation of an epiploic appendage. It has a nonspecific clinical presentation that may mimic other acute abdominal pathologies on physical exam, such as appendicitis, diverticulitis, or cholecystitis. However, EA is usually benign and self-limiting and can be treated conservatively. We present the case of a patient with two episodes of EA, the first mimicking acute appendicitis and the second mimicking acute cholecystitis. Although recurrence of EA is rare, it should be part of the differential diagnosis of acute, localized abdominal pain. A correct diagnosis of EA will prevent unnecessary hospitalization, antibiotic use, and surgical procedures. PMID:28127129

  10. Laparoscopic Appendectomy for Acute Gangrenous Perforated Appendicitis%腹腔镜阑尾切除术治疗急性坏疽穿孔性阑尾炎

    Institute of Scientific and Technical Information of China (English)

    王东君; 张新元; 张震波; 刘瑞鹏; 孙宏伟

    2016-01-01

    目的:探讨腹腔镜切除术治疗急性坏疽穿孔性阑尾炎的临床价值。方法2011年6月~2014年9月对36例急性坏疽穿孔性阑尾炎施行腹腔镜下阑尾切除术,腹腔镜下探查腹腔,吸净脓液及渗液,提起阑尾显露系膜,用双极电凝钳切断阑尾系膜,编织线双重套扎阑尾根部,阑尾残端予以荷包包埋,放置腹腔引流。结果36例均顺利完成手术,无中转开腹,无并发症发生。手术时间45~115 min,平均65 min。术后引流管留置2~4 d。术后5~7 d出院。33例随访3~6个月,无腹痛、腹胀等表现。结论腹腔镜阑尾切除术治疗急性坏疽穿孔性阑尾炎安全、有效,可直视下腹腔冲洗,放置准确有效的引流管。%Objective To explore the clinical value of laparoscopic appendectomy for acute gangrenous perforated appendicitis . Methods A total of 36 patients with acute gangrenous perforated appendicitis underwent laparoscopic appendectomy from June 2011 to September 2014.After laparoscopic exploration and suction of purulent fluid and exudate , the appendix was lifted to expose and cut off mesenterium with bipolar electrocoagulation .The appendix root was double-ligated and the stump was purse string sutured.An abdominal drainage was placed . Results All the 36 cases were successfully operated .There was no conversion to laparotomy and complications .The operation continued for 45 -115 min, with a mean of 65 min.The postoperative drainage was indwelled for 2-4 d.All the patients recovered and went home after 5-7 d.Follow-ups for 3-6 months in 33 patients found no abdominal pain or distention . Conclusion Laparoscopic appendectomy for acute gangrenous perforated appendicitis is safe and effective, with advantages of peritoneal washing under direct vision and accurately and effectively placing drainage tube .

  11. 儿童急性阑尾炎住院费用的统计分析%The Statistic Analysis on Hospitalization Expenses of Children Acute Appendicitis

    Institute of Scientific and Technical Information of China (English)

    房芳

    2011-01-01

    目的 探讨儿童急性阑尾炎住院费用的分布特点和影响因素.方法 统计分析医保患者与自费患者费用构成,采用多元逐步回归模型分析急性阑尾炎住院费用的影响因素,用非参数秩的方法检验各因素的差异.结果 住院费用医保患者高于自费患者,住院天数越长费用越高,而且儿童急性阑尾炎的药费比例高;付费方式、药品、住院天数、年龄、手术方案以及切口愈合对住院费用有显著影响.结论 合理用药、加强对住院天数较长患者诊疗情况的监测,以有效缩短平均住院日可以节约医疗成本,降低医疗费用,合理分配医疗资源.%Objective A discussion on the distribution characteristics and influence factors about hospitalization expenses of children acute appendicitis.Methods A statistic analysis on expenses formation of medical insurance patients and self-financed patients; an analysis on influence factors about hospitalization expenses of acute appendicitis by using multiple stepwise regression, testing the differences of the factors by using non-parametric order.Results The hospitalization expenses of medical insurance patients are higher than self-financed patients; The more days of hospitalization the higher of expenses, while the proportion of drug expenses about children acute appendicitis is high; the way of payment, drug, hospitalization day, age, operation plan and wound healing affect the hospitalization expensos obviously.Conclusion The article suggests that reasonable medication, monitor about long hospitalization days patients strengthening in order to reduce effectively the average hospitalization day, which can achieve medical cost saving,medical expenses reduction and reasonable medical resources distribution.

  12. 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....

  13. 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....

  14. Five-Year Retrospective Review of Acute Generalized Exanthematous Pustulosis

    Directory of Open Access Journals (Sweden)

    Chitprapassorn Thienvibul

    2015-01-01

    Full Text Available Background. Acute generalized exanthematous pustulosis (AGEP is an acute pustular eruption characterized by widespread nonfollicular sterile pustules. The aim of this study is to characterize the etiology, clinical features, laboratory findings, management, and outcome of patients with AGEP in Asians. Patient/Methods. A retrospective analysis was performed on patient who presented with AGEP between August 2008 and November 2012 in a tertiary center in Thailand. Results. Nineteen patients with AGEP were included. AGEP was generally distributed in seventeen patients (89.5% and localized in two (10.5%. Fever and neutrophilia occurred in 52.6% and 68.4%, respectively. Hepatitis was found up to 26.3%. The most common etiology was drugs (94.7%, comprising of antibiotics (73.6%, proton pump inhibitors (10.5%, nonsteroidal anti-inflammatory drugs (5.3%, and herbal medicine (5.3%. Beta-lactams were the most common causal drug, particularly carbapenems and cephalosporins. This is the first report of Andrographis paniculata as an offending agent for AGEP. We found no differences between various treatment regimens (topical corticosteroid, systemic corticosteroid, and supportive treatment regarding the time from drug cessation to pustules resolution (P=0.171. Conclusions. We have highlighted the presentation of AGEP among Asians. We found high association with systemic drugs. Carbapenems were one of the leading culprit drugs. Finally, a localized variant was observed.

  15. 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

  16. Appendicitis Presenting Concurrently with Cecal Arteriovenous Malformation in a Child

    Directory of Open Access Journals (Sweden)

    Sahil P Parikh

    2015-09-01

    Full Text Available Acute appendicitis is a commonly diagnosed surgical problem in the pediatric population. Arterio-venous malformations (AVM of the colonic tract are rarely reported in the pediatric literature. A 13-year old boy who presented with acute appendicitis with concurrent cecal AVM is reported in whom appendectomy was done. Later on radiological investigations AVM was confirmed.

  17. [Appendicitis in the aged (author's transl)].

    Science.gov (United States)

    Hupe, K

    1981-01-01

    In cases of partially uncharacteristic clinical symptoms with no typical leukocytosis and no ESR elevation, laparotomy reveals not seldom an acute phlegmonous appendix. As compared with the similar disease in younger people appendicitis of the aged presents more complications and a higher mortality rate which can partially explained by clinically meaningful secondary findings and a lesser degree of peritoneal inflammation. The mortality rate of appendicitis in the aged could be markedly reduced. This may be attributed to emergency operation of clinically diagnosed appendicitis in the aged, to improve anaesthetic technique, to infusion therapy and parenteral feeding and last not least postoperative administering of antibiotics.

  18. 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

  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. 小儿急性阑尾炎20年回顾%A 20-year Review of Acute Appendicitis in Children

    Institute of Scientific and Technical Information of China (English)

    张金哲; 谢兴雅

    1987-01-01

    著者根据20年临床与病理观察提出早期急性阑尾炎应立即阑尾切除.但三天以上病例应看精神食欲,如已好转,双合诊摸到右下腹浸润块者不宜手术,反之继续恶化则仍需手术.三岁以下患儿发烧呕吐,应注意阑尾炎怕动怕震症状,反复对比腹部固定性压痛,可疑者腹穿常可确诊.近十年5000例(1/4穿孔)只1例死亡,无严重合并症.虽多次更换总住院及实习人员,证明上述方案经得考验.%Based on the previous studies in the early 1960s on the correlation between the local pathology and the clinical manifestations of acute appendicitis among children, a 20-year review of some 10000 cases and a further improvement in the treatment are presented. It is reported that about 5,000 cases treated in the decade(1976-1985), 1/4 perforated and one died and the postoperative complications have been reduced remarkably. The author emphasizes that if the general condition(especially appetite and activity)and the local tenderness of the Patients is worse than yesterday. appendectomy should be performed immediately. Otherwise, any surgical disturbance must be a voided. In order to make a correct digonsis of appendicitis in children under three years of age, a careful comparison-palpation of different parts of the abdomen to find out the definite tenderness, and to feel out an abdominal mass (under sedative) or peritoneocentesis looking for pus cells should be done.

  1. Schistosomal appendicitis: Incidence in Japan and a case report

    Institute of Scientific and Technical Information of China (English)

    Tadashi Terada

    2009-01-01

    Schistosomal appendicitis is very rare in developed countries like the USA, Europe, and Japan. The author reviewed 311 pathologic archival specimens of vermiform appendix over the past 10 years. One case of schistosomal appendicitis was recognized. Therefore, the incidence of this disease was 0.32% in all appendices surgically resected in our hospital. The patient was a 41-year-old woman presenting with lower abdominal pain. She was a sailor traveling to many countries including endemic areas. Physical examination, laboratory data, and imaging modalities suggested an acute appendicitis, and appendectomy was performed under the diagnosis of ordinary appendicitis. Histologically, numerous schistosomal eggs were present in the vasculatures throughout the appendiceal walls. Some of the eggs were calcified. Stromal foreign body reaction was also recognized. The appendicitis was phlegmonous consisting of severe infiltrations of neutrophils and eosinophils. Acute serositis was also noted. Examination of feces revealed numerous eggs of Schistosoma mansoni. Clinicians should be aware of schistosomal appendicitis.

  2. Abdominal cystic lymphangioma mimicking appendicitis.

    Science.gov (United States)

    Wake, Sarah; Abhyankar, Aruna; Hutton, Kim

    2013-06-01

    A cystic lymphangioma arising within the abdomen is a rare entity in children. It may present with an abdominal mass and symptoms of abdominal pain, vomiting, and anorexia. These nonspecific clinical symptoms are often attributed to more common acute pediatric conditions. In this report, we describe two pediatric cases of intra-abdominal cystic lymphangioma that were initially diagnosed and treated as appendicitis. True diagnosis was only achieved on surgical excision and pathological investigation of cystic material.

  3. Abdominal Cystic Lymphangioma Mimicking Appendicitis

    OpenAIRE

    Wake, Sarah; Abhyankar, Aruna; Hutton, Kim

    2013-01-01

    A cystic lymphangioma arising within the abdomen is a rare entity in children. It may present with an abdominal mass and symptoms of abdominal pain, vomiting, and anorexia. These nonspecific clinical symptoms are often attributed to more common acute pediatric conditions. In this report, we describe two pediatric cases of intra-abdominal cystic lymphangioma that were initially diagnosed and treated as appendicitis. True diagnosis was only achieved on surgical excision and pathological investi...

  4. Retrospective analysis on acute respiratory distress syndrome in ICU

    Institute of Scientific and Technical Information of China (English)

    LI Jin-bao; ZHANG Liang; ZHU Ke-ming; DENG Xiao-ming

    2007-01-01

    Objective:To assess the incidence, etiology, physiological and clinical features, mortality, and predictors of acute respiratory distress syndrome (ARDS) in intensive care unit (ICU).Methods: A retrospective analysis of 5 314 patients admitted to the ICU of our hospital from April 1994 to December 2003 was performed in this study. The ARDS patients were identified with the criteria of the American-European Consensus Conference ( AECC ). Acute physiology and chronic health evaluation Ⅲ ( APACHE in), multiple organ dysfunction syndrome score (MODS score), and lung injury score (LIS) were determined on the onset day of ARDS for all the patients. Other recorded variables included age, sex, biochemical indicators, blood gas analysis, length of stay in ICU, length of ventilation, presence or absence of tracheostomy, ventilation variables, elective operation or emergency operation.Results:Totally, 131 patients (2.5%) developed ARDS, among whom, 12 patients were excluded from this study because they died within 24 hours and other 4 patients were also excluded for their incomplete information. Therefore, there were only 115 cases (62 males and 53 females, aged 22-75 years, 58 years on average) left,accounting for 2. 2% of the total admitted patients. Their average ICU stay was (11. 27±7. 24) days and APACHE in score was 17.23±7.21. Pneumonia and sepsis were the main cause of ARDS. The non-survivors were obviously older and showed significant difference in the ICU length of stay and length of ventilation as compared with the survivors. On admission, the non-survivors had significantly higher MODS and lower BE ( base excess). The hospital mortality was 55. 7%. The main cause of death was multiple organ failure. Predictors of death at the onset of ARDS were advanced age, MODS≥8, and LIS≥2.76.Conclusions: ARDS is a frequent syndrome in this cohort. Sepsis and pneumonia are the most common risk factors. The main cause of death is multiple organ failure. The mortality is

  5. Diagnosis of appendicitis during pregnancy and perinatal outcome in the late pregnancy

    Institute of Scientific and Technical Information of China (English)

    ZHANG Yan; ZHAO Yang-yu; QIAO Jie; YE Rong-hua

    2009-01-01

    Background Appendicitis is the most common surgical problem in pregnancy, however the particular dangers of appendicitis in pregnancy lie in the varied presentation of symptoms and the higher chance of delayed diagnosis. The aim of this study was to determine the risk factors associated with prenatal outcome in acute appendicitis during second and third trimester pregnancies.Methods This was a retrospective single-center study that presented a descriptive analysis of the results. A total of 102 pregnant women who were diagnosed with acute appendicitis and operated upon in Peking University Third Hospital,China between January 1993 and December 2007 were presented. SPSS 12.0 for Windows was used for data analysis.Results Seventy-eight pregnant women who were diagnosed with acute appendicitis (sixteen patients had a perforated appendix, 62 patients had a non-perforated appendix) were operated upon during late pregnancy. The interval between symptom onset and surgery was the only predictive variable. A longer interval between symptom onset and surgery was associated with appendix perforation ((109.5±52.7) hours) than with no appendix perforation ((35.1±19.62) hours;P=0.007). There was a significant difference in the rate of preterm labor (5.1% vs 1.3%) and the rate of fetal mortality (25% vs 1.7%) between patients with and without a perforated appendix.Conclusions Delaying surgery correlates to more advanced disease with an increased risk of perforation. This contributes to an increased risk of further complications, including premature labor or abortion, and to higher maternal complication rates. Prompt diagnosis may improve the prenatal outcome.

  6. 综合护理对急性阑尾炎患者的影响分析%Analysis on the Influence of Comprehensive Nursing Care on the Patients With Acute Appendicitis

    Institute of Scientific and Technical Information of China (English)

    刘寒梅

    2015-01-01

    目的:分析综合护理对急性阑尾炎患者的影响。方法将86例急性阑尾炎患者随机分为A组(综合护理)和B组(常规护理),各43例,分析两组护理效果。结果A组SAS评分、SDS评分及并发症发生率较B组低。结论给予急性阑尾炎患者综合护理可有效缓解患者不良情绪,减少并发症发生。%Objective To analyze the effect of comprehensive nursing care on the patients with acute appendicitis. Methods 86 cases of acute appendicitis were randomly divided into group A (Comprehensive Nursing) and group B (routine nursing),each of 43 cases,analyzed the nursing effect of the two groups. Results In group A,SAS score,SDS score and the incidence of complications were lower than that of B group. Conclusion Comprehensive nursing care given to patients with acute appendicitis patients can effectively al eviate the bad mood and reduce complications.

  7. The Clinical Manifestations and CT Findings of Cecal Diverticulitis: Comparison Study with Acute Appendicitis%盲肠憩室炎与急性阑尾炎的临床与CT征象对照分析

    Institute of Scientific and Technical Information of China (English)

    李坤炜; 田素伟; 秦培鑫; 丁香莲; 柳学国

    2014-01-01

    目的 探讨盲肠憩室炎的CT影像特点,分析其与急性阑尾炎的临床与影像学表现异同.方法 回顾性分析经手术病理或临床证实的13例盲肠憩室炎与66例急性阑尾炎的临床症状、体征、实验室检查及CT影像资料,分析其异同.结果 盲肠憩室炎组与急性阑尾炎组在发病-就诊时间、中性粒细胞百分比、是否发热、是否存在右下腹反跳痛上差异存在明显统计学意义(P<0.05);而在男女比例、年龄、白细胞计数、右下腹痛类型、是否有恶心呕吐、是否右下腹压痛上相当,差异无统计学意义.两组在阑尾直径、阑尾腔积气、积液、结石、局灶盲肠顶端增厚、阑尾周围渗出上差异存在明显统计学意义(P<0.05).结论 盲肠憩室炎与急性阑尾炎的临床表现极为相似,但具有发病-就诊时间较长,全身症状略轻,右下腹反跳痛相对较少的特点.两者影像表现有着本质区别,前者阑尾正常或相对正常,炎症渗出以盲肠为中心,常累及腹部右上象限;后者存在炎症阑尾,炎性渗出以阑尾为中心,多局限于腹部右下象限.%Objective To explore the clinical and CT imaging characteristics of cecal diverticulitis,and to discuss the differentiation of cecal diverticulitis from acute appendicitis.Methods A total of 13 patients with cecal diverticulitis and 66 patients with acute appendicitis were enrolled in this study.The diagnosis was pathologically or clinically confirmed in all cases.The clinical symptoms,signs,laboratory results and CT findings were retrospectively analyzed.Results Statistically significant differences in the interval of onset-medical visit,the percentage of neutrophils,the presence or absence of fever and right lower quadrant rebound tenderness existed between the two groups (P < 0.05),while no significant differences in the sex ratio,age,white blood cells count,the type of right lower abdominal pain,the presence or absence of nausea

  8. Outcomes of Nonoperative Management of Uncomplicated Appendicitis.

    Science.gov (United States)

    Bachur, Richard G; Lipsett, Susan C; Monuteaux, Michael C

    2017-07-01

    Nonoperative management (NOM) of uncomplicated pediatric appendicitis has promise but remains poorly studied. NOM may lead to an increase in resource utilization. Our objective was to investigate the trends in NOM for uncomplicated appendicitis and study the relevant clinical outcomes including subsequent appendectomy, complications, and resource utilization. Retrospective analysis of administrative data from 45 US pediatric hospitals. Patients appendicitis between 2010 and 2016 were studied. NOM was defined by an ED visit for uncomplicated appendicitis treated with antibiotics and the absence of appendectomy at the index encounter. The main outcomes included trends in NOM among children with uncomplicated appendicitis and frequency of subsequent diagnostic imaging, ED visits, hospitalizations, and appendectomy during 12-month follow-up. 99 001 children with appendicitis were identified, with a median age of 10.9 years. Sixty-six percent were diagnosed with nonperforated appendicitis, of which 4190 (6%) were managed nonoperatively. An increasing number of nonoperative cases were observed over 6 years (absolute difference, +20.4%). During the 12-month follow-up period, NOM patients were more likely to have the following: advanced imaging (+8.9% [95% confidence interval (CI) 7.6% to 10.3%]), ED visits (+11.2% [95% CI 9.3% to 13.2%]), and hospitalizations (+43.7% [95% CI 41.7% to 45.8%]). Among patients managed nonoperatively, 46% had a subsequent appendectomy. A significant increase in NOM of nonperforated appendicitis was observed over 6 years. Patients with NOM had more subsequent ED visits and hospitalizations compared with those managed operatively at the index visit. A substantial proportion of patients initially managed nonoperatively eventually had an appendectomy. Copyright © 2017 by the American Academy of Pediatrics.

  9. 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.

  10. Diagnostic utility of intravenous contrast for MR imaging in pediatric appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Lyons, Gray R.; Renjen, Pooja; Kovanlikaya, Arzu [New York-Presbyterian Hospital/Weill Cornell Medicine, Department of Radiology, New York, NY (United States); Askin, Gulce; Giambrone, Ashley E. [New York-Presbyterian Hospital/Weill Cornell Medicine, Department of Biostatistics and Epidemiology, New York, NY (United States); Beneck, Debra [New York-Presbyterian Hospital/Weill Cornell Medicine, Department of Pathology, New York, NY (United States)

    2017-04-15

    Magnetic resonance imaging (MRI) is increasingly employed as a diagnostic modality for suspected appendicitis in children. However, there is uncertainty as to which MRI sequences are sufficient for safe, timely and accurate diagnosis. Several recent studies have described different MRI protocols, including exams both with and without the use of intravenous contrast. We hypothesized that intravenous contrast may be useful in some patients but could be safely omitted in others. All MRI examinations (n=112) performed at our institution for evaluating appendicitis in children were retrospectively reevaluated. Exams were reread by pediatric radiologists under three conditions: With postcontrast images, Without postcontrast images, and Without/With - selective use of postcontrast sequences only when needed for diagnostic certainty. Samples were scored as positive, negative or equivocal for appendicitis. Findings were compared to pathological or clinical follow-up in the medical record. Without the use of intravenous contrast yielded more equivocal results (12.4%) compared to With contrast (3.4%). By selectively using postcontrast sequences, the Without/With group yielded fewer equivocal results (1.1%) compared to Without while also reducing contrast use 79.8% compared to the With contrast group. No significant differences in conditional sensitivity or conditional specificity were detected among the three groups. MRI diagnosis of acute appendicitis can be performed without contrast for most patients; injection of contrast can be reserved for only those patients with equivocal non-contrast imaging. (orig.)

  11. Role of the faecolith in modern-day appendicitis

    Science.gov (United States)

    Singh, JP

    2013-01-01

    Introduction The prevailing view on appendicitis is that the main aetiology is obstruction owing to faecoliths in adults and lymphoid hyperplasia in children. Faecoliths on imaging studies are believed to correlate well with appendicitis. Methods A retrospective chart review was conducted of 1,014 emergency appendicectomy patients between 2001 and 2011. Faecolith prevalence in adult and paediatric appendicectomy specimens with and without perforation was studied. The sensitivity and positive predictive value (PPV) of computed tomography (CT) for identifying faecoliths in the pathology specimen were examined. Results Overall, faecoliths were found in 18.1% (178/986) of appendicitis specimens and 28.6% (8/28) of negative appendicectomies. Faecolith prevalence for positive cases was 29.9% (79/264) in paediatric patients and 13.7% (99/722) in adults (pappendicitis but only 14.6% in non-perforated appendicitis (pappendicitis and 12.0% in non-perforated appendicitis (pappendicitis and 22.7% in non-perforated appendicitis (p=0.00). Sensitivity and PPV of preoperative CT in identifying faecoliths on pathology were 53.1% (86/162) and 44.8% (86/192) respectively. Conclusions Faecolith prevalence is too low to consider the faecolith the most common cause of non-perforated appendicitis. Faecoliths are more prevalent in paediatric appendicitis than in adult appendicitis. Preoperative CT is an unreliable predictor of faecoliths in pathology specimens. PMID:23317728

  12. 腹腔镜诊治非急性阑尾炎性右下腹痛19例体会%Diagnosis and treatment of right lower quarter abdominal pain caused not by acute appendicitis with laparoscopic

    Institute of Scientific and Technical Information of China (English)

    程书榜; 朱量; 黄丽君

    2012-01-01

    目的 总结腹腔镜诊治非急性阑尾炎性右下腹痛经验体会.方法 回顾性分析2010年1月至2012年5月,19例以右下腹痛为主要临床表现的患者临床资料、诊治经过及预后.结果 19例病例中大网膜扭转并坏死3例,盲肠化脓性炎并穿孔4例,盲肠脂肪垂化脓性炎3例,盲肠憩室炎2例,克罗恩病1例,阑尾假粘液瘤3例,输卵管积脓3例.所有病例中,1例克罗恩病和2例盲肠憩室炎终止手术行内科治疗,1例盲肠化脓性炎并穿孔中转开腹行回盲部切除术,其他病例在腹腔镜下行以下手术:大网膜部分切除3例,回盲部切除2例,盲肠脂肪垂切除3例,阑尾切除2例,右半结肠切除2例,妇科治疗3例.术后出现腹腔炎性肉芽肿1例,无死亡病例.结论 右下腹痛往往误诊为急性阑尾炎,腹腔镜可以减少盲目探查和明确诊断,同时可以完成相应治疗;腹腔镜可作为右下腹痛患者诊治的理想选择.%Objective To summary the experience of diagnosis and treatment of right lower quarter abdominal pain caused not by acute appendicitis with laparoscopy.Methods The clinical data,process of diagnosis and treatment and prognosis of 19 cases with right lower abdominal pain between January 2010 and May 2012 were analyzed retrospectively.Results All of 19 cases,there was 3 cases with omental torsion with nicrosis,4 with suppurative typhlitis with perforation,3 with suppurative inflammation fat hanging of caecum,2 with diverticulitis of caecum,1 with crohn's disease,3 with pseudo myxoma of appendix and 3 with empyema of fallopian tube.Fifty cases were operated by laparoscopy.Conclusions Right lower quarter was always misdiagnosed as acute appendicitis,laparoscopy may be ideal selection for patient with right lower quarter.

  13. De Garengeot's hernia: an unusual right groin mass due to acute appendicitis in an incarcerated femoral hernia.

    Science.gov (United States)

    Salkade, Parag R; Chung, Alexander Y F; Law, Y M

    2012-10-01

    The presence of an acutely inflamed vermiform appendix in a femoral hernia sac is extremely rare; the condition is termed De Garengeot's hernia. Here we describe an elderly patient for whom preoperative computed tomography aided the diagnosis of this rare entity. This Chinese woman had presented with a painful right groin mass. The patient successfully underwent an emergency appendicectomy and primary femoral hernia repair. Once diagnosed, it is imperative to follow key surgical principles to limit the spread of infection.

  14. Laparoscopic versus open approach in the management of appendicitis complicated exclusively with peritonitis: a single center experience.

    Science.gov (United States)

    Quezada, Felipe; Quezada, Nicolas; Mejia, Ricardo; Brañes, Alejandro; Padilla, Oslando; Jarufe, Nicolas; Pimentel, Fernando

    2015-01-01

    Controversial evidence exists regarding the laparoscopic approach in patients with acute appendicitis complicated with peritonitis due to a higher rate of surgical complications. The aim of this study was to compare post-operatory outcomes in patients with acute appendicitis complicated exclusively with peritonitis approached by laparoscopy versus open surgery. Single center retrospective analysis of clinical records of patients with appendicitis complicated with peritonitis operated from January 2003 until October 2013. Demographic data, intra-operative variables, length of stay, surgical complications, mortality, readmissions and reoperations were retrieved. 227 patients were identified, 43% males, mean age 39±17 years (range: 12-85 years). Ninety-seven patients (43%) underwent laparoscopic appendectomy, 13 of them were converted to open surgery (13%). Ninety-four patients presented with diffuse peritonitis (41.4%). Laparoscopic appendectomy showed longer operative time but shorter hospital stay (pperitonitis. In our experience, laparoscopic appendectomy is a safe approach in cases of appendicitis complicated exclusively with peritonitis. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  15. 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

  16. Intrauterine contraceptive device appendicitis: A case report

    Institute of Scientific and Technical Information of China (English)

    Hao-Ming Chang; Teng-Wei Chen; Chung-Bao Hsieh; Chung-Jueng Chen; Jyh-Cherng Yu; Yao-Chi Liu; Kuo-Liang Shen; De-Chuan Chan

    2005-01-01

    Uterine perforation is one of the serious complications associated with use of the intrauterine contraceptive device (IUD). Uterine perforation by IUD can involve several neighboring organs. A case of acute appendicitis was caused by a Multiload Cu 375 IUD inserted previously.This is a rare complication and only fourteen previous cases were recorded in the literature.

  17. 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

  18. An adult intussusception mimicking early appendicitis

    Institute of Scientific and Technical Information of China (English)

    Wei-Chun Tseng; Cheng-Ting Hsiao; Yu-Cheng Hung

    2012-01-01

    Adult intussusception is rare with variable clinical presentation. We reported a case of adult intussusception presenting with symptoms mimicking acute appendicitis. The patient presented as an abdominal pain from epigastric area with shifting gradually to RLQ. The atypical presentation of adult intussusception remains a diagnostic challenge to the emergency physician.

  19. Trends in the Diagnosis and Management of Pediatric Appendicitis.

    Science.gov (United States)

    Hansen, Laura W; Dolgin, Stephen E

    2016-02-01

    • On the basis of class B evidence and consensus, acute appendicitis in children can often be diagnosed clinically with only selective use of imaging. (13)(14)(15)(16) • On the basis of class B evidence and consensus, ultrasonography is the test of choice when acute appendicitis is suspected but is unclear based on history, physical examination, and laboratory results. (17)(18)(19) • On the basis of class B evidence and consensus, the use of computed tomography scan should be limited to cases of suspected complex appendicitis with abscess or when there is clinical suspicion for acute appendicitis but ultrasonography results are not helpful. (16) • On the basis of class C evidence and consensus, children with possible appendicitis ideally should be treated in medical centers that have skilled sonographic personnel. (21) • On the basis of class B evidence and consensus, simple appendicitis should be treated by appendectomy during normal operating hours. Preoperative treatment with intravenous antibiotics and fluids during the overnight hours halts disease progression and allows for the safest surgery with the benefit of a full and rested staff. (24)(25)(26) • On the basis of class B evidence and consensus, complex appendicitis with a well-defined abscess can be treated nonoperatively initially, with the option of an interval appendectomy after recovery from the acute infection. (29)(30) (31)(32)(33)

  20. Dynamic monitoring of serum LXA4 and procalcitonin in patients with acute appendicitis%血清LXA4与降钙素原在急性阑尾炎患者中的动态监测

    Institute of Scientific and Technical Information of China (English)

    朱克华; 张福

    2016-01-01

    Objective To analyze effects of LXA4 and PCT on the diagnosis and prognosis of patients with acute appendicitis by dynamic monitoring of peripheral blood lipoxin A4 (LXA4) and procalcitonin (PCT) levels. Methods 120 patients with acute appendicitis who were admitted to our hospital from March 2011 to June 2015 were selected.LXA4 and PCT levels before operation and the second day after operation (11-35h) were monitored by Enzyme-linked immunosorbent assay (ELISA) and they were analyzed and compared. Results In 120 patients with acute appendicitis,there were 35 cases of simple appendicitis,47 cases of suppurative appendicitis and 38 cases of perforated appendicitis or gangrenous appendicitis according to the surgery or (and) pathological diagnosis results. The levels of the serum LXA4 before operation of 120 patients with acute appendicitis before the operation were all higher than those after operation (P 0.05).Preoperative serum PCT levels of the simple,suppurative,perforated and gangrenous appendicitis groups were all higher than those before operation (P 0.05). Conclusion Monitoring of serum LXA4 and PCT levels of acute appendicitis patients has certain guiding significance in diagnosis, operation assessment and the prognosis recovery of acute appendicitis.%目的:通过动态监测急性阑尾炎患者手术前后外周血脂氧素A4(LXA4)与降钙素元(PCT)水平,分析LXA4、PCT在急性阑尾炎患者的诊断及预后中的作用。方法选取我院2011年3月~2015年6月,120例急性阑尾炎患者,采用酶联免疫吸附法(ELISA)检测术前及术后第2天(11~35h)患者外周血LXA4、PCT水平,并进行分析比较。结果120例急性阑尾炎患者,结合手术或(和)病理诊断结果分为单纯性阑尾炎(35例)、化脓性阑尾炎(47例)、穿孔性及坏疽性阑尾炎(38例)。120例急性阑尾炎患者术前血清LXA4水平均高于术后(P<0.05);化脓性、穿孔性及坏疽

  1. 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...

  2. Cytological diagnosis of xanthogranulomatous appendicitis

    Science.gov (United States)

    Kaushik, Rajni; Gulati, Anchana; Vedant, Deepak; Kaushal, Vijay

    2017-01-01

    Xanthogranulomatous reaction can occur in any organ but the most common sites are kidney and gallbladder. Xanthogranulomatous appendicitis (XA) is a rare clinical entity. There are a few case reports of XA diagnosed on histopathology but none on cytology. Here we report a case of a 47-year-old lady who presented with acute abdomen and was found to have a mass lesion in the right iliac fossa. She was diagnosed with XA intraoperatively on imprint cytology that was subsequently confirmed on histopathological examination. Due to the rarity of XA itself and the use of imprint cytology for intraoperative diagnosis the case is being presented. PMID:28182060

  3. Timely recognition of Amyand's hernia with appendicitis in infants

    Institute of Scientific and Technical Information of China (English)

    Zhen Shen; Shan Zheng

    2015-01-01

    Background: Amyand's hernia with acute appendicitis is rare in infants and is mostly delayed in diagnosis and treatment, resulting in a high morbidity. Methods: We presented two cases of infantile Amyand's hernia with acute appendicitis. Results: Early surgical interventions were performed and both patients recovered without complication. Conclusion: A practical strategy for this entity is to be aware of the rare disease and to perform early surgical exploration for suspected cases.

  4. Survival after acute hemodialysis in Pennsylvania, 2005-2007: a retrospective cohort study.

    Directory of Open Access Journals (Sweden)

    Sarah J Ramer

    Full Text Available BACKGROUND: Little is known about acute hemodialysis in the US. Here we describe predictors of receipt of acute hemodialysis in one state and estimate the marginal impact of acute hemodialysis on survival after accounting for confounding due to illness severity. MATERIALS AND METHODS: This is a retrospective cohort study of acute-care hospitalizations in Pennsylvania from October 2005 to December 2007 using data from the Pennsylvania Health Care Cost Containment Council. Exposure variable is acute hemodialysis; dependent variable is survival following acute hemodialysis. We used multivariable logistic regression to determine propensity to receive acute hemodialysis and then, for a Cox proportional hazards model, matched acute hemodialysis and non-acute hemodialysis patients 1∶5 on this propensity. RESULTS: In 2,131,248 admissions of adults without end-stage renal disease, there were 6,657 instances of acute hemodialysis. In analyses adjusted for predicted probability of death upon admission plus other covariates and stratified on age, being male, black, and insured were independent predictors of receipt of acute hemodialysis. One-year post-admission mortality was 43% for those receiving acute hemodialysis, compared to 13% among those not receiving acute hemodialysis. After matching on propensity to receive acute hemodialysis and adjusting for predicted probability of death upon admission, patients who received acute hemodialysis had a higher risk of death than patients who did not over at least 1 year of follow-up (hazard ratio 1·82, 95% confidence interval 1·68-1·97. CONCLUSIONS: In a populous US state, receipt of acute hemodialysis varied by age, sex, race, and insurance status even after adjustment for illness severity. In a comparison of patients with similar propensity to receive acute hemodialysis, those who did receive it were less likely to survive than those who did not. These findings raise questions about reasons for lack of

  5. 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.

  6. Orbital complications secondary to acute sinusitis– A 10 years retrospective review

    OpenAIRE

    2015-01-01

    Abstract Introduction: Orbital complication may accompany acute sinusitis in all age, commonly preseptal or orbital cellulitis. Aim: To evaluate the clinical presentation, management, and outcome of orbital complications of sinusitis in patients treated at our institution. Methods: A case study of retrospective review of 10 patients with orbital complications secondary to acute sinusitis was conducted in our centre over a 10-years period. The clinical presentation, relevant investigations, m...

  7. Retrospective study of therapy of acute myocardial infraction

    Directory of Open Access Journals (Sweden)

    Christina Marvaki

    2011-07-01

    Full Text Available Coronary artery disease consist the main cause of disability and morbidity in many developed countries. The purpose of the present study was to compare the treatment- therapy of Acute Coronary Disease during 1998 to 2008. Method and material : The sample of the present study consisted of patients with acute coronary syndrome that were hospitalized in Intensive Care Unit of a public hospital. Data were collected by the completion of a specially designed clinical protocol for the needs of the survey. Statistical analyses (t-test, X2 test and Relative Risk. were conducted using the Statistical Package for Social Sciences 17.0. Results : From the sample-studied during 1998, 27.5% were women and 72.5% men, with mean age 63.60 years old, while during 2008, 13.7% were women and 86.3% men with mean age 62.8 years old. Patients with final diagnosis STEMI during 2008 were more with statistically significant difference, compared to 1998, p= 55 years old. Percentage of patients who had coronary intervention during 2008 was higher with statistically significant difference compared to 1998, p=55 years old. Percentage of death was higher in 1998 with statistical significant difference compared to 2008, p=0.001.

  8. Stratified computed tomography findings improve diagnostic accuracy for appendicitis

    Science.gov (United States)

    Park, Geon; Lee, Sang Chul; Choi, Byung-Jo; Kim, Say-June

    2014-01-01

    AIM: To improve the diagnostic accuracy in patients with symptoms and signs of appendicitis, but without confirmative computed tomography (CT) findings. METHODS: We retrospectively reviewed the database of 224 patients who had been operated on for the suspicion of appendicitis, but whose CT findings were negative or equivocal for appendicitis. The patient population was divided into two groups: a pathologically proven appendicitis group (n = 177) and a non-appendicitis group (n = 47). The CT images of these patients were re-evaluated according to the characteristic CT features as described in the literature. The re-evaluations and baseline characteristics of the two groups were compared. RESULTS: The two groups showed significant differences with respect to appendiceal diameter, and the presence of periappendiceal fat stranding and intraluminal air in the appendix. A larger proportion of patients in the appendicitis group showed distended appendices larger than 6.0 mm (66.3% vs 37.0%; P appendicitis group. Furthermore, the presence of two or more of these factors increased the odds ratio to 6.8 times higher than baseline (95%CI: 3.013-15.454; P appendicitis with equivocal CT findings. PMID:25320531

  9. Enterobius vermicularis and its role in paediatric appendicitis: protection or predisposition?

    Science.gov (United States)

    Lala, Shareena; Upadhyay, Vipul

    2016-09-01

    E nterobius vermicularis is one of the most common parasitic infections of the gastrointestinal tract, and has been shown to infest up to 28% of children worldwide. The role of E . vermicularis in acute appendicitis has previously been questioned, with some studies identifying infection as a precursor for inflammation of the appendix, with others refuting such a link. A retrospective review was conducted of all appendices received for histological analysis at our unit from January 2002 to December 2011 (10-year period), removed in the course of acute appendicectomy in children aged 3 to 15 years. Appendices were categorized by degree of inflammation and infestation with E . vermicularis. Appendicectomy for clinical suspicion of acute appendicitis was performed in 2923 patients, 1694 (58%) male, median age 11.6 years. E . vermicularis was present in 4% of appendices; 25% of which showed concurrent acute inflammation. E . vermicularis infestation was more common in females (F : M 76% versus 24% of inflamed appendices and 66.7% versus 33.3% for non-inflamed appendices). European individuals showed higher representation in the E . vermicularis group than the total study population (79% versus 53% respectively). E . vermicularis was found to be more common in females and those of European descent. Seventy-seven percent of patients with E . vermicularis did not have concurrent acute inflammation of the appendix on histological examination. The question remains as to whether infestation is protective of inflammation or whether infestation causes appendiceal colic and subsequent appendicectomy of a non-inflamed appendix, thereby protective of the morbidity of acute appendicitis. © 2016 Royal Australasian College of Surgeons.

  10. Heterogeneous cytogenetic subgroups and outcomes in childhood acute megakaryoblastic leukemia : a retrospective international study

    NARCIS (Netherlands)

    Inaba, Hiroto; Zhou, Yinmei; Abla, Oussama; Adachi, Souichi; Auvrignon, Anne; Beverloo, H. Berna; de Bont, Eveline; Chang, Tai-Tsung; Creutzig, Ursula; Dworzak, Michael; Elitzur, Sarah; Fynn, Alcira; Forestier, Erik; Hasle, Henrik; Liang, Der-Cherng; Lee, Vincent; Locatelli, Franco; Masetti, Riccardo; De Moerloose, Barbara; Reinhardt, Dirk; Rodriguez, Laura; Van Roy, Nadine; Shen, Shuhong; Taga, Takashi; Tomizawa, Daisuke; Yeoh, Allen E. J.; Zimmermann, Martin; Raimondi, Susana C.

    2015-01-01

    Comprehensive clinical studies of patients with acute megakaryoblastic leukemia (AMKL) are lacking. We performed an international retrospective study on 490 patients (age 50 chromosomes (n=44, 11.8%). Chromosome gain occurred in 195 of 372 (52.4%) patients: +21 (n = 106, 28.5%), +19 (n = 93, 25.0%),

  11. 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

  12. Diagnosis and treatment of children with acute appendicitis with the performance of intestinal obstruction%以肠梗阻为表现的小儿急性阑尾炎的诊治

    Institute of Scientific and Technical Information of China (English)

    尚献会; 陈长梅; 王鑫; 金祝; 高明娟; 郑泽兵

    2016-01-01

    目的:分析表现为肠梗阻的小儿急性阑尾炎的临床诊治特点。方法:收治小儿急性阑尾患儿60例,分析患儿的临床资料。结果:60例患儿均出现了食欲不振,腹痛偶伴有腹泻,恶心,呕吐,少量患儿伴有发热等肠梗阻临床症状。入院后对患儿进行支持治疗。手术中明确急性阑尾炎导致肠梗阻发生。根据各患儿的病情进行针对性治疗。结论:提高对疾病的认识,做到早诊断、早治疗,这样大部分阑尾炎患者可以治愈,同时对患者认真探查,可有效减少并发症的产生。%Objective:To analyze the characteristics of clinical diagnosis and treatment of children with acute appendicitis with the performance of intestinal obstruction.Methods:60 children with acute appendicitis were selected.We analyzed the clinical data. Results:60 cases showed loss of appetite,abdominal pain occasionally accompanied by diarrhea,nausea and vomiting,a small amount of children with fever and other symptoms of intestinal obstruction.Support treatment for children after admission.In the operation,it was found the intestinal obstruction occurred due to acute appendicitis.According to the patient's condition for targeted treatment.Conclusion:Improve the understanding of the disease,make early diagnosis and early treatment,so that most of the patients with appendicitis can be cured,at the same time,serious exploration should be carried out for patients,which can effectively reduce the complications.

  13. Pediatric CT dose reduction for suspected appendicitis: a practice quality improvement project using artificial gaussian noise--part 2, clinical outcomes.

    Science.gov (United States)

    Callahan, Michael J; Anandalwar, Seema P; MacDougall, Robert D; Stamoulis, Catherine; Kleinman, Patricia L; Rangel, Shawn J; Bachur, Richard G; Taylor, George A

    2015-03-01

    OBJECTIVE. The purpose of this study was to determine the effect of a nominal 50% reduction in median absorbed radiation dose on sensitivity, specificity, and negative appendectomy rate of CT for acute appendicitis in children. MATERIALS AND METHODS. On the basis of a departmental practice quality improvement initiative using computer-generated gaussian noise for CT dose reduction, we applied a nominal dose reduction of 50% to abdominal CT techniques used for bowel imaging. This retrospective study consisted of 494 children who underwent a CT for suspected acute appendicitis before (n = 244; mean age, 133 months) and after (n = 250; mean age, 145 months) the nominal 50% dose reduction. Test performance characteristics of CT for acute appendicitis and impact on the negative appendectomy rate were compared for both time periods. Primary analyses were performed with histologic diagnosis as the outcome standard. Volume CT dose index and dose-length product were recorded from dose reports and size-specific dose estimates were calculated. RESULTS. The nominal 50% dose reduction resulted in an actual 39% decrease in median absorbed radiation dose. Sensitivity of CT for diagnosis of acute appendicitis was 98% (95% CI, 91-100%) versus 97% (91-100%), and specificity was 93% (88-96%) versus 94% (90-97%) before and after dose reduction, respectively. The negative appendectomy rate was 4.5% (0.8-10.25%) before dose reduction and 4.0% (0.4-7.6%) after dose reduction. CONCLUSION. The negative appendectomy rate and performance characteristics of the CT-based diagnosis of acute appendicitis were not affected by a 39% reduction in median absorbed radiation dose.

  14. 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.

  15. Fiber Intake and Childhood Appendicitis.

    Science.gov (United States)

    Brender, Jean D.; And Others

    1985-01-01

    Parents of 135 children with appendicitis and of 212 comparison children were interviewed about their children's diet. Results suggest that a liberal intake of whole-grain breads and cereals may decrease the risk of appendicitis during childhood. (KH)

  16. Fiber Intake and Childhood Appendicitis.

    Science.gov (United States)

    Brender, Jean D.; And Others

    1985-01-01

    Parents of 135 children with appendicitis and of 212 comparison children were interviewed about their children's diet. Results suggest that a liberal intake of whole-grain breads and cereals may decrease the risk of appendicitis during childhood. (KH)

  17. Sonographic Differentiation of Complicated From Uncomplicated Appendicitis: Implications for Antibiotics-First Therapy.

    Science.gov (United States)

    Xu, Yingding; Jeffrey, R Brooke; Chang, Stephanie T; DiMaio, Michael A; Olcott, Eric W

    2017-02-01

    To evaluate sonographic findings as indicators of complicated versus uncomplicated appendicitis in the setting of known appendicitis, a necessary distinction in deciding whether to proceed with antibiotic therapy or with appendectomy. With Institutional Review Board approval and Health Insurance Portability and Accountability Act compliance, appendiceal sonograms of 119 patients with histopathologically proven appendicitis were retrospectively blindly reviewed to determine the presence or absence of the normally echogenic submucosal layer, the presence of mural hyperemia, periappendiceal fluid, appendicoliths, and hyperechoic periappendiceal fat and to determine the maximum outside diameter. Results were compared with the presence of complicated versus uncomplicated appendicitis on histopathologic examination and assessed by both univariate and mulitvariate logistic regression; confidence intervals (CIs) of proportions were assessed by the exact binomial test. Thirty-two (26.9%) of the 119 patients had complicated appendicitis, including 11 with gangrenous appendicitis without perforation and 21 with gangrenous appendicitis and perforation. Loss of the submucosal layer was the only independent significant indicator of complicated appendicitis in multivariate regression (P appendicitis, being the only finding independently and significantly associated with complicated appendicitis and, additionally, providing both high sensitivity and high specificity. This information may help a physician decide whether to proceed with antibiotic therapy or with appendectomy when treating a patient with appendicitis. © 2016 by the American Institute of Ultrasound in Medicine.

  18. ACUTE APENDICITIS IN LIVER TRANSPLANT RECIPIENTS.

    Science.gov (United States)

    Fonseca-Neto, Olival Cirilo Lucena da; Lima, Heloise Caroline de Souza; Melo, Paulo Sérgio Vieira de; Lemos, Roberto; Leitão, Laércio; Amorim, Américo Gusmão; Lacerda, Cláudio Moura

    2016-03-01

    Appendicitis is a common cause of emergency surgery that in the population undergoing organ transplantation presents a rare incidence due to late diagnosis and treatment. To report the occurrence of acute appendicitis in a cohort of liver transplant recipients. Retrospective analysis in a period of 12 years among 925 liver transplants, in witch five cases of acute appendicitis were encountered. Appendicitis occurred between three and 46 months after liver transplantation. The age ranged between 15 and 58 years. There were three men and two women. The clinical presentations varied, but not discordant from those found in non-transplanted patients. Pain was a symptom found in all patients, in two cases well located in the right iliac fossa (40%). Two patients had symptoms characteristic of peritoneal irritation (40%) and one patient had abdominal distention (20%). All patients were submitted to laparotomies. In 20% there were no complications. In 80% was performed appendectomy complicated by suppuration (40%) or perforation (40%). Superficial infection of the surgical site occurred in two patients, requiring clinical management. The hospital stay ranged from 48 h to 45 days. Acute appendicitis after liver transplantation is a rare event being associated with a high rate of drilling, due to delays in diagnosis and therapy, and an increase in hospital stay.

  19. Risk factors for acute surgical site infections after lumbar surgery: a retrospective study.

    Science.gov (United States)

    Lai, Qi; Song, Quanwei; Guo, Runsheng; Bi, Haidi; Liu, Xuqiang; Yu, Xiaolong; Zhu, Jianghao; Dai, Min; Zhang, Bin

    2017-07-19

    Currently, many scholars are concerned about the treatment of postoperative infection; however, few have completed multivariate analyses to determine factors that contribute to the risk of infection. Therefore, we conducted a multivariate analysis of a retrospectively collected database to analyze the risk factors for acute surgical site infection following lumbar surgery, including fracture fixation, lumbar fusion, and minimally invasive lumbar surgery. We retrospectively reviewed data from patients who underwent lumbar surgery between 2014 and 2016, including lumbar fusion, internal fracture fixation, and minimally invasive surgery in our hospital's spinal surgery unit. Patient demographics, procedures, and wound infection rates were analyzed using descriptive statistics, and risk factors were analyzed using logistic regression analyses. Twenty-six patients (2.81%) experienced acute surgical site infection following lumbar surgery in our study. The patients' mean body mass index, smoking history, operative time, blood loss, draining time, and drainage volume in the acute surgical site infection group were significantly different from those in the non-acute surgical site infection group (p surgical site infection group were significantly different than those in the non-acute surgical site infection group (p surgical site infection following lumbar surgery. In order to reduce the risk of infection following lumbar surgery, patients should be evaluated for the risk factors noted above.

  20. 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.

  1. Operative management of appendicitis.

    Science.gov (United States)

    St Peter, Shawn D; Snyder, Charles L

    2016-08-01

    Appendectomy has been the standard of care for appendicitis since the late 1800s, and remains one of the most common operations performed in children. The advent of data-driven medicine has led to questions about every aspect of the operation-whether appendectomy is even necessary, when it should be performed (timing), how the procedure is done (laparoscopic variants versus open and irrigation versus no irrigation), length of hospital stay, and antibiotic duration. The goal of this analysis is to review the current status of, and available data regarding, the surgical management of appendicitis in children. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. 基层医院采用高频超声在急性阑尾炎诊断中的价值探讨%Discussion on the value of high frequency ultrasound in diagnosis of acute appendicitis in basic hospital

    Institute of Scientific and Technical Information of China (English)

    韦新鸿

    2015-01-01

    Objective:To explore the value of high frequency ultrasound in the diagnosis of acute appendicitis in basic hospital. Methods:Diagnosis of acute appendicitis by high-frequency probe.Results:In 128 patients by high frequency ultrasound diagnosis, 108 cases were diagnosed with acute appendicitis(84%).Conclusion:Most acute appendicitis can be diagnosed by high frequency ultrasound.It is worth promoting in ultrasound diagnosis in primary hospital.%目的:探讨基层医院采用高频超声在急性阑尾炎诊断中的价值。方法:采用高频探头对急性阑尾炎患者进行诊断。结果:128例患者中经高频超声诊断为急性阑尾炎108例(84%)。结论:高频超声可以诊断绝大多数急性阑尾炎,值得在基层医院超声诊断中推广。

  3. Retrospective Study of Seven Cases with Acute Fatty Liver of Pregnancy

    OpenAIRE

    Ma Runmei; Suchi Dwivedi

    2013-01-01

    Objectives. Our aim is to explore the clinical outcome of patients with acute fatty liver of pregnancy (AFLP), and evaluate the effect of early diagnosis and treatment. Methods. Seven patients who were diagnosed with AFLP were retrospectively analyzed from February 2005 to January 2013. The clinical records of the patients with AFLP were reviewed for clinical features, laboratory examinations, and maternal and perinatal prognosis. Routine laboratory evaluation revealed hyperbilirubinemia, mod...

  4. 急性阑尾炎患者外周血LXA4与降钙素原水平的检测及研究%The research and testing of the level of blood LXA4 and procalcitonin in the Acute appendicitis pa-tients

    Institute of Scientific and Technical Information of China (English)

    朱克华; 张福

    2016-01-01

    目的:通过监测比较急性阑尾炎患者外周血脂氧素A4(LXA4)与降钙素元(PCT)水平,分析LXA4、PCT在急性阑尾炎患者的诊断中的作用及机制。方法:随机选取120例急性阑尾炎患者,均于手术前采用酶联免疫吸附法( ELISA)检测患者外周血LXA4、PCT水平,并进行相关性分析。对照组选取同期健康体检者50例。结果:120例急性阑尾炎患者,结合手术或(和)病理诊断结果分为单纯性阑尾炎(35例)、化脓性阑尾炎(47例)、穿孔性阑尾炎(21例)、坏疽性阑尾炎(17例)。急性阑尾炎患者各组血清LXA4、PCT水平均显著高于对照组( P﹤0.01);化脓性阑尾炎组、穿孔性阑尾炎组及坏疽性阑尾炎组血清LXA4、PCT水平均显著高于单纯性阑尾炎组( P﹤0.05);坏疽性阑尾炎组及穿孔性阑尾炎组血清PCT水平高于化脓性阑尾炎组( P﹤0.05);急性阑尾炎患者血清LXA4与PCT水平呈显著正相关( r=-0.718,P=0.002)。结论:在急性阑尾炎患者中血清LXA4与PCT的水平与患者的病情有较高的相关性,对急性阑尾炎的诊断、术前病情评估及是否手术均有一定的指导意义。%Objective Through the detection of the level of blood LXA4 and PCT in the Acute appendicitis patients to re-search the role and mechanism of LXA4 and PCT in the diagnosis of patients with acute appendicitis. Method 120 cases of pa-tients with acute appendicitis were randomly selected,the level of blood LXA4 and PCT were detected and analyzed before the surgery by using the method of enzyme-linked immunosorbent( ELISA). 50 cases of healthy check-up were selected as the control group. Results According to the surgery or( and)the pathological diagnosis,the cases of 120 patients with acute appendi-citis was divided into simple appendicitis(35 cases),suppurative appendicitis(47 cases),perforated appendicitis(21 cases) and gangrenous appendicitis(17

  5. 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.

  6. Enterobius vermicularis: A Controversial Cause of Appendicitis

    Directory of Open Access Journals (Sweden)

    "Gh Mowlavi

    2004-08-01

    Full Text Available Enterobiasis is undoubtedly one of the most common human helminths infections through the world, with an estimate of 1000 million cases worldwide. Although adult worms and their eggs are frequently found in inflamed appendices, but the role of the parasite in producing appendicitis in humans still remains controversial. Although acute appendicitis may occur at any age, but it is relatively rare at the extremes of age. A histopathological study of infested appendices with Enterobius vermicularis was performed in Khuzestan province, south western Iran, during 2001 to 2003. All 40 samples had surgically been removed during the emergency operations and histopathological process with (H&E staining has been performed for each. One of the main objects of this work was to collect more data about the possible role of this highly prevalent human round worm as a causative agent of appendicitis in humans, leading to different types of appendicitis in this part of the country. In this occasion over the slide examinations of the tissue sections, fewer cases than expected, with worm infested appendices were seen exclusively affected with this parasite.

  7. 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.

  8. 健康教育对老年急性阑尾炎患者的影响研究%Study on Health Education Influence on Elderly Patients With Acute Appendicitis

    Institute of Scientific and Technical Information of China (English)

    于静

    2015-01-01

    目的:研究健康教育对老年急性阑尾炎患者的影响。方法搜集本院2014年1月~2015年1月老年急性阑尾炎40例,依据数字随机法进行分组。给予对照组常规护理,共20例;在此基础上给予研究组健康教育,共20例。观察比较两组效果。结果两组比较,研究组住院天数短(P<0.05),知识知晓评分高(P<0.05),满意度高(P<0.05)。结论健康教育可有效提高老年急性阑尾炎患者知识知晓评分,缩短住院天数。%Objective Health education influence on elderly patients with acute appendicitis is to be studied.Methods To choose 40 elderly patients with acute appendicitis who were treated in hospital from January 2014 to January 2015 and separated them into control group and study group according to random digit table. 20 patients in control group were given conventional care, while 20 patients in study group were given additional health education. Then make a comparison on treatment efects between two groups.ResultsCompared to patients in control group, patients’ in study group hospitalization days was shorter (P< 0.05).Heir knowledge mastery assessment score was higher (P< 0.05) and satisfaction rate was higher (P< 0.05) in study group .Conclusion For elderly patients with acute appendicitis,health education is efective to improve patients’ assessment scores of knowledge mastery and reduce their hospitalization days.

  9. Idiopathic Renal Infarction Mimicking Appendicitis

    Science.gov (United States)

    Lisanti, Francesco; Scarano, Enrico

    2017-01-01

    Renal infarction is a rare cause of referral to the emergency department, with very low estimated incidence (0.004%–0.007%). Usually, it manifests in patients aged 60–70 with risk factors for thromboembolism, mostly related to heart disease, atrial fibrillation in particular. We report a case of idiopathic segmental renal infarction in a 38-year-old patient, presenting with acute abdominal pain with no previous known history or risk factors for thromboembolic diseases. Because of its aspecific clinical presentation, this condition can mimic more frequent pathologies including pyelonephritis, nephrolithiasis, or as in our case appendicitis. Here we highlight the extremely ambiguous presentation of renal infarct and the importance for clinicians to be aware of this condition, particularly in patients without clear risk factors, as it usually has a good prognosis after appropriate anticoagulant therapy. PMID:28203466

  10. The influence of underweight and obesity on the diagnosis and treatment of appendicitis in children

    NARCIS (Netherlands)

    Timmerman, Marjolijn E. W.; Groen, Henk; Heineman, Erik; Broens, Paul M. A.

    2016-01-01

    The impact of lower body mass index (BMI) on appendicitis has never been addressed. We investigated whether different BMIs affect the diagnosis and treatment of appendicitis in children. The correlation between BMI and diagnosis accuracy and treatment quality was evaluated by retrospective analysis

  11. 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 Appe

  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. Diagnosis and treatment of acute sinusitis in the primary care setting: A retrospective cohort.

    Science.gov (United States)

    Pynnonen, Melissa A; Lynn, Shana; Kern, Hayley E; Novis, Sarah J; Akkina, Sarah R; Keshavarzi, Nahid R; Davis, Matthew M

    2015-10-01

    Our objectives were to characterize the quality of acute sinusitis care and to identify nonclinical factors associated with antibiotic use for acute sinusitis. We hypothesized that we would identify provider-level factors associated with antibiotic use. Retrospective cohort at a single academic institution. We developed and clinically annotated an administrative dataset of adult patients diagnosed with acute sinusitis between January 1, 2005, and December 31, 2006. We used identify factors associated with receipt of antibiotics. We find that 66.0% of patients with mild symptoms of short duration are given antibiotics, and that nonclinical factors, including the individual provider, the provider's specialty, and the presence of a medical trainee, significantly influence antibiotic use. Relative to internal medicine providers, family medicine providers use fewer antibiotics, and emergency medicine providers use more antibiotics for acute sinusitis. Antibiotics continue to be overused for patients with mild acute sinusitis of short duration. Nonclinical characteristics, including the individual provider, the provider's specialty, and the presence of a medical trainee, significantly influence use of antibiotics for acute sinusitis. 4. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  14. Rifampin use in acute community-acquired meningitis in intensive care units: the French retrospective cohort ACAM-ICU study

    National Research Council Canada - National Science Library

    Bretonnière, Cédric; Jozwiak, Mathieu; Girault, Christophe; Beuret, Pascal; Trouillet, Jean-Louis; Anguel, Nadia; Caillon, Jocelyne; Potel, Gilles; Villers, Daniel; Boutoille, David; Guitton, Christophe

    2015-01-01

    .... Five ICUs participated in the study. Baseline characteristics and treatment data were retrospectively collected from charts of patients admitted with a diagnosis of acute bacterial meningitis during a 5-year period (2004-2008...

  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. A RETROSPECTIVE STUDY OF MANAGEMENT OF ACUTE PANCREATITIS IN A PERIPHERAL TERTIARY HOSPITAL

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    Thomas Karunahara

    2016-06-01

    Full Text Available BACKGROUND & OBJECTIVES Acute pancreatitis (AP is one of the most common diseases in gastroenterology. Two percent of all patients admitted to hospital are diagnosed with AP. During the last decade, an increasing incidence was observed, mostly because of a higher sensitivity of diagnostic tests. Treatment of Acute Pancreatitis is still symptomatic and no specific medication is available today. As a result of popular belief that the pancreas should be put to rest during acute pancreatitis, the parenteral route for nutrition is still predominantly used in Acute Pancreatitis. There has been increasing evidence; however, about gut being main source of microorganisms causing infectious pancreatic complications and multiorgan failure. In patients with severe pancreatitis, oral intake is inhibited by nausea and subileus. Although some reports show that enteral feeding is possible in acute pancreatitis and associated with fewer septic complications. Although the evidence is inconclusive to support enteral nutrition in all patients with severe acute pancreatitis, the enteral route may be used if tolerated. Supportive treatment is the most important line of management in acute pancreatitis. The aim is to study the management of acute pancreatitis in a peripheral tertiary hospital and to assess the outcome of the management. METHODS & MATERIALS Data Collection: Patients with acute abdominal pain are admitted in hospital and diagnosed as acute pancreatitis based on blood investigations and radiological findings. Patients categorised- Revised Atlanta Classification. Different medical management modes followed and outcomes recorded, tabulated and analysed. Research Design: Retrospective study. Research Settings: Mahatma Gandhi Memorial Government Hospital, Trichy, Tamilnadu. Duration: 5 yrs. (2010-2015 Sample Size: 186. Inclusion Criteria: Patients between 12 and 75 yrs. of age, patients admitted to the hospital as a case of acute pancreatitis, both sexes

  17. Infecções parasitárias do apêndice cecal e suas relações com apendicite aguda Parasitic infection of the appendix and its possible relationship to acute appendicitis

    Directory of Open Access Journals (Sweden)

    Danielle Fernandes da Silva

    2008-06-01

    Full Text Available Investigou-se a prevalência de infecções parasitárias do apêndice cecal e suas relações com a apendicite. Dos 1.600 apêndices estudados 24 (1,5% apresentaram infecção parasitária. Enterobius vermicularis foi encontrado em 23 casos (95,8% e Taenia sp em apenas um (4,2%. Dezesseis pacientes (66,7% eram menores de 10 anos; 15 eram masculinos e 9 femininos. A análise histopatológica demonstrou inflamação aguda supurativa em 12 casos (50%, eosinofilia em 13 (54,2% e hiperplasia linfóide em 10 (41,7%. Complicações como peritonite ocorreram em 11 e gangrena em 3 casos. As infecções parasitárias do apêndice são causa pouco freqüente de apendicite aguda em crianças e adolescentes.From 1,600 surgically removed appendices, 24 (1.5% were found to have helminths. Enterobius vermicularis was observed in 23 of the 24 specimens (95.8% and Taenia sp was detected in only 1 (4.2% case. Sixteen patients (66.7% were less than 10 year-old; 15 patients were male and 9 female. Pathologic analysis disclosed acute neutrophilic inflammation in 12 cases and lymphoid hyperplasia in 10 of the 24 appendices. Gangrenous appendicitis was diagnosed in 3 cases and peritonitis was found in 11 of the 24 infested appendices. Parasitic infection of the appendix is an uncommon cause of acute appendicitis in children and adolescents.

  18. The NOTA study: non-operative treatment for acute appendicitis: prospective study on the efficacy and safety of antibiotic treatment (amoxicillin and clavulanic acid) in patients with right sided lower abdominal pain

    Science.gov (United States)

    Giorgini, Eleonora; Biscardi, Andrea; Villani, Silvia; Clemente, Nicola; Senatore, Gianluca; Filicori, Filippo; Antonacci, Nicola; Baldoni, Franco; De Werra, Carlo; Di Saverio, Salomone

    2011-01-01

    Background Case control studies that randomly assign patients with diagnosis of acute appendicitis to either surgical or non-surgical treatment yield a relapse rate of approximately 14% at one year. It would be useful to know the relapse rate of patients who have, instead, been selected for a given treatment based on a thorough clinical evaluation, including physical examination and laboratory results (Alvarado Score) as well as radiological exams if needed or deemed helpful. If this clinical evaluation is useful, the investigators would expect patient selection to be better than chance, and relapse rate to be lower than 14%. Once the investigators have established the utility of this evaluation, the investigators can begin to identify those components that have predictive value (such as blood analysis, or US/CT findings). This is the first step toward developing an accurate diagnostic-therapeutic algorithm which will avoid risks and costs of needless surgery. Methods/design This will be a single-cohort prospective observational study. It will not interfere with the usual pathway, consisting of clinical examination in the Emergency Department (ED) and execution of the following exams at the physician's discretion: full blood count with differential, C reactive protein, abdominal ultrasound, abdominal CT. Patients admitted to an ED with lower abdominal pain and suspicion of acute appendicitis and not needing immediate surgery, are requested by informed consent to undergo observation and non operative treatment with antibiotic therapy (Amoxicillin and Clavulanic Acid). The patients by protocol should not have received any previous antibiotic treatment during the same clinical episode. Patients not undergoing surgery will be physically examined 5 days later. Further follow-up will be conducted at 7, 15 days, 6 months and 12 months. The study will conform to clinical practice guidelines and will follow the recommendations of the Declaration of Helsinki. The protocol

  19. Retrospective Analyses Of The Acute Pancreatitis With Patients In The West Black Sea

    Directory of Open Access Journals (Sweden)

    Mehmet YAŞAR, Ali Kemal TAŞKIN, İsmet ÖZAYDIN, Yavuz DEMİRARAN

    2010-11-01

    Full Text Available Introduction: In these study patients who were our clinic with an etiology, diagnosis andtreatment methods, morbidity, mortality and effect of Ranson criteria to prognosis wereexamined retrospectively. Material and Method: In the study 44 mild and 18 severe total 62 AP cases among 2003-2008at the General Surgery of Duzce University were analyzed retrospectively. Results: A etiologic factor was 40 (66,7 %, gallstone 11 (17, 7% idiopathic, 4 (6,4 %hyperlipidemia, 3 (4,8% alchol-hyperlipidemia, 2 (3,2 % alcohol, 2 (3,2 % after ERCPcomplications. Patients were followed up with a diagnosis of acute pancreatitis, the average ageof 59.6 (18 - 84 and 23 (37% were man, 39 (63% were woman. ERCP were performed to 14patients with billiary pancreatitis 2 patients for the persistent billiary pancreatitis and for the 6patients cholecystitis accompanied pancreatitis in the first 48 hours period, 23 patients followingthe acute pancreatitis attack were performed cholecystectomy. Acute pancreatitis patients first6 cases of biliary 3 reputations have been switched to laparoscopic open cholecystectomy isbeing performed. 3 patients peritoneal lavage under local anesthesia, 4 patients’ diagnosticlaparoscopy and 2 patients nerosectomy were performed. Mean hospitalization times were 9.8days for mild and 11.2 days severe. In the severe group idiopathic a etiology 3 (4.8 % patientswere exitus. Conclusion: Acute pancreatitis is a disease that can watch a high mortality rate. Biliary factorswere the most common etiological factor. Idiopathic AP played a role in second place and wehave observed that the effect of alcohol is quite low. In biliary acute pancreatitis ERCP is auseful method in the first stage. Overall mortality in severe AP, as observed in patients with thediagnosis, treatment and follow-up was important in these patients.

  20. A Rare Case: Appendectomy After Connected Stump Appendicitis Perforation of the Cecum

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    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.

  1. Stump appendicitis is a rare delayed complication of appendectomy: A case report

    Institute of Scientific and Technical Information of China (English)

    Mehmet Uludag; Adnan Isgor; Muzaffer Basak

    2006-01-01

    Stump appendicitis is an acute inflammation of the residual appendix and one of the rare complications after appendectomy. Paying attention to the possibility of stump appendicitis in patients with right lower abdominal pain after appendectomy can prevent the delay of diagnosis and treatment. In patients with stump appendicitis,CT scan not only assists in making an accurate preoperative diagnosis but also excludes other etiologies. We report a 47-year old man with preoperatively diagnosed stump appendicitis by CT, who underwent an open appendectomy 20 years ago.

  2. Incarcerated appendicitis in port-site hernia: A rare case report

    Directory of Open Access Journals (Sweden)

    Tamir A. Hassan

    2015-09-01

    Case presentation: We describe a distinctive case of incarcerated appendicitis in port-site hernia following laparoscopic cholecystectomy. Acute appendicitis was pre-operatively CT diagnosed and appendectomy was performed followed by primary repair of the hernia defect. Awareness of atypical presentation and possible complications may raise the clinical suspicion index to ask for early CT.

  3. 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

  4. CT following US for possible appendicitis: anatomic coverage

    Energy Technology Data Exchange (ETDEWEB)

    O' Malley, Martin E. [University of Toronto, Princess Margaret Hospital, 3-920, Joint Department of Medical Imaging, Toronto, Ontario (Canada); Alharbi, Fawaz [University of Toronto, Toronto General Hospital, NCSB 1C572, Joint Department of Medical Imaging, Toronto, Ontario (Canada); Qassim University, Department of Medical Imaging, Buraydah, Qassim (Saudi Arabia); Chawla, Tanya P. [University of Toronto, Mount Sinai Hospital, Room 567, Joint Department of Medical Imaging, Toronto, Ontario (Canada); Moshonov, Hadas [University of Toronto, Joint Department of Medical Imaging, Toronto, Ontario (Canada)

    2016-02-15

    To determine superior-inferior anatomic borders for CT following inconclusive/nondiagnostic US for possible appendicitis. Ninety-nine patients with possible appendicitis and inconclusive/nondiagnostic US followed by CT were included in this retrospective study. Two radiologists reviewed CT images and determined superior-inferior anatomic borders required to diagnose or exclude appendicitis and diagnose alternative causes. This ''targeted'' coverage was used to estimate potential reduction in anatomic coverage compared to standard abdominal/pelvic CT. The study group included 83 women and 16 men; mean age 32 (median, 29; range 18-73) years. Final diagnoses were: nonspecific abdominal pain 50/99 (51 %), appendicitis 26/99 (26 %), gynaecological 12/99 (12 %), gastrointestinal 9/99 (10 %), and musculoskeletal 2/99 (2 %). Median dose-length product for standard CT was 890.0 (range, 306.3 - 2493.9) mGy.cm. To confidently diagnose/exclude appendicitis or identify alternative diagnoses, maximum superior-inferior anatomic CT coverage was the superior border of L2-superior border of pubic symphysis, for both reviewers. Targeted CT would reduce anatomic coverage by 30-55 % (mean 39 %, median 40 %) compared to standard CT. When CT is performed for appendicitis following inconclusive/nondiagnostic US, targeted CT from the superior border of L2-superior border of pubic symphysis can be used resulting in significant reduction in exposure to ionizing radiation compared to standard CT. (orig.)

  5. Oral antibiotics for perforated appendicitis is not recommended

    DEFF Research Database (Denmark)

    Gögenur, Ismail; Rosenberg, Jacob; Alamili, Mahdi

    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...

  6. Retrospective Analysis of Thrombolysis Therapy for 64 Cases of Acute Myocardial Infarction with Elevated ST Segment

    Institute of Scientific and Technical Information of China (English)

    傅晓霞; 肖文剑; 吕健; 吴乐文; 杨帆

    2009-01-01

    Objective:To explore the cardiac protective effect of integrative therapy in acute myocardial infarction(AMI) with elevated ST segment after reperfusion.Methods:Sixty-four AMI patients who having received decimalization by thrombolysis were assigned to two groups by retrospective analysis,36 patients in the treated group and 28 in the control group.Both were treated by intravenous administering of urokinase for thrombolysis,and to the treated group,intravenous dripping of Xueshuantong Injection(血栓通注射液,XS...

  7. Profiles of US and CT imaging features with a high probability of appendicitis

    Science.gov (United States)

    Laméris, W.; van Es, H. W.; ten Hove, W.; Bouma, W. H.; van Leeuwen, M. S.; van Keulen, E. M.; van der Hulst, V. P. M.; Henneman, O. D.; Bossuyt, P. M.; Boermeester, M. A.; Stoker, J.

    2010-01-01

    Objectives To identify and evaluate profiles of US and CT features associated with acute appendicitis. Methods 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. Results 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. Conclusion 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. PMID:20119730

  8. 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.)

  9. O uso da ultra-sonografia no diagnóstico e evolução da apendicite aguda Ultrasonography in the diagnosis and evolution of acute appendicitis

    Directory of Open Access Journals (Sweden)

    Arquimedes Artur Zorzetto

    2003-03-01

    Full Text Available OBJETIVO: Aproximadamente 35% das apendicites agudas têm diagnóstico clínico pré-operatório duvidoso ou incorreto, particularmente grávidas e crianças. A ultra-sonografia, em virtude do seu baixo custo e facilidade de acesso, tem-se mostrado um método diagnóstico importante. Este estudo propôs-se a demonstrar os principais achados de imagem das diversas fases da apendicite, com o objetivo de auxiliar o ultra-sonografista no diagnóstico precoce desta afecção. MATERIAIS E MÉTODOS: São relatados 14 casos de ultra-sonografias abdominais realizadas no período de janeiro a julho de 2001, em pacientes que se apresentavam com quadro de abdome agudo. O exame foi realizado com transdutores de 3,5 MHz e 7,5 MHz. RESULTADOS: O estudo ultra-sonográfico antes da perfuração demonstra apêndice não compressível, com espessamento e perda focal da definição das paredes. Após a perfuração, o apêndice pode não ser visualizado ao exame de ultra-sonografia, sendo evidenciadas alterações secundárias como efeito de massa, formação de plastrão, liquefação e formação de abscesso, além de ar dentro da coleção. CONCLUSÃO: O diagnóstico precoce da apendicite é essencial para minimizar a morbidade, que se mantém elevada se ocorrer perfuração. Apresentações atípicas resultam em confusão diagnóstica e retarde no tratamento. As principais dificuldades e erros são apendicite retrocecal, apendicite focal ou perfurada.OBJECTIVE: Approximately 35% of the patients with acute appendicitis have a doubtful or incorrect preoperatory diagnosis, particularly in pregnant women and children. Ultrasonography has demonstrated to be an important means of diagnosis due to its low cost and easy access. This study is intended to show the main imaging findings of the many phases of appendicitis, thus helping the ultrasonographist to establish an early diagnosis. MATERIALS AND METHODS: From January to June 2001, 14 patients with acute abdominal

  10. 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.)

  11. 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.

  12. Appendicitis/diverticulitis: minimally invasive surgery.

    Science.gov (United States)

    Mutter, D; Marescaux, J

    2013-01-01

    Complicated intra-abdominal infections such as acute appendicitis and complicated diverticulitis represent both diagnostic and therapeutic challenges. Both diseases, although different in many ways, are caused by the obstruction of a blind pouch leading to inflammation, abscesses, and perforation of surrounding tissues. For many decades, acute appendicitis was managed through a conventional surgical incision in the right iliac fossa. As for other diseases, there is a significant tendency to propose less invasive treatments. For many teams, laparoscopy, which leads to less postoperative pain, a shorter hospital stay, and a quicker recovery, represents the standard of care for appendectomy. For selected cases, a medical approach can be proposed with satisfactory outcomes. Additionally, the management of complicated diverticulitis is also quickly moving towards less invasive procedures than the deleterious '3-phase surgery', which is Hartmann's procedure, followed by reversal protected with a stoma, and finally stoma closure. Benefiting from the evolution of antimicrobial therapy and interventional radiology, many complicated cases classified as Hinchey stage I and Hinchey stage II complicated diverticulitis are now treated medically. CT images allow the identification of patients requiring radiological drainage of localized abscesses or collections over 5 cm in size. Patients with Hinchey stage III sigmoiditis may benefit from an initial laparoscopic exploration allowing, in some cases, a conservative nonresective approach that will prevent laparotomy and stoma. Major resection leading to temporary or definitive stoma is usually indicated for stage IV complications and is required only in exceptional cases. Although a surgical intervention can be the definitive treatment for complicated intra-abdominal infections, multidisciplinary management including radiology, medical treatment, and laparoscopic surgery may limit the severe consequences of an acute surgical

  13. Utilidad de la tomografía computada en pacientes con dolor en fosa iliaca derecha: Apendicitis aguda y su diagnóstico diferencial Usefulness of computed tomography in patients with right inferior abdominal quadrant pain: acute appendicitis and its alternative diagnosis

    Directory of Open Access Journals (Sweden)

    Sebastián Atilio Rossini

    2009-03-01

    fosa iliaca derecha. Conclusión: La TCH posee una elevada sensibilidad y especificidad para el diagnóstico de apendicitis aguda y para la evaluación y manejo de los pacientes con un cuadro de abdomen agudo de fosa iliaca derecha.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, uretheral litiasis, tiphlitis, diverticulitis, colitis, salpingitis, 18 patients did not present tomographic findings to support the clinical symptoms and 2 presented indetermined results. These data represented a sensibility of 100%, specifity of 95,7%, positive predictiv value (PPV of 96,2% and negative predictiv 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.

  14. Esofagitis necrosante aguda: análisis retrospectivo Acute esophageal necrosis: a retrospective case series

    Directory of Open Access Journals (Sweden)

    R. Ramos

    2008-09-01

    Full Text Available Introducción: la esofagitis necrosante aguda es una entidad rara. Se reconoce por el aspecto negro difuso del esófago a la endoscopia. Su incidencia e patogénesis se desconoce. Pacientes y métodos: se analizaron retrospectivamente 11 pacientes con esofagitis necrosante aguda desde el punto de vista de los datos clínicos, de laboratorio y endoscopicos en 2 años. Resultados: se analizaron las endoscopias realizadas a 3.976 pacientes, observándose esofagitis necrosante aguda en 11 pacientes. El estado nutricional era malo en 6 pacientes. La resolución completa de la esofagitis se observó en cuatro pacientes. Durante el seguimiento se observó una estenosis en un paciente y un nuevo episodio de esofagitis necrosante aguda en otro paciente. Siete pacientes fallecieron, pero esta elevada mortalidad parece deberse a las enfermedades de base y no es atribuible a las lesiones de la esofagitis necrosante. Conclusiones: la incidencia de esofagitis necrosante aguda en nuestra serie fue 0,28%. La esofagitis necrosante aguda tiene una elevada mortalidad.Background: acute esophageal necrosis has been considered a rare event. It is defined as the presence of diffuse dark pigmentation of the esophagus on upper endoscopy. Its incidence has not yet been established. The pathogenesis remains unknown. Patients and methods: a retrospective analysis of clinical, laboratory, endoscopic, and histological data, and of the clinical course of 11 patients with acute necrotizing esophagitis was carried out over a 2-year period. Results: among 3,976 patients who underwent upper endoscopy, 11 (0.28% with acute esophageal necrosis were identified. Nutritional status was poor for 6 patients. Complete resolution of acute esophageal necrosis without further recurrence was observed in 4. One stricture appeared during follow-up and other patient developed new-onset acute esophageal necrosis. Seven patients died, but no death was directly related to acute esophageal necrosis

  15. 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.)

  16. 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.

  17. Value of Multi-Slice Spiral CT in the Diagnosis of Atypical Appendicitis%多排CT对非典型阑尾炎的诊断价值

    Institute of Scientific and Technical Information of China (English)

    李水婷; 江魁明; 麦慧; 张家云; 侍丽

    2013-01-01

    To investigate the value of the multi-detector row computed tomography in the diagnosis of appendicitis with atypical clinical feature. Methods: 58 cases of appendicitis which were not initially considered on clinical presentation, were confirmed surgically and pathologically were collected, CT characteristics were retrospectively analyzed. Results: 54 of the 58 patients were correctly diagnosed on CT. It included: 6 cases of dissect abnormal appendicitis, 22 cases of women of childbearing age appendicitis. 19 cases of elderly appendicitis. 11 cases of pediatric appendicitis. The direct CT signs of acute appendicitis were an charged appendix with wall thickening and appendicolith. Indirect signs included appendiceal perityphlitis and periappendicular. Conclusion: Multi-detector row computed tomography is valuable for early diagnosis of appendicitis with atypical clinical feature.%目的:探讨多排CT对缺乏典型临床表现的阑尾炎的应用价值.材料方法:搜集2010年1月~2012年1月临床首诊未考虑阑尾炎,经手术、病理证实为阑尾炎患者58例,回顾分析其CT表现.结果:58例阑尾炎患者中CT术前诊断为阑尾炎54例,渗断准确率93%.其中:解剖位置异常的阑尾炎6例;育龄妇女急性阑尾炎22例;老年急性阑尾炎19例;小儿急性阑尾炎11例.急性阑尾炎CT直接征象:阑尾肿胀、阑尾壁增厚及阑尾结石.CT间接征象:阑尾周围炎、阑尾周围脓肿.结论:使用多排CT对临床早期明确非典型阑尾炎的诊断有重要意义.

  18. 小切口手术复合抗菌药治疗急性阑尾炎的临床观察%Clinical observation of small incision operation combined with antibacterial drugs in the treatment of acute appendicitis

    Institute of Scientific and Technical Information of China (English)

    许志新

    2016-01-01

    目的:研究小切口手术复合抗菌药治疗急性阑尾炎的临床效果。方法:收治急性阑尾炎患者150例,平分为两组。比较组采取传统开腹手术方式,术前不静脉滴注抗菌药物;研究组采取小切口手术复合抗菌药物治疗,术前对患者静脉滴注抗菌药物,对比两组手术情况与切口感染率。结果:研究组手术时长与术后恢复时间均明显短于比较组,手术出血量相比于比较组明显减少;研究组切口感染率2.6%,显著低于比较组的14.6%,研究组手术情况均显著优于比较组,两组对比,差异具有统计学意义(P<0.05)。结论:小切口手术复合抗菌药方式在急性阑尾炎的临床治疗中效果明显。%Objective:To study the clinical effect of small incision operation combined with antibiotics in the treatment of acute appendicitis.Methods:150 patients with acute appendicitis were selected.They were divided into the two groups on average.The comparison group was taken the traditional open surgery,without preoperative intravenous infusion of antibiotics.The research group was taken small incision surgery combined with antibiotic therapy,intravenous infusion of antibiotics was applied before operation.We compared the surgical conditions and incision infection rate of the two groups.Results:The duration of operation and recovery time were significantly shorter in the study group than in the comparison group,and the amount of bleeding was significantly decreased compared with the comparison group.The incision infection rate in the study group was 2.6%,which was significantly lower than 14.6% of the comparison group;the operation status of the study group was significantly better than that of the comparison group;the differences between groups were statistically significant(P<0.05).Conclusion:The effect of small incision surgery combined with antibacterial drugs in the clinical treatment of acute appendicitis is significant.

  19. 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.)

  20. 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 pap...

  1. The value of ultrasonography in the diagnosis and classifi cation of appendicitis%超声检查对不同病理类型阑尾炎的诊断价值

    Institute of Scientific and Technical Information of China (English)

    余俊丽; 刘广健; 艳玲; 刘小银; 程文捷; 陈瑶; 覃斯; 王韦力

    2015-01-01

    ObjectiveTo assess the diagnostic value of ultrasonography in the diagnosis and pathological classifi cation of appendicitis with pathological results.MethodsThe study included 111 cases who confi rmed by surgery and pathology in the Six Affi liated Hospital of Sun Yat-sen University from June2012 to December 2013. The image characteristics of ultrasonic images performed before surgery were analyzed retrospectively. The cases were divided into five groups based on the pathology: 6 acute simple appendicitis, 45 acute suppurative appendicitis, 15 acute gangrenous appendicitis, 33 chronic appendicitis, and 12 acute attack of chronic appendicitis. The length, width and wall thickness of the appendicitis measured by preoperative ultrasound between various pathological type were compared with Kruskal-Wallis statistical methord, and also used the same method to compared the one which had statistically signifi cance between the fi ve groups. As in the above case, Fisher Exact Test was used to compare the characters′ of ultrasonography included gradations of the appendix, the tube cavity expansion, stercorolith, the appendiceal abscess, mergering lymph node enlargement and the appendix around effusion, if there was statistically signifi cance, the same methord was used to the further comparison between thefi ve groups.ResultsTotally 90 of 111 cases of were reminded appendicitis by preoperative ultrasound, the diagnostic accuracy rate was 81.08%, including acute suppurative appendicitis 91.11% (41/45), acute gangrenous appendicitis 93.33% (14/15), acute simple appendicitis 83.33% (5/6), chronic appendicitis 60.61% (20/33), chronic appendicitis onset acute 83.33% (10/12). There were no statistical differences of preoperative ultrasound measured between various pathological type of appendicitis in length, while the appendix width measured by preoperative ultrasound of acute gangrenous appendicitis was wider than the acute simple group and chronic group, and there were

  2. Ascending retrocecal appendicitis presenting with right upper abdominal pain: Utility of computed tomography

    Institute of Scientific and Technical Information of China (English)

    Eugene Mun Wai Ong; Sudhakar Kundapur Venkatesh

    2009-01-01

    Acute appendicitis is a common surgical condition that is usually managed with early surgery, and is associated with low morbidity and mortality. However, some patients may have atypical symptoms and physical findings that may lead to a delay in diagnosis and increased complications. Atypical presentation may be related to the position of the appendix. Ascending retrocecal appendicitis presenting with right upper abdominal pain may be clinically indistinguishable from acute pathology in the gallbladder, liver, biliary tree, right kidney and right urinary tract. We report a series of four patients with retrocecal appendicitis who presented with acute right upper abdominal pain. The clinical diagnoses at presentation were acute cholecystitis in two patients, pyelonephritis in one, and ureteric colic in one. Ultrasound examination of the abdomen at presentation showed subhepatic collections in two patients and normal findings in the other two. Computed tomography (CT) identified correctly retrocecal appendicitis and inflammation in the retroperitoneum in all cases. In addition, abscesses in the retrocecal space ( n = 2) and subhepatic collections ( n = 2) were also demonstrated. Emergency appendectomy was performed in two patients, interval appendectomy in one, and hemicolectomy in another. Surgical findings confirmed the presence of appendicitis and its retroperitoneal extensions. Our case series illustrates the usefulness of CT in diagnosing ascending retrocecal appendicitis and its extension, and excluding other in- flammatory conditions that mimic appendicitis.

  3. Appendicitis in children less than five years old: A challenge for the general practitioner

    OpenAIRE

    Marzuillo, Pierluigi; Germani, Claudio; Baruch S. Krauss; Barbi, Egidio

    2015-01-01

    Acute appendicitis is one of the most common indications for abdominal surgery in pediatrics with peak incidence in the second decade of life. Acute appendicitis in the first years of life is an uncommon event. The clinical presentation is often varied and the diagnosis may be overshadowed by other medical conditions. Gastroenteritis is the most common misdiagnosis, with a history of diarrhea present in 33% to 41% of patients. Pain is the most common presenting symptom in children less than 5...

  4. Outpatient consolidation chemotherapy in pediatric acute myeloid leukemia: a retrospective analysis.

    Science.gov (United States)

    Bakhshi, Sameer; Singh, Preetpaul; Swaroop, Chetanya

    2009-10-01

    To assess the outcomes of outpatient high dose cytosine arabinoside consolidation cycles in pediatric acute myeloid leukemia (AML) patients in comparison to inpatient treatment. We retrospectively analyzed 90 cycles of AML consolidation given to 30 patients between July 2003 and July 2007. Median age was 8 years (range 1.5-15) and 22/30 (73.3%) were males. Sixty-nine of 90 (76.7%) cycles were given on an ambulatory basis; readmission occurred in 25/69 (36.2%) and there was one death. The outpatient cycles in comparison to the inpatient cycles required significantly fewer invasive blood investigations (pconsolidation therapy is safe and feasible in children. It appears to result in less frequent invasive blood studies; shorter duration of febrile neutropenia and consequently less antimicrobial and antifungal usage as compared to inpatient consolidation cycles. To our knowledge, this report is the first of its kind looking specifically at outpatient consolidation chemotherapy in AML.

  5. Risperidone versus olanzapine in the acute treatment of Persistent Delusional Disorder: A retrospective analysis.

    Science.gov (United States)

    Kulkarni, Karishma; Arasappa, Rashmi; Prasad M, Krishna; Zutshi, Amit; Chand, Prabhat K; Murthy, Pratima; Philip, Mariamma; Muralidharan, Kesavan

    2017-07-01

    There is a dearth of prospective trials studying treatment response in Persistent Delusional Disorder (PDD) to guide clinical practice. Available retrospective data indicate good response to second-generation antipsychotics (SGAs). We selected the data of patients prescribed either olanzapine or risperidone from a retrospective chart review of PDD (n=455) at our centre. We compared the two groups olanzapine (n =86) versus risperidone (n =280) on dose, drug adherence, response and adverse effects. The two groups were comparable on socio-demographic and clinical characteristics of PDD. There was no statistically significant difference between the two groups on adherence (>80%) and response to treatment (>52% good response). Olanzapine was effective at lower mean chlorpromazine equivalents than risperidone. Logistic regression analysis identified shorter mean duration of illness, good adherence and absence of substance dependence as predictors of good response to both drugs. Our study indicates that acute PDD responds well to treatment with both risperidone and olanzapine, provided adherence can be ensured. In the absence of specific treatment guidelines and randomized controlled trials for PDD, our analysis reaffirms the efficacy of SGAs. Copyright © 2017. Published by Elsevier B.V.

  6. Retrospective study of seven cases with acute Fatty liver of pregnancy.

    Science.gov (United States)

    Dwivedi, Suchi; Runmei, Ma

    2013-01-01

    Objectives. Our aim is to explore the clinical outcome of patients with acute fatty liver of pregnancy (AFLP), and evaluate the effect of early diagnosis and treatment. Methods. Seven patients who were diagnosed with AFLP were retrospectively analyzed from February 2005 to January 2013. The clinical records of the patients with AFLP were reviewed for clinical features, laboratory examinations, and maternal and perinatal prognosis. Routine laboratory evaluation revealed hyperbilirubinemia, moderately elevated liver transaminase, but negative serum hepatitis virus in each patient. For additional evidence, 126 cases of AFLP were reviewed retrospectively from original articles researched in A Medline-based English and Chinese Knowledge Infrastructure between the same periods. Results. The initial symptoms of all the 7 cases with AFLP were gastrointestinal symptoms; anorexia, nausea, vomiting, and progressive jaundice. Complications revealed with renal insufficiency in all 7 patients. Hepatic failure, MODS, hypoglycemia and DIC were seen in 4 patients (57.1%). Hemorrhagic shock, ARDS, and hepatic encephalopathy were seen in 3 patients (42.8%). There was only one case of maternal death (14.2%), three cases of perinatal death (30%) and one postnatal death (10%). Conclusion. AFLP occurs in late pregnancy is a rare clinical syndrome occurs at about 36 weeks of gestation. Early diagnosis and prompt termination of pregnancy is the key of management with multidisciplinary collaboration, comprehensive treatment and effective prevention are helpful to improve prognosis of the cases with AFLP and perinatal death.

  7. Citicoline for acute ischemic stroke in Mexican hospitals: a retrospective postmarketing analysis.

    Science.gov (United States)

    Leon-Jimenez, C; Chiquete, E; Cantu, C; Miramontes-Saldana, M J; Andrade-Ramos, M A; Ruiz-Sandoval, J L

    2010-06-01

    Some neuroprotective agents have shown benefits in animal models, but disappointing results in humans. Citicoline is used in several countries as coadjuvant treatment in acute ischemic stroke (AIS) patients; however, there are no retrospective postmarketing surveillances on the experience of citicoline in Mexico. The aim of this study was to evaluate the correlation between citicoline exposure and functional outcome at discharge and at 30 and 90 days post-stroke, in a retrospective case-control design on systematic descriptive databases from three referral hospitals. Clinical records of 173 consecutively registered patients were analyzed, 86 of whom were treated with citicoline within the first 48 h after AIS and the remaining 87 were untreated, randomly selected controls matched for age (+/- 5 years), gender and NIHSS (+/- 1 point) at hospital admission. Pretreatment conditions were similar between groups. Compared with controls, exposure to citicoline was associated with a significantly lower 30-day mean and median modified Rankin score (in both, P citicoline was independently associated with a lower 90-day mortality risk (P = 0.047) and with fewer in-hospital complications (mainly infections and sepsis, P = 0.001). In this observational study, citicoline use was associated with a better functional status and lower rates of short-term mortality, possibly due to fewer in-hospital systemic complications. The putative benefits should be interpreted as clinical associations, since this is not a randomized, controlled clinical trial.

  8. Can platelet indices be used as predictors of complication in subjects with appendicitis?

    Science.gov (United States)

    Ceylan, Bahadır; Aslan, Turan; Çınar, Ahmet; Ruhkar Kurt, Ayşe; Akkoyunlu, Yasemin

    2016-12-01

    We examined the changes of mean platelet volume (MPV) and platelet distribution width (PDW) in subjects with appendicitis and whether MPV and PDW could be used to predict the development of complication due to appendicitis. The healthy control group, the cases of appendicitis with perforation, and the cases of appendicitis without perforation were compared with regard to MPV and PDW. We determined whether MPV and PDW were independent variables predictive of the development of complication in subjects with appendicitis. This retrospective case-control study included a total of 362 patients (249 of which were male (68.8 %) and 113 were female (31.2 %); median age, 30 [range, 18-84 years]). One hundred and ninety-two subjects (53 %) presented with appendicitis and 170 (47 %) comprised the healthy control group. Sixty-six (18.2 %) of the subjects with appendicitis developed complication. MPVs were lower in subjects of appendicitis without complication compared to the subjects of appendicitis with complication and the control group (MPV, 9.78 ± 0.99 vs. 10.20 ± 1.21 and 10.14 ± 1.03, respectively [p = 0.005]). The PDW levels were not different between the three groups. Independent variables predictive of the presence of complication included increased MPV and time from onset of symptoms to hospital presentation (odds ratio[confidence interval], p-value: 1.507[1.064-2.133], 0.021 and 18.887[5.139-69.410], 0.0001, respectively). Our findings suggested these, MPV values in cases of appendicitis without complication were lower than the cases with complication and healthy control and MPV is a predictor of the development of complication in subjects with appendicitis.

  9. Acute bacterial prostatitis: heterogeneity in diagnostic criteria and management. Retrospective multicentric analysis of 371 patients diagnosed with acute prostatitis

    Directory of Open Access Journals (Sweden)

    Doucet Jean

    2008-01-01

    Full Text Available Abstract Background There is currently a lack of consensus for the diagnosis, investigations and treatments of acute bacterial prostatitis (AP. Methods The symptoms, investigations and treatments of 371 inpatients diagnosed with AP were analyzed through a retrospective study conducted in four departments – Urology (U, Infectious Diseases (ID, Internal Medicine (IM, Geriatrics (G – of two French university hospitals. Results The cause of admission, symptoms, investigations and treatments depended markedly on the department of admission but not on the hospital. In U, patients commonly presented with a bladder outlet obstruction, they had a large imaging and functional check-up, and received alpha-blockers and anti-inflammatory drugs. In ID, patients were febrile and received longer and more appropriate antibiotic treatments. In G, patients presented with cognitive disorders and commonly had post-void urine volume measurements. In IM, patients presented with a wide range of symptoms, and had very diverse investigations and antibiotic regimen. Overall, a 3:1 ratio of community-acquired AP (CA-AP to nosocomial AP (N-AP was observed. Urine culture isolated mainly E. coli (58% of AP, 68% of CA-AP, with venereal agents constituting less than 1%. The probabilistic antibiotic treatments were similar for N-AP and CA-AP (58% bi-therapy; 63% fluoroquinolone-based regimen. For N-AP, these treatments were more likely to be inadequate (42% vs. 8%, p vs. 19%, p Clinical failure at follow-up was more common than bacteriological failure (75% versus 24%, p Conclusion This study highlights the difficulties encountered on a daily basis by the physicians regarding the diagnosis and management of acute prostatitis.

  10. A retrospective study of 78 patients with severe acute respiratory syndrome

    Institute of Scientific and Technical Information of China (English)

    肖正伦; 黎毅敏; 陈荣昌; 李时悦; 钟淑卿; 钟南山

    2003-01-01

    Objective To summarize the clinical features of severe acute respiratory syndrome (SARS) and to discuss diagnosis and management of the disease.Methods A retrospective study was conducted on 78 cases of SARS referred to the Guangzhou Institute of Respiratory Diseases (GIRD) between December 22, 2002 and near the end of March 2003. Items reviewed cover all data concerning clinical manifestations, laboratory investigation and radiology.Results The patients in the study consisted of 42 males and 36 females, aged 20 -75 yrs (mean age 37. 5 +11.6 yrs), including 44 affected health-care professionals. Clinical symptoms seen in the group were fever (100. 0%), cough (88. 5%), and dyspnea (79. 5%). There were 12 cases (15. 3%) with WBCs <4.0×109/L, 49 cases (62. 8%) ranging between (4. 0 -10. 0) ×109/L and 17 cases (21.8%) over 10. 0 × 109/L. The average was(7. 58 ±4. 96) × 109/L, with 0.75 ±0. 14 (neutrophil) and 0.18 ±0.11 (lymphocyte). Chest films and CT scanning revealed changes related to pneumonia. The transmission of the disease was likely via close contact with contagious droplets.The prevalences of acute lung injury (ALI, in 37cases ) and acute respiratory distress syndrome (ARDS, 21 out of 37 cases ) were considerably high among the patients. Seven patients who developed ARDS complicated with multiple organs dysfunction syndrome (MODS) died.Conclusions A history of close contact, fever, sign of pneumonia by X-ray and normal-to-lowered WBC counts are favorable for the diagnosis of SARS. Recognition of All as the important index for critical SARS and comprehensive supportive management are of paramount in decreasing the mortality of the disease.

  11. Monosomy 7 and deletion 7q in children and adolescents with acute myeloid leukemia: an international retrospective study

    DEFF Research Database (Denmark)

    Hasle, Henrik; Alonzo, Todd A; Auvrignon, A

    2007-01-01

    Monosomy 7 (-7) and deletion 7q \\del(7q)] are rare in childhood acute myeloid leukemia (AML). We retrospectively collected data on 258 children with AML or refractory anemia with excess blasts in transformation (RAEB-T) and -7 or del(7q) with or without other cytogenetic aberrations \\+/- other...

  12. Disparities in appendicitis rupture rate among mentally ill patients

    Directory of Open Access Journals (Sweden)

    Bai Ya-Mei

    2007-11-01

    Full Text Available Abstract Background Many studies have been carried out that focus on mental patients' access to care for their mental illness, but very few pay attention on these same patients' access to care for their physical diseases. Acute appendicitis is a common surgical emergency. Our population-based study was to test for any possible association between mental illness and perforated appendicitis. We hypothesized that there are significant disparities in access to timely surgical care between appendicitis patients with and without mental illness, and more specifically, between patients with schizophrenia and those with another major mental illness. Methods Using the National Health Insurance (NHI hospital-discharge data, we compared the likelihood of perforated appendix among 97,589 adults aged 15 and over who were hospitalized for acute appendicitis in Taiwan between the years 1997 to 2001. Among all the patients admitted for appendicitis, the outcome measure was the odds of appendiceal rupture vs. appendicitis that did not result in a ruptured appendix. Results After adjusting for age, gender, ethnicity, socioeconomic status (SES and hospital characteristics, the presence of schizophrenia was associated with a 2.83 times higher risk of having a ruptured appendix (odds ratio [OR], 2.83; 95% confidence interval [CI], 2.20–3.64. However, the presence of affective psychoses (OR, 1.15; 95% CI: 0.77–1.73 or other mental disorders (OR, 1.58; 95% CI: 0.89–2.81 was not a significant predictor for a ruptured appendix. Conclusion These findings suggest that given the fact that the NHI program reduces financial barriers to care for mentally ill patients, they are still at a disadvantage for obtaining timely treatment for their physical diseases. Of patients with a major mental illness, schizophrenic patients may be the most vulnerable ones for obtaining timely surgical care.

  13. 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

  14. The Epidemiology of Appendicitis and Appendectomy in South Korea: National Registry Data

    Science.gov (United States)

    Lee, Jung Hun; Park, Young Sun; Choi, Joong Sub

    2010-01-01

    Background Appendicitis is one of the most frequent acute surgical conditions of the abdomen, and appendectomy is one of the most commonly performed operations in the world. However, epidemiological data on appendicitis have not been reported for South Korean or East Asian populations. Methods We analyzed the epidemiological features and lifetime risk of appendicitis and appendectomy in South Korea using data collected for the national health insurance database from 2005 through 2007. Results Appendectomy was performed in 59.70% of inpatients diagnosed with appendicitis. The overall incidences of appendicitis, total appendectomy, and perforated appendectomy were 22.71, 13.56, and 2.91 per 10 000 population per year, respectively. The incidence of appendicitis and appendectomy showed clear seasonality, with a peak in summer. The standardized lifetime risks of appendicitis and appendectomy were constant from 2005 through 2007. A life table model suggests that the lifetime risk of appendicitis is 16.33% for males and 16.34% for females, and that the lifetime risk of appendectomy is 9.89% for males and 9.61% for females. Conclusions As compared to results obtained in research on Western populations, appendicitis and appendectomy had a similar perforation rate and seasonality, but a higher overall incidence, in South Koreans. Between 2005 and 2007, the incidence of appendicitis and appendectomy was constant. Overall, an estimated 15 incidental appendectomies are performed to prevent 1 inpatient with suspected appendicitis, and 26 incidental appendectomies are performed to prevent 1 appendectomy. Incidental appendectomy may have greater preventive value in Koreans. PMID:20023368

  15. 血清高迁移率蛋白B1检测在急性阑尾炎诊断中的应用%Application of serum high mobility group box protein-1 level detection in diagnosis of acute appendicitis

    Institute of Scientific and Technical Information of China (English)

    张希儒; 张广文; 杨栋文; 李成利; 杨香玲

    2012-01-01

    目的:探讨急性阑尾炎患者血清中高迁移率蛋白B1( HMGB1)水平及其对急性阑尾炎诊断的意义.方法:采用ELISA定量试剂盒检测40例健康体检者(A组)和129例拟诊为急性阑尾炎患者血清HMGB1水平,同时检测白细胞(WBC)和C反应蛋白(CRP)水平.根据手术和病理结果将129例拟诊患者分为:B组(非阑尾炎15例),C组(急性单纯性阑尾炎63例),D组(急性化脓性、坏疽性、穿孔性急性阑尾炎及阑尾周围脓肿51例),比较上述指标在各组中的差异并采用受试者工作曲线( ROC)分析各指标对急性阑尾炎的诊断效率.结果:与A,B组比较,C,D组患者WBC,血清CRP及HMGB1均明显升高,差异均有统计学意义(均P<0.05),且D组各项指标均明显高于C组(均P<0.05);ROC曲线分析显示,WBC,CRP和HMGB1的曲线下面积(AUG)分别为0.729,0.811和0.850,HMGB1的诊断效率最高(均P<0.05).结论:急性阑尾炎患者血清HMGB1水平明显升高,血清HMGB1水平可望作为评价急性阑尾炎病变和炎症反应程度的辅助指标.%The serum HMGBl levels of 40 subjects undergoing health maintenance examination (group A) and 129 suspected acute appendicitis patients were detected by using quantitative ELISA kit, and their white blood cell (WBC) count and C-reactive protein (CRP) level were also determined. According to the surgical findings and postoperative pathological results, the 129 suspected cases were distinguished into group B (15 cases without appendicitis), group C (63 cases of simple acute appendicitis) and group D (51 cases of acute suppurative , gangrenous, perforated appendicitis or periappendiceal abscess). The differences in above mentioned indexes among the groups were compared and the receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic efficiency of each index for acute appendicitis. Results: The WBC count, serum level of HMGB1 and CRP markedly increased in group C and group D compared

  16. Clinical and Radiological Profile of Acute Fibrinous and Organizing Pneumonia: A Retrospective Study

    Institute of Scientific and Technical Information of China (English)

    Jing-Hong Dai; Hui Li; Wei Shen; Li-Yun Miao; Yong-Long Xiao; Mei Huang; Meng-Shu Cao

    2015-01-01

    Background:Acute fibrinous and organizing pneumonia (AFOP) is a unique pathological entity with intra-alveolar fibrin in the form of "fibrin balls" and organizing pneumonia.It was divided into rare idiopathic interstitial pneumonia according to the classification notified by American Thoracic Society/European Respiratory Society in 2013.As a rare pathological entity,it is still not well known and recognized by clinicians.We reviewed the clinical features of 20 patients with AFOP diagnosed in a teaching hospital.Methods:The medical records of 20 patients with biopsy-proven diagnosis of AFOP were retrospectively reviewed.The patients' symptoms,duration of the disease,comorbidities,clinical laboratory data,pulmonary function testing,radiographic studies,and the response to treatment were extracted and analyzed.Results:Fever was the most common symptom and was manifested in 90% of AFOP patients.For clinical laboratory findings,systematic inflammatory indicators,including C-reactive protein and erythrocyte sedimentation rate,were significantly higher than normal in AFOP patients.In accordance with this increased indicators,injured liver functions were common in AFOP patients.Inversely,AFOP patients had worse clinical conditions including anemia and hypoalbuminemia.For pulmonary function testing,AFOP patients showed the pattern of restrictive mixed with obstructive ventilation dysfunction.For high-resolution computerized tomography (HRCT) findings,the most common pattern for AFOP patients was lobar consolidation which was very similar to pneumonia.However,unlike pneumonia,AFOP patients responded well to glucocorticoids.Conclusion:Patients with AFOP manifest as acute inflammatory-like clinical laboratory parameters and lobar consolidation on HRCT,but respond well to steroid.

  17. Clinical and radiographic predictors of acute compartment syndrome in the treatment of tibial plateau fractures: a retrospective cohort study.

    Science.gov (United States)

    Gamulin, Axel; Lübbeke, Anne; Belinga, Patrick; Hoffmeyer, Pierre; Perneger, Thomas V; Zingg, Matthieu; Cunningham, Gregory

    2017-07-18

    The aim of the study was to evaluate the relation between demographic, injury-related, clinical and radiological factors of patients with tibial plateau fractures and the development of acute compartment syndrome. All consecutive adult patients with intra-articular tibial plateau fractures admitted in our urban academic medical centre between January 2005 and December 2009 were included in this retrospective cohort study. The main outcome measurement was the development of acute compartment syndrome. The charts of 265 patients (mean age 48.6 years) sustaining 269 intra-articular tibial plateau fractures were retrospectively reviewed. Acute compartment syndrome occurred in 28 fractures (10.4%). Four patients presented bilateral tibial plateau fractures; of them, 2 had unilateral, but none had bilateral acute compartment syndrome. Non-contiguous tibia fracture or knee dislocation and higher AO/OTA classification (type 41-C) were statistically significantly associated with the development of acute compartment syndrome in multivariable regression analysis, while younger age (compartment syndrome seemed unlikely during initial assessment. However, larger studies are mandatory to confirm and refine both factors in predicting the occurrence of acute compartment syndrome.

  18. O knowledge, where art thou? Evidence and suspected appendicitis.

    Science.gov (United States)

    Boehnert, Markus U; Zimmermann, Heinz; Exadaktylos, Aristomenis K

    2009-12-01

    Much effort goes into developing and publishing guidelines which physicians fail to implement. We feel that major discrepancies still exist between theory and reality and that the translational approach to this aspect of medical care has not yet established itself. We therefore decided to investigate in an exemplary audit how liberally inappropriate imaging is used in our emergency department (ED) to rule out acute appendicitis. Our electronic medical record ED database 'Qualicare' (http://www.qualidoc.ch) was searched using the 'appendicitis' sub data base. The frequency and accuracy of abdominal imaging was determined in patients with clinically suspected appendicitis on admission over a 5-year period at a university hospital emergency unit. In total, 272 (41.2%) of the 577 patients were male and 305 (46.3%) were female. The attending physicians ordered abdominal X-rays in 133 patients, abdominal ultrasounds in 319, and abdominal computerized tomography (CT) scans in 93 patients. 125 patients underwent more than one imaging procedure. In all, 85/125 patients received a combination of X-rays, ultrasound and CT scanning! Physicians are often insecure about indications for surgery and therefore order useless imaging procedures. The reliability of such procedures in excluding acute appendicitis is limited, which was confirmed by our results. Although evidence-based medicine guidelines exist, they are neglected for many reasons. Future academic efforts should therefore focus more on knowledge translation and the implementation of existing knowledge by heightening awareness, rather than on simply creating new guidelines.

  19. Necrotizing fasciitis caused by perforated appendicitis: a case report.

    Science.gov (United States)

    Hua, Jie; Yao, Le; He, Zhi-Gang; Xu, Bin; Song, Zhen-Shun

    2015-01-01

    Acute appendicitis is one of the most common causes of acute abdominal pain. Accurate diagnosis is often hindered due to various presentations that differ from the typical signs of appendicitis, especially the position of the appendix. A delay in diagnosis or treatment may result in increased risks of complications, such as perforation, which is associated with increased morbidity and mortality rates. Necrotizing fasciitis caused by perforated appendicitis is extremely rare. We herein report a case of 50-year-old man presenting with an appendiceal abscess in local hospital. After ten days of conservative treatment with intravenous antibiotics, the patient complained about pain and swelling of the right lower limb and computed tomography (CT) demonstrated a perforated appendix and gas and fluid collection extending from his retroperitoneal cavity to the subcutaneous layer of his right loin and right lower limb. He was transferred to our hospital and was diagnosed with necrotizing fasciitis caused by perforated appendicitis. Emergency surgery including surgical debridement and appendectomy was performed. However, the patient died of severe sepsis and multiple organ failure two days after the operation. This case represents an unusual complication of a common disease and we should bear in mind that retroperitoneal inflammation and/or abscesses may cause necrotizing fasciitis through lumbar triangles.

  20. 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.

  1. ACUTE ACCIDENTAL POISONING IN CHILDREN: A HOSPITAL-BASED RETROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Kameshore

    2014-10-01

    Full Text Available INTRODUCTION: Acute accidental poisoning in children is a big problem anywhere in the world. Studies done elsewhere in India showed a wide range of incidence of the problem. Hence, it was felt important to study its magnitude and associated characteristics as of now. OBJECTIVE: The current study was taken up to know the magnitude among children admitted in JNIMS, Imphal which is a newly established medical institute and also to study the characteristics like age, gender, type of poison, duration of hospital-stay and outcome of the cases. MATERIALS & METHODS: Retrospective data of all acute accidental poisoning cases among children admitted in the Pediatrics Ward, JNIMS, Imphal during the period July 2008 - December 2013 were analyzed by using descriptive statistics. RESULT: Of all the 13,663 children admitted, 148 cases were because of acute accidental poisoning giving an incidence rate of 1.08%. The male is to female ratio was 1.31:1. The last three years of the study period showed a slightly increasing trend in the incidence. Children aged 1-4 years were the most commonly affected (65.54%. Kerosene oil was by far the commonest (42% of all the poisonous substances consumed. Food poisoning, poisoning with organic compounds, poisoning with medicinal drugs and poisoning with corrosives comprised 21%, 12%, 9% and 8% respectively of all the cases. There was no mortality. DISCUSSION: The incidence rate of 1.08% as found out from the current study was on the lower side as compared to reports of previous studies done in other parts of the country. Yet, it was two-fold of the incidence reported from RIMS which is situated in the same State. Parental negligence in storing poisonous substances in the household was implicated. They need to be made aware for keeping harmful poisonous substances in safe places out of the reach of children. CONCLUSION: Community-based studies are recommended for estimating more accurately the magnitude of the problem in the

  2. Prevalence and Risk Factors for Delirium in Acute Stroke Patients. A Retrospective 5-Years Clinical Series.

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    Alvarez-Perez, Francisco José; Paiva, Fatima

    2017-03-01

    Delirium is characterized by disturbances of attention and cognition that cause functional decline and complications. The predisposing factors of delirium are age, male gender, systemic or metabolic disorders, dementia, and stroke. This study aims to evaluate the prevalence of delirium and to identify risk factors. This is a retrospective study that includes patients admitted over 5 years with acute stroke. Patients with transient ischemic attack or venous thrombosis were excluded. Delirium was defined according the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Demographical characteristics, clinical-radiological profile, dependence on discharge (modified Rankin Scale score of ≥3 and Barthel Index delirium. A total of 1161 patients were admitted (910 ischemic and 162 hemorrhagic). During hospitalization, 118 patients presented with delirium (10.2%) and 93 died (8%). On discharge, 517 patients were dependent (44.5%). Delirium was significantly associated with age, male gender, cortical infarcts in anterior circulation, higher leukocyte count, cholesterol and fibrinogen levels, lower albumin, atrial fibrillation, previous diagnosis of Alzheimer's disease, and hemorrhagic stroke. Logistic regression results showed that only previous Alzheimer's disease was related to delirium (odds ratio 21.68 [95% confidence interval 1.190-395.026, P = .038]). Dependence on discharge was associated with delirium. Ten percent of the patients presented with delirium associated with older age, Alzheimer's disease, and cortical anterior stroke. Patients with delirium had a higher risk of functional dependence on discharge. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  3. Acute hyponatremia after cardioplegia by histidine-tryptophane-ketoglutarate – a retrospective study

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    Lindner Gregor

    2012-06-01

    Full Text Available Abstract Background Hyponatremia is the most common electrolyte disorder in hospitalized patients and is known to be associated with increased mortality. The administration of antegrade single-shot, up to two liters, histidine-tryptophane-ketoglutarate (HTK solution for adequate electromechanical cardiac arrest and myocardial preservation during minimally invasive aortic valve replacement (MIAVR is a standard procedure. We aimed to determine the impact of HTK infusion on electrolyte and acid–base balance. Methods In this retrospective analysis we reviewed data on patient characteristics, type of surgery, arterial blood gas analysis during surgery and intra-/postoperative laboratory results of patients receiving surgery for MIAVR at a large tertiary care university hospital. Results A total of 25 patients were included in the study. All patients were normonatremic at start of surgery. All patients developed hyponatremia after administration of HTK solution with a significant drop of serum sodium of 15 mmol/L (p  Conclusions Acute hyponatremia during cardioplegia with HTK solution is isotonic and should probably not be corrected without presence of hypotonicity as confirmed by measurement of serum osmolality.

  4. Lymphoid Hyperplasia of the Appendix: A Potential Pitfall in the Sonographic Diagnosis of Appendicitis.

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    Xu, Yingding; Jeffrey, R Brooke; DiMaio, Michael A; Olcott, Eric W

    2016-01-01

    The objective of this study was to test the hypothesis that thickening of the lamina propria, a finding produced by lymphoid hyperplasia, is significantly associated with false-positive sonographic diagnoses of appendicitis in 6- to 8-mm noncompressible appendixes. Sonograms of 119 consecutive patients with suspected appendicitis and 6- to 8-mm noncompressible appendixes were retrospectively blindly evaluated for thickening of the lamina propria (short axis thickness ≥ 1 mm). The reference standard for appendicitis was pathologic analysis of resected specimens. Results were compared with the two-tailed Fisher exact test. Thirty-one patients (26.1%) had a thickened lamina propria and 88 (73.9%) did not. Of the 27 pediatric patients with a thickened lamina propria, five (18.5%) had true-positive and 22 (81.5%) had false-positive sonograms for appendicitis; among the 55 pediatric patients without a thickened lamina propria, 27 (49.1%) had true-positive and 28 (50.9%) had false-positive sonograms for appendicitis (p = 0.009). Similar differences in adult patients were not statistically significant. All five pediatric patients with appendicitis and thickened lamina propria also showed two or more findings of periappendiceal fluid, hyperechoic periappendiceal fat, or mural hyperemia on color Doppler examination, compared with two of 22 similar pediatric patients without appendicitis (p hyperplasia may result in a noncompressible appendix 6-8 mm in diameter and may be misdiagnosed as appendicitis in pediatric patients. True-positive diagnoses of appendicitis can be accurately identified by the presence of at least two additional findings from the group of periappendiceal fluid, hyperechoic periappendiceal fat, and mural hyperemia. Identifying the characteristic sonographic appearance of lymphoid hyperplasia may help prevent false-positive misdiagnoses of appendicitis.

  5. Apendicite aguda no ciclo gravídico-puerperal: um estudo de 13 casos Acute appendicitis in the gravidic-puerperal cycle: a study of 13 cases

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    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. Laparoscopic appendicectomy for suspected mesh-induced appendicitis after laparoscopic transabdominal preperitoneal polypropylene mesh inguinal herniorraphy

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    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.

  7. Communication Between Acute Care Hospitals and Skilled Nursing Facilities During Care Transitions: A Retrospective Chart Review.

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