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PubMed1992

[Appendicitis and its atypical causes].

The authors analysed 2849 patients who were admitted to the Department of General Surgery, Regional Hospital in Pisz in the years 1980-1989 with symptoms suggestive of appendicitis. In 983 cases surgical intervention was abandoned, because the symptoms regressed spontaneously or were caused by diseases of other organs. The pathological conditions associated with appendicitis are analysed in 1866 surgically treated patients. Cases of appendicitis caused by Oxyuris vermicularis, Salmonella-enteritidis and actinomycosis (one case each) and appendicular carcinoma (2 cases) are described in more detail. Attention is called to the aetiology, pathogenesis and treatment of these rare causes of appendicitis.

Actinomycosis↗
PubMed2003

The role of parasites in acute appendicitis of pediatric patients.

There is little evidence regarding the relationship between parasites and acute appendicitis. In order to determine such a relationship, if any, 830 appendectomy specimens were studied. Age, sex, pathological findings and the presence and type of parasites and the type of parasite were analyzed. Parasites were present in 62 cases (7.46%). Ascaris lumbricoides and Trichuris trichiura were the most frequently encountered parasites. These were observed, alone or in combination, in 45 cases (72.5%). Appendix perforation, peritonitis, necrosis and flegmonous appearance, were more frequent in the cases of acute appendicitis without parasitic infestation (p < 0.05). There were no differences between the cases with or without parasitic infestation (p > 0.05) In cases of peritonitis. The low incidence of parasites among the appendectomy specimens and the failure to demonstrate its relationship with all events derived of appendicitis, do not support the hypothesis that parasites are a major cause of appendicitis in pediatric patients.

Acute Disease↗
PubMed2003

Appendicitis complicated by hemoperitoneum.

Differential diagnosis of acute appendicitis in women of childbearing age is a challenge because of the range of gynecologic and obstetric problems with similar manifestations. We report a case of acute appendicitis with the rarely encountered complication of hemoperitoneum in a sexually active 32-year-old woman. The patient presented with right lower quadrant pain and a positive culdocentesis with non-clotting blood. Hemorrhagic corpus luteal cyst was the initial impression. Ruptured appendicitis with abscess formation and complicated hemoperitoneum was diagnosed later with the aid of abdominal computed tomographic scan, and was confirmed during operation. Hemoperitoneum may be a complication of appendicitis with abscess formation; a detailed medical history and physical examination are helpful in making the diagnosis.

Adult↗
PubMed2003

A successfully treated case of severe necrotizing fasciitis caused by acute appendicitis: a case report.

We successfully saved a patient with appendicitis followed by necrotizing fascitis. A 77-year-old man with a history of ambulatory treatment for depression underwent an emergency operation because of severe abdominal pain. Laparotomy demonstrated that necrotizing appendicitis was massively extending over the abdominal cavity, involving the right paracolic sulcus and Douglas pouch and posterior surface of the right kidney. Irrespective of the emergency surgery, redness and swelling in the right chest and abdomen, which was noted at the time of admission, was not decreased. Successively, a retension incision was performed under the diagnosis of necrotizing fasciitis. Necrotizing fasciitis is an extremely rare complication of appendicitis, and there were only 10 cases documented. Once necrotizing fasciitis occurs, the mortality rate is high, so that correct diagnosis and prompt debridement are mandatory. Particularly for elderly patients with appendicitis, rapid and accurate diagnosis and treatment are required.

Acute Disease↗
PubMedDate not supplied

A pitfall of the diagnostic process of differentiating bile peritonitis from acute appendicitis.

BACKGROUND/AIMS: We often encounter patients with bile peritonitis expressing right hypogastralgia who have been easily misdiagnosed as acute appendicitis. The aim of this study is to clarify why patients with bile peritonitis express right hypogastralgia and to recommend a way in which to prevent misdiagnosis of patients with bile peritonitis with right hypogastralgia as acute appendicitis. METHODOLOGY: Subjects were 12 patients with bile peritonitis who underwent laparotomy in Yokohama City Nambu Hospital or Critical Care and Emergency Center of Yokohama Citizen Medical Center Hospital. The spread of bile and inflammatory peritoneal fluid confirmed during laparotomy was compared with the preoperative abdominal findings. RESULTS: Five of the 12 cases (42%) showed signs of peritoneal irritation only in the epigastric and right hypochondral region; 6 (50%) in the right lateral and hypogastric region; and 1 (8%) in the diffuse abdomen. Four of the 12 cases (33%) showed widespread inflammation and accumulation of fluid in the whole peritoneal cavity (generalized peritonitis). Five cases (42%) showed limited peritoneal inflammation with green coating, leaked bile, and accumulation of inflammatory fluid within the hepatoduodenal ligament, Morison's pouch, right paracolic gutter, and right ileac pouch. Three of these 5 cases and 3 of the 4 generalized peritonitis cases showed signs of peritoneal irritation in the right hypogastric region. US of these cases showed signs of cholecystitis. Three of the 6 cases underwent emergency operation by right hypogastric incision under the diagnosis of acute appendicitis. One of these 3 cases underwent neither US nor CT; the second of these cases showed ileocecal inflammation by US but did not undergo CT; and the last of these cases expressed peritoneal irritation most strongly in the right hypogastric quadrant despite of signs of cholecystitis by US and CT. CONCLUSIONS: If patients who complain of right hypogastralgia like acute appendicitis also complain of right epigastralgia or right hypochondralgia, we should suspect biliary peritonitis due to gangrenous or perforated cholecystitis and should perform upper abdominal scanning, especially around the gallbladder, by US and CT.

Acute Disease↗
PubMed2004

The efficacy of postoperative oral antibiotics in appendicitis: a randomized prospective double-blinded study.

The conventional treatment of acute appendicitis is appendectomy followed by intravenous (IV) antibiotics until intraabdominal infection has resolved. It is controversial as to whether it is efficacious to add a course of oral antibiotics after cessation of IV antibiotics. All consenting patients who presented to Kern Medical Center between October 2000 and June 2003 with acute appendicitis were entered into the study. Perforated/gangrenous appendicitis was equally represented in the two study arms. After appendectomy, and when IV antibiotics were ready to be discontinued, patients were randomized to receive a 7-day outpatient course of either placebo (Group 1) or oral antibiotics (Group 2). Patients were monitored for infectious complications for a minimum of 3 months, and there was no statistical difference (11.5% in Group 1 vs 12.1% in Group 2, P = 0.61). The data suggest that adding a course of outpatient oral antibiotics, after completing a course of IV antibiotics, does not decrease postoperative infectious complications in appendicitis patients.

Abdominal Abscess↗
PubMed2004

Diagnostic pathways and delays on route to operative intervention in acute appendicitis.

The purpose of this study was to determine the elements associated with delay in the evaluation of acute appendicitis at a community teaching hospital. We performed a retrospective chart review of patients undergoing operative exploration for presumed appendicitis in a 12-month period. Cases were categorized by the presence or absence of advanced radiographic imaging. Demographic information and time intervals from triage to operative incision were compared. One hundred twenty-four patients underwent operative exploration for presumed appendicitis. Forty-one patients had no advanced imaging, 67 had a CT scan, 8 had a sonogram, and 8 had both CT/sonogram. Patients using advanced radiographic imaging prior to operative exploration were no less likely to have a normal appendix at surgery. Diagnostic imaging significantly increased the preoperative emergency department length of stay. Two-thirds of patients with presumed acute appendicitis were imaged before operative exploration. The use of abdominal CT and sonogram resulted in significantly increased preoperative emergency department length of stay with no apparent improvement in diagnostic accuracy.

Acute Disease↗
PubMed1992

[Diagnosis of acute appendicitis by transvaginal sonography].

Acute appendicitis is the most common indication for laparotomy. Nevertheless, diagnostic specificity is low and rates of false positive and false negative diagnoses are high, since there is no direct technique for visualizing the appendix. The ultrasonic appearance of appendicitis has recently been described. We present the first case of acute appendicitis identified via high frequency transvaginal sonography, in a 26-year-old woman. Because of the proximity to pelvic organs, transvaginal sonography may improve the diagnosis rate of acute appendicitis, especially in young women in whom the correct diagnosis is more difficult.

Acute Disease↗
PubMedDate not supplied

Evaluation of the Alvarado score in the diagnosis of acute appendicitis.

Acute appendicitis may simulate many other acute abdominal illnesses and the exact diagnosis is important for the proper management. The present study was undertaken to evaluate the role of the Alvarado score in the diagnosis of a patient with suspected appendicitis. The study was carried out on 100 patients operated with a presumptive diagnosis of acute appendicitis on the basis of clinical grounds. Alvarado scoring was done in all these patients preoperatively by different personnel. Discriminant analysis of the Alvarado score of all the patients was done to determine the cut-off value in an Indian set-up. The positive and negative predictive values of the Alvarado score were 77.6% and 52.4%, respectively. It is more effective in men and children, with a predictive value of 84% and 92.8%, respectively. Discriminant analysis revealed a cut-off value of > or = 6 rather than the original value of > or = 7. The sensitivity of the Alvarado score increased from 69.2% to 92% with the new cut-off value of > or =6. The Alvarado scoring system can be used in surgical emergency departments to diagnose acute appendicitis. In women, additional investigations may be required to confirm the diagnosis. The original cut-off value given by Alvarado may be changed in the Indian set-up to increase sensitivity.

Acute Disease↗
PubMedDate not supplied

[Early breastfeed weaning as a risk factor for acute appendicitis in children].

OBJECTIVE: To determine if short term exclusive (EBF), combined breastfeeding (CBF), or an early start of other kind of food constitute risk factors for appendicitis in children. MATERIALS AND METHODS: By means of a case-control study, the mothers of 200 children up to 16 years with a diagnosis of acute appendicitis and 200 matched controls were interviewed regarding the duration of breastfeeding and the start of other foods. Data were analyzed to calculate chi-square c2; odds ratio (OR) was used to calculate risk factors, confidence intervals (CI 95%) were also determined. RESULTS: There was no EBF in 52 cases (26%), or in 5 controls (2.5%) (p< 0.001). EBF lasted for 2.3 +/- 1.8 months in cases and 3 +/- 1.1 months in controls (p< 0.001). CBF lasted for 8.1 +/- 7.5 months in cases and 8.8 +/- 3.5 in controls (p< 0.001); ablactation was started at 4.4 +/- 1.3 months in cases and at 4.7+/-1.2 in controls (p< 0.05). The OR of developing appendicitis for non- EBF was 10.4 (CI 95% 4 - 26.5), for ablactation before 4 months 1.4, (CI 95% 0.9 - 2) and for CBF for less than 6 months 4.6, (CI 95% 2.3 - 8.3). CONCLUSIONS: The risk of developing appendicitis is higher among children who never received EBF and who were breastfed for less than 6 months.

Adolescent↗
PubMed2006

An evaluation of individual plain abdominal radiography findings in pediatric appendicitis: results from a series of 424 children.

BACKGROUND: This study was conducted to collect the results of the plain abdominal radiography (PAR) signs, to determine their individual diagnostic values, and to discuss them under a brief literature review. METHODS: Eight predetermined PAR signs were individually interpreted in a series of 424 consecutive children (278 males; 146 females; median age 10 years; range 11 months to 17 years) who underwent an operation for appendicitis. The sensitivity, specificity, and positive and negative predictive values for the signs were determined. RESULTS: Appendicitis was confirmed in 378 (89%) patients. Among the remaining 46 (11%) patients with a normal appendix, 20 (5%) had other intraabdominal pathologies. Calcified fecalith, mass image in right-lower-quadrant (RLQ), psoas obscuration, and localized extraluminal air signs were all highly specific and therefore, unlikely to be present if the appendix is normal. On the other hand, the sensitivity values were low, in general, for all the PAR signs investigated. Yet, presence of dilated transverse colon and/or single air fluid level in the RLQ has the highest percentage occurrence with appendicitis. CONCLUSION: Although the there is no single PAR finding capable of ruling the diagnosis of appendicitis out, basic knowledge on PAR findings could have an impact on decision making process for clinicians dealing with pediatric acute abdominal pain.

Adolescent↗
PubMed1991

Cytomegalovirus appendicitis in a patient with acquired immune deficiency syndrome.

We report a homosexual patient with the acquired immune deficiency syndrome (AIDS) and histopathologic evidence for cytomegalovirus (CMV) appendicitis in a patient with no prior history of CMV infection. The patient presented with right lower quadrant pain and intermittent fevers. The diagnosis of appendicitis was difficult to make in this patient because of the presumptive diagnosis of tuberculosis ileitis and the frequent presentation of abdominal pain with fever in AIDS patients. Although CMV colitis is frequently seen in AIDS patients, the prevalence of CMV appendicitis is exceedingly rare. The problems related to making a diagnosis of CMV appendicitis and the therapeutic management of CMV infections are reviewed.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Stump appendicitis: a comprehensive review of literature.

Appendectomy for appendicitis is one of the most common procedures performed in the United States. Residual tissue left after an initial appendectomy risks the development of stump appendicitis. A comprehensive review of the English-language literature revealed 36 reported cases of stump appendicitis. Typically, patients present with signs and symptoms similar to acute appendicitis; however, due to prior surgery, the diagnosis is difficult and the rate of appendiceal stump perforation is extremely high. Herein, we present a case of a 32-year-old female presenting with right lower quadrant pain, nausea, and fever 5 months after laparoscopic appendectomy. Upon surgery, an appendiceal stump was discovered.

Adult↗
PubMedDate not supplied

Interval laparoscopic appendectomy for appendicitis complicated by pylephlebitis.

BACKGROUND: Although rare, portal mesenteric venous thrombosis and pylephlebitis remain potential life-threatening sequelae of ruptured appendicitis in children. Treatment recommendations from recent reports have included urgent exploratory laparotomy with appendectomy, prolonged intravenous antibiotic therapy, and anticoagulation for up to a year. METHODS: This report describes successful management of pylephlebitis and mesenteric venous thrombosis complicating ruptured appendicitis with intravenous antibiotics and anticoagulation followed by interval laparoscopic appendectomy. RESULTS: A previously healthy 5-year-old girl was diagnosed with ruptured appendicitis complicated by pylephlebitis and mesenteric venous thrombosis at the time of presentation. She was treated with intravenous antibiotics and anticoagulated for 3 months. She subsequently underwent interval laparoscopic appendectomy. At 3-year follow-up, she is healthy without evidence of adverse sequelae. DISCUSSION: This is the first reported case of successful, minimally invasive management of ruptured appendicitis complicated by mesenteric venous thrombosis and pylephlebitis. CONCLUSION: Similar treatment of other children with this rare presentation seems reasonable.

Anti-Bacterial Agents↗
PubMed2006

Role of focused appendiceal computed tomography in clinically equivocal acute appendicitis.

OBJECTIVE: To determine the accuracy of FACT (focused appendiceal computed tomography) in evaluation of acute appendicitis. METHODS: The study was conducted in Aga Khan University Hospital, Karachi, over a period of one year. Sixty-three patients with clinically equivocal acute appendicitis underwent thin-section non-enhanced helical CT. Axial scans were obtained in a single breath hold from L2 vertebral level to the pubic symphysis with 5-mm collimation and a pitch of 1.5. All scans were obtained without oral, intravenous, or rectal contrast material. Criteria for diagnosis of acute appendicitis included an enlarged appendix (>6 mm diameter) and periappendiceal inflammation. Final diagnoses were established with the results of surgical or clinical follow-up. RESULTS: There were 21 true-positive diagnoses, 38 true-negative diagnoses, no false-positive diagnoses, and 2 false-negative diagnoses, which yielded a sensitivity of 91% and a specificity of 100%. CONCLUSION: Non-enhanced FACT is a highly accurate problem solving technique in clinically equivocal cases of acute appendicitis.

Acute Disease↗
PubMedDate not supplied

[The child with suspect acute appendicitis in emergency care].

Acute appendicitis is the most common acute abdominal pain in childhood. Appendicitis is rare during the first two years of life and uncommon before the age of five years. The rarity, coupled with the preschool inability to cooperate in history and physical examination, explain why more than 90% of children under five years of age with appendicitis are already complicated by the laparatomy is undertaken. The aim of this study is to evaluate the prediction of the marks left by appendicitis.

Abdominal Pain↗
PubMedDate not supplied

Urachal adenocarcinoma: incidental finding at the time of surgery for ruptured appendicitis.

BACKGROUND: The urachus is a vestigial structure between the dome of the bladder and the umbilicus. Tumors may develop from the remnants, most of which are well-differentiated, mucinous adenocarcinomas. Urachal adenocarcinoma is an exceedingly rare type of tumor. METHODS: We present a case of a 51-year-old female presenting to our institution with complaints of abdominal pain for 36 hours. The patient was taken to the operating room for an acute appendicitis. Laparoscopy was performed, and gross purulence and appendiceal perforation were noted as well as a mass on the anterior abdominal wall. Based on the location of the mass, we converted to an open midline laparotomy to treat both the perforated appendicitis and to remove the mass. RESULTS: Pathology confirmed the diagnosis of perforated appendicitis and a mucinous-producing urachal adenocarcinoma. DISCUSSION: Data support both open and laparoscopic approaches for appendicitis. This case, although rare, highlights the importance of laparoscopy in a complete and thorough examination of the abdominal cavity. A standard right lower quadrant incision for an open technique would likely have resulted in omission of this lesion, and the patient would have presented at a more typical late stage of her cancer development with significantly more morbidity.

Adenocarcinoma↗
PubMed1991

[Acute appendicitis in the elderly patient].

Presentation of 55 patients aged more than 65 years, appendectomized with the diagnosis of acute appendicitis. After histological study, we saw 6 normal cecal appendixes (10.9%), so the real number of acute appendicitis operated was 49 out of 435 (11.2%) interventions. The clinical history was typical in most of the patients and, nevertheless, we noticed a diagnostic delay greater than 24 hours in 31 (63.2%), and greater than 48 hours in 17 patients (34.6%). We verified the existence of a high percentage of perforated appendicitis (36.7%) closely related to a long evolution time, not being able to show, in the group studied, an increase of early appendix perforations in comparison with the rest. These results suggest that the high morbidity of acute appendicitis in old patients is due, to a great extent, to a delay in the performance of the appendectomy.

Acute Disease↗