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At least 739 records · Page 41Linked to original sources
PubMed2006

Nonoperative management of perforated appendicitis in children: can CT predict outcome?

BACKGROUND: The optimal treatment of perforated appendicitis remains controversial, but there is a trend toward nonoperative management. CT scanning might be helpful in determining which patients could benefit from this treatment option. OBJECTIVE: To determine the value of CT imaging in predicting clinical success or failure in children with nonoperative management of perforated appendicitis. MATERIALS AND METHODS: Admission CT scans of 34 children with perforated appendicitis treated nonoperatively between January 2003 and June 2006 were retrospectively reviewed. All children were given intravenous antibiotics. Clinical outcome was correlated with imaging findings including the maximal area, number and complexity of collections, presence of an appendicolith or extraluminal air, and extent of intra-abdominal disease outside the right lower quadrant. Patients with an accessible simple collection were drained if their clinical condition did not improve. RESULTS: Successful nonoperative management was achieved in 20 patients; 14 patients failed nonoperative therapy. The presence of collections in three or more sectors (defined as the pelvis and four abdominal quadrants) correlated strongly with clinical failure (P < 0.05), while there was no correlation found between clinical outcome and the presence of an appendicolith, extraluminal air, distant ascites, and collection size or complexity. CONCLUSION: In the nonoperative management of children with perforated appendicitis, admission CT findings demonstrating disease beyond the right lower quadrant correlate with treatment failure.

Adolescent↗
PubMedDate not supplied

[Spontaneous perforation of the cecum without colonic obstruction. Report of 3 cases].

Spontaneous perforation of the colon without obstruction is related to intestinal and extra intestinal diseases, mainly gynecological procedures. Its etiology is unknown, and there are many theories. Because of its diagnosis peculiarities, as well as its rarity, and mainly the severity of the disease, the authors describe three cases, relating the necessity of early diagnosis and correct surgical treatment.

Adult↗
PubMed1995

[Idiopathic granulomatous appendicitis or Crohn's disease confined to the appendix?].

Crohn's disease limited to the appendix is uncommon. When Crohn's disease affects the appendix it typically has a longer clinical course than most cases of acute appendicitis. The diagnosis is histological. Appendiceal Crohn's disease has a benign course after surgery, and that's why some authors believe that it could be a different entity which should be better addressed to as "Idiopathic Granulomatosus Appendicitis". We present three new cases of Crohn's disease limited to the appendix.

Adolescent↗
PubMed1997

Diseases and surgery of the cecum.

The cecum is an important site of water and electrolyte absorption, as well as microbial digestion of soluble and insoluble carbohydrates. These functions of the cecum and ascending colon require that ingesta be mixed constantly and retained long enough to complete the digestion of cellulose. Parasites, changes in regional blood flow, diet, and various pharmacologic agents are associated with alterations in normal cecal motility patterns.

Anastomosis, Surgical↗
PubMed1978

Angiography in the diagnosis of ileocecal tuberculosis.

Ileocecal tuberculosis is still found sporadically in industrialised countries and occurs commonly in the underdeveloped world. Differentiation from Crohn's disease is a major diagnostic problem on which rational treatment depends. An angiographic appearance demonstrated in two patients is believed to be a useful diagnostic indicator of tuberculous etiology.

Angiography↗
PubMed1998

[Appendicular pseudo-tumors: unusual diagnosis].

The discovery of a tumour mass of the appendix, in an acute or chronic context, raises the problem of its benign or malignant, inflammatory or infectious nature. We report five cases of patients operated by the same surgical team between June 1991 and September 1996, who presented macroscopically and histologically with unusual appendicular pseudotumours: appendicular diverticulosis (n = 1), Crohn's disease localized to the appendix (n = 2), yersiniosis (n = 1), actinomycosis (n = 1). The preoperative diagnosis was acute appendicitis (n = 2) or tumour (n = 3). The postoperative course was uneventful in every case, and specific medical treatment was prescribed in two cases (yersiniosis and actinomycosis). These differential diagnoses must be considered in all appendicular diseases, but they are extremely difficult to confirm preoperatively.

Actinomycosis↗
PubMed1996

Appendical fistulae formation as a complication of primary Crohn's disease prior to surgical management: report of a case.

We report herein the unusual case of a 55-year-old man who presented with primary Crohn's disease of the appendix with fistulae. In this patient there was no history of previous appendectomy. Although fistula formation around the orifice of the appendix after appendectomy for primary Crohn's disease of the appendix has been observed in a number of long-term follow-up studies, preoperative fistula formation is extremely rare.

Appendix↗
PubMed1988

Acute recurrent appendicitis with appendicolith.

Appendiceal disease can be acute, acute recurrent, or chronic. Acute appendicitis is the most common form. Acute recurrent appendicitis is more common than chronic appendicitis. In children the clinical manifestations of appendicitis are variable. Patients who have an appendicolith usually develop appendicitis, often with perforation. A case is presented of 3-year follow-up of a patient with an appendicolith and acute recurrent appendicitis. The literature about appendicoliths is reviewed. In the appropriate clinical setting, a history of prior episodes of similar right lower quadrant pain does not preclude the diagnosis of appendiceal disease. Awareness of the less common forms of appendicitis is important so that appropriate treatment is not delayed.

Appendectomy↗
PubMed2004

Distal intestinal obstruction syndrome in adults with cystic fibrosis.

BACKGROUND & AIMS: With the improved survival of patients with cystic fibrosis (CF), gastrointestinal complications become more evident in adults with this condition. The aims of this study were to determine the prevalence and clinical features of distal intestinal obstruction syndrome (DIOS) and its relationship with the cystic fibrosis transmembrane conductance regulator (CFTR) genotype in an adult CF population. METHODS: Cross-sectional study was conducted in an adult CF cohort. RESULTS: Among 171 adults with CF (mean age, 28.9 years), 27 patients (15.8%) reported 43 episodes of DIOS. No significant association was found between DIOS and a history of meconium ileus. The first episode of DIOS occurred in adulthood in 21 cases (77.8%). DIOS recurred in 13 patients (48.1%). All patients who developed DIOS had pancreatic insufficiency. Pulmonary function was significantly more altered in patients with DIOS than in the other patients, but pancreatic insufficiency and age might act as confounding factors. DIOS occurred in 21.9% of patients with a severe CFTR genotype and in only 2.4% of patients with a mild CFTR genotype (P < 0.005). CONCLUSIONS: DIOS is frequent in adults with CF with a severe CFTR genotype and/or advanced-stage pulmonary disease. The relative contributions of malabsorption and impaired intestinal secretion in the development of DIOS are discussed.

Adolescent↗
PubMed2002

Proctitis with caecitis: an atypical presentation of ulcerative colitis.

Ulcerative colitis is characterized as an inflammatory process of the distal colonic mucosa, which may extend proximally. Its proximal extension is classically as a continuous lesion. We describe six patients presenting with typical ulcerative proctiits, who were also found to have an inflammatory area in the caecum, while the remaining colon was macroscopically and histologically normal. With no features to support a diagnosis of Crohn's disease, we believe these cases challenge the classic teaching that ulcerative colitis is a continuous disease. Performing total colonoscopy in patients who seem to have solely distal colitis will permit recognition of this distribution of inflammation.

Adult↗
PubMed1980

Studies on the epidemiology of antibiotic-associated Clostridium difficile colitis.

Vancomycin protects hamsters from the development of Clostridium difficile colitis after treatment with clindamycin, and vancomycin is useful in treatment of humans with the disease. Relapses have occurred in both hamsters and humans when vancomycin is discontinued. Vancomycin appears to enhance susceptibility to colonization with C. difficile by eliminating competing intestinal organisms. The nature of these organisms is not known, but various tools are now available to aid in identifying them. Cancer chemotherapeutic agents should be added to the list of factors such as surgery and antibiotics that may predispose to emergence of C. difficile. The number of organisms required for colonization of antibiotic-treated hamsters is low and cross-infection seems to play a role in the disease in hamster colonies. The organism can be detected on surfaces in rooms of patients with the disease, and on the hands of personnel caring for them. Outbreaks of the disease have been recognized. Our results suggest isolation precautions should be used to prevent spread of the organism from patients with the disease to others being treated with antibiotics.

Animals↗
PubMed1995

[Intestinal obstruction caused by ischemic colitis: description of 3 surgically treated cases].

The diagnosis of ischemic colitis is challenging and still based upon a high index of suspicion. We report here, three patients affected by ischemic colitis causing stenosis and intestinal obstruction who required surgical treatment. Results of surgery in the three cases were not fair reflecting the high mortality and morbidity rate of ischemic colitis. However, the three cases showed peculiar features allowing us to make a few speculative considerations. Better results in the treatment of ischemic colitis might be achieved by means of a prompt recognition of the initial picture and through a better control of the many associated diseases, that represent the main risk factor for the development of ischemic colitis itself and for the bad prognosis of surgical treatment.

Aged↗
PubMed1982

Management of the appendix in young patients with Crohn's disease.

Sixty-six young patients (average age, 17.2 years) underwent intestinal operations for Crohn's disease during a 14-year period at the UCLA Hospital. Nine had undergone previous appendectomy for suspected appendicitis, and in seven subsequent enteric fistulae and/or obstruction involving the cecum developed. None of the appendices were acutely inflamed. During the same period, a total of 125 children with Crohn's disease underwent medical or surgical care, and in none did acute appendicitis develop. Of the 66 patients under 22 years old who required intestinal resection, 60 had removal of the cecum. In a child with ileal Crohn's disease, rarely should a normal appendix be removed because of the high likelihood of complications and the low incidence of subsequent appendicitis.

Adolescent↗
PubMed1996

Atypical PFAPA syndrome (periodic fever, aphthous stomatitis, pharyngitis, adenitis) in a young girl with Fanconi anemia.

PURPOSE: To describe a case of atypical, severe, periodic fever, aphthous stomatitis, pharyngitis and adenitis syndrome (PFAPA syndrome) in a patient with Fanconi anemia. Important aspects about the PFAPA syndrome and Fanconi anemia are reviewed. PATIENTS AND METHODS: An 8-year-old girl with Fanconi anemia was noted to have a pattern of periodic fever, stomatitis, and pharyngitis consistent with the diagnosis of PFAPA syndrome, a generally benign disorder. After prednisone treatment for the syndrome, life-threatening intestinal ulceration and perforation developed, which was successfully treated. CONCLUSION: In patients with underlying hematologic disease such as Fanconi anemia, PFAPA syndrome may be associated with severe clinical problems in contrast to otherwise normal children with the disorder.

Cecal Diseases↗
PubMed1972

Helminthic pseudotumours of the bowel: thirty-four cases of helminthoma.

Human infestation with nematode worms of the superfamily Strongyloidea has been recorded from time to time to give rise to serious surgical complications. Worms of the genus Oesophagostomum are most frequently responsible. These are common parasites of ruminants, monkeys, and apes in which their histotropic phase is confined to the bowel wall and sometimes results in multiple inflammatory nodules. Man is an accidental host and it seems an abnormal one. The worm fails to return to the bowel lumen, migrates further and persists in the tissues. The commonest manifestation is a solitary tumour-like inflammatory mass or abscess (;helminthoma') in the ileocaecal region. The ileum, transverse and sigmoid colons are affected less commonly and the lesions are occasionally multiple. Patients may also present with abscesses of the abdominal wall. The clinical diagnosis is difficult, even at laparotomy. Carcinoma, appendicitis, ileocaecal tuberculosis are frequently simulated and unnecessary radical surgery is often the result, particularly in expatriate Europeans. In this communication 34 cases from Uganda are reviewed with emphasis on histopathology as responsibility for the correct diagnosis is likely to fall on pathologists. Three characteristic appearances are described and related to phases in the natural history of the disease. Current knowledge on parasitology is reviewed. The disease affects Africans as well as Europeans and it is anticipated that cases will be seen in those returning from the tropics.

Abdominal Muscles↗
PubMed2001

[Endometriosis of the appendix vermiformis].

11 cases of the endometriosis of the appendix vermiformis were analyzed among women in age between 19-57 years. We observed that endometriosis of appendix were accompanied by advanced stages of the ovarian or peritoneum endometriosis in 9 cases. Diagnosis of endometriosis of the appendix is almost impossible before operation because it often could be covered by other genital organs diseases such like: uterine fibromas, ectopic pregnancy, PID. The clinical symptoms of appendicitis observed before an operation seldom find confirmation in results of additional laboratory tests.

Adult↗