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PubMedDate not supplied

Rare complications following colonoscopy: case reports of splenic rupture and appendicitis.

BACKGROUND: Appendicitis and splenic rupture are 2 rare complications of colonoscopy reported in the literature. To our knowledge splenic rupture following colonoscopy has been reported 17 times in the English-language literature and is associated with excess traction on the splenocolic ligament. Appendicitis after colonoscopy has been reported only 9 times and is usually associated with obstruction of the appendiceal lumen with fecal matter during colonoscopy. METHODS: We present the case reports of 2 patients: a 76-year-old woman who presented in consultation 24 hours after a routine colonoscopy with massive hemoperitoneum secondary to splenic rupture, seen on computed tomographic (CT) scan, who then underwent splenectomy; the second, a 60-year-old male who presented to the emergency room 16 hours after colonoscopy with clinical and computed tomographic scan findings of acute appendicitis who underwent a laparoscopic appendectomy. RESULTS: Treatment of both patients resulted in resolution of their complications, splenic rupture and appendicitis. They both had an uneventful postoperative course and are doing well several months postoperatively. CONCLUSIONS: We report 2 rare complications of colonoscopy, splenic rupture and appendicitis. In the setting of a recent colonoscopy and abdominal pain, a high index of suspicion is needed for their diagnosis.

Aged↗
PubMed2005

[Videolaparoscopy for suspected acute appendicitis].

Results of videolaparoscopy for suspected acute appendicitis are analyzed in 2165 patients (729 men and 1373 women) aged from 15 through 92 years. The diagnosis of acute appendicitis was excluded in 23.6% of men and 54.5% of women. Disagreement between the clinical and laparoscopic diagnoses took place more often in women aged younger than 20 and older than 70, and in men - younger than 20 and older than 50. Other diseases were found resembling acute appendicitis which required urgent operative treatment in half of the cases. In 88.7% of the observations the laparoscopic method was used. Laparoscopy resulted in sharply decreased number of appendectomies in patients with catarrhal (0.3%) and secondary (0.3%) appendicitis. The sensitivity of the videolaparoscopic method of diagnosing acute appendicitis was 98.7%, specificity - 91.1%, exactness - 95.9%.

Acute Disease↗
PubMed1991

[Prospective study of a predictive scoring system for the diagnosis of appendicitis in patients with right lower quadrant pain. Long-term outcome].

The results of prospectively determined scoring system for the diagnosis of appendicitis (sex, age, duration of symptoms, contracture, hyperleucocytosis) are reported. Between 1984 and 1989, 492 patients with suspected appendicitis were examined. Among the 208 operated patients, 169 had acute appendicitis (81.25 percent). Diagnosis of the abdominal pain was established in one of 3 patients without appendicitis (105/323; non operated patients or operated patients with normal appendix). Eighty-five percent of the non operated patients and 92 percent of the patients operated on with normal appendix have been followed (mean follow-up 26 months). Ten percent of the non operated patients (24/237) have been operated on during follow up; 13.9 percent of the operated patients with normal appendix (5/36) and 22.8 percent of the non operated patients (54/237) still complained of persistent right lower quadrant pain (no significative difference). In conclusion, a clinical scoring system is of help in suspected acute appendicitis. This attitude requires the cooperation of the general practitioner and must be well explained to families of patients.

Abdominal Pain↗
PubMedDate not supplied

[Acute appendicitis in pregnancy].

A retrospective analysis of acute appendicitis during pregnancy in patients seen at the Surgical Service of Ribeirão Preto between December 1959 and December 1988 showed that out of 18,065 deliveries performed there were 7 cases of acute appendicitis (0.038%). Gestational age in which acute appendicitis developed varied from the 11th to the 27th week, the second trimester prevailing. Both in pregnant and in non-pregnant patients, clinical history of appendicitis was similar, except for a few cases in which the cecum, mobile as it is, caused localized pain in a more cranial position. Acute appendicitis during pregnancy showed a more aggressive evolution and despite a period lower than 24 hours, only two of our patients did not exhibit a purulent secretion in the abdomen during surgery. The two patients with a prolonged time of history had necrosed and perforated appendices. There was no maternal mortality. Among complications observed, wall abscess (14%), adynamic ileum (14%), and premature labor (28%) were the most important. Inhibition was not possible in one of the cases of premature labor, with the birth of a live fetus on the second postoperative day. The fetus died eventually. Other patients gave birth to live and timely fetuses.

Acute Disease↗
PubMed1991

[Diagnostic value of the rectal examination and the difference in axillo-rectal temperatures in acute appendicitis in childhood].

The authors deal with the importance of pain in the Douglas space during rectal examination and the contribution of the axillo- rectal difference in temperature in the diagnosis of acute appendicitis in a group of 402 children operated on who had the above preoperative diagnosis. Marked pain in the Douglas space was recorded in 53.6% children and complete absence of pain in 31.2% of the children with acute appendicitis proved at operation. In children where so-called negative laparotomy was performed this ratio was reversed. When evaluating the axillo-rectal difference in temperature the authors reached the paradoxical conclusion that an obviously physiological difference in the axillo-rectal temperature (up to 0.5 degrees C) was slightly more frequent in acute appendicitis than in negative laparotomy. An obviously pathological difference (1 degrees C or more) was three times more frequent in patients with negative laparotomies than in acute appendicitis. Next the authors discuss views reported in the literature where data on the asset of rectal examination in acute appendicitis vary between 2.9-73%. In the conclusion the authors recommend rectal examinations in all children with suspicion of any type of acute abdomen, however, taking into account that pain in the Douglas space will contribute only little to the reduction of the number of negative laparotomies. They consider assessment of the axillo-rectal difference in temperature practically useless.

Acute Disease↗
PubMed1991

Review of the histopathological findings in appendices removed for acute appendicitis in Nigerians.

The vermiform appendix is a frequent surgical specimen in most routine histopathology laboratories. This is because acute appendicitis is one of the commonest reasons for undertaking emergency laparotomy in most hospitals, even in developing countries. Three hundred and sixteen appendices removed for acute appendix in our hospital over a 10-year period were analysed, of which 37 (11.7%) were found to be normal while 221 (69.9%) showed histopathological evidence of acute inflammation. There were 25 cases of chronic appendicitis, four (1.3%) of which were granulomatous. Of these, schistosomal appendicitis was observed in three cases (0.95%) and tuberculous appendicitis was seen in one case. Of the 33 cases classified as miscellaneous, intraluminal ova of parasites with phlegmonous eosinophilic infiltration of the appendix was observed in 17 cases (5.4%) and Toxoplasma appendicitis was observed in five cases. Carcinoid tumour was diagnosed in three cases (0.95%), and in two of these the tumour had spread beyond the appendix.

Acute Disease↗
PubMed1991

Diagnosis of appendicitis in childhood.

A retrospective study of the diagnostic value of the blood white cell count was carried out in 187 children who had had an appendicectomy for suspected appendicitis. All had preoperative measurement of the total white cell count. Normal appendices were present in 43 children (23%), with a mean white cell count of 9.5 x 10(6)/l (95% confidence interval 8.4-10.6). The 144 children with appendicitis had a mean white cell count of 16.1 x 10(6)/l (95% confidence interval 15.3-16.9). A white cell count of 10 x 10(6)/l gave the best discrimination, and 91% of patients with a white cell count which equalled or exceeded this value had appendicitis compared with 27% of patients with a lower total white cell count (P less than 0.0001). Only one patient of 46 with gangrenous or perforated appendicitis had a white cell count below 10 x 10(6)/l. In children with suspected appendicitis a low white cell count should lead to review of the diagnosis and to further observation when doubt about the need for surgery persists.

Adolescent↗
PubMed1990

[Acute appendicitis in patients with Yersinia infection].

The article is the result of the joint work of a surgeon and a specialist in infectious diseases and is based on the results of treatment of 307 patients with the abdominal form of Yersinia infection Acute appendicitis was diagnosed in 73 (23.8%) of them. The abdominal form of Yersinia infection is encountered frequently among children. The authors analyse the clinical picture of acute appendicitis in patients with Yersinia infection, the time between the onset of the disease and the patient's call for the doctor, the dependence of the histologic findings in the examined removed vermiform processes on the duration of the disease, and the results of surgery. The difficulties in making the diagnosis of acute appendicitis in patients with yersinosis and concomitant mesadenitis and terminal ileitis are discussed. It is concluded that laparoscopy is advisable in doubtful clinical signs of acute appendicitis in patients with Yersinia infection due to the high frequency of destructive forms (77.9%). The average duration of in-patient treatment of persons with acute appendicitis and Yersinia infection was 4.8 days. The positive results of treatment are attributed to timely prescription of specific antibacterial therapy--the prescription of chloramphenicol from the moment that the diagnosis of yersinosis was established.

Acute Disease↗
PubMed1990

Perforated appendicitis--the Malaysian experience.

Perforated appendicitis, with its increased complication rate, today still poses a formidable problem in the Kuala Lumpur General Hospital. Out of 1694 emergency operations performed by our unit in 1987, there were 927 appendicectomies. A retrospective study of these cases showed 126 cases of perforated appendicitis, which were then subjected to detailed analysis. We have a diagnostic accuracy of 81% and perforation rate of 18%. In addition, it is interesting to note the racial differences in the relationship of diagnostic accuracy to perforation rate. Perforation is associated with an increased wound infection rate. Transperitoneal drainage in perforated appendicitis did not lead to a lower incidence of wound infection or improve postoperative performance. Distinguishing between perforated and non-perforated appendicitis may be difficult. Perforation could occur while awaiting operation. We recommend the early administration of systemic antibiotics should appendicectomy be delayed and the cautious use of drains in cases of perforated appendicitis.

Adolescent↗
PubMed1990

Barium enema in the diagnosis of acute appendicitis.

Acute appendicitis is still a difficult diagnosis to make. Reports place the rate of incorrect diagnosis--the rate of negative laparotomy--at 15 to 42 per cent. This study is a prospective analysis of barium enema (BE) examinations performed upon 101 patients who presented with a history accompanied by signs and symptoms suggestive of, but not clearly diagnostic of, acute appendicitis. The over-all accuracy rate was 91.5 per cent. Sensitivity and specificity rates were 83 and 96 per cent, respectively. BE had a positive predictive value of 88 per cent and a negative predictive value of 95 per cent in this study. No complications resulted from the use of BE in this study, which included three instances of perforated appendicitis. We conclude that emergent BE is an inexpensive, safe and readily available adjunct to the diagnosis of acute appendicitis. Its use in the presence of a clear-cut presentation of acute appendicitis is not necessary. When clinical data were equivocal, BE reduced the rate of negative laparotomy to 7.2 per cent.

Acute Disease↗
PubMed1989

[The role of real-time sonography in the differential diagnosis of acute appendicitis and in the detection of post-appendectomy complications].

110 urgent sonography were performed on 101 patients with suspected acute appendicitis and on subsequent 26 patients 33 echography with suspected postappendectomy abscess. Although according to a few publications in connection with acute appendicitis there are characteristic sonographic signs, the authors didn't find any typical structures at patients having non-complicated appendicitis. But at perforated appendicitis and periappendicular abscesses the fluid collection was frequently very well visualizable and the periappendicular infiltration was detectable as well. The differentation between infiltration and abscess is difficult, often unsuccessfull. The authors confirm the high sensitivity of sonography in the detection of postappendectomy intraabdominal abscesses, similarly to other abscesses of unrelated origin. They emphasize the differentialdiagnostic aid of sonography, if the clinical symptoms are atypical or the signs of acute appendicitis are imitated by other disease.

Acute Disease↗
PubMed1989

Ultrasound with graded compression in the evaluation of acute appendicitis.

Acute appendicitis is the most common diagnosis made (in the Western world) in patients with an "acute abdomen." Although the mortality rate has been vastly reduced, the diagnostic inaccuracy rate of 15% to 20% has remained unchanged in the past 100 years. In this article, the authors report the ultrasonographic findings in 80 patients examined using a small linear-array transducer, which enables direct visualization of the inflamed appendix. During 22 months, 80 patients (28 males and 52 females; age range, 3 to 81 years; mean, 32.3 years) with equivocal clinical signs and symptoms of acute appendicitis were examined sonographically. Of the 29 patients whose appendicitis was verified at surgery, ultrasonography was positive in 26, with an overall sensitivity of 90%. Of the 51 patients who did not have appendicitis, ultrasonography was negative in all, with a specificity of 100%. The authors concur with reports in the literature that ultrasonography is helpful in diagnosing appendicitis.

Abdomen, Acute↗
PubMed1989

Sonography of acute appendicitis: a critical review.

In 20% of the cases of acute appendicitis, especially in children, the elderly, and ovulating women, the findings are atypical. The radiographic procedures used to aid in the diagnosis have not been proven reliable. Sonography has often been used to diagnose or rule out appendiceal abscesses, or diseases that can mimic acute appendicitis, such as gynecologic, obstetric, or biliary abnormalities. Recently, high-resolution sonography with graded compression has been shown to be very helpful in the diagnosis of acute appendicitis in several studies. High-resolution 5- to 7.5-MHz transducers are used to compress the bowels, displace the interfering gas in the right lower quadrant, and directly visualize the inflamed appendix with a sensitivity that varies from 80 to 95%, a specificity of 95 to 100%, and an accuracy of 91 to 95%. It is also possible to differentiate acute appendicitis from the gangrenous and perforated appendix. High-resolution sonography is currently the diagnostic method of choice for appendicitis, particularly in patients with equivocal clinical findings. The technique, normal and pathologic anatomy values, and limitations of sonography are discussed.

Acute Disease↗
PubMed1989

Factors responsible for the high perforation rate seen in early childhood appendicitis.

The incidence of perforated appendicitis has remained high in the infant and young child resulting in substantial morbidity. The purpose of the present study was to investigate the factors contributing to the high perforation rate seen in this age group. A retrospective analysis was done on 77 patients under the age of seven who underwent appendectomy for appendicitis. The perforation rate was 72.7 per cent. Duration of pain correlated with patient age and perforation rate. Under the age of five, only 17 per cent had symptoms for less than 36 hours. Children with symptoms that lasted longer than 48 hours had a perforation rate of 98 per cent. Associated illnesses including respiratory infections, otitis media, and gastroenteritis were common in both simple and perforated appendicitis, often leading to a delay in diagnosis. Of patients with perforation, 36 per cent were seen at least once by the primary physician and discharged. The keys to the diagnosis of appendicitis in this young age group were history and physical exam. Right lower quadrant findings were present in 95 per cent of patients with simple appendicitis and 71 per cent of patients with perforation. The primary-care physician and consulting surgeon have crucial roles in diagnosing the disease early in its course.

Appendicitis↗
PubMed1985

Acute appendicitis related to faecal stasis.

The objectives of the study presented here were to evaluate the role of faecal stasis in the development of acute appendicitis. Inquiries about bowel habits were made of 188 patients admitted to this Department of Surgery with a clinical diagnosis of acute appendicitis, and of 188 healthy volunteers without known gastrointestinal disease, matched for age and sex. The results show that the number of bowel actions per week were significantly lower in the group of patients with acute appendicitis. Furthermore, the patients with a gangrenous and perforated appendix found at operation had significantly fewer bowel actions per week than those with phlegmonous appendicitis. These findings support the hypothesis of the importance of the obstruction of the appendix lumen in the development of acute appendicitis.

Acute Disease↗
PubMed1988

[Sonography in the diagnosis of appendicitis--a prospective study].

In a prospective study the significance of ultrasonography in the diagnosis of appendicitis was evaluated. On 104 patients--57 women and 47 men between the ages of 5 and 88 years--with a preliminary diagnosis of acute appendicitis, ultrasonography was performed using a graded compression technique with small curved-array transducers following physical examination. In 32 of 36 patients with operatively confirmed appendicitis the inflamed appendix could be visualized clearly. All 6 perityphlitic abscesses and 4 of 5 perforations were detected correctly by ultrasonography. In 18 patients the use of sonography led to important differential diagnoses other than appendicitis, which in 4 cases required surgery. By direct visualization of the inflamed appendix and its periappendicidal complications the clinical diagnosis of acute appendicitis can be improved. As a result of sonographic detection or exclusion of other diseases, ultrasonography facilitates the--often difficult--clinical differential diagnosis of right lower abdominal pain.

Abscess↗
PubMed1986

Imipenem therapy for perforated and gangrenous appendicitis.

A matched patient control study of imipenem therapy of patients with perforated or gangrenous appendicitis was performed. Thirty-three patients treated with imipenem and cilastatin were compared with 66 control patients treated with clindamycin and gentamicin. Patients were matched for age and surgical pathologic factors. Twenty-five of the 33 imipenem treated patients had perforated (two with abscesses) and nine had gangrenous appendicitis. Anaerobes were recovered from 23 of 32 (72 per cent), anerobes from 31 of 32 (97 per cent) and Pseudomonas from six (26 per cent) of the 23 with perforated appendicitis. Only one isolate, a Fusobacterium species was resistant to imipenem. Enterococci were isolated only from three imipenem treated patients, all were susceptible and were not associated with failures. Frequency of other pathogens isolated was similar for the imipenem and clindamycin and gentamicin patients. One failure occurred in the imipenem treatment group. Failures and adverse reactions were not different for the two groups. The study would have detected as significant (p equals 0.03) a 9 per cent difference in failure rates. Mean days of fever of more than 38 degrees C and days of hospitalization were fewer (p less than 0.05) for imipenem treated patients even when only patients with perforated appendicitis were compared. Days to return of intestinal function were fewer for control patients. Imipenem and cliastatin appeared to be an effective antimicrobial agent used as an adjunct to surgical treatment for peritonitis associated with appendicitis even when caused by Bacteroides fragilis group organisms or Pseudomonas species, or both.

Adult↗
PubMed1987

[A prospective study of 776 cases of acute non-traumatic abdominal pain. Acute appendicitis and its diagnosis].

776 patients seen in our emergency ward with abdominal pain for less than one week duration were prospectively analysed. In 49% of these patients no cause was found and 19% had acute appendicitis. Among 180 appendectomized patients, 147 (82%) had acute appendicitis whereas 33 (18%) had no inflammation of the appendix. Clinical presentation with a pain duration of less than 36 hours, steady abdominal pain, guarding in the right iliac fossa and a white cell count above 12,000/mm3 (12 g/l) were the best criteria for prediction of acute appendicitis versus a normal appendix. Perforated appendicitis was found in 18% of the patients with acute appendicitis but in only one patient for whom appendectomy had been deferred on the grounds of atypical presentation. Thus, in most cases, the perforation was preexistent to admission. We therefore recommended a 24-48-hour observation period for patients with uncertain diagnosis. Rates of normal appendices and perforated appendices of about 20% seem to be difficult to improve upon.

Abdomen, Acute↗