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PubMed1985

[Acute appendicitis: a study on 118 patients].

One hundred eighteen patients with acute appendicitis operated on at Kawasaki Medical School Hospital during the 8-year period from Aug. 1, 1976 to Feb. 29, 1984 were reviewed. There were 78 children and 40 adults. The clinico-pathological types of acute appendicitis were: simple acute in 35 cases (29.7%); phlegmonous in 30 cases (25.4%); gangrenous in 24 cases (20.3%) and perforated in 29 cases (24.6%). Of the 78 children, 27 (34.6%) had perforated appendixes, whereas of the 40 adults only 2 (5.0%) showed perforated appendicitis. The initial symptoms were abdominal pain in 96.6%; nausea, vomiting or both in 33.1%, and fever in 11.9%. The physical findings on admission were abdominal tenderness in 99.2%, rebound tenderness in 52.5% and palpable mass in 17.8%. The mean body temperature on admission was 37.2 degrees C, and mean WBC count was 12,900/mm3. The roentgenography of the abdomen revealed the "sentinel loop sign" in 66.3%. In the patients under 15 years of age, the frequency of perforation seen in those underwent operation within 24 hours after onset and in those after 24 hours was 12.7% and 56.4%, respectively. From this result, it is advised that all the young patients suspected of having acute appendicitis should be admitted to the hospital promptly, and the diagnosis should be made within 24 hours.

Acute Disease↗
PubMed1985

Secondary appendicitis--a sign of some other intra-abdominal inflammation.

An operation was performed on a 37-year-old man with symptoms of acute appendicitis. A severely inflamed appendix was removed. Histology, however, showed an atypical picture of inflammation: the outer layers of the appendix were severely inflamed but the epithelium was intact. Re-laparotomy revealed an abscess around a perforated Meckel's diverticulum, with no evidence of complications at the site of appendicectomy. It appeared that the appendix had become inflamed directly from the primarily inflamed Meckel's diverticulum. The case shows that a careful exploration of the neighbouring organs as well as the dissection of the specimen by the surgeon himself is indicated during laparotomy despite detection of appendicitis. To distinguish the situation described here from classical appendicitis we suggest the term secondary appendicitis to define the direct invasion of inflammation to the appendix from an adjacent organ.

Acute Disease↗
PubMed1985

The management of severe appendicitis in children.

Appendicitis remains one of the commonest paediatric surgical emergencies in a busy paediatric surgical practice. In spite of improved diagnostic skills and surgical care, the incidence of severe appendicitis has remained unaltered in children over the past few decades and therefore remains a therapeutic challenge. A protocol for the treatment of severe appendicitis was instituted in the Division of Paediatric Surgery at the Royal Canberra Hospital by the author from 1981 to 1984 inclusive, and the results of treatment according to the protocol are presented. The results suggest that an aggressive approach to gangrenous and perforated appendicitis can result in very low morbidity from sepsis. The protocol is discussed.

Acute Disease↗
PubMed1979

[Ways to decrease the number of diagnostic errors and to improve the treatment results in acute appendicitis].

The investigation of 2114 patients admitted for acute appendicitis has shown that after an examination by the surgeon and the blood and urine tests the diagnosis of acute appendicitis was rejected in 922 patients (43%). Out of 1192 patients admitted to the hospital with the diagnosis of acute appendicitis 183 patients (15,4%) did not confirm the diagnosis of acute appendicitis after additional examination and observation of the patients.

Acute Disease↗
PubMed1984

Recurrent acute appendicitis with erythema annulare centrifugum.

Erythema annulare centrifugum (EAC), a chronic figurate eruption, occurred in a 28-year-old male physician several months following the onset of recurrent abdominal pain. Two months after the manifestation of EAC, another episode of abdominal pain culminated in appendectomy for perforated appendicitis. During his convalescence, the skin lesions faded and did not reappear. We propose that recurrent appendiceal inflammation caused both the episodic pain and the skin eruptions. Additionally EAC may be a sign of chronic infection, internal malignancy, or food allergy. Although truly chronic appendicitis is a disputed entity, recurrent, spontaneously resolving episodes of appendicitis occasionally do precede surgical appendicitis. The presence of EAC in a patient having recurrent abdominal pain should discourage a precipitant diagnosis of functional illness and prompt further investigation.

Acute Disease↗
PubMed1983

Acute appendicitis: a quality assurance analysis.

The management of 722 patients admitted to Christchurch Hospital in 1979 with acute appendicitis (308) or non-specific abdominal pain (414) was such that 86% of the appendicitis patients had a timely removal of an inflamed but not perforated appendix and 9.2% of the patients with non-specific abdominal pain had an unnecessary appendicectomy. The mean stay in hospital was 4.8 days for patients who had a timely operation for acute appendicitis, 8.1 days for patients undergoing operation for perforated appendicitis, 6.1 days for patients who had non-specific abdominal pain and appendicectomy, and 2.7 days for patients who had non-specific abdominal pain without appendicectomy. There was no mortality.

Abdomen↗
PubMed1983

Acute appendicitis risk in various phases of the menstrual cycle.

The significantly different age-specific incidence of acute appendicitis between males and females in the second, third and fourth decades of life led to a study of the frequency of acute appendicitis and the degree of appendiceal inflammation found at operation in the different phases of the menstrual cycle. The frequency of acute appendicitis was almost twice as high in the luteal phase as in the other half of the menstrual cycle. The proportion of gangrenous, perforated or normal appendices was significantly higher in the menstrual and follicular phases of the cycle. The study indicated that the female sex hormones may play an important etiologic part in acute appendicitis or may influence the inflammatory process in the appendix.

Acute Disease↗
PubMed1984

Reasons for delay of the diagnosis of acute appendicitis.

The essence of the problem, as previously reported, indicated that few complications of acute appendicitis occur as long as the infection is contained within the appendix, but once the invading bacteria have penetrated the peritoneal appendicular surface or have invaded the regional circulation, any one or more of a series of serious complications can develop. Thus, rightfully, emphasis has been placed upon early removal of the inflamed appendix before penetration has occurred as the best method of preventing complications. We have shown that early appendectomy is predicated on early diagnosis and that diagnostic delay is not limited to extremes of age. The diagnosis may be obscured by an accurate, although misleading, history of prior acute attacks, by precident acute disease, such as viral gastroenteritis and by unimpressive symptoms blunted by intercurrent chronic illness, such as diabetes mellitus. If the elements of periumbilical pain, anorexia, nausea or vomiting and the migration of pain to the right lower abdominal quadrant are contained within the clinical history, one must suspect transmural progression of acute appendicitis; frequent inpatient examinations will allow earliest diagnosis and, thereby, fewest perforations and their attendant serious complications. Misdiagnosis is common. Any patient observed for an ostensibly nonsurgical acute condition of the abdomen who fails to improve markedly during a brief course of appropriate specific or supportive therapy must be thoroughly re-evaluated as a potential surgical candidate. Despite the proliferation of accessible laboratory tests and imaging procedures, the early diagnosis of appendicitis rests upon the clinical skills of the physician. A high index of suspicion is crucial. As Doctor Warfield M. Firor, former senior surgeon commented: "Pain and tenderness at any point where the appendix can lie must raise the diagnostic possibility of appendicitis."

Abscess↗
PubMed1981

Appendicitis: a historical review.

The author traces the history of appendicitis through the successive stages of its evolution--from the early anatomic descriptions of the appendix by Leonardo da Vinci and Vesalius to Louyer-Villermay's recognition of the fatal course that appendiceal inflammation may take; through the confusion of typhlitis and perityphlitis, until Reginald Fitz at the end of the last century classified its pathology and the disease appendicitis was born. The author has described the efforts of the early surgeons as they grew to understand the symptomatology of appendicitis and to realize that only by early operation could the tragic outcome of delay be averted. Credit is given to those whose contributions have advanced the frontiers of surgery-- Lawson Tait was the first to diagnose and remove a diseased appendix in 1880 in England and Abraham Groves the first on the North American continent, in 1883, in Ontario. Within a decade, the early surgical treatment of appendicitis became established. The writings of men like Charles McBurney and John B. Murphy are shown to be as pertinent today as they were at the turn of the century.

Adolescent↗
PubMedDate not supplied

[Acute appendicitis in pregnancy, labour, and puerperium].

Four patients with appendicitis in pregnancy and one in puerperium are described. In two pregnant women, in the 12th and the 15th week of pregnancy, the surgery was applied in time and normal deliveries followed. The third patient, after a perforated appendicitis and applied appendectomy, developed the obstruction of the intestines, was operated on again, and then had a spontaneous abortion. The fourth patient, in the 20th week of pregnancy, came to hospital with a diffuse peritonitis following a perforated appendicitis and with a dead fetus. During appendectomy the fetus was removed by using small cesarean section. The fifth patient was surgically treated on the 8th day following delivery for retrocecal perforative appendicitis and diffuse peritonitis. All the patients survived.

Acute Disease↗
PubMed1981

[Diagnosis and results of treatment in appendicitis].

In a period of 5 years 3455 appendectomies were performed because of appendicitis. Acute appendicitis (i.e. gangrenous appendicitis, appendiceal abscess, perforated appendicitis) was found in 30% of all appendectomies. Histological finding, sex, age, symptoms, duration of illness until operation, technique of operation and postoperative complications were documented in a form suitable for computer input and analyzed. The lethality of appendectomy was 0.38%.

Adolescent↗
PubMed1980

The continuing challenge of perforating appendicitis.

A series of 335 consecutive patients treated for acute appendicitis is presented. The incidence of perforation in the series was 32.2 per cent. The mortality was 0.3 per cent for the total series and 0.9 per cent for those patients with perforating appendicitis. When perforation occurs, a twofold increase in the hospital stay and a threefold increase in hospital costs result. A complication rate of 47.2 per cent in instances of perforation was significantly greater than that noted in instances of nonperforation. A 40 per cent incidence of perforation was noted during the first decade of life, after which the frequency of perforation declines. Beginning with the fifth decade, a progressive increase in the incidence of perforation was noted. Prior to hospital admission, a significant delay was noted among patients with perforation. In addition, those with perforating appendicitis were far more likely to have been seen previously by a physician who failed to advise hospital admission. Finally, a significant inhospital delay, from admission to operation, was noted in patients with perforating appendicitis. While geographic access to health care did influence the incidence of perforation, insurance status and possession of a telephone did not.

Adolescent↗
PubMed1980

[Diagnosis of appendicitis: only experience helps].

Acute appendicitis is a very rare disease in children under 1 resp. 5 years of age. In a series of 1456 cases 8.9% of patients were older than 60 years. In both extreme age groups however perforating appendicitis is a common complication: 40% resp. 37% against 6 to 7% in patients between 5 and 60 years of age. In our series of 1456 cases the correct diagnosis of acute appendicitis was missed preoperatively in 11%. The well described clinical signs and the dates of history vary so widely that they do not guarantee the correct diagnosis. In our opinion clinical experience is the most helpful item in proving the diagnosis of acute appendicitis which ought to be operated upon.

Acute Disease↗
PubMed1995

Timing of antibiotic treatment in non-perforated gangrenous appendicitis.

OBJECTIVE: To assess whether antibiotic treatment with cefuroxime and tinidazole started during the operation was as effective as treatment started before operation in patients with gangrenous non-perforated appendicitis. DESIGN: Prospective randomised study. SETTING: University hospital, Sweden. SUBJECTS: 114 patients with gangrenous, non-perforated appendicitis who had had antibiotics started before operation and 120 whose treatment was started during operation out of a total of 575 who presented with a presumptive diagnosis of appendicitis. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: There were no deaths, and the rates of infective complications were 1/114 (0.9%) and 3/120 (3%), respectively. The median hospital stay was four days in both groups. CONCLUSION: Antibiotic treatment started during the operation is not significantly worse at preventing infective complications in non-perforated, gangrenous appendicitis than treatment started before the operation.

Acute Disease↗
PubMed1995

[Amebic appendicitis with subsequent perforated pancolitis].

Amoebic appendicitis is very rare, occurring in about 0.5 to 1% of acute appendicitis in tropical countries. The most severe complication is transmural amoebic colitis with perforation, described in 1.6 to 3.2% of cases. The mortality of such cases can be very high (up to 80%). We present a Swiss patient with amoebic appendicitis followed by severe perforated colitis; a total colectomy was necessary and the patient survived. Because of the good results of amoebicidal therapy and because of the severity of the complication after colitis we suggest that patients with signs of acute appendicitis after travel in tropical areas should be screened.

Aged↗
PubMed1995

Diagnostic scores for acute appendicitis. Abdominal Pain Study Group.

OBJECTIVE: To assess the value of predictive scores in the diagnosis of acute appendicitis. DESIGN: Multicentre evaluation with a prospective database. SUBJECTS: 1254 patients with acute abdominal pain. SETTING: 6 departments of surgery, Germany. INTERVENTIONS: To measure the performance of 10 scores on one database using standardised criteria and to compare the results with published data. MAIN OUTCOME MEASURES: The ability of a score to fulfill standardised criteria: an initial negative appendicectomy rate of 15% or less, a potential perforation rate of 35% or less, an initial missed perforation rate of 15% or less, and a missed appendicitis rate of 5% or less. RESULTS: Reevaluation of the published data showed that the Alvarado score fulfilled all four criteria and the Lindberg, the Fenyö and the Christian scores fulfilled two criteria each. If applied to our database (acute abdominal pain, suspected appendicitis), none of the scores fulfilled any of the given criteria, even if the cut-off point was varied systematically. There were significant differences among the scores. CONCLUSIONS: The original published data seemed to comply with our standardised criteria but evaluation of the scores on our database resulted in poor performances for all of them. Published data seem to be optimistically biased whereas our evaluation gives more realistic estimates of the routine performance in different clinical environments. Further well designed large scale trials are needed to investigate the clinical benefit of diagnostic scoring in acute appendicitis.

Abdominal Pain↗
PubMed1995

Appendicitis in older African patients: 10 year review and report of 84 cases.

Appendicitis in the aged patient is uncommon even in developed countries although it is now more frequently seen and treated. A review of 84 patients aged between 40 and 80 years and who had appendicectomy for appendicitis in a sub-Saharan hospital is presented. The study covered the 10 years January 1982 to December 1991. This number constituted 8.1 pc of the total appendicectomies for appendicitis. There were 59 males and 25 females with a cluster of appendicitis between the ages of 40 and 50 years forming 85.7 pc. The mean age was 52.2 pc years and the females tended to be younger. Only five patients constituting of 0.5 pc of total appendicectomies performed in the study period were aged 60 years and above. The presentation was only classical the nearer the ages of the patients were to 40 years. The only reliable clinical parameter was an area of maximal tenderness in the right iliac fossa at McBurney's point which was present in 70 patients (83.3 pc). The diagnostic accuracy rate as confirmed by histological reports was only 60.7 pc as opposed to clinical and peri-operative diagnoses of 70 (83.3 pc) and 90 pc respectively. Five of the inflamed appendices were suppurative, four perforated and one gangerous, thus only about 12 pc of the appendices were potentially catastrophic. There was no death.

Adult↗
PubMed1995

Ultrasonographic findings after conservative treatment of acute appendicitis and open appendicectomy.

In a randomized study we investigated the effects of antibiotics as the only treatment in acute appendicitis. Forty patients were examined, 19 after antibiotic treatment (one operated due to perforation) and 21 after surgery. All patients were examined prior to randomization, after 10 days and after 30 days. Of the positive ultrasonographic (US) findings, 18 (86%) of the 21 operated patients had histologically proven acute appendicitis. At the 10th day, 9 patients had a seroma under the scar, which had disappeared a month after surgery in all patients. In the 19 patients conservatively treated with antibiotics, the appendix could be visualized in 8 symptom-free cases on the 10th day. In 5 of the 8 patients the appendix was still visualized after 1 month. Three of these 5 had recurrent appendicitis within a year. It is concluded that US can be used not only in diagnosing acute appendicitis, but also in the evaluation of treatments such as antibiotics.

Acute Disease↗