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PubMedDate not supplied

Significance of SIRS score in therapeutic strategy for acute appendicitis.

BACKGROUND/AIMS: The surgical indication for acute appendicitis has been discussed diversely. SIRS (systematic inflammatory response syndrome) is a concept that has been advocated as the clinical criteria on inflammatory diseases. The aim of the current study was to elucidate the significance of SIRS score in deciding therapeutic strategies for acute appendicitis. METHODOLOGY: One hundred and twenty-five patients who were admitted with the diagnosis of acute appendicitis were investigated in the current study. The ultimate surgical indication was decided by the physical examination done by the surgeons. Fifty-nine patients were indicated for appendectomy. The relationship between decision for the surgical treatment for acute appendicitis and SIRS score/positive status was investigated. RESULTS: SIRS score of the patients who were treated with appendectomy was significantly higher than that of the patients treated with conservative therapy containing starvation and administration of antibiotics therapy and SIRS positive status in patients treated with appendectomy was also higher than that in patients with conservative therapy. CONCLUSIONS: SIRS score is also useful as objective and auxiliary information to determine the surgical indication for acute appendicitis.

Acute Disease↗
PubMed2002

Utility of a scoring system in the diagnosis of acute appendicitis in pediatric age. A retrospective study.

BACKGROUND: Acute appendicitis is the most frequent cause of surgical emergency in pediatric age. The aim of this study has been to evaluate the diagnostic accuracy of a scoring system, retrospectively applied, to the clinical and laboratory parameters in patients with acute appendicitis. METHODS: A group of 156 patients admitted for acute abdominal pain and operated for appendectomy, in the last 3 years, has been included in the study. The mean age was 8.4 years. The modified Alvarado score has been used as scoring system: white count, neutrophil count, fibrinogen level, body temperature, resistance in the right iliac fossa, length of symptoms, nausea/vomiting. The score has been calculated for each patient. They were subdivided into 3 groups. Group I (score 1-4), no admission; Group II (5-6), admission and observation; Group III (7-10), surgery. This subdivision was then compared with the intraoperative notes. RESULTS: Patients were divided into 3 groups. Group I, 24 patients (15%); Group II, 34 patients (22%); Group III, 98 patients (63%). On the basis of the intraoperative notes 61 patients had acute appendicitis and 95 complicated acute appendicitis. In this last subgroup the score gave a percentage of patients to operate of 90.5%. CONCLUSIONS: With the present work we confirm the utility of a scoring system in the preoperative diagnosis of acute appendicitis and in our opinion it is a useful system for a first, rapid and economic evaluation in the pediatric emergency department.

Abdomen, Acute↗
PubMed2002

[Acute appendicitis in pregnancy].

BACKGROUND: Review of our cases of appendicitis with pregnancy. METHODS: Between june 1990 and may 2001, eighteen cases were investigated, retrospectively. RESULTS: Six patients were in first trimester, 10 in second trimester and 2 in third trimester. Mean age was 25. Sixteen cases (88.9%) were acute appendicitis and 2 cases (11.1%) were perforated appendicitis. The time interval between the onset of complaints and operation was 1.6 days. There were no fetal or maternal mortality. One of perforated appendicitis developed wound infection and two developed atelectasis. CONCLUSION: Early laparotomy in appendicitis with pregnancy will reduce the fetal and maternal morbidity and mortality.

Acute Disease↗
PubMedDate not supplied

[Values of white blood cell count in the diagnosis of acute appendicitis].

BACKGROUND: The diagnosis of acute appendicitis remains a critical challenge for paediatric surgeons. White Blood Cell (WBC) count, once considered a basic exam, is still routinely performed in most institutions, despite its lack of accuracy. Aim of this study is to assess the additional value of WBC count in the diagnosis of acute appendicitis. METHODS: We retrospectively reviewed the charts of children who underwent appendectomy for acute appendicitis in the last two years at our institution. In the patients treated in 1999 (Group A), WBC count was assessed routinely after admission. The surgeons relied on leukocytosis as well as on clinical findings and on ultrasound abdominal scan for the diagnosis of acute appendicitis. In the patients treated in 2000 (Group B), blood cell count was not tested or deliberately ignored by the surgeons. RESULTS: There were 65 children in Group A and 70 in Group B; the two groups of patients were similar in terms of gender (p = 0.989) and age (p = 0.758). Criteria for operation were similar in the two groups (p = 0.222). No differences were found in the number of perforated (p = 0.989) and normal (p = 0.217) appendixes in the two groups as well as in the duration of hospital stay after surgery (p = 0.849). CONCLUSIONS: WBC count at admission has no proven additional value in the diagnosis of acute appendicitis and can be omitted without modifying diagnostic pathway and without affecting diagnostic accuracy.

Acute Disease↗
PubMed2002

[Acute appendicitis: to image or not to image?].

Acute appendicitis is frequently clinically suspected. However, about 50% of emergency room patients with such a diagnosis do not have acute appendicitis and between 20-25% of patients undergoing appendectomy based on clinical diagnosis have a normal appendix. On the other hand, if left untreated acute appendicitis may result in peritonitis. The purpose of this article is to review the indications for imaging patients with clinical suspicion of acute appendicitis, to describe the US and CT features of acute appendicitis, to review the advantages and limitations of US and CT, and to present the differential diagnosis to be considered in patients with right lower quadrant pain.

Acute Disease↗
PubMed2000

[Efficiency of ultrasonography in the diagnosis of acute appendicitis].

UNLABELLED: Importance of the problem. Atypical or precocious presentation of acute appendicitis in children causes false diagnosis. OBJECTIVES: To determine internal and external validity of ultrasonography for confirmation diagnosis of acute appendicitis. PATIENTS AND METHODS: Patients with suspicious acute appendicitis treated in 1998. They have been classified into two groups. Group 1: patients with appendicitis; Group 2: patients with non-specific abdominal pain. MATERIAL: Ultrasonography equipment (5 and 7.5 MHz). METHOD: Ultrasonography has been considered as positive when 3 or more of the typical signs of appendicitis have been detected. Analysis unit: positivity of the test and presence or absence of illness confirmed by histologic analysis of the appendix obtained through laparotomy. RESULTS: Number of patients selected for the work: 139. Middle age: 8 years-old (range: 2 to 14 years); 75% were males, 25% females. Patients included in group 1: 42; patients included in group 2:97. False positive rate was 12.23%, while false negative rate was 7.19%. Sensibility was 76%, specificity was 82%, positive predictive value was 65%, negative predictive value was 88% and precision was 80%. Odds-ratio pre-test: 0.43; Odds-ratio post-test: 0.64. CONCLUSIONS: Probability of accuracy diagnosis is duplicated by ultrasonography. Liability of the test is diminished by variability due to observer.

Acute Disease↗
PubMed2002

[Acute appendicitis. Usefulness of a evidence-based critical pathway].

OBJECTIVE: To determine the effects of an evidence-based clinical pathway for acute appendicitis in paediatric patients at a tertiary hospital. METHODS: We studied 229 patients with an age range from 3 to 14 years, with a pathological diagnosis of acute appendicitis divided in two groups. A prospective, experimental clinical pathway group of children (n = 114), (June 1999-January 2001) was compared with a historical control prepathway group of patients treated by conventional means in the previous years, (n = 115), (December 1997-May 1999). Age, gender, type of appendicitis (uncomplicated/complicated), length of hospitalisation, number of antibiotics doses supplied and rates of complications, were compared between pathway and and control patients. RESULTS: There were no differences in age (p = 0.61), gender (p = 0.73), either the number of complicated/uncomplicated appendicitis (p = 0.91) between the two groups. The average duration of hospitalisation was significantly shortened in pathway group (4.34 versus 5.33 days) (p = 0.000049) and the number of antibiotics doses were reduced from 16.13 to 11.17 doses (p = 0.000000). The number of major complications was lower in the pathway group than in the control group (6 and 16 respectively) but there was no significative difference (p = 0.09). CONCLUSIONS: Clinical pathway is an efficient and safe tool for acute appendicitis because decrease the length of hospitalisation and the number of antibiotics doses supplied, while maintaining quality of care.

Acute Disease↗
PubMedDate not supplied

Comparison between technetium-99m hexamethylpropyleneamineoxide labeled white blood cell abdomen scan and abdominal sonography to detect appendicitis in children with an atypical clinical presentation.

BACKGROUND/AIMS: Diagnosing acute appendicitis in children with equivocal signs and symptoms is usually difficult. The usual approach to the patient is hospital observation and frequent reexamination. However, many surgeons are reluctant to delay surgery because of the risk of perforation and a negative laparotomy. The aim of this study is to assess and compare the value of the Tc-99m HMPAO (technetium-99m hexamethylpropyleneamineoxide) labeled white blood cell abdomen scan and abdominal sonography in the diagnosis of acute appendicitis in children with an atypical clinical presentation. METHODOLOGY: Forty children with acute abdomen and possible acute appendicitis but atypical findings were included in this study. After an intravenous injection of Tc-99m HMPAO white blood cells, serial anterior abdomen scans at 30 min, 60 min, 120 min and 240 min were obtained using a gamma camera. Meanwhile, at the point of maximal tenderness, abdominal sonography was performed with a graded compression technique for both longitudinal and transverse images. RESULTS: Thirty-three children received operation for surgical and pathological diagnoses. The other 17 children did not receive operation but follow-up of at least a one-month period. The overall sensitivity, specificity, and accuracy of Tc-99m HMPAO white blood cell scan to diagnose acute appendicitis in children with atypical findings is 96.7%, 80.0%, and 90.0%, respectively. The overall sensitivity, specificity, and accuracy for abdominal sonography is 86.6%, 90.0%, and 88.0%, respectively. CONCLUSIONS: The Tc-99m HMPAO white blood cell abdomen scan provides a more sensitive and accurate method for the diagnosis of appendicitis in children with atypical clinical presentation when compared with abdominal sonography.

Abdomen↗
PubMed1992

[Female sterility after appendicitis in childhood].

The aim of the study was to establish the rate of sterility in women who had been operated on in childhood for perforated and non-perforated appendicitis. The group with perforated appendicitis consisted of 58 women who had been operated on at the age of 3 to 15 years and at the time of the follow-up examination they were in the age range of 23 to 41 years. Of these women 51 were married and 49 of them had one to three children. Two women (3.9%) were sterile. One had been operated on in adulthood for tubo-ovarial abscess in the right and pyosalpinx in the left tube and the other one was treated for repeated adnexitis in adulthood. The group with non-perforated appendicitis consisted of 168 women who had been operated on at the age of 3 to 15 years and at the time of the follow-up examination they were in the age range of 23 to 40 years. Of these women 145 were married and 141 had one to four children. Four women (2.8%) with the history of noncomplicated appendicitis were sterile. Our retrospective study showed no statistically significant difference in the occurrence rate of sterility in women operated on in childhood for perforated and non-perforated appendicitis.

Adult↗
PubMed2003

Liberal use of CT scanning helps to diagnose appendicitis in adults.

Appendicitis can be difficult to diagnose as patients get older and the incidence of other intra-abdominal processes increases. We hypothesize that with the use of helical computed tomography (CT), we will be better at diagnosing appendicitis in adults. We reviewed all the medical records of patients 18 years and older who were admitted to our service with the diagnosis of appendicitis (ICD-9: 540.0, 540.1, 540.9, and 541) from January 1999 through October 2002. In addition to demographics, we collected pathology results, if CTs were done, and CT results. This study was approved by the Institutional Review Board (IRB) of the University of Michigan. Three hundred thirty patients with the diagnosis of appendicitis were admitted to our service. We found the negative appendectomy rate in all patients to be 12.1 per cent. In all patients who had CT scans, the negative appendectomy rate was 7.3 per cent. In patients > or = 45 years, patients without CT had 5.6 per cent negative appendectomy rate versus 5 per cent (P = 0.02) with CT scanning. There were no mortalities. Our negative appendectomy rate in adult patients is lower than previously published reports. We believe our high rate of CT scanning helped in making the correct diagnosis. We recommend liberal use of CT scanning to help diagnose appendicitis in adults.

Adolescent↗
PubMed2004

Recurrent appendicitis as a cause of recurrent right iliac fossa pain.

Recurrent appendicitis is defined when patients with recurring similar right iliac fossa pain had acute appendicitis confirmed at the time of operation and the pain completely subsided after surgery. We conducted a retrospective study on our patients with appendicitis. There were 290 patients with appendicitis over a two-year period and 33 patients (11%) had reported recurring pain prior to the presentation. Majority had one prior episode but 15% had multiple episodes of right iliac fossa pain. Fifty-eight percent of the episode occur within six months of the presentation. We conclude that recurrent appendicitis should be considered as a differential diagnosis in patients with recurrent right iliac fossa pain.

Abdominal Pain↗
PubMedDate not supplied

Perforated appendicitis: is laparoscopy safe?

OBJECTIVE: The purpose of this study was to demonstrate the safety and efficacy of laparoscopy in children with perforated appendicitis. METHODS: This is a retrospective review of consecutive patients under the age of 18, operated on for perforated appendicitis between September 1997 and December 1999. RESULTS: Sixty-nine patients were operated on for perforated appendicitis. Eleven appendectomies were performed laparoscopically. Fifty-four patients underwent an open appendectomy. Four laparoscopic appendectomies were converted to an open procedure. The mean operative time was 79 minutes for the laparoscopic group, and 87 minutes for the open group. The mean length of hospital stay was 5.4 days versus 7.6 days for the laparoscopic and open groups, respectively. Neither of these differences was statistically significant. CONCLUSIONS: The above data support the use of laparoscopy in the management of perforated appendicitis in children. In conclusion, laparoscopy is as safe as open appendectomy. Laparoscopy is an effective alternative with a shorter length of hospital stay compared with that for an open appendectomy for perforated appendicitis in children.

Appendectomy↗
PubMed2004

The role of computed tomography in clinically-suspected but equivocal acute appendicitis.

INTRODUCTION: To study the role of contrast-enhanced computed tomography (CT) of the abdomen and pelvis in the evaluation of patients with clinically-suspected but equivocal acute appendicitis. METHODS: The medical records of 206 consecutive patients who had CT of the abdomen and pelvis for equivocal signs and symptoms of acute appendicitis were reviewed. 7 mm collimated axial sections from the diaphragm to the iliac crest and 5mm collimated sections of the pelvis with intravenous and oral contrast were obtained. The criteria used to diagnose acute appendicitis were: (a) a thickened appendix of more than 7 mm or (b) inflammatory changes in the periappendiceal fat. The CT findings were correlated with the histological diagnosis at appendectomy. If the CT findings were negative for acute appendicitis and surgery not performed, the results were correlated with other corroborating diagnostic investigations or clinical follow-up. RESULTS: A total of 206 patients were scanned, of which 39 were excluded due to lack of any follow-up. Of the final 167 that were studied, there were 36 true positives, 127 true negatives, 4 false negatives and no false positives, resulting in a sensitivity of 93.9 percent, specificity of 100 percent and accuracy of 98.5 percent. CONCLUSION: We have found CT to be a safe, reliable and accurate modality in the diagnosis of acute appendicitis in patients with equivocal presentation.

Acute Disease↗
PubMed2004

The diagnostic value of C-reactive protein, white blood cell count and neutrophil percentage in childhood appendicitis.

OBJECTIVE: To analyze the value of C-reactive protein (CRP), total white blood cell count (WBC), and neutrophil percentage in the diagnosis of suspected cases of childhood appendicitis. METHODS: Prospective study of 216 patients admitted with a history of suspected acute appendicitis, between October 2001 through to May 2002, Al Fateh Teaching Hospital for Children, Benghazi, Libya. Blood samples for estimation of CRP, total WBC and neutrophil percentage were sent immediately to the laboratory. Sensitivity, specificity, positive predictive and negative predictive values were calculated, for each test and in combination. RESULTS: There were 139 male and 77 female patients, the age range was 3-13-years, 135 patients were operated. Those who had appendicitis, we had 114 patients with positive CRP values of more than (8 microgram/ml), and 109 patients had total WBC count of more than (11,000/microL), and 111 patients with neutrophil percentage more of than 75%. One hundred and twelve patients out of 130 with appendicitis had the triple tests positive, and only 8 out of 86 patients without appendicitis had the triple tests positive. The sensitivity, specificity, positive and negative predictive values of the 3 tests in combination were 86%, 90.7%, 93% 81.2%. CONCLUSION: Evaluation of the clinical symptoms and signs combined with the triple tests can improve the diagnostic accuracy and significantly reduce the incidence of perforation and the rate of negative laparotomy.

Acute Disease↗
PubMed2005

Analysis of scores in diagnosis of acute appendicitis in women.

Acute appendicitis is a common surgical condition that requires prompt diagnosis. Besides modern imaging techniques, scoring systems, based on clinical signs and symptoms and routine laboratory assessments, have been used as a diagnostic aid. However, differences in sensitivities and specificities were observed if the scores were applied to various populations and clinical settings. The purpose of this paper is to assess validity of three scores (modified Alvarado score, Ohmann score and Eskelinen score) for diagnosis of acute appendicitis in women. 126 female patients admitted for suspicion of acute appendicitis in a tertiary hospital emergency department were analyzed prospectively. Modified Alvarado score, Ohmann score and Eskelinen score were calculated at admission and compared to final diagnosis. All patients with modified Alvarado score 7 or more had acute appendicitis (100% specificity) and it can be used to determine the need for immediate appendectomy. Values of Ohmann score greater than 6 resulted in 0.9% rate of overlooked appendicitis. Besides obvious educational role, scores may help to determine the group of patients who require immediate appendectomy, therefore expediting treatment and avoid unnecessary observation or more lengthy diagnostic procedures that require highly educated and skilled senior staff: No single score may be used alone to dictate or decline surgery. Different cut-off points may also be considered for different subpopulations.

Abdominal Pain↗
PubMed2005

[Programmed surgery for acute appendicitis].

Non-complicated appendicitis surgery is still considered to be an emergency, although it has been observed that a reasonable therapeutic delay (up to 18 hours) does not imply a higher number of complications. In our department, surgery is programmed for those non-complicated appendicitis, thus avoiding duty staff (surgeons, anaesthesiologists, nurses, assistants) to operate during late night. Acute appendicitis records from august 2001 to december 2002 were reviewed. Collected data included: clinical findings, physical examination, ultrasound findings, surgical delay (recorded time from emergency attendance until the end of the surgery) and evolution. A total of 209 patiens (125 males and 84 females) underwent surgery. Mean age was 10.1 years (standard deviation 3.02). A non-complicated appendicitis group (NC) included 171 subjects while the complicated appendicitis group (C) included 38, assessed by means of clinical evaluation plus ultrasonography. Patients in NC group had programmed surgery, with up to 20-hour delay (mean of 7 hours 45 minutes). Mean admission time was 4.87 days with a percentage of infectious complications of 1.73%. Patients in group C underwent surgery as soon as possible. Mean admission time was 9.23 days (p < 0.0001) and percentage of infectious complications of 43.6%. There was no difference between those operated rapidly and those who were delayed. Patiens with non-complicated disease could undergo programmed surgery, without having a higher risk of complicated disease and without disturbing normal department activity.

Acute Disease↗
PubMedDate not supplied

Application of alvarado scoring system in diagnosis of acute appendicitis.

BACKGROUND: In conditions like acute appendicitis it is impractical to have definitive diagnosis by gold standard test (histopathology) before surgery, we would like a simple test like Alvarado scoring system which depends on the presence and absence of certain variables and which provides an accurate guide to whether or not the patient has the condition. This study was conducted to evaluate Alvarado scoring system for the diagnosis of acute appendicitis in our set up. METHODS: 100 consecutive patients with suspected acute appendicitis admitted in Surgical B unit, Khyber Teaching Hospital Peshawar, during the period from July to December 2003 were included in the study. They were given specific scores according to the variables of Alvarado scoring system and then divided into 3 groups. Group 1 patients (score 7 or more) underwent surgery, group 2 patients (score 5-6) were admitted for observation and group 3 patients (score 4 or less) were discharged home. Patients from group 2 with increased symptom intensity (score 7 or more) in reevaluation underwent surgery. Diagnosis was confirmed by histopathological examination. Reliability of scoring system was assessed by calculating negative appendicectomy rate and positive predictive value. RESULTS: Out of a total 100 patients 64 patients underwent surgery and appendicitis was confirmed in 54 cases, thus giving negative appendicectomy frequency of 15.6% (male 12%, female 17.9%). Perforation rate was 7.8%. Positive predictive value was 84.3% (males 88%, females 82.1%). CONCLUSION: This scoring system is easy, simple and cheap complementary aid for supporting the diagnosis of acute appendicitis especially for junior surgeons.

Adolescent↗
PubMedDate not supplied

Clinical factors influencing CT findings in patients with acute appendicitis.

BACKGROUND/AIMS: CT has proven useful in diagnosing appendicitis, but it also has some disadvantages. In this study we investigated clinical factors influencing CT findings of acute appendicitis and identified the most appropriate patients for preoperative CT. METHODOLOGY: Enhanced helical CT scans were obtained preoperatively in 95 patients who underwent appendectomy. They were gangrenous in 52 (55%), phlegmonous in 38 (40%) and catarrhal in 5 (5%) and we usually indicated emergent surgery for phlegmonous or gangrenous appendicitis patients. 62 (69%) of 90 phlegmonous or gangrenous cases had both an enlarged appendix (> or = 6mm) and periappendiceal fat strand in CT, which strongly suggested the need for emergent operation (Positive group). We compared clinical factors in the positive group with those in the other 28 patients (Equivocal group). RESULTS: There was no significant difference between the positive and equivocal groups in age, gender, or white blood cell count. The depth of subcutaneous fat (SCF) at the umbilicus level in CT and the number of patients with gangrenous appendicitis were significantly increased in the positive group compared with the equivocal group by both univariate and multilogistic regression analysis. CONCLUSIONS: These indicated that the degree of inflammation and SCF were significantly associated with CT findings of appendicitis and CT should be routinely done in obese patients.

Acute Disease↗