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Sample records for appendectomy

  1. Transvaginal endoscopic appendectomy.

    Science.gov (United States)

    Shin, Eung Jin; Jeong, Gui Ae; Jung, Jun Chul; Cho, Gyu Seok; Lim, Chul Wan; Kim, Hyung Chul; Song, Ok Pyung

    2010-12-01

    Since Kalloo and colleagues first reported the feasibility and safety of a peroral transgastric approach in the porcine model in 2004, various groups have reported more complex natural orifice transluminal endoscopic surgery (NOTES) procedures, such as the cholecystectomy, splenectomy and liver biopsy, in the porcine model. Natural orifice access to the abdominal cavity, such as transgastric, transvesical, transcolonic, and transvaginal, has been described. Although a novel, minimally invasive approach to the abdominal cavity is a peroral endoscopic transgastric approach, there are still some challenging issues, such as the risk of infection and leakage, and the method of gastric closure. Hybrid-NOTES is an ideal first step in humans. Human hybrid transvaginal access has been used for years by many surgeons for diagnostic and therapeutic purposes. Here, we report a transvaginal flexible endoscopic appendectomy, with a 5-mm umbilical port using ultrasonic scissors in a 74-year-old woman with acute appendicitis. PMID:21221245

  2. A Comparison of Laparoscopic and Open Appendectomy

    OpenAIRE

    Tarnoff, Michael; Atabek, Umur; Goodman, Martin; Alexander, James B.; Chrzanowski, Francis; Mortman, Keith; Camishon, Rudolph; Pello, Mark

    1998-01-01

    Background and Objectives: To compare laparoscopic appendectomy with traditional open appendectomy. Methods: Seventy-one patients requiring operative intervention for suspected acute appendicitis were prospectively compared. Thirty-seven patients underwent laparoscopic appendectomy, and 34 had open appendectomy through a right lower quadrant incision. Length of surgery, postoperative morbidity and length of postoperative stay (LOS) were recorded. Both groups were similar with regard to age, g...

  3. Transvaginal appendectomy: a systematic review.

    Science.gov (United States)

    Yagci, Mehmet Ali; Kayaalp, Cuneyt

    2014-01-01

    Background. Natural orifice transluminal endoscopic surgery (NOTES) is a new approach that allows minimal invasive surgery through the mouth, anus, or vagina. Objective. To summarize the recent clinical appraisal, feasibility, complications, and limitations of transvaginal appendectomy for humans and outline the techniques. Data Sources. PubMed/MEDLINE, Cochrane, Google-Scholar, EBSCO, clinicaltrials.gov and congress abstracts, were searched. Study Selection. All related reports were included, irrespective of age, region, race, obesity, comorbidities or history of previous surgery. No restrictions were made in terms of language, country or journal. Main Outcome Measures. Patient selection criteria, surgical techniques, and results. Results. There were total 112 transvaginal appendectomies. All the selected patients had uncomplicated appendicitis and there were no morbidly obese patients. There was no standard surgical technique for transvaginal appendectomy. Mean operating time was 53.3 minutes (25-130 minutes). Conversion and complication rates were 3.6% and 8.2%, respectively. Mean length of hospital stay was 1.9 days. Limitations. There are a limited number of comparative studies and an absence of randomized studies. Conclusions. For now, nonmorbidly obese females with noncomplicated appendicitis can be a candidate for transvaginal appendectomy. It may decrease postoperative pain and enable the return to normal life and work off time. More comparative studies including subgroups are necessary. PMID:25614832

  4. Transvaginal Appendectomy: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Mehmet Ali Yagci

    2014-01-01

    Full Text Available Background. Natural orifice transluminal endoscopic surgery (NOTES is a new approach that allows minimal invasive surgery through the mouth, anus, or vagina. Objective. To summarize the recent clinical appraisal, feasibility, complications, and limitations of transvaginal appendectomy for humans and outline the techniques. Data Sources. PubMed/MEDLINE, Cochrane, Google-Scholar, EBSCO, clinicaltrials.gov and congress abstracts, were searched. Study Selection. All related reports were included, irrespective of age, region, race, obesity, comorbidities or history of previous surgery. No restrictions were made in terms of language, country or journal. Main Outcome Measures. Patient selection criteria, surgical techniques, and results. Results. There were total 112 transvaginal appendectomies. All the selected patients had uncomplicated appendicitis and there were no morbidly obese patients. There was no standard surgical technique for transvaginal appendectomy. Mean operating time was 53.3 minutes (25–130 minutes. Conversion and complication rates were 3.6% and 8.2%, respectively. Mean length of hospital stay was 1.9 days. Limitations. There are a limited number of comparative studies and an absence of randomized studies. Conclusions. For now, nonmorbidly obese females with noncomplicated appendicitis can be a candidate for transvaginal appendectomy. It may decrease postoperative pain and enable the return to normal life and work off time. More comparative studies including subgroups are necessary.

  5. Xanthogranulomatous appendicitis in interval appendectomy specimens of children

    OpenAIRE

    Yusuf Hakan Çavuşoğlu; Burak Ardıçlı; Sema Apaydın; Çağatay Evrim Afşarlar; Engin Yılmaz

    2016-01-01

    Xanthogranulomatous inflammation is common in interval appendectomy specimens in adults, but it is unusual in children. Histopathologic specimens of interval appendectomy, within an 8-year period, were reevaluated to assess the true incidence. A computer search of the hospital database of all appendectomies was performed between January 2008 and June 2015 to identify all interval appendectomy cases. A total of 2694 patients underwent appendectomies. Of these, 13 were interval appendectomies. ...

  6. Suprapubic approach for laparoscopic appendectomy

    OpenAIRE

    Singh, Manish K.; Kumar, Mani K.; Mohan, Lalit

    2013-01-01

    Objective: To evaluate the results of laparoscopic appendectomy using two suprapubic port incisions placed below the pubic hair line. Design: Prospective hospital based descriptive study. Settings: Department of surgery of a tertiary care teaching hospital located in Rohtas district of Bihar. The study was carried out over a period of 11months during November 2011 to September 2012. Participants: Seventy five patients with a diagnosis of acute appendicitis. Materials and Methods: All patients...

  7. Transvaginal Appendectomy: A Systematic Review

    OpenAIRE

    Mehmet Ali Yagci; Cuneyt Kayaalp

    2014-01-01

    Background. Natural orifice transluminal endoscopic surgery (NOTES) is a new approach that allows minimal invasive surgery through the mouth, anus, or vagina. Objective. To summarize the recent clinical appraisal, feasibility, complications, and limitations of transvaginal appendectomy for humans and outline the techniques. Data Sources. PubMed/MEDLINE, Cochrane, Google-Scholar, EBSCO, clinicaltrials.gov and congress abstracts, were searched. Study Selection. All related reports were included...

  8. Acceptable outcome after laparoscopic appendectomy in children

    DEFF Research Database (Denmark)

    Stilling, Nicolaj M; Fristrup, Claus; Gabers, Torben;

    2013-01-01

    An increasing proportion of childhood -appendicitis is being treated with laparoscopic appendectomy (LA). We wanted to elucidate the outcome of childhood appendicitis treated primarily by residents in a university hospital....

  9. Transvaginal Appendectomy in Morbidly Obese Patient

    OpenAIRE

    Mehmet Ali Yagci; Cuneyt Kayaalp; Mustafa Ates

    2014-01-01

    Introduction. Laparoscopic appendectomy has significant benefits in obese patients. However, morbid obesity can be accepted as an exclusion criterion for natural orifice transluminal endoscopic surgery (NOTES). Here, we present a transvaginal appendectomy in a 66-year-old morbidly obese (BMI 36 kg/m2, ASA III) patient. Case and Technique. Acute appendicitis was suspected based on history, physical examination, laboratory tests, and ultrasound findings. During laparoscopic surgery, a 5 mm troc...

  10. Laparoscopic vs mini-incision open appendectomy

    Institute of Scientific and Technical Information of China (English)

    Fatih; ?ift?i

    2015-01-01

    AIM: To compare laparoscopic vs mini-incision open appendectomy in light of recent data at our centre.METHODS: The data of patients who underwen appendectomy between January 2011 and June 2013 were collected. The data included patients’ demographic data, procedure time, length of hospital stay, the need for pain medicine, postoperative visual analog scale o pain, and morbidities. Pregnant women and patients with previous lower abdominal surgery were excluded Patients with surgery converted from laparoscopic appendectomy(LA) to mini-incision open appendectomy(MOA) were excluded. Patients were divided into two groups: LA and MOA done by the same surgeon. The patients were randomized into MOA and LA groups a computer-generated number. The diagnosis of acute appendicitis was made by the surgeon with physica examination, laboratory values, and radiological tests(abdominal ultrasound or computed tomography). Al operations were performed with general anaesthesia The postoperative vision analog scale score was recorded at postoperative hours 1, 6, 12, and 24. Patients were discharged when they tolerated normal food and passed gas and were followed up every week for three weeks as outpatients.RESULTS: Of the 243 patients, 121(49.9%) underwen MOA, while 122(50.1%) had laparoscopic appendectomy There were no significant differences in operation time between the two groups(P = 0.844), whereas the visua analog scale of pain was significantly higher in the open appendectomy group at the 1st hour(P = 0.001), 6th hour(P = 0.001), and 12 th hour(P = 0.027). The need for analgesic medication was significantly higher in the MOA group(P = 0.001). There were no differences between the two groups in terms of morbidity rate(P = 0.599)The rate of total complications was similar between the two groups(6.5% in LA vs 7.4% in OA, P = 0.599). Al wound infections were treated non-surgically. Six ou of seven patients with pelvic abscess were successfully treated with percutaneous drainage; one

  11. Xanthogranulomatous appendicitis in interval appendectomy specimens of children

    Directory of Open Access Journals (Sweden)

    Yusuf Hakan Çavuşoğlu

    2016-05-01

    Full Text Available Xanthogranulomatous inflammation is common in interval appendectomy specimens in adults, but it is unusual in children. Histopathologic specimens of interval appendectomy, within an 8-year period, were reevaluated to assess the true incidence. A computer search of the hospital database of all appendectomies was performed between January 2008 and June 2015 to identify all interval appendectomy cases. A total of 2694 patients underwent appendectomies. Of these, 13 were interval appendectomies. After pathologic evaluation, 2 (15.4% of the specimens were reported as xanthogranulomatous appendicitis (XA. Histopathologic examination of these interval appendectomy specimens, granulomas (59%, xanthogranulomatous inflammation (36% and Crohn-like changes (50% were common in adults. However, XA is a particularly rare clinical entity among children. Two cases of XA were reported in children in the English literature. One was a 12-year old boy that underwent interval appendectomy 6 weeks after an episode of acute appendicitis. The other was an 11-year old boy with acute (non-interval appendicitis, but the complete blood count was suggestive of an acute suppurative inflammation. These two cases are the 3rd and 4th cases of XA reported in children in the English literature, and both were managed by interval appendectomy. Thus, XA may be encountered in interval appendectomy specimens and association with IBD has to be ruled out.

  12. Transvaginal appendectomy in morbidly obese patient.

    Science.gov (United States)

    Yagci, Mehmet Ali; Kayaalp, Cuneyt; Ates, Mustafa

    2014-01-01

    Introduction. Laparoscopic appendectomy has significant benefits in obese patients. However, morbid obesity can be accepted as an exclusion criterion for natural orifice transluminal endoscopic surgery (NOTES). Here, we present a transvaginal appendectomy in a 66-year-old morbidly obese (BMI 36 kg/m(2), ASA III) patient. Case and Technique. Acute appendicitis was suspected based on history, physical examination, laboratory tests, and ultrasound findings. During laparoscopic surgery, a 5 mm trocar was inserted through the umbilicus and a 5 mm telescope was placed. A 12 mm trocar and a 5 mm grasper were inserted separately through the posterior fornix of the vagina under laparoscopic guidance. The appendix was divided with an endoscopic stapler through the transvaginal 12 mm trocar and removed from the same trocar. The operating time was 75 minutes with minimal blood loss (appendectomy at morbid obesity. We can say that morbid obesity does not constitute an obstacle for treatment of acute appendicitis by transvaginal endoscopic surgery. PMID:25506028

  13. Transvaginal Appendectomy in Morbidly Obese Patient

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    Mehmet Ali Yagci

    2014-01-01

    Full Text Available Introduction. Laparoscopic appendectomy has significant benefits in obese patients. However, morbid obesity can be accepted as an exclusion criterion for natural orifice transluminal endoscopic surgery (NOTES. Here, we present a transvaginal appendectomy in a 66-year-old morbidly obese (BMI 36 kg/m2, ASA III patient. Case and Technique. Acute appendicitis was suspected based on history, physical examination, laboratory tests, and ultrasound findings. During laparoscopic surgery, a 5 mm trocar was inserted through the umbilicus and a 5 mm telescope was placed. A 12 mm trocar and a 5 mm grasper were inserted separately through the posterior fornix of the vagina under laparoscopic guidance. The appendix was divided with an endoscopic stapler through the transvaginal 12 mm trocar and removed from the same trocar. The operating time was 75 minutes with minimal blood loss (<10 mL. The patient was discharged 16 hours after surgery uneventfully and she did not require any analgesic administration. Conclusion. To the best of our knowledge, this is the first clinical case that focuses on the transvaginal appendectomy at morbid obesity. We can say that morbid obesity does not constitute an obstacle for treatment of acute appendicitis by transvaginal endoscopic surgery.

  14. Mini-laparoscopic versus laparoscopic approach to appendectomy

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    Kercher Kent W

    2001-10-01

    Full Text Available Abstract Background The purpose of this clinical study is to evaluate the feasibility of using 2-mm laparoscopic instruments to perform an appendectomy in patients with clinically suspected acute appendicitis and compare the outcome of this mini-laparoscopic or "needlescopic" approach to the conventional laparoscopic appendectomy. Methods Two groups of patients undergoing appendectomy over 24 months were studied. In the first group, needlescopic appendectomy was performed in 15 patients by surgeons specializing in advanced laparoscopy. These patients were compared with the second or control group that included 21 consecutive patients who underwent laparoscopic appendectomy. We compared the patients' demographic data, operative findings, complications, postoperative pain medicine requirements, length of hospital stay, and recovery variables. Differences were considered statistically significant at a p-value Results Patient demographics, history of previous abdominal surgery, and operative findings were similar in both groups. There was no conversion to open appendectomy in either group. No postoperative morbidity or mortality occurred in either group. The needlescopic group had a significantly shorter mean operative time (p = 0.02, reduced postoperative narcotics requirements (p = 0.05, shorter hospital stay (p = 0.04, and quicker return to work (p = 0.03 when compared with the laparoscopic group. Conclusions We conclude that the needlescopic technique is a safe and effective approach to appendectomy. When performed by experienced laparoscopic surgeons, the needlescopic technique results in significantly shorter postoperative convalescence and a prompt recovery.

  15. Fatal cerebro-renal oxalosis after appendectomy.

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    Pfeiffer, H; Weiss, F U; Karger, B; Aghdassi, A; Lerch, M M; Brinkmann, B

    2004-04-01

    A case of a 24-year-old male with fatal cerebro-renal oxalosis assumed to be due to infusions of the sugar surrogate xylitol after appendectomy is reported. The diagnosis was established only after intensive histological investigations following the autopsy. The clinical picture was characterized by an acute seizure, coma and renal failure 2 days after the first xylitol infusion. Death occurred due to cerebral dysregulation as a very rare complication after parenteral administration of xylitol. Subendothelial double refractive calcium oxalate crystals were found in the walls of cerebral blood vessels, in particular in the stem ganglion regions and in the cortical renal tubules. The most common type of primary oxalosis was excluded by sequencing analysis. The young age, the minor surgical intervention and the otherwise unremarkable history are special features of this case. Since the genetic background of xylitol intolerance is still unclear, it is suggested that it should be banned as a sugar surrogate in clinical practice. PMID:14634832

  16. E-NOTES transumbilical laparoscopic appendectomy.

    Science.gov (United States)

    Graur, F; Elisei, R; Al-Hajjar, N

    2013-01-01

    We present a case of laparoscopic transumbilical single incision appendectomy. A 17-year-old patient with an insidious onset of symptoms 4 months ago by diffuse abdominal pain that later was localized in the right iliac fossa accompanied by loss of appetite, nausea and vomiting. Following clinical examination and abdominal ultrasound, she was diagnosed with chronic appendicitis and surgical treatment was recommended. Pneumoperitoneum was performed under general anesthesia. Three trocars of 5 mm diameter were inserted through a single umbilical incision of 10 mm length into the peritoneal cavity. The exploration has revealed a swollen appendix. After transsection of the mesoappendix with LigaSure forceps, two Roeder knots were placed at on the base of the appendix. Intervention duration was 60 minutes. Postoperative course was favorable. Patient assessment within 2 months after discharge showed disappearance of symptoms and the postoperative scar hidden in the umbilical scar. PMID:23958105

  17. Laparoscopic versus open appendectomy: Which way to go?

    Institute of Scientific and Technical Information of China (English)

    Ioannis Kehagias; Stavros Nikolaos Karamanakos; Spyros Panagiotopoulos; Konstantinos Panagopoulos; Fotis Kalfarentzos

    2008-01-01

    AIM:To compare the outcome of laparoscopic versus open appendectomy.METHODS:Prospectively collected data from 293 consecutive patients with acute appendicitis were studied.These comprised Of 165 patients who underwent conventional appendectomy and 128 patients treated laparoscopically.The two groups were compared with respect to operative time,length of hospital stay,postoperative pain,complication rate and cost.RESULTS:There were no statistical differences regarding patient characteristics between the two groups.Conversion to laparotomy was necessary in 2 patients(1.5%).Laparoscopic appendectomy was associated with a shorter hospital stay(2.2 d vs 3.1 d,P=0.04),and lower incidence of wound infection(5.3% vs 12.8%,P=0.03).However,in patients with complicated disease,intra-abdominal abscess formation was more common after laparoscopic appendectomy(5.3% vs 2.1%,P=0.002).The operative time and analgesia requirements were similar in the two groups.The cost of treatment was higher by 370 ∈ in the laparoscopic group.CONCLUSION:Laparoscopic appendectomy is as safe and efficient as open appendectomy,provided surgical experience and equipment are available.

  18. Postoperative pyoderma gangrenosum: A rare complication after appendectomy

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    G Faghihi

    2015-01-01

    Full Text Available Pyoderma gangrenosum (PG is an uncommon inflammatory ulcerative skin disease. It is characterized by painful progressive necrosis of the wound margins. Rarely, postoperative pyoderma gangrenosum (PPG manifests as a severe disturbance of wound healing following surgical interventions. Only rare cases of this complication have been reported after appendectomy. We report a case of PPG in a 29-year-old female after appendectomy. She was successfully treated with oral prednisolone. Postoperative pyoderma gangrenosum should be kept in mind in the differential diagnosis of any postoperative delayed wound healing, because this disease is simply distinguished from a postoperative wound.

  19. Unusual Presentation of Dengue Fever Leading to Unnecessary Appendectomy.

    Science.gov (United States)

    Kumar, Lovekesh; Singh, Mahendra; Saxena, Ashish; Kolhe, Yuvraj; Karande, Snehal K; Singh, Narendra; Venkatesh, P; Meena, Rambabu

    2015-01-01

    Dengue fever is the most important arbovirus illness with an estimated incidence of 50-100 million cases per year. The common symptoms of dengue include fever, rash, malaise, nausea, vomiting, and musculoskeletal pain. Dengue fever may present as acute abdomen leading to diagnostic dilemma. The acute surgical complications of dengue fever include acute pancreatitis, acute acalculous cholecystitis, nonspecific peritonitis, and acute appendicitis. We report a case of dengue fever that mimicked acute appendicitis leading to unnecessary appendectomy. A careful history examination for dengue-related signs, and serial hemogram over the first 3-4 days of disease may prevent unnecessary appendectomy. PMID:26167314

  20. Unusual Presentation of Dengue Fever Leading to Unnecessary Appendectomy

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    Lovekesh Kumar

    2015-01-01

    Full Text Available Dengue fever is the most important arbovirus illness with an estimated incidence of 50–100 million cases per year. The common symptoms of dengue include fever, rash, malaise, nausea, vomiting, and musculoskeletal pain. Dengue fever may present as acute abdomen leading to diagnostic dilemma. The acute surgical complications of dengue fever include acute pancreatitis, acute acalculous cholecystitis, nonspecific peritonitis, and acute appendicitis. We report a case of dengue fever that mimicked acute appendicitis leading to unnecessary appendectomy. A careful history examination for dengue-related signs, and serial hemogram over the first 3-4 days of disease may prevent unnecessary appendectomy.

  1. Patient and physician perception of natural orifice transluminal endoscopic appendectomy

    Institute of Scientific and Technical Information of China (English)

    Tomas Hucl; Adela Saglova; Marek Benes; Matej Kocik; Martin Oliverius; Zdenek Valenta; Julius Spicak

    2012-01-01

    AIM:To investigate perception of natural orifice transluminal endoscopic surgery (NOTES) as a potential technique for appendectomy.METHODS:One hundred patients undergoing endoscopy and 100 physicians were given a questionnaire describing in detail the techniques of NOTES and laparoscopic appendectomy.They were asked about the reasons for their preference,choice of orifice,and extent of complication risk they were willing to accept.RESULTS:Fifty patients (50%) and only 21 physicians (21%) preferred NOTES (P < 0.001).Patients had previously heard of NOTES less frequently (7% vs 73%,P < 0.001) and had undergone endoscopy more frequently (88% vs 36%,P < 0.001) than physicians.Absence of hernia was the most common reason for NOTES preference in physicians (80% vs 44%,P =0.003),whereas reduced pain was the most common reason in patients (66% vs 52%).Physicians were more likely to refuse NOTES as a novel and unsure technique (P < 0.001) and having an increased risk of infection (P < 0.001).The preferred access site in both groups was colon followed by stomach,with vagina being rarely preferred.In multivariable modeling,those with high-school education [odds ratio (OR):2.68,95%confidence interval (CI):1.23-5.83] and prior colonoscopy (OR:2.10,95% CI:1.05-4.19) were more likely to prefer NOTES over laparoscopic appendectomy.There was a steep decline in NOTES preference with increased rate of procedural complications.Male patients were more likely to consent to their wives vaginal NOTES appendectomy than male physicians (P =0.02).CONCLUSION:The preference of NOTES for appendectomy was greater in patients than physicians and was related to reduced pain and absence of hernia rather than lack of scarring.

  2. 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

  3. 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.

  4. Prior appendectomy and the phenotype and course of Crohn's disease

    Institute of Scientific and Technical Information of China (English)

    Jacques Cosnes; Philippe Seksik; Isabelle Nion-Larmurier; Laurent Beaugerie; Jean-Pierre Gendre

    2006-01-01

    AIM: To determine whether prior appendectomy modifies the phenotype and severity of Crohn's disease.METHODS: Appendectomy status and smoking habits were specified by direct interview in 2838 patients consecutively seen between 1995 and 2004. Occurrence of complications and therapeutic needs were reviewed retrospectively. Additionally, annual disease activity was assessed prospectively between 1995 and 2004 in patients who had not had ileocecal resection and of a matched control group.RESULTS: Compared to 1770 non-appendectomized patients, appendectomized patients more than 5 years before Crohn's disease diagnosis (n=716) were more often females, smokers, with ileal disease. Cox regression showed that prior appendectomy was positively related to the risk of intestinal stricture (adjusted hazard ratio,1.24; 95% confidence interval, 1.13 to 1.36; P=0.02)and inversely related to the risk of perianal fistulization (adjusted hazard ratio, 0.75; 95% confidence interval,0.68 to 0.83; P=0.002). No difference was observed between the two groups regarding the therapeutic needs, except for an increased risk of surgery in appendectomized patients, attributable to the increased prevalence of ileal disease. Between 1995 and 2004,Crohn's disease was active during 50% of years in appendectomized patients (1318 out of 2637 patient-years) and 51% in non-appendectomized patients (1454out of 2841 patient-years; NS).CONCLUSION: Prior appendectomy is associated with a more proximal disease and has an increased risk of stricture and a lesser risk of anal fistulization. However,the severity of the disease is unaffected.

  5. LAPAROSCOPIC APPENDECTOMY AS A CARE MODEL OF "FAST TRACK SURGERY"

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    F. Ferrara

    2012-01-01

    Full Text Available "Fast track surgery" is a model of care pathway that is gradually replacing and incorporating all the other models so far applied in surgery. In particular, this is possible thanks to minimally invasive procedures widely disseminated for the several benefits they offer. The authors present a preliminary study of laparoscopic appendectomy using endo-GIA as a model of fast track surgery. At the Department of Pediatric Surgery of the University of Siena, from December 2008 to May 2009 were carried out 10 surgery procedures of laparoscopic appendectomy. Patients were subjected to emergency surgery for acute appendicitis diagnosed by clinical examination, laboratory tests and ultrasound study. The mean age was 10.8 years (range 7-14 years. All procedures were performed under general anesthesia with the patient in supine decubitus and using three trocars. The first 12 mm, was introduced through the umbilical incision with "open" approach, the second, 12 mm in the left iliac fossa and the third, 5 mm, in sovrapubic seat. In each patient the appendectomy was carried out with endo-GIA (a linear stapling device that can be used for the section of appendix and vessels. Results: Any patient needed to convert to “open surgery”. The duration of surgery procedure was in mean 80 minutes (range 60-90 minutes. In any case intraoperative complications were observed. In 1 patient (10% further surgery procedure with technique "open" was necessary due to presence of purulent exudate in peritoneal cavity, depending to severity of endo-abdominal infection. The hospitalization was in mean 4.3 days (range 3-10 days with intestinal canalization on the 1st post-operative day. Laparoscopic appendectomy is a feasible and safe method with advantages for patients such as lower incidence of septic complications (better toilet of peritoneal cavity and possible placement of drainage, reduced time of hospitalization and convalescence, better control of postoperative pain, and

  6. Recurrent abdominal pain post appendectomy--a rare case.

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    Cama, Jitoko K

    2010-09-01

    Right iliac fossa pain in young adults who have previously had an appendicectomy represents a diagnostic challenge. In such cases it is important to review the histology of the appendix and the previous operation notes. The appendix stump, if left long following an appendectomy, can result in chronic appendicitis of the stump, or it can rarely develop into a mucocele. This case report describes a patient with an appendix stump mucocele who presented with chronic pain under the right iliac fossa incision and was successfully treated by laparoscopic resection. PMID:21714341

  7. Prophylactic Appendectomy during Laparoscopic Surgery for Other Conditions

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    S. Occhionorelli

    2014-01-01

    Full Text Available Acute appendicitis remains the most common surgical emergency. Laparoscopy has gained increasing favor as a method of both investigating right iliac fossa pain and treating the finding of appendicitis. A question arises: what to do with an apparent healthy appendix discovered during laparoscopic surgery for other pathology. We present a case of unilateral hydroureteronephrosis complicated with rupture of the renal pelvis, due to gangrenous appendicitis with abscess of the right iliopsoas muscle and periappendicular inflammation in a 67-year-old woman, who underwent laparoscopic right annessiectomy for right ovarian cyst few years earlier, in which a healthy appendix was left inside. There is a lack of consensus in the literature about what to do with a normal appendix. The main argument for removing an apparently normal appendix is that endoluminal appendicitis may not be recognized during surgery, leading to concern that an abnormal appendix is left in place. Because of a lack of evidence from randomized trials, it remains unclear whether the benefits of routine elective coincidental appendectomy outweigh the costs and risks of morbidity associated with this prophylactic procedure. Nevertheless, it appears, from limited data, that women aged 35 years and under benefit most from elective coincidental appendectomy.

  8. 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.

  9. Appendectomy due to lead poisoning: a case-report

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    Aghilinejad M

    2008-10-01

    Full Text Available Abstract Background Lead poisoning is a common occupational health hazard in developing countries and many misdiagnoses and malpractices may occur due to unawareness of lead poisoning symptoms. Case presentation We report a case of occupational lead poisoning in an adult battery worker with abdominal colic who initially underwent appendectomy with removal of normal appendix. Later on he was diagnosed with lead poisoning and was treated appropriately with lead chelator (CaNa2EDTA. Conclusion Lead poisoning is frequently overlooked as the differential diagnosis of acute abdomen which may result in unnecessary surgery. Appropriate occupational history taking is helpful in making a correct diagnosis. Occupational lead poisoning is a preventable disorder and a serious challenge for the health and labor authorities in developing countries.

  10. Single-access surgery laparoscopic cholecystectomy and appendectomy.

    Science.gov (United States)

    Mofid, Hamid; Zornig, Carsten

    2010-04-01

    The objective of this study was to achieve an ideal cosmetic result and minimize the access trauma to the abdominal wall. The authors developed a technique to perform cholecystectomies and appendectomies with only one incision in the umbilicus. With the upcoming idea of Natural Orifice Transluminal Endoscopic Surgery (NOTES) in the recent years and noticing the lack of feasibility of the technique for the daily routine beside the technique described by these authors, another development was raising the interest of the surgeons around the world. The single-access surgery through the umbilicus is a technique, that can be used in the daily routine and provides the best cosmetic results. Furthermore, injury of the abdominal wall is located at only one site, which might reduce the rate of trocar hernias and abdominal wall infections. Two 5.5-mm trocars were inserted through an incision at the upper edge of the umbilicus. After perforation of the abdominal wall with a stylet of a 5.5-mm trocar, a curved grasper was inserted, without the use of a trocar, into the abdominal cavity. The use of curved instruments facilitates better triangulation and instrument handling. No gas leakage was observed due to the nonexistence of a trocar. Dissection of the Calot' s triangle or appendix vessels can be done with standard instruments. The curved grasper allows retraction of the gallbladder or appendix. The specimen can be removed through the umbilical incision. The authors present a single-access surgery technique for cholecystectomies and appendectomies using curved instruments. The single-access surgery with parallel inserted curved instruments is feasible. No additional complications are related to this modification other than those known to be associated with laparoscopic surgery. This method offers an almost scarless surgery. Whether other advantages such as less trocar hernias, wound infections, and/or a faster recovery can be achieved, it has not yet to be proven. PMID

  11. A Single Case of Single-Port Access Laparoscopic Appendectomy During the Puerperium

    OpenAIRE

    MATSUHASHI, NOBUHISA; Takahashi, Takao; ICHIKAWA, KENGO; Yawata, Kazunori; TANAHASHI, TOSHIYUKI; Imai, Hisashi; Sasaki, Yoshiyuki; Tanaka, Yoshihiro; Okumura, Naoki; Yamaguchi, Kazuya; Osada, Shinji; Yoshida, Kazuhiro

    2015-01-01

    Laparoscopic appendectomy is now widely practiced for the treatment of acute appendicitis. As result of increased demand for minimally invasive surgery, single-incision access was introduced and is being performed in various abdominal surgeries. Conventional laparoscopic appendectomy (LA) is gradually being performed in pregnant women. A 33-year-old woman was referred to our department at 39 weeks and 1 day of gestation due to abdominal pain. She was aware of her gastroepiploic pain even afte...

  12. Unusual histopathological findings in appendectomy specimens: A retrospective analysis and literature review

    Institute of Scientific and Technical Information of China (English)

    Sami Akbulut; Mahmut Tas; Nilgun Sogutcu; Zulfu Arikanoglu; Murat Basbug; Abdullah Ulku; Heybet Semur; Yusuf Yagmur

    2011-01-01

    AIM: To document unusual findings in appendectomy specimens.METHODS: The clinicopathological data of 5262 pa-tients who underwent appendectomies for presumed acute appendicitis from January 2006 to October 2010 were reviewed retrospectively. Appendectomies per-formed as incidental procedures during some other operation were excluded. We focused on 54 patients who had unusual findings in their appendectomy specimens. We conducted a literature review via the PubMed and Google Scholar databases of English lan-guage studies published between 2000 and 2010 on unusual findings in appendectomy specimens.RESULTS: Unusual findings were determined in 54 (1%) cases by histopathology. Thirty were male and 24 were female with ages ranging from 15 to 84 years (median, 32.2 ± 15.1 years). Final pathology revealed 37 cases of enterobiasis, five cases of carcinoids, four mucinous cystadenomas, two eosinophilic infiltra-tions, two mucoceles, two tuberculosis, one goblet-cell carcinoid, and one neurogenic hyperplasia. While 52 patients underwent a standard appendectomy, two pa-tients who were diagnosed with tuberculous appendi-citis underwent a right hemicolectomy. All tumors were located at the distal part of the appendix with a mean diameter of 6.8 mm (range, 4-10 mm). All patients with tumors were alive and disease-free during a mean follow-up of 17.8 mo. A review of 1366 cases reported in the English literature is also discussed.CONCLUSION: Although unusual pathological findings are seldom seen during an appendectomy, all appen-dectomy specimens should be sent for routine histo-pathological examination.

  13. Characterization of Force and Torque Interactions during a Simulated Transgastric Appendectomy Procedure

    OpenAIRE

    Dargar, Saurabh; Brino, Cecilia; Matthes, Kai; Sankaranarayanan, Ganesh; De, Suvranu

    2014-01-01

    We have developed an instrumented endoscope grip handle equipped with a 6-axis load cell and measured forces and torques during a simulated transgastric NOTES appendectomy procedure performed in an EASIE-R© ex vivo simulator. The data were collected from 10 participating surgeons of varying degrees of expertise which was analyzed to compute a set of 6 force and torque parameters for each coordinate axis for each of the nine tasks of the appendectomy procedure. The mean push/pull force was ...

  14. Effect of acupressure of Ex-Le7 point on pain, nausea and vomiting after appendectomy: A randomized trial

    OpenAIRE

    Mohsen Adib-Hajbaghery; Mahmood Etri

    2013-01-01

    Background: The Le7 acupoint had been known as an acupoint for reducing pain of appendicitis. However, no study on the effect of its acupressure on post-appendectomy pain is available. The objective of this study was to evaluate the effects of acupressure of Le7 acupoint on pain, nausea, and vomiting after appendectomy. Materials and Methods: A single-blind randomized controlled trial was conducted on 70 post-appendectomy patients in a general surgical ward. Patients with inclusion criteria w...

  15. [Transvaginal hybrid natural orifice translumenal endoscopic surgery appendectomy].

    Science.gov (United States)

    Wada, Norihito; Tanabe, Minoru; Kataoka, Fumio; Kitagawa, Yuko

    2013-11-01

    Natural orifice translumenal endoscopic surgery (NOTES) is considered the ultimate minimally invasive intervention for visceral disease. The transvaginal route is now the only one that can be used for NOTES procedures in daily clinical practice. We performed hybrid NOTES appendectomy that was preevaluated and approved by the Japan NOTES and Institutional Review Board. A 5-mm trocar was inserted transumbilically and used for laparoscope access. An additional transumbilical 2.3-mm port was placed, through which the surgeon inserted a grasper. We created a transvaginal port with a long 12-mm trocar. Laparoscopic instruments such as a vessel sealing system, surgical staplers, and a retrieval bag were introduced, and the surgical technique consequently became safer, although the access route was limited. The appendix was removed transvaginally. The patient did not need epidural anesthesia or any pain medication. The cosmetic results were better than that of conventional single-port surgery. Triangulation is achieved in this procedure, which makes the surgery easier. To generalize NOTES to many types of surgery and enable it to be performed in men, the transgastric approach is essential. The development of flexible instruments designed for NOTES is also necessary. PMID:24358726

  16. Carcinoid tumor of the appendix: A consecutive series from 1237 appendectomies

    Institute of Scientific and Technical Information of China (English)

    Vincent Tchana-Sato; Arnaud De Roover; Michel Meurisse; Pierre Honoré; Olivier Detry; Marc Polus; Albert Thiry; Bernard Detroz; Sylvie Maweja; Etienne Hamoir; Thierry Defechereux; Carla Coimbra

    2006-01-01

    AIM: To report the experience of the CHU Sart Tilman,appendiceal carinoid tumor.METHODS: A retrospective review of 1237 appendectomies performed in one single centre from January 2000 to May 2004, was undertaken. Analysis of demographic data, clinical presentation, histopathology, operative reports and outcome was presented.RESULTS: Among the 1237 appendectomies, 5 appendiceal carcinoid tumors were identified (0.4%) in 4 male and 1 female patients, with a mean age of 29.2 years (range: 6-82 years). Acute appendicitis was the clinical presentation for all patients. Four patients underwent open appendectomy and one a laparoscopic procedure.One patient was reoperated to complete the excision of mesoappendix. All tumors were located at the tip of the appendix with a mean diameter of 0.6 cm (range: 0.3-1.0cm). No adjuvant therapy was performed. All patients were alive and disease-free during a mean follow-up of 33 mo.CONCLUSION: Appendiceal carcinoid tumor most often presents as appendicitis. In most cases, it is found incidentally during appendectomies and its diagnosis is rarely suspected before histological examination. Appendiceal carcinoid tumor can be managed by simple appendectomy and resection of the mesoappendix, if its size is ≤ 1cm.

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

    International Nuclear Information System (INIS)

    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.)

  18. Suture granuloma of the abdominal wall with intraabdominal extension 12 years after open appendectomy

    Institute of Scientific and Technical Information of China (English)

    Goran Augustin; Dragan Korolija; Mate Skegro; Jasminka Jakic-Razumovic Goran

    2009-01-01

    Most complications after appendectomy occur within ten days;however,we report the unusual case of a suture granuloma 12 years after open appendectomy.The afebrile 75-year-old woman presented with a slightly painful palpable mass in the right lower abdomen.There was no nausea or vomiting and bowel movements were normal.She lost 10 kg during the 3 mo before presentation.The patient had undergone an appendectomy 12 years previously.Physical examination revealed a tender mass,10 cm in diameter,under the appendectomy scar.The preoperative laboratory findings,tumor markers and plain abdominal radiographs were normal.Multi-slice computed tomography scanning showed an inhomogenous abdominal mass with minimal vascularization in the right lower abdomen 8.6 cm×8 cm×9 cm in size which communicated with the abdominal wall.The abdominalwall was thickened,weak and bulging.The abdominalwall mass did not communicate with the cecumor the ascending colon.Complete excision of the abdominalwall mass was performed via median laparotomy.Histopathological examination revealed a granuloma with a central abscess.This case report demonstrates that a preoperative diagnosis of abdominal wall mass after open appendectomy warrants the use of a wide spectrum of diagnostic modalities and consequently different treatment options.

  19. Short- and Long-Term Results of Open Versus Laparoscopic Appendectomy

    NARCIS (Netherlands)

    H.A. Swank; E.J. Eshuis; M.I. van Berge Henegouwen; W.A. Bemelman

    2011-01-01

    Clinical advantages of laparoscopic appendectomy have been shown in numerous trials and reviews. Most of these advantages are small and of limited clinical relevance, while laparoscopic operation costs are reported to be higher. The present study compares short- and long-term results of conventional

  20. The Evolution of the Appendectomy: From Open to Laparoscopic to Single Incision

    Directory of Open Access Journals (Sweden)

    Noah J. Switzer

    2012-01-01

    Full Text Available Beginning with its initial description by Fitz in the 19th century, acute appendicitis has been a significant long-standing medical challenge; today it remains the most common gastrointestinal emergency in adults. Already in 1894, McBurney advocated for the surgical removal of the inflamed appendix and is credited with the initial description of an Open Appendectomy (OA. With the introduction of minimally invasive surgery, this classic approach evolved into a procedure with multiple, smaller incisions; a technique termed Laparoscopic Appendectomy (LA. There is much literature describing the advantages of this newer approach. To name a few, patients have significantly less wound infections, reduced pain, and a reduction in ileus compared with the OA. In the past few years, Single Incision Laparoscopic Appendectomy (SILA has gained popularity as the next major evolutionary advancement in the removal of the appendix. Described as a pioneer in the era of “scarless surgery,” it involves only one transumbilical incision. Patients are postulated to have reduced post-operative complications such as infection, hernias, and hematomas, as well as a quicker recovery time and less post-operative pain scores, in comparison to its predecessors. In this review, we explore the advancement of the appendectomy from open to laparoscopic to single incision.

  1. Ipsilateral transversus abdominis plane block provides effective analgesia after appendectomy in children: a randomized controlled trial.

    LENUS (Irish Health Repository)

    Carney, John

    2010-10-01

    The transversus abdominis plane (TAP) block provides effective postoperative analgesia in adults undergoing major abdominal surgery. Its efficacy in children remains unclear, with no randomized clinical trials in this population. In this study, we evaluated its analgesic efficacy over the first 48 postoperative hours after appendectomy performed through an open abdominal incision, in a randomized, controlled, double-blind clinical trial.

  2. Laparoscopic appendectomy during pregnancy is safe for both the mother and the fetus

    DEFF Research Database (Denmark)

    Laustsen, Jesper Frølund; Bjerring, Ole Steen; Johannessen, Øyvind;

    2016-01-01

    , Apgar score, birth weight or height between the two groups. Five births (11%) were categorised as mildly to moderately preterm. There were no cases of fetal loss. CONCLUSION: Laparoscopic appendectomy is safe for both the mother and the fetus during pregnancy irrespective of gestational age...

  3. 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

  4. Laparoscopic appendectomy in a pediatric patient with type 1 Charcot-Marie-Tooth disease.

    Science.gov (United States)

    Heller, Joshua A; Marn, Richard Y

    2015-12-01

    A pediatric patient with type 1 Charcot-Marie-Tooth disease-a disorder associated with a demyelinating polyneuropathy-presented for laparoscopic appendectomy in the setting of acute appendicitis. Induction and maintenance of anesthesia were successfully managed without the use of any depolarizing or nondepolarizing neuromuscular blocking agents. The patient was successfully extubated at the completion of the procedure without any respiratory or neuromuscular sequelae, with excellent pain control and no postoperative nausea or vomiting.

  5. Transvaginal Laparoscopic Appendectomy Simultaneously with Vaginal Hysterectomy: Initial Experience of 10 Cases

    OpenAIRE

    Tian, Yu; Wu, Shuo-Dong; Chen, Ying-Han; Wang, Dan-Bo

    2014-01-01

    Background Natural orifice transluminal endoscopic surgery (NOTES) involves the introduction of instruments through a natural orifice into the peritoneal cavity to perform surgical interventions. The vagina is the most widely used approach to NOTES. We report the utilization of the vaginal opening at the time of vaginal hysterectomy as a natural orifice for laparoscopic appendectomy. Material/Methods We reviewed cases of 10 patients with chronic appendicitis who underwent transvaginal laparos...

  6. Development of a standardized laparoscopic caecum resection model to simulate laparoscopic appendectomy in rats

    OpenAIRE

    Lingohr, Philipp; Dohmen, Jonas; Matthaei, Hanno; Schwandt, Timo; Hong, Gun-Soo; Konieczny, Nils; Bölke, Edwin; Wehner, Sven; Kalff, Jörg C

    2014-01-01

    Background Laparoscopic appendectomy (LA) has become one of the most common surgical procedures to date. To improve and standardize this technique further, cost-effective and reliable animal models are needed. Methods In a pilot study, 30 Wistar rats underwent laparoscopic caecum resection (as rats do not have an appendix vermiformis), to optimize the instrumental and surgical parameters. A subsequent test study was performed in another 30 rats to compare three different techniques for caecum...

  7. Antiseptic wick: does it reduce the incidence of wound infection following appendectomy?

    LENUS (Irish Health Repository)

    McGreal, Gerald T

    2012-02-03

    The role of prophylactic antibiotics is well established for contaminated wounds, but the use of antiseptic wound wicks is controversial. The aim of this work was to study the potential use of wound wicks to reduce the rate of infection following appendectomy. This prospective randomized controlled clinical trial was conducted at a university hospital in the department of surgery. The subjects were patients undergoing appendectomy for definite acute appendicitis. They were randomized by computer to primary subcuticular wound closure or use of an antiseptic wound wick. For the latter, ribbon gauze soaked in povidone-iodine was placed between interrupted nylon skin sutures. Wicks were soaked daily and removed on the fourth postoperative day. All patients received antibiotic prophylaxis. They were reviewed while in hospital and 4 weeks following operation for evidence of wound infection. The main outcome measures were wound infection, wound discomfort, and cosmetic result. The overall wound infection rate was 8.6% (15\\/174). In patients with wound wicks it was 11.6% (10\\/86) compared to 5.6% (5\\/88) in those whose wounds were closed by subcuticular sutures (p = NS). We concluded that the use of wound wicks was not associated with decreased wound infection rates following appendectomy. Subcuticular closure is therefore appropriate in view of its greater convenience and safety.

  8. Two-port laparoscopic appendectomy with the help of a needle grasper: better cosmetic results and fewer trocars than conventional laparoscopic appendectomy

    Science.gov (United States)

    Sunamak, Oguzhan; Ferahman, Sina; Uludag, Server Sezgin; Yildirim, Dogan; Hut, Adnan

    2016-01-01

    Introduction The two-port laparoscopic appendectomy technique (TPLA) lays between the conventional three-port trocar procedure and single-port laparoscopic appendectomy surgery. During TPLA, the appendix is suspended with stitches, resulting in perforation risk and difficulty in exploration. Aim We used a needle grasper in TPLA to hang and manipulate the appendix. Material and methods Thirty-four patients (10 female, 24 male) who underwent TPLA between February 2015 and November 2015 were analyzed retrospectively for patient demographics, duration of operation, laparotomy or conventional laparoscopy necessity, drain use, complications, and hospital stay periods. The needle grasper was inserted at the right under the abdominal quadrant (McBurney point) without an incision to hang and manipulate the appendix. Results The mean age was 25.19 ±8.464 years; the mean body mass index (BMI) was 23.50 ±3.246 kg/m2. ASA scores were 1 and 2. The operations were completed without any additional trocar in 34 patients. The mean operation time was 57.03 ±3.814 min. There were no intraoperative complications in any patients. Three patients required a drain; all were discharged after drain removal. Thirty-one patients were discharged on the 1st postoperative day; three patients with drains were discharged on the 2nd day. The mean hospital stay period was 1.18 ±0.535 days. Conclusions Using the needle grasper, the appendix was held and suspended and the mesoappendix was cauterized and skeletonized successfully in TPLA. Inserting a needle grasper into the abdominal cavity at the McBurney point to manipulate the appendix helps and does not leave a visible scar.

  9. Combined spinal epidural anesthesia for laparoscopic appendectomy in adults: A case series

    Directory of Open Access Journals (Sweden)

    Rajesh S Mane

    2012-01-01

    Full Text Available Background: Laparoscopy is one of the most common surgical procedures and is the procedure of choice for most of the elective abdominal surgeries performed preferably under endotracheal general anesthesia. Technical advances in the field of laparoscopy have helped to reduce surgical trauma and discomfort, reduce anesthetic requirement resulting in shortened hospital stay. Recently, regional anaesthetic techniques have been found beneficial, especially in patients at a high risk to receive general anesthesia. Herewith we present a case series of laparoscopic appendectomy in eight American Society of Anaesthesiologists (ASA I and II patients performed under spinal-epidural anaesthesia. Methods: Eight ASA Grade I and II adult patients undergoing elective Laparoscopic appendectomy received Combined Spinal Epidural Anaesthesia. Spinal Anaesthesia was performed at L 2 -L 3 interspace using 2 ml of 0.5% (10 mg hyperbaric Bupivacaine mixed with 0.5ml (25 micrograms of Fentanyl. Epidural catheter was inserted at T 10 -T 11 interspace for inadequate spinal anaesthesia and postoperative pain relief. Perioperative events and operative difficulty were studied. Systemic drugs were administered if patients complained of shoulder pain, abdominal discomfort, nausea or hypotension. Results: Spinal anaesthesia was adequate for surgery with no operative difficulty in all the patients. Intraoperatively, two patients experienced right shoulder pain and received Fentanyl, one patient was given Midazolam for anxiety and two were given Ephedrine for hypotension. The postoperative period was uneventful. Conclusion: Spinal anaesthesia with Hyperbaric Bupivacaine and Fentanyl is adequate and safe for elective laparoscopic appendectomy in healthy patients but careful evaluation of the method is needed particularly in compromised cardio respiratory conditions.

  10. Transumbilical Laparoscopic-Assisted Appendectomy in the Treatment of Acute Uncomplicated Appendicitis in Children

    Directory of Open Access Journals (Sweden)

    Carmine Noviello

    2015-01-01

    Full Text Available Transumbilical laparoscopic-assisted appendectomy (TULAA is increasingly being performed worldwide. The authors report their experience in the treatment of acute uncomplicated appendicitis in children with TULAA. From January 2008 to December 2012 all types of acute appendicitis were divided, according to the clinical and ultrasonographic findings, into complicated (appendiceal mass/abscess, diffuse peritonitis and uncomplicated. Complicated appendicitis was treated by open appendectomy (OA. All patients with the suspicion of uncomplicated appendicitis were offered TULAA by all surgeons of the team. Conversion to open or laparoscopic appendectomy (LA was performed in case of impossibility to complete TULAA, depending on the choice of surgeon. The histopathologic examination of appendix was always performed. 444 children (252 males with acute appendicitis were treated. The mean age was 9.2 years (range, 2 to 14 years. Primary OA was performed in 144 cases. In 300 patients a transumbilical laparoscopic-assisted approach was performed. TULAA was completed in 252 patients. Conversion to OA was performed in 45 patients and to LA in 3. Conversion was related to the impossibility to adequately expose the appendix in 47 patients and bleeding in 1. The mean operative time for TULAA was 42 minutes. Histopathologic examination of the appendix removed by TULAA showed a phlegmonous/gangrenous type in 92.8% of cases. Among the 252 TULAA there were 11 cases of umbilical wound infection. TULAA is a feasible and effective procedure for uncomplicated appendicitis in children. It combines the advantages of open and laparoscopic technique (low operative time, low complications rate, and excellent cosmetic results.

  11. Robotic-assisted laparoscopic excision of gossypiboma simulating bladder wall mass after 35 years of appendectomy

    Directory of Open Access Journals (Sweden)

    Emad Sabri Rajih

    2014-01-01

    Full Text Available Gossypiboma or textiloma are terms commonly used to describe a retained sponge in the body that is composed of sponge invested within a layer of foreign body reaction in the form of an abscess or an aseptic fibrotic reaction. These cases are rarely reported despite an incidence of 1:1,000-1,500 of abdominal or pelvic surgery. We report a patient who presented with an incidental supravesical mass discovered upon work up for frequency and suprapubic pain. He had appendectomy 35 years ago. The mass was excised by robotic-assisted laparoscopic technique. The pathologic evaluation came as gossypiboma.

  12. Laparoscopic appendectomy: quality care and cost-effectiveness for today’s economy

    Science.gov (United States)

    2013-01-01

    Background Open appendectomy (OA) has traditionally been the treatment for acute appendicitis (AA). Beneficial effects of laparoscopic appendectomy (LA) for the treatment of AA are still controversial. Aim To present our technique for LA and to determine whether LA should be the technique of choice of any case of AA instead of OA. Material and methods All cases operated for AA (February 2011 through February 2012) by means of LA or OA were prospectively evaluated. Data regarding length of stay, complications, emergency department consultation after discharge or readmission were collected. Patients were classified into four groups depending on the severity of the appendicitis. Economic data were obtained based on the cost of the disposable material. Cost of hospital stay was calculated based on the Ley de Tasas of the Generalitat Valenciana according to the DRG and the length of stay. Results One hundred and forty-two cases were included. Ninety-nine patients underwent OA and 43 LA. Average length of stay for LA group was 2,6 days and 3,8 for OA. Average cost of the stay for OA was 1.799 euros and 1.081 euros for LA. Global morbidity rate was 16%, 5% for LA and 20% for OA. Conclusions LA is nowadays the technique of choice for the treatment of AA. PMID:24180475

  13. Oral Clonidine Premedication Reduces Nausea and Vomiting in Children after Appendectomy

    Directory of Open Access Journals (Sweden)

    Reza Alizadeh

    2012-09-01

    Full Text Available Objective: Clonidine is an α2-agonist which is used as a sedative premedication in children. There are conflicting results in the published literature about the effect of clonidine on the incidence of post operative nausea and vomiting (PONV. We therefore decided to evaluate the effect of oral clonidine given preoperatively on the incidence of PONV in children after appendectomy.Methods: sixty children, 5-12 years old, classified as American Society of Anesthesiologists physical status I and II, who were scheduled for appendecectomy were enrolled in this randomized double blinded clinical trial. Patients were randomly assigned into two groups of 30 patients. Patients in clonidine group were given4 μg.kg -1 clonidine in 20 cc of apple juice and patients in control group were given only 20 cc of apple juice 1 hour before transporting to operating room. The protocol of general anesthesia and postoperative analgesia was the same for two groups. Incidence of PONV and antiemetic usage of patients were assessed during 0-24hours after anesthesia.Findings: The patients' characteristics were similar in two groups. Patients who had received clonidine had significantly less episodes of PONV and also less rescue antiemetic usage than patients in control group.Conclusion: we showed that oral clonidine at a dose of 4 μg.kg -1 administered preoperatively is associated with a reduced incidence of postoperative vomiting in children who have undergone appendectomy.

  14. Analysis of the decision-making process leading to appendectomy: a grounded theory study.

    Science.gov (United States)

    Larsson, Gerry; Weibull, Henrik; Larsson, Bodil Wilde

    2004-11-01

    The aim was to develop a theoretical understanding of the decision-making process leading to appendectomy. A qualitative interview study was performed in the grounded theory tradition using the constant comparative method to analyze data. The study setting was one county hospital and two local hospitals in Sweden, where 11 surgeons and 15 surgical nurses were interviewed. A model was developed which suggests that surgeons' decision making regarding appendectomy is formed by the interplay between their medical assessment of the patient's condition and a set of contextual characteristics. The latter consist of three interacting factors: (1) organizational conditions, (2) the professional actors' individual characteristics and interaction, and (3) the personal characteristics of the patient and his or her family or relatives. In case the outcome of medical assessment is ambiguous, the risk evaluation and final decision will be influenced by an interaction of the contextual characteristics. It was concluded that, compared to existing, rational models of decision making, the model presented identified potentially important contextual characteristics and an outline on when they come into play.

  15. Effects of appendectomy and oral tolerance on dextran sulfate sodium colitis

    Institute of Scientific and Technical Information of China (English)

    Min Yue; Zhe Shen; Chao-Hui Yu; Hua Ye; Yue-Fang Ye; You-Ming Li

    2011-01-01

    AIM: To evaluate the concomitant effects of appendectomy and oral tolerance on colitis. METHODS: Delayed-type hypersensitivity (DTH) was investigated at a 7-d interval after ovalbumin (OVA) administration and immunization under normal and colitis conditions in appendectomized or sham-operated mice. Pathological scores for the colon were graded after ingestion of colon-extracted protein (CEP) and induction of dextran sulfate sodium (DSS) colitis in appendectomized or sham-operated mice. Thereafter, Th1 and Th2 in Peyer's patches and spleen lymphocytes were detected in CEP-treated and bovine serum albumin (BSA)-treated control mice. RESULTS: In appendectomized mice, DTH was not inhibited at day 7 after OVA administration and at the initial phase of DSS colitis, whereas it was inhibited at day 14 and day 21. However, in sham-operated mice, it was inhibited during the whole procedure and the onset of DSS colitis. The protective role of CEP against DSS colitis was present in sham-operated mice, with predominant improvement of colonic pathological changes, while vanished in the appendectomized mice. A shift from Th1 to Th2 in Peyer's patches resulted from a decrease of Th1 cells with the ingestion of CEP. Compared with BSA in the sham-operated group, no predominant changes were observed in the appendectomized mice. CONCLUSION: Appendectomy interferes with the protective role of CEP in DSS colitis via a shift from Th2 to Th1 during oral tolerance induction.

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

  17. Role of drains in laparoscopic appendectomy for complicated appendicitis at a busy county hospital.

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    Pakula, Andrea M; Skinner, Ruby; Jones, Amber; Chung, Ray; Martin, Maureen

    2014-10-01

    Laparoscopic appendectomy (LA) has become the treatment of choice for acute appendicitis with equal or better outcomes than traditional open appendectomy (OA). LA in patients with a gangrenous or perforated appendicitis carries increased rate of pelvic abscess formation when compared with OA. We hypothesized routine placement of pelvic drains in gangrenous or perforated appendicitis decreases pelvic abscess formation after LA. Three hundred thirty-one patients undergoing LA between January 2007 and June 2011 were reviewed. Patients with perforated or gangrenous appendicitis were included. Group I had a Jackson-Pratt (JP) drain(s) placed and Group II had no JP drain. Data included patient demographics, emergency department laboratory values and vital signs, and computed axial tomography scan findings, intra-abdominal or pelvic abscess postoperatively, interventional radiology drainage, and length of stay. Clinic follow-up notes were reviewed. One hundred forty-eight patients were identified. Forty-three patients had placement of JP drains (Group I) and 105 patients had no JP drain (Group II). Three patients (three of 43 [6%]) in Group I developed pelvic abscess and 21 of 105 (20%) patients in Group II developed pelvic abscesses requiring subsequent drainage. This was statistically significant. Patient demographics, temperature, and mean white blood count before surgery were similar. Presurgery computed tomography (CT) with appendicolith and CT with abscess were more prevalent in Group I. The use of JP drainage in patients with perforated or gangrenous appendicitis during LA has decreased rates of pelvic abscess. This was demonstrated despite the drain group having appendicolith or abscess on preoperative CT. PMID:25264664

  18. The Comparison of Open and Laparoscopic Appendectomy: Is There any Outcome Difference Between Non-Complicated and Complicated Appendicitis?

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    Ünal Bıçakcı

    2011-09-01

    Full Text Available Objective: The assessment of laparoscopic appendectomy (LA and open appendectomy (OA in patients with noncomplicated (NCA and complicated appendicitis (CA was aimed for. Material and Methods: Of 279 patients with appendectomy, 135 had NCA (48.3% (49 underwent LA (86M, 49F, median 9 years and144 had CA (51.7% (23 underwent LA (98M, 46F, median 11 years. Outcome measures: Wound infection (WI, intraabdominal abscess (IA, postoperative ileus (PI, requirement of reoperation (RO, time of surgery (TOS, length of stay (LOS, duration of postoperative pain (PP, nasogastric tube (NT, intraperitoneal drainage (ID were recorded.Results: Between OA and LA groups, there was no statistical significance in WI(3/86 vs 0/49, IA(2/86 vs 0/49, RO(2/86 vs 2/49, and PI rate (1/86 vs 2/49 in NCA group (p>0.05. The LOS(3±1.4 vs 4±1.3, NT (1.2±0.9 vs 1.8±0.6 days and PP(0.9±0.9 vs 2.3±1.1 days were lower in LA than OA (p0.05. In CA, patients with LA had less WI(0/23 vs 18/121 (p<0.05. NT (2±0.8 vs 2.7±1.5, PP (2.1±1.2 vs 3.2±1.5 and ID (3.1±2.3 vs 4.4±1.4 were lower in LA than OA (p<0.05.Conclusion: Laparoscopic appendectomy decreases wound infection, nasogastric tube duration, intraperitoneal drainage and pain in complicated appendicitis. The Laporoscopic approach is superior in complicated and noncomplicated appendicitis.

  19. A prospective randomized controlled multicenter trial comparing antibiotic therapy with appendectomy in the treatment of uncomplicated acute appendicitis (APPAC trial

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    Paajanen Hannu

    2013-02-01

    Full Text Available Abstract Background Although the standard treatment of acute appendicitis (AA consists of an early appendectomy, there has recently been both an interest and an increase in the use of antibiotic therapy as the primary treatment for uncomplicated AA. However, the use of antibiotic therapy in the treatment of uncomplicated AA is still controversial. Methods/design The APPAC trial is a randomized prospective controlled, open label, non-inferiority multicenter trial designed to compare antibiotic therapy (ertapenem with emergency appendectomy in the treatment of uncomplicated AA. The primary endpoint of the study is the success of the randomized treatment. In the antibiotic treatment arm successful treatment is defined as being discharged from the hospital without the need for surgical intervention and no recurrent appendicitis during a minimum follow-up of one-year (treatment efficacy. Treatment efficacy in the operative treatment arm is defined as successful appendectomy evaluated to be 100%. Secondary endpoints are post-intervention complications, overall morbidity and mortality, the length of hospital stay and sick leave, treatment costs and pain scores (VAS, visual analoque scale. A maximum of 610 adult patients (aged 18–60 years with a CT scan confirmed uncomplicated AA will be enrolled from six hospitals and randomized by a closed envelope method in a 1:1 ratio either to undergo emergency appendectomy or to receive ertapenem (1 g per day for three days continued by oral levofloxacin (500 mg per day plus metronidazole (1.5 g per day for seven days. Follow-up by a telephone interview will be at 1 week, 2 months and 1, 3, 5 and 10 years; the primary and secondary endpoints of the trial will be evaluated at each time point. Discussion The APPAC trial aims to provide level I evidence to support the hypothesis that approximately 75–85% of patients with uncomplicated AA can be treated with effective antibiotic therapy avoiding unnecessary

  20. Does a Negative Triple Test Reduce the Rate of Negative Appendectomy in Adults?

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    Mahmoud F. Sakr

    2012-08-01

    Results: Sixty-seven patients (65.9% were female and 35 (34.1% were male. Their ages ranged between 16 and 49 years (mean 27.5 years. Most patients (87.3% had their symptoms for 12-36 hours before hospital admission. The mean values for TLC, NP, and CRP were 7,573/ and micro;L, 54.53%, and 0.61 mg/L, respectively. Of the 102 patients with NTT, 101 (99% proved not to have appendiceal inflammation (NPV=99%. Only 39 patients were operated upon, of whom 38 (97.4% had a normal appendix, and the remaining 63 patients were either discharged (n=47 or referred to other specialties (n=16. There were significantly more women (76.3%, 29/38 with negative appendectomy than men (24.7%, 9/38 (X2= 21.1, p=0.0001. Gynecological causes were the most common (60.5%, 23/38 and in 11 cases, the exact etiology could not be identified. Conclusions: From the data presented, it may be concluded that TLC, NP and CRP blood levels (triple test should be measured upon hospital admission of adult patients with clinically suspected acute appendicitis. If used judiciously, they may spare the group of patients with an NTT an unnecessary surgical operation, hence markedly reducing the NAR with its potential risks. [Arch Clin Exp Surg 2012; 1(4.000: 229-236

  1. 单切口腹腔镜与传统腹腔镜阑尾切除术比较%Single-incision laparoscopic appendectomy and traditional triple-hole laparoscopic appendectomy: A comparative study

    Institute of Scientific and Technical Information of China (English)

    沈笛; 杜晓辉; 邱朔; 李松岩; 刘利利; 王淼

    2012-01-01

    Objective To describe the methods of single-incision laparoscopic appendectomy and our experience with it. Methods Fifty patients with appendicitis admitted to our hospital from October 2009 to March 2010 were enrolled in this study. The patients underwent single-incision laparoscopic appendectomy with 3 trocars inserted around the umbilicus(one was 12mm long and two were 5mm long). The incision was called a single incision when its length was >20mm. The appendix was pulled out from the 12mm-long trocar. If the appendix was large, two 5mm-long trocars or one 5mm-long trocar was fused into a single incision to form a new single incision to remove the appendix. Then, the outcomes of single-incision laparoscopic appendectomy and traditional triple-hole laparoscopic appendectomy were compared. Results The average operation time of single-incision laparoscopic appendectomy was 15min(range 10-20min). The hospital stay time of the patients was 2-3days after operation. No obvious abdominal scar formation, incision infection, appendix stump inflammation and adhesion occurred after operation. Conclusion Single-incision laparoscopic appendectomy is a simple and safe procedure for appendicitis with extremely small trauma.%目的 介绍单切口腹腔镜下阑尾切除术的方法和体会.方法 选取我院2009 年10 月-2010 年3 月50 例阑尾炎患者,在脐周建立三戳孔,对称安置3 个Trocar(1 个12mm Trocar,2 个5mm Trocar),腹腔镜下切除阑尾并以12mm Trocar 或扩切至20mm( 国际惯例认定:切口长度>20mm 的切口称之为单切口) 将标本取出.若阑尾标本较粗大,可将其中2 个5mmTrocar 孔或1 个5mm Trocar 和12mm Trocar 融合成新的单切口,然后将标本取出.传统的三孔法腹腔镜下阑尾切除术(50例),即在腹部正中线脐旁5mm 处置入5mmTrocar,脐下6-7mm 处置入12mm Trocar,反麦氏点置入5mm Trocar 进行手术.结果 平均手术时间15min(10-20min),住院时间2-3d,腹部未见

  2. Comparison of two maintenance electrolyte solutions in children in the postoperative appendectomy period: a randomized, controlled trial

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    Maria Clara da Silva Valadão

    2015-10-01

    Full Text Available ABSTRACT OBJECTIVE: To compare two electrolyte maintenance solutions in the postoperative period in children undergoing appendectomy, in relation to the occurrence of hyponatremia and water retention. METHODS: A randomized clinical study involving 50 pediatric patients undergoing appendectomy, who were randomized to receive 2,000 mL/m2/day of isotonic (Na 150 mEq/L or 0.9% NaCl or hypotonic (Na 30 mEq/L NaCl or 0.18% solution. Electrolytes, glucose, urea, and creatinine were measured at baseline, 24 h, and 48 h after surgery. Volume infused, diuresis, weight, and water balance were analyzed. RESULTS: Twenty-four patients had initial hyponatremia; in this group, 13 received hypotonic solution. Seventeen patients remained hyponatremic 48 h after surgery, of whom ten had received hypotonic solution. In both groups, sodium levels increased at 24 h (137.4 ± 2.2 and 137.0 ± 2.7 mmol/L, with no significant difference between them (p = 0.593. Sodium levels 48 h after surgery were 136.6 ± 2.7 and 136.2 ± 2.3 mmol/L in isotonic and hypotonic groups, respectively, with no significant difference. The infused volume and urine output did not differ between groups during the study. The water balance was higher in the period before surgery in patients who received hypotonic solution (p = 0.021. CONCLUSIONS: In the post-appendectomy period, the use of hypotonic solution (30 mEq/L, 0.18% did not increase the risk of hyponatremia when compared to isotonic saline. The use of isotonic solution (150 mEq/L, 0.9% did not favor hypernatremia in these patients. Children who received hypotonic solution showed higher cumulative fluid balance in the preoperative period.

  3. Apendicectomia laparoscópica na gestante Laparoscopic appendectomy during pregnancy

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    Fernando Antônio Santos Figueiredo

    2002-10-01

    Full Text Available OBJETIVO: A apendicite aguda é a doença cirúrgica não-obstétrica mais comum da gravidez e pode ocorrer em qualquer idade gestacional. O seu diagnóstico freqüentemente é tardio, o que pode acarretar alto índice de perfuração e complicações. O presente estudo visa apresentar os resultados da videolaparoscopia no tratamento da apendicite aguda na gravidez. MÉTODO: São analisados retrospectivamente quatro casos de pacientes com suspeita de apendicite aguda avaliadas em serviço de cirurgia de urgência e submetidas à cirurgia videolaparoscópica no segundo trimestre da gestação. RESULTADOS: A videolaparoscopia confirmou o diagnóstico de apendicite aguda em três casos e o outro tratava-se de cisto ovariano roto. Todas foram tratadas pelo método laparoscópico, sem necessidade de conversão, e receberam alta hospitalar em cerca de 72 horas. Não houve complicações pós-operatórias. As pacientes foram acompanhadas no restante da gestação, e os partos ocorreram na data prevista, sem complicações maternas ou para os recém-nascidos. CONCLUSÃO: A apendicectomia laparoscópica na gravidez revelou-se um procedimento seguro, que possibilita uma recuperação pós-operatória mais rápida e sem evidências de que interfira com o curso da gestação. Entretanto, estudos com maior número de casos são necessários para estabelecer o seu real valor.BACKGROUND: Acute appendicitis is the main abdominal non-obstetric surgical pathology during pregnancy. It may occur at any maternal age and in any gestational period. It is frequently diagnosed lately, leading to a high index of perforation and complications. The aim of the study was to evaluate the feasibility of videolaparoscopic appendectomy. METHOD: Four pregnant patients, all in the second trimester, who were attended at the Emergency Unit at Hospital Mãe de Deus with clinical suspicion of acute appendicitis, were submitted to videolaparoscopic exploration and were retrospectively

  4. Laparoscopic appendectomy for perforated appendicitis in children: Is intraperitoneal drainage necessary?

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    Mithat Günaydın

    2015-09-01

    Full Text Available Objective: In this study, our aim is to evaluate the necessity of intraperitoneal drainage in perforated appendicitis. Methods: 510 pediatric patients [246 laparoscopic (LA and 264 open (OA] underwent appendectomy between 2007 and 2014. 275 of them were perforated appendicitis (106 LA, 169 OA. The patients were retrospectively evaluated in terms of age, sex, symptoms, length of hospital stay (LOHS, antibiotherapy, postoperative nasogastric tube placement and intraperitoneal drainage, follow-up period, intraoperative and postoperative complications. Results: Statistically significant differences were observed between laparoscopic perforated appendicitis (71 male, 35 female; median 9.5 years and open perforated appendicitis (108 male, 61 female; median 9 years groups in terms of placement of nasogastric tube (102/106 vs.169/169 (p=0.021, length of hospital stay (1.67± 0.11 days vs. 2.34± 0.09 days (p<0.001, intraperitoneal drainage (32/106 vs. 138/169, (p<0.001, duration of intraperitoneal drainage (1.66± 0.28 vs. 4.21± 0.2 days and LOHS (5.82± 0.3 vs. 4.23± 0.6 days respectively (p <0.001. There was no significant difference between the two groups in terms of development of intra-abdominal abscess (10/106 vs. 9/169, (p=0.144, surgical site infection (2/106 vs. 8/169, (p=0.187 and development of adhesive intestinal obstruction (1/106 vs. 9/169 (p=0.053. Conclusion: Laparoscopic access reduces the necessity for drainage and shortens duration of nasogastric tube and length of hospital stay. J Clin Exp Invest 2015; 6 (3: 224-227

  5. A COMPARATIVE STUDY BETWEEN SINGLE INCISION MULTIPORT LAPAROSCOPIC APPENDICECTOMY AND CONVENTIONAL LAPAROSCOPIC APPENDECTOMY

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    Karunamoorthy

    2016-05-01

    Full Text Available BACKGROUND This is a comparative study between single incision multiport and conventional laparoscopy with triport in appendectomy. OBJECTIVES The objectives of this study were to compare procedures duration, postop recovery time, pain, complications, cosmesis. PLACE OF STUDY Department of General Surgery, Chennai Medical College Hospital and Research Centre, Irungalur, Trichy. METHOD OF COLLECTING DATA A randomised control study was done by alternation with sample size of 50, which divided into two groups (Study group 25 and control group 25 and study period is from April 2012 to September 2014. INCLUSION CRITERIA All patients with acute appendicitis diagnosed on basis of Clinical Examination, Radiological Correlation and Leucocytosis, presenting above the age of 18. EXCLUSION CRITERIA Patient with Phlegmon, Mass, Peri-Appendicular Abscess, Diffuse Peritonitis, Age <18, Pregnancy. RESULT Among 62 patients, a randomized control study of 50 patients who were divided into two groups (Study group 25 and control group 25. The study was done based on the monitoring parameters like, 1. Post-operative pain after 6 hours, 12 hours and 24 hours. 2. Duration of the procedure. 3. Surgical site infection. 4. Patient satisfaction regarding the scar. CONCLUSION Patient in single incision laparoscopy group show less post-operative pain in the first 6 and 12 hours compared to the conventional laparoscopy group, but no difference was noticed between the two groups after 24 hours. No significant difference in operating times was noted between the procedures. One patient in 25 who underwent single incision laparoscopy had wound infection, but no wound complications were noted in the conventional appendicectomy group. Patients who underwent single incision laparoscopy are happier with scar when compared with conventional laparoscopy group. No difference noted in the duration of post-operative hospital stay

  6. T helper type 17 pathway suppression by appendicitis and appendectomy protects against colitis.

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    Cheluvappa, R; Luo, A S; Grimm, M C

    2014-02-01

    Appendicitis followed by appendectomy (AA) at a young age protects against inflammatory bowel disease (IBD). We wanted to characterize the role of the T helper type 17 (Th17) system involved in this protective effect. AA was performed on 5-week-old male BALB/c mice and distal-colon samples were harvested. Mice with two laparotomies each served as sham-sham (SS) controls. RNA was extracted from four individual colonic samples per group (AA and SS groups) and each sample microarray-analysed and reverse transcription-polymerase chain reaction (RT-PCR)-validated. Gene-set enrichment analysis (GSEA) showed that the Th17 recruitment factor gene CCL20 was significantly suppressed at both 3 days post-AA and 28 days post-AA. Although Th17 cell development differentiation factor genes TGF-β2 and TGF-β3 were significantly up-regulated 3 days post-AA, GSEA 28 days post-AA showed that AA down-regulated 29 gene-sets associated with TGF-β1, TGF-β2 and TGF-β3 in contrast to none up-regulated with any of these genes. GSEA showed substantial down-regulation of gene-sets associated with Th17 lymphocyte recruitment, differentiation, activation and cytokine expression in the AA group 28 days post-AA. We conclude that Th17-system cytokines are kept under control by AA via down-regulation of proinflammatory CCL20, a rapid down-regulation of pro-Th17 cell differentiation genes TGF-β2 and TGF-β3, suppression of RORC-associated gene-sets, increased protective STAT1 expression and suppression of 81 'pro-Th17' system gene-sets. AA suppresses the Th17 pathway leading to colitis amelioration. Further characterization of Th17-associated genes and biological pathways will assist in the development of better therapeutic approaches in IBD management. PMID:24666024

  7. Retention mucocele of distal viable remnant tip of appendix: An unusually rare late surgical complication following incomplete appendectomy

    Institute of Scientific and Technical Information of China (English)

    Maria Antony Johnson; Damodaran Jyotibasu; Palaniappan Ravichandran; Satyanesan Jeswanth; Devy Gounder Kannan; Rajagopal Surendran

    2006-01-01

    A 67-year old man was presented with e 6-mo history of recurrent right lower quadrant abdominal pain. On physical examination, a vague mass was palpable in the right lumbar region. His routine laboratory tests were normal. Ultrasonography showed a hypoechoic lesion in the right lumbar region anterior to the right kidney with internal echoes and fluid components.Abdominal contrast-enhanced computed tomography(CECT) showed a well-defined hypodense cystic mass lesion lateral to the ascending colon/caecum, not communicating with the lumen of colon/caecum. After complete open excision of the cystic mass lesion, gross pathologic examination revealed a turgid cystic dilatation of appendiceal remnant filled with the mucinous material. On histopathological examination, mucinous cyst adenoma of appendix was confirmed. We report this rare unusual late complication of mucocele formation in the distal viable appendiceal remnant, which was leftover following incomplete retrograde appendectomy. This unusual complication is not described in the literature and we report it in order to highlight the fact that a high index of clinical and radiological suspicion is essential for the diagnosis of mucocele arising from a distal viable appendiceal remnant in a patient who has already undergone appendectomy presenting with recurrent abdominal pain.

  8. Appendectomy during the third trimester of pregnancy in a 27-year old patient: case report of a "near miss" complication

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    Holzer Thomas

    2011-05-01

    Full Text Available Abstract The management of acute appendicitis during pregnancy is not fully established, especially regarding the choice between open and laparoscopic surgery during the third trimester. We report herein the case of a major uterine variecele hemorrhage during a laparoscopic appendectomy in a 27-year old pregnant patient at 33 weeks of amenorrhea. After conversion to a Pfannenstiel incision, the baby was delivered, the bleeding stopped and the appendectomy completed. While both mother and child fully recovered, this «near miss» complication underlines the challenges linked to the management of acute appendicitis during pregnancy. Based on a literature review, we propose an algorithm favoring the laparoscopic approach during the first and second trimesters, and the open approach during the third trimester (especially after the 26th week of amenorrhea. In case of unclear pre-operative diagnosis, a laparoscopy should be conducted even during the third trimester with a Mc Burney conversion when the diagnosis of appendicitis is confirmed.

  9. New trend in endoscopic surgery: transvaginal appendectomy NOTES (Natural Orifice Transluminal Endoscopic Surgery).

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    Tabutsadze, T; Kipshidze, N

    2009-03-01

    Natural Orifice Transluminal Endoscopic Surgery is a new method of mini invasive surgery, which involves passing surgical instruments, and a tiny camera, through a natural orifice, such as the mouth, vagina, urethra or rectum, what provides the access to the desired organ. The procedure is approved due to its benefits - less pain, quicker recoveries, fewer complications and no scar - as it lets us avoid major incisions through the skin, muscle and nerves of the abdomen. Besides that the transluminal access is considered to be the most safe and feasible for clinical application. Here are discussed the two operations of Transvaginal Appendectomy performed in Caucasus - Academician N. Kipshidze University Hospital in Tbilisi. The first patient - a 28-year woman, weight - 72 kg, height - 180 cm, married, has one child - was submitted to the hospital with anamnesis of 48 hours acute appendicitis, typical clinical semiotics and laboratory records. In the second case the patient was a 22-year old woman, height - 170 cm, weight - 68 kg, married, with 2 children. She was hospitalized with 24 hours acute appendicitis anamnesis and typical clinical semiotics and laboratory records. Both operations were performed under general anesthesia, using Karl Storz GmbH & Co. equipment. The duration of the first procedure was 76 minutes and the second operation lasted for 88 minutes. The operations were made without any technical difficulties or complications. None of the patients had the need of non-narcotic analgesia during the post-operational period. No gynecological or surgical problems or any complications were detected during the observation period. The patients had superior postoperative evolution, so the stationary stay made up 36 hours after the first operation and 30 hours after the second. Essentially NOTES is a new trend in endoscopic surgery - the non-scar surgery with major advantages compared to the conventional - the NOTES takes endoscopic surgery one step further in

  10. 阑尾切除术不缝合腹膜的临床应用体会%Clinical experience in non - closure of peritoneum in appendectomy

    Institute of Scientific and Technical Information of China (English)

    刘凤祝

    2011-01-01

    目的 探讨阑尾切除术中不缝合腹膜对手术时间和伤口感染的影响.方法 回顾分析阑尾切除术中不缝合腹膜810例与缝合腹膜320例的临床资料,并进行对比.结果 与缝合腹膜组相比,阑尾切除术不缝合腹膜组的手术时间明显缩短,伤口感染率明显下降,差异有显著性意义.结论 阑尾切除术中不缝合腹膜可以缩短手术时间,预防术后伤口感染,值得临床推广的应用.%Objective To explore the influence of non - closure of peritoneum in appendectomy on duration of operation and wound infection.Methods The clinical data of 810 cases with non - closure of peritoneum in appendectomy were retrospectively reviewed and analyzed in comparison with those of 320 cases with closure of peritoneum in appendectomy.Results The rate of wound infection and duration of operation were obviously decreased in the group of non - closure of peritoneum in appendectomy.Conclusion Non - closure of peritoneum in appendectomy can prevent wound infection and decrease the duration of operation, and it is worthy to be popularized.

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

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    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

  12. 经脐孔腹腔镜阑尾切除术225例临床观察%Clinical research on laparoscopic appendectomy through umbilicus

    Institute of Scientific and Technical Information of China (English)

    符松; 王苏明

    2013-01-01

    Objective To explore the feasibility and therapeutic experience of laparoscopic appendectomy through umbilicus in children. Methods 225 cases of acute appendicitis were treated with umbilical single hole laparoscopic appendectomy. For umbilical 1. 0cm incision, insert two 0. 5cm Trocar insertion forceps injury Profiler abdominal organs to find appendectomy grip appendix tip, the appendix completely pulled out from the umbilical abdominal resection using conventional open appendectomy processing the appendix and its mesentery, the completion of the appendectomy. Results The operative time was 10 to 40min ( 20±6. 55 min). The postoperative exhaust time was 4 to 24h (16±5. 45) h. There was no short-term complications. The abdomen has no incision scar. Conclusion The umbilical single-hole method laparoscopic appendectomy is a simple, effective surgical method in the treatment of pediatric appendicitis and it can make the part appendicitis operation become a cosmetic surgery and to become a part of the appendicitis surgery cosmetic surgery.%目的 探讨经脐部单孔法腹腔镜小儿阑尾切除术的可行性及治疗经验.方法 对225例小儿急性阑尾炎采用脐部单孔法腹腔镜阑尾切除术,并观察其疗效.结果 本组手术时间10~40min,平均(20士6.55)min,术后排气时间4~24h,平均(16士5.45)h.术后切口全部Ⅰ期愈合,无近期并发症.腹部未见切口瘢痕.结论 脐部单孔法腹腔镜阑尾切除术是小儿阑尾炎治疗中简洁、有效的手术方法之一,可使部分阑尾炎手术成为一种美容手术.

  13. 小儿阑尾切除术后第五日综合征%The Fifth Day Syndrome After Appendectomy in Children

    Institute of Scientific and Technical Information of China (English)

    钟麟; 胡廷泽

    1989-01-01

    小儿阑尾切除术后第五甘综合征极为少见.本文报告11例,总结分析了其临床特点,并就诊断和治疗进行简要讨论.%The fifth day syndrome is a rare complication after the appendectomy in children.11 cases with this complication were found out of 1 128 cases receiving appendectomy in our hospital in 30 years.5 were male and 6 female,with age ranged from 2 to 12 years.All of them were diagnosed as appendicitis before operation(acute 5,subacute 2,and chronic appendicitis with acute attack 4).8 were simple appendicitis and 3 pyogenic.The operative process was favourable and the early postoperative recovery was well,without wound infection.Symptoms and signs of peritonitis or intestinal obstruction developed at the 5th or 6th day after the operation in all of cases.9 cases received conservative therapy including fast,intravenous infusion,continuous gastric suction and antibiotics.2 cases were subjected to re-laparotomy.11 cases were cured and discharged.It is emphasized that if peritonitis and intestinal obstruction developed at the 5th day after the appendectomy,the 5th day syndrome as well as common complications should be considered.

  14. clinical observation of Laparoscopic appendectomy%腹腔镜阑尾切除术临床观察

    Institute of Scientific and Technical Information of China (English)

    胡立春; 罗竟勇; 熊建宁

    2015-01-01

    Objective To study effect and experience of laparoscopic appendectomy for appendicitis. Method Retrospective analysis was made on clinical data for 620 cases of acute or chronic appendicitis patients who were underwent LA,andthe results were summarized. Results Among 620 patients with acute appendicitis,613 cases underwent LA,3 underwent laparoscopic periappendiceal abscess drainage surgery,and 7 cases of patients with ectopic appendix perforation with cecal edema were converted to open surgery duing to unsatisfied LA. All patients were successfully completed surgery. The average operation time was(44. 6 ± 11. 8)min,the average amount of bleeding during operation (26. 7 ± 6. 8)ml,the average antibiotic use time after operation(3. 6 ± 1. 2)d;and the average in hospital time after operation(3. 2 ± 0. 9) d. After operation, 6 patients had wound infection, with the incidence of 0. 97%, who were cured after dressing change. Conclusion Laparoscopic appendectomy is a safe and effective appendectomy which can be clinically popularized.%目的:探讨腹腔镜阑尾切除术( LA)治疗阑尾炎的效果以及总结经验。方法:回顾分析620例急慢性阑尾炎患者均行LA的临床资料,并进行总结分析。结果:620例阑尾炎患者中,613例行LA,3例行腹腔镜阑尾周围脓肿引流手术,其中有7例患者因异位阑尾根部穿孔伴盲肠水肿,LA不满意而转为开腹,所有患者均顺利完成手术。平均手术时间为(44.6±11.8)min,平均术中出血量(26.7±6.8)ml,平均术后使用抗生素时间(3.6±1.2)d;平均术后住院时间(3.2 ± 0.9)d。术后6例患者出现伤口感染,发生率0.97%,均经换药后治愈。结论:腹腔镜阑尾切除术是一种安全、有效的阑尾切除手术,可以在临床上广泛推广和应用。

  15. Apendicectomia videolaparoscópica: análise prospectiva de 300 casos Laparoscopic appendectomy: prospective study of 300 cases

    Directory of Open Access Journals (Sweden)

    André Luiz Gonçalves de Oliveira

    2008-06-01

    tratado quadro de apendicite aguda em qualquer idade.BACKGROUND: Appendectomy is the chosen treatment for patients with acute appendicitis and laparoscopic approach for these cases is an option to have in mind. AIM: To analyze the clinical aspects, technical results and the evolution during and after the operation in 300 cases of laparoscopic appendectomy. METHODS: All the patients with diagnosed appendicitis were submitted to laparoscopic appendectomy on Beneficencia Nipo-Brasileira Hospital of Amazon, between 2000 (august and 2008 (july, using a specific protocol. RESULTS: There was a predominance in teen and young adults, male sex, having a classic clinical finding of acute appendicitis in 65,44% of the cases, leucocytosis in 84,29% and by anatomic pelvic site of vermiform appendix in 84,29. The mean time taken by the operation was 55 minutes with a conversion rate of 7,1%. In hospital period was 48,5 hours with 5 days to return to normal activities. CONCLUSION: The laparoscopic appendectomy can be useful in male and female, at any age, in all the phases of acute appendicitis and in all anatomic sites of vermiform appendix.

  16. 阑尾系膜电凝法在腹腔镜阑尾切除中的应用%Clinical practice research of the laparoscopic appendectomy with electrocoagulation

    Institute of Scientific and Technical Information of China (English)

    未德成; 戚士芹; 吕成超; 卞剑

    2014-01-01

    目的:探讨阑尾系膜电凝法在腹腔镜阑尾切除术中的可行性及安全性。方法回顾分析2011年6月-2013年6月该院腹腔镜阑尾切除术80例,术中紧贴阑尾自阑尾尖端向根部电凝切断阑尾动脉及其系膜,系膜不予以结扎。结果80例中,76例顺利行腹腔镜阑尾切除术,中转开腹4例。平均手术时间35.5 min。结论阑尾系膜电凝法安全可靠,可缩短手术时间,降低手术难度。%objective To study the feasibility and safety of the application of electrocoagulation in the laparoscopic appendectomy . Methods Retrospective analysis was made of 80 patients undergoing laparoscopic appendectomy in Anhui Children ’ s Hospital from June 2011 to June 2013 .In the course of laparoscopic appendectomy ,appendix artery and velum were cut and coagulated by electricity near the root.The velum needed not to be ligated .Results Among 80 cases,76 achieved successful laparoscopic appendectomy ,while the other 4 transferred to open appendectomy .The average operation time was 35 .5 min.Conclusions Laparoscopic appendectomy with electrocoagulation is safe and reliable ,which can shorten the operation time and decrease the operation difficulties .

  17. Ultrasonic diagnosis after appendectomy in patients with abdominal wall incisional hernia%阑尾切除术后腹壁切口疝的超声诊断

    Institute of Scientific and Technical Information of China (English)

    赵鸿雁; 唐华; 郝磐石; 廉锦燕

    2014-01-01

    目的:探讨彩色多普勒超声对阑尾切除术后腹壁切口疝的诊断价值。方法回顾性分析2008年6月至2012年12月,首都医科大学附属北京朝阳医院京西院区收治阑尾切除术后经超声诊断为腹壁切口疝患者52例,观察其腹壁超声图像解剖特点并进行总结。结果腹壁网膜嵌顿疝11例,腹壁膨出疝6例,腹壁滑动疝35例,52患者均经手术证实。结论多普勒超声对阑尾术后腹壁切口疝的诊断有很高诊断价值。%Objective To investigate the value of color doppler ultrasound in the diagnosis of abdominal incisional hernia after appendectomy. Methods The clinical data of 52 patients were retrospectively observed and summarized with the ultrasound abdominal anatomical images characteristics. All the patients were admitted in Jingxi Campus of Beijing Chaoyang Hospital Affiliated to Capital Medical University from June 2008 to December 201 2 and were diagnosed of abdominal incisional hernia after appendectomy via ultrasound.Results Eleven cases of abdominal omental hernia,6 cases of abdominal wall bulge hernia,and 35 cases of abdominal wall typical hernia were included.All the cases were confirmed by operation. Conclusion Ultrasound diagnosis after appendectomy in patients with abdominal wall incisional hernia owns a high diagnostic value.

  18. 经脐双套管技术小儿腹腔镜阑尾切除术%Transumbilical Double-trocar Technique for Laparoscopic Appendectomy in Children

    Institute of Scientific and Technical Information of China (English)

    王利; 李贵斌; 邱云; 陈瑜峰; 赵卫斌; 尹辉; 宋连杰

    2011-01-01

    Objective To investigate the feasibility of transumbilical double-trocar technique combined with single-channel laparoscopic appendectomy in children. Methods Totally 40 children with appendicitis ( 18 cases of acute simple appendicitis, 12 cases of acute suppurative appendicitis, and 10 cases of chronic appendicitis) underwent transumbilical laparoscopic appendectomy by using double-trocar technique. One 10-mm trocar (to post single channel peritoneoscope) and one 5-mm trocar were placed through umbilical incision. Laparoscopic appendectomy was completed by using a lengthened operating apparatus. Results The operation was completed in all the cases except in two, who were converted to conventional laparoscopic surgery because of operation difficulties. The operation time for laparoscopy was between 30 and 80 minutes ( mean 50 minutes ). No incision infection, abdominal abscess, intestinal fistula or other complications occurred. After wound healing there was almost no abdominal visible scar. Conclusion Transumbilical laparoscopic appendectomy by using double-trocar technique combined with single-channel is a novel surgical technique without visible abdominal scars for children.%目的 探讨经脐双套管技术联合单通道腹腔镜小儿腹腔镜阑尾切除术的可行性.方法 经脐部置入1个10mill trocar(置入单通道腹腔镜),1个5 mm trocar,经腹腔镜操作通道和5 mm trocsr置入加长操作器械完成小儿腹腔镜阑尾切除术.结果 38例患儿顺利完成经脐入路腹腔镜阑尾切除术;2例因局部粘连严重,操作困难,中转常规腹腔镜手术.手术时间30~80 min,平均50 min.无切口感染、腹腔脓肿、肠漏等并发症发生.40例术后6个月随访,患儿均恢复顺利,腹壁几乎无可见手术瘢痕.结论 经脐双套管技术联合单通道腹腔镜小儿阑尾切除术是一种新型的腹壁无瘢痕手术,可行.

  19. Systematic Review of Laparoscopic Versus Open Appendectomy%腹腔镜与开腹阑尾切除术的系统评价

    Institute of Scientific and Technical Information of China (English)

    何欢; 张抒; 李云涛; 刘雁军; 侯康; 夏乡

    2012-01-01

    To evaluate the clinical effectiveness of laparoscopic and open appendectomy. Methods Literatures relating to randomized controlled trials in English and Chinese on the comparison of clinical effectiveness after laparoscopic and open appendectomy in appendicitis from PubMed, Wiley Online Library, Medline, Embase, Cochrane, CNKI, VIP, CBM databases were extracted, and methodological quality was evaluated by two reviewers independently with designed extraction form. The Cochrane Collaboration's RevMan 4.2. 2 software was used for data analysis. The wound infection, hospitalization time, operation time, hospitalization expenses, and peritoneal abscess were compared between laparoscopic and open appendectomy. Results Eight published reports of eligible studies were extracted. Compared with the open appendectomy, laparoscopic appendectomy had significant differences in lower wound infection rate [OR=0. 19, 95%CI (0. 09, 0. 38), P<0. 000 01], longer operation time (WMD=3. 66, 95%CI (0. 50, 6.82), P=0.02], and more hospitalization expenses [ WMD=5O3.96, 95%CI (337. 23, 670.70), P<0. 000 01 ]. But there were no significant differences in hospitalization time [WMD=-0. II, 95%CI (-3. 64, 3.43), P=0. 95] and incidence rate of peritoneal abscess [OR=1.40, 95%CI (0. 23, 8. 64), P=0. 71 ] between laparoscopic and open appendectomy. Conclusions The wound infection rate is lower, but the operation time is longer, the hospitalization expenses is more in laparoscopic appendectomy as compared with open appendectomy. There are no statistically significant differences of hospitalization time and incidence rate of abdominal abscess between laparoscopic and open appendectomy.%目的 评价腹腔镜和开腹阑尾切除术的临床效果.方法 按照Cochrane系统评价方法,计算机检索PubMed、Wiley Online Library、Medline、Embase、Cochrane图书馆及中国生物医学文献数据库(CBM)、中国学术期刊网全文数据库(VIP)、中文科技期刊全文

  20. Transumbilical Laparo-Assisted Appendectomy: A Safe Operation for the Whole Spectrum of Appendicitis in Children—A Single-Centre Experience

    Directory of Open Access Journals (Sweden)

    D. Codrich

    2013-01-01

    Full Text Available The paper reports the results of a retrospective review of the medical charts of 203 patients admitted to a pediatric surgical unit with a diagnosis of acute appendicitis between January 2006 and December 2010 when a transumbilical laparoscopic-assisted appendectomy (TULAA was introduced as a new surgical technique. Among 203 admitted patients, 7 (3.5% had a localized appendiceal abscess and were treated with antibiotics. All of them responded to antibiotics and underwent TULAA interval appendectomy 8 weeks later. 196 patients (96.5% underwent immediate surgery. In 12/181 (6.6% urgent cases, conversion to laparotomy was necessary, in 3 patients because of bowel distension and in 9 for retrocecal position of appendix. In all 181 TULAA completed procedures, one trocar was used in 151 cases (89.4%, two trocars in 16 (9.4%, and three trocars in 2 (1.2%. The mean operative time for single port TULAA was 52′ Complications included 5 wound infections and 5 intra-abdominal abscesses, all managed conservatively. In conclusion, TULAA is a safe, minimally invasive approach with acute appendicitis, regardless of the perforation status, and can be recommended in the pediatric urgical settings.

  1. Tratamento não-cirúrgico de abscessos intra-cavitários pós-apendicectomia Non surgical management of post appendectomy intraperitoneal abscesses

    Directory of Open Access Journals (Sweden)

    Giliatt Hanois Falbo Neto

    2001-12-01

    Full Text Available OBJETIVOS: avaliar a eficácia do tratamento não cirúrgico em crianças que desenvolveram abscessos intra-cavitários pós-apendicectomia, no Instituto Materno Infantil de Pernambuco, Recife, Brasil, e comparar os resultados obtidos com dois esquemas antimicrobianos (Cefoxitina versus Amicacina com Metronidazol utilizados. MÉTODOS: o estudo corresponde ao período de janeiro de 1997 a janeiro de 2000 no qual 427 crianças foram apendicectomizadas; 41 delas desenvolveram abscessos intra-cavitários sendo 39 incluídas no estudo. O diagnóstico dos abscessos intra-cavitários baseou-se em sinais clínicos e exames complementares. RESULTADOS: A incidência de abscessos intra-cavitários pós-apendicectomias foi de 9,6%. 89,7% dos pacientes obtiveram sucesso com o tratamento. Não houve diferença entre os percentuais de cura obtidos com os dois esquemas antimicrobianos. CONCLUSÕES: o tratamento não cirúrgico de abscessos intra-cavitários pós-apendicectomias, baseado na antibioticoterapia endovenosa é uma opção segura e eficaz. Os esquemas antimicrobianos com Cefo-xitina e associação de Amicacina com Metronidazol têm eficácia semelhantes. A associação Amicacina com Metronidazol é recomenda pelo seu menor custo.OBJECTIVES: to evaluate the effectiveness of non-surgical treatment of post appendectomy, abdominal abscesses in children at the Instituto Materno Infantil de Pernambuco, Recife, Brazil and to compare the results of two anti-microbial schemes (Cefoxitin versus Amikacin plus Metronidazole. METHODS: the study corresponds to the period from January 1997 to January 2000. There were 427 appendectomies performed in children during this period and 41 of them developed intra-abdominal abscesses. Thirty-nine were studied. The diagnosis of the abscesses was based on clinical signs, laboratorial tests and ultrasound examination. RESULTS: abscesses developed in 9,6% of the cases. Healing of the abscess occurred in 89,7% of the patients

  2. Transvaginal appendectomy with traditional laparoscopic tools%使用传统腹腔镜器械的经阴道阑尾切除术

    Institute of Scientific and Technical Information of China (English)

    田雨; 吴硕东; 王丹波; 陈英汉

    2012-01-01

    Objective To establish the technique and methodology of appendectomy through transvaginal natural orifice transluminal endoscopic surgery (NOTES)under laparoscopy.Methods Three cases of chronic appendicitis were selected to receive laparoscopic transvaginal resection of appendixes with concurrent vaginal hysterectomies for uterine fibroids at Shengjing Hospital of China Medical University from November 2010 to November 2011.The procedure was performed by a multidisciplinary team composed of surgeons and gynecologists.The clinical data such as operative duration,bleeding volume,morbidity and stay duration were collected and analyzed.Results Appendectomies were performed with the working laparoscopic tools inserted through vagina. The en bloc resection was removed transvaginally through laparoscope.It took 34,23 and 26 minutes respectively to complete the appendectomies.And the blood loss volume was minimal.There were no postoperative complications.And the patients were discharged scar-free after 3 days.Conclusions Transvaginal appendectomy is both feasible and safe when performed by a multidisciplinary team.As an emerging innovation,natural orifice transluminal endoscopic surgery is miniinvasive,better tolerated and more respectful of esthetics.%目的 探索和建立使用传统腹腔镜手术器械的经阴道阑尾切除术的技术和方法.方法 选择中国医科大学附属盛京医院妇科2010年11月至2011年11月3例既往有反复发作的慢性阑尾炎病史的子宫肌瘤患者在阴式子宫切除术完成后暂不闭合阴道断端,经阴道断端置入Trocar,导入腹腔镜和传统腹腔镜手术器械施行经阴道阑尾切除,手术结束闭合阴道断端.收集分析手术时间、出血量、术后并发症发生率、出院时间等临床资料.结果 3例经阴道人路手术均成功完成.阑尾切除部分手术时间分别为34、23和26 min,术中均无明显失血,术后均无阑尾残端瘘等并发症发生,术后3d痊愈出院,

  3. Transvaginal Endoscopic Appendectomy

    OpenAIRE

    Shin, Eung Jin; Jeong, Gui Ae; Jung, Jun Chul; Cho, Gyu Seok; Lim, Chul Wan; Kim, Hyung Chul; Song, Ok Pyung

    2010-01-01

    Since Kalloo and colleagues first reported the feasibility and safety of a peroral transgastric approach in the porcine model in 2004, various groups have reported more complex natural orifice transluminal endoscopic surgery (NOTES) procedures, such as the cholecystectomy, splenectomy and liver biopsy, in the porcine model. Natural orifice access to the abdominal cavity, such as transgastric, transvesical, transcolonic, and transvaginal, has been described. Although a novel, minimally invasiv...

  4. 经脐三孔腹腔镜下阑尾切除56例体会%Transumbilical Laparoscopic Appendectomy with Three Trocars: Experience in 56 Cases

    Institute of Scientific and Technical Information of China (English)

    王家兴; 林龙英; 刘袁君; 李捷; 何剑; 蒲琦

    2011-01-01

    目的 探讨经脐三孔腹腔镜阑尾切除术的可行性. 方法 2010年2~7月经脐三孔行腹腔镜阑尾切除术56例,以脐为中心,沿脐周皮肤皱褶线画圆,从2点钟方向弧行切开皮肤1 cm,置入10 mm trocar,入镜观察阑尾及盆腔情况后,决定行经脐腹腔镜手术,于脐10点钟方向置入10 mm trocar 为主操作孔,脐5~6点钟方向置入5 mm trocar 为副操作孔.游离出阑尾动静脉,4号丝线结扎,结扎切除阑尾,荷包埋入. 结果 56例采用普通硬质腹腔镜器械经脐切除阑尾取得成功,无一例中转开腹.术后无腹腔出血、戳孔感染及脐疝等并发症.手术时间30~90 min,平均40 min.术后1个月随访瘢痕被脐皱襞遮盖,不易察觉. 结论 经脐三孔腹腔镜阑尾切除术安全可行但操作较为困难,术后腹壁瘢痕不明显.%Objective To investigate the feasibility of the transumbilical laparoscopic appendectomy with three trocars.Methods A retrospective analysis on the clinical data of 56 patients who underwent transumbilical three-trocar laparoscopic appendectomy in our hospital from February 2010 to July 2010. After making a circle incision around the umbilicus ( started from 2 o'clock), a 10-mm optical trocar was introduced to observe the appendix and the pelvic cavity, afterwards, if laparoscopy was determined, two operational trocars were placed at 10 o' clock and 5 or 6 o' clock (10 mm and 5 mm) respectively to resect the appendix. Results The operation was completed successfully in all the cases without conversion to open surgery. No intraabdominal hemorrhage, perforation, infection or umbilical herniation occurred after the procedure. The mean operation time was 40 min (30 -90 min ). Follow-up showed satisfying cosmetic results in the patients. Conclusions Transumbilical laparoscopic appendectomy is safe and feasible but difficult to carry out. Its cosmetic outcomes are satisfying.

  5. 腹腔镜阑尾切除术中系膜处理分析%Comparative Study of Mesoappendix Electrocoagulation and Silk Ligature in Laparoscopic Appendectomy

    Institute of Scientific and Technical Information of China (English)

    黄文伟; 劳日初; 黄永泰; 叶卫东

    2014-01-01

    Objective To compare the clinical effects of mesoappendix electrocoagulation and silk ligature in LA. Methods 709 cases of appendicitis were treated by LA using either electrocoagulation or silk ligature to ligate the mesoappendix. The therapeutic effect of the two groups were compared. Results Laparoscopic appendectomy was successfully completed in 709 cases. Conclusion The two methods of treating the mesenterium are reliable. Compared to silk ligature,electrocoagulation is easy to be mastered,and it can decrease operating time and reduce the hospitalization fees.%目的:比较腹腔镜阑尾切除术(LA)“阑尾系膜电凝法”和“丝线结扎法”的临床效果。方法随机将709例患者分为两组,分别采用“阑尾系膜电凝法”和“丝线结扎法”处理阑尾系膜,对比其治疗效果。结果709例均顺利完成手术。结论两种系膜处理方法均可靠,系膜电凝法较丝线结扎法可明显缩短手术时间,节省住院费用,操作简单可行。

  6. PERSPECTIVE STUDY ON NON-PERITONEUM SKIN PROTECTION TO PREVENT INFECTION OF INCISIONAL WOUND AFTER APPENDECTOMY%非腹膜化护皮防治阑尾切除术切口感染的前瞻性研究

    Institute of Scientific and Technical Information of China (English)

    卢世红; 庄光利; 刘国成

    2014-01-01

    Objective To explore the effect of non-peritoneum skin protection on infection of incisional wound after appendectomy .Methods From May ,2006 to March ,2014 ,1200 cases of acute appendicitis were randomly assigned into two groups ,600 cases in the improved group received non-peritoneum skin protection to prevent infection of incisional wound after appendectomy and 600 cases in the contrast group received peritoneum protection .Results Infections occurred in 12 cases in the improved group ,while infec-tions occurred in 31 cases in the contrast group .Conclusion Non-peritoneum skin protection can help to re-duce infections of incisional wound after appendectomy .%目的:探讨非腹膜化护皮对阑尾切除术后切口感染的影响。方法2006年5月至2014年3月,将患有急性阑尾炎需行手术治疗的患者1200例随机分到两组,其中600例(改进组)为切口非腹膜化保护切口,与切口腹膜化600例(对照组)比较。结果改进组发生切口感染12例;而对照组发生切口感染31例。结论切口非腹膜化护皮可以降低切口感染率。

  7. 非腹膜化护皮防治阑尾切除术切口感染的前瞻性研究%PERSPECTIVE STUDY ON NON-PERITONEUM SKIN PROTECTION TO PREVENT INFECTION OF INCISIONAL WOUND AFTER APPENDECTOMY

    Institute of Scientific and Technical Information of China (English)

    卢世红; 庄光利; 刘国成

    2014-01-01

    目的:探讨非腹膜化护皮对阑尾切除术后切口感染的影响。方法2006年5月至2014年3月,将患有急性阑尾炎需行手术治疗的患者1200例随机分到两组,其中600例(改进组)为切口非腹膜化保护切口,与切口腹膜化600例(对照组)比较。结果改进组发生切口感染12例;而对照组发生切口感染31例。结论切口非腹膜化护皮可以降低切口感染率。%Objective To explore the effect of non-peritoneum skin protection on infection of incisional wound after appendectomy .Methods From May ,2006 to March ,2014 ,1200 cases of acute appendicitis were randomly assigned into two groups ,600 cases in the improved group received non-peritoneum skin protection to prevent infection of incisional wound after appendectomy and 600 cases in the contrast group received peritoneum protection .Results Infections occurred in 12 cases in the improved group ,while infec-tions occurred in 31 cases in the contrast group .Conclusion Non-peritoneum skin protection can help to re-duce infections of incisional wound after appendectomy .

  8. Risk factors for wound infection in diabetic patients after appendectomy%糖尿病患者行阑尾切除手术伤口感染的分析

    Institute of Scientific and Technical Information of China (English)

    司马军

    2011-01-01

    OBJECTIVE To investigate the incidence and analyze the risk factors for wound infection in diabetic patients after appendectomy. METHODS From Jan 2004 to Jan 2011, diabetic patients who underwent appendectomy (n=450) in our hospital were grouped into those with wound infections (52 cases) and those without (398 cases). Possible factors associated with wound infection were analyzed. RESULTS For diabetic patients, age, body mass index, diabetes mellitus, smoking history, appendicitis, preoperative and intraoperative blood glucose levels were the main factors affecting wound infection after appendectomy (P<0. 01 or 0. 01

  9. Analysis on current status and the change of pediatric negative appendectomy rate -20 years experience in a children’s hospital%某医院20年间阴性阑尾切除调查与分析

    Institute of Scientific and Technical Information of China (English)

    吕挺正; 陈功; 郑珊

    2015-01-01

    目的:探讨临床阴性阑尾切除的现状、变迁及影响因素。方法回顾性分析本院1991—2010年所有因诊断急性阑尾炎而接受阑尾切除,术后结合临床和病理诊断明确为阴性阑尾切除的病例资料。①搜集阴性阑尾切除病例基本资料;②按年份分成4组:A 组(1991—1995年)、B 组(1996—2000年)、C 组(2001—2005年)及 D 组(2006—2010年)。分析各组阴性阑尾切除的发生率,并与同期阑尾穿孔率进行比较;③按年龄分成4组:婴幼儿组(1 d 至3岁)、学龄前组(4~7岁)、学龄期组(8~12岁)、青春期组(13~16岁),统计各年龄组患儿阴性阑尾切除率。结果本院20年间共实施阑尾切除术5469例,其中阴性阑尾切除694例,占同期阑尾切除病例的12.7%。阴性阑尾切除病例中,阑尾误切47例(6.77%);酷似阑尾炎病例647例(93.2%);阴性阑尾切除率从1991—1995年的14.9%下降至2006—2010年的7.58%,P 值<0.001,提示阴性阑尾切除率呈稳定下降趋势;阴性阑尾切除最多发生于8~12岁患儿,最少发生于0~3岁患儿;男女比例为1∶0.9。最常见误诊疾病为肠系膜淋巴结炎、上呼吸道感染、胃肠炎、梅克尔憩室、原发性腹膜炎。结论20年间本院阴性阑尾切除率为12.7%,与阑尾穿孔率相同,均呈稳定下降趋势,大多为酷似阑尾炎疾病,误诊病例少见。%Objetive to analyze the change and current status of negative appendectomy rate(NAR) and its affecting factors.Methods A retrospective study on all cases that underwent appendectomy and were pathologically proven to be negative appendectomy(NA)during 1991—2010.1)Collection of patient informa-tion,2)NA cases were divided into 4 groups by year:group A(1991—1995),group B(1996—2000),group C(2001—2005)and group D(2006—2010).NAR of each group were analyzed and compared with

  10. 皮纹横切口阑尾切除术治疗阑尾炎疗效探讨%To Explore the Effect of Dermatoglyph Crosscutting Mouth Appendectomy Treatment Appendicitis

    Institute of Scientific and Technical Information of China (English)

    韩顺昌

    2015-01-01

    目的:探讨皮纹横切口阑尾切除术治疗阑尾炎的治疗效果。方法选取我院于2012年10月~2014年10月收治的86例阑尾炎患者,使用单双号方法将其分成实验组和对照组,对照组采用传统阑尾切除术进行治疗,实验组使用皮纹横切口阑尾切除术治疗,分析并对比两组患者治疗后的临床效果。结果通过对两组患者施以不同治疗方法可知,实验组治疗后的临床效果明显优于对照组,P<0.05,差异具有统计学意义。结论通过研究发现,皮纹横切口阑尾切除术治疗阑尾炎临床效果明显,不仅临床效果好,而且并发症少,更为安全有效。%Objective To explore the effect dermatoglyph crosscutting mouth appendectomy treatment appendicitis.Methods Selected 86 cases of appendicitis patients from 2012 October to 2014 October in our hospital, divided into the experimental group and the control group use of single and double methods, control group using conventional appendectomy treatment, the experimental group use the dermatoglyph crosscutting appendectomy treatment, analyze and compare the clinical effect of two groups of patients after treatment.ResultsBy means of two groups of patients with different treatment methods, the experimental group clinical effect was better than control group after treatment, the difference had statistical significance (P<0.05).Conclusion The research shows that dermatoglyph crosscutting mouth appendectomy appendicitis clinical treatment effect is obvious, not only clinical effect is good, but also fewer complications and more safety..

  11. Efficacy and complications of laparoscopic appendectomy%腹腔镜阑尾切除术的疗效及对并发症的影响

    Institute of Scientific and Technical Information of China (English)

    沈韧斌; 朱建华; 袁政

    2015-01-01

    Objective To compare the efficacy and complications between laparoscopic appen-dectomy (LA) and open appendectomy (OA). Methods One hundred and eighteen appendicitis patients undergoing appendectomy were chosen from January 2014 to May 2015. All the cases were divided into the trial group (59 cases, received LA) and the control group (59 cases, received OA). The clinical efficacy and complications of two groups and the outcome of LA for acute and chronic appendicitis were compared. Results Compared with control group, the operation time increased in the trial group, while hospital stay, postoperative first bed-off time, passing flatus, and first food-taking shortened;usage of anesthetics within 24 h reduced, and hospitalization expenses increased (t=14.342, 6.916, 4.166, 9.527, 8.036, χ2=5.950, t=32.663, P<0.05). In the trial group, compared with 25 cases with chronic appendicitis, the other 34 cases with acute appendicitis had longer operation time, hospital stay, time of postoperative first pass-ing flatus and first food-taking, more intraoperative blood loss (t=8.195, 1.776, 5.329, 4.337, 3.757, P<0.05). The levels of WBC, CRP at 24 h, 48 h after operation in the trial group were significantly lower than those in control group (P<0.05). The incidence of wound infection, celiac abscess and total incidence in experimental group were significantly lower than those in control group (χ2=4.827, 4.140, 10.602, P<0.05). Conclusion LA is safe and effective in the treatment of acute and chronic appendicitis, which can reduce the postoperative complications and promote postoperative recovery.%目的 比较腹腔镜阑尾切除术(LA)与开腹阑尾切除术(OA)治疗急阑尾炎的临床疗效及并发症.方法 选择2014年1月至2015年5月收治的拟行阑尾切除术的阑尾炎患者118例,将患者随机分为试验组和对照组,每组59例,试验组采用LA术,对照组采用OA术,比较两组患者的临床效果及并发症发生情况,评价急性和慢性

  12. Initial experience of single-incision laparoscopic appendectomy performed above the pubic symphysis%经耻骨联合上单孔腹腔镜阑尾切除术

    Institute of Scientific and Technical Information of China (English)

    余江; 王亚楠; 胡彦锋; 邓海军; 程侠; 甄莉; 李国新

    2012-01-01

    Objective:To evaluate the feasibility of single-incision iaparoseopie appendectomy performed above the pubic symphysis. Methods: From Dec.2009 to Mar. 2010,six single-incision laparoscopic appendectomies above the pubic symphysis had been performed. During each operation,a 2 cm transverse incision was made in the pubic hair area 3-4 cm above the pubic symphysis,and after cutting through the skin and subcutaneous fat,the linea alba was cut vertically. A 5 mm Trocar was then placed through the peritoneal layer as an observation port with other two 5 mm Trocars as main- and assisted-operating ports, arranged in a triangular distribution. The Trocar above the observation port was slightly longer than those of the operating ports. The laparoscopic appendectomy was then performed using conventional laparoscopic instruments through this single-incisional access,and it could be said that abdominal procedures were similar to the three-port laparoscopic appendectomy. Follow-up of the patients were done at least one month, and the detailed operative, parameters and post-operative recovery were recorded to assess the feasibility and safety of this novel procedure. Results;Five male and one female patients {aged 16,20,27,29,33 and 38 respectively;body mass indexes were ]8. 07,19. 27,21. 67,18. 34,26. 83 and 22. 46 kg/m2,respectively) underwent successful single-incision laparoscopic appendectomy above the pubic symphysis. No conversion to three-port laparoscopic appendectomy or open appendectomy occurred. Operating time was 55 min,58 min,47 min,51 min,42 min and 33 min,the corresponding post-operative lime to return bowel movement was 25 h,24 h,22 h, 18 h,7 h and 10 h,while postoperative hospital stay was 3 d,5 d,2 d,l d,3 d and 2 d,respectively. No complications occurred during or after operation within the follow-up period. Conclusions; The initial experiences imply the safety and feasibility of single-incision laparoscopic appendectomy performed above the pubic symphysis

  13. Transumbilical Triple-hole Approach Laparoscopic Cholecystectomy Combined with Appendectomy:a Report of 42 Cases%脐周三孔法腹腔镜胆囊联合阑尾切除术42例

    Institute of Scientific and Technical Information of China (English)

    王家兴; 林龙英; 李萍; 李捷

    2014-01-01

    Objective-To-evaluate-the-feasibility-of-the-transumbilical-triple-hole-laparoscopic-cholecystectomy-combined-with-appendectomy-.-Methods-From-March-2012-to-December-2012,-a-total-of-42-cases-subject-to-transumbilical-triple-hole-laparoscopic-cholecystectomy-combined-with-appendectomy-in-this-hospital-were-retrospectively-analyzed-.Under-general-anesthesia-,-the-patients-were-maintained-at-recumbent-position-,-with-a-pneumoperitoneum-pressure-of-12-14-mm-Hg.With-the-navel-as-the-center-,-10-mm,-5-mm,-and-10-mm-trocars-were-introduced-at-5,-8,-and-1-o’-clock-direction-along-the-circumference-of-periumbilical-skin-fold-,-respectively-.After-observation-and-exploration-,-cholecystectomy-and-appendectomy-were-successively-performed-.-Results-All-the-patients-were-successfully-treated,-without-any-complications.The-operation-time-was-60-130-min-(mean,-78-min).A-follow-up-observation-for-2--12-month-(-mean,-7-month-)-was-conducted-in-40-cases.No-obvious-scars-or-complications-were-noted-.-Conclusions-Transumbilical-triple-hole-laparoscopic-cholecystectomy-combined-with-appendectomy-is-a-safe-and-feasible-operation-.-This-method-can-be-carried-out-at-large-scale-in-hospitals-as-improved-alternative-of-cholecystectomy-combined-with-appendectomy-.%目的:探讨脐周三孔法腹腔镜胆囊联合阑尾切除术的可行性。方法2012年3~12月行脐周三孔腹腔镜胆囊联合阑尾切除术42例。全身麻醉。采用平卧位,气腹压力12~14 mm Hg(1 mm Hg=0.133 kPa)。以脐为中心,沿脐周皮肤皱褶线画圆,从5、8、1点方向分别置入10、5、10 mm trocar,入镜观察胆囊和阑尾情况,先行胆囊切除后再行阑尾切除术。结果42例采用普通腹腔镜器械经脐周行三孔胆囊切除联合阑尾切除术取得成功。手术时间60~130 min,平均78 min。40例术后随访2~12个月(平均7个月),腹壁瘢痕不明显,无并发症发生。结论脐周三孔腹腔镜胆囊联合阑尾切除术

  14. 腹腔镜阑尾切除术在基层医院的临床应用%The Clinical Application of Laparoscopic Appendectomy in Primary-level Hospitals

    Institute of Scientific and Technical Information of China (English)

    吴中全

    2015-01-01

    目的:探讨在基层医院应用腹腔镜对急、慢性阑尾炎患者行阑尾切除术的临床应用价值及应用注意事项。方法选取本院2008年1月~2013年12月所完成的腹腔镜阑尾切除术126例,从中转开腹数、手术时间、出血量、住院时间等多个方面分析其应用价值,以及在基层医院的应用注意事项。结果腹腔镜阑尾切除术126例,中转开腹6例,中转开腹率4.76%,中转开腹原因主要有阑尾根部及盲肠壁水肿明显,组织较脆(4/6),阑尾根部坏疽(2/6)。结论腹腔镜阑尾切除术在治疗慢性阑尾炎及急性单纯性阑尾炎和早期化脓性阑尾炎的患者中效果显著。但阑尾炎症波及盲肠壁致阑尾根部及盲肠壁水肿明显、组织较脆时及急性炎症性粘连严重以及阑尾根部坏疽时仍限制了其应用,仍不能完全代替传统开腹手术。%Objective To discuss clinical application value and application notes of laparoscopic appendectomy in patients with acute and chronic appendicitis in basic level hospitals.MethodsSelected 126 cases of laparoscopic appendectomy from January 2008 to December 2013 in our hospital, the application value and application notes in basic level hospitals are analyzed from the aspects of conversion to open surgery, operation time, bleeding amount, length of hospitalstay.Results126 cases of laparoscopic appendectomy, 6 cases of the conversion to laparotomy, the rate of conversion to laparotomy was 4.76% the reasons of conversion to laparotomy including the root of appendix and lamina edema, tissue fragility (4/6), root gangrenous appendix (2/6).Conclusion The effect that laparoscopic appendectomy treats patients with chronic appendicitis , acute appendicitis and early suppurative appendicitis is remarkable. But when the appendicitis affects the caecum wall, there will be the root of the appendix and caecum wall edema, tissue fragility, serious eonglutination and gangrene at

  15. Transumbilical laparoscopic appendectomy with three trocars in primary hospital clinical research%腹腔镜脐周三孔法阑尾切除术在基层医院的应用体会

    Institute of Scientific and Technical Information of China (English)

    甄宏云

    2012-01-01

    Objective;To investigate the feasibility of the transumbilical laparoscopic appendectomy with three trocars. Methods; Clinical data of 72 patients who underwent transumbilical three-trocar laparoscopic appendectomy from Jan. 2011 to Dec. 2011 were analysed retrospectively. After making acircle incision around the umbilicus(started from 12 o′clock) ,a 10 mm optical trocar was introduced to observe the appendix and the pelvic cavity, afterwards, if laparoscopy was determined, two operational trocars were placed at 4 o′clock and 8 o′clock(5 mm) respectively to resect the appendix. Results;The operation was completed successfully in all the cases without conversion to open surgery, No intra-abdominal hemorrhage, perforation, infection or umbilical hemiation occurred after the procedure. The mean operation time was 40 min(30-85 min). Follow-up showed satisfying cosmetic results in the patients. Conclusions; Transumbilical laparoscopic appendectomy is safe and feasible but difficult to carry out. Its cosmetic outcomes are satisfying.%目的:探讨脐周三孔法腹腔镜阑尾切除术的手术方法与可行性.方法:回顾分析2011年1月至12月为72例急性阑尾炎患者行经脐周三孔法腹腔镜阑尾切除术的临床资料.以脐为中心,沿脐周皮肤皱褶线画圆,从12点钟方向弧行切开皮肤1 cm,穿刺10 mm Trocar,探查阑尾及盆腔情况,决定行经脐腹腔镜手术后,分别于脐4、8点钟方向穿刺5 mm Trocar,游离阑尾,结扎切除阑尾.结果:72例手术均获成功,无一例中转开腹.术后无腹腔出血、切口感染及脐疝等并发症发生.手术时间30 ~ 85 min,平均40 min.术后随访瘢痕被脐皱襞掩盖,不易察觉.结论:脐周三孔法腹腔镜阑尾切除术安全可行,但操作较困难,术后腹壁瘢痕不明显.

  16. Single Pore Microlaparoscopic Appendectomy%微型腹腔镜单孔阑尾切除术治疗急、慢性阑尾炎

    Institute of Scientific and Technical Information of China (English)

    瞿明; 钟林坚; 张翠绿

    2006-01-01

    目的:探讨微型腹腔镜单孔阑尾切除术(One-pore microlaparoscopic appendectomy,OMLA)治疗急、慢性阑尾炎的临床疗效.方法:118例急、慢性阑尾炎患者随机分为两组:OLMA组53例LA组65例.OMLA组采用微型腹腔镜单孔阑尾切除术;LA组采用腹腔镜阑尾切除术.并观察两组的手术时间、术中失血量、术后肠道功能恢复时间、术后体温恢复正常时间、住院时间和疼痛情况.结果:OMLA组手术时间(23.58±8.07)min,短于LA组(36.43±7.32)min(t=9.0579,P=0.0000);术中出血量:MOLA组(10.9±2.5)mL与LA组(11.3±3.2)mL之间差异无统计学意义(t= 0.7434,P=0.4587);OMLA组术后肠道功能恢复时间(16.0±5.3)h,明显短于LA组(29.0±10.1)h(t=8.4639,P=0.0000);OMLA组术后体温恢复正常时间(29.0±8.3)h,明显短于LA组(41.0±16.2)h(t=4.8919,P=0.0000);住院时间:OMLA组(2.5±1.5)d与LA组(3.0±2.1)d之间差异无统计学意义(t=1.4562,P=0.1480);术后切口疼痛消失平均时间:OMLA组(39.0±12.9)h,明显短于LA组(56.0±21.2)h(t=5.1144,P=0.0000).两组患者术后随访7 d~1.5年,平均8个月,OMLA组未发现手术并发症;LA组右下腹戳孔感染1例,未发现其它并发症.结论:OMLA具有损伤小,康复快,并发症少和住院时间短的优点,治疗急、慢性阑尾炎较理想的微创手术方法.

  17. 免钛夹单极梯度电凝法腹腔镜阑尾切除术120例临床体会%Clinical analysis of 120 cases of laparoscopic appendectomy using monopolar gradient electrocoagulation without clips

    Institute of Scientific and Technical Information of China (English)

    徐玉刚; 崔刚; 梁建伟; 杨光; 刘君

    2011-01-01

    Objective:To explore the security and surgical techniques of monopolar gradient electrocoagulation in laparoscopic appendectomy (LA) without clips. Methods:Clinical data of 120 patients who underwent LA with monopolar gradient electrocoagulation from 2009 to 2011 were retrospectively analyzed. Results:All of the 120 cases were treated successfully under laparoscopy without conversion to open surgery. Mean operation time was 45min ( range ,30-90min). Mean length of hospital stay was 4d (range,2-7d). No severe complications were found. Conclusions:The monopolar gradient electrocoagulation is a feasible and safe method with shorter operation time,less blood loss, and less hosptial cost. This procedure is worth popularization without titanium clips left.%目的:探讨腹腔镜阑尾切除术(laparoscopic appendectomy,LA)应用免钛夹单极梯度电凝法处理阑尾系膜的安全性和手术技巧.方法:回顾分析为120例患者应用免钛夹单极梯度电凝法行LA的临床资料.结果:120例手术均获成功,手术时间30~90min,平均45min.术后住院2~7d,平均4d,术后无出血、肠梗阻等并发症发生.结论:应用免钛夹梯度电凝法行LA安全可行,患者出血少,手术时间短,费用低,且无钛夹遗留,值得推广应用.

  18. 某院腹腔镜阑尾切除术患者围术期抗菌药物应用分析%Perioperative Use of Antibiotics in Patients Undergoing Laparoscopic Appendectomy in a Hospital

    Institute of Scientific and Technical Information of China (English)

    李小燕; 许利敏

    2014-01-01

    OBJECTIVE:To investigate the perioperative use of prophylactic antibiotics in patients undergoing laparoscopic ap-pendectomy in a hospital before and after carrying out the special rectification activity on antibiotic use. METHODS:The utiliza-tion data of antibiotics in surgical patients undergoing laparoscopic appendectomy in a hospital before and after carrying out the rec-tification activity on antibiotic use (in 2012 vs. in 2013) were analyzed statistically. RESULTS:Perioperative use of prophylactic antibiotics was noted in 100% of the patients before and after the rectification activity. Before carrying out the rectification activity, the top 5 drugs in terms of usage frenquency were ornidazole,cefoxitin,cefotiam,cefmetazole and cefoperazone/tazobactam,with drugs used for 6.3 days on average;after carrying out the rectification activity,only 3 kinds were used,the use of cephamycins and special antibiotics were discontinued and the antibiotics were used for an average of 4.2 days. CONCLUSIONS:The periopera-tive use of prophylactic antibiotics in patients undergoing laparoscopic appendectomy is improved after carrying out special rectifica-tion activity on antibiotics.%目的:对比抗菌药物专项整治活动前后某院普外科腹腔镜阑尾切除术患者围术期预防性应用抗菌药物情况。方法:查阅该院普外科2012年(整治前)及2013年(整治后)腹腔镜阑尾切除术患者的出院病历,对各病历中抗菌药物的应用数据进行统计、分析。结果:该院整治前后患者围术期预防性抗菌药物使用率均为100%。整治前应用例次列前5位的药品分别是奥硝唑、头孢西丁、头孢替安、头孢美唑、头孢哌酮/他唑巴坦钠,平均用药时间为6.3 d;整治后共使用3个品种,头霉素及特殊级抗菌药物未再使用,抗菌药物平均用药时间为4.2 d。结论:抗菌药物整治活动后,该院普外科腹腔镜阑尾切除术患者围术期抗菌药

  19. Transumbilical Single-port Laparoscopic Cholecystectomy and Appendectomy:Report of 16 Cases%经脐单孔腹腔镜胆囊阑尾联合切除术16例报告

    Institute of Scientific and Technical Information of China (English)

    刘宝胤; 骆成玉; 段煜飞; 李鑫

    2012-01-01

    目的 探讨经脐单孔腹腔镜胆囊阑尾联合切除术的临床应用价值. 方法 回顾性分析我院2010年7月~2012年1月16例经脐单孔腹腔镜胆囊阑尾联合切除术的临床资料.经脐置入多孔道trocar,曲线形腹腔镜器械先切除胆囊并使用推结器丝线打结结扎胆囊动脉及胆囊管,然后行阑尾切除,4例由脐孔行拖出式阑尾切除,12例应用常规腹腔镜器械切除阑尾并使用推结器丝线打结结扎阑尾动脉及阑尾根部. 结果 16例均获成功,未放置引流.手术时间60~150 min,平均80.4 min,无并发症发生. 结论 使用专用器械行经脐单孔腹腔镜胆囊阑尾联合切除术安全、可行,但较传统腹腔镜手术操作困难,需要有一个学习曲线.%Objective To investigate the efficacy of transumbilical laparoscopic cholecystectomy (LC) and laparoscopic appendectomy (LA) with a single port and free clips. Methods The clinical data of 16 patients, who received transumbilical single-port LC plus LA in our hospital from July 2010 to January 2012, were analyzed retrospectively. A multi-channel trocar was inserted through the umbilicus, and then cholecystectomy were performed with curved laparoscopic instruments. After the cystic artery and duct were ligated with a knot pusher, LA was carried out. The appendix was pulled out through the umbilicus in 4 patients, and in the other 12 patients, appendectomy was made with conventional laparoscopic instruments, and the appendix artery and stump were ligated with a knot pusher. Results The procedure was completed in all the 16 patients without placing drainage tube. The operation time ranged from 60 to 150 minutes with a mean of 80. 4 min. No patient had complications. Conclusions Transumbilical single-port LC and LA are feasible and safe, but more difficult than conventional laparoscopic procedure. A learning curve is expected.

  20. Laparoscopic appendectomy with double Trocars via a single incision at the umbilical part:a report of 27 cases%脐部单孔双Trocar腹腔镜阑尾切除术27例报告

    Institute of Scientific and Technical Information of China (English)

    黄建彪; 郑小锋

    2007-01-01

    目的:探讨开展脐部单孔双Trocar腹腔镜阑尾切除术(laparoscopic appendectomy,LA)治疗阑尾炎的经验和体会.方法:在脐部建立一个戳孔,安置双Trocar,将阑尾提出腹腔,于体外行阑尾切除术.结果:手术时间20~50min,平均35min.术后当天患者即可下床活动,进流质饮食,住院时间2~3d,腹部留不下可以看得见的疤痕,27例患者均无切口感染、腹腔残余脓肿、肠粘连等并发症发生.结论:只要腹腔镜操作技术熟练,病例选择恰当,手术成功率高.该术式进一步减小了对患者的创伤.

  1. 经脐单孔腹腔镜阑尾切除术52例报告%Laparoscopic Appendectomy with three Trocars Via a Single Incision at the Umbilical part: a Report of 52 Cases

    Institute of Scientific and Technical Information of China (English)

    蔡宇

    2011-01-01

    目的:探讨开展脐部单孔三Trocar腹腔镜阑尾切除术(laparoscopic appendectomy,LA)治疗阑尾炎的经验和体会.方法:在脐部建立一个戳孔,安置三Trocar,行腹腔内阑尾切除术.结果:手术时间30~60 min,平均40 min.术后当天患者即可下床活动,进流质饮食,住院时间3~5 d,腹部不留下可以看得见的疤痕,52例患者均无切口感染、腹腔残余脓肿、肠粘连等并发症发生.结论:在严格掌握手术适应证、不断提高手术技巧的基础上,单孔三Trocar腹腔镜阑尾切除术是可行的,该术式进一步减小了对患者的创伤.

  2. Conservative approach versus urgent appendectomy in surgical management of acute appendicitis with abscess or phlegmon Resultados del tratamiento conservador inicial y de la cirugía urgente en la apendicitis aguda evolucionada

    Directory of Open Access Journals (Sweden)

    J. M. Aranda-Narváez

    2010-11-01

    Full Text Available Background: Surgical management of acute appendicitis with appendiceal abscess or phlegmon remains controversial. We studied the results of initial conservative treatment (antibiotics and percutaneous drainage if necessary, with or without interval appendectomy compared with immediate surgery. Methods: We undertook an observational, retrospective cohort study of patients with a clinical and radiological diagnosis of acute appendicitis with an abscess or phlegmon, treated in our hospital between January 1997 and March 2009. Patients younger than 14, with severe sepsis or with diffuse peritonitis were excluded. A study group of 15 patients with acute appendicitis complicated with an abscess or phlegmon underwent conservative treatment. A control group was composed of the other patients, who all underwent urgent appendectomy, matched for age and later randomized 1:1. The infectious risk stratification was established with the National Nosocomial Infections Surveillance System (NNIS index. Dependent variables were hospital stay and surgical site infection. Analysis was with SPSS, with p Introducción: Existe controversia acerca del tratamiento idóneo de la apendicitis aguda evolucionada en forma de absceso o flemón. Realizamos un estudio para la evaluación de resultados del tratamiento conservador inicial (antibiótico y drenaje percutáneo si se precisa, con/sin apendicectomía diferida y del tratamiento quirúrgico urgente. Método: Estudio observacional analítico de cohortes retrospectivas. Criterios de inclusión: pacientes con diagnóstico clínico y radiológico de apendicitis aguda evolucionada en forma de absceso o flemón, tratados en nuestro hospital entre enero 1997 y marzo 2009, excluyendo pacientes pediátricos, con sepsis grave o peritonitis difusa. En 15 pacientes con apendicitis complicada con absceso o flemón (cohorte de estudio se indicó tratamiento conservador inicial. El grupo control se obtuvo del resto de pacientes (en

  3. 预注氯诺昔康用于腹腔镜阑尾切除术后镇痛%Preempty analgesic effect of lornoxican on postoperstive analgesia in patients undergoing laparoscopic appendectomy

    Institute of Scientific and Technical Information of China (English)

    吴亚彬; 胡旭东; 林金兵; 何仁亮

    2011-01-01

    Objective To investigate the effect of pretreatment with lornoxicam on postoperative analgesia in patients undergoing laparoscopic appendectomy. Methods Eighty patients undergoing laparoscopic appendectomy were randomly assigned to receive intravenous lornoxicam of 16 mg (40patients,study group ) or normal saline of 4 ml (40 patients,control group ) before anesthesia. All the patients were anesthetized with combined spinal epidural blockage and tranquilized with pethedine,droperidol and midazolan. Postoperative pain was assessed by visual analogue scale(VAS )and Bruggman Comfort Scale (BCS ). Adverse reactions were noted. Results The VAS scores were lower in the study group than in the control group at hours 2,8,12,and 24(1.5 ± 0.6 vs. 4.9 t 0.9,2.1 ± 0.8 vs. 5.6 ±0.8,2.0 ± 0.7 vs. 5.5 ± 0.9,and 1.9 ± 1.0 vs. 5.4 ± 1.1; P<0.05 ) and the BCS scores were higher in the study group than in the control group (3.9 ± 0.7 vs. 1.2 ± 0.8,3.2 ± 0.8 vs. 0.9 ± 0.6,3.5±0.9 vs. 0.9 ± 0.5,and 2.8 ± 1.1 vs. 0.6 ± 0.8 P<0.05 ; while the number of supplemental analgesic use decreased in the study group (4 vs. 10,P<0.05 ) Conclusions Pretreatment with lornoxicam for patients undergoing laparoscopic appendectomy can relieve postoperative pain while reducing the use of supplemental analgesics.%目的 观察预注氯诺昔康对腹腔镜阑尾切除术后疼痛的影响.方法 ASA级Ⅰ~Ⅱ行腹腔镜阑尾切除术的患者80例,随机分为实验组和对照组,每组40例.麻醉前实验组静注氯诺昔康16 mg,对照组静注生理盐水4 ml.采用腰硬联合麻醉,术中静注哌替啶、氟哌利多和咪唑安定维持镇静.术后4、8、12、24 h对患者用视觉模拟评分法(VAS)和BCS(Bruggman Comfort Scale)舒适评分法进行评分.记录术后不良反应.结果 实验组术后4、8、12、24 h的VAS评分显著低于对照组(1.5±0.6,2.1±0.8,2.0±0.7,1.9±1.0 VS4.9±0.9,5.6±0.8,5.5±0.9,5.4±1.1,P<0.05);实验组术后4、8、12、24h

  4. Clinical analysis of 19 cases of ectopic appendicitis with laparoscopic exploration and appendectomy%腹腔镜探查并阑尾切除术治疗异位阑尾炎19例临床分析

    Institute of Scientific and Technical Information of China (English)

    阿合提别克·塔布斯; 周军; 李剑辉; 努尔保拉提·阿曼; 艾龙龙; 张玉江; 张童鑫

    2015-01-01

    目的 探讨异位阑尾炎的临床表现、诊断要点及腹腔镜治疗的策略.方法 对新疆医科大学第二附属医院2011年4月-2015年4月间收治的19例异位阑尾炎的临床资料进行回顾性分析,总结其临床表现、诊治、腹腔镜探查指征及腹腔镜阑尾切除术的技巧.所有患者均在气管插管全麻下行腹腔镜探查+腹腔镜阑尾切除术.结果 19例患者中,术前有16例经B超检查得到确诊,B超确诊率为92.63%;3例急性局限性腹膜炎患者术前误诊,分别为右侧肾结石、急性胆囊炎、右侧附件炎各1例;中转开腹手术2例,手术中转率为10.53%.术中出血5~ 20 mL,术后9h下床活动,12 h进全流质饮食;平均住院时间4d.戳孔处感染1例,全腹腔镜手术的并发症发病率为5.27%,术后随访12 ~18个月未发现其他远期并发症.结论 异位阑尾炎无特异性的临床表现,易误诊.辅助检查中,超声检查是诊断异位阑尾炎的首选检查手段.腹腔镜探查术+腹腔镜阑尾切除术是急诊治疗异位阑尾炎的理想术式,值得临床推广.%Objective To explore the clinical manifestations,diagnosed main points,laparoscopic trestment strategy of ectopic appendicitis.Methods The 19 clinical data of ectopic appendicitis,from April 2011 to April 2015 in our hosipital,were retrospective analysised,and we sum up the clinical manifestation,diagnosis and treatment,laparoscopic exploration indications and the technique of laparoscopic appendectomy.Laparoscopy exploration and laparoscopic appendectomy were made on all patients under general anesthesia by tracheal cannula.Results Of 19 patients,16 cases by ultrasonic examination get correct diagnosis before operation,of which the ultrasound diagnosis rate is 92.63%,3 limitations of acute peritonitis patients were preoperative misdiagno~s,they were the right kidney stones,acute cholecystitis and the right side of the annex inflammation;there were 2 patients converted to open

  5. 不同术式阑尾切除术后切口感染的对比分析一项大型多中心回顾性研究%Wound infection after emergency appendectomy by open vs laparoscopic approach: a multicenter retrospective large cohort study

    Institute of Scientific and Technical Information of China (English)

    曹建国; 李志洲; 王晓刚; 朱弋良; 钱正海; 吴品飞; 杨田; 王树生

    2014-01-01

    Objective Emergency laparoscopic appendectomy (LA) has been rapidly applied at county-level hospitals in China.This study is to analyze wound infection after appendectomy.Methods This retrospective study was conducted among patients with acute appendicitis undergoing either laparoscopic or open appendectomy (OA) at 6 county-level general hospitals in Eastern China from 2011 to 2013,using multivariate Logistic regression model to assess independent risk factors associated with wound infection.Results Among 9 340 patients,1 831 (19.6%) and 7 509 (80.4%) patients underwent LA and OA respectively.The overall postoperative wound infection rate was 5.1%.The proportion of LAs increased yearly from 9.2% to 15.0% to 32.9%,while the LA postoperative wound infection rate decreased from 5.6% to 4.4% to 3.5% (P < 0.05).Compared with OA,LA was associated with lower wound infection rate after appendectomy (2.1% vs.5.8%,P < 0.01).By multivariate logistic regression analysis,various procedure was found to be independently associated with postoperative wound infection [odds ratio (95% confidence interval) OR (95% CI),1.37 (1.12-1.63); P =0.02].Conclusions Laparoscopic appendectomy carries a decreasing postoperative wound infection rate by year basis.Laparoscopic procedure was independently associated with a significantly lower incidence of wound infection after appendectomy.%目的 探讨腹腔镜阑尾切除手术(laparoscopic appendectomy,LA)后常见并发症切口感染的发生情况.方法 回顾性分析2011-2013年华东地区6家县市级医院所有急性阑尾炎手术患者的临床资料,对LA和开腹阑尾切除术(open appendectomy,OA)后的结果进行对比,并对所有阑尾切除术后导致切口感染的危险因素进行多因素回归分析.结果 9 340例患者中行LA阑尾切除术1 831例(19.6%),开腹阑尾切除术7 509例(80.4%);3年间LA手术开展的比例分别为9.2%、15.0%及32.9%.所有阑尾切除患者

  6. 单孔与传统三孔腹腔镜阑尾切除术临床疗效的Meta分析%Clinical efficacy of single-incision and conventional three-port laparoscopic appendectomy: a Meta analysis

    Institute of Scientific and Technical Information of China (English)

    高俊; 张继燃; 叶年源; 陆琪; 牛刚; 王道荣

    2014-01-01

    -port laparoscopic appendectomy.Methods According to the Cochrane systematic review methods,literatures on the comparison of the effects of single-incision laparoscopic appendectomy (SILA) and conventional three-port laparoscopic appendectomy (CTLA) were searched for in the PubMed,EMBASE,the Cochrane Controlled Trials Register,CNKI,CBM and VIP database.Data including the operation time,pain visual analogue scales scores,duration of postoperative hospital stay,incidence of postoperative complications,mean time of hospital stay and cost between the SILA and CTLA were compared by 2 reviewers.RevMan 4.2 software was used for Meta analysis,and the heterogeneity of the study was analyzed using the 12 test.Categorical variables were presented by odds ratio and 95% confidence interval (95% CI),and continuous variables were presented by weighted mean difference (WMD) and 95%C1.Results Eight randomized controlled trials including 1 444 patients were selected.All the patients were subdivided into the adults group (760 patients) and the children group (684 patients).A total of 721 patients received SILA (SILA group) and 723 received CTLA (CTLA group).The operation time of patients who received SILA in the adults group and the children group were significantly longer than those who received CTLA (WMD =4.40,7.39,95% CI:2.14-6.66,2.16-12.61,P <0.05).There were no significant difference in the pain visual analogue scales scores,incidence of postoperative complications and duration of hospital stay between patients who received SILA and CTLA in the adults group and the children group (WMD =-0.34,95 % CI:-1.02-0.33,OR=0.97,95%CI:0.64-1.47; WMD=-0.19,95%CI:-1.14-0.76,P>0.05).The cost of patients who received SILA was significantly higher than those who received CTLA in the children group (WMD =0.87,95 % CI:0.26-1.48,P < 0.05).Conclusions There is no obvious advantages of SILA in perioperative and postoperative outcomes when compared with CTLA.Therefore,SILA is only a possible

  7. 单双极电凝法行腹腔镜阑尾切除术的临床应用研究%The clinical practice research of the iaparoscopic appendectomy with the monopolar and bipolar electrocoagulation

    Institute of Scientific and Technical Information of China (English)

    杨富财; 李建忠; 任恒宽

    2011-01-01

    目的:研究应用单双极电凝法行腹腔镜阑尾切除术的可行性和安全性.方法:48例阑尾炎患者均采用单双极电凝法行腹腔镜阑尾切除术,用双极电凝和剪刀处理阑尾动脉和系膜,用单极电钩分离粘连并切开阑尾根部浆膜层,钛夹或缝线处理阑尾根部后切除阑尾.结果:48例手术均获成功,均无残端粪漏发生,亦无残端脓肿及其他并发症发生.术后平均住院3.5d,均痊愈出院.结论:用单双极电凝法行腹腔镜阑尾切除术安全、可行、经济实用,易在基层医院大力推广.%Objective:To study the feasibility and safety of the application of monopolar and bipolar electrocoagulation in the laparoscopic appendectomy (LA). Methods:Forty-eight patients who suffered from appendicitis underwent LA with the monopolar and bipolar electrocoagulation. Appendix artery and mesoappendix were treated with bipolar electrocoagulation and scissors, the adhesion and placenta percreta layer in the root of appendix was isolated and cut with monopolar electrical hook, the root of appendix was dealt with Titanium clip or suture before appendix was cut. Results:All operations were successfully performed,no complications such as stump fecal leakage or stump abscess occurred. The mean postoperative hospital stay was 3.5 d. Conclusions:The monopolar and bipolar electrocoagulation in LA is a workable,secure,economical and practical method,which is worth generalization in primary hospital.

  8. 皮纹横切口阑尾切除术治疗阑尾炎疗效探讨%Curative Effect of Dermatoglyph Crosscutting Mouth Appendectomy in Appendicitis

    Institute of Scientific and Technical Information of China (English)

    王辉

    2015-01-01

    目的:探讨皮纹横切口阑尾切除术治疗阑尾炎的疗效。方法选取于2013年5月~2014年5月在我院就诊的阑尾炎患者共126例,随机分为观察组与对照组,两组各63例。其中,观察组运用经麦氏点皮纹横切口行阑尾手术,而对照组运用常规麦氏切口阑尾炎手术。观察两组患者的术后下床时间、肛门排气时间以及疤痕长度,并进行分析。结果观察组患者术后下床时间为(13.3±2.1)min,低于对照组的(23.6±2.5)min,且组间差异具有统计学意义(P<0.05);观察组患者术后肛门排气时间为(17.6±4.2)min,低于对照组的(25.6±7.2) min,且组间差异具有统计学意义(P<0.05);观察组患者疤痕长度为(1.2±0.5)cm,低于对照组的(5.2±1.3)cm,且组间差异具有统计学意义(P<0.05)。结论皮纹横切口阑尾切除术在治疗阑尾炎上,取得了良好的效果。%Objective Explore the curative effect of dermatoglyph crosscutting appendectomy appendicitis treatment.Methods Selected from May 2013 to May 2014 in our hospital,a total of 126 patients with appendicitis,were randomly divided into observation group and control group. The observation group used by mcintosh point line dermatoglyph crosscutting appendix operation,control group using conventional mcintosh appendicitis surgical incision. Observed the two groups of patients with postoperative bed time,anus exhaust time,and the length of the scar.ResultsObservation group of patients with postoperative time for bed was(13.3±2.1)min,was significantly lower than the control group,and statistically significant difference between the groups(P< 0.05). Observation group of patients with postoperative anal exhaust time was(17.6±4.2)min,significantly lower than the control group,and statistically significant difference between the groups(P< 0.05). Observation group of patients with scar length was(1.2±0.5)cm,significantly lower than

  9. Dispnea After Appendectomy Operation: Case Report

    OpenAIRE

    Arslan, Zeliha; BIYIKLI, Mithat; YILDIZ, Kürşat; Ilgazli, Ahmet

    2010-01-01

    Pulmonary Langerhans cell histiocytosis (PLCH) is a rare interstitial lung disease. Its estimated prevalence is two to five cases per million. Young male adults develop the disease most frequently. Greater than 90% of cases of PLCH occur in smokers. Diabetes insipidus (DI) occurs in about 11% to 40% of patients and pneumothoraces occur in 10% to 30% of patients. The diagnosis of PLCH can be confirmed by BAL, transbronchial biopsy, or surgical lung biopsy. We present a case referred to us with...

  10. Appendectomy: Surgical Removal of the Appendix

    Science.gov (United States)

    ... to a recovery room where your heart rate, breathing rate, oxygen saturation, blood pressure, and urine output will ... are sleepiness; lowered blood pressure, heart rate, and breathing rate; skin rash and itching; constipation; nausea; and difficulty ...

  11. Dexmedetomidine in anesthesia of children submitted to videolaparoscopic appendectomy: a double-blind, randomized and placebo-controlled study Dexmedetomidina na anestesia de crianças submetidas à apendicectomia por videolaparoscopia: um estudo duplo cego randomizado e placebo-controlado

    Directory of Open Access Journals (Sweden)

    Maria Cristina Smania

    2008-08-01

    Full Text Available OBJECTIVES: To evaluate the hemodynamic responses to nociceptive stimuli in children submitted to videolaparoscopic appendectomy under balanced anesthesia with isoflurane and dexmedetomidine. METHODS: Randomized, double-blind and placebo-controlled study involving 26 children submitted to videolaparoscopic appendectomy carried out at Hospital São Lucas (PUCRS between May 2004 and February 2005. Patients were assigned to two groups: (a Dexmedetomidine group (n=13: infusion of 1µg/kg over 10 minutes and maintenance dose of 0.5µg/kg/h as an adjuvant to inhaled isoflurane anesthesia; (b Control group (n=13: normal saline infusion at a similar rate and volume of the dexmedetomidine infusion. During the different surgical and anesthetic periods, groups were compared regarding heart rate, systolic and diastolic arterial blood pressures as well as need of supplemental fentanyl infusion. Student's t test, ANOVA, and Finner's procedure were used for statistical analysis. RESULTS: During the strongest nociceptive stimuli (airway access and abdominal catheter placement, the heart rate and systolic blood pressure increased significantly (pOBJETIVOS: Avaliar a resposta hemodinâmica aos estímulos nocicepticos em crianças submetidas à apendicectomia por videolaparoscopia sob anestesia balanceada com isoflorane e dexmedetomidina. MÉTODOS: Estudo randomizado, duplo cego e placebo controlado envolvendo 26 crianças submetidas à apendicectomia por videolaparoscopia no Hospital São Lucas da PUCRS entre maio de 2004 a fevereiro 2005. Os pacientes foram alocados: a Grupo Dexmedetomidina (n=13, administrada 1µg/kg em 10 minutos e manutenção de 0,5µg/kg/h como coadjuvante à anestesia inalatória com isoforane; b Grupo Controle (n=13, que recebia solução fisiológica com volume e velocidade de infusão semelhante ao grupo anterior. Durante os diferentes tempos cirúrgicos e anestésicos os grupos foram comparados em relação à freqüência card

  12. Transumbilical Single-incision Laparoscopic Cholecystectomy Combined with Appendectomy with a Patented Electrocoagulation Hook: Report of 3 Cases%应用专利电凝钩经脐单一部位腹腔镜胆囊联合阑尾切除3例

    Institute of Scientific and Technical Information of China (English)

    朱家万; 宝宏革; 张霞; 易剑霞

    2012-01-01

    From March 2010 to April 2011, we used a patented electrocoagulation hook for single-incision laparoscopic cholecystectomy combined with appendectomy on 3 cases. Through a 2-cm curve incision above the umbilicus, we placed two S-mm and one 10-mm trocars. Afterwards, with a self-invented electrocoagulation hook and modified domestic equipments, we resected the gallbladder, and then without removing the gallbladder, we cut the appendix by changing the direction of the trocars and the position of the patients. Finally, the gallbladder and appendix were pulled out together. The operation was completed in all the patients with a mean of 63 min (ranged from 50 to 85 min). The mean intraoperative blood loss was 25 ml (ranged from 15 to 40 ml). The patients were followed up for 1,5, and 20 months respectively, during which no patient complained of abdominal pain or scars. All of them resumed daily activities in 1 week after the surgery. Therefore, we believe that this self-invented electrocoagulation hook is effective for single-incision laparoscopic cholecystectomy combined with appendectomy.%2010年3月~2011年4月应用专利电凝钩经脐单一部位行腹腔镜胆囊联合阑尾切除3例.在脐上缘做2cm弧形单一切口,置入2个5 mm及1个10 mm trocar,使3个trocar呈倒三角形,采用我们自己发明的专利电凝钩及改良的国产直形器械,先切除胆囊,暂不取出,然后在原单一切口内改变trocar的方向及体位的情况下切除阑尾,最后一并取出阑尾及胆囊.3例均顺利完成单一部位腹腔镜下胆囊联合阑尾切除术,手术时间50 ~85 min,平均63 min;出血量为15 ~40 ml,平均25 ml.3例分别随访1、5、20个月,均恢复良好,无腹痛等不适症状,腹壁无明显瘢痕,出院后1周即恢复正常工作.应用专利电凝钩行经脐单一部位腹腔镜胆囊联合阑尾切除方法可行、微创,美容效果明显.

  13. 经脐单孔与三孔法腹腔镜胆囊、阑尾联合切除的对比研究%A Comparative Study on Transumbilical Single-port and Three-port Laparoscopic Cholecystectomy and Appendectomy

    Institute of Scientific and Technical Information of China (English)

    麻忠武; 陈峰; 徐迈宇; 金肖丹

    2014-01-01

    Objective To evaluate the safety and effectiveness of transumbilical single-port laparoscopic cholecystectomy and appendectomy ( TSPLCA) . Methods A retrospective analysis was conducted in 45 patients who received TSPLCA by single operator in our hospital from January 2011 to January 2014.The operative and postoperative effects of TSPLCA were compared with 56 cases of conventional laparoscopic cholecystectomy and appendectomy ( CLCA ) during the same period.There was no obvious statistical difference in patients’age, gender, BMI, and abdominal surgery history (P>0.05). Results In the TSPLCA group, conversions to CLCA were carried out in 3 cases because of unsatisfied exposure of the Calot’ s triangle.Fat liquefaction occurred in 1 patient.The rest of the patients experienced no complications.Although TSPLCA was superior to CLCA on the satisfactory degree of operative effects during one-week’s follow-up (8.4 ±1.0 vs.7.7 ±1.0, t=3.184, P=0.002), the operative time was significantly longer in TSPLCA group than in CLCA group [(61.2 ±17.6) min vs.(51.7 ±16.2) min, t=2.822, P=0.006].And there was no significant difference between TSPLCA and CLCA in blood loss, post-operative pain, post-operative intestinal recovery time, post-operative hospital stay, and post-operative complications. Conclusions Transumbilical single-port laparoscopic cholecystectomy and appendectomy is safe and effective, having the advantage of high levels of overall satisfaction.But the operation is more difficult and the operative time is relatively long, suitable for proper patients in experienced hands.%目的:探讨经脐单孔腹腔镜胆囊、阑尾联合切除的安全性与有效性。方法回顾性分析2011年1月~2014年1月45例单一术者完成的单孔腹腔镜胆囊、阑尾联合切除术的资料,并与同期另一组术者进行的56例三孔法腹腔镜胆囊、阑尾联合切除进行对比分析。2组年龄、性别、体重指数及腹部手术

  14. Unusual Presentation of Dengue Fever Leading to Unnecessary Appendectomy

    OpenAIRE

    Lovekesh Kumar; Mahendra Singh; Ashish Saxena; Yuvraj Kolhe; Karande, Snehal K.; Narendra Singh; Venkatesh, P.; Rambabu Meena

    2015-01-01

    Dengue fever is the most important arbovirus illness with an estimated incidence of 50–100 million cases per year. The common symptoms of dengue include fever, rash, malaise, nausea, vomiting, and musculoskeletal pain. Dengue fever may present as acute abdomen leading to diagnostic dilemma. The acute surgical complications of dengue fever include acute pancreatitis, acute acalculous cholecystitis, nonspecific peritonitis, and acute appendicitis. We report a case of dengue fever that mimicked ...

  15. Appendix stump closure with endoloop in laparoscopic appendectomy.

    Science.gov (United States)

    Caglià, Pietro; Tracia, Angelo; Spataro, Daniele; Borzì, Laura; Lucifora, Bibiana; Tracia, Luciano; Amodeo, Corrado

    2014-01-01

    L’appendicite acuta rappresenta la più comune patologia infiammatoria della cavità adddominale. Mc Burney ne ha per primo descritto il trattamento chirurgico utilizzando la classica incisione nel quadrante addominale inferiore destro. Tale approccio è stato considerato il trattamento standard della patologia appendicolare per più di un secolo, fino all’inizio dell’era video laparoscopica. I rapidi cambiamenti tecnici e gli innegabili vantaggi della procedura videolaparoscopica ha portato ad una ampia diffusione della metodica in ambito clinico. La chiusura del moncone appendicolare, durante l’appendicectomia video laparoscopica, rappresenta uno degli aspetti tecnici fondamentali della procedura per le gravi potenziali complicanze che possono derivare da un suo non appropriato trattamento. Gravi complicanze sono infatti rappresentate da deiscenza, fistole stercoracee e peritonite. La chiusura con endostapler, hem-o-look e legatura intracorporea rappresentano le metodiche più comunemente utilizzate. Tutte le alternative descritte presentano vantaggi e svantaggi e vanno rapportate ai diversi stadi clinici della patologia appendicolare. Va inoltre notato che le differenti metodiche di trattamento del moncone appendicolare non sono state testate in studi randomizzati. In base alla nostra esperienza si può affermare che il trattamento del moncone appendicolare con endoloop può essere utilizzato con sicurezza e dovrebbe essere considerata la metodica di scelta anche in relazione al rapporto costo-beneficio. Metodi alternativi di chiusura del moncone appendicolare andrebbero utilizzati in caso di appendicite flemmonosa o gangrenosa, ascesso peritiflitico e/o contemporaneo trattamento di diverticolo di Meckel.

  16. Technical and social challenges of laparoscopic appendectomy performed in a rural setting.

    Science.gov (United States)

    Kucuk, Gultekin Ozan

    2015-01-01

    Lo studio illustra i dettagli tecnici e sociali delle difficoltà da affrontare nell’adozione dell’appendicectomia laparoscopica in un ospedale periferico in ambiente rurale, e suggerisce le soluzioni, includendo la casistica nell’intervallo tra aprile 2009 e dicembre 2010, di cui sono analizzati le caratteristiche demografiche, i reperti operatori ed i risultati. La casistica si riferisce a 51 pazienti (28 uomini e 23 donne) sottoposti ad appendicectomia laparoscopica, di età media di 23 anni (tra 13 e 74 anni). In media l’intervento ha richiesto 45 minuti (tra 20 e 75 minuti). La base appendicolare è stata trattata con endoloop in 4 casi (7,8%) o per nodo intracorporeo in 46 casi (90,2%); in un caso la base è stata suturata. In 20 casi (39,2%) si sono dovute fronteggiare difficoltà tecniche, ed in un paziente (2%) si è fatto ricorso alla conversione al trattamento laparotomico. La degenza postoperatoria è stata di 2.4 ± 0.8 giorni, ed in un paziente (2%) si è sviluppato un ascesso intra-addominale. In conclusione la appendicectomia laparoscopica può essere adottata con sicurezza in ambiente rurale, anche se si tratta di casi complicati. Si discutono alcune difficoltà tecniche e sociali da affrontare, e le soluzioni adottate.

  17. The effect of perioperative esmolol infusion on the postoperative nausea, vomiting and pain after laparoscopic appendectomy

    OpenAIRE

    Lee, Sang-Jun; Lee, Jong-Nam

    2010-01-01

    Background Perioperative opioid administration results in postoperative nausea and vomiting (PONV) and acute opioid tolerance that manifests in increased postoperative pain. Esmolol is an ultra short acting cardioselective β1-adrenergic receptor antagonist, and it has been successfully used for perioperative sympatholysis and it reduces the opioid requirement during total intravenous anesthesia. We tested the hypothesis that perioperative esmolol administration results in decreased PONV and p...

  18. SCAR AFTER SURGICAL INCISION FOR APPENDECTOMY: S-SHAPE VS LINEAR INCISION

    OpenAIRE

    M OMRANI FARD; M. Nouri

    2003-01-01

    Introduction: Hyperthrophic scar and keloid is a big problem after many operation. Hypertrophic scar depended on many factor one of them is Incision. Method: This is a randomized clinical trial and sequential sampling in Alzahra hospital and Kashani hospital. we selected two groups, one group we used S shape incision and observed group linear incision. Age was between 10-30 years and dermatological problems and cigaret smoking was Negative in two groups perforated and secondly skin closu...

  19. SCAR AFTER SURGICAL INCISION FOR APPENDECTOMY: S-SHAPE VS LINEAR INCISION

    Directory of Open Access Journals (Sweden)

    M OMRANI FARD

    2003-03-01

    Full Text Available Introduction: Hyperthrophic scar and keloid is a big problem after many operation. Hypertrophic scar depended on many factor one of them is Incision. Method: This is a randomized clinical trial and sequential sampling in Alzahra hospital and Kashani hospital. we selected two groups, one group we used S shape incision and observed group linear incision. Age was between 10-30 years and dermatological problems and cigaret smoking was Negative in two groups perforated and secondly skin closure was excluded in our study. patient divided in two group each group was twenty and fllowed for one year. Patients satisfaction and skin collor normality and itchiny was evaluated in two groups. Results: Appearance of scar was different in collor much and shape. Normality for collor of incision in s shape groups were 68.4% but in linar incision was 31.6% (Pvalue= 0.026 with statically meaningful. Mean of scar width: In 5-shape =1.33+0.49mm in Linear shape = 2.23+0.92. P = 0.001. Prevalence of itching was same in both groups. Discussion: patients overall satisfaction and itching were the same for both groups. skin color normality was 68.4% in 5 shape incision groups versus 31.6% in linear incision groups which has been shown to be statistically meaningful using chi-square test so it seems reasonable to conclude that calor mathing is more favorable in 5 shape incisions rather than linear incision. Mean of scare width in licear incision group was 2.23+0.92 mm versus 1.32+0.49 mm in 5 shape incision group. this difference is also statistically meaningful using T test. 50 it can be concluded that using 5 shape incision is better because post operative scar is smaller and exposure is like linear incision.

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

    OpenAIRE

    Frank, L.; J. T. Ferreira; J. Pellow

    2013-01-01

    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...

  1. A COMPARATIVE STUDY BETWEEN RECTAL DICLOFENAC PLUS PARACETAMOL AND INJECTABLE TRAMADOL FOR POSTOPERATIVE PAIN MANAGEMENT IN OPEN/LAPAROSCOPIC APPENDECTOMY

    Directory of Open Access Journals (Sweden)

    Manoranjan Ujjaini

    2016-05-01

    Full Text Available Both rectal diclofenac and paracetamol are commonly used to treat acute postoperative, but combining them to improve the quality of analgesia is controversial. This study aimed to detect whether the preoperative combined administration of rectal diclofenac and paracetamol is superior to injectable tramadol alone, is effective in postoperative pain management. METHODS 57 patients were randomly assigned to receive the suppository 1 hr. prior to surgery. In the first 24 hrs. postoperatively, pain was assessed using the visual analogue pain scale (VAS. If the patients experienced a pain score of 5 or more, tramadol 50 mg IV was given. The total dose of tramadol and number of doses required were recorded. Patients who received the rectal diclofenac-paracetamol combination experienced a lower pain scale and a decreased need for tramadol compared with those receiving tramadol alone. RESULTS The overall VAS score and consumption of injectable tramadol was lower in the group receiving the rectal suppository. The mean VAS score in group 1 at 4, 8 and 24 hours was lower than those in group 2, this difference was statistically significant (p<0.000. CONCLUSIONS Patients receiving the rectal diclofenac-paracetamol combination experienced significantly a lower pain as compared with patients getting only injectable analgesics. The need for injectable analgesics was also found to be reduced in the immediate postoperative period in the patients receiving rectal suppository.

  2. Pediatric Appendectomy Assisted With Single Hole Bi- Trocar Laparoscope%单孔双Trocar腹腔镜辅助小儿阑尾切除术

    Institute of Scientific and Technical Information of China (English)

    杨振宇; 刘明学; 纪延辉; 苏毅; 连晃

    2005-01-01

    目的探讨单孔双Trocar腹腔镜辅助阑尾切除术应用于小儿急性阑尾炎可行性和适应证.方法本组36例小儿急性阑尾炎行单孔腹腔镜辅助阑尾切除术.手术中在麦氏点取单孔(0.8~1.0cm)置入腹腔镜及器械双Trocar,将阑尾自该孔提出,体外结扎系膜,切除阑尾,再将阑尾残端放回腹腔,腹腔镜观察无异常后,关闭切口.结果本组36例患儿,手术时间为20~45min,平均35min,术后12~24h开始流质饮食,及下床活动;5~7d出院.未见切口和腹腔内并发症.结论单孔双Trocar腹腔镜辅助小儿阑尾切除术手术方法简单,并发症少,切口小而美观.

  3. 不同培养基对家兔盲肠细菌生长的影响%Different media on the growth of bacteria rabbits appendectomy

    Institute of Scientific and Technical Information of China (English)

    陈桂银; 张力; 张振瑞; 杨晓智

    2007-01-01

    用不同的培养基对健康家兔盲肠内容物进行培养,并对菌群进行初步鉴定.结果表明:在MRS肉汤培养基的基础上添加10%的软粪浸出物可获得更多的细菌种类,并可培养出更多有利于家兔健康的有益菌.

  4. What is the optimal treatment for appendiceal mass formed after acute perforated appendicitis?

    Institute of Scientific and Technical Information of China (English)

    Enver Zerem; Goran Imamovi(c); Farid Ljuca; Jasmina Alid(z)anovi(c)

    2012-01-01

    We read with great interest the editorial article by Meshikhes AWN published in issue 25 of World J Gastroenterol 2011.The article described the advantages of emergency laparoscopic appendectomy compared with interval appendectomy as a new safe treatment modality for the appendiceal mass.The author concluded that the emergency laparoscopic appendectomy was a safe treatment modality for the appendiceal mass,and might prove to be more cost-effective than conservative treatment,with no need for interval appendectomy.However,we would like to highlight certain issues regarding the possibility of percutaneous catheter drainage to successfully treat the appendiceal mass,with no need for appendectomy,too.

  5. Práticas cirúrgicas baseadas em evidências: apendicectomia laparoscópica versus a céu aberto Evidence-based surgical practices: laparoscopic versus open appendectomy

    Directory of Open Access Journals (Sweden)

    Bráulio dos Santos Júnior

    2008-02-01

    Full Text Available Os cirurgiões são instados a não somente ler os artigos dos periódicos, mas também a compreendê-los e analisá-los criticamente quanto à validade. Eles cuidam melhor dos seus pacientes se são capazes de analisar criticamente a literatura e aplicar os resultados a sua prática. Este é o primeiro artigo de uma série - Práticas Cirúrgicas Baseadas em Evidência - que tem por objetivo apresentar tópicos de Cirurgia Baseada em Evidências.Surgeons are told that they need not only read journal articles, but also understand them and make a critical appraisal of their validity. They offer better care if they are able to appraise critically the original literature and apply the results to their practice. This is a first article of a series - Evidence-Based Surgical Practices - which focus on issues of Evidence-Based Surgery.

  6. 脐部单孔双Trocar腹腔镜阑尾切除术27例%Laparoscopic Appendectomy with Double Trocar through Single Port on Umbilicus: A Report of 27 Cases

    Institute of Scientific and Technical Information of China (English)

    黄建彪; 郑小锋

    2006-01-01

    目的 介绍开展脐部单孔双Trocar腹腔镜阑尾切除术的经验和体会. 方法 2004年6月~2006年6月对27例阑尾炎患者应用腹腔镜在脐部建立一个戳孔,安置双Trocar,将阑尾提出腹腔,于体外行阑尾切除术. 结果 平均手术时间35(20~50)min.术后当天患者即能下床活动,进流质饮食,术后住院时间2~3 d,腹部疤痕不明显,27例患者均无切口感染、腹腔残余脓肿、肠粘连等并发症. 结论 只要腹腔镜操作技术熟练,病例选择恰当,脐部单孔双Trocar腹腔镜阑尾切除术创伤小,手术安全,成功率高.

  7. 三孔法腹腔镜阑尾切除术不同Trocar入路的对比研究%Comparative study of different trocar approach in laparoscopic appendectomy

    Institute of Scientific and Technical Information of China (English)

    卢先州; 肖帅; 周筱筠; 刘龙飞

    2014-01-01

    目的 比较腹腔镜阑尾切除术中常规Trocar入路与改良Trocar入路的优缺点.方法 不同性质阑尾炎患者采用不同Trocar入路行腹腔镜阑尾切除术,对患者的手术时间进行比较.结果 腹腔镜阑尾切除术采用改良Trocar入路与常规Trocar入路手术时间比较,差异有显著性(P<0.05).结论 改良Trocar入路能节约手术时间,降低手术风险,在腹腔镜阑尾切除术具有推广应用的价值,用超声刀行腹腔镜阑尾切除术治疗效果良好.

  8. Acute appendicitis: position paper, WSES, 2013

    OpenAIRE

    Agresta, Ferdinando; Ansaloni, Luca; Catena, Fausto; Verza, Luca Andrea; Prando, Daniela

    2014-01-01

    Appendectomy is one of the most frequently performed operative procedures in general surgery departments of every size and category. Laparoscopic Appendectomy – LA - as compared to Open Appendectomy – OA - was very controversial at first but has found increasing acceptance all over the World, although the percentage of its acceptance is different in the various single National setting. Various meta-analyses and Cochrane reviews have compared LA with OA and different technical details. Further...

  9. [Retrospective evaluation of carcinoid tumors of the appendix in children].

    Science.gov (United States)

    San Vicente, B; Bardají, C; Rigol, S; Obiols, P; Melo, M; Bella, R

    2009-04-01

    Carcinoids of the appendix are rare in children. Usually diagnosed incidentally on histologic investigation following appendectomy for acute apendicitis. To investigate the significance of the diagnosis of appendiceal carcinoid tumors in children, we conducted a retrospective study in our institution. Between 1990 and 2007 a total of 1158 appendectomy were done. In four patients the diagnosis was appendiceal carcinoid. We studied treatment, follow-up and prognosis of this patients. Indicacion for appendectomy was acute pain in lower right quadrant. The median tumor diameter was lower than 1 cm and the appropriate treatment was appendectomy. The prognosis was excellent in all the patients.

  10. Stump appendicitis: A rare clinical entity

    Directory of Open Access Journals (Sweden)

    Abhinav Kumar

    2013-01-01

    Full Text Available Stump appendicitis is one of the rare delayed complications after appendectomy with reported incidence of 1 in 50,000 cases. Stump appendicitis can present as a diagnostic dilemma if the treating clinician is unfamiliar with this rare clinical entity. We report an 18-year-old patient with Stump appendicitis, who underwent completion appendectomy laparoscopically.

  11. Clinico-pathological study of appendicitis in a tertiary centre in Vindhya region, Madhya Pradesh, India

    Directory of Open Access Journals (Sweden)

    Priyank Sharma

    2016-07-01

    Conclusions: In this study we found that clinical score is a simple, rapid and non-invasive method to early diagnosis of appendicitis. TLC are inflammatory marker are also useful in early diagnosis of acute appendicitis. Ultrasound abdomen is also useful to confirm the diagnosis. The majority of our patients presented early disease. Conservative approach of treatment gave positive response and then we planned for elective appendectomy after regular interval. Because of these negative appendectomy rate are decreasing and morbidity period are also decreasing pre or post appendectomy. There was much less post-operative complication, which were higher in emergency appendectomy. In our study we concluded that timely intervention reduce the negative appendectomy and reduce the length of morbidity. [Int J Res Med Sci 2016; 4(7.000: 2914-2920

  12. [New ways in the surgery of acute appendicitis?].

    Science.gov (United States)

    Magdeburg, R; Kähler, G

    2013-06-01

    Acute appendicitis is still one of the most common abdominal emergencies necessitating operative treatment. For the past century, the conventional management of appendicitis has been open appendectomy. Since the introduction of laparoscopic appendectomy, it has been performed with increased frequency. Clinical trials evaluating outcomes comparing open appendectomy with laparoscopic appendectomy indicate that laparoscopic appendectomy is associated with lower complication rate and lower mortality and is to be considered the procedure of choice for patients with suspected acute appendicitis. Ever since Kalloo's first report on transgastric peritoneoscopy in a porcine model in 2004, this dramatic surgical revolution has prompted many surgeons and endoscopists to study this new technique. This complex technique involves breaching the wall of a hollow organ to gain access into the peritoneum: Natural Orifice Translumenal Endoscopic Surgery (NOTES). In recent years, several NOTES experiments have been carried out in animal models and even on humans, including appendectomy. NOTES may help to reduce surgical pain and shorten recovery time. The concept of NOTES has generated intensive interest in the medical community as well as in the group of patients. Although the novel procedure is still far from being mature and many technical problems have to be overcome and more clinical studies have to be done before its widespread application in human appendectomy, NOTES is a promising procedure for the future. PMID:23325519

  13. Appendicitis as an early manifestation of subsequent malignancy: an asian population study.

    Directory of Open Access Journals (Sweden)

    Shih-Chi Wu

    Full Text Available Cancer risk after appendectomy in patients with appendicitis remains unclear. This study examined the role of appendicitis as an early manifestation harbingering the distant malignancy.From the insurance claims data of Taiwan, we identified a cohort of 130,374 patients newly received appendectomy from 2000-2009, without cancer diagnosis. A comparison cohort of 260,746 persons without appendectomy and cancer was selected from the same database, frequency matched by age, sex, comorbidity and index year. We monitored subsequent cancers with a12-month follow-up.Over all, 1406 and 616 cancer cases were identified in the appendectomy cohort and comparisons, respectively, with all cancers incidence rate 4.64-fold higher in the appendectomy cohort (9.06 vs. 1.96 per 1000 person-months. Digestive and female genital organs harbored 80.9% of cancer cases in the appendectomy cohort. The Cox model measured site-specific hazard ratio (HR was the highest for female genital cancers (23.3, followed by cancers of colorectum (14.7, small intestine (10.1, pancreas (7.40, lymphoma (5.89 and urinary system (4.50, all significant at 0.001 level. The HR of all cancers decreased from 13.7 within 3 months after appendectomy to 1.37 in 7-12 months after the surgery. In general, relative to the comparison cohort, younger appendectomy patients tended to have a higher HR than older patients.The high incident cancers identified soon after appendectomy suggest the acute appendicitis is the early sign of distant metastatic malignancy. The risk of colorectal cancer, female genital cancer and haemopoietic malignancy deserve attention.

  14. Laparo-Endoscopic Single-Site (LESS) Procedure

    Medline Plus

    Full Text Available ... that it's a little harder if they have acute disease. And it's a little harder if they ... patient -- for example, adding more trocars -- is not failure; it's good ... cyst excision, appendectomies, spleenectomies -- everything that you can ...

  15. Laparo-Endoscopic Single-Site (LESS) Procedure

    Medline Plus

    Full Text Available ... Heller myotomies, inguinal hernias, pancreatectomies, hepatic cyst excision, appendectomies, spleenectomies -- everything that you can think of that ... viewers is can this be done as a NOTES procedure? A NOTES, by definition, is a natural ...

  16. Belly Pain

    Science.gov (United States)

    ... appendicitis, you will need an operation called an appendectomy. If stress seems to be causing your stomach ... Terms of Use Visit the Nemours Web site. Note: All information on KidsHealth® is for educational purposes ...

  17. Laparo-Endoscopic Single-Site (LESS) Procedure

    Science.gov (United States)

    ... Heller myotomies, inguinal hernias, pancreatectomies, hepatic cyst excision, appendectomies, spleenectomies -- everything that you can think of that ... viewers is can this be done as a NOTES procedure? A NOTES, by definition, is a natural ...

  18. What Is Elective Surgery? (For Parents)

    Science.gov (United States)

    ... or possibly the next day (for example, an appendectomy). If your child is scheduled for elective surgery, ... Guidelines Share this page using: What are these? Note: Clicking these links will take you to a ...

  19. Single-port Nephroscope Assisted Appendectomy Through One Trocar at McBurney Point with Latex Fingerstall Incision Protection : Report of 57 Cases%乳胶指套切口保护麦氏点单孔单trocar肾镜辅助阑尾切除术57例报告

    Institute of Scientific and Technical Information of China (English)

    邹立新; 翁永彩

    2016-01-01

    目的 探讨乳胶指套切口保护麦氏点单孔单trocar肾镜辅助阑尾切除术的可行性. 方法 2007年5月~2013年8月选择57例腹壁较薄、腹膜炎较局限的急慢性阑尾炎,于麦氏点穿刺建立气腹后置入套有乳胶指套的10 mm trocar,刺破乳胶指套的前端,通过trocar置入肾镜探查腹腔及阑尾,利用肾镜的工作通道吸除腹腔渗出液或脓液,充分游离后将阑尾拖进trocar,退出trocar,保留乳胶指套保护切口,解除气腹后于体外进行阑尾切除术.肾镜下探查认为不适宜本方法的患者,改行常规三孔法腹腔镜阑尾切除术. 结果 53例成功完成麦氏点单孔单trocar肾镜辅助阑尾切除术,术后恢复快,仅遗留1个长约10 mm瘢痕.4例分别因阑尾严重坏疽,阑尾严重化脓肿胀,阑尾系膜严重扭曲缩短,慢性阑尾炎合并明显粘连无法拖入trocar,改行三孔法腹腔镜下阑尾切除,术后恢复顺利,未发生并发症.49例随访2 ~ 29个月,平均19.5月,无术后出血、肠粘连、戳孔感染和戳孔疝等并发症发生. 结论 乳胶指套切口保护麦氏点单孔单trocar肾镜辅助阑尾切除术适合腹壁较薄、腹膜炎较局限的急慢性闌尾炎患者,操作简单易学,安全、美容效果好.

  20. Hospital-and Patient-Level Characteristics and the Risk of Appendiceal Rupture and Negative Appendectomy in Children%儿童阑尾穿孔以及阴性阑尾切除术的危险与医院、患者特征

    Institute of Scientific and Technical Information of China (English)

    Todd A. Ponsky; Zhihuan J. Huang; Kory Kittle; Martin R. Eichelberger; James C. Gilbert; Fredrick Brody; Kurt D. Newman; 周静

    2006-01-01

    @@ 背景:即使作了努力,儿童阑尾穿孔和阴性阑尾切除术的发生率依然居高不下.这两种结局均被用作衡量医院质量的指标.对影响其发生率的因素还知之甚少. 目的:研究儿童阑尾穿孔和阴性阑尾切除术的发生率与医院、患者特征的相关性.

  1. 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. MATERIA...... 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...

  2. Acute appendicitis: position paper, WSES, 2013.

    Science.gov (United States)

    Agresta, Ferdinando; Ansaloni, Luca; Catena, Fausto; Verza, Luca Andrea; Prando, Daniela

    2014-01-01

    Appendectomy is one of the most frequently performed operative procedures in general surgery departments of every size and category. Laparoscopic Appendectomy - LA - as compared to Open Appendectomy - OA - was very controversial at first but has found increasing acceptance all over the World, although the percentage of its acceptance is different in the various single National setting. Various meta-analyses and Cochrane reviews have compared LA with OA and different technical details. Furthermore, new surgical methods have recently emerged, namely, the single-port/incision laparoscopic appendectomy and NOTES technique. Their distribution among the hospitals, however, is unclear. Using laparoscopic mini-instruments with trocars of 2-3.5 mm diameter is proposed as a reliable alternative due to less postoperative pain and improved aesthetics. How to proceed in case of an inconspicuous appendix during a procedure planned as an appendectomy remains controversial despite existing study results. But the main question still is: operate or not operate an acute appendicitis, in the meaning of an attempt of a conservative antibiotic therapy. Therefore, we have done a literature survey on the performance of appendectomies and their technical details as well as the management of the intraoperative finding of an inconspicuous appendix in order to write down - under the light of the latest evidence - a position paper. PMID:24708651

  3. Pathology of the appendix in children: an institutional experience and review of the literature

    International Nuclear Information System (INIS)

    The appendix can be affected by a variety of congenital and acquired diseases, but acute appendicitis is the most common pathology found in the pediatric population. This is a retrospective review of all appendectomies performed during a 2-year period at a major children's hospital with a review of the literature regarding the most common pathologic findings. The pathology database was reviewed for appendectomy specimens, and patient medical records were evaluated to determine the age, gender, race and operative diagnosis. All slides were reviewed and the histologic findings were recorded. A total of 392 appendectomies were performed, including 68 incidental appendectomies and 324 performed for clinical suspicion of acute appendicitis. In 247 of the latter, acute appendicitis was confirmed histologically, and of the remainder 14 were interval appendectomies, 2 had findings suspicious for Crohn disease, 1 confirmed diverticulitis and 60 were histologically negative for appendicitis. Acute appendicitis is the most common pathologic cause of appendectomy, but various other pathologic entities are found in children. Examination of the appendix is warranted even when it appears normal on exploration. (orig.)

  4. Patient and surgeon factors are associated with the use of laparoscopy in appendicitis.

    LENUS (Irish Health Repository)

    McCartan, D P

    2012-02-01

    Aim The use of a minimally invasive approach to treat appendicitis has yet to be universally accepted. The objective of this study was to examine recent trends in Ireland in the surgical management of acute appendicitis. Method Data were obtained from the Irish Hospital In-Patient Enquiry system for patients discharged with a diagnosis of appendicitis between 1999 and 2007. An anonymous postal survey was sent to all general surgeons of consultant and registrar level in Ireland to assess current attitudes to the use of laparoscopic appendectomy. Results The use of laparoscopic appendectomy increased throughout the study and was the most common approach for appendectomy in 2007. Multivariate analysis revealed age under 50 years (OR = 1.51), female sex (OR = 2.84) and residence in high-density population areas (OR = 4.15) as predictive factors for undergoing laparoscopic appendectomy in the most recent year of the study. While 97% of surgeons reported current use of laparoscopy in patients with acute right iliac fossa pain, in most cases it was selective. Surgeons in university teaching hospitals (42 of 77; 55%) were more likely to report using laparoscopic appendectomy for all cases of appendicitis than those in regional (six of 23; 26%) or general (13 of 53; 25%) hospitals (P = 0.048). Conclusion This study has demonstrated a significant increase in laparoscopic appendectomy, yet a variety of patient and surgeon factors contribute to the choice of procedure. Differences in the perception of benefit of the laparoscopic approach amongst surgeons appears to be an important factor in determining the operative approach for appendectomy.

  5. Peritonitis Aguda por Diverticulo Apendicular Perforado / Acute perforated diverticulum appendiceal peritonitis

    Directory of Open Access Journals (Sweden)

    Martinez Villalba N

    2015-11-01

    Full Text Available Appendix diverticular disease is a casual finding after appendectomies or pathological studies of surgical samples. Most patients are male adults between the fourth and fifth decade of life. 16 years old male consults for a 48 hours stitch pain in right iliac fossa of moderate intensity radiating to lower abdomen with nausea and fever, without vomiting or diarrhea. Presents lower abdominal pain with muscle guarding and pain on physical examination. Bowel sounds negative. Laboratory routine study shows leukocytosis with neutrophilia. A perforated diverticulum of about 15cm diameter is found during surgery in the middle third of the cecum appendix with 200cc purulent fluid in and multiple adhesions to transverse colon, omentum and small intestine. A conventional appendectomy is performed. Acute appendix diverticulitis is a rare entity and its finding is by casualty. It is important to consider it a differential diagnosis especially in the intraoperative treatment which in most cases does not differ from conventional appendectomy.

  6. 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.

  7. 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. PMID:27521710

  8. 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.

  9. Hyperferritinemia as the Diagnostic Clue in Life-Threatening Hemophagocytic Lymphohistiocytosis

    NARCIS (Netherlands)

    Kerzel, S.; Zemlin, M.; Koemhoff, M.; Klaus, G.; Maier, R. F.

    2009-01-01

    We report on a seventeen year old girl with persistent fever of unknown origin. An initial episode of abdominal pain led to laparotomy and appendectomy, which did not reveal any pathological findings. In the course of the next 3 weeks, the girl's general condition progressively deteriorated. Despite

  10. Harms of CT scanning prior to surgery for suspected appendicitis.

    Science.gov (United States)

    Rogers, William; Hoffman, Jerome; Noori, Naudereh

    2015-02-01

    In this brief analysis we compare the risks and benefits of performing a CT scan to confirm appendicitis prior to surgery instead of operating based on the surgeon's clinical diagnosis. We conclude that the benefit of universal imaging is to avoid 12 unnecessary appendectomies but the cost of those 12 avoided surgeries is one cancer death due to the imaging. PMID:25429870

  11. Management of Acute Apendicitis in the New Millennium

    NARCIS (Netherlands)

    K-H. in 't Hof (Klaas)

    2009-01-01

    textabstractThe prevalence of acute appendicitis in The Netherlands is 16460 times a year, 8647 man and 7813 women in 2006 and is still increasing. The chance of undergoing an appendectomy is higher in women than in men, 23 versus 12 percent, this is in contradiction with the chance of developing ac

  12. 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

  13. Pregnancy Outcomes and Surgical Management of Pregnancy Complicated By Appendicitis: Obstetrician View

    Directory of Open Access Journals (Sweden)

    Deniz Şimşek

    2015-08-01

    Full Text Available Objective: To evaluate the pregnancy outcomes of patients who underwent appendectomy during pregnancy. Materials and Methods: Patients who underwent appendectomy between years 2010 and 2014 were retrospectively evaluated. All patients’ pregnancy outcomes were followed-up by using university registry system and telephone interview. Patients were evaluated regarding age, gestational age, clinical and laboratory examinations, imaging studies, mean time interval between emergency department and operation, mean operative time, pregnancy outcome and pathologic results of the appendix. Results: Thirty-nine patients were included in the study. Sixteen of 39 patients were in the first, 15 of them in the second and 8 of them were in the third trimester of the pregnancy. Three patients underwent laparoscopic appendectomy and the rest underwent laparotomy. In pathologic evaluation of the appendix, seven patients (17% had normal appendix, 4 patients had perforated appendix, one patient had neuro-endocrine tumor and rest of the patients had appendicitis. Two missed abortion occurred after operation, rest of the patients had live birth. Six of them were preterm and 31 had term birth. Twelve patients delivered through vaginal birth and the rest via caesarean section. Twenty patients were in the first half of the pregnancy (group 1 and 19 patients were in the second half of the pregnancy (group 2. There were no significant differences between the groups in operation time and mean time interval between emergency administration and operation. Conclusion: Delayed operation and negative appendectomy can cause adverse pregnancy outcomes. Expectant management in suspected cases may decrease negative appendectomy rates but can also lead to perforation. Computed tomography and MRI ought to be considered if ultrasonography is inconclusive. Tocolytic regimens can be administered to prevent threatened preterm labor. Obstetric indications were valid for delivery mode.

  14. Natural orifice transluminal endoscopic surgery: New minimally invasive surgery come of age

    Institute of Scientific and Technical Information of China (English)

    Chen Huang; Ren-Xiang Huang; Zheng-Jun Qiu

    2011-01-01

    Although in the past two decades, laparoscopic surgery, considered as a great revolution in the minimally invasive surgery field, has undergone major development worldwide, another dramatic surgical revolution has quietly appeared in recent years. Ever since Kalloo's first report on transgastric peritoneoscopy in a porcine model in 2004, interest in a new surgical procedure named natural orifice transluminal endoscopic surgery (NOTES) has blossomed worldwide. Considering that a NOTES procedure could theoretically avoid any abdominal incision, operation-related pain and scarring, many surgeons and endoscopists have been enthusiastic in their study of this new technique. In recent years, several NOTES studies have been carried out on porcine models and even on humans, including transvaginal cholecystectomy, transgastric appendectomy, transvaginal appendectomy, and transvesical peritoneoscopy. So what is the current situation of NOTES and how many challenges do we still face? This review discusses the current research progress in NOTES.

  15. 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.

  16. Acute Appendicitis in a Man Undergoing Therapy for Mantle Cell Lymphoma

    Directory of Open Access Journals (Sweden)

    Michael Linden

    2012-01-01

    Full Text Available A 71-year-old man was diagnosed with an aggressive mantle cell lymphoma and was started on six cycles of R-CHOP chemotherapy. Approximately two weeks after starting his first cycle of chemotherapy, he complained of severe right lower quadrant abdominal pain, and an abdominal CT scan demonstrated an enlarged appendix with evidence of contained perforation. The man underwent open appendectomy for acute appendicitis and recovered. The appendectomy specimen was submitted for routine pathological analysis. There was histologic evidence of perforation in association with an inflammatory infiltrate with fibrin adhered to the serosal surface; scattered small lymphoid aggregates were present on the mucosal surface. Although the lymphoid aggregates in the submucosa and lamina propria were rather unremarkable by routine histologic examination, immunohistochemistry revealed the lymphocytes to be predominantly Cyclin D1-overexpressing B cells. To our knowledge, this is the first reported case of acute appendicitis in association with appendiceal involvement by mantle cell lymphoma.

  17. Acute appendicitis with a neuroendocrine tumor G1 (carcinoid): pitfalls of conservative treatment.

    Science.gov (United States)

    Watanabe, Hiroyuki A; Fujimoto, Taketoshi; Kato, Yo; Sasaki, Mayumi; Ikusue, Toshikazu

    2016-08-01

    A man in his early thirties presented to our clinic with right lower abdominal pain. Computed tomography (CT) and ultrasonography (US) revealed a swollen appendix and an appendicolith. Abscess formation was not observed but ongoing appendiceal rupture was not ruled out. Three months after successful conservative therapy, the lumen of the apical portion was kept dilated and laparoscopic interval appendectomy was performed. No tumorous findings were observed macroscopically. However, histology revealed many tiny nests infiltrating the submucosa, muscular layer, and subserosa at the root of the appendix. An appendiceal neuroendocrine tumor G1 (NET G1; carcinoid) was diagnosed immunohistologically. Neither CT nor US visualized the tumor because of its non-tumor-forming but infiltrative growth. In conclusion, after successful conservative treatment, interval appendectomy should be considered to uncover a possible appendiceal NET G1 (carcinoid), particularly when dilatation of the distal lumen is kept under observation. PMID:27311320

  18. Natural orifice transluminal endoscopic surgery: new minimally invasive surgery come of age.

    Science.gov (United States)

    Huang, Chen; Huang, Ren-Xiang; Qiu, Zheng-Jun

    2011-10-21

    Although in the past two decades, laparoscopic surgery, considered as a great revolution in the minimally invasive surgery field, has undergone major development worldwide, another dramatic surgical revolution has quietly appeared in recent years. Ever since Kalloo's first report on transgastric peritoneoscopy in a porcine model in 2004, interest in a new surgical procedure named natural orifice transluminal endoscopic surgery (NOTES) has blossomed worldwide. Considering that a NOTES procedure could theoretically avoid any abdominal incision, operation-related pain and scarring, many surgeons and endoscopists have been enthusiastic in their study of this new technique. In recent years, several NOTES studies have been carried out on porcine models and even on humans, including transvaginal cholecystectomy, transgastric appendectomy, transvaginal appendectomy, and transvesical peritoneoscopy. So what is the current situation of NOTES and how many challenges do we still face? This review discusses the current research progress in NOTES. PMID:22110263

  19. Primary signet ring cell carcinoma of the appendix: A rare case report and our 18-year experience

    Institute of Scientific and Technical Information of China (English)

    Yoon Ho Ko; Young Seon Hong; Chan-Kwon Jung; Soon Nam Oh; Tae Hee Kim; Hye Sung Won; Jin Hyoung Kang; Hyung Jin Kim; Won Kyung Kang; Seong Taek Oh

    2008-01-01

    Primary adenocarcinoma of the appendix is a rare malignancy that constitutes < 0.5% of all gastrointestinal neoplasms.Moreover,primary signet ring cell carcinoma of the appendix is an exceedingly rare entity.We have encountered 15 cases of primary appendiceal cancer among 3389 patients who underwent appendectomy over the past 18 years.In the present report,we describe a rare case of primary signet ring cell carcinoma of the appendix with ovarian metastases and unresectable peritoneal dissemination occurring in a 67-year-old female patient.She underwent appendectomy and bilateral salpingo-oophorectomy with a laparoscopy procedure.She then received palliative systemic chemotherapy with 12 cycles of oxaliplatin,5-flurorouracil,and leucovorin (FOLFOX-4).The patient currently is well without progression of disease 12 mo after beginning chemotherapy.

  20. Retroperitoneal mucinous cystadenoma of the appendix mimicking hydatid cyst: A case report

    Science.gov (United States)

    Sikar, Hasan Ediz; Çetin, Kenan; Gündoğan, Ersin; Gündoğan, Gökçen Alinak; Kaptanoğlu, Levent

    2016-01-01

    Appendiceal mucocele is a cystic dilatation of the appendix due to abnormal appendiceal mucinous secretion. Cystadenoma of the appendix is one of the most common causes and is encountered in 0.6% of all appendectomy specimens. The diagnosis may be difficult due to the asymptomatic nature of the disease; pain in the right lower quadrant may be the only symptom. Complex ovarian cyst, urolithiasis or cystic hydatid disease of the liver have been reported as mimicking appendiceal mucocele in the literature. In this study, we present a case of mucinous cystadenoma of the appendix mimicking retroperitoneal hydatid cyst in a 59-year-old woman. The patient was treated with laparoscopic appendectomy with partial resection of the caecum following laparoscopic exploration. PMID:27446577

  1. Appendicular Band Syndrome simulating Appendicular Mass in a Child

    Directory of Open Access Journals (Sweden)

    Bilal Mirza

    2014-09-01

    Full Text Available Appendicular band syndrome is an exceedingly rare surgical emergency that may lead to intestinal obstruction and strangulation. We report a case of 2-year-old boy who presented with acute intestinal obstruction with a mass in right iliac fossa (RIF. At exploration, an inflamed appendix had entrapped a loop of terminal ileum leading to its strangulation and gangrene. The appendectomy and resection of gangrenous gut were done with formation of an ileostomy.

  2. Appendicular Band Syndrome simulating Appendicular Mass in a Child.

    Science.gov (United States)

    Mirza, Bilal; Saleem, Muhammad

    2014-09-01

    Appendicular band syndrome is an exceedingly rare surgical emergency that may lead to intestinal obstruction and strangulation. We report a case of 2-year-old boy who presented with acute intestinal obstruction with a mass in right iliac fossa (RIF). At exploration, an inflamed appendix had entrapped a loop of terminal ileum leading to its strangulation and gangrene. The appendectomy and resection of gangrenous gut were done with formation of an ileostomy.

  3. Diagnostic Value of White Blood Cell and C-Reactive Protein in Pediatric Appendicitis

    OpenAIRE

    Sevgi Buyukbese Sarsu; Fatma Sarac

    2016-01-01

    Background. Acute appendicitis (AA) associated with acute phase reaction is the most prevalent disease which requires emergency surgery. Its delayed diagnosis and unnecessarily performed appendectomies lead to numerous complications. In our study, we aimed to detect the role of WBC and CRP in the exclusion of acute and complicated appendicitis and diagnostic accuracy in pediatric age group. Methods. Appendectomized patient groups were constructed based on the results of histological evaluatio...

  4. Horseshoe Appendix: An Extremely Rare Appendiceal Anomaly.

    Science.gov (United States)

    Singh, Ch Gyan; Nyuwi, Kuotho T; Rangaswamy, Raju; Ezung, Yibenthung S; Singh, H Manihar

    2016-03-01

    Appendiceal anomalies are extremely rare malformations that are usually found incidentally. Agenesis and duplication of the appendix has been well documented however, the cases of horseshoe appendix reported is very limited, only four cases reported so far. Here, we report a four and half-year-old who underwent interval appendectomy. Intraoperatively both the ends of the appendix were found to be communicating with the cecum with two separate base or stump located at a sagital disposal- the so called "horseshoe appendix".

  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...... in predicting acute and perforated appendicitis, and receiving operating characteristics curves were used to find the specificity, sensitivity, and the negative and positive predictive values. RESULTS: A total of 1008 patients were operated under suspicion of appendicitis. From these, 700 patients had...

  6. Reliability of diagnostic imaging techniques in suspected acute appendicitis: proposed diagnostic protocol; Indicacion de las tecnicas de diagnostico por la imagen en la sospecha de apendicitis aguda: propuesta de protocolo diagnostico

    Energy Technology Data Exchange (ETDEWEB)

    Cura del, J. L.; Oleaga, L.; Grande, D.; Vela, A. C.; Ibanez, A. M. [Hospital de Basureto. Bilbao (Spain)

    2001-07-01

    To study the utility of ultrasound and computed tomography (CT) in case of suspected appendicitis. To determine the diagnostic yield in terms of different clinical contexts and patient characteristics. to assess the costs and benefits of introducing these techniques and propose a protocol for their use. Negative appendectomies, complications and length of hospital stay in a group of 152 patients with suspected appendicitis who underwent ultrasound and CT were compared with those of 180 patients who underwent appendectomy during the same time period, but had not been selected for the first group: these patients costs for each group were calculated. In the first group, the diagnostic value of the clinical signs was also evaluated. The reliability of the clinical signs was limited, while the results with ultrasound and CT were excellent. The incidence of negative appendectomy was 9.6% in the study group and 12.2% in the control group. Moreover, there were fewer complications and a shorter hospital stay in the first group. Among men, however, the rate of negative appendectomy was lower in the control group. The cost of using ultrasound and CT in the management of appendicitis was only slightly higher than that of the control group. Although ultrasound and CT are not necessary in cases in which the probability of appendicitis is low or in men presenting clear clinical evidence, the use of these techniques is indicated in the remaining cases in which appendicitis is suspected. In children, ultrasound is the technique of choice. In all other patients, if negative results are obtained with one of the two techniques, the other should be performed. (Author) 49 refs.

  7. [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.

  8. Amyad's hernia while reparing the bilateral inguinal hernia

    Directory of Open Access Journals (Sweden)

    Arif Aslaner

    2015-01-01

    Full Text Available Amyand's hernia is the term used for inguinal hernia containing appendix. It is a rare condition and found in 1% of inguinal hernia repairs. Here we report a case of Amyand's hernia in a 61 years old male who was diagnosed with bilateral inguinal hernia. He underwent surgery and bilateral inguinal hernia repair with prosthetic meshes and without appendectomy. The patient was discharged uneventfully. 

  9. Diagnostic value of procalcitonin for acute complicated appendicitis

    OpenAIRE

    Yamashita, Hiromasa; YUASA, NORIHIRO; TAKEUCHI, EIJI; Goto, Yasutomo; Miyake, Hideo; Miyata, Kanji; Kato, Hideki; Ito, Masafumi

    2016-01-01

    ABSTRACT A rapid and reliable test for detection of complicated appendicitis would be useful when deciding whether emergency surgery is required. We investigated the clinical usefulness of procalcitonin for identifying acute complicated appendicitis. We retrospectively analyzed 63 patients aged ≥15 years who underwent appendectomy without receiving antibiotics before admission and had preoperative data on the plasma procalcitonin level (PCT), body temperature (BT), white blood cell count (WBC...

  10. Single-Incision Laparoscopic Ladd's Procedure for Intestinal Malrotation

    OpenAIRE

    Vassaur, John; Vassaur, Hannah; Buckley, F. Paul

    2014-01-01

    Introduction: The potential of single-incision laparoscopic surgery (SILS) as a less invasive and more cosmetically appealing technique has prompted the expansion of its adoption. SILS has been shown to be a safe and feasible alternative to traditional multiport cholecystectomy, appendectomy, colectomy, and many other laparoscopic procedures. The objective of this study is to provide an initial report of the feasibility of correcting intestinal malrotation via a single-incision laparoscopic t...

  11. George Ryerson Fowler: Brooklyn's surgical pioneer: a biographical sketch based on historical documents.

    Science.gov (United States)

    Kelleher, Mary E; Swan, Kenneth G; Kelleher, Denis P

    2011-06-01

    The Fowler position, widely used in surgery and obstetrics for patient placement, marks a fraction of 19th-century Brooklyn surgeon George Ryerson Fowler's prodigious accomplishments. Fowler was a pioneer who refined the appendectomy, performed the first lung decortication, advocated for sterile techniques, introduced first aid in the US Army, and helped start a precursor to Annals of Surgery. His publications include the first US textbook on appendicitis--ironically, the disease that killed him.

  12. Intricacies in the surgical management of appendiceal mucinous cystadenoma: a case report and review of the literature

    OpenAIRE

    Saleem Taimur; Ahmed Rashida; Khan Muhammad R

    2010-01-01

    Abstract Introduction Mucinous cystadenoma is a type of mucocele of the appendix that is rarely encountered in clinical practice. Dogmatic consensus on the optimal surgical modus operandi of appendicular mucocele is lacking in the literature and this remains a subject of controversy. There is little agreement with regard to the best procedure (right hemicolectomy versus appendectomy) or the best surgical approach (laparoscopic versus laparotomy). Case presentation We report the case of a 70-y...

  13. Is single port incisionless-intracorporeal conventional equipment-endoscopic surgery feasible in patients with retrocecal acute appendicitis?

    OpenAIRE

    Karakus, Suleyman Cuneyt; Kilincaslan, Huseyin; Koku, Naim; Ertaskin, Idris

    2013-01-01

    Purpose Since laparoscopic appendectomy was first described, various modifications, such as single port incisionless-intracorporeal conventional equipment-endoscopic surgery (SPICES), have been described for reducing pain and improving cosmetic results. In the retrocecal and retrocolic positions, attachments to the lateral peritoneum and cecum may lead to difficulties during SPICES, which is performed with only one port. Here, we present the effects of variations in the position of the vermif...

  14. Natural orifice transluminal endoscopic surgery (NOTES): implications for anesthesia.

    Science.gov (United States)

    Schaefer, Michael

    2009-01-01

    Natural orifice transluminal endoscopic surgery (NOTES) has recently evolved as a novel approach for abdominal surgery with great potential to further improve the advantages of laparoscopy over laparotomy. The first patients undergoing NOTES cholecystectomy or appendectomy reported no or only minimal pain, required no narcotic analgesics, and were discharged early from the hospital and immediately resumed daily activities. If this is confirmed by randomized controlled clinical trials, what are the potential implications for anesthesia? PMID:20948698

  15. Natural orifice transluminal endoscopic surgery (NOTES): implications for anesthesia

    OpenAIRE

    Schaefer, Michael

    2009-01-01

    Natural orifice transluminal endoscopic surgery (NOTES) has recently evolved as a novel approach for abdominal surgery with great potential to further improve the advantages of laparoscopy over laparotomy. The first patients undergoing NOTES cholecystectomy or appendectomy reported no or only minimal pain, required no narcotic analgesics, and were discharged early from the hospital and immediately resumed daily activities. If this is confirmed by randomized controlled clinical trials, what ar...

  16. Xanthogranulomatous Appendicitis in a Child: Report of a Case and Review of the Literature

    OpenAIRE

    Al-Rawabdeh, Sura M.; Vinay Prasad; Denis R. King; Kahwash, Samir B.

    2013-01-01

    Xanthogranulomatous inflammation is a well-described inflammatory process, which may involve any organ but is most frequently encountered in the gall bladder and the kidney. There are rare reports of xanthogranulomatous appendicitis (XA) in the adult population, but only one brief mention of such a diagnosis in a child. In this report, we describe the case of an 11-year-old boy who presented with clinical signs and symptoms of acute appendicitis necessitating appendectomy. Upon microscopic ex...

  17. Radiologic imaging of a right pseudo colon: report of one case

    International Nuclear Information System (INIS)

    A 24-year old patient with history of appendectomy that some months later had episodes of fever that disappear with profuse diarrheas is presented. The radiologic and surgical diagnosis proved the presence of a colonic internal fistula with the confirmation of a right pseudocolon at the expense of the right parietocolic. The curative treatment included the resection of the affected colon segment with drainage and curettage of the right parietocolic

  18. Appendicitis in children: evaluation of the pediatric appendicitis score in younger and older children.

    OpenAIRE

    Salö, Martin; Friman, Gustav; Stenström, Pernilla; Ohlsson, Bodil; Arnbjörnsson, Einar

    2014-01-01

    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 wa...

  19. Postoperative intussusception in 10-year-old presenting as decreased intestinal motility

    OpenAIRE

    Arielle Spellun; Loren Berman; Stephen Murphy

    2016-01-01

    Postoperative intussusception is a rare surgical complication. It typically presents as bilious emesis with abdominal pain following a symptom-free period within two weeks of either intra or extra-abdominal surgery. We present the case of a 10-year-old boy who had undergone uncomplicated open appendectomy. He developed abdominal pain, bilious vomiting and tenesmus at one week post-operatively, and postoperative intussusception was suspected. At laparotomy, he was noted to have an ileal–ileal ...

  20. The natural history of pancreatic acinar cell cystadenoma: Is resection better than surveillance? An update to a case report from 2010

    OpenAIRE

    Darcy, David G.; Dominique Jan

    2016-01-01

    Cystic lesions of the pancreas are a rare entity, and few reports have described their natural history in children. A previously published report described a 9-year-old boy with an acinar cell cystadenoma, discovered during a laparoscopic appendectomy. Initially asymptomatic and followed by serial MRI, this patient presented to our institution several years later with chronic obstructive symptoms that required surgical intervention. Planning for resection included multidisciplinary input from...

  1. Changes in plasma potassium concentration during carbon dioxide pneumoperitoneum

    DEFF Research Database (Denmark)

    Perner, A; Bugge, K; Lyng, K M;

    1999-01-01

    Hyperkalaemia with ECG changes had been noted during prolonged carbon dioxide pneumoperitoneum in pigs. We have compared plasma potassium concentrations during surgery in 11 patients allocated randomly to undergo either laparoscopic or open appendectomy and in another 17 patients allocated randomly...... to either carbon dioxide pneumoperitoneum or abdominal wall lifting for laparoscopic colectomy. Despite an increasing metabolic acidosis, prolonged carbon dioxide pneumoperitoneum resulted in only a slight increase in plasma potassium concentrations, which was both statistically and clinically insignificant...

  2. Amyad's hernia while reparing the bilateral inguinal hernia

    OpenAIRE

    Arif Aslaner; Tuğrul Çakır; Umut Rıza Gündüz; Burhan Mayir; Nurullah Bülbüller

    2015-01-01

    Amyand's hernia is the term used for inguinal hernia containing appendix. It is a rare condition and found in 1% of inguinal hernia repairs. Here we report a case of Amyand's hernia in a 61 years old male who was diagnosed with bilateral inguinal hernia. He underwent surgery and bilateral inguinal hernia repair with prosthetic meshes and without appendectomy. The patient was discharged uneventfully. 

  3. TORSION OF THE VERMIFORM APPENDIX: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Dr. Imtiaz Wani

    2009-07-01

    Full Text Available Torsion of the vermiform appendix is a rare condition with few cases reported in the literature. Various factors predispose to torsion. Various factors predispose to torsion. We report a case of primary torsion of the vermiform appendix. The clinical presentation was indistinguishable from acute appendicitis and the diagnosis was made at operation. Appendix was preileal in position and the direction of torsion was anticlockwise. There was intrinsic torsion with no obvious factor for torsion identified. Appendectomy was performed.

  4. 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.

  5. Amyand's hernia-a vermiform appendix presenting in an inguinal hernia: a case series

    Directory of Open Access Journals (Sweden)

    Pavlidis Theodoros

    2011-09-01

    Full Text Available Abstract Introduction A vermiform appendix in an inguinal hernia, inflamed or not, is known as Amyand's hernia. Here we present a case series of four men with Amyand's hernia. Case presentations We retrospectively studied 963 Caucasian patients with inguinal hernia who were admitted to our surgical department over a 12-year period. Four patients presented with Amyand's hernia (0.4%. A 32-year-old Caucasian man had an inflamed vermiform appendix in his hernial sac (acute appendicitis, presenting as an incarcerated right groin hernia, and underwent simultaneous appendectomy and Bassini suture hernia repair. Two patients, Caucasian men aged 36 and 43 years old, had normal appendices in their sacs, which clinically appeared as non-incarcerated right groin hernias. Both underwent a plug-mesh hernia repair without appendectomy. The fourth patient, a 25-year-old Caucasian man with a large but not inflamed appendix in his sac, had a plug-mesh hernia repair with appendectomy. Conclusion A hernia surgeon may encounter unexpected intraoperative findings, such as Amyand's hernia. It is important to be prepared and apply the appropriate treatment.

  6. Autoradiographic investigations on the prednisolone-induced atrophy and on interdependent reactions in different lymphatic tissues of rabbit

    International Nuclear Information System (INIS)

    Under the application of 3H-thymidine the method of organ extirpation (thymectomy and appendectomy) was combined with the cell labeling technique. By autoradiographic evaluation of histologic specimens the content of labelled lymphocytes in the examined tissues was determined. Thymus, appendix, subcutaneous lymphatic nodes and spleen were examined. In the thymus the application of prednisolone induced organ atrophy. Appendectomy leads in the thymic marrow to an increase of the mitotic activity. In the appendix the application of prednisolone causes the emptying of basal lymphatic follicles. Thymectomy induces a large increase of the mitotic activity of the lymphatic tissue. Not all lymphatic nodes show identical changes after organ extirpation and after prednisolone application, but considerable differences. Only a decreased proliferation of labled lymphocytes, occuring under prednisolone application, can be detected in the marrow of the mesenteric lymphatic nodes and of the red splenic pulp in the animal with thymectomy. This result is also valid for the marrow of the remaining deep lymphatic nodes, after thymectomy and appendectomy. The lymphocyte counting in the peripheral blood done during prednisolone treatment, does not indicate that the lymphocyte values depend to a notable extent on the previous surgical treatment of the animals. (orig./MG)

  7. Comparison and efficacy of LigaSure and rubber band ligature in closing the inflamed cecal stump in a rat model of acute appendicitis.

    Science.gov (United States)

    Yeh, Chun-Chieh; Jan, Chia-Ing; Yang, Horng-Ren; Huang, Po-Han; Jeng, Long-Bin; Su, Wen-Pang; Chen, Hui-Chen

    2015-01-01

    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). PMID:25699264

  8. Appendiceal Abscess in Children%小儿阑尾脓肿

    Institute of Scientific and Technical Information of China (English)

    李毓秀; 方中南; 王文敬

    1986-01-01

    @@ 小儿阑尾脓肿的治疗,目前仍有分歧,即行非手术治疗或手术治疗.现将我院1971~1985年14年来收治年龄在15岁以下的小儿阑尾脓肿50例分析报道如下. 临床资料%50 patients,aged between 3 and 15,with appendiceal abscess were treated at our hospital from 1971 to 1985.25 Were given conservative treatment and 25 received operations.without death reported.The surgical procedures employed include appendectomy with drainage (20 cases),simple drainage (3 cases) and appendectomy without drainage (2 cases).Early diagnosis and treatment are important to lessen the complications.Operation is indicated in cases with severe clinical manifes tations,poorly localized periappendiceal infec tion,complicating intestinal obstruction,failure to respond to conservative treatment and those under the age of three.The authors emphasized that interval appendectomy should be held in treated cases until appendicitis recurs.

  9. Intricacies in the surgical management of appendiceal mucinous cystadenoma: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Saleem Taimur

    2010-05-01

    Full Text Available Abstract Introduction Mucinous cystadenoma is a type of mucocele of the appendix that is rarely encountered in clinical practice. Dogmatic consensus on the optimal surgical modus operandi of appendicular mucocele is lacking in the literature and this remains a subject of controversy. There is little agreement with regard to the best procedure (right hemicolectomy versus appendectomy or the best surgical approach (laparoscopic versus laparotomy. Case presentation We report the case of a 70-year-old Asian woman from Karachi who presented with pain in the right iliac fossa for 15 days. On physical examination, a mobile and firm mass was palpable in the right iliac fossa. A colonoscopy was performed which showed external compression of the cecum. A biopsy of the mucosa was normal. Computed tomography scan showed a mucocele of the appendix with minimal periappendiceal fat stranding. She underwent an initial diagnostic laparoscopy to evaluate any mucin spillage in the peritoneal cavity. Once no spillage was identified, an open appendectomy was then performed. Intra-operatively, a frozen section of the appendiceal sample was sent to ascertain the need for an extension of surgery to a right hemicolectomy. Absence of any malignancy on the frozen section obviated the need for a surgical extension. The final histopathological examination showed a mucinous cystadenoma of the appendix. The patient was symptom-free at one year after surgery. Conclusion It is important to distinguish between mucinous cystadenomas and mucinous cystadenocarcinomas. However, this distinction remains elusive in the pre-operative setting. A simple appendectomy using an intra-operative frozen section appears to be a reasonable surgical approach for selected cases with an intact mucocele of the appendix. However, long-term follow-up is warranted in such patients to evaluate the risks of using this approach.

  10. Granulomatous appendicitis in children: A single institutional experience

    Directory of Open Access Journals (Sweden)

    Kamalesh Pal

    2014-01-01

    Full Text Available Background: Granulomatous appendicitis (GA is a rare entity, mostly mentioned in adults. There have been anecdotal case reports describing GA in the paediatric population. This study was aimed at reviewing the cases of appendectomies to assess the incidence and characteristics of GA in children in a tertiary care University hospital. Materials and Methods: Records of children (<13 years age with biopsy proven granulomatous lesions in the appendectomy specimen, treated during 1991-2011, were analysed. Data regarding demography, clinical presentation, radiological findings, intra-operative finding, histology, diagnosis and follow-up were recorded and descriptively analysed. Results: Twelve out of 1150 (1.04% appendectomies were biopsy proven GA. Male to female ratio was 8:4. Four had Yersinia enterocolitis, two had Crohn′s disease (CD; one isolated Crohn′s Appendicitis, one Ileo-cecal Crohn′ with appendicitis and five were idiopathic. Remaining one case, initially diagnosed as idiopathic GA, developed full blown ileo-cecal CD at 2 nd month post-operative. Age ranged between 4 and 11 years with inflammatory bowel disease (IBD affecting older children and Yersinia, seen in younger children. Majority (10/12 remained asymptomatic at a maximum of 5 years of follow-up. Two patients had recurrent symptoms; one with sub-acute obstruction (2 years follow-up and another with flaring of Crohn′s ileitis (2 months follow-up. Conclusions: GA in children is a rare entity, with incidence of 1.04% and male preponderance in our series. Idiopathic causes were the most common followed by Yersinia enterocolitis and CD. Although majority remained asymptomatic, IBD should be ruled out in case of recurrence of pain or alteration of bowel habit. Therefore, a long-term follow-up (at least for 5 years of idiopathic GA is suggested in children.

  11. Mucocele appendix: A rare differential diagnosis of pelvic mass

    Directory of Open Access Journals (Sweden)

    Vishal Yadav

    2013-01-01

    Full Text Available Mucocele of the appendix is a descriptive term that implies a dilated appendiceal lumen caused by abnormal accumulation of mucus. Mucocele is found in 0.2-0.3% of all appendectomy specimens. The male to female ratio is 1:4 and the average age at the time of diagnosis is over 50 years. Ultrasonography and computed tomography are useful tools for the diagnosis of appendiceal mucocele. Pre-operative diagnosis is a major component for minimizing intra operative and post-operative complications. We herein report a case of 40-year-old female presented as pelvic mass and this pose a diagnostic challenge

  12. Right adrenal abscess -- an unusual complication of acute apendicitis.

    Science.gov (United States)

    Dimofte, Gabriel; Dubei, Liviu; Lozneanu, Lili-Gabriela; Ursulescu, Corina; Grigora Scedil, Mihai

    2004-09-01

    Acute appendicitis represents one of the most frequent abdominal emergencies encountered in everyday surgical practice. Local infectious complications are not unusual and retroperitoneal abscesses after acute retrocaecal appendicitis have been previously described. The authors present the case of a 22-years-young female patient, admitted for a right iliac fossa abscess, secondary to gangrenous appendicitis. A right adrenal mass 35/40 mm was revealed during preoperative ultrasound evaluation, which evolved in an adrenal abscess that spontaneously drained 10 days after appendectomy and retrocecal drainage. Adrenal abscesses are exceptionally rare, with only a few cases being reported in the literature, but none of these after acute appendicitis.

  13. Appendicular mass complicating acute appendicitis in a patient with dengue fever.

    Science.gov (United States)

    Low, Y N; Cheong, B M K

    2016-04-01

    Abdominal pain with dengue fever can be a diagnostic challenge. Typically, pain is localised to the epigastric region or associated with hepatomegaly. Patients can also present with acute abdomen. We report a case of a girl with dengue fever and right iliac fossa pain. The diagnosis of acute appendicitis was made only after four days of admission. An appendicular mass and a perforated appendix was noted during appendectomy. The patient recovered subsequently. Features suggestive of acute appendicitis are persistent right iliac fossa pain, localised peritonism, persistent fever and leucocytosis. Repeated clinical assessment is important to avoid missing a concurrent diagnosis like acute appendicitis. PMID:27326951

  14. Cavernous hemangioma presenting as a right adnexal mass in a child.

    Science.gov (United States)

    Correa-Rivas, María S; Colón-González, Gloria; Lugo-Vicente, Humberto

    2003-09-01

    This is the case of an 11-year-old girl who presented with a right adnexal mass and vague abdominal symptoms since seven months prior to her hospital admission for surgery. CT-scan and sonographic images were those of a benign lesion, probably ovarian torsion or infarction. Serum tumoral markers were normal. A right salpingo-oophorectomy and appendectomy were performed. Pathology examination revealed a cavernous hemangioma of the ovary. The clinicopathologic presentation of this unusual benign ovarian tumor is discussed. PMID:14619460

  15. 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.

  16. CT scan for suspected acute appendicitis

    OpenAIRE

    Widlus, David M.

    2012-01-01

    Appendicitis is common with a 7% lifetime risk for an individual in the United States. Mean age at diagnosis is 22 years old. While frequently clinically obvious, by 2006, more than 90% of patients diagnosed with appendicitis had a CT scan of the abdomen and pelvis performed. Use of CT scans has allowed a decrease in false-negative rate at appendectomy to under 10% from a rate of approximately 20% before routine use of CT scan. In addition, the rate of perforation has decreased from nearly 30...

  17. Retroperitonealt hæmatom som komplikation i forbindelse med start af laparoskopisk operation

    DEFF Research Database (Denmark)

    Christensen, Jakob Gerlach; Achiam, Michael Patrich

    2015-01-01

    After laparoscopic appendectomy complications and injury to the intraabdominal organs and major vessels are rare but well documented. The majority of complications occur during establishment of pneumoperitoneum. Frequently used entries are open trocar (Hasson), closed using Veress needle and direct...... trocar insertion. In this case we describe an incident where the towel clip, used to get hold of the supraumbilical fascia to minimize the risk of injury, was pressed down too hard. The retroperitoneum was accidentally punctured and a haematoma above vena cava was created....

  18. Amyand's Hernia. Case Report

    Directory of Open Access Journals (Sweden)

    Joel Ramos Rodriguez

    2015-04-01

    Full Text Available Amyand's hernia is a rare disease generally diagnosed during the surgical act. Its incidence is between the 0, 28-1 %. The proposed treatment of election is the appendectomy through a herniotomy with primary reparation of the hernia using the same incision. It is presented an 85 year old male patient’s case who was hospitalized for surgical treatment with diagnosis of impacted right inguinal hernia and Amyand's hernia was diagnosed in the operative act. He had a satisfactory evolution. It was decided to report the case for being an uncommon entity.

  19. The 'wandering appendicolith'

    Energy Technology Data Exchange (ETDEWEB)

    Betancourt, Sonia L.; Palacio, Diana [The University of Texas, Thoracic Imaging, MD Anderson Cancer Center, Houston, TX (United States); Bisset, George S. [Texas Children' s Hospital, Department of Radiology, Baylor College of Medicine, Houston, TX (United States)

    2015-07-15

    Acute appendicitis is a common pediatric surgical emergency. Successful surgical appendectomy requires removal of the appendix and its contents. A retained appendicolith is a complication that occurs when the appendicolith is expulsed from the appendix as a result of perforation or failure of removal during surgery. An ectopic appendicolith can migrate to a variety of ectopic locations, acting as a nidus for abscess. Clinical presentation may be delayed by days, weeks or even months after surgery. We present and discuss an unusual case of empyema caused by migration of an appendicolith into the chest cavity. Management of these retained appendicoliths requires drainage of the abscess and extraction of the appendicolith. (orig.)

  20. Impact of laparoscopic surgery on stress responses, immunofunction, and risk of infectious complications

    DEFF Research Database (Denmark)

    Kehlet, H; Nielsen, Hans Jørgen

    1998-01-01

    implications of laparoscopic surgery on postoperative infectious complications have not been assessed in large-scale prospective, randomized studies, except in appendectomy, in which a reduced incidence of wound infection has been demonstrated. Data from cholecystectomy and colorectal surgery suggest...... a reduction in wound complications, whereas the sparse data on intraperitoneal infections and sepsis are not conclusive. Thus, laparoscopic surgery modifies the injury response and reduces the risk of infectious complications. If integrated into an accelerated rehabilitation program, further improvement may...... result. The impact of these findings on prophylactic antibiotic regimens cannot be assessed from available data and requires evaluation in prospective clinical studies....

  1. A rare case of appendicitis incarcerated in an inguinal hernia

    OpenAIRE

    Smith-Singares, Eduardo; Boachie, Joseph Adjei; Iglesias, Izaskun Melania

    2016-01-01

    Amyand's hernia was coined after Claudius Amyand (1660–1740), who was the first to describe the presence of a perforated appendix in a hernial sac and also was the first to perform a successful appendectomy in 1735. It is an exceptionally rare condition in which the hernia itself contains the appendix, which may not necessarily be inflamed. The presence of an inflamed appendix further contributes to the rarity of this case. We report a case of acute appendicitis brought on by its incarceratio...

  2. An adult case of polysplenia syndrome associated with sinus node dysfunction, dextrocardia, and systemic venous anomalies.

    Science.gov (United States)

    Fukuda, Kentaro; Onda, Toshihito; Kimura, Yuki; Miura, Seiji; Matsumori, Rie; Masaki, Yoshiyuki; Nishino, Akihisa; Inoue, Kenji; Fujiwara, Yasumasa; Sumiyoshi, Masataka

    2015-01-01

    A 54-year-old woman was referred to our hospital for symptomatic sinus bradyarrhythmia with a sinus pause of 8 seconds. She was diagnosed with dextrocardia during childhood and discovered to have heterotaxy syndrome when she had an appendectomy during her teenager years. Chest and abdominal examinations by computed tomography showed multiple spleens located on the right side and abnormal drainages of the superior and inferior vena cava. Left isomerism was diagnosed by bilaterally bilobed lungs. Because of a patent bilateral superior vena cava, pacemaker leads were implanted using the right cephalic vein approach. Her fainting symptoms disappeared after pacemaker implantation.

  3. Xanthogranulomatous Appendicitis Mimicking Residual Burkitt's Lymphoma After Chemotherapy.

    Science.gov (United States)

    Nam, Soomin; Kang, Jeonghyun; Choi, Sung-Eun; Kim, Yu Ri; Baik, Seung Hyuk; Sohn, Seung-Kook

    2016-04-01

    The case of a 23-year-old female treated with aggressive high-dose therapy for Burkitt's lymphoma is reported. A positron emission tomography and computed tomography scan after completion of chemotherapy revealed a residual hypermetabolic lesion in the right pelvic cavity. A pelvic magnetic resonance imaging scan showed circumferential wall thickening at the tip of the appendix. A laparoscopic exploration and appendectomy were performed, and a pathologic examination of the resected appendix revealed xanthogranulomatous appendicitis. This is a rare case of a xanthogranulomatous appendicitis mimicking remnant Burkitt's lymphoma after completion of chemotherapy. PMID:27218100

  4. Calcified reticulate rind sign: A characteristic feature of gossypiboma on computed tomography

    Institute of Scientific and Technical Information of China (English)

    Yi-Ying Lu; Yun-Chung Cheung; Sheung-Fat Ko; Shu-Hang Ng

    2005-01-01

    We herein report a gossypiboma resulting from a retained surgical swab, which had been left in peritoneum for 20years after appendectomy. CT revealed a cystic mass with a calcified reticulate rind. Subsequent surgery and pathological examination showed a gossypiboma. A simple experiment, using a barium-soaked surgical swab demonstrating similar CT appearance, supported our postulation that calcium deposition on the reticulated fibers of a surgical swab could generate such a characteristic "calcified reticulate rind" sign. We believe that identification of this CT sign facilitates the diagnosis of gossypibomas.

  5. [Mucinous adenocarcinoma of the appendix. Report of a case].

    Science.gov (United States)

    Wolniczak, Isabella; Cáceres Del Águila, Alonso; Santillana Callirgos, Juan Alberto

    2016-01-01

    Mucinous adenocarcinoma of the appendix is a rare neoplasm with an incidence rate of 0.08% of all malignancies. The diagnosis is usually made by biopsy because its clinical presentation may mimic other diseases of structures located in the right lower quadrant. Currently, the treatment is still controversial, being surgery the best option. This report describes a patient with a history of appendectomy 27 years ago that is hospitalized for a painful mass in the lower abdomen associated with carcinoembryonic antigen of 138 ng/dl. PMID:27409095

  6. [Natural orifice translumenal endoscopic surgery: historical and future perspectives].

    Science.gov (United States)

    Yasuda, Kazuhiro; Shiroshita, Hidefumi; Inomata, Masafumi; Kitano, Seigo

    2013-11-01

    Natural orifice translumenal endoscopic surgery (NOTES) has gained much attention worldwide since the first report of transgastric peritoneoscopy in a porcine model in 2004. In this review, we summarize and highlight the current status and future directions of NOTES. Thousands of human NOTES procedures have been performed. The most common procedures are cholecystectomy and appendectomy, mainly performed through transvaginal access in a hybrid fashion with laparoscopic assistance, and the general complication rate is acceptable. Although much work is still needed to refine the techniques for NOTES, the development of NOTES has the potential to create a paradigm shift in minimally invasive surgery. PMID:24358724

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

    OpenAIRE

    Chun-Chieh Yeh; Chia-Ing Jan; Horng-Ren Yang; Po-Han Huang; Long-Bin Jeng; Wen-Pang Su; Hui-Chen Chen

    2015-01-01

    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, th...

  8. Carcinoid of the Appendix During Laparoscopic Cholecystectomy: Unexpected Benefits

    Science.gov (United States)

    Haluck, Randy; Cooney, Robert N.; Minnick, Kathleen E.; Ruggiero, Francesco; Smith, J. Stanley

    1999-01-01

    Carcinoid tumors of the midgut arise from the distal duodenum, jejunum, ileum, appendix, ascending and right transverse colon. The appendix and terminal ileum are the most common location. The majority of carcinoid tumors originate from neuroendocrine cells along the gastrointestinal tract, but they are also found in the lung, ovary, and biliary tracts. We report the first case of elective laparoscopic cholecystectomy in which we found a suspicious lesion at the tip of the appendix and proceeded to perform a laparoscopic appendectomy. The lesion revealed a carcinoid tumor of the appendix. PMID:10323177

  9. 68Ga-DOTATATE Breast Uptake and Expression in Breast Milk.

    Science.gov (United States)

    Forwood, Nicholas J; Kanthan, Gowri L; Bailey, Dale L; Chan, David L; Schembri, Geoffrey P

    2016-08-01

    The excretion of Ga-DOTA-Octreotate (DOTATATE) and related somatostatin analogues in breast milk has not been demonstrated. We report a case of a 34-year-old woman, 7 months postpartum and breastfeeding, who was referred for DOTATATE imaging after the diagnosis of appendiceal carcinoid and subsequent appendectomy. Prominent breast uptake was noted. A breast milk sample from the patient at 90 minutes postinjection was assayed in a gamma counter and shown to have a concentration of 5.6 Bq/g per MBq administered. The excretion of DOTATATE in breast milk is important to consider when providing radiation safety advice to breastfeeding patients. PMID:27276203

  10. Changes in plasma potassium concentration during carbon dioxide pneumoperitoneum

    DEFF Research Database (Denmark)

    Perner, A; Bugge, K; Lyng, K M;

    1999-01-01

    Hyperkalaemia with ECG changes had been noted during prolonged carbon dioxide pneumoperitoneum in pigs. We have compared plasma potassium concentrations during surgery in 11 patients allocated randomly to undergo either laparoscopic or open appendectomy and in another 17 patients allocated randomly...... to either carbon dioxide pneumoperitoneum or abdominal wall lifting for laparoscopic colectomy. Despite an increasing metabolic acidosis, prolonged carbon dioxide pneumoperitoneum resulted in only a slight increase in plasma potassium concentrations, which was both statistically and clinically insignificant....... Thus hyperkalaemia is unlikely to develop in patients with normal renal function undergoing carbon dioxide pneumoperitoneum for laparoscopic surgery....

  11. A Rare Cause of Intestinal Obstruction: Meckel´s Diverticulitis

    OpenAIRE

    Kaya, Oskay; MORAN, Münevver; Fatih ÖZDEMİR (M.A.H.); ÇETİNKUNAR, Süleyman

    2008-01-01

    Small bowel obstruction is a rare complication of Meckel´s diverticulitis. Our purpose is to present a case of a 16-year-old boy with a 3 days history of abdominal pain, recurrent vomiting, and absence of stool discharge. He had appendectomy 3 years ago. Upon laparotomy, we observed small bowel obstruction due to an adhesion between the tip of the inflamed Meckel´s diverticulum and anterior abdominal wall. Although postoperative abdominal adhesions account for the most frequent cause of inte...

  12. Acute Myeloid Leukemia Presenting as Acute Appendicitis

    Directory of Open Access Journals (Sweden)

    Sherri Rauenzahn

    2013-01-01

    Full Text Available Appendicitis in leukemic patients is uncommon but associated with increased mortality. Additionally, leukemic cell infiltration of the appendix is extremely rare. While appendectomy is the treatment of choice for these patients, diagnosis and management of leukemia have a greater impact on remission and survival. A 59-year-old Caucasian female was admitted to the surgical service with acute right lower quadrant pain, nausea, and anorexia. She was noted to have leukocytosis, anemia, and thrombocytopenia. Abdominal imaging demonstrated appendicitis with retroperitoneal and mesenteric lymphadenopathy for which she underwent laparoscopic appendectomy. Peripheral smear, bone marrow biopsy, and surgical pathology of the appendix demonstrated acute myeloid leukemia (AML with nonsuppurative appendicitis. In the setting of AML, prior cases described the development of appendicitis with active chemotherapy. Of these cases, less than ten patients had leukemic infiltration of the appendix, leading to leukostasis and nonsuppurative appendicitis. Acute appendicitis with leukemic infiltration as the initial manifestation of AML has only been described in two other cases in the literature with an average associated morbidity of 32.6 days. The prompt management in this case of appendicitis and AML resulted in an overall survival of 185 days.

  13. Stump Appendicitis: An Uncompleted Surgery, a Rare but Important Entity with Potential Problems

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    J. A. A. Awe

    2013-01-01

    Full Text Available Appendicectomy for appendicitis is one of the commonest surgical procedures performed worldwide. The residual appendiceal stump left after an initial appendectomy risks the development of stump appendicitis. Stump appendicitis is a real recognized entity but not often considered when evaluating patients with right lower quadrant abdominal pain, especially those with past history of appendectomy. It remains a clinical challenge with the result that its diagnosis and effective treatment are often delayed with possible attendant morbidity or mortality. Stump appendicitis results from obstruction of the lumen of the remaining appendix stump, usually by a faecolith. This increases intraluminal pressure, impairing venous drainage and allowing subsequent bacterial infection. We present the case of a twenty-five (25-year-old female who underwent laparoscopic appendicectomy and presented four and half (4(1/2 months later with fever, right lower quadrant abdominal pain, and tenderness associated with repeated vomiting. Exploratory laparotomy was carried out after clinical and imaging studies which revealed big inflammatory mass with abscess at the right iliac fossa and recurrent appendicitis of the appendiceal stump. Surgical treatment is easy but recognition of this important entity but potentially dangerous condition should always be borne in mind in order to avoid delay in its diagnosis and treatment.

  14. "Spaghetti Maneuver": A useful tool in pediatric laparoscopy - Our experience

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    Antonio Marte

    2011-01-01

    Full Text Available Aims: The laparoscopic "Spaghetti Maneuver" consists in holding an organ by its extremity with a grasper and rolling it up around the tool to keep the organ stable and facilitate its traction within a small space. We describe our experience with the "Spaghetti Maneuver" in some minimally invasive procedures. Materials and Methods: We successfully adopted this technique in 13 patients (5F : 8M aged between 6 and 14 years (average age, 10 on whom we performed 7 appendectomies, 2 ureteral reimplantation and 4 cholecystectomies. In all cases, after the first steps, the appendix, the gallbladder and the ureter were rolled around the grasper and easily isolated; hemostasis was thus induced and the organ was mobilized until removal during cholecystectomy and appendectomy, and before the reimplantation in case of ureteral reimplantation. Results: We found that this technique facilitated significantly the acts of holding, isolating and removing, when necessary, the structures involved, which remained constantly within the visual field of the operator. This allowed a very ergonomic work setting, overcoming the problem of the "blind" zone, which represents a dangerous and invisible area out of the operator′s control during laparoscopy. Moreover the isolation maneuvers resulted easier and reduced operating time. Conclusion: We think that this technique is easy to perform and very useful, because it facilitates the dissection of these organs, by harmonizing and stabilizing the force of traction exercised.

  15. Impaired consciousness revealing a cerebral amebiasis in an immunocompetent adult

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    Hanane Ezzouine

    2012-01-01

    Full Text Available Amebiasis is a parasitic infection with manifestations, mainly digestives. It is rarely described extra-gastrointestinal locations including the brain. We report the case of a patient aged 42, made five months earlier for an appendectomy, and was admitted to the ICU after a convalescent stable uncomplicated. At admission, he was 12/15 in Glasgow and had a right hemiplegia. Brain CT revealed a discrete diffuse hypodensities perilesional edema. An abdominal ultrasound found an aspect for multiple hepatic abscesses. Abscess puncture was performed, which was not conclusive, and no seed could be identified. On Ultrasound, no cardiac abnormalities were found, and no endocarditis was present. And since the appearance macroscopic (chocolate-brown, amebic serology is performed and has been highly positive. The therapeutic management included an intubation and ventilation as well as a tri-antibiotic-based ceftriaxon, metronidazol and gentamycin. Confirmation of amebiasis required high doses of metronidazol for an extended period. The replay of the play was an appendectomy for an amebome. Evolution was favorable. Amebiasis can have extraintestinal locations, issues to think about including the cerebral forms.

  16. 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.

  17. 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.

  18. An elective detection of an Amyand′s hernia with an adhesive caecum to the sac: Report of a rare case

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    Ilker Sengul

    2011-01-01

    Full Text Available Context: Existence of non-inflamed or inflamed vermiform appendix in an inguinal hernia is named Amyand′s hernia in honor to the surgeon Claudius Amyand who successfully performed first perforated appendicitis. Case Report: A 69-year-old Turkish male patient with a slight right groin pain and swelling was presented to our clinic, and found to have a slightly tender and reducible right inguinal hernia. He underwent surgery under general anesthesia, and a adhesive caecum and an inflamed appendix were explored within the hernia sac. Adhesions were divided by sharp dissection and appendectomy was performed. After carrying out a Lichtenstein hernioplasty, a broad-spectrum antibiotic was postoperatively admitted for 3 days. He recovered uneventfully, and neither complication nor recurrence was detected during 52 months of follow-up. Conclusions: Although occurrence of an appendicitis in an inguinal hernia is rare, a surgeon should be vigilant for facing with it even in elective cases. Treatment can be provided only surgically, but surgical treatment is not standard except from appendectomy. In our opinion, application of mesh hernia repair should depend on the degree of inflammation of appendix and the presence of incarceration of hernia sac with a suitable antibiotic admission for 3-5 days postoperatively.

  19. 浅谈阑尾炎手术切口感染的预防

    Institute of Scientific and Technical Information of China (English)

    曹翌

    2014-01-01

    Through the analysis of a large amount of clinical data of appendectomy and comparing of 200cases with emergency appendicitis we found some effective measurements of preventing the cut infections after appendectomy. It is very important to complete the folowing procedures: the early diagnosis to the emergent appendicitis patients, performing the surgery immediately, completely preparation before the surgery, choosing correct anesthesia, choosing the reasonable cuts, strictly asepsis performance, correct usage of antibiotics before and after the surgery, and the correct utility of drainage tubes.%本文通过大量阑尾手术资料的分析并对200例急性阑尾炎采取早诊断及时手术,采取充分做好术前准备、正确选择麻醉、选择合理的切口、术中严格执行无菌操作、手术前后合理应用抗生素、合理运用引流条等措施,通过对切口的观察,阐述了预防阑尾手术后切口感染的措施。

  20. 浅谈阑尾炎手术切口感染的预防

    Institute of Scientific and Technical Information of China (English)

    曹翌

    2013-01-01

    本文通过大量阑尾手术资料的分析并对200例急性阑尾炎采取早诊断及时手术,采取充分做好术前准备、正确选择麻醉、选择合理的切口、术中严格执行无菌操作、手术前后合理应用抗生素、合理运用引流条等措施,通过对切口的观察,阐述了预防阑尾手术后切口感染的措施。%Through the analysis of a large amount of clinical data of appendectomy and comparing of 200cases with emergency appendicitis we found some effective measurements of preventing the cut infections after appendectomy. It is very important to complete the fol owing procedures: the early diagnosis to the emergent appendicitis patients, performing the surgery immediately, completely preparation before the surgery, choosing correct anesthesia, choosing the reasonable cuts, strictly asepsis performance, correct usage of antibiotics before and after the surgery, and the correct utility of drainage tubes.

  1. An elective detection of an Amyand's hernia with an adhesive caecum to the sac: Report of a rare case

    Science.gov (United States)

    Sengul, Ilker; Sengul, Demet; Aribas, Duygu

    2011-01-01

    Context: Existence of non-inflamed or inflamed vermiform appendix in an inguinal hernia is named Amyand's hernia in honor to the surgeon Claudius Amyand who successfully performed first perforated appendicitis. Case Report: A 69-year-old Turkish male patient with a slight right groin pain and swelling was presented to our clinic, and found to have a slightly tender and reducible right inguinal hernia. He underwent surgery under general anesthesia, and a adhesive caecum and an inflamed appendix were explored within the hernia sac. Adhesions were divided by sharp dissection and appendectomy was performed. After carrying out a Lichtenstein hernioplasty, a broad-spectrum antibiotic was postoperatively admitted for 3 days. He recovered uneventfully, and neither complication nor recurrence was detected during 52 months of follow-up. Conclusions: Although occurrence of an appendicitis in an inguinal hernia is rare, a surgeon should be vigilant for facing with it even in elective cases. Treatment can be provided only surgically, but surgical treatment is not standard except from appendectomy. In our opinion, application of mesh hernia repair should depend on the degree of inflammation of appendix and the presence of incarceration of hernia sac with a suitable antibiotic admission for 3-5 days postoperatively. PMID:22171249

  2. Experience of single-incision laparoscopy in children

    Science.gov (United States)

    Ming, Yung Ching; Yang, Wendy; Chen, Jeng Chang; Chang, Pei Yeh; Lai, Jin Yao

    2016-01-01

    CONTEXT: Laparoscopic surgery is commonly used for the treatment of many pediatric surgical diseases at our department. Single-incision laparoscopic surgery (SILS) is well-known for its cosmetic benefit. We, hereby, present our experience of SILS and evaluate its efficacy. MATERIALS AND METHODS: From July 2012 to June 2014, 78 patients aged less than 18 years who underwent SILS were retrospectively evaluated. There were 44 males and 34 females, with a mean age of 10.3 years. The procedures included appendectomy (n = 64), reduction of intussusception (n = 8), removal of an intestinal foreign body (n = 3), and Meckel's diverticulectomy (n = 3). We compared the patients who underwent SILS with those who underwent conventional laparoscopic surgery (CLS), regarding these procedures. The parameters for analysis included the patient's demographic data, surgical indication, complications, operative time, and length of hospital stay. CONCLUSION: SILS is comparable to CLS regarding two major procedures, namely, appendectomy and reduction of intussusception. There were no significant differences between the two groups regarding the patients' demographic data, complications, and length of hospital stay. According to our experience of SILS, it could be a feasible and safe procedure for the treatment of various pediatric surgical diseases. However, large prospective randomized studies are needed to identify the differences between SIL and CLS. PMID:27279396

  3. Conservative management of post-appendicectomy intra-abdominal abscesses

    Directory of Open Access Journals (Sweden)

    Dhaou Mahdi

    2010-10-01

    Full Text Available Abstract Purpose Appendicitis is the most common abdominal inflammatory process in children which were sometimes followed by complications including intra-abdominal abscess. This later needs classically a surgical drainage. We evaluated the efficacy of antibiotic treatment and surgical drainage. Methods Hospital records of children treated in our unit for intra-abdominal post appendectomy abscesses over a 6 years period were reviewed retrospectively. Results This study investigates a series of 14 children from 2 to 13 years of age with one or many abscesses after appendectomy, treated between 2002 and 2007. Seven underwent surgery and the others were treated with triple antibiotherapy. The two groups were comparable. For the 7 patients who receive medical treatment alone, it was considered efficient in 6 cases (85% with clinical, biological and radiological recovery of the abscess. There was one failure (14%. The duration of hospitalization from the day of diagnosis of intra-abdominal abscess was approximately 10.28 days (range 7 to 14 days. In the other group, the efficacy of treatment was considered satisfactory in all cases. The duration of hospitalization was about 13 days (range: 9 to 20. Conclusion Compared to surgical drainage, antibiotic management of intra-abdominal abscesses was a no invasive treatment with shorter hospitalization.

  4. [Use Of Hospital Services By The Immigrant Population In Umbria, Italy].

    Science.gov (United States)

    Casadei, Riccardo; Angeli, Giuseppe; Casucci, Paola; Minelli, Liliana; Pasquini, Rossana

    2016-01-01

    The aim of this study was to identify possible inequalities in the quality of health care services for the management of conditions such as cardiovascolar diseases, psychiatric disorders, appendectomy, and hysterectomy, offered to the immigrant population in the Umbria region (central Italy). Hospital discharge data covering the period 2009-2012 were analysed and crude and standardized hospitalization rates per 100,000 calculated. Immigrants were found to have an increased risk of undergoing procedures such as appendectomy and hysterectomy for benign disease, indicating a greater degree of nonappropriateness in this category of users. In the young immigrant population, admissions were mainly due to reproductive health problems in women, and injuries/trauma in men. The results of this study confirm that, despite regional efforts to reduce social inequalities and consequently inequalities in health, through regional legislation, information to the population, training of healthcare personnel, and cultural mediation, some inequalities are present in the quality of health care delivered to foreign-born persons in the region. Hence, there is a need to strengthen information campaigns for immigrants, to keep them informed of their rights, and to strengthen training courses among healthcare and social workers. PMID:27077557

  5. COMPARISON OF DEXMEDETOMIDINE AND CLONIDINE ( 2 AGONIST DRUGS IN LAP A ROSCOPIC APPENDISECTOMY UNDER G.A .

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    Anil Kumar

    2015-07-01

    Full Text Available BACKGROUND: The use of opioids in anaesthesia could cause respiratory depression. Clonidine, a selective alpha - 2 adrenergic agonist, and dexmedetomidine, a new generation highly selective alpha - 2 adrenoreceptor agonist, are well known to inhibit catecholamine release. The present study compares the effects of intravenously administered clonidine versus dexmedetomidine to attenuate hemodynamic responses to pneumoperitoneum during laparoscopic appendectomy under general anaesthesia. METHODOLOGY: A total of 60 patients of ASA physical status I and II, aged between 16 to 52 years, of either sex. scheduled for elective laparoscopic appendectomy were randomized into 3 groups (Group Clo, Dex and C in a double - blind fashion, to receive either clonidine 1 μg/kg in normal saline, dexmedetomidine 0.8 μg/kg in normal saline or normal saline IV respectively. Total volume of the study drug was adjusted to 50 ml and administered over a period of 20 minutes before induction. RESULT: After pneumoperitoneum, sign ificant rise in heart rate and arterial pressure was observed in group Clo. Patients in group Dex showed best control of arterial pressure. No significant episodes of hypotension were found in any group. CONCLUSION: Clonidine or Dexmedetomidine attenuates hemodynamic response to pneumoperitoneum, dexmedetomidine being more effective in this regard.

  6. Determinants of Weight Loss prior to Diagnosis in Inflammatory Bowel Disease: A Retrospective Observational Study

    Directory of Open Access Journals (Sweden)

    Yasser Elsherif

    2014-01-01

    Full Text Available Aims. To identify prevalence, severity, and environmental determinants of weight loss in inflammatory bowel disease (IBD patients just prior to time of formal diagnosis. Methodology. IBD patients attending outpatient clinic were questioned about weight loss prior to diagnosis and other environmental and demographic variables. The percentage BMI loss was calculated for each subject and factors associated with weight loss were determined. Results. Four hundred and ninety-four subjects were recruited (237 cases of Crohn’s disease (CD and 257 cases of ulcerative colitis (UC. Overall, 57% of subjects with CD and 51% of subjects with UC experienced significant weight loss prior to diagnosis (>5% BMI loss. Younger age at diagnosis and history of previous IBD surgery were significantly associated with both lower BMI at diagnosis and increased weight loss prior to diagnosis. In CD patients, increasing age at diagnosis was inversely associated with weight loss prior to diagnosis. Ileal disease was a risk factor of weight loss, whereas prior appendectomy was associated with reduced risk of weight loss. Conclusions. Weight loss is a significant problem for many IBD patients at presentation, especially in younger age and CD with ileal involvement. Appendectomy is associated with diminished weight loss.

  7. A new look at an old dogma: wound complications in two methods of skin closure in uncomplicated appendicitis

    Directory of Open Access Journals (Sweden)

    Hamid Ghaderi

    2010-04-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Appendicitis is more common during the second and third decade of life and appendectomy scar is important in terms of cosmetic issues. The scar is an important factor in the patient's satisfaction. Conventional teaching has an emphasis on the closure of skin incision with "separate" sutures. The aim of this study was to reconsider this dogma."n"nMethods: Among 321 patients with acute appendicitis who came to the emergency unit of Imam Khomeini Hospital in Tehran, Iran since april 2007 till april 2008, 278 (86.6% patients had uncomplicated appendicitis and were enrolled in our clinical trial. The patients were randomly assigned to two groups of interrupted suture closure (n=139 and subcuticular suture closure (n=139. Anesthesia method and surgical technique were similar between the two groups. All patients were followed up post-operatively (four weeks for the presence of infectious drainage, pain, erythema, swelling and warmness at the surgical site."n"nResults: The patients' sex and their mean age were not statistically different between the groups. There was no significant difference in the frequency of surgical site complications between the two groups (five cases in the "interrupted" group and

  8. Malignant peritoneal esothelioma masqueradesas peritoneal metastasis on {sup 18}F-FDG PET/CT scans: A rare diagnosis that should not be missed

    Energy Technology Data Exchange (ETDEWEB)

    Claimon, Apichaya; Bang, Ji In; Cheon, Gi Jeong; Lee, Dong Soo [Dept. of Nuclear Medicine, Seoul National University Hospital, Seoul (Korea, Republic of); Kim, Eui Shin Edmund [Molecular Medicine and Biopharmaceutical Sciences, WCU Graduate School of Convergence Science and Technology, Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2015-12-15

    Malignant peritoneal mesothelioma (MPM) is a rare but fatal tumor. The clinical presentations and imaging findings are nonspecific and resemble various diseases, including peritoneal metastasis. Imaging findings of MPH on {sup 18}F-{sup 18}F-fluorodeoxyglucose ({sup 18}F-FDG) positron emission tomography (PET)/computed tomography (CT) are diverse and not well described. We report the two cases of biopsy-proven MPH using {sup 18}F-FDG PET/CT. In our cases, interesting disease patterns—including MPH arising from visceral peritoneal lining of kidney that suffer from polycystic disease and from the parietal peritoneum beneath the appendectomy scar—were presented. One case showed classical metastases localized within the abdominal cavity; while the other case exhibited the rare pattern of extensive multi-organ metastases. By knowing the possible variations and diagnostic pitfalls of {sup 18}F-FDG PET/CT findings in MPM, more accurate interpretation of such mysterious cancer is attainable.

  9. Paradigm Shifts in the Treatment of Appendicitis.

    Science.gov (United States)

    Mak, Grace Zee; Loeff, Deborah S

    2016-07-01

    Acute appendicitis is the most common cause of emergent surgery in children. Historically, surgical dogma dictated emergent appendectomy due to concern for impending perforation. Recently, however, there has been a paradigm shift in both the understanding of its pathophysiology as well as its treatment to more nonoperative management. No longer is it considered a spectrum from uncomplicated appendicitis inevitably progressing to complicated appendicitis over time. Rather, uncomplicated and complicated appendicitis are now considered two distinct pathophysiologic entities. This change requires not only educating the patients and their families but also the general practitioners who will be managing treatment expectations and caring for patients long term. In this article, we review the pathophysiology of appendicitis, including the differentiation between uncomplicated and complicated appendicitis, as well as the new treatment paradigms. [Pediatr Ann. 2016;45(7):e235-e240.]. PMID:27403670

  10. Trends in the development of natural orifice translumenal endoscopic surgery%经自然腔道内镜外科的发展趋势

    Institute of Scientific and Technical Information of China (English)

    梁平

    2009-01-01

    Natural orifice translumenal endoscopic surgery(NOTES)is a surgical technique which is performed with an endoscope passed through a natural orifice,and then through an internal incision in the viscera(stomach,vagina or rectum)to perform intraabdominal operations.Since the first successful transgastric appendectomy performed by Dr.Rao and Reddy in 2004,NOTES is developing rapidly.The advantages of NOTES include no injury and scar in the body surface;lower anesthesia requirements;faster recovery and shorter hospital stays;avoidance of transabdominal wound infections.NOTES can also be applied to patients who are not suitable for open surgery and lapascopic surgery.NOTES has the potential to revolutionize the field of minimally invasive surgery by eliminating abdominal incisions,however,the safety and efficacy of NOTES still needs to be investigated in lhe future.

  11. 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.

  12. Incarcerated recurrent Amyand′s hernia

    Directory of Open Access Journals (Sweden)

    Benjamin Quartey

    2012-01-01

    Full Text Available Amyand′s hernia is a rarity and a recurrent case is extremely rare. A 71-year-old male with a previous history of right inguinal hernia repair presented to the emergency department with a 1-day history of pain in the right groin. A physical examination revealed a nonreducible right inguinal hernia. A computed tomography scan showed a 1.3-cm appendix with surrounding inflammation within a right inguinal hernia. An emergent right groin exploration revealed an incarcerated and injected non-perforated appendix and an indirect hernia. Appendectomy was performed through the groin incision, and the indirect hernia defect was repaired with a biological mesh (Flex-HD. We hereby present this unique case - the first reported case of recurrent Amyand′s hernia and a literature review of this anatomical curiosity.

  13. Small-bowel perforation caused by fish bone

    Institute of Scientific and Technical Information of China (English)

    Sheng-Der Hsu; De-Chuan Chan; Yao-Chi Liu

    2005-01-01

    A diagnosis of small-bowel perforation, caused by a sharp or pointed foreign body, is rarely made preoperatively because the clinical symptoms are usually nonspecific and can mimic other surgical conditions, such as appendicitis and diverticulitis. We report the case of a 62-year-old woman who experienced severe pain in the right iliac fossa and fever for about five days before arrival at our hospital. The presumptive diagnosis was acute purulent appendicitis and an emergency appendectomy was planned. Swelling and erythema were noted in a segment of the small bowel in the lower right abdomen. A tiny pointed object was found penetrating the inflamed portion of the bowel, which proved to be a sharp fish bone (gray snapper). The bone was removed, followed by segmental resection of the terminal ileum and ascending colon. The postoperative course was uneventful.

  14. [The future of "NOTES"].

    Science.gov (United States)

    Maffei, Massimo; Dumonceau, Jean-Marc

    2008-09-01

    In 2003, the first peroral appendectomy was carried out in a human subject. In order to prevent the premature adoption in clinical practice of the so-called "Natural orifice transluminal endoscopic surgery" (NOTES), a rational framework for its development was proposed in 2005. After animal experimentation, further abdominal interventions were carried out in humans (example: cholecystectomy) through the mouth, vagina, or in a combined approach. The main advantage of NOTES compared to laparoscopic surgery is, from the patient viewpoint, the absence of body scar, but other benefits (example: less pain and costs) could prove to be significant. It is impossible to predict whether or not NOTES will enter in routine clinical practice, but it will generate significant improvements for digestive endoscopy. PMID:18831409

  15. Study of 150 cases of acute appendicitis in children

    Directory of Open Access Journals (Sweden)

    Fallahi Gh

    1998-06-01

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

  16. [Oral hydration with rehydration salts in appendectomized patients].

    Science.gov (United States)

    Azabache Puente, W; Johanson Arias, L

    1992-01-01

    A randomised prospective study of 80 patients to demonstrate if oral hydration with rehydratant salts is as effective as the parenteral infusion for the hydration of patients immediately after appendectomy was performed. The tolerance and conditions of hydration were excellent with 92.5% and 87.5% respectively with oral hydration and with parenteral hydration (p > 0.05). The use of Metronidazole orally with Gentamycetin intramuscular or complication such a wound infection did not influence the hospital stay. With oral hydration, apatite returned sooner, (p saving of cost, saving of time en administration of fluids and shorter hospital stay in the patient with oral hydration than with the parenteral hydration group. PMID:1340245

  17. The ectopic appendicolith from perforated appendicitis as a cause of tubo-ovarian abscess

    Energy Technology Data Exchange (ETDEWEB)

    Vyas, Rajashree C.; Sides, Corey; Klein, Deborah J. [University of Rochester Medical Center, Rochester, NY (United States); Reddy, Sireesha Y. [University of Rochester, Obstetrics and Gynecology, Rochester, NY (United States); Santos, Mary C. [University of Rochester, Pediatric Surgery, Rochester, NY (United States)

    2008-09-15

    Acute appendicitis is a common surgical cause of abdominal pain in the pediatric population. History and physical examination are atypical in up to a third of patients. Known potential complications of untreated or delayed management of acute appendicitis include appendiceal perforation, periappendiceal abscess formation, peritonitis, bowel obstruction and rarely septic thrombosis of mesenteric vessels. We report an unusual complication of perforated appendicitis. A tubo-ovarian abscess developed secondary to appendicolith migration into the right fallopian tube in a patient who had undergone interval laparoscopic appendectomy for perforated appendicitis. The retained appendicolith was visualized within the obstructed and dilated fallopian tube on contrast-enhanced CT. We discuss the CT imaging features of this unusual complication of perforated appendicitis. (orig.)

  18. Laparoscopic management of acute appendicitis in situs inversus

    Directory of Open Access Journals (Sweden)

    Golash Vishwanath

    2006-01-01

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

  19. Treatment of appendiceal mass– a qualitative systematic review

    DEFF Research Database (Denmark)

    Olsen, Jesper Arnold; Skovdal, Jan; Qvist, Niels;

    2014-01-01

    . METHODS: The analysis was based on the principles of a qualitative systematic review. The literature was searched in PubMed for the period from 1966 to March 2014. The articles were reviewed with respect to complications, treatment failure and hospital stay. Papers on post-operative intra...... in total 3,772 patients. Operation for appendiceal mass was beset with a moderate to high risk of complications of up to 57% and a risk of intestinal resection of up to 25%. Major complications were observed in up to 18% of cases. Conservative treatment with or without antibiotics was associated...... with a treatment failure rate of 8-15%. Drainage was beset with a risk of complications of 2-15% and a risk of treatment failure of 2-13%. CONCLUSION: Operation with appendectomy for appendiceal mass carries a high risk of complications compared with conservative treatment or drainage. Drainage may lower the risk...

  20. Giant appendicolith: Rare finding in a common ailment

    Directory of Open Access Journals (Sweden)

    Sanjeev Singhal

    2016-01-01

    Full Text Available Acute appendicitis is one of the commonest surgical emergencies worldwide. There is considerable variation in prevalence of appendicoliths with appendicitis. Most of the patients with appendicoliths are asymptomatic and they are not pathognomic for acute appendicitis. However, appendicoliths show increased association with perforation and abscess formation. Appendicolith are quite common, being present in 3% of general population and in nearly 10% cases of appendicitis. However, giant appendicoliths measuring over 2 centimeters (cms are extremely rare. Computed Tomography (CT has increased their pre-operative diagnosis considerably. Use of spectral analysis can give us the details of composition of the stone pre-operatively. We present a young male diagnosed pre-operatively on Non-Contrast Computed Tomography (NCCT to have a giant calcium struvite appendicolith. On laparoscopy he had a 3 cm stone and an incidental Meckel's diverticulum and underwent appendectomy. The case is presented for the unique size of the appendicolith alongwith review of literature.

  1. [Murphy's Law].

    Science.gov (United States)

    Heij, H A; van Lieburg, M J

    2016-01-01

    Non-surgical treatment of acute phlegmonous appendicitis has been receiving increasing attention in recent years, representing a reversal of policy. The appendectomy came into vogue at the beginning of the 20th century. It is true that prompt surgical intervention in all patients with appendicitis or an indication thereof almost guarantees success, but it gradually came to be forgotten that this intervention was not always necessary. In this article we will document the historical development of this disease and its treatment, and return to the original reports made by pathologist Reginald Fitz and the internist William Osler to show that their opinion was not black and white. Many surgeons in the Netherlands were also initially more restrained. In the course of time recognition of the natural progression of the disease vanished, until new developments placed this more sharply in the limelight. PMID:27650019

  2. Environmental risk factors for inflammatory bowel disease.

    Science.gov (United States)

    Molodecky, Natalie A; Kaplan, Gilaad G

    2010-05-01

    Inflammatory bowel disease (IBD) is characterized by chronic inflammation of the gastrointestinal tract and is associated with significant morbidity. The etiology of IBD has been extensively studied during the last several decades; however, causative factors in disease pathology are not yet fully understood. IBD is thought to result from the interaction between genetic and environmental factors that influence the normal intestinal commensal flora to trigger an inappropriate mucosal immune response. Although many IBD susceptibility genes have been discovered, similar advances in defining environmental risk factors have lagged. A number of environmental risk factors have been explored, including smoking, appendectomy, oral contraceptives, diet, breastfeeding, infections/ vaccinations, antibiotics, and childhood hygiene. However, most of these factors have demonstrated inconsistent findings, thus making additional studies necessary to better understand the etiology of IBD. PMID:20567592

  3. 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. PMID:10642949

  4. Incarcerated appendix in a Spigelian hernia

    Directory of Open Access Journals (Sweden)

    Caroline Reinke

    2010-12-01

    Full Text Available Spigelian hernias are rare, making up only 1-2% of all hernias. Like other hernias, they may contain abdominal contents but are more likely to be incarcerated due to the small size of the fascial defect.(1 We describe here the case of a 71-year-old female with a 10-year history of right lower quadrant pain that remained undiagnosed despite multiple imaging studies. Prior to presentation the patient developed a new bulge and increasing pain at this site; an ultrasound revealed the presence of a bowel-containing hernia. The patient was taken urgently to the operating room for a laparoscopic Spigelian hernia repair, and was found to have an incarcerated appendix in the hernia. After the hernia was reduced, an appendectomy was performed and the hernia was repaired with biological mesh. Postoperatively, the patient did well, and her pain resolved.

  5. Crohn's disease limited to the vermiform appendix

    DEFF Research Database (Denmark)

    Bak, Martin; Andersen, J C

    1987-01-01

    Thirteen cases of Crohn's disease confined to the vermiform appendix were seen during a 12-year period. They constituted 16.9% of patients with primary resection of the bowel for Crohn's disease in the same period, but only 0.4% of the cases of acute appendicitis. In 10 of the 13 cases...... to approach that of recurrence after resection in other parts of the intestines. Collective review of this and three other relatively large case series gave an estimated recurrence rate of 3.5%. We conclude that in Crohn's disease initially confined to the appendix the course appears to be indolent....... there was marked fibrous thickening of the appendiceal wall, and in 11 there were epithelioid cell granulomas. Appendectomy was performed in all cases. None had postoperative fistula or later manifestations of the disease within the observation time averaging 6.3 years. The recurrence rate was previously believed...

  6. Pre-operative Identification and Surgical Management of the Appendiceal Mucocele: A Case Report.

    Science.gov (United States)

    Lynch, Kevin; Cho, Sung; Andres, Robert; Knight, Jennifer; Con, Jorge

    2016-01-01

    An appendiceal mucocele (AM) is an uncommon differential in the patient being evaluated for acute appendicitis. Although often asymptomatic, AMs can clinically mimic acute appendicitis, and preoperative distinction between these processes facilitates optimal management. We report the case of a 60-year-old male with an AM presenting with nausea and periumbilical pain radiating to the right lower quadrant. Literature relevant to the diagnosis and treatment of AMs is reviewed, with emphasis on diagnosis through radiographic imaging and surgical management. Abdominal CT scan or ultrasound are useful in identifying AMs preoperatively. A decision to perform a right hemicolectomy should be influenced by the criteria reported by Gonzalez-Moreno. The safety of the laparoscopic resection relative to an open appendectomy is debated. PMID:27491099

  7. H1N1 infection in emergency surgery: A cautionary tale.

    LENUS (Irish Health Repository)

    Galbraith, J G

    2010-01-01

    Pandemic 2009 influenza A H1N1 has spread rapidly since its first report in Mexico in March 2009. This is the first influenza pandemic in over 40 years and it atypically affects previously healthy young adults, with higher rates of morbidity and mortality. The medical literature has been inundated with reports of H1N1 infection, the majority found in critical care and internal medicine journals with a relative paucity in the surgical literature. Despite this, it remains an important entity that can impact greatly on acute surgical emergencies. We present a case of previously healthy 31-year-old male who underwent open appendectomy. His post-operative recovery was complicated by acute respiratory distress syndrome secondary to H1N1 infection. This case report highlights the impact that H1N1 virus can have on acute surgical emergencies and how it can complicate the post-operative course.

  8. Idiopathic abdominal cocoon syndrome with unilateral abdominal cryptorchidism and greater omentum hypoplasia in a young case of small bowel obstruction

    Science.gov (United States)

    Fei, Xiang; Yang, Hai-Rui; Yu, Peng-Fei; Sheng, Hai-Bo; Gu, Guo-Li

    2016-01-01

    Abdominal cocoon syndrome (ACS) is a rare cause of intestinal obstruction due to total or partial encapsulation of the small intestine by a fibrocollagenous membrane. Idiopathic ACS with abdominal cryptorchidism and greater omentum hypoplasia is even rarer clinically. We successfully treated a 26-year-old male case of small bowel obstruction with acute peritonitis. He was finally diagnosed with idiopathic ACS with unilateral abdominal cryptorchidism and greater omentum hypoplasia during exploratory laparotomy. He then underwent enterolysis, cryptorchidectomy, and appendectomy. He recovered gradually from the operations and early postoperative inflammatory ileus. There has been no recurrence of intestinal obstruction since the operation, and he is still in follow-up. We analyzed his clinical data and retrospectively reviewed the literature, and our findings may be helpful for the clinical diagnosis and treatment on ACS. PMID:27239122

  9. Complete invagination of vermiform appendix with adenocarcinoma: case report

    International Nuclear Information System (INIS)

    Appendiceal intussusception is a very rare pathological condition, an incidence, as revealed by appendectomy specimens, of only 0.01 percent. There are various types among which complete invagination of the appendix is very rare. We encountered a case of intussusception of the appendix with complete invagination induced by appendiceal adenocarcinoma. A preoperative diagnosis of appendiceal adenocarcinoma and intussusception was not possible, but a final pathological report confirmed these conditions and retrospective analysis of a barium enema showed a finger-like filling defect of the cecum, a relatively specific finding in such cases. We describe a case involving a 39-year old man who one month earlier had noted the onset of pain in the right lower abdomen. (author)

  10. Kinematic Measures for Evaluating Surgical Skills in Natural Orifice Translumenal Endoscopic Surgery (NOTES).

    Science.gov (United States)

    Roche, Christopher A; Sankaranarayanan, Ganesh; Dargar, Saurabh; Matthes, Kai; De, Suvranu

    2014-01-01

    Natural Orifice Translumenal Endoscopic Surgery is an emerging procedure that requires training and adoption to be successful. Currently no objective performance metrics exist for evaluating skills for NOTES. In this work, we have improved upon our previous study on objective performance metrics using kinematic measures by introducing two new measures, the flex and the roll and recruiting more subjects to increase the statistical power. The measures were evaluated in a transgastric NOTES appendectomy procedure performed with ex-vivo organs using the EASIE-RTM trainer box. Four motion tracking sensors attached to an endoscope were used to measure the scope position and orientation to compute the kinematic measures. Results from our study showed that completion time, economy of motion, jerk and roll of the scope are valid kinematic measures to differentiate between expert and novice NOTES surgeons. PMID:24732533

  11. NOTES in Europe: summary of the working group reports of the 2012 EURO-NOTES meeting.

    Science.gov (United States)

    Meining, A; Spaun, G; Fernández-Esparrach, G; Arezzo, A; Wilhelm, D; Martinek, J; Spicak, J; Feussner, H; Fuchs, K H; Hucl, T; Meisner, S; Neuhaus, H

    2013-01-01

    The sixth EURO-NOTES workshop (4 - 6 October 2012, Prague, Czech Republic) focused on enabling intensive scientific dialogue and interaction between surgeons, gastroenterologists, and engineers/industry representatives and discussion of the state of the practice and development of natural orifice transluminal endoscopic surgery (NOTES) in Europe. In accordance with previous meetings, five working groups were formed. In 2012, emphasis was put on specific indications for NOTES and interventional endoscopy. Each group was assigned an important indication related to ongoing research in NOTES and interventional endoscopy: cholecystectomy and appendectomy, therapy of colorectal diseases, therapy of adenocarcinoma and neoplasia in the upper gastrointestinal tract, treating obesity, and new therapeutic approaches for achalasia. This review summarizes consensus statements of the working groups. PMID:23446668

  12. Objective performance measures using motion sensors on an endoscopic tool for evaluating skills in natural orifice translumenal endoscopic surgery (NOTES).

    Science.gov (United States)

    Chin, Lauren I; Sankaranarayanan, Ganesh; Dargar, Saurabh; Matthes, Kai; De, Suvranu

    2013-01-01

    Natural orifice translumenal endoscopic surgery is an emerging procedure. High fidelity virtual reality-based simulators allow development of new surgical procedures and tools and train medical personnel without risk to human patients. As part of a project funded by the National Institutes of Health, we are developing a Virtual Transluminal Endoscopic Surgery Trainer (VTEST TM) for this purpose. In this work, objective performance measures derived from motion tracking sensors attached to an endoscope was tested for the transgastric NOTES appendectomy procedure performed with ex-vivo pig organs using the EASIE-R(TM) trainer box. Results from our study shows that both completion time and economy of motion parameters were able to differentiate between expert and novice NOTES surgeons with p value of 0.039 and 0.02 respectively. Jerk computed on sensor 2 data also showed significant results (p = 0.02). We plan to incorporate these objective performance measures in VTEST(TM). PMID:23400134

  13. PELVIC ACTINOMYCOSIS MIMICKING A LOCALLY ADVANCED PELVIC MALIGNANCY--CASE REPORT.

    Science.gov (United States)

    Velenciuc, Natalia; Velenciuc, I; Makkai Popa, S; Roată, C; Ferariu, D; Luncă, S

    2016-01-01

    We present the case of a former user of an intrauterine contraceptive device (IUD) for 10 years, diagnosed with a bulky, fixed pelvic tumor involving the internal genital organs and the recto sigmoid, causing luminal narrowing of the rectum, interpreted as locally advanced pelvic malignancy, probably of genital origin. Intraoperatively, a high index of suspicion made us collect a sample from the fibrous wall of the tumor mass, large Actinomyces colonies were thus identified. Surgery consisted in debridement, removal of a small amount of pus and appendectomy, thus avoiding a mutilating and useless surgery. Specific antibiotic therapy was administered for 3 months, with favorable postoperative and long-term outcomes. Pelvic actinomycosis should always be considered in the differential diagnosis of pelvic tumors in women using an IUD. The association of long-term antibiotic treatment is essential to eradicate the infection and prevent relapses. PMID:27483724

  14. Endometrial Adenocarcinoma and Mucocele of the Appendix: An Unusual Coexistence

    Directory of Open Access Journals (Sweden)

    Ioannis Kalogiannidis

    2013-01-01

    Full Text Available Appendiceal mucocele is a rare clinical entity, which is however quite often associated with mucinous ovarian tumor. The coexistence of mucinous cystadenoma of the appendix and endometrial adenocarcinoma has not been reported before. A 49-year-old woman presented to our clinic with postmenopausal bleeding and no other symptom. Endometrial biopsy revealed endometrial adenocarcinoma of endometrioid type (grade I. Preoperative CT scanning revealed an appendiceal mucocele, and a colonoscopy confirmed the diagnosis. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and appendectomy. The final histopathological examination showed a mucinous cystadenoma of the appendix and confirmed the diagnosis of endometrioid endometrial adenocarcinoma. The coexistence of appendiceal mucocele and female genital tract pathology is rare. However, gynecologists should keep a high level of suspicion for such possible coexistence. Both the diagnostic approach and the therapeutic management should be multidisciplinary, most importantly with the involvement of general surgeons.

  15. A case of De Garengeot hernia requiring early surgery.

    Science.gov (United States)

    Pan, Chao-Wen; Tsao, Min-Jen; Su, Ming-Shan

    2015-01-01

    De Garengeot hernia is a rare clinical entity defined as the presence of a vermiform appendix within a femoral hernia sac. A 50-year-old woman presented to the emergency department with a painful lump over her right groin region. A bedside ultrasound was performed and soft tissue lesion was suspected. CT was performed and revealed a swollen tubular structure with fat stranding within the mass. De Garengeot hernia with acute appendicitis was diagnosed preoperatively, and an emergency appendectomy and hernioplasty were performed. Although it is usually an incidental finding during hernioplasty, De Garengeot hernia should be considered in the differential diagnosis of patients with an incarcerated femoral hernia. Mesh repair can be performed depending on the clinical situation. We report a rare case of incarcerated femoral hernia with acute appendicitis that required early surgical management to avoid associated complications. PMID:26199302

  16. Carcinoid of the Meckel′s diverticulum: Case report and review of literature

    Directory of Open Access Journals (Sweden)

    Guraya Salman

    2006-01-01

    Full Text Available We report a 19-year-old female admitted to the Emergency Room with excruciating right lower abdominal pain of 1-day duration. The abdominal examination revealed a soft, lax abdomen with rigidity and guarding in her right iliac fossa without abdominal defense. Apart from a leukocytosis of 18.3/mm3, the rest of her baseline investigations and imaging, including abdominal X-rays, abdominal and pelvic ultrasound and abdominal CT scan were unremarkable. Patient′s persistent pain prompted the treating surgeon to undertake exploratory laparotomy, which disclosed an inflamed Meckel′s diverticulum and a normal-looking appendix. Meckel′s diverticulectomy along with appendectomy was performed. The histopathological report demonstrated carcinoid tumor in the Meckel′s diverticulum with free resection margins, whereas appendix was reported to be normal. The patient had an uneventful recovery and was discharged home on the sixth postoperative day.

  17. Diet and risk of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Andersen, Vibeke; Olsen, Anja; Carbonnel, Franck;

    2012-01-01

    Background: A better understanding of the environmental factors leading to inflammatory bowel disease should help to prevent occurrence of the disease and its relapses. Aim: To review current knowledge on dietary risk factors for inflammatory bowel disease. Methods: The PubMed, Medline and Cochrane...... Library were searched for studies on diet and risk of inflammatory bowel disease. Results: Established non-diet risk factors include family predisposition, smoking, appendectomy, and antibiotics. Retrospective case–control studies are encumbered with methodological problems. Prospective studies...... on European cohorts, mainly including middle-aged adults, suggest that a diet high in protein from meat and fish is associated with a higher risk of inflammatory bowel disease. Intake of the n-6 polyunsaturated fatty acid linoleic acid may confer risk of ulcerative colitis, whereas n-3 polyunsaturated fatty...

  18. Acute Appendicitis Together with Chylous Ascites: Is It a Coincidence?

    Directory of Open Access Journals (Sweden)

    Sami Akbulut

    2010-01-01

    Full Text Available Acute chylous ascites is a rarely seen clinical picture, therefore, examination findings are often confused with acute appendicitis. To the best of our knowledge, there is no publication to date showing the occurrence of them together. This study presents the treatment plan for a 25-year-old male patient with both acute chylous ascites and appendicitis. Surgical findings were retrocaecal appendicitis, evident lymphangiectasia in the proximal segment of jejunum, and approximately 3 lt of chylous fluid. An appendectomy was performed and drainage was applied. Low-fat total parenteral nutrition (TPN and octreotide treatment were administered for 7 days postoperatively. We also present a general review of some studies on chylous ascites, which have been published in the English language medical literature since 1910.

  19. Abdominal actinomycosis mimicking acute appendicitis.

    Science.gov (United States)

    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.

  20. Meckels divertikel-perforation med intraabdominal blødning og periappendikulaer inflammation

    DEFF Research Database (Denmark)

    El-Hussuna, Alaa; Zeb, Aurang; Mogensen, Anne Mellon;

    2009-01-01

    Perforation of Meckel's diverticulum (MD) is a rare and serious complication. The authors report a case of a 12-year-old girl who presented with acute abdominal pain and anaemia. Haemoperitoneum, perforated MD and peri-appendicular inflammation were found during laparotomy. The patient was treate...... with resection of a segment of ileum bearing the diverticulum and appendectomy. Postoperative recovery was uneventful. Pathological examination showed a perforated peptic ulcer with acute peritonitis and periappendicitis. Udgivelsesdato: 2009-Dec......Perforation of Meckel's diverticulum (MD) is a rare and serious complication. The authors report a case of a 12-year-old girl who presented with acute abdominal pain and anaemia. Haemoperitoneum, perforated MD and peri-appendicular inflammation were found during laparotomy. The patient was treated...

  1. Giant Uterine Fibromyoma. A Case Report

    Directory of Open Access Journals (Sweden)

    Tahiluma Santana Pedraza

    2013-12-01

    Full Text Available The uterus is the common site for multiple benign and malignant conditions. Giant uterine fibromyoma is a benign tumor of low incidence. Its management poses a challenge for the surgical team because of the volume of the surgical specimen and the variations in the distribution of intra-abdominal organs caused by uterine growth. A case of a 43-year-old patient with a history of bronchial asthma and hypertension who presented with enlargement of the abdomen and vaginal bleeding is reported. The patient was attended by the General Surgery Department of the María Genoveva Guerrero Ramos Comprehensive Diagnostic Center in the Libertador Municipality, Capital District, Venezuela. Total abdominal hysterectomy and complementary appendectomy were performed. The histopathological study showed a giant uterine fibromyoma. Postoperative progress was satisfactory. It was decided to present the case due to its rarity.

  2. Peripheral nerve injuries resulting from common surgical procedures in the lower portion of the abdomen.

    Science.gov (United States)

    Stulz, P; Pfeiffer, K M

    1982-03-01

    Twenty-three patients had a painful ilioinguinal and/or iliohypogastric nerve entrapment syndrome following common surgical procedures in the lower portion of the abdomen (appendectomy, repair of inguinal hernia, and gynecologic procedures through transverse incision). The diagnostic triad of nerve entrapment after operation comprises (1) typical burning or lancinating pain near the incision that radiates to the area supplied by the nerve, (2) clear evidence of impaired sensory perception of the nerve, and (3) pain relieved by infiltration with anesthetic for local effects at the site where the two nerves leave the internal oblique muscle. Surgical repair of the scar with resection of the compromised nerve is the most effective treatment. Sixteen patients became symptom free after neurectomy, seven still suffer chronic pain in the scar. PMID:7065874

  3. Synchronous occurrence of appendiceal mucinous cystadenoma, with colon adenocarcinoma and tubulovillous rectal adenoma: Management and review of the literature

    Science.gov (United States)

    Salemis, Nikolaos S.; Nakos, Georgios; Katikaridis, Ilias; Zografidis, Andreas

    2016-01-01

    Appendiceal mucocele (AM) is a rare clinical entity comprising 8% of all appendiceal tumors, and it is seen in 0.2-0.3% of all appendectomy specimens. Apart from sporadic cases, there are no enough published data about the incidence of synchronous appendiceal tumors in patients with colorectal cancer. We describe a very rare case of synchronous occurrence of AM, colon adenocarcinoma, and tubulovillous adenoma of the rectum and review the relevant literature. We conclude that thorough preoperative and perioperative evaluations are mandatory in patients undergoing surgery for colorectal cancer to exclude a synchronous colon or an appendiceal primary tumor. Larger prospective studies are necessary to accurately determine the incidence of synchronous appendiceal tumors and colorectal cancer. PMID:27433069

  4. Epidemiologic study of 80 patients with ulcerative colitis referred to Imam Hospital in Ardabil city during 2004-2011

    Directory of Open Access Journals (Sweden)

    Vahid Sadeghifard

    2014-08-01

    Results: Mean age of patients was 36.4 (SD=18.4. Duration of symptoms onset until diagnosis was 8 months. Male to female ratio was 0.8/1. 38(47.5% of patients were male and 42 (52.5% were female. 3 (3.75% of patients have history of positive UC and 4 (5% history of appendectomy. According to colonoscopy finding, 1 (1.25% have rectum involvement, 27 (33.75% recto sigmoid, 23 (28.75% left side colon and 4 (5% have pan colitis. Conclusion: Results showed that in compare with other places, clinical signs of ulcerative colitis in Ardabil province are different and so doing other d epidemiologic studies based on population to determine incidence and prevalence ulcerative colitis in Ardabil province is necessary. [Int J Res Med Sci 2014; 2(4.000: 1417-1422

  5. Giant appendicolith: Rare finding in a common ailment

    Science.gov (United States)

    Singhal, Sanjeev; Singhal, Anu; Mahajan, Harsh; Prakash, Brahm; Kapur, Sunil; Arora, Pankaj K.; Tiwari, Bishwanath; Sethi, Punit

    2016-01-01

    Acute appendicitis is one of the commonest surgical emergencies worldwide. There is considerable variation in prevalence of appendicoliths with appendicitis. Most of the patients with appendicoliths are asymptomatic and they are not pathognomic for acute appendicitis. However, appendicoliths show increased association with perforation and abscess formation. Appendicolith are quite common, being present in 3% of general population and in nearly 10% cases of appendicitis. However, giant appendicoliths measuring over 2 centimeters (cms) are extremely rare. Computed Tomography (CT) has increased their pre-operative diagnosis considerably. Use of spectral analysis can give us the details of composition of the stone pre-operatively. We present a young male diagnosed pre-operatively on Non-Contrast Computed Tomography (NCCT) to have a giant calcium struvite appendicolith. On laparoscopy he had a 3 cm stone and an incidental Meckel's diverticulum and underwent appendectomy. The case is presented for the unique size of the appendicolith alongwith review of literature. PMID:27073312

  6. 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.

  7. 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...

  8. Treatment of appendiceal mass

    DEFF Research Database (Denmark)

    Olsen, Jesper; Skovdal, Jan; Qvist, Niels;

    2014-01-01

    INTRODUCTION: The treatment strategy for appendiceal mass is controversial, ranging from operation or image-guided drainage to conservative treatment with or without antibiotics. The aim of this study was to assess the various treatment modalities with respect to complications and treatment failure...... in total 3,772 patients. Operation for appendiceal mass was beset with a moderate to high risk of complications of up to 57% and a risk of intestinal resection of up to 25%. Major complications were observed in up to 18% of cases. Conservative treatment with or without antibiotics was associated...... with a treatment failure rate of 8-15%. Drainage was beset with a risk of complications of 2-15% and a risk of treatment failure of 2-13%. CONCLUSION: Operation with appendectomy for appendiceal mass carries a high risk of complications compared with conservative treatment or drainage. Drainage may lower the risk...

  9. Polymorphisms in interleukin-10 gene according to mutations of NOD2/CARD15 gene and relation to phenotype in Spanish patients with Crohn's disease

    Institute of Scientific and Technical Information of China (English)

    Juan L Mendoza; Elena Urcelay; Raquel Lana; Alfonso Martinez; Carlos Taxonera; Emilio G de la Concha; Manuel Díaz-Rubio

    2006-01-01

    AIM: To examine the contribution of interleukin-10(IL-10) gene polymorphisms to Crohn's disease (CD)phenotype, and the possible genetic epistasis between IL-10 gene polymorphisms and CARD15/NOD2 gene mutations.METHODS: A cohort of 205 Spanish unrelated patients with Crohn's disease recruited from a single center was studied. All patients were rigorously phenotyped and followed-up for at least 3 years (mean time, 12.5years). The clinical phenotype was established prior to genotyping.RESULTS: The correlation of genotype-Vienna classification groups showed that the ileocolonic location was significantly associated with the -1082G allele in the NOD2/CARD15 mutation-positive patients (RR= 1.52,95%CI, 1.21 to 1.91,P= 0.008). The multivariate analysis demonstrated that the IL-10 G14 microsatellite allele in the NOD2/CARD15 mutation positive patients was associated with two risk factors, history of appendectomy(RR=2.15, 95%CI=1.1-4.30, P=0.001) and smoking habit at diagnosis (RR = 1.29, 95%CI= 1.04-4.3,P= 0.04).CONCLUSION: In Spanish population from Madrid, in CD patients carrying at least one NOD2/CARD15 mutation,the -1082G allele is associated with ileocolonic disease and the IL-10G14 microsatellite allele is associated with previous history of appendectomy and smoking habit at diagnosis. These data provide further molecular evidence for a genetic basis of the clinical heterogeneity of CD.

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

    Directory of Open Access Journals (Sweden)

    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.

  11. Increased Risk of Ischemic Stroke in Young Nasopharyngeal Carcinoma Patients

    International Nuclear Information System (INIS)

    Purpose: Radiation/chemoradiotherapy-induced carotid stenosis and cerebrovascular events in patients with nasopharyngeal carcinoma (NPC) can cause severe disability and even death. This study aimed to estimate the risk of ischemic stroke in this patient population over more than 10 years of follow-up. Methods and Materials: The study cohorts consisted of all patients hospitalized with a principal diagnosis of NPC (n = 1094), whereas patients hospitalized for an appendectomy during 1997 and 1998 (n = 4376) acted as the control group and surrogate for the general population. Cox proportional hazard model was performed as a means of comparing the stroke-free survival rate between the two cohorts after adjusting for possible confounding and risk factors. Results: Of the 292 patients with ischemic strokes, 62 (5.7%) were from the NPC cohort and 230 (5.3%) were from the control group. NPC patients ages 35–54 had a 1.66 times (95% CI, 1.16–2.86; p = 0.009) higher risk of ischemic stroke after adjusting for patient characteristics, comorbidities, geographic region, urbanization level of residence, and socioeconomic status. There was no statistical difference in ischemic stroke risk between the NPC patients and appendectomy patients ages 55–64 years (hazard ratio = 0.87; 95% CI, 0.56–1.33; p = 0.524) after adjusting for other factors. Conclusions: Young NPC patients carry a higher risk for ischemic stroke than the general population. Besides regular examinations of carotid duplex, different irradiation strategies or using new technique of radiotherapy, such as intensity modulated radiation therapy or volumetric modulated arc therapy, should be considered in young NPC patients.

  12. Inflammatory bowel disease: the role of environmental factors.

    Science.gov (United States)

    Danese, Silvio; Sans, Miquel; Fiocchi, Claudio

    2004-07-01

    Environmental factors are essential components of the pathogenesis of inflammatory bowel disease (IBD) and primarily responsible for its growing incidence around the globe. Epidemiological, clinical and experimental evidence support an association between IBD and a large number of seemingly unrelated environmental factors, which include smoking, diet, drugs, geographical and social status, stress, microbial agents, intestinal permeability and appendectomy. Data supporting the involvement of each of these factors in predisposing to, triggering, or modulating the course or outcome of IBD vary from strong to tenuous. Smoking and the enteric bacterial flora are the ones for which the most solid evidence is currently available. Smoking increases the risk of Crohn's disease (CD) and worsens its clinical course, but has a protective effect in ulcerative colitis (UC). Presence of enteric bacteria is indispensable to develop gut inflammation in most animal models of IBD, and modulation of the quantity or quality of the flora can be beneficial in patients with IBD. Surprisingly, evidence for a major role of the diet in inducing or modifying IBD is limited, while that for nonsteroidal anti-inflammatory drugs is more convincing than for oral contraceptives. Northern geographic location, and a high social, economical, educational or occupational status increase the risk of IBD, an observation fitting the hygiene hypothesis for allergic and autoimmune diseases. Stress is also associated with IBD, but more as a modifier than an inducing factor, and its contribution is more obvious in IBD animal models than human IBD. Finally, an increased intestinal permeability may increase the risk for developing CD, whereas an appendectomy lowers the risk of developing UC. PMID:15288007

  13. Magnetic resonance imaging in pediatric appendicitis: a systematic review.

    Science.gov (United States)

    Moore, Michael M; Kulaylat, Afif N; Hollenbeak, Christopher S; Engbrecht, Brett W; Dillman, Jonathan R; Methratta, Sosamma T

    2016-05-01

    Magnetic resonance imaging for the evaluation of appendicitis in children has rapidly increased recently. This change has been primarily driven by the desire to avoid CT radiation dose. This meta-analysis reviews the diagnostic performance of MRI for pediatric appendicitis and discusses current knowledge of cost-effectiveness. We used a conservative Haldane correction statistical method and found pooled diagnostic parameters including a sensitivity of 96.5% (95% confidence interval [CI]: 94.3-97.8%), specificity of 96.1% (95% CI: 93.5-97.7%), positive predictive value of 92.0% (95% CI: 89.3-94.0%) and negative predictive value of 98.3% (95% CI: 97.3-99.0%), based on 11 studies. Assessment of patient outcomes associated with MRI use at two institutions indicates that time to antibiotics was 4.7 h and 8.2 h, time to appendectomy was 9.1 h and 13.9 h, and negative appendectomy rate was 3.1% and 1.4%, respectively. Alternative diagnoses were present in ~20% of cases, most commonly adnexal cysts and enteritis/colitis. Regarding technique, half-acquisition single-shot fast spin-echo (SSFSE) pulse sequences are crucial. While gadolinium-enhanced T1-weighted pulse sequences might be helpful, any benefit beyond non-contrast MRI has not been confirmed. Balanced steady-state free precession (SSFP) sequences are generally noncontributory. Protocols do not need to exceed five sequences; four-sequence protocols are commonly utilized. Sedation generally is not indicated; patients younger than 5 years might be attempted based on the child's ability to cooperate. A comprehensive pediatric cost-effectiveness analysis that includes both direct and indirect costs is needed.

  14. 经脐单孔腹腔镜手术35例初探%Initial experience of 35 cases of transumbilical single-port Iaparoscopic surgery

    Institute of Scientific and Technical Information of China (English)

    高魁; 孟源; 晁忠; 李涛

    2011-01-01

    Objective:To investigate the equipment selection and indication of transumbilical single-port laparoscopic operation. Methods:The clinical data of 35 patients who underwent transumbilical single-port laparoscopic surgery from Jun. 2010 to Apr. 2011 were retrospectively analyzed. Results: Nineteen cases of transumbilical single-port cholecystectomy, 11 cases of appendectomy, 3 cases of cholecystectomy and appendectomy ,2 cases of high ligation of spermatic vein were successful, postoperative recovery was satisfactory. Conclusions:-The transumbilical single-port laparoscopic surgery can make use of conventional laparoscopic instruments, and the learning time is short. With the maturity of the technology, this procedure can be generalized in clinic.%目的:总结经脐单孔腹腔镜手术的设备选择及手术适应证.方法:回顾分析2010年6月至2011年4月为35例患者行经脐单孔腹腔镜手术的临床资料.结果:35例手术均获成功,19例行经脐单孔胆囊切除术,11例行阑尾切除术,3例行胆囊联合阑尾切除术,2例行精索静脉高位结扎术,术后患者均恢复顺利.结论:经脐单孔腹腔镜手术可使用常规腹腔镜手术器械,学习时间短,随着腹腔镜手术技能的熟练,可进一步推广应用.

  15. Laparoscopy in the Management of Children with Chronic Recurrent Abdominal Pain

    Science.gov (United States)

    Berezin, Stuart H.; Bostwick, Howard E.; Halata, Michael S.

    1999-01-01

    Background and Objectives: The purpose of the present study was to evaluate the results of diagnostic laparoscopy in children with chronic recurrent abdominal pain. Patients and Methods: Thirteen children with chronic recurrent abdominal pain were subjected to diagnostic laparoscopy. Ages varied from 10 to 17 years. There were six males and seven females. Abdominal pain was present from 3 weeks to 12 months (mean, 2 months). Extensive laboratory and imaging studies did not contribute to the diagnosis. In all patients, the pain was disabling and severe enough to warrant repeated visits to the pediatrician, emergency room visits, or hospital admissions, as well as absence from school. Results: All children recovered uneventfully. Laparoscopic findings that identified the cause of abdominal pain were obtained in 12 of 13 patients. Laparoscopic appendectomy was done in all patients. There were no operative complications. One child presented three months later with incomplete small bowel obstruction, which resolved with conservative management. There were no other postoperative complications. Follow-up varied from six months to three years. Abdominal pain resolved in ten patients. One patient presented eight months later with biliary dyskinesia. She improved following laparoscopic cholecystectomy and later on sphincterotomy, but her pain has not yet completely resolved. One patient presented six months later with abdominal pain secondary to intestinal adhesions. Her pain completely resolved after laparoscopic lysis of adhesions. A third patient who developed lower abdominal pain six months after laparoscopy improved with conservative management and antibiotics for pelvic inflammatory disease. Conclusions: Diagnostic laparoscopy is a valuable procedure in the management of children with chronic recurrent abdominal pain. In the present study, laparoscopic examination revealed the cause of abdominal pain in most patients, and this pain resolved in most cases. Based on our

  16. 瞬时毒血症是阑尾术中寒战的一大原因

    Institute of Scientific and Technical Information of China (English)

    樊宁忠; 程铖

    2013-01-01

    Objective To compare the simple appendicitis and suppurative appendicitis surgery appendectomy operation to deal with the incidence of shivering in a different,indicating the instantaneous toxemia may be prompted to chill place.Methods Appendectomy surgery 76 patients were divided into two groups,36 cases of simpleappendicitis excision,suppurative appendicitis,40 cases of resection,intraoperative appendix operation start to deal with the incidence of shivering within 10 minutes. Results Appendix surgery operations to deal with the incidence of shivering within 10 minutes difference between the control group was significantly(P <0.05).Conclu- sion Appendix clamp led to transient toxemia is a major cause of shivering occurred.%目的比较单纯性阑尾炎和化脓性阑尾炎术中处理阑尾操作时寒战发生率的不同,说明瞬时毒血症可能会促使寒战发生。方法阑尾切除手术76例,分为两组,单纯性阑尾炎切除36例,化脓性阑尾炎切除40例,观察术中开始处理阑尾操作10分钟内寒战发生率。结果术中处理阑尾操作10分钟内寒战发生率对照组比较差异有统计学意义(P<0.05)。结论钳夹阑尾导致瞬时毒血症是寒战发生的一大原因。

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-08-15

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

  18. 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

  19. Goblet cell carcinoid of the appendix

    Directory of Open Access Journals (Sweden)

    Pahlavan Payam S

    2005-06-01

    Full Text Available Abstract Background Goblet cell carcinoid (GCC of the appendix is a rare neoplasm that share histological features of both adenocarcinoma and carcinoid tumor. While its malignant potential remains unclear, GCC's are more aggressive than conventional carcinoid. The clinical presentations of this neoplasm are also varied. This review summarizes the published literature on GCC of the appendix. The focus is on its diagnosis, histopathological aspects, clinical manifestations, and management. Methods Published studies in the English language between 1966 to 2004 were identified through Medline keyword search utilizing terms "goblet cell carcinoid," "adenocarcinoid", "mucinous carcinoid" and "crypt cell carcinoma" of the appendix. Results Based on the review of 57 published papers encompassing nearly 600 diagnosed patients, the mean age of presentation for GCC of the appendix was 58.89 years with equal representation in both males and females. Accurate diagnosis of this neoplasm requires astute observations within an acutely inflamed appendix as this neoplasm has a prominent pattern of submucosal growth and usually lacks the formation of a well-defined tumor mass. The mesoappendix was involved in 21.64% followed by perineural involvement in 2.06%. The most common clinical presentations in order of frequency were acute appendicitis in 22.5%; asymptomatic in 5.4%; non-localized abdominal pain in 5.15% and an appendicular mass in 3.09%. The most common surgical treatment of choice was appendectomy with right hemicolectomy in 34.70% followed by simple appendectomy in 24.57%. Concomitant distant metastasis at diagnosis was present in 11.16% of patients with the ovaries being the most common site in 3.60% followed by disseminated abdominal carcinomatosis in 1.03%. Local lymph node involvement was seen in 8.76% of patients at the time of diagnosis. The reported 5-year survival ranges from 60 % to 84%. GCC's of the appendix remains a neoplasm of unpredictable

  20. Hernia de Amyand: Descripción de un caso con diagnóstico preoperatorio Amyand's hernia: description of one case with presurgical diagnosis

    Directory of Open Access Journals (Sweden)

    J.M. Peraza Casajús

    2011-06-01

    Full Text Available La hernia de Amyand constituye un raro tipo de herniación inguinal en la que su contenido es el apéndice vermiforme, siendo infrecuente encontrarnos con un apéndice inflamado en el interior del saco herniario, y excepcional realizar su diagnóstico preoperatorio, siendo pocos los casos descritos en la literatura. La forma de presentación más frecuente es como una hernia inguinal incarcerada. La sospecha clínica, junto con la realización de pruebas de imagen, fundamentalmente la tomografía computarizada, permitirán una aproximación diagnóstica. El tratamiento depende de los hallazgos intraoperatorios, realizándose apendicectomía transherniotomía o laparotómica, con herniorrafia o hernioplastia inguinales, dependiendo de la presencia de inflamación apendicular o sepsis abdominal. Presentamos el caso de un paciente con una hernia de Amyand diagnosticada preoperatoriamente, con apéndice inflamado y retrocecal, sin evidencias de herniación a la exploración, al que se practicó apendicectomía por vía laparotómica con reparación herniaria en un segundo tiempo.Amyand's hernia is a rare form of inguinal hernia in which the content is the appendix. It is rare to find an inflamed appendix in the inguinal hernia sac and exceptional to perform a presurgical diagnosis, the number of cases described in the literature being small. The most frequent presentation form is as an incarcerated inguinal hernia. The diagnostic approach is based on the clinical suspicion together with imagery techniques, basically computerized tomography. The treatment depends on the intrasurgical findings, either appendix inflammation or abdominal sepsis indicating transherniotomy or laparotomic appendectomy, with inguinal herniorrhaphy or hernioplasty. We present one patient with an Amyand's hernia diagnosed prior to the surgery, with an inflamed retrocecal appendix, without evidence of hernia on clinical examination. A laparotomic appendectomy was carried out

  1. ALVARADO SCORE AND ITS CORRELATION WITH APPENDICITIS

    Directory of Open Access Journals (Sweden)

    Surajit

    2015-11-01

    Full Text Available BACKGROUND Acute appendicitis is the most common cause of an acute abdomen. The treatment is surgical and negative appendectomy rates are high. The Alvarado score can be used to stratify patients with symptoms of suspected appendicitis. It enables risk stratification in patients presenting with abdominal pain, linking the probability of appendicitis to recommendations regarding discharge, observation or surgical intervention. AIMS AND OBJECTIVES This study was conducted to evaluate Alvarado scoring system for diagnosis of acute appendicitis and its correlation with operative finding and histopathology. Patients presenting in the Emergency Department in primary and secondary care settings, especially in low-resource countries where emergency CT scan is not available round the clock can be benefitted from the Alvarado scoring system. MATERIALS AND METHODS The score has 6 clinical items and 2 laboratory measurements with a total 10 points. This study was conducted on 98 patients irrespective of age and sex, who attended the emergency and OPD during the course of the work with symptoms suggestive of acute appendicitis including abdominal pain, rebound tenderness, nausea, vomiting or elevated temperature with/without leukocytosis and neutrophilia, and charts were made for each of the patients. Using the scoring system for appendicitis developed by Alvarado, each chart was scored. Out of 98 patients, 7 patients with Alvarado score of ≤ 4 were treated conservatively and later discharged in stable condition. The remaining 91 patients with score of 5-6 and those with score of ≥ 7 were operated. Operative finding and later histopathological examination confirmed the diagnosis of acute appendicitis in 83 patients out of 91 who underwent appendectomy. RESULT In this study, we compared the Alvarado score of the patient recorded prior to operation with the operative finding and histopathological report. The results were statistically analysed by Student

  2. 腹腔镜Roux-en-Y胃旁路手术中意外发现中肠旋转不良的应对%Malrotation of the midgut in laparoscopic Roux-en-Y gastric bypass

    Institute of Scientific and Technical Information of China (English)

    DAN Dilip; BASCOMBE Nigel; HARNANAN Dave; HARIHARAN Seetharaman; NARAYNSINGH Vijay

    2010-01-01

    Objective To investigate the strategy of malrotation of the midgut encountered during laparoscopic gastrointestinal surgery. Methods A 37 year old morbidly obese male (body weight=140 kg, BMI > 65), presented with complaints of severe lower back pain and significant sleep apnea. After thorough pre-operative assessment, the patient was scheduled for a LRYGB procedure. Malrotation of midgut was found accidentally during the procedure. Besides scheduled LRYGB procedure, an incidental laparoscopic appendectomy was performed and Ladd bands were left intact. Results The procedure was performed successfuly. The total operative time was 3 hours and 10 minutes and the estimated blood loss was minimal. The patient had an uneventful post-operative recovery, an acceptable body weight loss and no longer complains of back pains or sleep apnea. Conclusion Laparoscopic surgeons need to be mindful of the possibility of such anomalies during gastrointestinal surgery. LRYGB can be safely performed in patients with intestinal rotation disorders. Routine appendectomy should be considered as a useful addition to LRYGB in these patients.%目的 探讨在腹腔镜肠道手术中意外发现中肠旋转不良的应对策略.方法 1例37岁男性肥胖症患者,体质量140 kg,BMI大于65,伴有严重下背部疼痛及睡眠呼吸暂停.行腹腔镜Roux-en-Y胃旁路手术(LRYGB),术中意外发现中肠扭转.术中仔细探查后制订合理手术计划,除行原胃旁路手术外,另加行阑尾切除术.结果 手术顺利实施,术中出血极少,手术用时3.17 h.术后恢复良好,体质量明显下降,相关症状亦显著改善.结论 在腹腔镜肠道手术中应留意此类畸形的出现;对于伴有中肠旋转不良的患者,LRYGB手术仍然可安全施行;阑尾切除术或可使患者受益.

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

    Science.gov (United States)

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

    2013-01-01

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

  4. Clinical experience of embryonic natural orifice transluminal endoscopic surgery%经脐单孔腹腔镜手术体会

    Institute of Scientific and Technical Information of China (English)

    龚昭; 周程; W.J.KARCZ; 胡思安; 阮剑; 严白莉

    2011-01-01

    [Objective] To discuss the feasibility, methods and clinical experience of embryonic natural orifice transluminal endoscopic surgery. [Methods] The 37 patients were treated by transumbilical single port laparoscopic method, 26 cases of cholecystectomies, 7 liver cyst fenestrations and 4 appendectomies were performed. [ Results ] All the operations were done successfully. The average operation time is about 56.6min. No drainage was placed and there were no bleeding, intra-abdominal abscess or incision infection complications. No visible scar was observed two weeks after operation. [Conclusion] The Embryonic natural orifice transluminal endoscopic surgery technique could be safely and effectively used in cholecystectomy, liver cyst fenestration, and appendectomy. It has the advantages of cosmetic and less post operation pain. Compared with classic laparoscopic surgery, the technique of E-NOTES is more difficult and the instruments still need to be mend, anyway the E-NOTES is a creative method and technique.%目的 探讨经脐单孔腹腔镜手术的可行性.方法 37例患者均经脐单孔入路腹腔镜操作,完成胆囊切除26例,肝囊肿开窗术7例,阑尾切除术4例.结果 37例均顺利完成手术,平均手术时间56.6min,术后来置引流管、无出血、腹脓肿及切口感染等并发症.术后2周复查无明显脐部手术瘢痕.结论 经脐单孔腹腔镜外科技术在胆囊切除、肝囊肿开窗以及阑尾切除术中的应用是安全可行的,且美容效果好,术后疼痛轻.虽然较传统腹腔镜外科技术而言存在着相对难度较大、手术器械需完善等问题,仍是一种有创新性的手术思路和方法.

  5. 经脐单孔腹腔镜胆囊切除术20例报告%The transumhilical single port laparoscopic cholecystectomy :a report or 20 cases

    Institute of Scientific and Technical Information of China (English)

    孙凯; 李杰; 田虎; 徐宗珍; 刘锋

    2011-01-01

    Objective:To discuss the clinical application of transumbilical single port laparoscopic surgery. Methods:The clinical data of 20 patients with gallbladder and appendix diseases undergoing transumbiiical single port laparoscopic surgery from Jul. 2010 to Jan.2011 were analyzed retrospectively. Results: All the operations were successfully performed. 18 patients underwent eholecystecto-my ,2 patients accepted cholecystectomy and appendectomy. None of them experienced conversion to open surgery or conventional laparoscopic surgery. The operating time ranged from 15 to 70 min,the blood loss was little without drainage tube. No complications occurred, postoperative hospital slay was 2-4 d. The abdominal wall scar was not obvious in follow-up of one month. Conclusions: Transumbiiical single port laparoscopic cholecystectomy and appendectomy is safe and feasible. Compared with the routing laparoscopic surgery, it has more mini-invasive advantages,less pain and abdominal wall scar,but the operation is difficult to perform. This surgery can be applied in qualified hospital with suitable indication.%目的:探讨经脐单孔腹腔镜手术的应用价值.方法:回顾分析2010年7月至2011年1月为20例患者行经脐单孔腹腔镜手术的临床资料,结果:18例行胆囊切除术,2例同时切除胆囊及阑尾,手术均获成功,无中转开腹或常规腹腔镜手术,手术时间15~70 min,术中出血少,均未放置引流管,无并发症发生,术后2~4 d出院,随访1个月腹部瘢痕不明显.结论:经脐单孔腹腔镜胆囊及阑尾切除术安全可行,比常规腹腔镜手术更微创,具有患者疼痛轻、腹壁瘢痕不明显等优点.但手术操作相对困难,对术者技术水平要求高,可在有条件的医院选择适合病例开展.

  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. Home-care After Apperdoctomy for Early Acutc Appendicitis in Children%阑尾炎术后的门诊治疗

    Institute of Scientific and Technical Information of China (English)

    牛文英; 张金哲

    1992-01-01

    Owing to the fact that the postoperative course of simple acute appendicitis is always uneventful,the rationality of home-care after appendectomy has been considered.100 random cases were collected on the following criteria,age above 4 years,history shorter than 24 heurs,general condition good and free from toxic symptoms,localized tenderness in R.L.Q.without distension,no mass by either rectal or abdominal examination,and no gross perforation of appendix or frank pus found in peritoneal cavity at operation.All cases met the above criteria were admitted and treated under the following regimen including:free from bed,eral feeding and oral medication,no infusion or injection,imitating the home-life care according to the age.Another 116 random cases of the sanle criteria were admitted as controls,but treated under the conventional inpatient regimen in eluding:I.v.drip for a day or two,antibiotics for a week,and routine hospital nursing care until discharge.All the 216 cases were discharged uneventfully.There was no significant difference between these 2 groups.The conclusion is naturally that the simple and early acute appendicitis in children would be better sent home after appendectomy to enjoy the family care.It is not only good for mother and child,but also good for the hospital and society in solving the shortage of the pediatric surgical beds.%作者报告采用模拟门诊治疗,前瞻性观察急性阑尾炎未穿孔的100例患儿,并与同期同祥条件常规住院治疗的116例阑尾炎相比较,说明该类息儿术后出院,在门诊继续治疗是可行的,并且是安全可靠的.

  8. Idiopathic omental infarction, diagnosed and managed laparoscopically: a case report.

    Science.gov (United States)

    Abdulaziz, Ahmed; El Zalabany, Tamer; Al Sayed, Abdul Rahim; Al Ansari, Ahmed

    2013-01-01

    Idiopathic omental infarction is a rare cause of acute abdomen in adults, and the clinical finding can mimic acute appendicitis. Although idiopathic omental infarction is uncommon, the incidence of its detection has become more frequent as a result of advances in radiological technologies. We reported on a 21-year-old man who presented with sudden onset of intermittent right lower quadrant abdominal pain for seven days. The pain became more localized at the right iliac fossa (RIF) at day 2 before admission. A physical examination revealed a fever (38.2°C), severe RIF tenderness, mass-like fullness, and positive rebound tenderness. A CT of the abdomen showed inflammatory changes and increased fat density mass in the right upper quadrant measuring 5 × 4 cm representing focal panniculitis. However, the appendix was visualized normally and the findings were not in favor of acute appendicitis. Diagnosis was carried on laparoscopically. Serosanguinous free fluid was found in all abdominal quadrants. A 6 × 4 cm gangrenous omental mass was noted. The omental mass was excised and an appendectomy was performed. In summary, omental infarction should be considered as a deferential diagnosis for acute right-sided abdominal pain, especially if the clinical finding does not correspond to appendicitis.

  9. Idiopathic Omental Infarction, Diagnosed and Managed Laparoscopically: A Case Report

    Directory of Open Access Journals (Sweden)

    Ahmed AbdulAziz

    2013-01-01

    Full Text Available Idiopathic omental infarction is a rare cause of acute abdomen in adults, and the clinical finding can mimic acute appendicitis. Although idiopathic omental infarction is uncommon, the incidence of its detection has become more frequent as a result of advances in radiological technologies. We reported on a 21-year-old man who presented with sudden onset of intermittent right lower quadrant abdominal pain for seven days. The pain became more localized at the right iliac fossa (RIF at day 2 before admission. A physical examination revealed a fever (38.2∘C, severe RIF tenderness, mass-like fullness, and positive rebound tenderness. A CT of the abdomen showed inflammatory changes and increased fat density mass in the right upper quadrant measuring 5×4 cm representing focal panniculitis. However, the appendix was visualized normally and the findings were not in favor of acute appendicitis. Diagnosis was carried on laparoscopically. Serosanguinous free fluid was found in all abdominal quadrants. A 6×4 cm gangrenous omental mass was noted. The omental mass was excised and an appendectomy was performed. In summary, omental infarction should be considered as a deferential diagnosis for acute right-sided abdominal pain, especially if the clinical finding does not correspond to appendicitis.

  10. Benign metastasizing leiomyoma in triple location: lungs, parametria and appendix

    Science.gov (United States)

    Raś, Renata; Książek, Mariusz; Skręt-Magierło, Joanna; Kąziołka, Wojciech; Fudali, Ludmiła; Filipowska, Justyna; Skręt, Andrzej

    2016-01-01

    Benign metastasizing leiomyoma (BML) usually are situated in one organ, most often in lungs. BML patients typically have a history of uterine leiomyoma treated with hysterectomy, myomectomy or subtotal hysterectomy. The aim of the study was to present the case of a 53-year-old woman with triple location in the lungs, parametria and appendix. She had undergone a myomectomy 26 years earlier. In 2015, she was admitted to the surgical department because of abdominal pain, whereupon a cholecystectomy was performed. CT scans showed pelvic mass with pulmonary metastasis. Upon discharge the patient was referred to the Gynecology Clinic, where a laparotomy was performed. The intraoperative findings were: 1) uterus with multiple leiomyomas, 2) four tumors in the parametria, 3) tumor connected to the appendix. A subtotal hysterectomy, with a bilateral salpingo-oophorectomy, removal of the tumors from the parametria and appendectomy was performed. Pathology confirmed the diagnosis based on morphology and immunohistochemical staining (strongly positive for estrogen receptors and SMA, while Ki67 was very low, below 1%). Upon postoperative recovery, the patient was referred to the Thoracic Surgery Department. During the thoracotomy, multiple nodes, surrounded by lung parenchyma, were revealed. Wedge resection was performed, for localized pulmonary lesions, and sent for pathological examination. The final pathological diagnosis was benign metastasizing leiomyomatosis. In conclusion, the triple location of BML could possibly be a result of a parallel different metastasizing mechanism, although it is impossible to exclude one mechanism, which may be the cause of the metastases in three locations.

  11. Environmental risk factors for inflammatory bowel diseases: a review.

    Science.gov (United States)

    Ananthakrishnan, Ashwin N

    2015-02-01

    Inflammatory bowel diseases comprising Crohn's disease (CD) and ulcerative colitis (UC) are chronic immunologically mediated diseases. The key mechanism underlying the pathogenesis of these diseases is a dysregulated immune response to commensal flora in a genetically susceptible host. Thus intestinal microbial dysbiosis, host genetics, and the external environment all play an important role in the development of incident disease and in determining subsequent disease behavior and outcomes. There are several well-defined or putative environmental risk factors including cigarette smoking, appendectomy, diet, stress and depression, vitamin D as well as hormonal influence. The effect of some of the risk factors appears to differ between CD and UC suggesting that despite shared genetic and immunologic mechanisms, distinct pathways of pathogenesis exist. There is a growing body of literature identifying risk factors for incident disease. There is less rigorous literature defining triggers of relapse, and few controlled clinical trials examining if modification of such risk factors results in an improvement in patient outcomes. This is an area of considerable patient, physician, and scientific interest, and there is an important unmet need for rigorous studies of the external environment in disease pathogenesis and subsequent course.

  12. Malignant peritoneal mesothelioma presenting with persistent high fever

    Institute of Scientific and Technical Information of China (English)

    Li-ying CHEN; Ling-xiu HUANG; Jin WANG; Yi QIAN; Li-zheng FANG

    2011-01-01

    Malignant peritoneal mesothelioma (MPM) is a rare tumor that develops in the peritoneum. In this paper,we describe an extremely rare case of MPM metastasizing to the appendix in a 48-year-old female who initially presented with a persistent high fever. The woman reported a slight lower abdominal discomfort which had been relieved by urination for four months. She had lost 5 kg of weight. There was no nausea, vomiting, diarrhea, abdominal pain, or abdominal distension. Many broad spectrum antibiotics were given without relief of fever. Computed tomography (CT) scans revealed a thickened omentum majus and diffused multiple omental nodules. An omentectomy, appendectomy, and adnexectomy were carried out. A gross pathologic specimen of omentum tissue revealed a firm gray-white mass. Microscopic and immunohistochemical examinations confirmed the diagnosis of appendiceal and bilateral adnexal metastases of an MPM. These results suggest that MPM should be considered in the differential diagnosis of unexplained persistent high fever. Awareness of such atypical presentations of mesothelioma may help to make a correct diagnosis.

  13. Complex Laparoscopic Myomectomy with Severe Adhesions Performed with Proper Preventive Measures and Power Morcellation Provides a Safe Choice in Certain Infertility Cases

    Science.gov (United States)

    Alfaro-Alfaro, Jaime; Flores-Manzur, María de los Ángeles; Nevarez-Bernal, Roberto

    2016-01-01

    Laparoscopic myomectomy offers a real benefit to infertile patients with uterine fibroids and peritoneal adhesions. The procedure requires a skilled surgeon and laparoscopy technique to minimize adhesion formation and other proven benefits. Restrictions arise since this procedure requires power morcellation for fibroid tissue extraction. Two years ago, the Food and Drug Administration in the United States of America (FDA) issued the alert on power morcellation for uterine leiomyomas, addressing the risk of malignant cell spreading within the abdominal cavity (actual risk assessment from 1 in 360 to 1 in 7400 cases). We review a 30-year-old female, without previous gestations, hypermenorrhea, intermenstrual bleeding, and chronic pelvic pain. Transvaginal ultrasound reports multiple fibroids in the right portion of a bicornuate uterus. Relevant history includes open myomectomy 6 years before and a complicated appendectomy, developing peritonitis within a year. Laparoscopy revealed multiple adhesions blocking uterine access, a bicornuate uterus, and myomas in the expected site. Myomectomy was performed utilizing power morcellation with good results. FDA recommendations have diminished this procedure's selection, converting many to open variants. This particular case was technically challenging, requiring morcellation, and safety device deployment was impossible, yet the infertility issue was properly addressed. Patient evaluation, safety measures, and laparoscopy benefits may outweigh the risks in particular cases as this one. PMID:27668110

  14. Emergency presurgical visit

    Directory of Open Access Journals (Sweden)

    Alfredo Castro Díaz

    2009-07-01

    Full Text Available The objective has been to create a Protocol of Structured Presurgical Visit applicable to the patients who are undergoing an emergency surgery, to provide the user and his family all the necessary cares on the basis of those nursing diagnosis that prevail in all the cases of surgical emergency interventions. The used method has been an analysis of the emergency surgical interventions more prevalent from February 2007 until October 2008 in our area (a regional hospital, and statistic of those nursing diagnosis that more frequently appeared in these interventions, the previous moment to the intervention and in addition common to all of them. The results were the following ones: the more frequent emergency operations were: Caesarean, ginecological curettage, laparotomy, help in risk childbirth, orthopaedic surgery and appendectomy. The more frequent nursing diagnosis in all the emergency operations at the previous moment of the intervention were: risk of falls, pain, anxiety, deficit of knowledge, risk of infection, movement stress syndrome, risk of hemorrhage, cutaneous integrity deterioration. The conclusion is that users present at the previous moment to an emergency operation several problems, which force to the emergency surgical ward nurse to the introduction of the nursing methodology, in order to identify the problems, to mark results and to indicate the interventions to achieve those results, besides in a humanitarian way and with quality. This can be obtained by performing a Structured Emergency Presurgical Visit.

  15. Predicting outcome after appendicectomy.

    LENUS (Irish Health Repository)

    Kell, M R

    2012-02-03

    AIM: To validate an intraoperative appendicitis severity score (IASS) and examine outcome following emergency appendectomy. METHODS: A prospective study was undertaken, enrolling consecutive patients undergoing emergency appendicectomy. Data were obtained independently on preoperative Alvarado scores, IASS (0-3: 0 no inflammation, 1 engorged appendix\\/no peritonitis, 2 peritoneal reaction\\/exudate or 3 evidence of perforation\\/abscess) and postoperative outcome parameters. RESULTS: There were 149 patients identified with a mean age of 20.7 years. There was no association between Alvarado score and length of hospital stay, septic complication, patient sex or duration of symptoms (p>0.05). IASS was found to be an independent risk factor for septic complication, wound infection (p<0.05) and length of hospital stay (p<0.001). There was no correlation between preoperative duration of symptoms or time until surgery and intraoperative score. CONCLUSIONS: This simple scoring system can identify patients more likely to suffer morbidity following emergency appendicectomy. Specifically, this system identifies patients who have a high risk of sepsis and therefore could be of use when comparing healthcare performance.

  16. Geographic disparities in the risk of perforated appendicitis among children in Ohio: 2001–2003

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    Nwomeh Benedict C

    2008-11-01

    Full Text Available Abstract Background Rural-urban disparities in health and healthcare are often attributed to differences in geographic access to care and health seeking behavior. Less is known about the differences between rural locations in health care seeking and outcomes. This study examines how commuting patterns in different rural areas are associated with perforated appendicitis. Results Controlling for age, sex, insurance type, comorbid conditions, socioeconomic status, appendectomy rates, hospital type, and hospital location, we found that patient residence in a rural ZIP code with significant levels of commuting to metropolitan areas was associated with higher risk of perforation compared to residence in rural areas with commuting to smaller urban clusters. The former group was more likely to seek care in an urbanized area, and was more likely to receive care in a Children's Hospital. Conclusion To our knowledge, this is the first study to differentiate rural dwellers with respect to outcomes associated with appendicitis as opposed to simply comparing "rural" to "urban". Risk of perforated appendicitis associated with commuting patterns is larger than that posed by several individual indicators including some age-sex cohort effects. Future studies linking the activity spaces of rural dwellers to individual patterns of seeking care will further our understanding of perforated appendicitis and ambulatory care sensitive conditions in general.

  17. Cholecystectomy by single incision laparoscopic surgery (SILS): early experience and technique standardization.

    Science.gov (United States)

    Ceci, F; Di Grazia, C; Cipriani, B; Nicodemi, S; Corelli, S; Pecchia, M; Martellucci, A; Costantino, A; Stefanelli, F; Salvadori, C; Napoleoni, A; Parisella, M; Spaziani, E; Stagnitti, F

    2012-01-01

    Single Incision Laparoscopic Surgery (SILS) is a recent surgical technique, first described in the 1990s. Its aim is to optimize the esthetic result offered by laparoscopy by minimizing the number of abdominal incisions. Various preliminary studies have been carried out on the application of SILS, especially in cholecystectomy and appendectomy. This study evaluates the preliminary results of cholecystectomy by SILS (SILS™ Port) conducted between October 2009 and February 2011 on 21 patients (4 men and 17 women) with a mean age of 49.9 years and a mean Body Mass Index (BMI) of 22.8. All patients were treated by the same team, which had previously undergone six months' simulator training. There were two main selection criteria, both evaluated intraoperatively: absence of adhesions and of significant inflammatory sequelae from previous cholecystitis; and suitable distance between gallbladder and SILS access port. Conversion to traditional laparoscopy was necessary in just two cases, while an accessory trocar was introduced in another two cases. Conversion to open surgery was not necessary in any case. One case of SILS cholecystectomy was complicated by postoperative bile leakage, which was treated conservatively, as the fistula had a low output. The mean duration of hospitalization was 3.6 days. This preliminary experience led us to conclude that SILS is safe and highly satisfactory in the postoperative phase, thanks to the reduced need for painkillers and the improved esthetic result. PMID:23017290

  18. 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.

  19. Benign metastasizing leiomyoma in triple location: lungs, parametria and appendix

    Science.gov (United States)

    Raś, Renata; Książek, Mariusz; Skręt-Magierło, Joanna; Kąziołka, Wojciech; Fudali, Ludmiła; Filipowska, Justyna; Skręt, Andrzej

    2016-01-01

    Benign metastasizing leiomyoma (BML) usually are situated in one organ, most often in lungs. BML patients typically have a history of uterine leiomyoma treated with hysterectomy, myomectomy or subtotal hysterectomy. The aim of the study was to present the case of a 53-year-old woman with triple location in the lungs, parametria and appendix. She had undergone a myomectomy 26 years earlier. In 2015, she was admitted to the surgical department because of abdominal pain, whereupon a cholecystectomy was performed. CT scans showed pelvic mass with pulmonary metastasis. Upon discharge the patient was referred to the Gynecology Clinic, where a laparotomy was performed. The intraoperative findings were: 1) uterus with multiple leiomyomas, 2) four tumors in the parametria, 3) tumor connected to the appendix. A subtotal hysterectomy, with a bilateral salpingo-oophorectomy, removal of the tumors from the parametria and appendectomy was performed. Pathology confirmed the diagnosis based on morphology and immunohistochemical staining (strongly positive for estrogen receptors and SMA, while Ki67 was very low, below 1%). Upon postoperative recovery, the patient was referred to the Thoracic Surgery Department. During the thoracotomy, multiple nodes, surrounded by lung parenchyma, were revealed. Wedge resection was performed, for localized pulmonary lesions, and sent for pathological examination. The final pathological diagnosis was benign metastasizing leiomyomatosis. In conclusion, the triple location of BML could possibly be a result of a parallel different metastasizing mechanism, although it is impossible to exclude one mechanism, which may be the cause of the metastases in three locations. PMID:27582687

  20. Segmental Infarction of Omentum –A Case Report

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    SA Jalali

    2001-09-01

    Full Text Available Idiopathic or spontaneous segmental infarction of omentum is a rare disease producing acute abdominal emergency. This rare entity is in a small group of abdominal emergencies with circulatory compromise. Infarction could be caused by omental torsion which could be due to adhesion of a previouse surgery or it could be spontaneous. Less than 150 cases of idiopathic segmental infarction of omentum has been reported since it was first reported about hundred years ago. The importance of this abdominal emergency lies ion differential diagnosis of acute appendecitis because its defenitive diagnosis is made only after laparotomy. In these cases the appendix is normal and besides an amount of serosanguinous fluid in the peritoneal cavity, a segment of omentum is infarcted. A case of idiopathic segmental infarction is reported in a 37-year-old heavy weigh male. The suggested procedure is appendectomy and segmental resection of the necrotic piece of omentum. In this case no adhesion or torsion of omentum was present.

  1. A changing trend in the management of patients with newly diagnosed Crohn's disease.

    LENUS (Irish Health Repository)

    Qasim, A

    2012-02-01

    BACKGROUND: Epidemiologic shift with rising incidence of Crohn\\'s disease (CD) has been reported in recent studies. AIMS: To determine disease behaviour and therapeutic interventions undertaken in newly diagnosed patients with CD. METHODS: Patients diagnosed with CD between January 2006 and June 2008 were included. Disease type, location, degree of involvement and type of therapeutic interventions were recorded. RESULTS: A total of 78 patients were included. Colonic, ileo-colonic, terminal ileal and isolated small bowel disease were present in 37, 27, 9 and 5 patients, respectively. Disease phenotype was inflammatory, stenosing and fistulising in 42, 30 and 6 patients, respectively. Surgery was required in 22 patients, including right hemicolectomy (n = 8), subtotal colectomy (n = 4), segmental colonic resection (n = 2), segmental small bowel resection (n = 2), appendectomy (n = 2) and perianal surgery (n = 4). Fourteen patients underwent surgery at the time of diagnosis. Laparoscopic surgery was performed in 14 patients. CONCLUSIONS: A significant proportion of newly diagnosed patients with CD underwent surgical intervention on their first admission to hospital. This may signify a changing trend in the management approach.

  2. Oxaliplatin-Induced Tonic-Clonic Seizures

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    Ahmad K. Rahal

    2015-01-01

    Full Text Available Oxaliplatin is a common chemotherapy drug used for colon and gastric cancers. Common side effects are peripheral neuropathy, hematological toxicity, and allergic reactions. A rare side effect is seizures which are usually associated with posterior reversible leukoencephalopathy syndrome (PRES. A 50-year-old male patient presented with severe abdominal pain. CT scan of the abdomen showed acute appendicitis. Appendectomy was done and pathology showed mixed adenoneuroendocrine carcinoma. Adjuvant chemotherapy was started with Folinic acid, Fluorouracil, and Oxaliplatin (FOLFOX. During the third cycle of FOLFOX, the patient developed tonic-clonic seizures. Laboratory workup was within normal limits. EEG and MRI of the brain showed no acute abnormality. The patient was rechallenged with FOLFOX but he had tonic-clonic seizures for the second time. His chemotherapy regimen was switched to Folinic acid, Fluorouracil, and Irinotecan (FOLFIRI. After 5 cycles of FOLFIRI, the patient did not develop any seizures, making Oxaliplatin the most likely culprit for his seizures. Oxaliplatin-induced seizures rarely occur in the absence of PRES. One case report has been described in the literature. We present a rare case of tonic-clonic seizures in a patient receiving Oxaliplatin in the absence of PRES.

  3. 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.

  4. Single-Incision Single-Instrument Adnexal Surgery in Pediatric Patients

    Directory of Open Access Journals (Sweden)

    Tara Loux

    2015-01-01

    Full Text Available Introduction. Pediatric surgeons often practice pediatric gynecology. The single-incision single-instrument (SISI technique used for appendectomy is applicable in gynecologic surgery. Methods. We retrospectively analyzed the records of patients undergoing pelvic surgery from 2008 to 2013. SISI utilized a 12 mm transumbilical trocar and an operating endoscope. The adnexa can be detorsed intracorporeally or extracorporealized via the umbilicus for lesion removal. Results. We performed 271 ovarian or paraovarian surgeries in 258 patients. In 147 (54%, the initial approach was SISI; 75 cases (51% were completed in patients aged from 1 day to 19.9 years and weighing 4.7 to 117 kg. Conversion to standard laparoscopy was due to contralateral oophoropexy, solid mass, inability to mobilize the adnexa, large mass, bleeding, adhesions, or better visualization. When SISI surgery was converted to Pfannenstiel, the principal reason was a solid mass. SISI surgery was significantly shorter than standard laparoscopy. There were no major complications and the overall cohort had an 11% minor complication rate. Conclusion. SISI adnexal surgery is safe, quick, inexpensive, and effective in pediatric patients. SISI was successful in over half the patients in whom it was attempted and offers a scarless result. If unsuccessful, the majority of cases can be completed with standard multiport laparoscopy.

  5. Lead poisoning in a 16-year-old girl: a case report and a review of the literature (CARE compliant)

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    Mărginean, Cristina Oana; Meliţ, Lorena Elena; Moldovan, Horaţiu; Lupu, Vasile Valeriu; Mărginean, Maria Oana

    2016-01-01

    Abstract Background: Lead is a toxic element of the environment which leads to major complications once it enters the blood stream, affecting multiple organs and systems of the body. Methods: We present the case of a 16-year-old girl, diagnosed with lead poisoning after occupational exposure due to the fact that the girl was actively involved in the family's pottery business. History revealed that the girl participated in the process of pottery, her father was also diagnosed with lead poisoning 2 years before. The patient's personal history underlined that approximately 1 year ago she presented with severe abdominal pain, being diagnosed with acute appendicitis and she underwent appendectomy, but the pain persisted, thus due to family history of lead poisoning, the suspicion of saturnine colic rose, and she was diagnosed with lead poisoning. The main symptoms and signs were severe abdominal pain, vomiting, and arterial hypertension. The clinical evolution was favorable under symptomatic treatment and chelation therapy. Results: Lead toxicity is a life-threatening condition because of its severe acute and chronic complications. In children, there is no safe blood lead level, prevention methods are, therefore, very important in order to avoid toxic multiorganic effects of this metal. Conclusion: Even though the diagnosis of lead poisoning remains difficult in children, it must also be taken into consideration by the clinician facing a child with gastrointestinal or neurological involvement. PMID:27661040

  6. Laparoscopic management of intra-abdominal infections: Systematic review of the literature

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    Coccolini, Federico; Tranà, Cristian; Sartelli, Massimo; Catena, Fausto; Saverio, Salomone Di; Manfredi, Roberto; Montori, Giulia; Ceresoli, Marco; Falcone, Chiara; Ansaloni, Luca

    2015-01-01

    AIM: To investigate the role of laparoscopy in diagnosis and treatment of intra abdominal infections. METHODS: A systematic review of the literature was performed including studies where intra abdominal infections were treated laparoscopically. RESULTS: Early laparoscopic approaches have become the standard surgical technique for treating acute cholecystitis. The laparoscopic appendectomy has been demonstrated to be superior to open surgery in acute appendicitis. In the event of diverticulitis, laparoscopic resections have proven to be safe and effective procedures for experienced laparoscopic surgeons and may be performed without adversely affecting morbidity and mortality rates. However laparoscopic resection has not been accepted by the medical community as the primary treatment of choice. In high-risk patients, laparoscopic approach may be used for exploration or peritoneal lavage and drainage. The successful laparoscopic repair of perforated peptic ulcers for experienced surgeons, is demonstrated to be safe and effective. Regarding small bowel perforations, comparative studies contrasting open and laparoscopic surgeries have not yet been conducted. Successful laparoscopic resections addressing iatrogenic colonic perforation have been reported despite a lack of literature-based evidence supporting such procedures. In post-operative infections, laparoscopic approaches may be useful in preventing diagnostic delay and controlling the source. CONCLUSION: Laparoscopy has a good diagnostic accuracy and enables to better identify the causative pathology; laparoscopy may be recommended for the treatment of many intra-abdominal infections. PMID:26328036

  7. Teníase: uma causa rara de apendicite aguda Taeniasis: a rare cause of acute appendicitis

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    Fábio Vieira Teixeira

    2008-02-01

    Full Text Available Acute appendicitis is the most common surgical condition of acute abdomen. Approximately 7 percent of the population will have appendicitis during their lifetime, with the peak incidence occurring between 10 through 30 years-old. Obstruction of the appendix lumen with subsequent bacterial infection initiates the pathophysiological sequence of acute appendicitis. Obstruction may have multiple causes, including fecalith, lymphoid hyperplasia (related to viral illnesses, including upper respiratory infection, mononucleosis, and gastroenteritis, foreign bodies, carcinoid tumor, and parasites. In Asia, Africa and Latin America, Enterobius vermicularis has been reported as the main parasite that causes appendix obstruction. Rarely, Taenia sp., has been pointed as a cause of parasitic appendicitis. We reported a 30 years-old patient clinically diagnosed with acute appendicitis. The appendectomy was performed through a McBurney incision. The patient's convalescence was uneventful, and he was discharged from hospital 48 hours after operation. Histological examination of the appendix showed acute appendicitis, and it was found a parasite (Taenia sp. lying inside of the appendix lumen at a transverse section. He has received 10 mg/Kg weight of praziquantel for taeniasis treatment.

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

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    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.

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

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    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. 免钛夹单双极电凝法腹腔镜阑尾切除术60例临床体会

    Institute of Scientific and Technical Information of China (English)

    郑富强; 邓润钦; 梁绍诚; 骆剑华; 张焕彬; 黄海; 杨守东; 甘秋萍

    2013-01-01

    Objective To explore the feasibility and security of monopolar and bipolar electrocoagulation in the laparoscopic appendectomy(LA) without clips.Methods The clinical data of 60 patients who underwent LA with monopolar and bipolar electrocoagulation without clips from Nov.2010 to Oct.2012 were retrospectively analyzed.Results A 1 l of the 60 eases were treated successfully under laparoscopy without conversiong to open surgery.Mean operation time was(50±10.1)min (range,30~80 min).Mean length of hospital stay was(5±0.8)d(range, 4~7 d).No severe complications such as postoperative hemorrhage ,infection or intestinal obstructio were found.Conclusion We conclude that the monopolar and bipolar electrocoagulation without clips can be used safely in LA with shorter operative time ,less blood loss and cost .This procedure is worth popularization without titanium clips left.%  目的探讨腹腔镜阑尾切除术(laparoscopic appendeetolny,LA)应用单双极电凝法的可行性及安全性。方法回顾分析2010年11月-2012

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

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    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

  12. Continuous Amenorrhea May Be Insufficient to Stop the Progression of Colorectal Endometriosis.

    Science.gov (United States)

    Millochau, Jenny-Claude; Abo, Carole; Darwish, Basma; Huet, Emmanuel; Dietrich, Gauthier; Roman, Horace

    2016-01-01

    We present the case of a patient in whom consecutive imaging assessment and surgery demonstrated the obvious progression of colorectal endometriosis under continuous medical therapy. A 26-year-old nullipara presented with secondary dysmenorrhea, deep dyspareunia, diarrhea, and constipation during menstruation. Magnetic resonance imaging (MRI) assessment revealed 2 right ovarian endometriomas, but no deep endometriosis lesion. Intraoperatively, we found a 2-cm length of thickened and congestive area of sigmoid colon, along with small superficial lesions arising in the small bowel and appendix. We performed ablation of ovarian endometriomas and appendectomy, and decided to not resect the bowel. Postoperative computed tomography-based virtual colonoscopy (CTC) revealed a slight abnormality of the sigmoid colon. Endorectal ultrasound identified a normal rectum and sigmoid colon. Despite long-term continuous medical treatment, the patient presented 4 years later with impaired digestion consisting in constipation alternating with diarrhea, bloating, dyschesia, and pelvic pain. MRI and CTC revealed an abnormal sigmoid colon from 42 to 50 cm above the anus, with digestive tract diameter reduced from 10 mm down to the virtual lumen, along with an overall rigid appearance. Laparoscopy revealed the extent of endometriosis lesions in the sigmoid colon and multiple implantations in the small bowel. We performed sigmoid and small bowel resection. This case demonstrates the obvious progression of deep rectal endometriosis despite 4 years of continuous hormonal therapy. PMID:27130533

  13. Perforation Peritonitis: A Two Year Experience

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    Shyam Kumar Gupta, Rajan Gupta, Gurdev Singh, Sunil Gupta

    2010-07-01

    Full Text Available Four hundred patients who presented in the emergency of GMC Jammu as a case of perforation peritonitisover a period of two years were studied. In most of the cases diagnosis was made by clinical examinationsupplemented by investigations in the form of standing X-ray chest PA view with domes of diaphragm,Ultrasound abdomen and abdominal paracentesis. Contrast enhanced CT scans of abdomen wereconducted on patients where the diagnosis of perforation peritonitis was doubtful. After resuscitation,Laparotomy was done in all the patients and thorough peritoneal lavage was done. A note of the site,size, type, number of perforations was made and biopsy was taken from the edge of the perforationwhenever indicated. The most common cause of gastrointestinal perforation in our study was duodenalulcer perforation, followed by appendicitis, typhoid perforation, blunt/penetrating trauma, gastric perforation,obstruction, iatrogenic, malignancy, and recurrent perforation. Primary closure of the perforation wasmost commonly done procedure, followed by appendectomy, resection anastomosis of the gut andexteriorization of the gut. The overall mortality was 6 % and morbidity in the form of wound infection,fever, respiratory complications, residual abscess, dyselectrolytemia, burst abdomen, jaundice, sepsis,cardiac complications, anastomotic disruption was present

  14. [A Case of Intra-Abdominal Desmoid Tumor with Abacterial Peritonitis].

    Science.gov (United States)

    Sumiyama, Fusao; Inada, Ryo; Nakamura, Fumiko; Ryota, Hironori; Miki, Hirokazu; Oishi, Masaharu; Matsumoto, Tomoko; Iwamoto, Shigeyoshi; Mukaide, Yumi; Ozaki, Takeshi; Michiura, Taku; Inoue, Kentaro; Kon, Masanori; Miyasaka, Chika; Uemura, Yoshiko; Hamada, Madoka

    2016-03-01

    A woman in her 50s visited our hospital in February 2015 with a complaint of dull abdominal pain in the right lower quadrant. She had a medical history of appendectomy for appendicitis in her 20s. Computed tomography(CT)revealed a tumor 90 mm in diameter near the ileocecum. Elective surgery was planned under the suspicion of gastrointestinal tumor, malignant lymphoma, or ileal cancer. She was emergently hospitalized 1 day earlier than scheduled because of high fever and severe abdominal pain. CT revealed that the tumor had increased to 120 mm in diameter without free air. Her white blood cell count was not elevated, and her symptoms improved readily with medical treatment. Thus, we performed the operation as scheduled. A tumor with a dark red recess on the surface had invaded the transverse colon intraoperatively, and a small amount of purulent ascites was present at the pouch of Douglas. We performed ileocecal resection with partial transverse colectomy. Histopathological examination led to the diagnosis of desmoid tumor in the mesentery of the terminal ileum. The surgical margins were negative for tumor cells. The tumor surface around the recess showed peritonitis, and the ascites showed no bacteria or tumor cells. The patient had been doing well without recurrence after discharge. Some cases of desmoid tumor with peritonitis have been reported, but most were caused by tumor penetration into the intestinal tract. We report herein a rare case of intra-abdominal desmoid tumor with abacterial peritonitis.

  15. 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.

  16. Situs inversus totalis with perforated duodenal ulcer: a case report

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    Khan Faiz

    2011-07-01

    Full Text Available Abstract Introduction Situs inversus is an uncommon anomaly. Situs inversus viscerum can be either total or partial. Total situs inversus, also termed as mirror image dextrocardia, is characterized by a heart on the right side of the midline while the liver and the gall bladder are on the left side. Patients are usually asymptomatic and have a normal lifespan. The exact etiology is unknown but an autosomal recessive mode of inheritance has been speculated. The first case of perforated duodenal ulcer with situs inversus was reported in 1986; here, we report the second case of this nature in the medical literature. Case presentation A 22-year-old Pakistani man presented with severe epigastric and left hypochondrial pain. Examination and investigations (chest X-ray and ultrasonography confirm peritonitis in a case of situs inversus totalis. On exploratory laparotomy, a diagnosis of situs inversus totalis with perforated duodenal ulcer was confirmed. Graham's patch closure of the duodenal ulcer was performed with absorbable sutures, and a thorough peritoneal lavage was also performed; an incidental appendectomy was also performed to avoid further diagnostic problems. Our patient had an uneventful recovery. Conclusions A diagnostic dilemma arises whenever abdominal pathology occurs in patients with situs inversus. Although an uncommon anomaly, to choose a proper surgical incision site for abdominal exploration pre-operative recognition of the condition is important.

  17. [Environmental risk factors in Crohn's disease and ulcerative colitis (excluding tobacco and appendicectomy)].

    Science.gov (United States)

    Jantchou, Prévost; Monnet, Elisabeth; Carbonnel, Franck

    2006-01-01

    A rapid increase in the incidence of Crohn's disease and ulcerative colitis in developed countries, the occurrence of Crohn's disease in spouses, and a lack of complete concordance in monozygotic twins are strong arguments for the role of environmental factors in inflammatory bowel disease (IBD). Research in the field of environmental factors in IBD is based upon epidemiological (geographical and case-control), clinical and experimental studies. The role of two environmental factors has clearly been established in IBD. Smoking is a risk factor for Crohn's disease and a protective factor for ulcerative colitis; appendectomy is a protective factor for ulcerative colitis. Many other environmental factors for IBD have been investigated, including infectious agents, diet, drugs, stress and social status. They are detailed in the present review. Among them, atypical Mycobacteria, oral contraceptives and antibiotics could play a role in Crohn's disease. To date, three hypotheses associate environmental factors with the pathophysiology of IBD (loss of tolerance of intestinal immune system towards commensal bacterial flora): the hygiene, infection and cold chain hypotheses. Much work remains to be done to identify risk factors for IBD. Research identifying environmental factors that might cause a predisposition to IBD is useful. It may lead to disease prevention in subjects who are genetically predisposed and disease improvement in patients. PMID:16885870

  18. Etiology and pathophysiology of inflammatory bowel disease--environmental factors.

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    Andus, T; Gross, V

    2000-01-01

    Environmental factors play an important role in the pathophysiology of inflammatory bowel disease. There is a strong and consistent association between smoking and Crohn's disease, and between nonsmoking and ulcerative colitis. Despite extensive research, the exact pathophysiological mechanisms for these associations remain unclear. In spite of this, some clinical trials with nicotine-patches showed beneficial effects for the treatment of ulcerative colitis. Associations of Crohn's disease and ulcerative colitis with other environmental factors are weaker like the association with use of oral contraceptives or those less well investigated such as the association with childhood hygiene. Most studies suggesting a potential pathogenetic role of Mycobacterium paratuberculosis or an effect of tuberculostatic therapy in Crohn's disease could not be reproduced by others. Perinatal or childhood infections by viruses like measles are heavily debated, but not proven to be causal for inflammatory bowel disease. Coagulation disorders have been described as protecting from inflammatory bowel disease, suggesting hypercoagulability to be a pathogenetic factor. Some studies described that appendectomy may prevent the onset of ulcerative colitis in man and mice. Other environmental factors such as hydrogen sulfide, tonsillectomy, diet, blood transfusions, and Listeria also require confirmation. There are, however, convincing data from genetic animal models and twin studies that environmental factors as the intestinal bacterial flora interact with susceptible hosts to cause inflammatory bowel disease. Inflammatory bowel diseases have multifactorial etiologies, which require a differentiated approach for treatment and prevention. PMID:10690583

  19. Transcatheter embolization for treatment of acute lower gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Treatment of lower gastrointestinal bleeding was attempted in 13 patients by selective embolization of branches of the mesenteric arteries with Gelfoam. Bleeding was adequately controlled in 11 patients with active bleeding during the examination. One patient improved after embolization but bleeding recurred within 24 hours and in another patient the catheterization was unsuccessful. Five patients with diverticular hemorrhage were embolized in the right colic artery four times, and once in the middle colic artery. Three patients had embolization of the ileocolic artery because of hemorrhage from cecal angiodysplasia, post appendectomy, and leukemia infiltration. Three patients had the superior hemorrhoidal artery embolized because of bleeding from unspecific proctitis, infiltration of the rectum from a carcinoma of the bladder, and transendoscopic polypectomy. One patient was septic and bled from jejunal ulcers. Ischemic changes with infarction of the large bowel developed in two patients and were treated by partial semi-elective colectomy, three and four days after embolization. Four other patients developed pain and fever after embolization. Transcatheter embolization of branches of mesenteric arteries in an effective way to control acute lower gastrointestinal bleeding, but still has a significant rate of complications that must be seriously weighed against the advantages of operation. (orig.)

  20. Increased risk of ischemic stroke in cervical cancer patients: a nationwide population-based study

    International Nuclear Information System (INIS)

    Increased risk of ischemic stroke has been validated for several cancers, but limited study evaluated this risk in cervical cancer patients. Our study aimed to evaluate the risk of ischemic stroke in cervical cancer patients. The study analyzed data from the 2003 to 2008 National Health Insurance Research Database (NHIRD) provided by the National Health Research Institutes in Taiwan. Totally, 893 cervical cancer patients after radiotherapy and 1786 appendectomy patients were eligible. The Kaplan-Meier method and the Cox proportional hazards model were used to assess the risk of ischemic stroke. The 5-year cumulative risk of ischemic stroke was significantly higher for the cervical cancer group than for the control group (7.8% vs 5.1%; p <0.005). The risk of stroke was higher in younger (age <51 years) than in older (age ≥51 years) cervical cancer patients (HR = 2.73, p = 0.04; HR = 1.37, p = 0.07) and in patients with more than two comorbid risk factors (5 years cumulative stroke rate of two comorbidities: 15% compared to no comorbidities: 4%). These study demonstrated cervical cancer patients had a higher risk of ischemic stroke than the general population, especially in younger patients. Strategies to reduce this risk should be assessed

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

    Directory of Open Access Journals (Sweden)

    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

  2. April 2015 critical care case of the month: half-sided light house

    Directory of Open Access Journals (Sweden)

    Loftsgard T

    2015-04-01

    Full Text Available No abstract available. Article truncated after 150 words. History of Present Illness: A 55 year old woman was transferred to the ICU from the general medicine ward for tachycardia and acute hypoxic respiratory distress. She has multiple myeloma and had received cycle one of bortezomib, dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide and etoposide (VDT-PACE and radiotherapy to T7 for a pathologic compression. She was admitted for pain control from mucositis.Past Medical History: In addition to the multiple myeloma she has a past medical history of asthma, ovarian cysts, diverticulitis, eczema, pneumonia, laparoscopic cholecystectomy, total abdominal hysterectomy with bilateral salpingo-oophorectomy, appendectomy, ectopic pregnancy in the past, and left Bell's palsy. Current Medications: Acyclovir 400 mg BID, Albuterol 90 HFA prn, Allopurinol 300 mg daily, Fluconazole 200 mg BID, Gabapentin 300 mg BID, Hydromorphone , Levofloxacin 500 daily, Morphine, Omeprazole, Bactrim 400-80 mg daily for PCP prophylaxis, Thalomid 200 mg capsule daily, Ativan 0.5 mg just prior to transfer. Physical Examination ...

  3. Giant thoracic schwannoma presenting with abrupt onset of abdominal pain: a case report

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    Yang Isaac

    2009-10-01

    Full Text Available Abstract Introduction Giant intradural extramedullary schwannomas of the thoracic spine are not common. Schwannomas, that is, tumors derived from neoplastic Schwann cells, and neurofibromas represent the most common intradural extramedullary spinal lesions. We report the case of a patient with a giant thoracic schwannoma presenting unusually with acute abdominal pain and with delayed neurological impairment. Case presentation A 26-year-old Hispanic man with no previous medical problems presented with acute periumbilical pain. After extensive work-up including an exploratory laparotomy for appendectomy, magnetic resonance imaging scans of the lumbar and thoracic spine revealed a giant intradural extramedullary thoracic schwannoma within the spinal canal posterior to the T9, T10, and T11 vertebral bodies. Magnetic resonance imaging signal prolongation was noted in the spinal cord both rostral and caudal to the schwannoma. The patient underwent an urgent laminectomy from T8 to L1. After sacrificing the T10 root, the tumor was removed en bloc. Postoperatively, the patient improved significantly gaining antigravity strength in both lower extremities. Conclusion The T10 dermatome is represented by the umbilical region. This referred pain may represent a mechanism by which a giant thoracic schwannoma may present as acute abdominal pain. Acute, intense abdominal pain with delayed neurologic deficit is a rare presentation of a thoracic schwannoma but should be considered as a possible cause of abdominal pain presenting without clear etiology. Although these lesions may be delayed in their diagnosis, early diagnosis and treatment may lead to an improved clinical outcome.

  4. [The future of gastrointestinal therapeutic endoscopy: NOTES].

    Science.gov (United States)

    Dray, X; Marteau, P

    2009-01-01

    Natural orifice translumenal endoscopic surgery (NOTES) allows access into the peritoneal cavity with a flexible endoscope, through the wall of the digestive or urogenital tracts. NOTES can be combined to laparoscopic surgery in so-called techniques. In the absence of any incision of the abdominal wall, NOTES procedures provide perfect cosmetic results, with virtually no risk of parietal complications, and with decreased postoperative pain. NOTES could particularly benefit to overweight patients and to patients receiving intensive or palliative care. Most NOTES studies have been performed on animal models, with great interest for both transgastric and transpelvic approaches. Successful NOTES peritoneoscopy, hysterectomy, oophorectomy, tubal ligation, gastrojejunal anastomosis, cholecystectomy, splenectomy, nephrectomy, and abdominal-wall hernia repair have been described. In human studies, the transvaginal route is preferred. NOTES clinical research focuses on low-morbidity procedures, such as cholecystectomy, appendectomy, and peritoneoscopy. Indirect benefits are expected from this research, with possible technological innovations in the field of endoscopic instrumentation (including sutures, anastomosis, traction and triangulation). Overall, NOTES is believed to make evolve both interventional endoscopy and minimally invasive surgery. PMID:19683406

  5. [Minilaparoscopic surgery : alternative or supplement to single-port surgery?].

    Science.gov (United States)

    Brinkmann, L; Lorenz, D

    2011-05-01

    In recent years scarless surgery (axillo-bilateral-breast aproach [ABBA], natural orifice transluminal endoscopic surgery [NOTES], single-port surgery) has gained importance in order to improve postoperative outcome in laparoscopic surgery. As part of this effort minilaparoscopic surgery might be a suitable alternative concerning cosmetic outcome without implementing a completely new technique. Due to the definition minilaparoscopic surgery is based on instruments which reduce the total length of trocar incisions to less than 2.5 cm. Nevertheless the total number of incisions is similar to conventional laparoscopic techniques. Most recent indications for minilaparoscopic surgery are cholecystectomy, appendectomy, hernia and colorectal surgery. This article describes the technical aspects and feasibility of minilaparoscopic cholecystectomy and transabdominal preperitoneal hernia repair (TAPP).While the trocar positions remain in the original setting the laparoscopic surgeon benefits from experience gained in conventional laparoscopic surgery. Although the cosmetic outcome is not comparable to single-port surgery, in the author's opinion minilaparoscopic surgery is a useful alternative in scarless surgery due to the fact that it is easy to adapt without establishing a completely new technique. PMID:21424297

  6. Clinical spectrum of internal hernia. A surgical emergency

    International Nuclear Information System (INIS)

    The purpose of this study was to define the indicators of bowel ischemia caused by congenital or acquired internal hernia, based on our 10-year experience in one center. We reviewed the medical records, imaging studies, and operative findings of 20 patients who underwent surgery for an internal hernia at our medical center between 1995 and 2005. The clinical characteristics and related indicators of the patients with, and those without bowel ischemia were compared and analyzed statistically. The subtypes of congenital internal hernia (CIH) included transmesenteric (n=6, 60%), paraduodenal (n=2, 20%), and pericecal (n=2, 20%) hernia. The abdominal surgical procedures preceding acquired internal hernia (AIH) were Roux-en-Y anastomosis (n=6, 60%) and appendectomy (n=3, 30%). Transmesenteric hernia was the most prevalent type of CIH in children. Abdominal rebound tenderness, advanced leukocytosis (>18000/mm3), or a high level of manual band form (>6%) were the positive predictive factors for bowel ischemia, whereas a history of chronic intermittent abdominal pain was a negative indicator. No recurrence was noted during the 10-year study period. The overall mortality rate was 20%, attributable to enteral bacteria sepsis in all cases. Internal hernia is a rare but lethal condition. Early diagnosis and prompt surgical intervention provide the only chance of a successful outcome. (author)

  7. Past, Present, and Future of Minimally Invasive Abdominal Surgery.

    Science.gov (United States)

    Antoniou, Stavros A; Antoniou, George A; Antoniou, Athanasios I; Granderath, Frank-Alexander

    2015-01-01

    Laparoscopic surgery has generated a revolution in operative medicine during the past few decades. Although strongly criticized during its early years, minimization of surgical trauma and the benefits of minimization to the patient have been brought to our attention through the efforts and vision of a few pioneers in the recent history of medicine. The German gynecologist Kurt Semm (1927-2003) transformed the use of laparoscopy for diagnostic purposes into a modern therapeutic surgical concept, having performed the first laparoscopic appendectomy, inspiring Erich Mühe and many other surgeons around the world to perform a wide spectrum of procedures by minimally invasive means. Laparoscopic cholecystectomy soon became the gold standard, and various laparoscopic procedures are now preferred over open approaches, in the light of emerging evidence that demonstrates less operative stress, reduced pain, and shorter convalescence. Natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopic surgery (SILS) may be considered further steps toward minimization of surgical trauma, although these methods have not yet been standardized. Laparoscopic surgery with the use of a robotic platform constitutes a promising field of investigation. New technologies are to be considered under the prism of the history of surgery; they seem to be a step toward further minimization of surgical trauma, but not definite therapeutic modalities. Patient safety and medical ethics must be the cornerstone of future investigation and implementation of new techniques. PMID:26508823

  8. NOTES and endoscopic pancreatic necrosectomy for the GI endoscopist.

    Science.gov (United States)

    Isayama, Hiroyuki; Yamamoto, Keisuke; Mizuno, Suguru; Yashima, Yoko; Togawa, Osamu; Kogure, Hirofumi; Sasaki, Takashi; Sasahira, Naoki; Nakai, Yousuke; Hirano, Kenji; Tsujino, Takeshi; Tada, Minoru; Kawabe, Takao; Omata, Masao

    2009-01-01

    Endoscopists seek to conduct more aggressive surgical procedures that surpass the limitations of existing endoscopic procedures. Endoscopic pancreatic necrosectomy and natural orifice transluminal endoscopic surgery (NOTES) are typical examples of this new trend; both are performed through the gastrointestinal wall without a skin incision. Endoscopic necrosectomy is effective for managing organized pancreatic necrosis and abscesses. The necrotic tissues are removed endoscopically by directly entering the cavity of the organized pancreatic necrosis. NOTES is a possible advance over surgical intervention, as it is a less invasive, more cosmetic, and effective procedure. There are various approaches, including the esophagus, stomach, colon, and vagina; Various procedures are possible using NOTES, such as cholecystectomy, appendectomy, full-thickness stomach resection, splenectomy, gastrointestinal (GI) anastomosis, and peritoneoscopy. The requirements for NOTES include high proficiency in endoscopic techniques, including knowledge of various devices, anatomy, and surgical procedures. Since most GI endoscopists have no surgical background, to increase the usage of NOTES, GI endoscopists should form and lead teams that include various specialists. We believe that endoscopic necrosectomy and NOTES represent a major shift in the treatment paradigm because physicians can treat beyond the gastrointestinal wall and endoscopic procedures will replace surgical treatment. PMID:19347662

  9. Advances in abdominal access for laparoscopic surgery: a review

    Directory of Open Access Journals (Sweden)

    Ogaick M

    2014-11-01

    Full Text Available Maurice Ogaick,1 Guillaume Martel1,2 1Department of Surgery, 2Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada Abstract: There are several laparoscopic surgery abdominal wall access techniques. The most useful and well-established is the open Hasson technique. The Veress needle closed technique is another alternative, but its use is controversial owing to possibly higher rates of rare insertion complications. Optical trocars have been developed in an attempt to decrease complication rates even further, although the evidence base supporting their use is limited. Single-incision laparoscopic surgery (SILS is used in certain centers to carry out various abdominal surgeries, but most commonly appendectomy and cholecystectomy. To date, SILS appears safe and feasible, with possibly greater costs and operative time. Natural orifice translumenal endoscopic surgery (NOTES is an evolving area of incisionless surgery. While some progress has been made in achieving transgastric or transvaginal peritoneal endoscopic access, this technique remains largely unproven and best-suited for experimental or clinical trial protocols. Keywords: laparoscopy, Hasson, Veress, optical trocar, SILS, NOTES

  10. 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.

  11. Prospective study of use of perioperative antimicrobial therapy in general surgery.

    LENUS (Irish Health Repository)

    Fennessy, Brendan G

    2012-02-03

    BACKGROUND: Perioperative antimicrobial therapy has demonstrated efficacy in reducing the rate of surgical site infections in clinical trials. With the emergence of antibiotic resistance, the risk of reaction, and the inevitable financial repercussions, use of prophylactic antibiotics is not a panacea, and their misuse may have considerable implications. The aim of this study was to assess the use of antibiotics in the perioperative period in both general and vascular surgery procedures. METHODS: A prospective study was undertaken of 131 patients with a mean age of 43 years (range one month-88 years), of whom 68 (51%) were male, who underwent twenty-seven different general or vascular surgery procedures over a four-week period. Each patient was evaluated from the time of antibiotic commencement through their operative procedure until the treatment was discontinued. RESULTS: A total of 73 patients (54%) received ten antibiotics, with 71 (97%) of these uses being prophylactic. Of the 15 appendectomies performed for uncomplicated appendicitis, the mean number of prophylactic antibiotic doses was 5.3 (range 1-12). Where they were documented, written postoperative directives were not adhered to in 18\\/27 prescriptions (66%). CONCLUSION: This study has demonstrated a lack of adherence to guidelines in the perioperative administration of antimicrobial agents. In addition, it calls attention to the economic implications of unnecessary prophylaxis.

  12. Transumbilical scarless surgery with thoracic trocar: easy and low-cost

    Science.gov (United States)

    Okur, Mehmet Hanifi; Aydogdu, Bahattin; Arslan, Mehmet Serif; Cimen, Hasan; Otcu, Selcuk

    2013-01-01

    Purpose Single-site laparoscopic surgery has become increasingly common. We herein report an easy and low-cost thoracic trocar technique (TTT) for these types of procedures and recommend the simpler name "transumbilical scarless surgery" (TUSS) to minimize confusion in nomenclature. Methods We retrospectively reviewed patients who underwent TUSS by TTT using a thoracic trocar and surgical glove in our hospital between November 2011 and November 2012. Operating time, postoperative stay, and complications were detailed. Results A total of 101 TUSS by TTT were successfully performed, comprising appendectomy (n = 63), ovarian cyst excision (n = 7), splenectomy (n = 5), nephroureterectomy (n = 5), orchidopexy (n = 4), pyeloplasty (n = 3), nephrolithotomy (n = 2), orchiectomy (n = 2), varicocelectomy (n = 2), lymphangioma excision (n = 2), ureterectomy (n = 1), Morgagni diaphragmatic hernia repair (n = 1), ovarian detorsion (n = 1), antegrade continence enema (n = 1), intestinal resection anastomosis (n = 1), and intestinal duplication excision (n = 1). Kirschner wires were used for some organ traction. Nine patients required an additional port, but no major complications occurred. The postoperative stay (mean ± standard deviation) was 3.2 ± 1.4 days, and operating time was 58.9 ± 38.3 minutes. Conclusion We recommend the simpler name of TUSS to minimize confusion in nomenclature for all transumbilical single-incision laparoendoscopic surgeries. TTT is an easy and low-cost TUSS technique. PMID:23741694

  13. Recommendations in the management of epithelial appendiceal neoplasms and peritoneal dissemination from mucinous tumours (pseudomyxoma peritonei).

    Science.gov (United States)

    Barrios, P; Losa, F; Gonzalez-Moreno, S; Rojo, A; Gómez-Portilla, A; Bretcha-Boix, P; Ramos, I; Torres-Melero, J; Salazar, R; Benavides, M; Massuti, T; Aranda, E

    2016-05-01

    The epithelial appendiceal neoplasms are uncommon and are usually detected as an unexpected surgical finding. The general surgeon should be aware of the diversity of its clinical manifestations and biological behaviors along with the significance of the surgical treatment on the progression of the illness and the prognosis of the patients. The operative findings and, especially, tumor histology, determine the type of surgery. Intestinal histologic subtype behaves and should be treated similarly to the right colon neoplasms; while mucinous tumors, often discordant between histology and its aggressiveness, can be treated with a simple appendectomy or require complex oncological surgeries. Mucinous tumors are often associated with the presence of mucin or tumor implants in the abdominal cavity, being the clinical syndrome known as pseudomyxoma peritonei (PMP). PMP tends to present an indolent but deadly evolution and requires a multimodal approach as a single treatment with curative potential: complete cytoreductive surgery plus hyperthermic Intra-peritoneal chemotherapy (CCRS + HIPEC) now considered the standard of care in this pathology. The general surgeon should be aware of the governing principles of the treatment of appendiceal neoplasms with or without peritoneal dissemination, know the therapeutic frontiers in every situation (avoiding unnecessary or counterproductive surgeries) and sending early these patients to specialised centres in the radical management of malignant diseases of the peritoneum in the conditions and with the necessary information to facilitate a possible radical treatment. PMID:26489426

  14. To explore the necessity of peritoneal lavage in acute appendicitis operation%小儿急性阑尾炎手术中腹腔冲洗的必要性探讨

    Institute of Scientific and Technical Information of China (English)

    王建尧; 刘磊; 王斌; 叶明; 冯奇; 陈子民; 叶晓烁; 吴宙光

    2016-01-01

    目的:通过对比各型小儿阑尾炎术中行腹腔冲洗与未行腹腔冲洗的疗效,探讨术中行腹腔冲洗的必要性。方法收集本院近3年内收治的急性阑尾炎病例共350例,其中 A 组为单纯性阑尾炎,行腹腔镜阑尾切除术;B、C 组为化脓性阑尾炎未穿孔,B 组行腹腔镜阑尾切除+腹腔引流术,C 组行腹腔镜阑尾切除+腹腔冲洗+腹腔引流术;D、E 组为坏疽穿孔性阑尾炎,D 组行腹腔镜阑尾切除+腹腔引流术,E 组行腹腔镜阑尾切除+腹腔冲洗+腹腔引流术。术后对患者资料进行详细统计和相应分析。结果急性单纯性阑尾炎行腹腔镜阑尾切除术后患儿预后良好。急性化脓性阑尾炎组术中行腹腔冲洗后,术后患儿肛门排气排便时间、直肠刺激症状、间断腹痛情况明显增加,且术后腹腔脓肿的发生率明显增多,术后5 d 血常规白细胞稍高,1例并发右侧膈下脓肿,平均住院时间较未冲洗组明显延长;相反,急性坏疽穿孔性阑尾炎组,术中行腹腔冲洗后,患儿术后肛门排气排便时间缩短,术后腹腔残余感染、直肠刺激症状、间断腹痛情况降低,术后腹腔脓肿等并发症的发生率降低,术后5 d 血白细胞较未冲洗组稍低。术后患儿恢复相对较快,住院时间短。结论小儿急性阑尾炎术中冲洗治疗应根据具体情况选择合适的方法,术中调节体位,充分显露脓腔,引流彻底,引流管位置适宜;急性化脓性阑尾炎未穿孔者不需行腹腔冲洗,而急性坏疽穿孔性阑尾炎则需术中行腹腔冲洗。%Objetive To explore the necessity of peritoneal lavage in the operation by comparing post-operative results of various types of acute appendicitis.Methods A total of 350 cases of acute appendicitis in our hospital were collected in 3 years.A group include appendicitis which undergo laparoscopic appendectomy. B,C group which

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

    Directory of Open Access Journals (Sweden)

    Musa Zorlu

    2016-01-01

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

  16. Ovarian Metastasis from Lung Cancer: A Rare Entity

    Directory of Open Access Journals (Sweden)

    Huseyin Cengiz

    2013-01-01

    Full Text Available This paper describes a case of ovarian metastasis from lung carcinoma along with its diagnostic challenges, clinical management, and review of the literature. A 49-year-old woman was admitted to our emergency department with complaints of abdominal pain and vomiting. A laparoscopic appendectomy was performed due to acute appendicitis, and a unilateral oophorectomy (left side via laparoscopy was performed due to the detection of an ovarian mass. Immunohistochemical staining of the ovarian mass revealed that it was reactive to cytokeratin-7 (CK-7 but negative for CK-20. The immunohistochemical and pathological features of the tumor indicated an ovarian metastasis of non-small-cell lung cancer. The patient underwent chemotherapy and was followed up by the oncology department. Her postoperative regular followup of 6 months showed that her condition was stable with no recurrence. The management of female patients with acute abdominal pain and pelvic masses should consist of a multidisciplinary approach to include the diagnosis of any distant organ metastasis.

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

    Directory of Open Access Journals (Sweden)

    Martin Salö

    2014-01-01

    Full Text Available Background. This study aimed to evaluate Pediatric Appendicitis Score (PAS, diagnostic delay, and factors responsible for possible late diagnosis in children <4 years compared with older children who were operated on for suspected appendicitis. Method. 122 children, between 1 and 14 years, operated on with appendectomy for suspected appendicitis, were retrospectively analyzed. The cohort was divided into two age groups: ≥4 years (n=102 and <4 years (n=20. Results. The mean PAS was lower among the younger compared with the older patients (5.3 and 6.6, resp.; P=0.005, despite the fact that younger children had more severe appendicitis (75.0% and 33.3%, resp.; P=0.001. PAS had low sensitivity in both groups, with a significantly lower sensitivity among the younger patients. Parent and doctor delay were confirmed in children <4 years of age with appendicitis. PAS did not aid in patients with doctor delay. Parameters in patient history, symptoms, and abdominal examination were more diffuse in younger children. Conclusion. PAS should be used with caution when examining children younger than 4 years of age. Diffuse symptoms in younger children with acute appendicitis lead to delay and to later diagnosis and more complicated appendicitis.

  18. Dystrophinopathy presenting with arrhythmia in an asymptomatic 34-year-old man: a case report

    Directory of Open Access Journals (Sweden)

    Wakefield Seth E

    2009-07-01

    Full Text Available Abstract Introduction Important clues in the recognition of individuals with dystrophin gene mutations are illuminated in this case report. In particular, this report seeks to broaden the perspective of early signs and symptoms of a potentially life-limiting genetic disorder. This group of disorders is generally considered to be a pediatric muscular dystrophy when in actual fact, this case report may represent a spectrum of subclinically affected adults. Case presentation We present the diagnostic saga of a 34-year-old Caucasian man who had two liver biopsies for elevated liver enzymes and 16 years later presented with a cardiac arrhythmia amidst an emergent appendectomy which finally led to his specific genetic diagnosis. Conclusions This genetic disorder can affect more than one organ, and in our patient affected both skeletal and cardiac muscle. Furthermore, liver function tests when elevated may erroneously implicate a liver disorder when they actually reflect cardiac and skeletal muscle origin. Presented here is a patient with Becker's muscular dystrophy and cardiomyopathy.

  19. Laparoscopic management of intra-abdominal infections:Systematic review of the literature

    Institute of Scientific and Technical Information of China (English)

    Federico; Coccolini; Cristian; Tranà; Massimo; Sartelli; Fausto; Catena; Salomone; Di; Saverio; Roberto; Manfredi; Giulia; Montori; Marco; Ceresoli; Chiara; Falcone; Luca; Ansaloni

    2015-01-01

    AIM: To investigate the role of laparoscopy in diagnosis and treatment of intra abdominal infections.METHODS: A systematic review of the literature was performed including studies where intra abdominal infections were treated laparoscopically.RESULTS: Early laparoscopic approaches have become the standard surgical technique for treating acute cholecystitis. The laparoscopic appendectomy has been demonstrated to be superior to open surgery in acute appendicitis. In the event of diverticulitis, laparoscopic resections have proven to be safe and effective procedures for experienced laparoscopic surgeons and may be performed without adversely affecting morbidity and mortality rates. However laparoscopic resection has not been accepted by the medical community as the primary treatment of choice. In high-risk patients, laparoscopic approach may be used for exploration or peritoneal lavage and drainage. The successful laparoscopic repair of perforated peptic ulcers for experienced surgeons, is demonstrated to be safe and effective. Regarding small bowel perforations, comparative studies contrasting open and laparoscopic surgeries have not yet been conducted. Successful laparoscopic resections addressing iatrogenic colonic perforation have been reported despite a lack of literature-based evidence supporting such procedures. In post-operative infections, laparoscopic approaches may be useful in preventing diagnostic delay and controllingthe source.CONCLUSION: Laparoscopy has a good diagnostic accuracy and enables to better identify the causative pathology; laparoscopy may be recommended for the treatment of many intra-abdominal infections.

  20. 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

  1. [Amyand hernia--a rare anatomic and clinical entity diagnosed intraoperatively].

    Science.gov (United States)

    Grecu, F; Filip, B; Moţoc, I; Andriescu, Nadia; Lăpuşneanu, A; Ursaru, Manuela

    2010-01-01

    The Amyand hernia is an uncommon variant of the inguinal hernia, rarely recognised before the surgical treatment because of the confusion with a strangled hernia. In spite of this, the clinical presentation seems to follow a well determined pathway, so it is possible to state that the uncorrect diagnosis is to be attributed to the ignorance of this variant of hernia. We present two consecutive case reports of acute appendicitis founded in an inguinal hernia sac. The clinical presentation depended on the inflammation extension inside the hernia sac and the presence or not of peritoneal contamination. The patients were admitted for a painful pseudotumor in the inguinal region with irreducibility, mimicking strangled inguinal hernia with acute inflammatory syndrome. Intraoperatively we have found a hernia sac with a phlegmonous/gangrenous appendix inside. Appendectomy was performed, followed by hernioplasty (retrofunicular technique) without prosthetic material). The operation followings were favorable. We conclude that amyand hernia must be considered as differential diagnosis of apparently strangled inguinal hernias. Technical precautions and antibioprophylaxy applied during surgery may prevent septic complications after hernioplasty. The hernia repair must be performed without prosthetic material and using exclusively resorbable sutures.

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

    Directory of Open Access Journals (Sweden)

    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.

  3. The incidence of venous thromboembolism in cervical cancer: a nationwide population-based study

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    Tsai Shiang-Jiun

    2012-06-01

    Full Text Available Abstract Background Venous thromboembolism (VTE is a life-threatening condition that occurs as a complication of cervical cancer. The aim of this study was to evaluate the incidence of VTE in cervical cancer patients during a 5-year follow-up. Methods The study analyzed data deposited between 2003 and 2008 in the National Health Insurance Research Database (NHIRD, provided by the National Health Research Institutes in Taiwan. Totally, 1013 cervical cancer patients after treatment and 2026 appendectomy patients were eligible. The Kaplan-Meier method and the Cox proportional hazards model were used to assess the VTE risk. Results The 5-year cumulative risk for VTE was significantly higher in the cervical cancer group than in the control group (3.3% vs 0.3%, p vs 30.3%, p  Conclusions The cumulative risk of VTE was significantly higher in cervical cancer patients, and these patients also had lower survival rates. Strategies to reduce these risks need to be examined.

  4. Risk factors of intrahepatic cholangiocarcinoma in patients with hepatolithiasis:a case-control study

    Institute of Scientific and Technical Information of China (English)

    Zhen-YuLiu; Yan-MingZhou; Le-HuaShi; Zheng-FengYin

    2011-01-01

    BACKGROUND: Why 3.3% to 10% of all patients with hepatolithiasis develop intrahepatic cholangiocarcinoma (ICC) remains unknown. We carried out a hospital-based case-control study to identify risk factors for the development of ICC in patients with hepatolithiasis in China. METHODS: Eighty-sevenpatientswithpathologicallydiagnosed hepatolithiasis associated with ICC and 228 with hepatolithiasis alone matched by sex, age (±2 years), hospital admittance and place of residence were interviewed during the period of 2000-2008. Odds ratios (OR) and 95% confidence intervals (CI) were calculatedforeachriskfactor. RESULTS: Among the patients with hepatolithiasis associated with ICC, the mean age was 57.7 years and 61.0% were female. Univariate analysis showed that the significant risk factors for ICC development in hepatolithiasis were smoking, family history of cancer, appendectomy during childhood (under age 20), and duration of symptoms >10 years. In multivariate stepwise logistic regression analysis, smoking (OR=1.931, 95%CI: 1.000-3.731), family history of cancer (OR=5.175, 95% CI:1.216-22.022), and duration of symptoms >10 years (OR=2.348, 95% CI: 1.394-3.952) were independent factors. CONCLUSION: Smoking, family history of cancer and duration of symptoms >10 years may be risk factors for ICC in patients with hepatolithiasis.

  5. May 2015 critical care case of the month: an infected leg

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    Till SL

    2015-05-01

    Full Text Available No abstract available. Article truncated at 150 words. History of Present Illness: A 46-year-old transferred due to concern for necrotizing fasciitis. One the day prior to transfer purple discoloration was not noted in the lower portion of the left leg. On the day of transfer the leg became more purple, painful, and swollen. She presented to a pain clinic that advised her to go to an emergency room. The emergency room performed arterial Doppler ultrasound, which was normal and transferred her due to concern of necrotizing fasciitis. Past Medical History, Social History and Family History: She has a past medical history of fibromyalgia. She had an extensive surgical history including an appendectomy, bladder implant, cholecystectomy, dilatation and curettage, esophageal repair, left femoral artery repair due to a motor vehicle accident, partial hysterectomy, left knee surgery, and several left leg operations with grafting. Family history was non-contributory. The patient was single with two children, and smoked 1-2 packs of ...

  6. EXTENSIVE NECROTIZING FASCIITIS OF TRUNK FOLLOWING APPENDICECTOMY

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    Siddharth

    2015-03-01

    Full Text Available Acute appendicitis is usually diagnosed and managed easily with a low mortality and morbidity. However, in 20.74% patients, acute appendicitis may occasionally become extraordinarily complicated and life threatening with significant morbidity and mortality . [1] We report a case of 44 year old male, a known case of Diabetes Mellitus since 4 years (on irregular treatment who was brought to our hospital with severe pain in right lower quadrant of abdomen since 4 days. On examination, patient had tachycardia, tender ness and guarding in the right iliac fossa. Laboratory results revealed leucocytosis and raised blood glucose levels. Measures for glycemic control were initiated. At exploratory laparotomy, an inflamed and retrocaecal appendix ruptured at the base with sm all local abscess was found. Abscess was drained and appendectomy done. Initially patient did well but at the end of second post - operative week, the patient started having pain and swelling over posterior chest wall, flank, sacral and occipital regions sug gestive of inflammation. CT abdomen and pelvis showed extensive necrotizing fasciitis of trunk, occiput and sacrum. Repeated multiple fasciotomies were performed over the back. The patient finally recovered fully at the end of 8 th post - operative week

  7. A STUDY OF CONVERSIONS OF LAPAROSOCOPIC SURGERIES INTO OPEN SURGERIES: A ANALYTICAL STUDY

    Directory of Open Access Journals (Sweden)

    Venkata Reddy

    2015-12-01

    Full Text Available INTRODUCTION: The aim of present study is to know the Conversions in Laparoscopic surgery to Open surgery in The patients of all the surgical units in the Department of General Surgery, Government General Hospital, Rangaraya Medical College, Kakinada over a period of 2 years from July 2013 to July 2015. The Objectives of present study is to compare the Conversion Rates of Laparoscopic Surgery to Open Surgery and the factors causing Conversion to Open Surgery in our institution. PATIENTS AND METHODS The protocol is approved by institution ethics committee and written informed consent was taken from each patient. Present clinical Study is an Analytical study conducted over period of 2 years from July 2013 to July 2015 in the Department of General Surgery, Government General Hospital, Rangaraya Medical College, Kakinada, Andhra Pradesh. RESULTS Total number of 536 laparoscopic surgeries were attempted in elective operation theatres with 21 cases out of 536 cases were converted from laparoscopy to open surgery. Total conversion rate in present study is 4%. Most of conversions occurred in laparoscopic chelecystectomy 5.73% cases in comparison to laparoscopic appendectomy 2.26% and laparoscopic hernia repair with 0%. CONCLUSIONS Over all conversion rates of laparoscopic procedure into open surgery is low when compared to other international studies. Most common causes of conversion in present study is altered anatomy, adhesions and intra operative bleed. Conversion of laparoscopic surgery into open surgery resulted in decreased morbidity, complications and increase in duration of hospital stay

  8. Single incision pediatric endoscopic surgery: advantages of relatively large incision

    International Nuclear Information System (INIS)

    To describe Single Incision Pediatric Endoscopic Surgery (SIPES) performed on children with various diagnoses, emphasizing its advantages. Study Design: An observational case series. Place and Duration of Study: Department of Pediatric Surgery, Dr. Sami Ulus Maternity and Child Health Hospital, Ankara, Turkey, from January 2011 to November 2014. Methodology: A review of patient charts was conducted in which SIPES was preferred as the surgical procedure. Patient demographics, operative details, operative time, clinical outcomes, postoperative pain and cosmesis were analyzed. Results: SIPES was performed on 45 patients (21 girls, 24 boys). Thirty-three appendectomies, 5 varicocelectomies, 3 oophorectomies, 2 ovarian and one paratubal cyst excision, and one fallopian tube excision were performed. All except one procedures were performed through our standard 2cm umbilical vertical or smile incision. In 18 cases, abdominal irrigation/aspiration was easily performed through the existing larger incision, as is done with open surgical technique. None of the patients had early postoperative shoulder/back pain since complete disinflation of CO/sub 2/ could be ensured. All of the patients/parents were satisfied with the cosmesis. Conclusion: SIPES has the advantages of limiting the surgical scar to within the umbilicus and providing easy disinflation of CO/sub 2/, allowing intraabdominal cleaning and extraction of large volume tissue samples through a single large umbilical incision. (author)

  9. PNEUMOPERITO NEUM BY DIRECT TROCAR INSERTION : SAFE LAPAROSCOPIC ACCESS

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    Rajneesh

    2015-02-01

    Full Text Available Purpose of this study is to access the safety and efficacy of direct trocar insertion (DTI for accessing the abdominal cavity for operative laparoscopy without prior pneumoperitoneum. DTI is one of the safe and effective alternative to veress needle inser tion , open access (Hassan’s technique and visual entry systems (disposable optic trocars and endotip visual cannula in laparoscopic surgery. METHODS: The study included 2480 patients who has undergone laparoscopic procedures at civil hospital , Jalandhar from Nov . 2003 to Sept . 2012 and at Punjab Institu t e of Medical Sciences ( PIMS Jalandhar from S ept . 2012 to June 2014. Procedures include 2310 laparoscopic cholecystectomies , 148 laparoscopic appendectomies , 10 cases of TAPP Groin hernia repairs and 12 cases of simple ovarian cysts. For DTI , abdominal wall was lifted and trocar was pushed through the fascia and muscle layer. The surgeon felt click when the trocar had pierced the peritoneum and entered the abdominal cavity. RESULTS: Direct trocar insertio n was feasible in 100% of patients. There was no evidence of intestinal or vascular injury during trocar placement. Peritoneal access and creation of laparoscopic workspace were attained faster and more efficiently by the DTI technique. CONCLUSIONS: DTI is a fast , safe and reliable alternative to traditional techniques of primary port placement in laparoscopic procedures for creation of pnuemoperitoneum.

  10. Computed Tomography and Ultrasound of Omental Infarction in Children: Differential Diagnoses of Right Lower Quadrant Pain

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    Lim, So Yeoun; Hong, Hyun Sook; Lee, Hae Kyung; Lee, Min Hee [Dept. of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon (Korea, Republic of); Kim, Young Tong [Dept. of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan (Korea, Republic of)

    2013-03-15

    Omental infarction in children occurs rarely and is often confused with other diseases that cause right lower quadrant (RLQ) pain. This study evaluates ultrasonography (US) and computed tomography (CT) findings of omental infarction in children with abdominal pain. The CT and US findings and clinical presentations of nine children diagnosed with omental infarction between 2005 and 2012 were retrospectively reviewed. Distributions of abdominal pain in the patients included RLQ (n = 6), right upper quadrant (RUQ, n = 1), periumbilical (n = 1), and the epigastric (n = 1) region. All patients underwent abdominal CT, and three underwent abdominal US. On CT scan, a typical triangular, heterogeneous fatty mass was seen between the abdominal wall and ascending colon (n = 6) or hepatic flexure (n = 1). A fatty mass with an enhanced rim that mimicked acute appendagitis was present in two patients. The other two patients had diffuse fat infiltration without mass. On US, a heterogeneously hyperechoic omental mass was seen in the RLQ (n = 2) or RUQ (n = 1). Three patients underwent appendectomy and partial omentectomy, and pathology confirmed omental infarction. Knowledge of the typical imaging features of omental infarction and application for diagnosis are important for its differentiation from other conditions that also present with RLQ pain and can avoid unnecessary surgery.

  11. 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

  12. Clinical treatment experience of 48 cases of elderly patients with acute appendicitis%老年急性阑尾炎48例临床治疗体会

    Institute of Scientific and Technical Information of China (English)

    鲍克平

    2014-01-01

    目的:总结老年急性阑尾炎治疗经验及临床疗效。方法:2012年8月-2014年1月收治老年阑尾炎患者48例,其中10例阑尾周围脓肿,应用抗生素治疗1周,症状未见好转,行脓肿切开引流术,坏疽性阑尾炎行急诊阑尾切除和腹腔引流术治疗,9例急性化脓性阑尾炎和28例急性单纯性阑尾炎行急诊阑尾切除手术治疗。结果:本组48例急性阑尾炎患者经过治疗,47例患者伤口愈合良好,1例并发糖尿病导致伤口感染,经换药后延迟愈合,经过2~6个月的随访,48例患者均无粘连性肠梗阻和腹腔内出血及残余脓肿形成。结论:老年人急性阑尾炎症状不典型,需要仔细检查,根据患者阑尾炎的具体情况来选择相应的治疗方法,才能达到较好的临床效果。%Objective:To sum up the treatment experience and clinical effect of patients with acute appendicitis.Methods:48 patients with acute appendicitis were selected from August 2012 to January 2014.Among 10 cases of appendiceal abscess were treated by antibiotics for 1 week,but their symptoms had not been better,so they were treated by abscess incision drainage.The gangrenous appendicitis were given emergency appendectomy and peritoneal drainage treatment.9 cases of acute suppurative appendicitis and 28 cases of acute simple appendicitis were given emergency appendectomy operation treatment.Results:In 48 patients with acute appendicitis,the wound of 47 patients healed well,1 patient complicated with diabetes leaded to wound infection,and healed after dressing change.After 2~6 months follow-up.48 patients were free of adhesive ileus,intraperitoneal hemorrhage and residual abscess formation.Conclusion:Elderly patients with acute appendicitis have atypical symptoms,need careful examination.In order to achieve good clinical results,the corresponding treatment methods should be choosen according to the specific situation of patients with appendicitis.

  13. Application of high frequency bipolar electrocoagulation LigaSureTM in appendix vermiformis of rabbits with or without acute inflammatory process Aplicação do eletrocoagulador bipolar de alta frequência LigaSureTM no apêndice vermiforme na vigência ou não de processo inflamatório agudo

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    Laura Cristina de Souza

    2012-05-01

    Full Text Available PURPOSE: To evaluate the efficacy of the use of LigaSureTM in appendectomy, with or without acute inflammatory process, and to compare with simple ligature and conventional therapy. METHODS: A total of 30 rabbits (Oryctolagus cuniculus randomly allocated in two groups, group A and B, of 15 animals each were used. The group A without acute appendicitis and the group B with acute appendicitis were submitted to appendectomy. After, the groups were subdivided into three groups, each group containing five rabbits submitted to simple ligature, conventional therapy and application of LigaSureTM. We assessed macroscopic and microscopy parameters of appendiceal stump and operative wound. RESULTS: The group with acute appendicitis that LigaSureTM was applied had fibrosis in 100% of animals, as well as in the other operative techniques used. It suggested that application of LigaSureTM is efficient as other techniques used in healing of appendiceal stump. CONCLUSIONS: The application of LigaSureTM induces the formation of fibrosis in the appendiceal stump. The technique proved efficacy to induce enough fibrous tissue to obstruct leakage of enteric content.OBJETIVO: Avaliar a eficácia da utilização do LigaSureTM na apendicectomia, com ou sem a presença de processo inflamatório agudo, comparando com ligadura simples ou técnica tradicional. MÉTODOS: Um total de 30 coelhos (Oryctolagus cuniculus foi alocado em dois grupos, grupos A e B, cada um composto por 15 animais. O grupo A não apresentava apendicite aguda e o grupo B com apendicite aguda, sendo os animais submetidos à apendicitectomia. Cada grupo foi divido em três subgrupos, cada um com cinco animais onde foram então submetidos à ligadura simples, técnica tradicional ou utilização do LigaSureTM. Foram avaliados parâmetros macroscópicos assim como microscópicos do coto apendicular assim como da ferida operatória. RESULTADOS: No grupo que apresentava apendicite aguda onde foi utilizado o

  14. Transverse abdominal incision sutured by single layer extraperitoneal suture for purulent appendicitis during gestational period%横切口腹膜外单层缝合用于妊娠期化脓性阑尾炎治疗

    Institute of Scientific and Technical Information of China (English)

    薛玉珍; 吕会增; 陈图锋; 郑宗珩; 周如建

    2011-01-01

    目的 探讨横切口腹膜外单层缝合法应用于妊娠期化脓性阑尾炎的临床效果.方法 2006年1月至2010年11月3所大学附属医院收治129例妊娠期化脓阑尾炎患者,分为2组,观察组68例采用横切口腹膜外单层缝合法行阑尾切除术,对照组61例常规麦氏切口(或横切口)分层缝合法行阑尾切除术,对2组患者的手术时间、术后疼痛程度、术后流产或早产率、术后切口感染率、术后住院时间等指标进行观察比较.结果 观察组与对照组术后流产或早产率比较差别无统计学意义(P>0.05).观察组可明显减少手术时间(P<0.01),降低患者术后切口疼痛、切口感染率及术后住院时间(P<0.01).2组患者在住院治疗期间均未发生切口出血、切口疝、肠粘连、肠梗阻等并发症.结论 横切口腹膜外单层缝合法在妊娠期化脓性阑尾炎切除术中具有操作简单、安全、并发症少等优点,值得推广.%Objective To investigate the clinical effect of transverse abdominal incision sutured by single layer extrap eritoneal suture for purulent appendicitis during gestational period. Methods During January 2006 to November 2010 , 129 pa tients with suppurative appendicitis from three universities ' affiliated hospital were divided into observation group and control group. Sixty-eight patients in observation group were taken transverse incision sutured by single layer extraperitoneal suture af ter appendectomy. Sixty-one patients in control group were taken McBumeys' incision ( or transverse incision) sutured by multi-layer extraperitoneal suture for the appendectomy. The operating time, the degree of postoperative pain, the abortion or premature birth rate, the incision infection rate and the length of hospitalization of patients between observation group and con trol group were compared. Results There were no statisitic significance of the abortion or premature birth rate between obser vatioin group and control

  15. Feasibility of laparoscopy for small bowel obstruction

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    De Sol Angelo A

    2009-01-01

    Full Text Available Abstract Background Adherential pathology is the most common cause of small bowel obstruction. Laparoscopy in small bowel obstruction does not have a clear role yet; surely it doesn't always represent only a therapeutic act, but it is always a diagnostic act, which doesn't interfere with abdominal wall integrity. Methods We performed a review without any language restrictions considering international literature indexed from 1980 to 2007 in Medline, Embase and Cochrane Library. We analyzed the reference lists of the key manuscripts. We also added a review based on international non-indexed sources. Results The feasibility of diagnostic laparoscopy is high (60–100%, while that of therapeutic laparoscopy is low (40–88%. The frequency of laparotomic conversions is variable ranging from 0 to 52%, depending on patient selection and surgical skill. The first cause of laparotomic conversion is a difficult exposition and treatment of band adhesions. The incidence of laparotomic conversions is major in patients with anterior peritoneal band adhesions. Other main causes for laparotomic conversion are the presence of bowel necrosis and accidental enterotomies. The predictive factors for successful laparoscopic adhesiolysis are: number of previous laparotomies ≤ 2, non-median previous laparotomy, appendectomy as previous surgical treatment causing adherences, unique band adhesion as phatogenetic mechanism of small bowel obstruction, early laparoscopic management within 24 hours from the onset of symptoms, no signs of peritonitis on physical examination, experience of the surgeon. Conclusion Laparoscopic adhesiolysis in small bowel obstruction is feasible but can be convenient only if performed by skilled surgeons in selected patients. The laparoscopic adhesiolysis for small bowel obstruction is satisfactorily carried out when early indicated in patients with a low number of laparotomies resulting in a short hospital stay and a lower postoperative

  16. Pelvic actinomycosis presenting as a malignant pelvic mass: a case report

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    Perek Asiye

    2011-01-01

    Full Text Available Abstract Introduction Pelvic actinomycosis constitutes 3% of all human actinomycosis infections. It is usually insidious, and is often mistaken for other conditions such as diverticulitis, abscesses, inflammatory bowel disease and malignant tumors, presenting a diagnostic challenge pre-operatively; it is identified post-operatively in most cases. Here we present a case that presented as pelvic malignancy and was diagnosed as pelvic actinomycosis post-operatively. Case presentation A 48-year-old Caucasian Turkish woman presented to our clinic with a three-month history of abdominal pain, weight loss and difficulty in defecation. She had used an intra-uterine device for 16 years, however it had recently been removed. The rectosigmoidoscopy revealed narrowing of the lumen at 12 cm due to a mass lesion either in the wall or due to an extrinsic lesion that prevented the passage of the endoscope. On examination, there was no gynecological pathology. Magnetic resonance imaging showed a mass, measuring 5.5 × 4 cm attached to the rectum posterior to the uterus. The ureter on that side was dilated. Surgically there was a pelvic mass adhered to the rectum and uterine adnexes, measuring 10 × 12 cm. It originated from uterine adnexes, particularly ones from the left side and formed a conglomerated mass with the uterus and nearby organs; the left ureter was also dilated due to the pelvic mass. Because of concomitant tubal abscess formation and difficulty in dissection planes, total abdominal hysterectomy and bilateral salphingo-oophorectomy was performed (our patient was 48 years old and had completed her childbearing period. The cytology revealed inflammatory cells with aggregates of Actinomyces. Penicillin therapy was given for six months without any complication. Conclusions Pelvic actinomycosis should always be considered in patients with a pelvic mass especially in ones using intra-uterine devices, and who have a history of appendectomy, tonsillectomy

  17. Early experience with laparoscopic surgery in children in Ile-Ife, Nigeria

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    Ademola Olusegun Talabi

    2015-01-01

    Full Text Available Background: Laparoscopy is not yet routinely employed in many Paediatric Surgical Units in Nigeria despite the advantages it offers. This study describes the preliminary experience with laparoscopic procedures in a single centre. Patients and Methods: A retrospective analysis of all children who had laparoscopic surgery between January 2009 and December 2013 at the Paediatric Surgical Unit of Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife was carried out. Their sociodemographic, preoperative and intraoperative data along with postoperative records were subjected to descriptive analysis. Results: Eleven (44% diagnostic and 14 (56% therapeutic procedures were performed on 25 children whose age ranged from 5 months to 15 years (Median: 84 months, Mean: 103 ± 64.1 months, including eight (32% females and 17 (68% males. Indications included acute appendicitis in 12 (48%, intra-abdominal masses in six (24%, three (12% disorders of sexual differentiation, two (8% ventriculoperitoneal shunt malfunctions and impalpable undescended testes in two (8% children. The procedures lasted 15-90 minutes (Mean = 54 (±21.6 minutes. Conversion rate was 17% for two patients who had ruptured retrocaecal appendices. No intra operative complications were recorded while three (12% patients had superficial port site infections post-operatively. All diagnostic (11 and two therapeutic procedures were done as day case surgery. The mean duration of hospital stay was 3.1 (±3.3 days for those who had appendectomies. Conclusion: Laparoscopic surgery in children is safe and feasible in our hospital. We advocate increased use of laparoscopy in paediatric surgical practice in Nigeria and similar developing settings.

  18. 空气灌肠失败和晚期肠套迭的手术治疗%Surgical Treatment of Advanced Intussusceptions and Failure of Rectal Inflation Reduction

    Institute of Scientific and Technical Information of China (English)

    唐伟椿; 成守礼

    1983-01-01

    From Nov.,1975 to July,1982,80 cases(51 males and 29 females)of intussusceotion were operated on.Among them,31 rectal inflation reduction failed.49 cases were advanced intussusdeption including some small intestinal intussusception.66 cases were primary.62 children were aged under one.Most of them had either enlarged regional mesenteric lymph node or mobile cecum.14 had secondary intussusceptions,13 of whom aged over one.There were 5 cases of Meckel's diverticulum,4 polyps,4 ileal duplications and one allergic purpura complicated with hematoma in the anterior wall of the cecum.Manual reductions were accomplished in 58 patients,together with simultaneous appendectomy.No plication of the cecum was attempted nor relapse noted.Intestinal resection followed by anastomosis was performed in 22 cases for intestinal gangrene.While rectal inflation on two patients with intestinal perforation was not successful,surgical repair was performed immediately.Only one death due to preoperative pneumonia and chickenpox was recorded.Thus mortality rate was 1.25%.%@@ 肠套迭是婴儿常见的急腹症,自从应用空气灌肠治疗以来,早期肠套迭的整复治疗取得了肯定的疗效,显著地降低了手术率.但对于复杂型和晚期肠套迭的病例使用空气灌肠,不但难以奏效,而且往往发生危险,而仍需手术治疗.

  19. Acute perforated appendicitis: An analysis of risk factors to guide surgical decision making

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    Savio G Barreto

    2010-01-01

    Full Text Available Introduction: Acute perforated appendicitis is associated with increased post-operative morbidity and mortality. Avoiding delays in surgery in these patients may play a role in reducing observed morbidity. Objective: To analyze the clinico-pathological profile and outcomes in a cohort of patients undergoing emergency appendicectomies for suspected acute appendicitis and to determine factors influencing the risk of perforated appendicitis in order to aid better identification of such patients and develop protocols for improved management of this subset of patients. Materials and Methods: A retrospective analysis of patients undergoing emergency appendicectomies following presentation with acute appendicitis to the Modbury hospital, South Australia from March 2007 to April 2011 was conducted. Statistical analyses were performed in SAS 9.2. Results and Discussion: 506 patients underwent emergency appendectomy for acute appendicitis which included equal number of male and female patients with a median age of 25 years. Perforated appendicitis was found in 102 (20% patients. Post-operative morbidity was significantly higher in patients with perforated appendicitis (28.4% vs 4.7%; P<0.0001. Male sex, patients older than 60 years, along with raised neutrophil counts and C-reactive protein levels were found to be significantly associated with the risk of perforation (P<0.05. Conclusions: Acute perforated appendicitis is associated with high morbidity. The increased risk of perforation in males and elderly patients appears unrelated to delays in presentation, diagnosis, or surgery. Patients with clinically diagnosed acute appendicitis and an elevation in neutrophil count and CRP level must be considered candidates for early surgery as they are likely to have an appendicular perforation.

  20. Apendicitis del muñón apendicular Appendicitis of the appendicular stump

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    María Carolina Berrogain

    2012-03-01

    Full Text Available La apendicitis del muñón es una entidad rara, caracterizada por un proceso inflamatorio del remanente apendicular luego de una apendicectomía incompleta. Los signos y síntomas no difieren de una apendicitis aguda. Al no ser una patología usualmente pensada como posible diagnóstico diferencial del abdomen agudo inflamatorio, tiene mayor riesgo de complicaciones y morbi-mortalidad. Los métodos seccionales de diagnósticos por imágenes resultan muy beneficiosos para definir el diagnóstico. La ultrasonografía (US y tomografía computada (TC demuestran signos similares a los observados en cuadros habituales de inflamación aguda del apéndice cecal. Se presentan dos casos de apendicitis del muñón, uno de ellos recibió tratamiento quirúrgico y el otro tratamiento médico.Stump appendicitis is a rare entity characterized by inflammation of the appendiceal remanent after incomplete appendectomy. Signs and symptoms do not differ from acute appendicitis. As it is not a condition usually considered as a potential differential diagnosis of acute inflammatory abdomen, it has higher risks of complications and morbidity and mortality. Imaging methods are highly useful to define the diagnosis. Ultrasound (US and Computed Tomography (CT show signs similar to those found in standard cases of acute appendicitis. Two cases of stump appendicitis are reponed: one managed with surgical treatment and the other with medical treatment.

  1. Primary peritoneal serous papillary carcinoma (PSPC involving ovary and colon: Management and Treatment

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    Leanza V

    2013-05-01

    Full Text Available We present a case report of a 47-year-old woman who was admitted to our University-Hospital following diagnosis of pelvic mass. Abdominal examination revealed a tender, palpable mass on the right iliac region. At the gynecological examination uterus was regular in size. On the left side of the uterus a mass of 9 cm was observed; its surface was irregular and no mobility was found. Abdominal CT and NMR revealed massive ascites, omental cake and increased volume of both ovaries. Patient underwent longitudinal suprombelical-pubic laparotomy. After opening abdominal cavity, a free-fluid sample was taken and the results were positive for malignant cells. Typical neoplastic localizations on both ovaries, Douglas’ peritoneum, rectum, sigmoid colon and omentum were observed. Extemporaneous histological examination diagnosed a peritoneal serous papillary carcinoma. Hysterectomy with salpingo oophorectomy, total omentectomy, appendectomy, pelvic and lumbo-aortic lymphadenectomy was performed. Retroperitoneal approach to remove the whole Douglas’ peritoneum together with the pouch malignant localizations was done. Sigmoid colon and rectum were resected. A latero-terminal anastomosis with stapler was performed. All the visible abdominal maligant lesions were cut out. No transfusion was necessary. The postoperative course was regular and after seven days the patient was discharged. Chemotherapy ended the therapeutic management (six cycles of carboplatin and paclitaxel. After one year the patient is in good health and instrumental investigations (Ultrasounds, TC and NMR are negative for recurrence. Such a case is very interesting for the discrepancy between slight symptoms and severity of the disease, the solution of which was very complex requiring a skillful polyspecialized oncological team.

  2. Validity and reliability of a pain location tool for pediatric abdominal surgery.

    Science.gov (United States)

    Hamill, James K; Cole, Alana M; Liley, Andrew; Hill, Andrew G

    2015-06-01

    For children with surgical problems, pain location conveys important clinical information. We developed a Location and Level of Intensity of Postoperative Pain (Lolipops) tool consisting of a body outline with a seven-sector abdominal grid, the International Association for the Study of Pain Revised Faces Pain Scale, and a recording chart. The aim of the study was to assess the validity and reliability of Lolipops. Children aged 5-14 years who had undergone laparoscopic appendectomy took both nurse- and investigator-administered Lolipops, and an investigator administered Varni Thompson Pediatric Pain Questionnaires, within 24 hours of surgery. The average age of the 42 participants was 10.7 years; 64% were boys; 24 (57.1%) had acute appendicitis, 13 (31%) had perforated appendicitis, and 5 (11.9%) were uninflamed. Pain scores were higher at the laparoscopic port incision sites than in upper abdominal sites distant from incisions or expected inflammation, mean (SD) 3.3 (2.3) and 1.1 (1.8), respectively (p pain scores were higher in the right iliac fossa than in upper abdominal sites, mean (SD) 3.3 (2.5) and 0.4 (0.7), respectively (p = .001). In children with perforated appendicitis, Lolipops demonstrated a more widespread pain pattern. Correlations between nurse and investigator were fair to moderate with an overall intraclass correlation coefficient of 0.597. This study presents a new tool to measure the location of pain in pediatric surgical patients and shows it to be valid and reliable.

  3. Diagnostic value of procalcitonin for acute complicated appendicitis

    Science.gov (United States)

    Yamashita, Hiromasa; Yuasa, Norihiro; Takeuchi, Eiji; Goto, Yasutomo; Miyake, Hideo; Miyata, Kanji; Kato, Hideki; Ito, Masafumi

    2016-01-01

    ABSTRACT A rapid and reliable test for detection of complicated appendicitis would be useful when deciding whether emergency surgery is required. We investigated the clinical usefulness of procalcitonin for identifying acute complicated appendicitis. We retrospectively analyzed 63 patients aged ≥15 years who underwent appendectomy without receiving antibiotics before admission and had preoperative data on the plasma procalcitonin level (PCT), body temperature (BT), white blood cell count (WBC), neutrophil / lymphocyte ratio (N/L ratio), and C-reactive protein level (CRP). Patients were classified into 3 groups: group A (inflammatory cell infiltration of the appendix with intact mural architecture), group B (inflammatory cell infiltration with destruction of mural architecture, but without abscess or perforation), and group C (macroscopic abscess and/or perforation). For identifying destruction of mural architecture, the diagnostic accuracy of PCT was similar to that of BT or CRP. However, the diagnostic accuracy of PCT was highest among the five inflammatory indices for identifying abscess and/or perforation, with the positive predictive value of PCT for abscess and/or perforation being higher than that of CRP (73% vs. 48%). Univariate analysis of the predictors of abscess and/or perforation revealed that a plasma PCT level ≥0.46 ng/mL had the highest odds ratio (30.3 [95% confidence interval: 6.5–140.5] versus PCT <0.46 ng/mL). These findings indicate that procalcitonin is a useful marker of acute appendicitis with abscess and/or perforation. PMID:27019529

  4. Primary appendiceal mucinous adenocarcinoma alongside with situs inversus totalis: a unique clinical case

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    Evangelou Konstantinos

    2010-06-01

    Full Text Available Abstract Introduction Mucinous adenocarcinoma is a rare neoplasm of the gastrointestinal tract and one of the three major histological subtypes of the primary appendiceal adenocarcinoma. The most common type of presentation is that of acute appendicitis and the diagnosis is usually occurred after appendectomy. The accurate preoperative diagnosis and management of the above condition represents a real challenge when uncommon anatomic anomalies such intestinal malrotation and situs inversus take place. Situs inversus totalis with an incidence of 0.01% is an uncommon condition caused by a single autosomal recessive gene of incomplete penetration in which the major visceral organs are mirrored from their normal positions. Case presentation We present an unusual case of a 59 years old, previously healthy man presented with a left lower quadrant abdominal pain, accompanied with low fever, leukocytosis, anorexia and constipation. A chest radiograph demonstrated dextrocardia with a right side positioned stomach bubble. Both preoperative US and CT scan of the abdomen and pelvis declared situs inversus, with a characteristic thickening in its wall, appendix situated in the left lower quadrant of the abdomen. These findings reached to the diagnosis of acute appendicitis with situs inversus and a standard appendicectomy was performed. Pathologic evaluation established primary mucinous adenocarcinoma of the appendix and three months afterwards the patient underwent a subsequent extended left hemicolectomy. Conclusion In conclusion, the occurrence of primary appendiceal mucinous adenocarcinoma along with situs inversus, definitely accounts as a unique clinical case. Even synchronous manifestation of primary mucinous adenocarcinoma of the appendix and situs inversus totalis represents an unusual anatomo-pathological entity, all physicians should be familiar having the knowledge to make an appropriate and accurate diagnosis that will lead to prompt and correct

  5. A rational approach to estimating the surgical demand elasticity needed to guide manpower reallocation during contagious outbreaks.

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    Hsiao-Mei Tsao

    Full Text Available Emerging infectious diseases continue to pose serious threats to global public health. So far, however, few published study has addressed the need for manpower reallocation needed in hospitals when such a serious contagious outbreak occurs.To quantify the demand elasticity of the major surgery types in order to guide future manpower reallocation during contagious outbreaks.Based on a nationwide research database in Taiwan, we extracted the monthly volumes of major surgery types for the period 1998-2003, which covered the SARS period, in order to carry out a time series analysis. The demand elasticity of each surgery type was then estimated by autoregressive integrated moving average (ARIMA analysis.During the study period, the surgical volumes of most selected surgery types either increased or remained steady. We categorized these surgery types into low-, moderate- and high-elastic groups according to their demand elasticity. Appendectomy, 'open reduction of fracture with internal fixation' and 'free skin graft' were in the low demand elasticity group. Transurethral prostatectomy and extracorporeal shockwave lithotripsy (ESWL were in the high demand elasticity group. The manpower of the departments carrying out the surgeries with low demand elasticity should be maintained during outbreaks. In contrast, departments in charge of surgeries mainly with high demand elasticity, like urology departments, may be in a position to have part of their staff reallocated.Taking advantage of the demand variation during the SARS period in 2003, we adopted the concept of demand elasticity and used a time series approach to figure out an effective index of demand elasticity for various types of surgery that could be used as a rational reference to carry out manpower reallocation during contagious outbreak situations.

  6. Unusual cause of a painful right testicle in a 16-year-old man: a case report

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    Riaz Amjid A

    2011-01-01

    Full Text Available Abstract Introduction Urgent surgical exploration of the scrotum of a child or teenager who presents with a painful and swollen testicle is paramount if testicular torsion is not to be missed. It is extremely rare for a non-scrotal pathology to present with acute scrotal signs. Here we present such a rare case and emphasize the importance of being aware of this potential clinical pitfall. Case presentation A 16-year-old Caucasian man presented as a surgical emergency with a five to six hour history of a painful, red, and swollen right hemiscrotum. He also complained of vague lower abdominal pain, vomiting, and watery diarrhea. He had a temperature of 38.5°C and a tender, red, and swollen right hemiscrotum. The right testicle appeared elevated. He was mildly tender in his central and upper abdomen and less so in the lower abdomen. No convincing localizing abdominal signs were noted. He had an increased white cell count (15 × 109/L and C-reactive protein (CRP; 300 mg/L. Urgent right hemiscrotal exploration revealed about 5 ml of pus in the tunica vaginalis and a normal testicle. A right iliac fossa incision identified the cause: a perforated retrocecal appendix. Appendectomy was performed, and both the abdomen and scrotum washed copiously with saline before closure. The patient made an uneventful recovery. Conclusion Acute appendicitis presenting with scrotal signs due to a patent processus vaginalis is an extremely rare clinical entity. To date, fewer than five such cases have been reported in the medical literature. It is, therefore, extremely important to be aware of this unusual clinical scenario, as only a high index of suspicion will enable prompt, successful management of both the appendicitis and the scrotal abscess.

  7. [Results of the participation of resident physicians in the surgical treatment of gallbladder lithiasis].

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    González Ojeda, A; Herrera Hernández, M F; Torres Mejía, G; Odor Morales, A; de la Garza Villaseñor, L

    1991-01-01

    The aim of this retrospective study was to evaluate the impact of resident participation in the results of surgical treatment in 1149 consecutive patients operated for biliary disease between January, 1980 and December, 1987 at the Instituto Nacional de la Nutrición "Salvador Zubirán". Patients were divided in three groups: GROUP I. 640 cases treated by surgical residents under a senior surgeon supervision. GROUP II. 168 patients operated by the chief surgical resident. GROUP III. 341 patients treated by senior staff surgeons. Age, sex and risk factors were similar between groups. Residents performed more operative cholangiograms (p less than 0.05). In general, senior surgeons performed more transduodenal sphincteroplasties (p less than 0.05) and other additional procedures like appendectomies and gastrostomies during the same surgery. Wound infection was more frequent in group III patients (p less than 0.005) but there was no significant clinical difference in other postoperative complications like intraabdominal abscess, bile fistula, wound dehiscence, intraabdominal bleeding, iatrogenic injury of the biliary tract, and residual common duct stone. The duration of the in-hospital convalescence period was similar in all three groups. The mortality rate for the total series was 2.2%. In group II there were more patients affected for acute cholecystitis, and more patients died postoperatively (p = less than 0.01). We may consider this difference attributable to the more complex patients handled by the chief resident. Mortality rate among patients with chronic biliary tract disease was less than 1%. We were not able to demonstrate any significant difference in mortality and complication rates between those patients operated by residents, chief residents and senior surgeons.(ABSTRACT TRUNCATED AT 250 WORDS)

  8. The diagnostic value of barium enema in acute appendicitis

    International Nuclear Information System (INIS)

    Acute appendicitis is the most common acute surgical condition of the abdomen. When the clinical presentation is atypical, barium enema has proven to be safe and useful in confirming the diagnosis and reducing the negative surgical exploration. However, the performance of barium enema in acute appendicitis has known contraindication primarily because of fear of leakage by perforation of the inflamed appendix. This study using barium enema as a diagnostic aid in acute appendicitis with atypical clinical presentation was performed to further support the previously noted efficacy and safety of this procedure. The results were as followings: 1. In case of acute appendicitis with atypical clinical presentation, the use of barium enema as a diagnostic aid increased the accuracy of diagnosis and decreased the negative surgical exploration. In women between 11 to 50 years old age, especially, it played important role differentiating appendicitis from nonsurgical acute abdomen. 2. The results of the study were 92.31% in sensitivity, 7.69% in false positive, 6.9% in false negative, and 10.26% in negative appendectomy. 3. None of case of leakage of barium by perforation of the inflamed appendix was noted, therefore, barium enema was thought to be safe as a diagnostic aid in acute appendicitis. 4. A simple partial or non filling of appendix without other associated positive finding could not exclude appendicitis, therefore, close clinical observation was necessary. 5. The positive findings of barium enema and their sensitivity were as followings: 1. Non filling of appendix: 90% 2. Partial filling of appendix: 91.7% 3. Displacement or a local impression on terminal ileum: 100%

  9. 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.

  10. Ovarian Mucoproducer Cystadenocarcinoma . A Case Presentation Cistoadenocarcinoma mucoproductor de ovario. Presentación de un caso

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    Regla Fang Mederos

    2012-05-01

    Full Text Available Ovarian cancer is the most common cause of death among malignant tumors of the genital tract and is the third cause of death according to requency out of all malignant tumors in women. The case of a 60 years old patient of rural origin who was admitted to the Gynecology Service of the Dr. Gustavo Aldereguía Lima General University Hospital of Cienfuegos because of lower abdomen pain, abdominal enlargement, general malaise and weight loss is presented. Complementary tests allowed diagnosing a giant ovarian tumor. She underwent total abdominal hysterectomy with bilateral adnexectomy, omentectomy and appendectomy. The anatomical and pathologic diagnosis reported a well-differentiated cystadenocarcinoma.

    El cáncer de ovario representa la causa más frecuente de muerte entre los tumores malignos del tracto genital y constituye la tercera causa en orden de frecuencia de todos los tumores malignos de la mujer. Se presenta el caso de una paciente de 60 años de edad, de procedencia rural, que ingresó en el Servicio de Ginecología del Hospital General Universitario Dr. Gustavo Aldereguía Lima, de Cienfuegos, por sentir dolor en bajo vientre, aumento de volumen del abdomen, con toma del estado general y pérdida de peso. Al realizarle exámenes complementarios se diagnosticó un tumor de ovario gigante. Se le realizó una histerectomía total abdominal con doble anexectomía, omentectomía y apendicectomía. El diagnóstico anatomopatológico informó un cistoadenocarcinoma bien diferenciado.

  11. Single-port laparoscopic surgery in children: A new alternative in developing countries

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    Ben Dhaou Mahdi

    2015-01-01

    Full Text Available Background: Single-incision laparoscopic surgery (SILS is a technique in laparoscopic surgery, which is based on the idea that all the laparoscopic trocars are inserted through a single umbilical incision. This paper documents a single-centre experience, which performed the single-port surgery in children using an improvised trans-umbilical glove-port with conventional rigid instruments. Materials and Methods: We prospectively studied the outcomes of SILS procedures between January 2013 and June 2014. Materials required making our homemade trans-umbilical port consisted on: A flexible ring, a rigid larger ring, one powder-free surgical glove, a wire-to-skin and standard standards laparoscopic trocars. Results: A total of 90 consecutive procedures had been done in our institution: 15 girls and 75 boys (mean age: 7.5 years. We used SILS on 59 appendectomies with an average operative time of 48 minutes. We needed conversion to conventional surgery in three cases (two with perforated appendicitis and one for difficulty to mobilize the appendix. SIL cholecystectomy was performed for four patients with symptomatic cholelithiasis; mean operative time was 60 min. All patients were discharged on postoperative day 2. Eighteen boys with non-palpable testis were explored and treated. Other procedures included: Varicocelectomy (n = 2, intra-abdominal lymph node biopsies (n = 2, ovarian cystectomy (n = 1, ovarian transposition (n = 1, aspiration of renal hydatid cyst (n = 1, explorative laparoscopy in research to Meckel′s diverticulum (n = 1 and intestinal intussusceptions (n = 1. No post-operative complications were seen in all cases. Conclusions: SILS in the paediatric population using conventional rigid instruments is feasible, safe and effective. It may be an alternative to the costly commercially available single-port systems especially in a developing country like Tunisia.

  12. MODIFIED LAPAROSCOPIC CHOLECYSTECTOMY

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    To furtherly reduce the subxiphoid port site pain,improve the cosmetic result and patient satisfaction,and increase the safety for patients underwent laparoscopic cholecystectomy by advanced laparoscopic knotting skill.Methods:Among our 1500 patients underwent laparoscopic cholecystectomy since 1991,120 cases of modified laparoscopic cholecystectomy (MLC) were performed with three 5-mm ports and one 10-mm port(for laparoscope and sepcien withdrawn).There were 25 male and 95 female patients with an average age of 55 years (24~77years).The indications for MLC included polypoid lesions of gallbladder (21),simple cholecystitis(3),cholecystolithiasisi with chronic cholecystitis(84),with acute suppurative cholecystitis(7),with atrophic cholecystitis(5).Results:There were 5 patients underwent combined laparoscopic appendectomy(3),fenestration of hepatic cyst(1),and drainge for liver abscess(1).The average operative time for MLC was 55 minutes(30~150min),blood loss was 10ml(3~50ml),and postoperative stay was 3 days(1~5days).There were no conversion from MLC to either LC or open surgery,without mortality.Complications were limited to two patients(1.7%).One was retained common bile duct stone and another was port site bleeding after operation.They were treated by transduodenal endoscopic stone retrieval and simple suture ligation,respecrtively.Conclusions:The advantages of MLC conducted mainly by advanced laparoscopic knotting techniques were no more laparoscope (either 2-mm or 5-mm)needed,no sacrifice of good illumination and laproscopic image.Most of all,its costeffective and operative safety were all improved furtherly.

  13. Emergency Operating Room Workload Pattern: A Single Center Experience from Southern Iran

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    Hamid Reza Abbasi

    2013-01-01

    Full Text Available Objective: To determine the epidemiology and pattern of emergency operating room workload in Nemazee hospital affiliated with Shiraz University of Medical Sciences, Shiraz, Iran.Methods: All surgical emergency operations which were performed in Nemazee hospital, Shiraz, Iran were collected over twelve months (September 2007 to September 2008. The data obtained included indications, presenting symptoms the services provided and the demographic information of the patients.Results: Overall number of recorded emergency operations in this cross sectional descriptive study was 3946, with males constituting 72% of the patients. The highest male/female ratio reported in trauma patients was 6.4:1 with the median age of 23 years, and the mean age of the operated patients was 27.8 years. Second to neurosurgery (19.64% the general surgery was the busiest discipline in emergency operations (59.14%. Appendectomy (11.77%, double/triple lumen/central venous catheter insertion (9.4%, and fiber optic/rigid bronchoscopy (3.27% were the commonest general surgical operations. Among trauma patients, neurotrauma was the commonest reason for operation (10%.Conclusion: Based on a new approach toward emergency operating room workload, in our country and centre, we showed that it is necessary to devote particular and individualized attention to the fields of agenda and hospital management of emergency operations. This is due to a high emergency operating room workload and its unique characteristics in our centre in contrast to other hospitals and departments. Although a decision making and operational strategy is recently seen to improve the quality and quantity of emergency services available to our patients, there is still a gap between present and optimal emergency healthcare which should be provided for our residents.

  14. Ovarian vein thrombosis mimicking acute abdomen: a case report and literature review

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    Arkadopoulos Nikolaos

    2011-12-01

    Full Text Available Abstract Background Ovarian vein thrombosis (OVT is a rare, but serious condition that affects mostly postpartum women. A high index of suspicion is required in order to diagnose this unusual cause of abdominal pain. Case presentation A 19-year-old woman at three days postpartum was admitted to our hospital because of severe right lower quandrant abdominal pain and fever 38.5'C. Physical examination revealed an acutely ill patient and right lower quadrant tenderness with positive rebound and Giordano signs. The patient underwent appendectomy which proved to be negative for acute appendicitis. Postoperatively fever and pain persisted and abdominal CT-scan with intravenous contrast agent demonstrated a thrombosed right ovarian vein. The patient was initiated on low-molecular weight heparin (LMWH and antibiotic treatment and a month later a new abdominal CT-scan showed a patent right ovarian vein. Discussion Pathophysiologically, OVT is explained by Virchow's triad, because pregnancy is associated with a hypercoagulable state, venous stasis due to compression of the inferior vena cava by the uterus and endothelial trauma during delivery or from local inflammation. Common symptoms and signs of OVT include lower abdomen or flank pain, fever and leukocytosis usually within the first ten days after delivery. The reported incidence of OVT ranges 0,05-0,18% of pregnancies and in most cases the right ovarian vein is the one affected. Anticoagulation and antibiotics is the mainstay of treatment of OVT. Complications of OVT include sepsis, extension of the thrombus to the inferior vena cava and renal veins, and pulmonary embolism. The incidence of pulmonary embolism is reported to be 13.2% and represents the main source of mortality due to OVT. Conclusions OVT is a rare condition, usually in the postpartum period. A high index of suspicion is required for the prompt diagnosis and management especially in cases that mimic acute abdomen.

  15. Pneumoperitoneum due to perforated appendicitis: a rare anatomo-radiologic correlation Pneumoperitônio devido à apendicite perfurada: correlação anátomo-radiológica rara

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    André Luiz Santos Rodrigues

    2008-09-01

    Full Text Available BACKGROUND: Pneumoperitoneum is usually associated with a perforated peptic ulcer. However, perforated appendicits may be evolved on it. In the medical literature, the anatomo-radiologic correlation between them is an uncommon event. CASE REPORT: Man with 56-year-old look for assistance with diffuse abdominal pain and distension associated with fever, vomit and absence of flatus and evacuation for about 14 days. The chest radiography revealed a pneumoperitoneum. Diffuse peritonitis was found during the exploratory laparotomy. Appendectomy, peritoneal cavity cleaning and drainage with tubular drains were carried out. However, severe sepsis occurred and the patient died on the 16th post-operative day with multiple systemic organ failure. CONCLUSION: Although rare as pneumoperitoneum ethiology, acute appendicitis may be thought as it's cause.INTRODUÇÃO: Penumoperitôneo é usualmente associado à perfuração gástrica ou duodenal. Entretanto, apendicite perfurada pode também desenvolvê-lo. Na literatura, correlação clínica-radiológica é rara nesses eventos. RELATO DO CASO: Homem com 56 anos foi atendido com dor abdominal difusa, distensão abdominal e febre, vômitos, parada de eliminação de gazes e fezes por 14 dias. Estudo radiológico de tórax mostrou pneumoperitôneo. No procedimento cirúrgico, peritonite difusa foi encontrada e apendicectomia com lavagem abdominal e drenagem foi efetuada. Entretanto, o paciente morreu por sepse generalizada e falência múltipla de órgãos e sistemas no 16o. dia do pós-operatório. CONCLUSÃO: Embora rara como causa de pneumoperiotôneo, a apendicite aguda deve ser pensada como sua possível causa.

  16. Perforated peptic ulcer in an adolescent boy with acute appendicitis: a case report

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    Aazam Khorassani

    2013-06-01

    Full Text Available Background: Peptic ulcer disease is one of the most common GI disorders. Perforation has the highest mortality rate of any complication of ulcer disease, while early diagno-sis and emergency treatment save patient life.Case presentation: This paper reports an adolescent boy admitted to the Ziaeian University Hospital. He suffered from severe abdominal pain with dyspnea had been started since past three hours. Periumbilical pain started from past 2-3 days, gradually localized to the right lower quadrant. He had anorexia without nausea and vomiting. He was tachycardic and tachypneic, but he did not have fever. On physical examination, bowel sound was hypoactive, there was generalize tenderness, guarding and rebound tender-ness focused in the right lower quadrant and suprapubic region. Laboratory finding indicated leukocytosis. Chest X-ray showed free air under diaphragm. Once the diagno-sis has been made, the patient was given analgesia and antibiotics, resuscitated with isotonic fluid, and taken to the operating room. Laparotomy was implemented through a midline incision. There was bile secretion in the peritoneal cavity. Appendix was inflamated. Cecum and ileum were normal. A small perforation, 4mm in size was detected in first portion of duodenum. Appendectomy and omental patch repair were done. Ten days later, the patient was discharged in a good state. Serologic test for helicobacter pylori was negative.Conclusion: Stomach and duodenal perforation should be considered in patients with-out peptic ulcer disease, especially in children and adolescents with sudden and severe abdominal pain who are admitted to the hospital for other diseases. Because some patients present with peptic ulcer complications that are seemingly exacerbated by stressful life events.

  17. The effects of medical tourism: Thailand’s experience

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    NaRanong, Viroj

    2011-01-01

    Abstract Objective To explore the positive and negative effects of medical tourism on the economy, health staff and medical costs in Thailand. Methods The financial repercussions of medical tourism were estimated from commerce ministry data, with modifications and extrapolations. Survey data on 4755 foreign and Thai outpatients in two private hospitals were used to explore how medical tourism affects human resources. Trends in the relative prices of caesarean section, appendectomy, hernia repair, cholecystectomy and knee replacement in five private hospitals were examined. Focus groups and in-depth interviews with hospital managers and key informants from the public and private sectors were conducted to better understand stakeholders’ motivations and practices in connection with these procedures and learn more about medical tourism. Findings Medical tourism generates the equivalent of 0.4% of Thailand’s gross domestic product but has exacerbated the shortage of medical staff by luring more workers away from the private and public sectors towards hospitals catering to foreigners. This has raised costs in private hospitals substantially and is likely to raise them in public hospitals and in the universal health-care insurance covering most Thais as well. The “brain drain” may also undermine medical training in future. Conclusion Medical tourism in Thailand, despite some benefits, has negative effects that could be mitigated by lifting the restrictions on the importation of qualified foreign physicians and by taxing tourists who visit the country solely for the purpose of seeking medical treatment. The revenue thus generated could then be used to train physicians and retain medical school professors. PMID:21556301

  18. Chronic kidney disease itself is a causal risk factor for stroke beyond traditional cardiovascular risk factors: a nationwide cohort study in Taiwan.

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    Yi-Chun Chen

    Full Text Available BACKGROUND: Cardiovascular disease (CVD is a leading cause of mortality and morbidity in patients with chronic kidney disease (CKD. In Taiwan, CVD is dominated by strokes but there is no robust evidence for a causal relationship between CKD and stroke. This study aimed to explore such causal association. METHODS: We conducted a nationwide retrospective cohort study based on the Taiwan National Health Insurance Research Database from 2004 to 2007. Each patient identified was individually tracked for a full three years from the index admission to identify those in whom any type of stroke developed. The study cohort consisted of patients hospitalized with a principal diagnosis of CKD and no traditional cardiovascular risk factors at baseline (n = 1393 and an age-matched control cohort of patients hospitalized for appendectomies (n = 1393, a surrogate for the general population. Cox proportional hazard regression and propensity score model were used to compare the three-year stroke-free survival rate of the two cohorts after adjustment for possible confounding factors. RESULTS: There were 256 stroke patients, 156 (11.2% in the study cohort and 100 (7.2% in the control cohort. After adjusting for covariates, patients with primary CKD had a 1.94-fold greater risk for stroke (95% CI, 1.45-2.60; p<0.001 based on Cox regression and a 1.68-fold greater risk for stroke (95% CI, 1.25-2.25; p = 0.001 based on propensity score. This was still the case for two cohorts younger than 75 years old and without traditional cardiovascular risk factors. CONCLUSIONS: This study of Taiwanese patients indicates that CKD itself is a causal risk factor for stroke beyond the traditional cardiovascular risk factors. Primary CKD patients have higher risk for stroke than the general population and all CKD patients, irrespective of the presence or severity of traditional cardiovascular risk factors, should be made aware of the stroke risk and monitored for stroke prevention.

  19. A pin in appendix within Amyand's hernia in a six-years-old boy: case report and review of literature

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    Jashari Hysni J

    2010-05-01

    Full Text Available Abstract Introduction Presence of vermiform appendix (non-inflamed or inflamed in inguinal hernia is called Amyand's hernia in honor to surgeon C. Amyand who published the first case of perforated appendicitis within inguinal hernia in a boy caused by ingested pin. This presentation of foreign body Amyand's hernia appendicitis is very rare, and here we present such a case. Case presentation A 6-year-old boy, white Kosovar ethnicity, presented with right groin pain, swelling and redness. Two days before admission the patient was injured by football during a children game in the right lower abdomen and the next day he complained of pain in the right inguinal area. On admission patient had a painful non-reducible mass in the right inguinal region and cellulitis. Plain abdominal x-ray showed no fluid-air levels, but a metallic foreign body (pin under right superior pubic ramus was apparent. With preoperative diagnosis of suspect incarcerated inguinal hernia with cellulitis the patient was operated on under general anaesthesia in December 2, 2006. Intraoperatively we found the inflamed vermiform appendix perforated by a pin in the hernial sac. Appendectomy and herniotomy were performed. The wound was primary closed, without any post-operative complications and follow up for the patient is three years long. Conclusion Foreign body (pin Amyand's hernia appendicitis seems to be extremely rare, maybe once in a century (Amyand 1735, Hall 1886, and our case in 2006. In patients with clinical signs of incarcerated inguinal hernia, with locally inflammatory signs, but without signs of intestinal obstruction Amyand's hernia appendicitis in differential diagnosis must be considered. In our case, it is possible that the injury during the football game might have induced perforation of the vermiform appendix with the foreign body in it.

  20. Analgesic efficacy of the ultrasound-guided blockade of the transversus abdominis plane - a systematic review

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    Javier Ripollés

    2015-08-01

    Full Text Available BACKGROUND: The transverse abdominal plan blockade is a block of abdominal wall that has diffused rapidly in the clinical practice as part of a multimodal analgesia for abdominal surgery. The performance of the ultrasound-guided technique has allowed the lowering of potential complications, as well as new approaches that were carried out according to the descriptions, and the prospective studies would make it possible to utilize the transverse abdominal plan blockade in different surgical interventions; however, the results obtained in randomized clinical trials are inconsistent.OBJECTIVES: To prepare a systematic review aiming to determine the efficacy of the ultrasound-guided transverse abdominal plan blockade for different surgical interventions, as well as the indications according to the approaches and their influences.METHODS: Two research approaches, one manual, and the other in Pubmed returned 28 randomized clinical trials where intervention with ultrasound-guided transverse abdominal plan blockades was performed to compare the analgesic efficacy in contrast to another technique in adults, published between 2007 and October 2013, in English or Spanish, with Jadad score > 1, according to the inclusion criteria for this review. The authors analyzed independently all the randomized clinical trials.CONCLUSIONS: The transverse abdominal plan blockades have been shown to be an effective technique in colorectal surgery, cesarean section, cholecystectomy, hysterectomy, appendectomy, donor nephrectomy, retropubic prostatectomy, and bariatric surgery. However, the data found in randomized clinical trial are not conclusive, and as a result, it is necessary to develop new and well designed randomized clinical trial, with enough statistical power to compare different approaches, drugs, doses, and volumes for the same intervention, aiming to answer the current questions and their effects in the habitual clinical practice.

  1. Mandatory imaging cuts costs and reduces the rate of unnecessary surgeries in the diagnostic work-up of patients suspected of having appendicitis

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    Lahaye, M.J.; Lambregts, D.M.J.; Mutsaers, E.; Beets-Tan, R.G.H. [Maastricht University Medical Centre, Department of Radiology, Maastricht (Netherlands); Essers, B.A.B. [Maastricht University Medical Centre, Department of Epidemiology and Medical Technology, Maastricht (Netherlands); Breukink, S.; Beets, G.L. [Maastricht University Medical Centre, Department of Surgery, Maastricht (Netherlands); Cappendijk, V.C. [Jeroen Bosch Hospital, Department of Radiology, ' s Hertogenbosch (Netherlands)

    2015-05-01

    To evaluate whether mandatory imaging is an effective strategy in suspected appendicitis for reducing unnecessary surgery and costs. In 2010, guidelines were implemented in The Netherlands recommending the mandatory use of preoperative imaging to confirm/refute clinically suspected appendicitis. This retrospective study included 1,556 consecutive patients with clinically suspected appendicitis in 2008-2009 (756 patients/group I) and 2011-2012 (800 patients/group II). Imaging use (none/US/CT and/or MRI) was recorded. Additional parameters were: complications, medical costs, surgical and histopathological findings. The primary study endpoint was the number of unnecessary surgeries before and after guideline implementation. After clinical examination by a surgeon, 509/756 patients in group I and 540/800 patients in group II were still suspected of having appendicitis. In group I, 58.5% received preoperative imaging (42% US/12.8% CT/3.7% both), compared with 98.7% after the guidelines (61.6% US/4.4% CT/ 32.6% both). The percentage of unnecessary surgeries before the guidelines was 22.9%. After implementation, it dropped significantly to 6.2% (p<0.001). The surgical complication rate dropped from 19.9% to 14.2%. The average cost-per-patient decreased by 594 EUR from 2,482 to 1,888 EUR (CL:-1081; -143). Increased use of imaging in the diagnostic work-up of patients with clinically suspected appendicitis reduced the rate of negative appendectomies, surgical complications and costs. (orig.)

  2. Association between tonsillectomy, adenoidectomy, and appendicitis Asociación entre amigdalectomía, adenoidectomía y apendicitis

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    J. C. Andreu Ballester

    2005-03-01

    Full Text Available Introduction: tonsillectomy, with or without adenoidectomy, is one of the most frequent surgical procedures generally performed, especially in young patients. Several studies suggest that there is a relationship between tonsillectomy and altered MALT immune system. Objective: to examine the possible association between tonsillectomy or adenoidectomy and the risk of subsequent appendicitis. Material and method: a cross-sectional study was performed in 650 patients admitted to the emergency department of a general hospital in Valencia, Spain. Previous history of tonsillectomy and/or adenoidectomy was related to a history of appendectomy. A descriptive study and an analysis of the relationship between previous operations and appendicitis was performed. A multivariable analysis controlled for age and sex was also performed, including the possible interaction of the gender variable. The independent effect of each of the procedures (tonsillectomy, adenoidectomy was tested. Results: the 25.5% of patients had undergone tonsillectomy and 11.5% adenoidectomy; 17.5% had had an appendectomy. On average, women were operated on more frequently than men. In the bivariate analysis, both tonsillectomy and adenoidectomy were significantly associated with subsequent appendectomy. In the multivariate analysis, this association was only maintained for tonsillectomy (OR: 3.23; 95% CI: 2.11-4.94. A stratified analysis controlling for sex showed a modification of this effect, with a higher association in women (OR: 5.20; 95% CI: 2.91-9.28 than in men (OR: 1.74; 95% CI: 0.90-3.39. Conclusions: a clear association has been found, especially in women, between previous tonsillectomy and subsequent acute appendicitis. Due to a lack of data on acute appendicitis there should be further studies to explain the findings of this study, as this could be the first described risk factor of acute appendicitis.Introducción: la amigdalectomía, sola o acompañada de adenoidectom

  3. LAPAROSCOPIC SURGICAL TRAINING. A THREE STAGES MODE

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    R. Moldovanu

    2013-03-01

    Full Text Available The classic “Halstedian” apprenticeship model for surgical training takes place into the operating theater under the strict coordination of a senior surgeon. The development of minimally invasive surgery (MIS rapidly revealed that this apprenticeship model is insufficient to successful fulfill the well known three stages of training of Rasmussen model – skill-based behavior (SBB, rule-based behavior (RBB and knowledge-based behavior (KBB – due to ethical, medico-legal and economic considerations and a specific training using different methods (theoretical and hands-on courses using simulators, animal models and web resources is mandatory. However it isn’t a worldwide accepted laparoscopic training curriculum. We present our experience with different types of teaching methods; in this way we retrospectively reviewed our experience in laparoscopic education, presenting data using Rasmussen model, as a dynamic three stages model: 1 first stage (the beginning, from 1993 until 1995, our staff acquired SBB, RBB and KBB for basic MIS procedures: cholecystectomy, appendectomy, surgical ablation of ovarian cysts; 2 the second stage, from 1996 until 1999, characterized by continuous training of our surgical staff until the achievement of the KBB level for basic MIS procedures and training for other operations (laparoscopic treatment of the groin hernias, eso-gastric and bariatric surgery and the teaching of the residents and the surgeons from Moldova region to achieve SBB and RBB for basic MIS procedures; 3 the third stage, from 2000 until present characterized by a continuous improvement of the surgical teams’ laparoscopic skills for different procedures, and developing a modern curricula for laparoscopic education. CONCLUSIONS: There is no universal method for laparoscopic training. Our experience demonstrates good results using a combination of training methods which allowed acquiring: SBB (Basic skills using virtual reality (VR simulators

  4. Colon interposition for oesophageal replacement.

    Science.gov (United States)

    Thomas, Pascal A; Gilardoni, Adrian; Trousse, Delphine; D'Journo, Xavier B; Avaro, Jean-Philippe; Doddoli, Christophe; Giudicelli, Roger; Fuentes, Pierre

    2009-01-01

    the mesentery to avoid a further internal hernia, and routine appendectomy. When applying these technical aids, the chances of achieving a viable and well-functioning colon graft are excellent.

  5. ELITE--the ex vivo training unit for NOTES: development and validation.

    Science.gov (United States)

    Fiolka, Adam; Gillen, Sonja; Meining, Alexander; Feussner, Hubertus

    2010-10-01

    Skill training is an essential part of surgical education. Every physician has to get familiar with the various operation techniques and needs to handle the different instruments. However, mechanical and computer-based VR-simulators offer only one specific procedure, either laparoscopic or endoscopic. We designed the universal training system ELITE (endoscopic-laparoscopic interdisciplinary training entity) which is a new full synthetic ex vivo surgical training model for laparoscopic surgery, combined endoluminal/endocavitary procedures ("hybrid surgery") and NOTES. The aim of the current investigation was to integrate respiration and electro dissection into the model, and the evaluation of both innovations. The ELITE is a full-size replica of a human female torso including a gas-tight abdominal wall and offering various accesses to the abdomen. A complete organ package including liver, gallbladder, spleen, gastrointestinal tract, including the mesentery and omentum is available for this system. Cholecystectomy and appendectomy can be simulated realistically with this new training system. For more realistic conditions during operations breathing-induced organ motion could be integrated into this system. Two latex balloons were inserted into the system to imitate the function of the diaphragm. They are inflated and deflated according to the respiration cycle and move the artificial organs in a natural way. Physicians, including endoscopic/laparoscopic novices and experts, were asked to train different NOTES procedures on the model. Performance of their training and subjective appraisal of the model itself were evaluated. The opportunity of electrodissection of the gallbladder and appendix and simulation of breath excursion of the diaphragm could successfully be implemented into the training system. One recently published study showed that ELITE is a suitable tool to train different surgical procedures. All subjects (novices and endoscopic/laparoscopic experts

  6. Frequency of Ketoacidosis in Newly Diagnosed Type 1 Diabetic Children

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    Zahra Razavi

    2010-04-01

    Full Text Available ABSTRACTObjectives: Diabetic ketoacidosis (DKA is the leading cause of morbidity and mortality in children with type 1 diabetes mellitus (TIDM. Many patients with newly diagnosed type 1 diabetes present with DKA. The aim of this study is to determine the frequency and the clinical presentation of diabetic ketoacidosis at the diagnosis of type 1 diabetes mellitus in youths in hamadan, Western Province of Iran.Methods: The Clinical and laboratory data of a total of 200 patients under 19 years of age with newly diagnosed type 1 diabetes mellitus between 1995-2005 were retrospectively reviewed. Statistical analysis was performed using SPSS 11.Results: 48 (24%of the children were presented in a state of ketoacidosis. Sever form of DKA (pH≤7.2 was observed in 54.5% of patients. The mean age at diagnosis was 7.3±5.15 years in DKA group and 8.59±3.07 in non-DKA group (p=0.22. 60.4% of patient with DKA were female whereas in the non-DKA group, 53.3% of patients were female, the difference was not significant (p=0.38. The duration of symptoms before diagnosis was 14.84±8.19 days in patients with DKA and 22.39±2.27 in the non-DKA group, (p=0.11. No significant difference was found between the age, sex and duration of the symptoms and occurance of DKA. Polydipsia (85.4 polyuria (83.3%, weakness (68.8% and abdominal pain (52.1% were the most frequently notified symptoms among the patients. In two cases, diagnosis of DKA was preceded by as appendicitis and the patient underwent appendectomy.Conclusion: Frequency of DKA at onset of type 1 diabetes mellitus was significant in the studied region. However, it was lower than other regions in Asia. Polydipsia, polyuria, fatigue and abdominal pain were the most common symptoms on presentation.

  7. Case Sequencing of Diagnostic Imaging Studies Performed Under General Anesthesia or Monitored Anesthesia Care During Nights and Weekends.

    Science.gov (United States)

    Mueller, Rashmi N; Dexter, Franklin; Truong, Van-Anh; Wachtel, Ruth E

    2015-11-01

    General anesthesia or monitored anesthesia care sometimes is provided in nonoperating room (OR) locations during nights and weekends (e.g., for magnetic resonance imaging [MRI] or computerized tomography [CT]). Rational and consistent scheduling and sequencing decisions for these diagnostic imaging procedures, including coordination with OR cases, cannot be done without knowing how long each case can wait to be started without risking a worsening of the patient's condition. We reviewed the medical records of the 81 patients who underwent diagnostic imaging procedures (78 = MRI, 3 = CT scan) under general anesthesia or monitored anesthesia care either on weekends or between 6 pm and 6 am at the University of Iowa Hospitals between March 2012 and February 2014. For 77.8% of patients, the indications could have changed clinical management within 4 hours (N = 63/81). Among the 63 imaging studies with potential immediate impact, there was documentation of results having been communicated to the treating team within 4 hours of the completion of imaging for 39 of the patients. Among the 39 patients, 15 promptly received medications or underwent procedures based on the imaging results. Thus, 15 of the 81 patients had a change in care (18.5%, 95% lower confidence limit = 11.2%). Our results are important since we showed previously that it is not possible to make rational and consistent decisions in case sequencing without knowing how long each case (including diagnostic imaging procedures) can wait to be started without a change in the patient's risk. The scheduled surgical procedure itself provides sufficient information to assess safe waiting times to start add-on cases (e.g., appendectomy). In contrast, MRI provides no context as to how potential findings will influence treatment. Our results show that the assumption cannot reasonably be made when sequencing cases that all imaging studies can or cannot wait longer than pending surgical procedures. Our results show that

  8. Experience of developing rural surgical care in a remote mountainous region of Pakistan: Challenges and opportunities

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    R Alvi

    2011-01-01

    and orthopedic 66 cases; 64% of cases in the main operation room were done under general and 22% under spinal anesthesia. The commonest surgeries were exploratory laparotomy, caesarian sections, open prostatectomy, urological stone surgeries, appendectomy, hernia repairs and surgery for osteomyelitis. There were 21 surgical mortalities including six operative deaths, 15 non-operative deaths and 89% of the mortalities were unavoidable. The crude in-hospital mortality decreased significantly from 5.5% in 1992 to 1.1% in 2001 and the contributing factors were improved structure and process of care. Conclusion: The impact of a secondary care rural medical centre (AKMC is very obvious from the clinical audit including accessibility, sustainability and quality of care. This could be a model of care in rural Pakistan where accessibility, affordability and quality of care is lacking.

  9. 电凝法处理胆囊动脉在腹腔镜胆囊切除术中的应用%Electrocoagulation of Gallbladder Artery in Laparoscopic Cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    程鑫; 陈心怡; 甘有均

    2014-01-01

    Objective To investigate the safety and feasibility of electrocoagulation of gallbladder artery in laparoscopic cholecystectomy ( LC) . Methods A total of 376 patients with gallbladder benign diseases underwent LC in our hospital from May 2004 to September 2013.The gallbladder artery was treated by electrocoagulation . Results Because of unclear gallbladder triangle due to abdominal adhesion , conversion to laparotomy was performed in 9 patients.In the remaining 367 patients, three-port LC with electrocoagulation of the gallbladder artery was conducted successfully .Laparoscopic appendectomy was conducted simultaneously in 12 patients.An additional fenestration and drainage of the left renal cyst was performed in 1 patient.Postoperatively, a secondary bile duct exploration was conducted in 1 patient because of bile duct obstruction caused by common bile duct stones . Conclusion The electrocoagulation of gallbladder artery is safe and feasible in LC for the treatment of gallbladder benign diseases .%目的:探讨电凝法处理胆囊动脉在腹腔镜胆囊切除( laparoscopic cholecystectomy ,LC)术中的安全性、可行性。方法我院2004年5月~2013年9月采用电凝法处理胆囊动脉行三孔法LC 376例。结果中转开腹9例(腹腔粘连致胆囊三角解剖不清),其余367例在腹腔镜下完成手术,均以电凝法处理胆囊动脉,12例同期行腹腔镜阑尾切除术,1例行左肾囊肿开窗引流术。术后1例因胆总管结石致胆道梗阻行二次手术胆总管切开取石。结论胆囊良性疾病行LC时,电凝法处理胆囊动脉是安全、可行的。

  10. Correlation of serum C-reactive protein, white blood count and neutrophil percentage with histopathology findings in acute appendicitis

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    Xharra Shefki

    2012-08-01

    Full Text Available Abstract Background Acute appendicitis is one of the most common surgical emergencies. Accurate diagnosis of acute appendicitis is based on careful history, physical examination, laboratory and imaging investigation. The aim of the study is to analyze the role of C-reactive protein (CRP, white blood count (WBC and Neutrophil percentage (NP in improving the accuracy of diagnosis of acute appendicitis and to compare it with the intraoperative assessment and histopathology findings. Materials and methods This investigation was a prospective double blinded clinical study. The study was done on 173 patients surgically treated for acute appendicitis. The WBC, NP, and measurement of CRP were randomly collected pre-operatively from all involved patients. Macroscopic assessment was made from the operation. Appendectomy and a histopathology examination were performed on all patients. Gross description was compared with histopathology results and then correlated with CRP, WBC, and NP. Results The observational accuracy was 87,3%, as compared to histopathological accuracy which was 85.5% with a total of 173 patients that were operated on. The histopathology showed 25 (14.5% patients had normal appendices, and 148 (85.5% patients had acutely inflamed, gangrenous, or perforated appendicitis. 52% were male and 48% were female, with the age ranging from 5 to 59 with a median of 19.7. The gangrenous type was the most frequent (52.6%. The WBC was altered in 77.5% of the cases, NP in 72.3%, and C-reactive protein in 76.9% cases. In those with positive appendicitis, the CRP and WBC values were elevated in 126 patients (72.8%, whereas NP was higher than 75% in 117 patients (67.6%. Out of 106 patients with triple positive tests, 101 (95.2% had appendicitis. The sensitivity, specificity, and positive predictive values of the 3 tests in combination were 95.3%, 72.2%, and 95.3%, respectively. Conclusion The raised value of the CRP was directly related to the severity of

  11. Discriminating Potential of Extraintestinal Systemic Manifestations and Colonoscopic Features in Chinese Patients with Intestinal Beh(c)et's Disease and Crohn's Disease

    Institute of Scientific and Technical Information of China (English)

    Ji Li; Pan Li; Jing Bai; Hong Lyu; Yue Li; Hong Yang; Bo Shen

    2015-01-01

    Background:The distinction between intestinal Beh(c)et's disease (BD) and Crohn's disease (CD) is always challenging due to many overlapping clinical features.We conducted a retrospective study to reveal valuable strategies for the differential diagnosis between intestinal BD and CD in Chinese patients based on their clinical and colonoscopic features.Methods:Thirty-five intestinal BD patients and 106 CD patients hospitalized from January 1983 to January 2010,who had ulcerative lesions in the terminal ileum or colon under colonoscopy and no history of gastrointestinal operation except appendectomy before admission,were enrolled.Univariate and multivariate logistic regression analyses were conducted to find discriminating predictors among demographic data,clinical manifestations,and colonoscopic findings.Results:Based on univariate analysis,massive gastrointestinal hemorrhage,fever,and extraintestinal systemic manifestations were more common in intestinal BD patients (P =0.022,0.048 and 0.001,respectively),while diarrhea,intestinal obstruction,and perianal lesions were more common in CD patients (P =0.002,0.010,and 0.027 respectively).Based on colonoscopy,focal involvement,ileocecal valve deformity,solitary ulcers,large ulcers (ulcer size > 2 cm),and circumferential ulcers were more common in intestinal BD patients (P =0.003,0.003,0.014,0,013,and 0.003,respectively),while segmental involvement,longitudinal ulcers,a cobblestone or nodular appearance,and pseudo-polyps were more common in CD patients (P =0.003,0.008,0.023,and 0.002,respectively).Based on multivariate logistic regression analysis,diarrhea,extraintestinal manifestations,ulcer distribution,size,and type,and pseudo-polyps were independent discriminating predictors between the two groups (P =0.048,0.008,0.006,0.021,0.002,and 0.041,respectively).The discriminating algorithm composed of the above independent predictors had the highest area under the curve of 0.987 for distinguishing between the two diseases

  12. 自体骨髓干细胞移植联合脾脏切除断流术治疗失代偿期肝硬化的临床研究%Clinical study on combined therapy of autologous bone marrow stem cells transplantation and splenectomy plus disconnection in decompensated liver cirrhosis

    Institute of Scientific and Technical Information of China (English)

    王靖程; 龚建平; 涂兵

    2012-01-01

    Objective To observe the curative effect and side effects of combined therapy of autologous bone marrow stem cell transplantation and splenectomy plus disconnection in decompensated liver cirrhosis. Methods 34 patients with decompensated liver cirrhosis(child-pugh C) from department of hepatobiliary surgery were collected, 17 patients as the test group underwent combined therapy of autologous bone marrow stem cell transplantation and splenectomy plus disconnection, 17 patients as the control group were treated by appendectomy and disconnection only. Then we compared the treatment result of two groups. Results AST, ALT, TBIL and abdominal circumference in test group after treatment reduced gradually, but WBC, PLT, PT, ALB and PA increased gradually. The result was better than the control one. It showed that the liver function of the patients in test group improved obviously. Conclusion The curative effect combined therapy of autologous bone marrow stem cell transplantation and splenectomy plus disconnection in decompensated liver cirrhosis is significant. It s one of the best treatment to liver cirrhosis.%目的 观察自体骨髓干细胞联合脾切除断流术治疗失代偿期肝硬化的疗效及不良反应.方法 选择肝胆外科失代偿期肝硬化(child-pugh C)患者34例,其中17例为治疗组,在一般治疗的基础上应用自体骨髓干细胞联合脾切除断流术治疗,另17例为对照组,仅行脾脏切除断流术.观察并比较两组的治疗结果.结果 术后干细胞治疗组天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、总胆红素(TBIL),腹围等指标逐渐降低;白细胞(WBC)、血小板(PLT)、凝血酶原时间(PT)、血清清蛋白(ALB)、前清蛋白(PA)逐渐升高,程度优于对照组,可以提示治疗组患者肝功能明显改善优于对照组.结论 自体骨髓干细胞联合脾切除断流术治疗失代偿期肝硬化疗效显著,应属目前最有效治疗肝硬化方法之一.

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

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    Seung-Whan Cha

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

  14. Appendiceal endometriosis as a rare cause of abdominal pain: a case report and literature review

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    Rafael Denadai

    2012-09-01

    Full Text Available Endometriosis is an estrogen-dependent inflammatory disease, common in young women, characterized by the presence of endometrial tissue outside the uterine cavity. This ectopic endometrial tissue is most commonly found in the ovaries, peritoneum, uterosacral ligaments and rectovaginal cul-de-sac, with extremely rare involvement of the appendix. The main symptom is chronic abdominal pain, and the diagnosis is often made later, after the result of the histopathological examination. This study reports a 34-year-old patient complaining of chronic pelvic pain refractory to medical treatment, having undergone diagnostic laparotomy. During the surgery, we observed the presence of endometrioma fixed to the uterine wall, and the appendix was enlarged, but without evidence of inflammation. Endometrioma resection and appendectomy were performed, with good postoperative recovery. The anatomopathological exam showed endometriosis in the cecal appendix.Endometriose é uma doença inflamatória estrogênio-dependente frequente em mulheres jovens, caracterizada pela presença de tecido endometrial fora da cavidade uterina. Esse tecido ectópico de endométrio é mais comumente encontrado nos ovários, peritônio, ligamentos uterossacros e fundo de saco retovaginal, sendo o acometimento do apêndice cecal extremamente raro. O quadro clínico predominante é o de dor abdominal crônica, sendo muitas vezes o diagnóstico feito posteriormente, após o resultado do anatomopatológico. Relatamos o caso de uma paciente de 34 anos com queixa de dor pélvica crônica, refratária ao tratamento clínico, tendo sido submetida à laparotomia exploradora diagnóstica. Durante o ato cirúrgico, observamos a presença de endometrioma fixo à parede uterina, bem como apêndice cecal aumentado de volume, porém sem evidência de sinais flogísticos. Procedeu-se à ressecção do endometrioma e apendicectomia, com boa evolução pós-operatória. O resultado do exame

  15. Apendicitis crónica, ¿existe o no?

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    Mario Sánchez- Arias

    2007-01-01

    are so clear to diagnose acute appendicitis, in a certain percentage of those cases we proceded with appendectomy and the histopathologycal findings showed chronic inflammation. In the present communication, I present a retrospective analysis of 6 cases. The first 5 were operated with a preoperative diagnosis of acute appendicitis, and the last one with a preoperative diagnosis of chronic appendicitis. These cases were collected over 8 years at the former Hospital Clínica Católica. The frecuency was 5% of the total cases of appendectomy performed by the author, 67% were males and 33% were females, with an average preoperative course of 64 days. Right lower quadrant pain was present in 83% and all the cases had a positive biopsy for chronic inflammation and fibrosis. One 100% were asymptomatic after surgery. Special attention should be paid to case number 6 who had 3 consulations for recurrent right lower pain during the last year an ultra sound was consistent with chronic appendicitis. I made the diagnosis pre-operatively and operated on him electively. The biopsy was also positive for chronic inflammation. Because of that I concluded that chronic appendicitis is a real entity and recommend surgery (open or laparoscopic in those patients with chronic or recurrent pain in the right lower abdominal quadrant

  16. Faecal retention: a common cause in functional bowel disorders, appendicitis and haemorrhoids--with medical and surgical therapy.

    Science.gov (United States)

    Raahave, Dennis

    2015-03-01

    as defecation improved overall. The novel knowledge of faecal retention in the patients does not explain why faecal retention occurs. However, it may be inferred from the present results that a constipated or irritable bowel may belong to the same underlying disease dimension, where faecal retention is a common factor. Thus, measuring CTT and faecal load is suggested as a guide to a positive functional diagnosis of bowel disorders compared to the constellation of symptoms alone. Thirty-five patients underwent surgery after being refractory to the conservative treatment for constipation. They had a significantly prolonged CTT and heavy faecal loading, which was responsible for the aggravated abdominal and defaecatory symptoms. The operated patients presented with a redundant colon (dolichocolon) significantly more often. These patients also had an extremely high rate of previous appendectomy. Twenty-one patients underwent hemicolectomy, and 11 patients had a subtotal colectomy with an ileosigmoidal anastomosis; three patients received a stoma. However, some patients had to have the initial segmental colectomy converted to a final subtotal colectomy because of persisting symptoms. Six more subtotal colectomies have been performed and the leakage rate of all colectomies is then 4.9 % (one patient died). After a mean follow-up of 5 years, the vast majority of patients were without abdominal pain and bloating, having two to four defecations daily with control and their quality of life had increased considerably. A faecalith is often located in the appendix, the occlusion of which is responsible for many cases of acute appendicitis, which is infrequent in all except white populations. An effort to trace the origin of the faecalith to faecal retention in the colon was made in a case control study (56 patients and 44 random controls). The CTT was longer and faecal load greater in patients with appendicitis compared to controls, though the difference was not significant

  17. 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.

  18. Multislice CT scanning with three-dimensional reconstruction in early diagnosis of atypical appendicitis%多层螺旋CT三维重建对不典型阑尾炎的早期诊断价值

    Institute of Scientific and Technical Information of China (English)

    钱雷敏; 戈军刚; 黄建明

    2016-01-01

    Objective To investigate the value of multislice spiral CT (MSCT)with three-di-mensional reconstruction in early diagnosis of acute appendicitis with atypical clinical features.Methods The clinical data of 108 patients preoperatively diagnosed as suspected appendicitis were retrospec-tively analyzed,and 58 patients were subjected to MSCT scan (MSCT group),the remaining were not given (non-MSCT group).Results In MSCT group,53 patients with acute appendicitis were confined by surgery and histopathology. The positive predictive value for pre-appendectomy MSCT was 91.5%.Five patients were misdiagnosed:1 case of adhesive ileum obstruction,1 case of right pyosal-pinx with pelvic inflammatory disease,1 case of Meckel diverticulitis with fish bone penetrating inj ury and 2 cases of cecum and ascending colon diverticulitis.The confirmed diagnostic rate of non-MSCT group was 78.0%.Eleven misdiagnoses were detected by exploratory laparotomy or postoperative CT scan:3 cases of duodenal bulbar ulcer perforation,2 cases of cecum tumor,2 cases of right lower ure-teral calculi with hydronephrosis,1 case of right ovarian cyst torsion,1 case of right corpus luteum rupture,1 case of ectopic pregnancy in isthmus of right uterine tube and 1 case of mesenteric lymphad-enitis.Conclusions MSCT scan with three-dimensional reconstruction of the appendix can improve early diagnosis level of atypical appendicitis,decrease the misdiagnosis rate and thereby provide signif-icant clinical benefit.%目的 探讨多层螺旋CT(multislice spiral CT,MSCT)三维重建对临床表现不典型阑尾炎的早期诊断价值.方法 回顾性分析2011年1月至2014年12月收治的108例不典型阑尾炎手术病人的临床资料,对两组在性别比、年龄、主诉、伴随症状、体征和白细胞计数等方面资料进行统计,其中经MSCT检查的病人58例,为MSCT组,50例为非MSCT组.结果 53例术前MSCT检查的不典型阑尾炎经手术、病理证实为

  19. 子宫内膜和卵巢双原发癌43例临床研究%Synchronous primary cancers of the endometrium and ovary:review of 43 cases

    Institute of Scientific and Technical Information of China (English)

    Shaokang Ma; Hongtu Zhang; Yangchun Sun; Lingying Wu

    2009-01-01

    Objective:To investigate the clinicsl and pathological characteristics.treatment methods,and prognosis of synchronous primary cancer of the endometrium and ovary.Methods:The clinical data of 43 patients with synchronous primary cancer of endometrium and ovary were retrospectively reviewed.The survival was calculated by Kaplan-Meier method and compared using the log-rank test.Results:The median age of the patients at diagnosis was 49 years(range.28-73 years).The most common symptoms were abnormal vaginal bleeding(69.8%)and abdominal or pelvic pain(44.2%).Pelvic masses were found in 39.5%of the patients and enlarged corpus in 27.9%at physic examination.while pelvic masses were found in 67.4%of the 43 patients(29 cases)and thickening or abnormal endometrium in 23.3%(10 cases)during ultrasound exami-nation.Of 25 patients examined by CT/MRI.pelvic masses were found in 13 cases and enlarged uterus in 11 cases.All 15 patients who underwent endometriaI biopsies were proven to have endometrioid carcinomas.Serum CA125 level was found to be elevated in 22 of the 34 examined cases(64.7%)with median value 500 U/mL(range,39-3439 U/mL).FIGO stages of endometrial carcinomas:ⅠA 18 cases,ⅠB 20 cases.ⅠC 2 cases,and ⅡA 3 cases;Stages of ovarian cardnomas:ⅠA 19 case,ⅠB 4 cases,ⅠC 7 cases.Ⅱ 4 cases,and ⅢC 9cases.Twenty-four patients(55.8%)were in stage Ⅰ both endometrial and ovar-ian carcinomas.Thirty-one patients underwent total hysterectomy plus bilateral salpingo-oophorectomy with omentectomy and appendectomy,meanwhile,12 patients had pelvic lymph nedes dissection.Thirty-eight of the 43 patients(88.4%)had a pathologically proven endometrial adenocarcinomas.The predominant ovarian histologies were endometrioid or mixed tumors with endometrioid components(30/43,69.8%).Postoperatively,26 patients(60.5%)received adjuvant chemotherapy alone.12 had chemotherapy plus radiotherapy,only one patients had radiation alone and the remaining 4 cases received no adiuvant

  20. Parecoxib frente a ketorolaco en el control del dolor agudo postoperatorio moderado Parecoxib versus ketorolac for the management of moderate postoperative acute pain

    Directory of Open Access Journals (Sweden)

    P. García-Harel

    2005-09-01

    cyclooxygenase 2 (COX-2. Our aim was to determine its effectiveness for the management of moderate postoperative pain. Material and methods: A prospective randomized study was conducted on a total of 96 patients undergoing: appendectomies, oophorectomies, hernioplasties and hip fractures between January and February 2004. One group received parecoxib 40 mg IV each 12 hours (group P and the other one received ketorolac 30 mg IV each 8 hours (group K. Rescue analgesia was paracetamol 1 g IV each 6 hours. An analogical visual scale was used 30 minutes after admittance to the postoperative recovery unit, and after 2, 24 and 48 hours. Results: Pain was assessed through the VAS scale, with no differences found between groups. The need of rescue analgesia on the first day was 83.3% (40/48 in group K, versus 66.7% (32/48 in group P; (p = 0.059. On the second day, the demand of additional analgesia decreased. The need of rescue analgesia was greater among patients undergoing traumatological surgery. Patients that received parecoxib showed a greater percentage of satisfaction, this difference being significant. Conclusions: Pain management was similar in both groups. However, the analgesic patterns showed limitations in the management of pain, since the VAS score and the degree of satisfaction during the first hours can be improved. Considering the effectiveness of rescue therapy with paracetamol, parecoxib combined with paracetamol may be an useful combination for postoperative analgesic management.

  1. Endocardite infecciosa com apresentação inicial de abdome agudo Endocarditis infecciosa con presentación inicial de abdomen agudo Infective endocarditis with initial presentation of acute abdomen

    Directory of Open Access Journals (Sweden)

    Humberto F. G Freitas

    2010-04-01

    Full Text Available Paciente de 35 anos de idade foi atendido em Serviço de Emergência com seis horas de dor em fossa ilíaca direita e febre. Feita hipótese diagnóstica de apendicite aguda e realizada laparotomia exploradora. com apendicectomia. O paciente retornou ao hospital três dias após alta hospitalar. prostrado. febril. com alteração de fala. diminuição de nível de consciência e com hemiparesia completa à esquerda. CT scan de crânio e punção de líquor normal. RMN de encéfalo revelou aspectos compatíveis com AVC isquêmico vertebro-basilar. Ecocardiograma transesofágico demonstrou vegetação em valva aórtica e insuficiência aórtica moderada e hemoculturas foram positivas para Enterococcus bovis.Paciente de 35 años de edad ingresó en el servicio de emergencia con seis horas de dolor en fosa ilíaca derecha y fiebre. Se llevó a cabo la hipótesis diagnóstica de apendicitis aguda y realizada laparotomía exploradora, con apendicectomía. El paciente regresó al hospital tres días tras alta hospitalaria, prostrado, febril, con alteración de habla, disminución de nivel de conciencia y con hemiparesia izquierda completa. Scanner de cráneo y punción de líquido cefalorraquídeo (LCR normal. RMN de encéfalo reveló aspectos compatibles con ACV isquémico vertebrobasilar. El ecocardiograma transesofágico demostró vegetación en válvula aórtica y insuficiencia aórtica moderada y hemocultivos fueron positivas para Enterococcus bovis.A 35-year-old patient was seen in an Emergency Department. with six hours of pain in the right iliac fossa and fever. The hypothesis diagnosis was acute appendicitis and an exploring laparotomy for appendectomy was carried out. The patient returned to the hospital three days after having been discharged. debilitated. feverish. having alterations in speech. reduction in the level of consciousness and complete hemiparesis to the left. The computed tomography scan of the skull and the liquor puncture were

  2. Impact factors for general surgery incision infections and analysis of etiology%普外科切口感染影响因素及病原学分析

    Institute of Scientific and Technical Information of China (English)

    戴江峰; 林智宏; 胡月明

    2012-01-01

    目的 分析普外科切口感染影响因素及病原学特点,为临床预防感染及治疗提供参考.方法 选择医院2010年6月-2011年12月普外科手术患者726例的资料,对感染患者的影响因素及病原学进行回顾性分析.结果 结直肠癌根治术感染率最高,为14.29%,其次是阑尾切除手术和肠道修补、切除术,分别为12.44%、10.53%,肝脏手术感染率为3.13%,其他手术未出现感染病例;急期手术、高龄、合并慢性疾病、合并糖尿病、肥胖是导致切口感染的高危因素(P<0.05);对感染患者切口分泌物培养结果显示,以革兰阴性杆菌居多,占61.90%,其次是革兰阳性球菌,占38.10%.结论 针对易发切口感染的高危患者加强预防措施,强化污染类手术及急期手术的无菌控制与术后护理,是预防手术切口感染的重要措施.%OBJECTIVE To analyze the influencing factors and etiology for general surgery incision infections and provide the reference for clinical prevention and treatment of the infections. METHODS The clinical date of 726 cases of general surgical patients in the hospital from Jun 2010 to Dec 2011 were chosen as the research objects. The influencing factors and etiology for general surgery incision infection were analyzed retrospectively. RESULTS The incidence rate of the infections in the patients undergoing resection of colorectal cancer was the highest (14. 29%), followed by the appendectomy (12. 44%), intestinal repair and resection (10. 53%), and the liver surgery (3. 13%), no infections occurred in other cases. The acute surgery, old age, associated with chronic disease, diabetes mellitus, and obesity were the risk factors for incision infection (P <0. 05). The incision secretion culture showed that the gram-negative bacilli were the main pathogens,accounting for 61. 90%, followed by the gram-positive bacteria (38. 10%). CONCLUSION It is of great significance in the prevention of surgical incision

  3. Management of postoperative pain in abdominal surgery in Spain. A multicentre drug utilization study

    Science.gov (United States)

    Vallano, Antonio; Aguilera, Cristina; Arnau, Josep Maria; Baños, Josep-Eladi; Laporte, Joan-Ramon

    1999-01-01

    surgery, admitted between October 1994 and January 1995. For each patient, information about the surgical procedure and the use of analgesics was prospectively collected. The severity of postoperative pain was assessed during the first day after surgery by means of a six-category (none, mild, moderate, severe, very severe, and unbearable) rating scale and a visual analogue scale (VAS). Results Nine hundred and ninety-three patients (547 men) were included. The most common surgical procedures were inguinal hernia repair (315, 32%), cholecystectomy (268, 27%), appendectomy (140, 14%), bowel resection (137, 14%), and gastric surgery (58, 6%). Fifty-nine percent of patients (587) received nonopioid analgesics only, 9% (89) received opioid analgesics only, and 27% (263) received both opioid and nonopioid analgesics. The most frequently administered drugs were metamizole (667 patients) and pethidine (213 patients). Although in the majority of medical orders the administration of analgesics was scheduled at regular time intervals, the majority of actual doses were given ‘as-needed’. The average administered daily doses of all analgesics were lower than those prescribed. Thirty-eight percent (371/967) of patients rated their maximum pain on the first day as severe to unbearable. Wide interhospital variability was recorded in the surgical procedures which had been performed, in the analgesics used, and also in the pain scores referred by patients. The percentage of patients in each centre who suffered severe to unbearable pain varied from 22 to 67%. Conclusions In Spain many patients still suffer severe pain after abdominal surgery, and this seems to be due to an inadequate use of analgesics. Wide interhospital variability in the management of postoperative pain and in its prevalence was also recorded. PMID:10383545

  4. Effect of surgical trauma on the expression of COX-2 and PGE2 in hippocampus in aged rats%手术创伤对老龄大鼠海马环氧化酶-2和前列腺素E2的影响

    Institute of Scientific and Technical Information of China (English)

    彭勉; 鲁胜强; 王焱林; 王成夭; 陈畅

    2010-01-01

    Objective To investigate the effect of surgical trauma on the expression of COX-2 and PGE2in the hippocampus in aged rats. Methods Forty-five 18-month-old male SD rats weighing 500-600 g were randomly divided into 3 groups (n = 15 each): group Ⅰ control (group C); group Ⅱ anesthesia (group A) and group Ⅲ surgery + anesthesia (group S). Anesthesia was induced by intraperitoneal 1% pentobarbital sodium 50 mg/kg in group A and S. The animals underwent appendectomy and splenectomy under anesthesia in group S.Cognitive function was assessed by open field test and Y-mase test on the 1st, 3rd and 7th day after anesthesia and surgery (T1-3). The animals were sacrificed after behavior tests at T1.2.3 and the hippocampi were removed for determination of the expression of COX-2 mRNA (by RT-PCR) and PGE2 content (by ELISA). Results The time the animal spent in the central square was significantly prolonged, the number of crossing grid and standing on the back legs and the number of right response were decreased, the total reaction time was prolonged and the COX-2mRNA expression at T1 and PGE2 content in the hippocampus were increased at T1,2 in group S as compared with group C and A. There was no significant difference in the variables mentioned above between group C and A. Conclusion Surgical trauma can induce early postoperative cognitive dysfunction through up-regulation of COX-2 mRNA expression and by increasing PGE2 content in the hippocampus in aged rats.%目的 探讨手术创伤对老龄大鼠海马环氧化酶-2(COX-2)和前列腺素E2(PGE2)的影响.方法 健康雄性SD大鼠45只,月龄18月,体重500~600 g,随机分为3组(n=15):对照组(C组)腹腔注射生理盐水3 ml;麻醉组(A组)和手术组(S组)腹腔注射1%戊巴比妥钠50 mg/kg(稀释至3 ml)麻醉,S组麻醉下行腹腔探查+阑尾切除术+脾切除术.于麻醉或术后1、3、7 d(T1~3)时测定认知功能、海马COX-2 mRNA表达和PGE2含量.结果 与C组和A组比较,S组中央格

  5. Tratamento laparoscópico de 98 pacientes com endometriose intestinal Laparoscopic treatment of 98 women with bowel endometriosis

    Directory of Open Access Journals (Sweden)

    Luciana Maria Pyramo Costa

    2010-03-01

    Full Text Available OBJETIVO: Identificar os tipos de tratamento cirúrgico e a morbidade operatória na endometriose intestinal. MÉTODOS: Estudo retrospectivo de pacientes operadas no Biocor Instituto (Belo Horizonte, MG por uma equipe multidisciplinar para tratamento de endometriose no período de janeiro de 2002 a junho de 2009. RESULTADO: Noventa e oito pacientes foram submetidas aos seguintes procedimentos para tratamento da endometriose intestinal: ressecção segmentar do reto (n 46; 45,5%, ressecção em disco (n 25; 24,7%, "shaving" (n 18; 17,8%, apendicectomia (n 5; 5%, liberação de aderências sem ressecção (n 5; 5%, ressecção segmentar do sigmóide (n 1; 1% e ressecção segmentar do colo direito (n 1, 1%. A cirurgia concomitante mais freqüente foi a ressecção de endometriomas ovarianos (n 45. A morbidade operatória foi de 9,2%, sendo as complicações maiores uma fístula retovaginal (1% e uma deiscência de anastomose (1%. Quarenta e duas pacientes tiveram seguimento médio de 14 meses com recidiva clínica em 8 casos (dor pélvica e dispareunia e 4 recidivas de imagem à ultrassonografia em parede intestinal, assintomáticas. CONCLUSÃO: O tratamento da endometriose por laparoscopia é factível e seguro, com baixos índices de recidiva.OBJECTIVE: The purpose of this study was to identify the types of surgical procedures performed and the operative morbidity in women with bowel endometriosis. METHODS: Retrospective evaluation of surgical records of women who underwent surgical treatment of endometriosis by a mutidisciplinar team at Biocor Instituto (Belo Horizonte, MG from January 2002 to June 2009. RESULTS: Ninety-eight women underwent surgical treatment of bowel endometriosis during the study period. The following surgical procedures were performed: segmetnal rectal resection (n 46; 45,5%, intestinal disc excision (n 25; 24,7%, "shaving" (n 18; 17,8%, appendectomy (n 5; 5%, adhesiolysis without intestinal resection (n 5; 5%, segmental

  6. 陕西地区人群克罗恩病发病危险因素的病例对照研究%A Case-control Study on the Risk Factors of Crohn's Disease in Shaanxi Population

    Institute of Scientific and Technical Information of China (English)

    张伟; 董涛; 刘真真; 韩霜; 梁树辉; 王飙落; 吴开春

    2012-01-01

    目的:探讨陕西地区人群克罗恩病发病的危险因素.方法:采用病例对照研究,选择2009年1月~2010年12月在我院就诊的64例克罗恩病患者和64例健康对照者为研究对象,通过问卷的方式进行调查,调查内容包括饮食习惯、受教育情况、职业、家庭卫生情况、吸烟、母乳喂养、肠道疾病家族史、感染性肠病史、阑尾切除术、麻疹等内容,采用条件logistic回归分析影响陕西地区人群克罗恩病发病的危险因素.结果:64例克罗恩病患者及64例配对的健康对照者均完成问卷调查,多因素条件logistic回归分析结果显示,人均居住面积(大)(OR 0.4003,95%CI 0.1577,1.0165)、饮茶(OR 0.2597,95%CI 0.0662,1.0184)、油炸食品(OR3.1465,95%CI 1.2841,7.7101)、口服避孕药(OR 5.4500,95%CI 0.8400,35.1158)是陕西地区人群克罗恩病发病的危险因素.结论:油炸食品、服避孕药可能为陕西地区人群克罗恩病发病的危险因素,人均居住面积(大)、饮茶可能为陕西地区人群克罗恩病发病保护因素.%Objective: To analyze the risk factors of Crohn's disease in Shanxi population. Methods: A case control study was applied on 64 cases of Crohn's disease admitted in our hospital from January 2009 to December 2010 and 64 cases of healthy control. A survey was employed. The questionnaire consisted of 23 items, including family history of Crohn's disease, smoking, milk intake, work tension, alcohol intake, history of intestinal infection. Appendectomy and use of NSAID drugs, and so on. Logistic regression analysis was used to analyze the risk factors of Crohn's disease in Shanxi population. Results: Multivariate logistic regression analysis indicated that fried food (OR 3.1465, 95%CI 1.2841, 7.7101), oral contraceptive (OR 5.4569, 95%CI 0.8480, 35.1158), per capita living space (larger)(OR 0.4003, 95%CI 0.1577, 1.0165), tea drink (OR 0.2597, 95%CI 0.062,1.0184) were risk factors of Crohn's disease in

  7. Effects of ethidine and hydrocortisone on post-anesthesia shivering in surgery for acute purulent appendicitis%氢化可的松和哌替啶治疗急性化脓性阑尾炎麻醉后寒战疗效评价

    Institute of Scientific and Technical Information of China (English)

    谢文静; 李北平

    2013-01-01

    目的 评价氢化可的松和哌替啶对急性化脓性阑尾炎蛛网膜下隙阻滞麻醉后寒战的治疗作用.方法 急性化脓性阑尾炎蛛网膜下隙阻滞麻醉后寒战Wrench分级2级及以上的患者73 例,随机分为氢化可的松(2.0 mg/ kg)组、哌替啶( 0.05 mg/ kg)组和生理盐水 (10 ml)组.术中监测肛温(T)及常规麻醉监测指标.记录各组基础体温(T0),寒战发生时(T1),寒战后10 min(T2)、30 min(T3)、60 min(T4)体温,对T1~T4时间点的寒战进行评分,并观察不良反应的发生情况.结果 与对照组相比,哌替啶组和氢化可的松组患者麻醉后寒战缓解迅速,持续时间短,症状较轻(P<0.05);哌替啶组患者恶心、呕吐发生率较氢化可的松组高(P<0.05).结论 哌替啶和氢化可的松均可用于麻醉后寒战治疗;氢化可的松较少引起恶心、呕吐等不良反应,更适用于急性化脓性阑尾炎麻醉后寒战的治疗.%Objective To investigate the effects of treatment with pethidine and hydrocortisone on post-anesthesia shivering following subarachnoid block anesthesia in surgery for acute purulent appendicitis . Methods 73 patients with purulent appendectomy (Wrench Ⅱ-Ⅳ) were randomly divided into three groups,pethidine (0.05 mg/kg) group,hy- drocortisone (2.0 mg/ kg) group and normal saline group. Signs and parameters such as body temprature were monitored during the operation. Manifestations of shivering,were evaluated at 0,10,30 and 60 min after shivering,and the side effects such as nausea and vomiting were observed . Results The time of recovery from shivering was significantly shorter in pethidine and hydrocortisone group ( P < 0.05 ) . The incidence of nausea and vomiting was much lower in hydrocorti-sone group than in pethidine and saline group ( P < 0.05 ). Conclusions Pethidine and hydrocortisone are effective for the treatment of post -anesthesia shivering. Compared with pethidine,hydrocortisone had fewer side effects such as nausia and

  8. 回盲部病变55例诊治分析%Analysis of 55 patients with ileocecal lesions

    Institute of Scientific and Technical Information of China (English)

    王修中; 汤海涛

    2014-01-01

    Objective To analyze the etiology and clinical data of ileocecal lesions to improve the level of the diagnosis and treat -ment.Methods Clinical data of all patients with ileocecal lesions were analyzed in our department from May 2005 to April 2014.All cases had received the routine inspection ,B-ultrasound examination ,CT,barium enema radiography and colonoscopy ,and were confirmed by histopa-thology after the operation.Results The clinical symptoms of all patients included abdominal pain or distension (48 cases),right lower ab-dominal mass (16 cases),hematochezia and blood purulent stool (9 cases),low back pain (2 cases),diarrhea (4 cases),intestinal obstruc-tion (7 cases),intussusception (2 cases) and intestinal perforation (2 cases).In all patients,one case was misdiagnosed as cholecystolithia-sis before operation;eight cases were misdiagnosed as acute appendicitis but were found in the operation that there was ileocecal mass inclu -ding malignancies in ileocecal region ,stromal tumor,diverticulitis and inflammatory mass .Three cases with the history of appendectomy were diagnosed as malignancies in ileocecal region ,inflammatory mass and enterocutaneous fistula respectively .Colonoscopy was a better method to improve the correct rate of the diagnosis of ileocecal lesions than B-ultrasound examination ,CT and barium enema radiography .Conclusion Detailed disease history and attentive physical examination combined with colonoscopy ,B-ultrasound,CT,barium enema radiography can effec-tively improve the understanding and clinical diagnosis of ileocecal lesions .%目的:分析回盲部病变的病因及临床特征,提高对回盲部病变认识及诊治水平。方法收集我院自2005年5月至2014年3月有完整资料的回盲部疾病的手术病例,统计入院后的B超、CT、X线钡剂灌肠造影及结肠镜等检查结果及术前诊断和术后病理诊断。结果资料完整的回盲部病变患者55例,临床表现为腹痛、腹胀48例,

  9. 应用达芬奇机器人手术系统行脏器联合切除4例报告%Combined resection of organs by using the daVinci Surgical System:reports of 4 cases

    Institute of Scientific and Technical Information of China (English)

    吕赤; 张成; 高广荣; 李达; 单永琪; 张雪峰

    2015-01-01

    The daVinci Surgery System is an emerging technology,which has broaden the application of laparoscopy in surgical field.Since FDA approved the daVinci Surgical System in 2000,a number of medical institutions have used it in clinics worldwide and its clinical efficacy and safety have also been approved.Our department has completed 180 robot-assisted operations since the system was introduced into our hospital in 2011.Of these operations,4 were combined resection of organs(2.2%) in which one case was the rectal anterior resection and right hemicolectomy,one was the rectal anterior resection plus splenectomy,one was the rectal anterior re-section and appendectomy and one was the rectal anterior resection and hysterectomy.The most operations of combined resection of or-gans by using traditional laparoscopy were benign tumors.This is because that the radical resection of malignant tumor was relatively dif-ficult and the traditional laparoscopy has limitation to complete such operations.In contrast,the daVinci Surgical System has advantages of 7 degree-of-freedom operation instrument that makes the operation has a great dexterity.Therefore,the system has a great advantage in the operations of combined resection of organs.The operations in the 4 cases were successfully completed.Postoperative recovery was well and no serious complications were found.The authors suggested that the selection of the operation indications still need to be cau-tious and multidisciplinary cooperation and preoperative plan should be noticed.%机器人外科是一项新兴技术,拓宽了腹腔镜技术在外科领域的应用。达芬奇机器人手术系统自2000年获得FDA批准后,国外多家医疗机构陆续开展临床应用,其安全性与疗效已得到肯定与共识。沈阳军区总医院自2011年引进该设备,普外科目前共完成达芬奇机器人手术180例,其中腹腔多器官联合切除4例,占2.2%。4例中直肠前切除+右半结肠切除1例,

  10. HIV/AIDS合并普外科疾病临床诊治分析%Clinical diagnosis and treatment of general surgical diseases of HIV/AIDS patients

    Institute of Scientific and Technical Information of China (English)

    赵东; 何清; 陶红光; 宗华; 钱福永; 李红春

    2015-01-01

    . The clinical data were collected and analyzed, retrospectively. Results The 91 operations of general surgery include:left hemihepatectomy (1 case), cholecystectomy+choledocholithotomy+T tube drainage (2 cases), laparoscopic cholecystectomy (1 case), radical resection of thyroid cancer (1 case), subtotal thyroidectomy (1 case), modiifed radical mastectomy (1 case), injuinal hernia repair (4 cases), resection benign tumors of rectum (2 cases), appendectomy (1 case), repair of sigmoid colon perforation+descending colostomy (1 case), radical gastrectomy (1 case), partial small intestine resection (1 case), anal ifstula resection or thread-drawing (23 cases), crissum abscess drainage (9 cases), haemorrhoidectomy (2 cases), cleaning up the lesion of cervical lymph node tuberculosis (12 cases), abscess drainage of armpit (5 cases), biopsy of superifcial lymph nodes (16 cases) and resection of superifcial masses (6 cases). Antibiotic was forbidden to use for the patients with clean incision during operation, while for the patients with unclean incision, antibiotics were permitted to use to prevent or treat infection. All the 91 patients recovered safely. After operation, there were 45 patients with incision healing in the ifrst intention and 46 patients with incision delayed healing. During all the operations, there was one doctor got occupational exposure, who got local wound treatment rapidly and got test of HIV antibody regularly. The doctor did not use the drug of antivirus and did not get HIV infection. Conclusions HIV/AIDS is not the contraindication of general surgical operation. Proper operation may be the only method to cure patients with HIV/AIDS. All the medical workers should give a positive attitude to the HIV/AIDS patients that needed operations. If we get proper protection of occupation, and do as the rules strictly, the iatrogenic infection could be avoided. So the opening special operation room for infectious diseases in general hospitals were needed, in

  11. Anestesia para peritonectomia com quimioterapia intraperitoneal hipertérmica transoperatória: relato de caso Anestesia para peritonectomía con quimioterapia intraperitoneal hipertérmica transoperatória: relato de caso Anesthesia for peritonectomy with hyperthermic intraoperative peritoneal chemotherapy: case report

    Directory of Open Access Journals (Sweden)

    Giorgio Pretto

    2010-10-01

    procedimiento y de la gran demanda quirúrgica, es fundamental que el anestesista vigile el mantenimiento de los parámetros clínicos, laboratoriales, el reconocimiento y el tratamiento de cualquier alteraciónBACKGROUND AND OBJECTIVES: Pseudomyxoma peritonei is a rare condition related to epithelial neoplasia of the appendix and ovaries. Surgical cytoreduction, peritonectomy, and hyperthermic intraoperative peritoneal chemotherapy (HIPEC is the treatment of choice. Maintenance of normovolemia, normothermia, postoperative pain management and coagulation status are all responsibility of the anesthesiologist. The objective of this report was to describe a case of peritonectomy with HIPEC. CASE REPORT: This is a 37 year-old female, ASA I, with a history of appendectomy 3 months ago with an anatomopathological report of mucinous cystoadenoma. After review of the pathological sample, a pseudomyxoma peritonei was diagnosed with indication of peritonectomy with HIPEC. An epidural catheter (T11-T12 was placed and a test-dose, as well as morphine, was administered. Anesthesia was induced with remifentanil, 0.4 µg.kg-1.min-1, propofol, and rocuronium, besides rapid-sequence orotracheal intubation. Remifentanil, sevoflurane, and rocuronium were used for anesthesia maintenance according to the TOF. Ropivacaine 50 mg, and fentanyl 10 µg. in 10 mL were administered through the epidural catheter 10 minutes before incision. During the surgery, CVP, SpO2, FeCO2, temperature, heart rate, MAP, and urine output maintained stable levels within normal limits, including during HIPEC. Reduction of the hematocrit and SvO2, increased PT, and thrombocytopenia were corrected by administering blood products. After 13 hours of surgery, the patient was admitted to the ICU under controlled ventilation. She was extubated on the 1st postoperative day, being discharged from the hospital on the 17th day of hospitalization. CONCLUSIONS: Surgical cytoreduction and peritonectomy with HIPEC goes back to the decade

  12. 多发性内分泌腺瘤2A型家系中嗜铬细胞瘤的临床及RET原癌基因突变特点%The clinical patterns and RET proto-oncogene identification of pheochromocytoma in 13 multiple endocrine neoplasia type 2A pedigrees

    Institute of Scientific and Technical Information of China (English)

    戚晓平; 陈振光; 金杭阳; 李峰; 成军; 应荣彪; 赵坚强; 郭定刚; 罗世云

    2013-01-01

    Objective To explore the clinical patterns and clinical significance for RET screening in adrenal pheochromocytoma (PHEO) associated with multiple endocrine neoplasia type 2A (MEN2A).Methods The clinical data of 32 PHEO patients with MEN2A from 13 unrelated MEN2A pedigrees from August 1989 to January 2013 were analyzed.The comprehensive medical data included systemic examinations and germline RET gene screening.Results Among 68 patients belonging to 13 MEN2A families,32 (47.1%) presented with PHEO.There were 19 males and 13 females with a mean age of (41 ± 12) years.And the mean maximum diameter of PHEO was (4.6 ± 2.2) cm.The diagnosis of PHEO was made after medullary thyroid carcinoma (n =12,37.5%),simultaneously (n =12,37.5%),initially (n =7,21.9%) and death during appendectomy for PHEO-induced hypertensive crisis (n =1,3.1%).The diagnosis of PHEO was made before (n =22) or after (n =10) clinical screening.The former had 12 symptomatic cases while the latter only 1 case (12/22 vs 1/10,P =0.024).Except for 5 asymtomatic fatal cases during non-PHEO operations,bilateral PHEO was found in 17 cases including 3 unilaterally treated cases developing another PHEO in contralateral adrenal with a lag period of 5,10 and 17 years.There were 7 symptomatic patients in bilateral cases versus 6 in unilateral cases (7/17 vs 6/10,P =0.440).Twenty-five patients underwent PHEO surgery:laparascopic approach in 14 cases (8 with bilateral simultaneous adrenalectomy) and open approach in 11 (2 with bilateral simultaneous adrenalectomy).And 10 patients undergoing bilateral adrenal-sparing operations or adrenalectomy required hormonal replacement therapy.During a mean observation period of 72 (1-282) months,no local recurrence,distant metastasis or Addisonian crisis were noted in 25 cases (contralateral relapse in 3 cases).Among them,2 cases developed adrenocortical insufficiency unresponsive to an adjustment of hormonal doses.RET screening showed 4 recurrent missense