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PubMed2001

Ileocecectomy is definitive treatment for advanced appendicitis.

Although appendectomy is the most commonly performed emergency operation septic complications of appendectomy remain a major source of morbidity. Historically, advanced appendicitis has been treated by appendectomy with cecostomy and/or drainage tubes. Our objective was to evaluate the use of ileocecal resection for the immediate treatment of advanced appendicitis. We examined the cases of all patients undergoing ileocecal resection for appendicitis from August 1989 through April 2000. There were 92 patients (60 male and 32 female) with a median age of 34 (range 6-71). Abdominal pain was present in 98 per cent of patients with duration of 5.1+/-0.6 days. Right lower quadrant tenderness was present in 91 per cent with accompanying right lower quadrant mass in 30 per cent. Temperature on admission was 38.0+/-0.1 degrees C with a white blood cell count of 15,300+/-500. Preoperative radiological studies included abdominal X-rays (33), contrast enemas (two), CT scans (41), and abdominal ultrasound (17); these studies yielded a correct preoperative diagnosis in 89 per cent. Previous appendectomy had been performed in six patients with failed percutaneous drainage of intra-abdominal abscesses in five. There were 94 cecal resections performed in 92 patients. The extent of surgical resection varied between patients and ranged from partial cecectomy (34) to ileocecectomy (55) to ileocecectomy with diverting ileostomy (five). Intra-abdominal abscesses were present at operation in 46 cases (50%), and drains were placed in 38 (41%). Skin incisions were packed open in most cases (65); there was skin closure in 27. There was no mortality encountered in this period. There were 25 complications in 23 patients (25%). Complications included postoperative abscess (10; 11%), wound infection (10; 11%), partial small bowel obstruction (two) and pulmonary embolus (one). Reoperation was required in seven patients and CT-guided percutaneous drainage in five patients. Anastomic leaks occurred in two cases of partial cecectomy and required conversion to ileocecectomy. Mean hospital stay was 10.5+/-1.0 days with adjusted hospital costs of $31,689+/-3018. We conclude that definitive treatment of advanced appendicitis can be performed by resection of the involved areas of the ileocecum. This can be accomplished with a primary anastomosis obviating the need for ileostomy and secondary operation. This aggressive surgical approach may reduce infectious complications and reduce hospital costs.

Adolescent↗
PubMed1975

[Bacteroides and appendicitis (author's transl)].

Bacteroides fragilis is frequently recovered from cases of appendicitis with perforation and from infections developing secondary to appendicitis. In order to assess the part played by B. fragilis in the aetiology of appendicitis, quantitative aerobic and anaerobic culture studies of the contents of 49 inflammated appendices were performed. Anaerobic gram-negative non-sporing rods were cultivated from 43 appendices in the range 10(3)-10(9)/g. A total of 1,473 isolates was differentiated by biochemical methods, and 1,374 cultures were found to belong to the saccharolytic species of the genus Bacteroides (B. fragilis, B. thetaiotaomicron, B. vulgatus, B. distasonis etc.). B fragilis was detected in 31 appendices; the species predominated in 18 samples. B theraiotamicron, recovered from 27 samples, was prevalent in 4 appendices. In one sample, B. fragilis and B. thetaiotaomicron outnumbered the other appendicular bacterial. B. vulgatus was cultivated from 12 appendices, but did once constitute the prevalent group. It has been previously shown that B. vulgatus (43% of intestinal isolates) and B. thetaiomicron predominate in the normal narge bowel flora. On the other hand, approximately 80% of pyrogenic Bacteroides strains belong to B. fragilis, B. thetaiotaomicron accounting for 19% and B. vulgatus being virtually absent. From these striking differences in species distribution the conclusion was drawn that B. fragilis possesses the highest virulence for man. Species distribution within the 1,374 appendicular isolates of saccharolytic Bacteroides (percentages of 62, 19 and 4.3 for B. fragilis, B. thetaiotaomicron, and B. vulgatus, respectively) was very similar to that encountered in clinical specimens. From the results obtained it becomes evident that pyrogenic Bacteroides, in particular B. fragilis, plays an important role in nearly 50% of cases of appendicitis.

Adolescent↗
PubMed2001

Acute appendicitis during pregnancy.

Acute appendicitis is the most common surgical emergency occurring during pregnancy. To determine possible methods for improving diagnostic and management accuracy, a retrospective review was conducted of 23 pregnant patients who underwent laparotomy with a preoperative diagnosis of acute appendicitis. Gestational stage at presentation included the first trimester in 2 patients, the second trimester in 6 patients and the third trimester in 15 patients. Eighteen patients (78.26%) had pathologically proven acute appendicitis. Perforation occurred in 2 patients. Postoperative fetal complications included one intrauterine death (4.3%) and three premature births. There was no maternal deaths and morbidity was limited to atelectasis and wound infection in 4 patients. Gestational physiologic changes make difficult the diagnosis of acute appendicitis. Prompt surgical intervention prevent maternal complications and foetal loss.

Acute Disease↗
PubMedDate not supplied

[CT diagnosis of appendicitis. Report of a case and review of the literature].

Diagnosis of appendicitis has been historically supported in clinical findings. Imaging studies such as US and CT have been used mainly in cases where clinical diagnosis of appendicitis is uncertain. CT techniques have ranged between full abdominopelvic examinations after administration of oral and intravenous contrast media and unhenhanced scanning limited to the right bowel quadrant. We present the case report of an 18-year-old male patient with recurrent abdominal pain, with clinical suspicion of appendicitis; an abdominopelvic CT examination was performed that showed a suggestive image of appendicitis. This diagnosis was confirmed with the results of surgery and pathologic examination of the appendix.

Adolescent↗
PubMed2002

Surgical wound infection post surgery in perforated appendicitis in children.

OBJECTIVE: To compare the rate of wound infection of perforated appendicitis in children between primary wound closure and delayed primary wound closure. STUDY DESIGN: Prospective clinical trial. MATERIAL AND METHOD: Children diagnosed with perforated appendicitis between January 1999 and December 1999 received gentamicin and metronidazole pre- and post-operatively. Intra-abdominal fluid cultured and tested for sensitivity. The rate of wound infection, skin closure for patients were compared between primary wound closure and delayed primary wound closure. RESULTS: Among 198 children diagnosed with appendicitis, 44 cases were perforated (22.22%). Of these 44 cases, 8 cases had wound infection (18.18%), 2 of 8 Infected cases (9.1%) were in the primary wound closure group, 6 of 8 (27.3%) were in the delayed primary wound closure group. CONCLUSION: The rate of wound infection from perforated appendicitis in children is still high. Primary wound closure has a significantly lower rate of wound infection compared with delayed primary wound closure.

Adolescent↗
PubMed1975

[Complications of acute appendicitis in children].

Among 976 children with acute appendicitis 966 were operated upon, 169 of them (17.4%)-for common appendicitis, 401 (41.2%)-for phlegmonous appendicitis, 396 (40.4%)-for gangrenous appendicitis; 10 children were subjected to surgery due to the presence of appendicular infiltration. Preoperatively, in 137 (13.7%) patients peritonitis was observed: local-in 90, diffuse and progressive-in 47. There was noted a dependence of complications on the terms of the disease and patients' stay at the hospital prior to surgery. Following the operation in 98 (10.1%) patients different complications were observed: the postoperative wound suppuration (61), inflammatory processes in the abdomen (infiltrations, abscesses-in 33), intestinal obstruction (2), intra-abdominal hemorrhage (1), enteric fistula (1). There were no lethal issues. The preoperative complications were conditioned by gravity and advanced forms of the principal lesion, technical drawbacks in operation and treatment of purulent peritonitis.

Acute Disease↗
PubMed2002

Prospective evaluation of modified Alvarado score for diagnosis of acute appendicitis.

Modified Alvarado scoring system was evaluated regarding its usefulness in the early diagnosis of acute appendicitis and in reduction of the incidence of negative appendicectomies. One hundred and ten patients with a provisional diagnosis of acute appendicitis were studied prospectively at R G Kar Medical College and Hospital, Calcutta over a period of 10 months. High score was found to be a dependable aid both in the pre-operative diagnosis of acute appendicitis and in the reduction of negative appendicectomies in men and children but the same was not true for women who had a high false positive rate for acute appendicitis.

Acute Disease↗
PubMed2003

[Urologic presentation of acute appendicitis: a frequent cause of delayed diagnosis, including in HIV infected patients].

Acute appendicitis rarely presents in the form or urinary tract symptoms. Atypical forms of acute appendicitis occur more frequently in subjects infected by the human immunodeficiency virus (HIV). The authors report a case of acute appendicitis in an HIV-infected subject mimicking acute pyelonephritis secondary to obstruction. Atypical forms of acute appendicitis must be diagnosed and treated as early as possible. Computed tomography plays an essential role in the diagnostic assessment of abdominal and lumbar symptoms in HIV-infected patients.

Adult↗
PubMedDate not supplied

Plasma D-lactate levels in diagnosis of appendicitis.

We investigated the possible use of D-lactate as a predictor in the diagnosis of appendicitis. C-reactive protein level (CRP) and leukocyte counts were also evaluated. Venous blood D-lactate, CRP, and leukocyte counts were measured preoperatively in 53 patients undergoing surgery for appendicitis, as well as in 20 healthy subjects. Levels of all three parameters in the surgical patients were significantly higher than in the control group (p <.05). Previous studies have shown that venous D-lactate is more specific to the intestine than CPR or leukocyte count. Based on our data, venous D-lactate, which had the lowest false-negative rate among these laboratory parameters, may be a useful diagnostic marker for appendicitis. None of these parameters were helpful in identifying the type of the appendicitis.

Acute Disease↗
PubMed1956

Acute perforated appendicitis in childhood; analysis of management, including the use of hypothermia.

From an analysis of a recent series of 99 cases of acute perforated appendicitis in childhood several conclusions appeared valid.1. The majority of infants and young children with acute perforated appendicitis do not exhibit the signs of localization of peritoneal irritation so characteristically seen in older children and adults. Hence if a history compatible with acute perforated appendicitis is present and there is evidence of peritoneal irritation on repeated examinations, patients of this age group may be assumed to have the disease and should be prepared and operated upon with minimal delay. Early operation after a maximum of several hours of preparation with parenteral hydration, nasogastric suction and antibiotics is the treatment of choice.2. In nine patients in the present series with temperature and rapid pulse that did not fall to safe levels with the usual preoperative preparation, mild hypothermia appeared to reduce the risk of anesthesia and operation.3. The use of intraperitoneal drains in children with acute perforated appendicitis is associated with a definite reduction in the incidence of postoperative intraperitoneal abscesses and with a probable reduction in the number of serious wound infections.

Abdominal Abscess↗
PubMed1992

[Antibacterial and detoxification therapy in acute appendicitis].

An analysis of clinical effectiveness of antibacterial therapy, photomodification of autoblood, hemosorption and their combinations was made in 395 patients with acute appendicitis. It was established that no antibacterial and desintoxicating therapy is required in catarrhal appendicitis. The prophylactic application of photomodification of autoblood is thought to be most expedient for phlegmonous appendicitis at the postoperative period, a combination of antibacterial therapy and photomodified autoblood--for gangrenous appendicitis, a combination of antibacterial therapy, photomodification of autoblood and hemosorption--for appendicular diffuse suppurative peritonitis.

Acute Disease↗
PubMed1992

[Utility of high-resonance ultrasonography in the diagnosis of acute appendicitis].

The clinical records and the ultrasound findings of 48 patients studied because of a presumptive diagnosis of acute appendicitis in a one-year period were reviewed. Ultrasound examination was performed using graded compression and high resolution probes when acute appendicitis was suspected and the clinical history or physical examination was unclear. The ultrasound findings were correlated with the clinical course or surgical and pathological findings. This procedure was useful in the diagnosis of acute appendicitis, with 84.6% sensibility and 95.5% specificity. Predictive value for positive results was 95.7% and 84% for negative results. These figures agree with results previously communicated in the literature. It is concluded that high resolution ultrasonography is useful in the differential diagnosis of atypical acute appendicitis.

Abdomen, Acute↗
PubMed1992

Accurate diagnosis of acute appendicitis: a retrospective and prospective analysis of 686 patients.

OBJECTIVE: To formulate a score system that would make the preoperative diagnosis of acute appendicitis more accurate. DESIGN: Retrospective then prospective study. SETTING: City University Hospital. SUBJECTS: 536 patients who had their appendixes removed between 1981 and 1986 (retrospective study), and 150 consecutive patients admitted with a presumptive diagnosis of appendicitis between 1987 and 1988 (prospective study). MAIN OUTCOME MEASURES: Correlation between the histological diagnosis of appendicitis and variables representing history, clinical examination, and laboratory investigations. RESULTS: The rate of histologically proven negative appendicectomies in the retrospective series was 40% and in the prospective series 33%. The variables that were thought to be predictive were: male sex, white cell count of greater than 11 x 10(9)/l, history of less than 24 hours with no previous complaints, rebound tenderness, shift of pain from the epigastrium, and localised guarding, but all criteria had low specificities and sensitivities when applied prospectively, and combining the scores did not improve them. CONCLUSION: The accurate diagnosis of appendicitis depends largely on the experience of the surgeon and is not improved by the application of a score system that includes the above variables.

Acute Disease↗
PubMed1992

[Laparoscopy in the diagnosis of acute appendicitis in pregnant women].

Diagnostic laparoscopy in 96 pregnant women with suspected acute appendicitis revealed inflammation of the vermiform process only in two (2.1%) of them. In 81 cases acute surgical diseases of the abdominal organs were not found, extrauterine pregnancy was revealed in 9 and other diseases of the abdominal organs were detected in 4 cases. The threat of abortion was mistaken for acute appendicitis most frequently. Unjustified operation in such cases intensifies still more the signs of the threat of abortion. Analysis allows the assertion that the laparoscopic method should be decisive in the examination of pregnant women with a doubtful clinical diagnosis in suspected acute appendicitis. Laparoscopy is indicated when the reserves of the generally accepted clinical methods and noninvasive instrumental examination do not allow the diagnosis of acute appendicitis to be established or excluded; it is also recommended in establishing the exact diagnosis and determining the approach and volume of an operative intervention when there is a clinical picture of an acute surgical disease of the abdominal cavity.

Acute Disease↗
PubMed1976

[Clinical aspects and morphology of acute catarrhal appendicitis in children].

The authors compared the clinical and pathoanatomical diagnoses in 1399 patients, operated upon for catarrhal appendicitis. In 123 children the clinical diagnosis was revised as a result of further observations following surgery. In 1276 patients the clinical diagnosis of catarrhal appendicitis was remained. An exploration of the appendicular process in these patients supported the diagnosis in 748 cases (58.6%). In 16 cases chronic appendicitis was recognized, in 111 -- phlegmonous and gangrenous appendicitis (8.7%).

Acute Disease↗
PubMed2003

[Ultrasound in the diagnosis and differential diagnosis of acute appendicitis in childhood].

UNLABELLED: Acute appendicitis represents a leading cause of an abdominal pain in children which requires urgent surgical treatment. AIM OF THE STUDY: To investigate into value of ultrasound (US) in diagnostics and differential-diagnostics of acute appendicitis in children. PATIENTS AND METHODS: A prospective study during a two-year period, was conducted to analyse abdominal US findings in 95 patients, 3-16 years of age who had acute abdominal pain. In all patients we were checking for clinical symptoms of an acute abdomen: pain, nausea, vomiting, fever, frequent urination, diarrhea, duration of symptoms and count of leukocytes. US findings were compared with pathohistological results We have used Toshiba Sonolayer SAL 77 ultrasound machine with a convex 3.75 MHz probe and a linear 8 MHz probe. RESULTS: In 50 patients sonographic diagnoses were confirmed by surgery .36 patients had other pathological conditions that lead to an acute abdomen. Nine findings were false-negative. The study results reveal that the US scanning enables not only reliable diagnosis of acute appendicitis, but also reliable differential-diagnosis of other pathological conditions and diseases. CONCLUSION: US should be the imaging method of choice in diagnostic evaluation of little patients with acute abdominal pain. This method represents a great help in differential diagnosis not only to eliminate acute appendicitis but also to confirm accuracy of the diagnosis.

Abdomen, Acute↗
PubMed2003

Appendicitis, 2002: relationship between payors and outcome.

As the status of health-care insurance changes in the United States, studies have indicated that uninsured patients are less likely to receive timely and quality health care. Previous studies of appendicitis have shown that insurance status may effect the stage of presentation and outcome. However, these studies were based on databases lacking information regarding stage of presentation, timeliness of diagnosis and treatment, and character of hospitalization (length of stay, duration of antibiotic therapy, hospital costs). We accomplished a case control study, retrospective analysis of 975 patients treated for acute appendicitis between January 1996 and December 1999. Times to operation, number of preoperative outpatient visits, number of studies, severity of presentation, length of antibiotics and hospital stay, and hospital costs were analyzed [analysis of variance (ANOVA) techniques, P < 0.05 significant]. We sought answers to the following: (1) Did insurance status affect the timeliness of diagnosis and treatment? (2) Did insurance status affect the stage of presentation? (3) Did insurance status affect hospitalization, as measured by length of stay, duration of antibiotic therapy, and hospital costs? (4) Did age affect outcome independent of insurance status? There were no correlations between insurance status and timeliness of diagnosis or severity of presentation. Length of stay and hospital costs were also not different between insurance categories. Pediatric patients (< 12 years old) and the elderly (> 65 years old) presented with more advanced appendicitis, independent of insurance category. In contrast to previously published data, the treatment of acute appendicitis is not affected by insurance coverage in the sample community. Age and timeliness of presentation were the only factors correlating to outcomes.

Adult↗
PubMedDate not supplied

[Diagnostic efficiency in acute appendicitis].

Diagnostic efficiency and the means to achieve it constitute one of the main parameters that evaluates quality of hospital care within an institution. In addition, concerning surgery acute appendicitis is without doubt the most frequent pathology we face at our service. Therefore, we conceived of a way to determine degree of concordance and other parameters of diagnostic efficiency for this disease. This is an analytic, longitudinal study that took into account the cases of acute appendicitis out of the most frequent pathologies of surgical acute abdomen (acute appendicitis, perforated peptic ulcer, intestinal occlusion, and acute cholecystitis) from April 1 to June 17, 2002 for a total of two hundred cases. To establish correlation, main symptoms and signs upon admission were recorded, as well as presumptive, operatory, histopathologic, and laparoscopic diagnoses in cases in which such procedures were performed. Other aspects were also considered as efficiency parameters, namely Kappa correlation index, sensitivity, specificity, positive and negative predictive values, and positive and negative verisimilitude reasons. Clinical-surgical correlation found was very good, with Kappa value of 0.92. Clinical-pathological concordance was good also, with Kappa value of 0.71. The same can be said concerning the surgical-anatomopathologic case, with a value of 0.79. Regarding laparoscopy, both clinical-laparoscopic and surgical-laparoscopic concordances were poor, with Kappa value of 0.15. Also, concordance between laparoscopic and anatomopathologic diagnoses was weak, with a value of 0.25. Diagnostic efficiency in acute appendicitis was good, contrary to laparoscopic efficiency as diagnostic evidence.

Acute Disease↗