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PubMed1987

Barium appendicitis: fact or fancy? Report of a case and review of the literature.

Whether barium retained in the appendix can be a cause of acute appendicitis is debatable. We describe a 40-year-old man who developed nonspecific right abdominal pain 7 weeks after a barium enema, which proved to be normal. On abdominal film a distended appendix containing barium was seen, and at laparotomy acute appendicitis was present. Thus far, 26 cases of "barium appendicitis" have been reported. On the basis of the relevant literature and the cases collected, it is appropriate to draw the following conclusions: 1) With present knowledge it is not possible to state whether retained barium plays any etiologic role in the development of subsequent uncomplicated acute appendicitis. 2) If a later appendicitis does supervene, it carries a high risk of being complicated; barium seems to be responsible for the complication. 3) The longer the interval between the barium study and the subsequent appearance of acute appendicitis, the higher will be the risk of complications.

Acute Disease↗
PubMed1987

Campylobacter-associated appendicitis: prevalence and clinicopathologic features.

To determine the prevalence of Campylobacter fetus subspecies jejuni-associated appendicitis, we studied, retrospectively, by means of immunohistochemistry, the appendectomy specimens of 116 consecutive patients, operated upon because of suspected acute appendicitis. We found immunohistochemical evidence of Campylobacter fetus subspecies jejuni infection in three patients. These findings were confirmed by electron microscopy. Based upon these three cases and five additional appendectomy specimens from patients with Campylobacter enteritis diagnosed by stool cultures, the clinical and histologic picture of Campylobacter-associated appendicitis is described. It is concluded that Campylobacter infection may present with an acute appendicitis-like clinical picture. In contrast with acute phlegmonous appendicitis, the histologic abnormalities in Campylobacter-associated appendicitis are limited to the appendiceal mucosa.

Acute Disease↗
PubMed1984

An assessment of the value of the menstrual history in differentiating acute appendicitis from pelvic inflammatory disease.

In acute appendicitis, the most difficult group of patients to evaluate is that of women of childbearing age. The results of a recent report showed that women of this age group with acute appendicitis tend to have the onset of symptoms in the luteal phase of the menstrual cycle. In view of this, and since some forms of pelvic inflammatory disease tend to have the onset of symptoms in the menstrual phase of the cycle, a study was undertaken to determine if menstrual history might be of value in differentiating acute appendicitis and PID. In comparing the onset of symptoms of five groups--1, perforated or gangrenous appendicitis; 2, acute suppurative appendicitis; 3, normal appendix; 4, normal appendix with PID (a subgroup of group 3), and 5, PID only--no difference was found in the percentage of patients presenting in each phase of the menstrual cycle among the groups. The incidence of disease (per day) appeared to remain the same between phases of the cycle in each group, suggesting that patients in all groups present in a random manner in relation to the menstrual cycle. We conclude that the menstrual history does not appear helpful in differentiating acute appendicitis and pelvic inflammatory disease in women of childbearing age.

Acute Disease↗
PubMed1978

The radiological signs of acute appendicitis in infancy and childhood.

The radiological findings in 93 children operated on for acute appendicitis were reviewed retrospectively; acute appendicitis was confirmed in 76 (81%). These children were compared with 40 children with abdominal pain, but without appendicitis. Pre-operative radiographs in the children with appendicitis showed a significantly higher incidence of scoliosis, properitoneal line displacement, caecal dilatation with air/fluid levels and terminal ileal dilatation with air/fluid levels. The incidence of radiologically demonstrable faecaliths was not statistically higher in the children suffering from acute appendicitis. In children under the age of 4 years, in whom the diagnosis of acute appendicitis is often difficult, the radiological signs are helpful.

Acute Disease↗
PubMed1983

[Postoperative chemotherapy of perforating appendicitis in children; with special reference to latamoxef therapy].

We employed latamoxef (LMOX) as antibiotic therapy subsequent to the performance of appendectomies in children. Fifteen patients, consisting of 8 cases of catarrhal appendicitis and 7 cases of gangrenous appendicitis, were administered LMOX at 50 mg/kg/day, while 13 patients with peritonitis due to a perforated appendix were treated with a dosage of 90 mg/kg/day. Both of these dosages were administered in 3 equally-divided doses, as one shot intravenous injections. All of the cases of catarrhal and gangrenous appendicitis showed good, steady recovery after the surgery, and there were no instances of complications. With regard to the 13 cases of perforating appendicitis, a clinical efficacy of at least "good" was obtained in 12 patients, for an efficacy rate of 92.3%. In addition, bacteriologically, 35 out of 36 strains that were isolated initially could no longer be detected after the LMOX therapy, indicating an eradication rate of 97.2%. Complications consisted of 1 case of dehiscence of the wound, and 1 case of adhesive ileus. Comparison of the values of the laboratory tests before and after the LMOX therapy revealed no development of abnormalities. Moreover, with regard to side effects, with the exception of 1 case of transient diarrhea, there were no side effects which presented clinical problems. It was found that the causative microbes involved in these cases of appendicitis--especially in the perforative appendicitis cases--were Gram-negative bacilli such as E. coli, and an anaerobic bacterium, B. fragilis.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Bacterial Agents↗
PubMed1982

A feasibility study of computer aided diagnosis in appendicitis.

In this study, the hypothesis that computer aided diagnosis could enable a more accurate differentiation between patients with acute appendicitis and those with abdominal pain but normal appendixes was examined. A data base was established by analyzing the records of 476 patients having an emergency measure appendectomy during a five year period. There were 360 or 76 per cent with acute appendicitis, 98 or 20 per cent with normal appendixes and 18 or 4 per cent with other diseases requiring operation. The records were analyzed with regard to history, physical examination and laboratory findings. The data base was then divided randomly into two parts. Part 1 was subjected to univariate discriminant analysis, using the chi-square test. The only quantities which were significantly different between appendicitis and a normal appendix were sex, duration of symptoms, anorexia and vomiting. Multivariate discriminant analysis was used to derive an abdominal pain index which discriminated between appendicitis and a normal appendix with a sensitivity of 0.82 and a specificity of 0.39. Using the abdominal pain index to evaluate the patients in part 2 of the data base, 23 or 40 per cent of the 58 patients with a normal appendix would have avoided operation. However, 31 or 18 per cent of the 169 patients with appendicitis would have not been operated upon; three of those 31 had perforated appendixes. Computer aided diagnosis was no more effective than unaided clinical diagnosis in appendicitis.

Abdomen↗
PubMed1982

The incidence of acute appendicitis and appendectomy. An epidemiological study of 971 cases.

The incidence of acute appendicitis was studied in a well defined population. Results from 971 appendectomies performed on suspicion of appendicitis, comprising 955 primary and 16 interval operations, were collected over a four-year period. Appendicitis was diagnosed in 657 cases and the mean yearly incidence was 1.16 per thousand. The incidence in males was 1.33 per thousand versus 0.99 for females. The difference was statistically significant (p = 0.0002). The mean yearly incidences of appendectomies were 1.72 per thousand for males and 1.71 for females. The highest incidences of both appendicitis and appendectomies for both sexes occurred in the second decade of life (2.34/1,000 and 3.63/1,000 per annum, respectively). Slight increases in the frequencies of appendicitis and appendectomies were noticed in the very old patients. There were no differences between the results of this study and other recent comparable reports. Compared with earlier studies there was no marked decline in the incidence of appendicitis.

Acute Disease↗
PubMed1980

Clinical and laboratory findings in patients subjected to laparotomy for suspected acute appendicitis.

In a retrospective study, clinical and laboratory findings in 454 patients subjected to laparotomy for suspected acute appendicitis were evaluated. A normal appendix was found in 25% of the total series and was twice as common in female as in male patients. Perforated appendicitis was present in 8% of the series, most commonly in the youngest (less than 5 years) and the oldest (greater than 40 years) age groups. The incidence of severe appendicitis increased with the duration of the preoperative abdominal symptoms. Of the patients with a 'laboratory profile' including fever and leukocytosis, 44% had gangrenous or perferated appendicitis. Of those who additionally had elevated ESR (greater than 20 mm), 62% showed a gangernous or perforated appendicitis. The overall incidence of wound infection was 13.9%. Wound infection was closely related to the state of the appendix. The results thus indicated that patient's age, duration of abdominal symptoms and the 'laboratory profile' are important parameters for assessment of clinically suspected acute appendicitis.

Acute Disease↗
PubMed1995

Colonoscopic diagnosis and treatment of acute appendicitis.

An atypical case of acute appendicitis is reported, in which the initial presentation was not suggestive of this diagnosis. A routine work-up revealed elevated levels of inflammatory markers, an ultrasonographically normal abdomen and normal endoscopic findings in the upper gastrointestinal tract. During colonoscopy, performed 3 days after admission, the inflamed appendiceal orifice was localized and intubated using an endoscopic retrograde cholangio-pancreatography (ERCP) catheter; pus was aspirated. Elective appendectomy was carried out 5 months later on the asymptomatic patient. Histological analysis revealed fibrous thickening of the appendiceal wall, correlating with an old inflammatory process, along with changes typical for acute ulcerophlegmonous appendicitis. To the best of our knowledge, this is the first case of an endoscopically diagnosed and treated acute ulcero-phlegmonous appendicitis. We draw the following conclusions: (1) Acute appendicitis may present atypically, leading to an extensive clinical work-up including gastroscopy and colonoscopy. (2) This condition may be effectively treated, at least temporarily, by colonoscopic suction of appendiceal pus, provided that clinical urgency for laparotomy is absent. (3) Histological changes typically associated with acute ulcero-phlegmonous appendicitis may be present in asymptomatic patients and in patients without fever and with normal erythrocyte sedimentation rates and blood leucocyte counts. (4) Elective appendectomy should be considered in patients with conservatively healed acute appendicitis or periappendiceal abscess.

Acute Disease↗
PubMed1995

[Diagnostic value of computerized tomography in acute appendicitis in adults].

The diagnosis of acute appendicitis is generally based on clinical and laboratory findings. In 1/3 of the cases, acute appendicitis presents atypically and, consequently, the contribution of the radiologist becomes necessary. Conventional radiologic methods, i.e. plain abdominal film and barium enema, generally yield aspecific and indirect information. In contrast, the modern methods of cross-sectional imaging, i.e. sonography and Computed Tomography (CT), allow to identify, directly and accurately, the inflammation of appendix and periappendiceal tissues. We report our experience with 25 cases of surgically confirmed adult acute appendicitis studied with abdominal CT examination. CT was usually performed with contiguous 5-mm-thick scans and with oral and intravenous contrast agent administration. CT showed abnormal appendix (72% of cases), pericecal or periappendiceal inflammatory infiltration (68%), phlegmon (20%), appendicoliths (16%), abscess (12%). CT was diagnostic for appendicitis in 21 cases (84%) and suggestive of it in 4 cases (16%). CT is an interesting diagnostic alternative to US in the assessment of clinically questionable cases of appendicitis. Furthermore, it is the method of choice in the analysis of complicated appendicitis and in the percutaneous management of periappendiceal abscesses.

Acute Disease↗
PubMed1994

[Neurogenic appendicitis. A case].

Laparoscopic procedures have changed the indications for appendectomy. Routine exeresis should not be performed if a normal organ is observed during an exploratory procedure, but should be in cases with clinical manifestations of right flank pain since neurogenic appendicitis is not rare. We report a recent case observed in a 76-year-old woman. The patient was initially hospitalized for right flank pain with nausea and irregular episodes of diarrhoea. Clinical examination and complementary exploration led to cholecystectomy via subcostal access. On per-operative cholangiography the common bile duct appeared normal. Immediate follow-up was uneventful and the patient was discharged. Twelve days later, the patient complained of the same type of abdominal pain and was hospitalized with a fever at 38 degrees C and shivers. The right flank was very painful at palpation. Echography and computed tomography eliminated a subphrenic abscess or secondary pancreatitis. Pain localized at MacBurney's point 8 days later. Barium study showed a normal colon with the exception of uncomplicated diverticulosis. Subjective pain persisted and appendectomy was decided. Pathological examination revealed neurogenic appendicitis. First described in 1924, neurogenic appendicitis is relatively frequent. Macroscopically, a sclerous fibromyxomatous nodule obliterates the lumen. Microscopically, the central obliterating lesion is composed of hyperplastic nervous tissue in a fibromyxoid matrix, particularly important at the point of the appendix. Clinically neurogenic appendicitis is usually chronic and the appendix appears healthy in situ. Cure is always achieved with resection. Laparoscopic procedures can identify para-appendicular causes of painful abdominal syndromes and sclero-atrophic appendicitis, but in the absence of another explanation exeresis appears to be justified due to the possibility of neurogenic appendicitis.

Aged↗
PubMed1994

Recurrent and chronic appendicitis: the other inflammatory conditions of the appendix.

Episodic abdominal pain, a common clinical problem, can be a diagnostic and therapeutic conundrum when the surgeon encounters it acutely in the emergency department. Appendicitis is often excluded from the differential diagnosis because the natural history of appendicitis is usually appreciated as acute, progressing to some degree of peritonitis quite rapidly and inevitably. However, recurrent and chronic forms of appendicitis occur also and can mislead the clinician. Herein, we describe two patients with recurrent appendicitis that were misinterpreted as other abdominal conditions, and we review the literature implicating recurrent and chronic appendicitis as disease processes, distinct from acute appendicitis, that occur with an incidence of approximately 10 per cent and 1 per cent, respectively.

Acute Disease↗
PubMed1993

[Sonography of acute appendicitis. A 5-year prospective study of 2074 patients. 2].

High-resolution real-time ultrasound (US) with a 5 MHz transducer has proved to be an important method in the diagnosis of acute appendicitis. In a prospective study we examined 2074 unselected patients with suspected appendicitis to assess the diagnostic and epidemiological value of US. According to the clinical diagnosis females aged 10 to 30 represented the majority of suspected cases. Appendicitis was most often proved in male patients aged 15-30 years. The prevalence of acute appendicitis in childhood is lower (7%) than in elderly patients (33%). US enables the diagnosis of acute appendicitis with a sensitivity of 91%, a specificity of 98% and an overall accuracy of 97%. For differential diagnosis US demonstrates other diseases that mimic acute appendicitis. Thus it is possible to reduce the negative appendectomy rate particularly in children by revealing mesenteric lymphadenitis or terminal ileitis and in young women by directing attention to gynecological diseases.

Acute Disease↗
PubMedDate not supplied

Laboratory aid and ultrasonography in the diagnosis of appendicitis in children.

Forty-seven consecutive patients with clinically suspected acute appendicitis were studied at this hospital from June, 1994 to March, 1995. All the patients had received a complete study protocol including: detailed history and physical examination; complete blood cell count with differential count; erythrocyte sedimentation rate; C-reactive protein and sonographic examination. The male to female ratio is 29: 18. The age range is from 4 to 14 years. Thirty patients received laparotomy and 27 were diagnosed as appendicitis by histologic findings including 6 cases of perforated appendicitis. The remaining 3 patients had no evidence of appendicitis histologically. The other 17 patients were observed clinically. In these, the abdominal pain resolved spontaneously, or it was proved due to other diseases. The sensitivity and specificity of these laboratory examinations are: leukocytosis (> 10,000/mm3): 85. 2%, 65%; leukocytosis with a shift-to-the-left (neutrophil > 75%): 81.5%, 70%; elevated ESR (> 20 mm/hr): 40.7%, 85%; elevated CRP (> 0.9 mg/dl): 70.4%, 65%; (> 5 mg/dl); 51.9%, 95%; sonography: 85.2%, 100%. There were 4 false-negative and no false-positive ultrasonographic results in our study. Five of the 6 case of perforated appendicitis had elevated CRP levels of more than 8 mg/dl. In conclusion, detailed history taking and physical examination are still the most reliable tools for diagnosis. For the doubtful cases, sonography can provide excellent specificity and good sensitivity for differential diagnosis. The classical tools of leukocytosis and shift-to-the-left can only provide a screening property but not for diagnosis. CRP was not a good predictor in our study, but it can be a useful parameter when perforated appendicitis is suspected.

Acute Disease↗
PubMed1995

Leucocyte elastase as a marker in the diagnosis of acute appendicitis.

OBJECTIVE: To investigate the value of measuring the activity of the leucocyte elastase complex in plasma in the diagnosis of acute appendicitis, either as a single or four-hourly test. DESIGN: Open study. SETTING: Teaching hospital, Sweden. SUBJECTS: 165 consecutive patients admitted with suspected acute appendicitis. MAIN OUTCOME MEASURES: Correlation of concentrations of leucocyte elastase complex (elastase) and total white blood cell count (WBC) with C-reactive protein concentration and histological appearance of the appendix. RESULTS: Of 165 patients, 101 patients had their appendixes removed, and of these 86 had histologically confirmed appendicitis. An elastase value of less than 54 micrograms/l was considered to be the reference range. Elastase activity measured on admission gave a sensitivity of 61% and a specificity of 43% for acute appendicitis compared with the WBC which had a sensitivity of 81% and a specificity of 36%. The above blood tests were taken on two or more occasions four hourly after admission in 29 patients. Appendicitis was found in 25 of the 29 cases (87%), in which repeated tests showed a significant reduction in WBC together with a definite but not significant reduction in the elastase activity during the preoperative period. Repeated tests were of no value. CONCLUSIONS: Measurement of the leucocyte elastase complex in plasma does not increase the accuracy of the diagnosis of acute appendicitis. There was no significant correlation between the leucocyte elastase activity and the total white cell count.

Acute Disease↗
PubMed1995

[Wrong diagnoses of acute appendicitis in women].

In the years 1988 through 1992, 434 patients with acute appendicitis were operated at Third Department of Surgery, Medical Academy, in Kraków. The group included 201 females aged 14 to 90 years of life. In 159 women the diagnosis of acute appendicitis was confirmed, whereas 42 patients were subjected to surgical procedures due to other than appendicitis conditions located within the abdominal cavity. Surgeries prompted by symptoms suggesting appendicitis were most often performed in women with gynecological diseases. Only in several cases laparotomies were performed for other reasons. Wrong diagnoses were most often noted in women below 20 years of life and in the group between 40 and 60 years of life. The introduction of routine ultrasound examinations into the diagnostic management of acute peritonitis and diseases of the reproductive system might result in decrease of the number of diagnostic errors in acute appendicitis in women. An emergency procedure performed when the diagnosis is unclear is recommended rather than prolonged observation. The latter often results in delayed diagnosis of acute appendicitis when diffuse peritonitis develops.

Adolescent↗
PubMedDate not supplied

[Potentialities of echography in the diagnosis of uncomplicated acute appendicitis in children].

Ultrasonography was performed in 97 children admitted to hospital for suspected acute appendicitis. According to the results of primary surgical examinations and the magnitude of clinical manifestations, all the patients were divided into two groups. Group 1 comprised 53 patients with clinically diagnosed acute appendicitis and with a worded indication for an emergency surgical intervention; this group was formed for describing the ultrasonic semiotics of different types of acute appendicitis in children. Group 2 (n = 44) was enrolled to study the differential diagnostic potentialities of echography in the primary diagnosis of acute appendicitis in children with acute stomach ache and they are diagnostically unclear. All echocardiographic findings are supported by intraoperative data and pathohistological evidence. The ultrasonic semiotics of different forms of uncomplicated acute appendicitis is described, the optimal procedure has been developed for examining children with this pathology. The results of the study confirm the high informative value of the proposed algorithm of an echographic examination and sensitivity of the method as to the patients of this group. Thus, the sensitivity of the echographic method in uncomplicated acute appendicitis was 88%.

Abdominal Pain↗
PubMed1997

Diagnostic decision support in suspected acute appendicitis: validation of a simplified scoring system.

OBJECTIVE: To validate a simplified scoring system as an aid to the diagnosis of acute appendicitis. DESIGN: Open prospective study. SETTING: County district hospital, and university hospital, Sweden. SUBJECTS: 1167 Patients with suspected appendicitis. MAIN OUTCOME MEASURES: Correlation between scoring system and final diagnosis. RESULTS: A total of 475 patients were operated on and 392 (82.5%) of these had histologically verified appendicitis. The negative laparotomy rate was 17.5% (11.2% for men and 25.4% for women). The sensitivity of the scoring system for appendicitis at the main cut-off point (score -2 or more) was 0.73 and the specificity was 0.87. At the cut-off level (score - 17 or less) for predicting non-specific abdominal pain (NSAP) the proportion of correctly classified patients was 0.72 and the proportion of false negatives (patients with appendicitis classified as NSAP) was 0.14. Analysis of the area under the receiver operating characteristic (ROC) curve showed that the scoring system performed slightly worse in the university hospital (area 0.83) than in the district hospital where it was originally developed (area 0.89). CONCLUSION: The scoring system was a valid instrument for discriminating between acute appendicitis and NSAP in the two centres studied. Use of the scoring system in daily clinical work was associated with a reduced rate of negative laparotomies.

Acute Disease↗