Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “APPENDICITIS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 829 records · Page 46Linked to original sources
PubMed2002

Measles-related appendicitis.

Owing to the characteristic Warthin-Finkeldey giant cells found in hyperplastic mucosa-associated lymphoid tissue, it has been emphasized that pathologists can make a diagnosis of measles from appendectomy specimens even in the prodromal stage before diagnostic rashes develop. However, to date, those reported cases of measles-related appendicitis have dealt with the histologic features of the prodromal stage and we found no reports in the English literature describing the histopathologic findings of appendicitis during the full-blown stage of measles. Here, we describe 2 cases of measles-related appendicitis that show contrasting histologic features according to stage, one discovered during the prodromal stage and the other occurring during the full-blown stage. This report describes heretofore unreported histopathologic findings of measles-related appendicitis observed during the full-blown stage of the infection and highlights histopathologic changes caused by replication of the virus in different compartments of the same organ during the course of infection.

Appendicitis↗
PubMed2003

Nitrergic hyperinnervation in appendicitis and in appendices histologically classified as normal.

CONTEXT: The pathogenesis of appendicitis remains poorly understood. Despite new diagnostic techniques, appendices removed from patients with suspected appendicitis often appear histologically normal on conventional examination. There is increasing evidence of involvement of the enteric nervous system in immune regulation and in inflammatory responses in the gastrointestinal system. OBJECTIVE: To investigate the nitrergic innervation of (a) acutely inflamed appendices, (b) appendices classified as histologically normal from patients with a clinical diagnosis of appendicitis, and (c) normal control appendix specimens, using the whole-mount preparation technique. PATIENTS AND DESIGN: Full-thickness specimens were collected from 28 acutely inflamed appendices (age range, 3.2-13.4 years), 31 histologically normal appendices removed from patients (age range, 5.7-13.6 years) with suspected appendicitis, and 23 histologically normal appendices from patients (age range, newborn to 12.1 years) undergoing elective abdominal surgery (controls). Whole-mount preparation using nicotinamide adenine dinucleotide phosphate (NADPH) diaphorase histochemistry and neuronal nitric oxide synthase immunohistochemistry were performed. The density of myenteric plexus was measured with a computerized analysis system. RESULTS: The density of myenteric plexus in normal appendix specimens was similar to that of large bowel from the newborn period up to 3 years of age; this density decreased significantly thereafter. The myenteric plexus of normal appendix specimens from patients older than 4 years demonstrated smaller ganglia connected by thin nerve bundles, compared to larger ganglia and nerve bundles in large bowel. Significant neuronal hypertrophy was found in 55% of acutely inflamed and 41% of histologically classified normal appendix specimens. The myenteric plexus of these appendix specimens had even thicker nerve bundles connecting an increased number of ganglion cells. CONCLUSIONS: Differences in the architecture of the myenteric plexus in patients older than 3 years suggest an altered function and motility of appendix in the early years of life. The significant increase in neuronal components of the myenteric plexus in a high proportion of acutely inflamed and histologically normal appendix specimens is unlikely to have developed during a single acute inflammatory episode. This suggests an underlying chronic abnormality as a secondary response to chronic luminal obstruction or repeated inflammatory episodes in the histologically normal appendix.

Adolescent↗
PubMed2004

Systematic review: computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents.

BACKGROUND: Although clinicians commonly use computed tomography or ultrasonography to diagnose acute appendicitis, the accuracy of these imaging tests remains unclear. PURPOSE: To review the diagnostic accuracy of computed tomography and ultrasonography in adults and adolescents with suspected acute appendicitis. DATA SOURCES: The authors used MEDLINE, EMBASE, bibliographies, review articles, textbooks, and expert opinion to retrieve English- and non-English-language articles published from 1966 to December 2003. STUDY SELECTION: The authors included prospective studies evaluating computed tomography or ultrasonography followed by surgical confirmation or clinical follow-up in patients at least 14 years of age with suspected appendicitis. DATA EXTRACTION: One assessor (for non-English-language studies) or 2 assessors (for English-language studies) independently reviewed each article to abstract relevant study characteristics and results. DATA SYNTHESIS: Twelve computed tomography studies and 14 ultrasonography studies met inclusion criteria. Computed tomography had an overall sensitivity of 0.94 (95% CI, 0.91 to 0.95), a specificity of 0.95 (CI, 0.93 to 0.96), a positive likelihood ratio of 13.3 (CI, 9.9 to 17.9), and a negative likelihood ratio of 0.09 (CI, 0.07 to 0.12). Ultrasonography had an overall sensitivity of 0.86 (CI, 0.83 to 0.88), a specificity of 0.81 (CI, 0.78 to 0.84), a positive likelihood ratio of 5.8 (CI, 3.5 to 9.5), and a negative likelihood ratio of 0.19 (CI, 0.13 to 0.27). Verification bias and inappropriate blinding of reference standards were noted in all of the included studies. LIMITATIONS: The summary assessment of the diagnostic accuracy for both tests was limited by the small number of studies, heterogeneity among study samples, and poor methodologic quality in the original studies. CONCLUSIONS: Computed tomography is probably more accurate than ultrasonography for diagnosing appendicitis in adults and adolescents. Prospective studies that apply gold standard diagnostic testing to all study participants would more reliably estimate the true diagnostic accuracy of these tests.

Acute Disease↗
PubMed1991

The gas-containing appendix: potential sonographic pitfall in the diagnosis of acute appendicitis.

The presence of gas within the appendix on plain abdominal radiographs is nonspecific and may or may not be associated with acute appendicitis. This finding, however, has not previously been reported with graded compression sonography of the right lower quadrant. Gas within the appendix was identified in four of 154 patients with a visualized appendix. All four patients had surgically confirmed acute appendicitis. Diagnostic difficulties were encountered in three of these four patients. In two patients, the findings were misinterpreted as an extraluminal gas-forming periappendiceal abscess. In an additional patient, the gas-filled appendix was initially mistaken for a segment of normal terminal ileum. The gas-filled appendix is a potential pitfall in the sonographic diagnosis of acute appendicitis. However, if other diagnostic criteria are met, gas within the appendix should not preclude establishing a sonographic diagnosis of appendicitis.

Acute Disease↗
PubMed2000

Ultrasonography improves diagnostic accuracy of acute appendicitis and provides cost savings to hospitals in Japan.

A cost analysis based on changes in patient care was used to evaluate the utility of abdominal ultrasonography in both the clinical management of patients clinically suspected of having acute appendicitis and in reducing expenditure of hospital resources. Among the 200 patients suspected of having acute appendicitis, 57 actually had acute appendicitis. Interpretation of appendiceal ultrasonographic results was 98.5% accurate. The ultrasonographic result led to changes in the treatment of 103 patients. Moreover, ultrasonography led to the prevention of unnecessary appendectomy in 25 patients, providing a savings to the hospital of about Yen 8,013,450 ($65,150), and prevented unnecessary hospital admission for 78 patient-days, thus saving the hospital approximately Yen 1,199,250 ($9750). The cost of performing the 200 ultrasonographic examinations was about Yen 1,096,176 ($8912), and thus the overall savings to the hospital was approximately Yen 40,590 ($330) per patient. Ultrasonography performed in patients with suspected acute appendicitis improves patient diagnostic accuracy, thus leading to more appropriate selection of patient treatment and reduced hospital expenditure.

Acute Disease↗
PubMed1998

Serologic examinations in acute appendicitis.

Authors studied the formation of endotoxic antibody level in healthy adults and in patients with appendicitis with a technique (indirect haemagglutination) not used till now. They found the antibody level against endotoxin to be increased in 91% of their patients in the postoperative period. Decrease in the antibody level against endotoxin was observed in two patients with gangrenous appendicitis and two patients with perforated appendicitis. Summarizing their results, authors consider mixed (aerobic, anaerobic) infection to be of decisive importance in the development of acute appendicitis, contributing to the weakened immune response of the host.

Acute Disease↗
PubMed1999

Markers of severe appendicitis.

Appendicitis is a common surgical disease that often presents with vague, inconclusive symptoms. Despite the development of technologically advanced diagnostic modalities, perforation has usually occurred before the surgeon sees the patient. Morbidity, length of stay, and hospital costs associated with appendiceal perforation have not changed markedly in the past 50 years. To evaluate prognostic markers for severe appendicitis, we reviewed 18 years' worth of records of patients with appendicitis who were admitted to St. Elizabeth's Medical Center of Boston and found that the combination of history and physical examination has withstood the test of time. We found that advancing age, duration of symptoms for 36 or more hours, white blood cell count, shift left in white blood cell count, and fever were significantly related to severe appendicitis. An abnormal plain film was a marker if fever coexisted.

Adolescent↗
PubMed1999

Recognizing the various presentations of appendicitis.

Appendicitis is one of the most common causes of acute abdominal pain in the industrialized world. Appendicitis must be considered in the differential diagnosis of any patient presenting with abdominal pain. Workup may include blood tests, abdominal radiographs, abdominal ultrasound, and focused appendix computed tomography. Unfortunately, none of these provides definitive results. Although several signs and symptoms are associated with appendicitis, their inconsistent presentation, especially among the young and the elderly, can lead to an erroneous diagnosis. The classic sequence of symptoms includes the onset of vague epigastric or periumbilical pain; associated nausea, anorexia, or unsustained vomiting; and pain migrating to the right lower quadrant. In uncomplicated cases, the treatment of appendicitis is appendectomy. However, less definitive presentations merit further diagnostic testing and close follow-up.

Abdominal Pain↗
PubMed1999

[Problem of acute appendicitis].

A combination of various kinds of allergic reactions of both the specific immediate type and of the local reaction of hypersensitivity of the slow type plays its role in the development of acute appendicitis. As a rule, the process is developing by the mixed variant with the involvement of the autoimmune component. Clinico-laparoscopic verification of the character of alterations in the vermiform process allows differentiation of primary (true) appendicitis and secondary (false) appendicitis. The present-day conception of pathogenesis of acute appendicitis determines the necessity of a differentiated approach when choosing the strategy of treatment.

Acute Disease↗
PubMed2000

Association between Streptococcus milleri and abscess formation after appendicitis.

Abscesses after appendicitis occur in some patients despite timely surgery and antibiotics. The Streptococcus milleri group of bacteria are commonly associated with gastrointestinal abscesses. This study investigated the relationship between S. milleri and abscess formation after appendicectomy a total of 301 patients (172 males, 129 females, median age 22 years) with appendicitis were identified retrospectively from the hospital PAS computer system who had an appendicectomy and peritoneal bacteriology swabs taken. All but one patient had prophylactic antibiotics. Patients were divided into three groups according to peritoneal bacteriology: group 1 (S. milleri +/- mixed faecal organisms, n = 61); group 2 (mixed faecal organisms, n = 126); and group 3 (sterile, n = 114). The chi squared and Student t-tests were used for statistical analysis. Thirteen (21%) of group 1 patients developed an intra-abdominal abscess compared with 4 (3%) in group 2 and 2 (1.7%) in group 3 (P < 0.0001). There was no difference in the prevalence of gangrenous or perforated appendicitis between groups 1 and 2 (56% versus 52%) but these worse forms of appendicitis were less common in group 3 (22%). Group 1 patients had a mean total hospital stay of 10 days versus 6 days for group 2 and 4 days for group 3 (P < 0.001). S. milleri was associated with a 7-fold increase in abscess formation after appendicectomy and a longer hospital stay. Antibiotic prophylaxis did not prevent this complication.

Abdominal Abscess↗
PubMed2000

Appendicitis due to bird shot ingestion: a case study.

Appendicitis due to foreign bodies is rare. Foreign bodies leading to appendicitis or perforation are usually sharp, pointed objects. Lead shot can become lodged in the appendix. Few prior cases have shown a causal relationship between the presence of pellets in the appendix and acute appendicitis. We present the case of a 9-year-old white boy who presented to the emergency room with a 36-hour history of right lower quadrant pain over McBurney's point accompanied by anorexia. The patient's history was significant for consumption of pheasant meat 4 days before onset of symptoms. The pheasant had been shot with a shotgun. X-ray of the child's abdomen revealed a metallic foreign body in the right lower quadrant. Appendectomy was performed. Bird shot was found obstructing the lumen of the grossly inflamed appendix. Pathology was consistent with acute appendicitis. This case is presented as an interesting consequence of bird shot ingestion.

Acute Disease↗
PubMed2000

[Clinical and histopathologic picture of acute appendicitis in children].

A retrospective study of the clinical and histopathological picture of acute appendicitis in children confirms agreement of the evaluation of the finding on the appendix made by the surgeon and pathologist in 72.2% and disagreement in 27.8%. The finding is overrated in 11.3% and underrated in 16.5%. Agreement is closest in phlegmonous appendicitis (88.1%) and lowest in gangrenous appendicitis (54.9%). The most frequently overrated finding is in catarrhal appendicitis (20.7%). The number of missed appendectomies is from the pathologist's point of view significantly lower (21.8%) than from the surgeon's point of view (34.7%). This indicates obviously that it is not possible to make an accurate macroscopic assessment of the progress of appendiceal inflammation. The number of "negative" appendectomies is according to the surgeon 15.8% and according to the pathologist 16.8%, i.e. almost equal.

Acute Disease↗
PubMed2000

[Detection of acute appendicitis using ultrasonography].

1318 patients with a clinically equivocal diagnosis of appendicitis were evaluated using graded compression sonography. Sonographic (US) examination could able be performed in 1199 patients. Appendicitis was diagnosed if the appendiceal maximal mural thickness was 3 mm or more, or the appendices presented with luminal dilatation due to a large appendicolith or non-expressible fluid. In patients with verified appendicitis (n = 176) sonographic findings on a visualized appendix were correlated with surgical and histopathological findings. In patients who did not have surgery the reference standard was the clinical consensus based follow-up. A pathological appendix was detected in 165 cases of 176 surgically verified ones. The sensitivity of US in detecting appendicitis was 93.7%, the specificity 95.5% and the accuracy 95.2%.

Acute Disease↗
PubMed2000

[Validity of clinical tests to confirm or to exclude the diagnosis of acute appendicitis].

AIMS: The clinical usefulness of the diagnostic tests (usually employed to diagnose an acute appendicitis in a group of patients in which this diagnosis is clinically highly suspected). PATIENTS AND METHODS: A cross sectional study was designed. The sample (n = 116) was randomly selected by term and specific days from the patients attending the Emergency Service at Elda General Hospital in a year period. The method used was is a validity study making 2 x 2 tables. We have cross matched the habitual routine tests with: a) the clinical outcome if the patient was not surgically treated, or b) the result of the biopsy for those operated. Being these the gold standard. The validity indexes studied were sensibility (S), specificity (E). The 95% confidence index of the CF were calculated. RESULTS: Acute appendicitis clinical suspicion was confirmed in 29.4% (IC 95%: 20.8-38). The best validity indexes were: a) kind of pain (S = 81.3; E = 33.8); b) peritoneal inflammatory signs (S = 78.5%, E = 45.9%); c) presence of leucocytosis in blood exam (S = 100%, E = 54.5%), and d) a greater difference in axillary-rectum temperature (S = 13.6%, E = 96.6%). Only leucocytosis reached 0 for PP- and CP-; the blood leucocytosis (PP+ = 47.8%, CP+ = 2.20) and the axillary-rectum temperature (PP+ = 60%, CP+ = 4.0) dissociation were the test with most valuable indexes. CONCLUSIONS: Clinical suspicion of acute appendicitis in a group of patients having a great probability of suffering it over estimates this diagnosis. The symptoms or signs routinely used in the diagnosis did not reach high validity indexes in these patients. They are a poor help to stress or reject the diagnosis of acute appendicitis. To be careful is the main tool the doctors have. Blood leucocytosis is the test that has the best agreement indexes of clinical usefulness and it has the best countence with the gold standard.

Acute Disease↗
PubMed2000

[Abdominopelvic ultrasonography in suspected acute appendicitis: prospective study in adults].

STUDY AIM: The aim of this prospective descriptive study was to evaluate the accuracy of abdomino-pelvic ultrasonography in suspected acute appendicitis in adults. PATIENTS AND METHODS: From March to July 1998, 100 consecutive patients, 63 women, 37 men (mean age: 25 years), after examination by a visceral surgeon for suspected acute appendicitis, had an abdominal ultrasonography (US) examination with high frequency transducer (7.5 to 9 MHz). The US examination concerned appendice, periappendicular tissues and neighbouring organs. The US data were correlated with the histopathologic findings in operated on patients, and with the clinical and biological follow up in non operated patients. RESULTS: Fourty-seven patients had acute appendicitis; 53 were operated on and 47 non operated. Analysis of US data revealed sensitivity 91.5%, specificity 94.3%, positive predictive value 93.5%, negative predictive value 94.3%, accuracy 93%; 75% of the other diagnosis were found by US. CONCLUSION: Systematic abdominal ultrasonography in suspected acute appendicitis is recommended in adults.

Abdominal Pain↗
PubMedDate not supplied

Are antibiotics necessary in nonperforated appendicitis in children? A double blind randomized controlled trial.

BACKGROUND: The use of antibiotics in uncomplicated appendicitis in children, remains the area of controversy. The aim of the study was to assess the necessity of antibiotic administration in nonperforated appendicitis in children. MATERIAL AND METHODS: The design of the study was a double blind randomized controlled trial, with a follow-up of 4 to 20 months. SETTING: Surgical Department in a University Pediatric Hospital. PATIENTS: One hundred and eighty seven out of 249 children subjected to emergency appendectomies met the inclusion criteria, with 35 eligible but not included in the study. The remaining 152 patients were randomized; 41 had complicated appendicitis, 3 other diagnosis, 108 were analyzed within 3 study groups: 1 (n = 31) no antibiotic, 2 (n = 41) one dose, 3 (n = 36) 5-day course. Open appendectomy was a surgical procedure and Ceftriaxone 1.0 g i.v. was administered. Investigated parameters were: body temperature, WBC, bowel sounds, wound healing, recovery and morbidity. RESULTS: Valid outcome data were available for 90 of 108 randomized patients. Protocols of 18 children due to fever > 39 degrees C, upper airway infection or allergy were disclosed. In the remaining 90 children, there were no differences in WBC and oral feeding between groups 1 (n = 24), 2 (n = 35) and 3 (n = 31). Group 1 and 2 had a higher mean temperature on day 1 post-op, without any clinical significance. A higher mean temperature was noted on day 5 post-op in group 1, due to wound infection in one patient. There were no intraabdominal abscesses. The only other complications were 2 adhesion small bowel obstructions (in groups 1 and 2 each). CONCLUSION: Routine use of antibiotics in nonperforated appendicitis in children is not necessary.

Appendicitis↗
PubMed1998

[Diagnosis and treatment of tuberculous appendicitis].

OBJECTIVE: To study the diagnosis and treatment of tuberculous appendicitis. METHOD: 12 cases (0.26%) with tuberculous appendicitis diagnosed by histopathological examination selected from 4,652 patients during 1968 to 1997 were analysed retrospectively. RESULT: The mean age of the patients with tuberculous appendicitis was 35 years, the disease occurred 2 times more frequently in women than in men and was usually secondary to tuberculosis elsewhere in the body (7 cases). There were 7 cases with proliferative lesions, 3 cases with ulcerative lesions and 2 cases with two kinds of lesions. 12 cases were all misdiagnosed preoperatively, 2 cases were diagnosed definitely in the operation. In 12 cases, 7 cases underwent simple appendectomy, 2 cases partial celectomy and 1 case right hemicolectomy, appendectomy and resection of regional lymph nodes were performed on 2 cases, treatment of anti-TB was given postoperatively to 9 patients. All the patients recovered without complications. CONCLUSION: It's hard to get definite diagnosis of tuberculous appendicitis before operation because of low incidence and non-specific clinical manifestations, so careful observation in the operation and routine histopathological examination must be emphasized. Early operation and postoperative treatment of anti-TB should be advocated in order to prevent from complications.

Adult↗
PubMed2001

Comparison of three databases with a decision tree approach in the medical field of acute appendicitis.

Decision trees have been successfully used for years in many medical decision making applications. Transparent representation of acquired knowledge and fast algorithms made decision trees one of the most often used symbolic machine learning approaches. This paper concentrates on the problem of separating acute appendicitis, which is a special problem of acute abdominal pain from other diseases that cause acute abdominal pain by use of an decision tree approach. Early and accurate diagnosing of acute appendicitis is still a difficult and challenging problem in everyday clinical routine. An important factor in the error rate is poor discrimination between acute appendicitis and other diseases that cause acute abdominal pain. This error rate is still high, despite considerable improvements in history-taking and clinical examination, computer-aided decision-support and special investigation, such as ultrasound. We investigated three different large databases with cases of acute abdominal pain to complete this task as successful as possible. The results show that the size of the database does not necessary directly influence the success of the decision tree built on it. Surprisingly we got the best results from the decision trees built on the smallest and the biggest database, where the database with medium size (relative to the other two) was not so successful. Despite that we were able to produce decision tree classifiers that were capable of producing correct decisions on test data sets with accuracy up to 84%, sensitivity to acute appendicitis up to 90%, and specificity up to 80% on the same test set.

Abdomen, Acute↗