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PubMedDate not supplied

Incidence of acute appendicitis confirmed by histopathologic diagnosis.

The annual incidence of acute appendicitis by gender, age, and race in Sedgwick County, Kansas was lower than values reported in most other communities. However, the trends of peak incidence during the second decade, male predominance among all races, and the highest incidence in Caucasians also were noted in the current study. The rates of perforation and gangrenous appendicitis were significantly higher in the elderly. No association was noted between the presence of fecalith and acute appendicitis or perforation. A better understanding of the etiology of acute appendicitis may explain the trends and differences in the incidence of acute appendicitis observed.

Acute Disease↗

PubMed2005

Pediatric appendicitis rupture rate: a national indicator of disparities in healthcare access.

BACKGROUND: The U.S. National Healthcare Disparities Report is a recent effort to measure and monitor racial and ethnic disparities in health and healthcare. The Report is a work in progress and includes few indicators specific to children. An indicator worthy of consideration is racial/ethnic differences in the rate of bad outcomes for pediatric acute appendicitis. Bad outcomes for this condition are indicative of poor access to healthcare, which is amenable to social and healthcare policy changes. METHODS: We analyzed the KID Inpatient Database, a nationally representative sample of pediatric hospitalization, to compare rates of appendicitis rupture between white, African American, Hispanic and Asian children. We ran weighted logistic regression models to obtain national estimates of relative odds of rupture rate for the four groups, adjusted for developmental, biological, socioeconomic, health services and hospital factors that might influence disease outcome. RESULTS: Rupture was a much more burdensome outcome than timely surgery and rupture avoidance. Rupture cases had 97% higher hospital charges and 175% longer hospital stays than non-rupture cases on average. These burdens disproportionately affected minority children, who had 24% - 38% higher odds of appendicitis rupture than white children, adjusting for age and gender. These differences were reduced, but remained significant after adjusting for other factors. CONCLUSION: The racial/ethnic disparities in pediatric appendicitis outcome are large and are preventable with timely diagnosis and surgery for all children. Furthermore, estimating this disparity using the KID survey is a relatively straightforward process. Therefore pediatric appendicitis rupture rate is a good candidate for inclusion in the National Healthcare Disparities Report. As with most other health and healthcare disparities, efforts to reduce disparities in income, wealth and access to care will most likely improve the odds of favorable outcome for this condition as well.

Journal Article↗

PubMed2005

[Intususception of appendical cystadenoma imitating a caecal tumor].

Appendical cystadenoma is one of the histological forms of the appendical mucocele. Preoperative diagnostics is difficult, however, due to potential iatrogennic rupture during a surgical procedure, is very important. The authors present a case review of a 62-year-old patient with itususception of the appendical cystadenoma, until now rarely reported in literature. Upon the preoperative diagnosis the appendical cystadenoma appeared as a caecal tumor or a tumor of the terminal ileum. A histological, intraoperative, diagnosis was established, followed by a final histological examination of the resected tissue. The authors discuss contemporary options of the preoperative diagnostic measures of the appendical tumors, stressing up all risks of aspiration cytology as well as risks of laparoscopic approach in this pathology management

Appendix↗

PubMed2001

Computed tomography and ultrasonography in the diagnosis of appendicitis: when are they indicated?

HYPOTHESIS: Relative merits and indications exist for ultrasonography (US) and computed tomography (CT) in the diagnosis of appendicitis. DESIGN: Prospective study. SETTING: General community and tertiary care hospital. METHODS: Ninety-nine patients (50 males and 49 females) were studied. Following consent, the initial disposition was recorded, designating the patient for operation, observation, or discharge from the hospital. Each patient was studied by CT and US. Studies were independently evaluated by 2 radiologists, and the results were designated as positive, negative, or equivocal. The surgeon reevaluated patients before and after learning the results of US and CT, recording whether the CT scan, US, or reexamination influenced the final disposition. RESULTS: Fifty patients had appendicitis; 6 appendixes were perforated. The initial clinical impression called for 44 operations, 49 observations, and 6 discharges. Thirty-four patients had their treatment plan changed from the initial disposition. Ultrasonography did not affect the initial impression. In contrast, 18 patients were rediagnosed solely on CT scan findings. Seven patients were rediagnosed by reexamination. Of 44 patients initially designated for operation, the CT scan and reexamination spared 6 females from surgery; the negative appendectomy rate potentially decreased from 50% to 17% (P =.03). The CT scan, US, or reexamination failed to spare 2 males from exploration with negative results. Of the 49 patients initially designated for observation, 23 were rediagnosed after reevaluation, 13 were discharged from the hospital, and 10 underwent expedient operation. One patient was spared from inappropriate discharge from the hospital. The reliability of the CT scan was good, with high sensitivities and specificities. Equivocal scan results lowered the diagnostic value. CONCLUSIONS: Selective use of a CT scan with a second examination can improve the diagnostic accuracy and management of suspected cases of appendicitis by (a) reducing the negative appendectomy rate in females, (b) moving patients from observation to earlier operation or discharge from the hospital, and (c) preventing inappropriate discharge of patients with appendicitis.

Adolescent↗

PubMed1977

Radiologic diagnosis of appendicitis.

Many articles published in the medical literature have stated that a normal-appearing appendix as seen via contrast enema is inconsistent with the diagnosis of acute appendicitis. This assumes that appendicitis is always associated with complete luminal obstruction of the appendix, and that the length of the normal appendix is known to the interpreter of the x-ray examination. Retrospective analysis of the barium contrast studies of three patients found to have acute appendicitis demonstrated the limitations of this hypothesis. These patients were diagnosed as having acute appendicitis at operation in spite of radiologic evidence of normal-appearing appendices. We review radiologic findings that can be helpful in recognizing this condition and discuss the severe limitations of barium contrast studies in making an accurate diagnosis.

Abscess↗

PubMed1983

Acute appendicitis and dietary fiber.

The role of dietary fiber in the cause of acute appendicitis was evaluated. By means of food diaries the average daily fiber consumption was determined in 31 patients with acute appendicitis and in 30 control patients, matched for age and sex. The average daily dietary fiber intake was 17.4 g in the group with appendicitis and 21.0 g in the control group. The difference is statistically significant. Adjustment for the total energy intake in each instance did not change this conclusion. The results support the hypothesis that diet, in particular a lack of fiber, may be an important factor in the pathogenesis of acute appendicitis.

Acute Disease↗

PubMed1989

Perforated or gangrenous appendicitis treated with aminoglycosides. How do bacterial cultures influence management?

To study the influence of bacterial culture data on the clinical management of gangrenous or perforated appendicitis, we reviewed records of 104 patients who had been treated empirically with aminoglycoside antibiotics. Culture results appeared to influence antibiotic therapy in only 7 patients (7%). The routine cultures obtained at appendectomy affected therapy in only 2 patients. Discriminant analysis identified postoperative infectious complications and related factors as the principal determinants of culture utility. We conclude that, in patients with perforated appendicitis treated empirically with aminoglycoside combination regimens, culture results were seldom used for clinical management except in instances of postoperative infectious complication. Routine cultures and Gram's stains of perforated appendicitis, however, should still be obtained (1) to allow epidemiologic tracking in the hospital; (2) to identify organisms that are recovered infrequently but may cause serious disease (eg, Clostridium); and (3) because newer antibiotics are replacing aminoglycosides in the treatment of perforated appendicitis.

Abscess↗

PubMed1977

The neutrophil count in childhood acute appendicitis.

A study was made of the total leucocyte count, neutrophil percentage and absolute neutrophil count in 100 consecutive children with acute appendicitis and in 25 children from whom, following a provisional diagnosis of acute appendicitis, a normal appendix had been removed, no other infective or inflammatory lesion having been found. In the first group there was a raised total leucocyte count in 42 per cent, a raised neutrophil percentage in 93 per cent and a raised absolute neutrophil count in 77 per cent. In the second group the corresponding figures were 4, 24 and 16 per cent. Acute appendicitis is associated with changes in the total leucocyte and neutrophil counts and a correct interpretation of the results of these investigations requires that account be taken of the age of each child. A probable maximum absolute neutrophil count has been calculated. An explanation has been suggested for the presence of normal total leucocyte counts in certain cases in spite of acute appendicitis.

Acute Disease↗

PubMed1987

Role of Enterobius vermicularis in the aetiology of appendicitis.

An evaluation was made of the histological material obtained from all 1529 appendices removed during the last 5 years at Southmead Hospital, Bristol, in order to elucidate possible relationships between the incidence of Enterobius vermicularis and the origin of inflammation in the appendix. In total, 1419 appendices were removed as cases of clinical appendicitis and 110 in the course of another surgical procedure. E. vermicularis was identified in 2.7 per cent of patients with clinical appendicitis and was most commonly seen in appendices with either chronic inflammation or where the appendix was histologically normal. E. vermicularis was rarely associated with histological changes of acute appendicitis. No cases of E. vermicularis infestation occurred in appendices removed during the course of other surgical procedures. The results suggest that, although E. vermicularis may have a causal role in appendicular pain and chronic inflammation, it is rarely related to acute appendicitis.

Animals↗

PubMed2005

Randomized clinical trial of laparoscopic versus open appendicectomy for confirmed appendicitis.

BACKGROUND: Laparoscopy is safe for diagnostic and therapeutic purposes in patients with suspected acute appendicitis. This study compared recovery after laparoscopic (LA) and open appendicectomy (OA) for confirmed appendicitis, carried out by experienced surgeons in an educational setting. METHODS: One hundred and sixty-three patients with laparoscopically confirmed appendicitis suitable for LA were randomized prospectively to either LA or OA in a blinded fashion. The primary endpoint was time to full recovery. Secondary endpoints were operating time, complications, hospital stay and functional status. RESULTS: There was no significant difference between LA and OA in time to full recovery (9 and 11 days respectively; P = 0.225). Operating time was 55 min in the LA group and 60 min in the OA group (P = 0.416). The complication rate was 8.6 and 11.0 per cent respectively (P = 0.696), and median hospital stay was 2 days in both groups (P = 0.192). Functional status was significantly better in the LA group 7-10 days after operation (P = 0.045). CONCLUSION: There was no difference in time to full recovery after LA and OA in patients with laparoscopically confirmed appendicitis. A trend towards better physical activity was noted after the laparoscopic procedure.

Adolescent↗

PubMed1982

Acute appendicitis as a sign of a colorectal carcinoma.

The relationship of acute appendicitis occurring previous to cancer in colon and rectum was studied in the consecutive records of 561 patients, of 40 years of age and older, operated upon with an appendectomy because of acute appendicitis. Sixteen (2.9%) of these patients were readmitted within three years because of a carcinoma in colon or rectum. The incidence of carcinoma in the colon and rectum in the population, of the same age, is only 0.1%, according to the Sweden Cancer Registry (1). This difference is statistically significant. Where acute appendicitis and colon carcinoma co-exist, the danger is that the carcinoma may be missed. Therefore, any patient over the age of 40 presenting with acute appendicitis should be carefully checked for carcinoma in the colon.

Acute Disease↗

PubMed2002

Impact of abdominal CT imaging on the management of appendicitis: an update.

BACKGROUND: Abdominal computed tomographic scanning (ACTS) has recently been shown to be an accurate diagnostic tool for appendicitis and may improve the negative exploration rate in our patient population. MATERIALS AND METHODS: We reviewed 224 patients evaluated for appendicitis during 1998. Forty-two patients underwent appendectomy on clinical grounds alone (Group I), 182 patients underwent ACTS (Group II), and 79 patients in Group II were explored for appendicitis. Diagnostic errors, alternative diagnoses, and perforation rates were noted. RESULTS: There were five negative explorations in Group I (11.9%) and five in Group II (6.3%), resulting in a combined negative rate of 8.3%. The negative exploration rate in women was 23.5% in Group I and 5.3% in Group II (P = 0.07), producing a combined negative rate of 10.9%. Fifty-eight alternative diagnoses were made by ACTS. The ACTS made a critical difference in the management of 67% of patients over 50 years of age and in 79% of Group II patients. CONCLUSIONS: The negative exploration rate for appendicitis at our institution fell from 13.6 to 8.3% with selective use of ACTS. The most striking benefit occurred in women and in patients over 50 years of age.

Abdomen↗

PubMed1994

[Ultrasound diagnosis of appendicitis by surgeons--a matter of experience? A prospective study].

A number of studies have shown that ultrasound has an advantage over physical examination in the diagnosis of acute appendicitis. Most of these studies were conducted by experts in the field of ultrasonography. In this study the influence of experience on the results of the sonography of acute appendicitis were evaluated. All 203 patients admitted to our unit between December 1990 and December 1992 were examined physically and sonographically by a team of surgeons consisting of one experienced sonographer and six inexperienced surgical trainees. Laparotomy was performed in 136 patients (46%). Appendicitis was demonstrated histologically in 119 cases (39.4%). Initial clinical findings were positive in 87 (28.8%). Sonography was positive in 119 patients (39.4%). The 163 patients not operated on demonstrated other pathology on ultrasound in 60 cases (19.9%). The rate of negative laparotomies amounted to 7.2% in our study. Sensitivity and specificity for the sonographic diagnosis were 92% and 95%, respectively. They were only 81% and 80% for physical examination. Overall accuracy was 92% for sonography. Sensitivity and specificity for the inexperienced surgeons were 87% and 93%, respectively, while the experienced surgeon reached values of 97% and 98%, respectively. The results of both groups are comparable with values in the literature, suggesting that ultrasound evaluation of appendicitis is not a diagnostic tool limited to a few experienced sonographers.

Abdomen, Acute↗

PubMed1996

Tissue superoxide dismutase (SOD) activity and immunohistochemical staining in acute appendicitis: correlation with degree of inflammation.

The mechanism of progression of appendicitis has not been clarified. We examined tissue superoxide dismutase (SOD) activity, thiobarbituric acid reactive substance (TBARS), and the localization of Cu, Zn-SOD in 56 inflamed appendices in relation to histopathological classification. There was a significant difference in SOD activity between catarrhal appendix and phlegmonous and gangrenous appendix (2.3 +/- 0.1 vs 5.0 +/- 0.2 and 4.6 +/- 0.6 units/mg protein, respectively P < 0.05). TBARS value was highest in gangrenous appendix, being significantly different from the levels in the other two types (0.47 +/- 0.04 vs 0.19 +/- 0.01 n mol/mg protein, in catarrhal and 0.20 +/- 0.02, in phlegmonous appendix P < 0.05). Positive staining for Cu, Zn-SOD was demonstrated in 64% of catarrhal appendices, 96% of phlegmonous appendices, and 75% of gangrenous appendices, and intense positive staining was recognized in 9%, 28%, and 40% of these appendices, respectively. These results indicated that active oxygen influences the degree of inflammation in phlegmonous and gangrenous appendicitis. Gangrenous appendicitis and the other two types of appendicitis seemed to be different entities.

Acute Disease↗

PubMed1986

Perforated appendicitis and obstructing colonic carcinoma in the elderly.

Two patients admitted with perforated appendicitis and obstructing colonic cancers are presented. The first patient, a 75-year-old man, developed a persistent fecal fistula following appendectomy. Barium enema demonstrated an obstructing hepatic flexure carcinoma. The second patient, a 62-year-old man, recovered uneventfully following appendectomy. Persistent occult blood was found in his stools during follow-up examinations. Three months after surgery, diagnostic colonoscopy revealed a nearly obstructing sigmoid carcinoma. Obstruction of the appendiceal lumen by such lesions as fecaliths, carcinoid tumors, lymphoid hyperplasia, or cecal carcinoma accounts for appendicitis in the majority of patients. These two patients illustrate a less common cause. As many as 3 percent of patients over 40 years of age presenting with appendicitis also have obstructing colonic carcinomas. Elderly patients with appendicitis should be evaluated for colonic neoplasms at a clinically suitable time.

Aged↗

PubMed1979

The significance of a "positive" rectal examination in acute appendicitis.

The results of rectal examinations of 495 patients with suspected acute appendicitis were correlated with six other variables from the patients' histories and results of physical examinations. Positive rectal examination results were recorded for 46 per cent of all patients with acute appendicitis and for 53 per cent of those with normal appendices. The diagnosis of acute appendicitis should not be based solely or primarily on the results of the rectal examination. The examination should, however, be performed in all suspected cases of appendicitis to rule out gynecologic and urologic disease.

Acute Disease↗

PubMed1993

Correlation of peritoneal aspiration cytology with acute appendicitis.

Fifty-one patients in whom a clinical diagnosis of acute appendicitis had been made underwent peritoneal aspiration cytology (PAC). Thirty-six had a positive result, 11 had a negative result and aspiration failed in four cases. All patients had an appendicectomy and the histological findings were correlated with the PAC results. Thirty-five of the 36 patients with a positive PAC had histologically proven appendicitis. Seven of the 11 patients with a negative result had normal appendices. The sensitivity of PAC for acute appendicitis was 85% and the specificity was 70%. The positive predictive value was found to be 97% and the negative predictive value 60%. Peritoneal aspiration cytology is a useful aid in the diagnosis of acute appendicitis however, a negative result does not exclude this diagnosis.

Acute Disease↗

PubMedDate not supplied

An unusual case of appendicitis.

BACKGROUND: Acute appendicitis in elderly patients often presents late and atypically. Presentation as an incarcerated femoral hernia is rare. AIM: To describe the management of an elderly patient presenting with acute appendicitis in an incarcerated femoral hernia. METHODS: The femoral canal was explored and the hernia repaired. Formal appendicectomy was performed via a midline laparotomy incision. RESULTS: Histological examination confirmed the diagnosis of acute appendicitis. CONCLUSION: Unusual clinical presentations of acute appendicitis represent an interesting diagnostic challenge.

Acute Disease↗