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PubMed1994

Parameters for a knowledge base for acute appendicitis.

Acute appendicitis is the most common cause of acute abdomen requiring surgical intervention. The clinical diagnosis of acute appendicitis is not always easy due to variable symptomatology, particularly at the onset. The contributions of history-taking and physical examination in the diagnosis of acute appendicitis was studied in connection with the Research Committee of the World Organization of Gastroenterology (OMGE) survey of acute abdominal pain. Especially the suitability of diagnostic parameters in the construction of an expert system for automatic decision making was studied. The results clearly show that it is possible to construct an expert system for automatic decision making in the diagnosis of acute appendicitis.

Abdomen, Acute↗
PubMed1994

Continuing fall in the incidence of acute appendicitis.

Previous reports have shown a marked decrease in the incidence of acute appendicitis. This study has set out to discover whether this decrease has continued. The pathology records over 15 years have been reviewed to tabulate the frequency of appendicitis in one large district general hospital. The results were then analysed statistically. The incidence of acute appendicitis was seen to decrease from approximately 100 to 52 over the 15-year period. This continuing decrease in the incidence of acute appendicitis has implications on acute surgical bed usage, experience for trainee surgeons and referral patterns for general practitioners.

Acute Disease↗
PubMed1993

C reactive protein in the diagnosis of acute appendicitis.

OBJECTIVE: To find out if the C reactive protein concentration is of any value in the diagnosis of acute appendicitis, either alone or in combination with other laboratory tests. DESIGN: Open study. SETTING: Drechtsteden Hospital, Dordrecht, and Spaarne Hospital, Heemstede, The Netherlands. SUBJECTS: 209 consecutive patients admitted with suspected appendicitis. MAIN OUTCOME MEASURES: Correlation of C reactive protein concentration with age, sex, body temperature, duration of abdominal pain, anorexia, nausea, vomiting, white cell count, neutrophil count, erythrocyte sedimentation rate, and histological appearance of the appendix. RESULTS: 125 patients of the 209 patients had their appendixes removed, and of these 101 had histologically confirmed appendicitis: A C reactive protein concentration of > or = 6 mg/1 alone had a sensitivity of 87% and a specificity of 50%. When the selected variables were subjected to multivariate analysis the most important, in decreasing order, were white blood cell count, female sex, and C reactive protein concentration. Combining the variables was of no additional value. CONCLUSION: measurement of the C reactive protein concentration can increase the accuracy in the diagnosis of acute appendicitis.

Acute Disease↗
PubMed1994

[Value of sonography in routine diagnosis of acute appendicitis. A retrospective analysis].

Our retrospective study of ultrasound examinations in 261 consecutively appendectomized patients shows a lower sensitivity in sonographic diagnosis of acute appendicitis compared to our former prospective study. One reason seems to be the different experience of the participating surgeons in ultrasound examination of acute appendicitis. Conditions of a prospective study might be another reason for our former better results. In conclusion recognition of appendicitis during ultrasound must lead to early operation, but a negative ultrasound alone is not safe enough to avoid surgical intervention in clinically supposed appendicitis. In every-day surgery clinical experience combined with additionally performed ultrasound leads to an early and safe indication for appendectomy.

Abdomen, Acute↗
PubMed1976

[Epidemiological data on appendicitis].

Various statistical data on the assessment of the appendicitis situation in the Federal Republic of Germany (BRD) and the GDR in recent years are drawn upon which show that the mortality rate in the BRD has declined by almost 40% since 1970. The number of hospital cases of appendicitis has been constant since 1965 among those insured by the Regional Insurance bodies, but a marked increase occured in children between 1966 and 1969. In the GRD there was a marked reduction in hospital cases of appendicitis between 1969 and 1973. The period of hospitalization for this disease reduced in the BRD by an average of less than one day within 13 years. The heavy load on hospitals and insurance companies, and consequently on the entire national economy, due to the high rates of appendicitis in comparison to other countries and the very long average duration of hospitalization should be reasons enough for stricter indication with the aim of preventing unnecessary deaths and unneccessary operations.

Appendectomy↗
PubMed1993

Childhood appendicitis in Zaria: a retrospective study.

Very little had been reported about childhood appendicitis from Africa. This retrospective report comprises two parts. One part is an overview of appendicitis in 207 children operated upon between January, 1981 and December, 1990 and the other involved a detailed study of 44 patients seen in the last 2 years of that decade. Overall, there were 135 males and 72 females, aged 4 years and younger than 15 years. 78 children were operated upon between 1989 and 1990 and only the records of 44 patients had detailed enough information for inclusion in this study. The common symptoms of appendicitis in children were: vague abdominal pain, vomiting, constipation and fever. The common signs were high grade pyrexia, dehydration, generalized or localized abdominal tenderness. In the larger group, 105 patients presented with perforation, 47 with gangrene, only 26.6% presented with uncomplicated appendicitis. In the smaller group 45.5% presented with perforation, 8 patients had wound infection. Four patients died; giving a mortality of 9%.

Acute Disease↗
PubMed1993

Laparoscopic appendectomy for acute appendicitis: is there really any benefit?

Laparoscopic appendectomy is emerging as a popular treatment modality for acute appendicitis. Although claims have been made to potential superiority over traditional appendectomy, comparisons of operative difficulty, hospital stay, hospital costs, complication rates, postoperative pain, and convalescence have not been well studied. Two hundred consecutive patients presenting with signs and symptoms of acute appendicitis underwent appendectomy. Traditional appendectomy was employed in 101 patients, while 99 underwent laparoscopy. Successful laparoscopic appendectomy was possible in 89 patients who were compared with the 101 patients with traditional appendectomy. There were two pregnant patients with appendicitis in each group. The incidence of acute appendicitis was 72 per cent for traditional appendectomy and 74 per cent for laparoscopic appendectomy. Operating time was significantly longer with laparoscopic appendectomy (60.1 vs 45.4 minutes, P = 0.0001). This was reflected in higher (although not significant) hospital costs ($8,683 vs $6,213). Post-op hospital stay was shorter for laparoscopic appendectomy (2.7 vs 3.8 days, P = 0.001). Complication rates were no different between the two groups. Post-op pain, as evaluated by a patient grading scale, was less for laparoscopic appendectomies up to the third post-op week (P = 0.003). The amount of IM pain medication was greater with traditional appendectomy (P = 0.009). Convalescence was significantly shorter with laparoscopic appendectomy as measured by: 1) return to normal household activity (7.8 vs 13.2 days, P = 0.016), 2) returned ability to exercise (19.7 vs 29.0 days, P = 0.009), 3) patient feeling well enough to return to work (14.1 vs 19.2 days, P = 0.032), and 4) actual return to work (15.4 vs 20.5 days, P = 0.038).(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1993

[Laparoscopy useful in the diagnosis and surgery of acute appendicitis].

The value of diagnostic laparoscopy was evaluated in 74 patients who had clinical signs of acute appendicitis. The average age was 27 years (5-67). The laparoscopically determined degree of inflammation was compared with the results of histologic examination, and the results of laparoscopic appendectomy were evaluated. In 6 patients laparoscopic appendectomy was not performed, because of infiltrative disease (twice), twisted ovary, ovulatory bleeding, enteritis and partially incarcerated inguinal hernia. In 2 patients suffering of acute appendicitis conversion to laparotomy was necessary because of obscured anatomy. On 57 out of 68 patients who underwent appendectomy, the laparoscopic findings were in accordance with histologic examination; i.e. 54 times acute appendicitis and 3 times appendix sana. In 7 patients the appendix was classified as inflamed during laparoscopy, histological examination revealing lymphoid hyperplasia or a subacute inflammation. In 4 patients with a laparoscopically normal appendix, inflammation was seen histologically. The average operation time was 29 minutes and the average postoperative hospital stay was 4 days. Three complications occurred: an inflammatory mass developed in 2 patients post-operatively and I patient had a hematoma in the trocar puncture site and a wound abscess developed. Laparoscopy is an aid in diagnosing appendicitis, and may prevent unnecessary appendectomy. If inflammation is established appendectomy can be performed safely and effectively.

Acute Disease↗
PubMed1993

[Acute appendicitis in the first 3 years of life: presentation of 72 cases and review of the literature].

The appendicitis in infants, including premature and newborn are exceptional. In smallers of three years is few frequently and plenty they are driving to fulfill the laparotomy. Diagnostic is hard for the atypical clinical picture and the rapid evolution toward appendicular boring and generalized peritonitis, modified or not for antibiotics use. The main symptoms of appendicitis finding in this study were: fever, vomitus, pain and abdominals distention. To research the muscular resistance become generalized, the McBurney signs and bonce. There were leucocytosis, urine alterations and the "X"-rays films showed occlusion signs and paralytic ileo. The ultra-sound scan were of great utility in the diagnostic of acute appendicitis and its complications, abscess of walls of intraperitoneal. There surgery was be urgent. The insiction for right half supra and infraumbilical become more frequently, next with appendicectomy of Oschner. Were utilized drain pipe in perforating or abscess cases. The post-operative complications more frequent seen were infection on the surgical hurt. The supured and gangrened appendicitis and perforated and abscessed walls were treated with antibiotics. The mortality rate were zero in this analyzed group.

Acute Disease↗
PubMed1996

Simultaneous acute appendicitis in monozygotic twins: coincidence or genetic?

Acute appendicitis is the most common cause of an acute surgical abdomen. The authors present the first case of simultaneous acute appendicitis in monozygotic twins in the English literature and the fifth case reported in the world literature. Twin sisters, whose homozygosity is proven by DNA testing, presented with symptoms of acute appendicitis within 16 hours of each other. Both had acute appendicitis, one with free intraperitoneal perforation. These cases are presented, the world literature reviewed, and possible etiologic factors are discussed.

Adolescent↗
PubMed1996

Assessment of peritonism in appendicitis.

The aim of this study was to evaluate the accuracy of different methods of demonstrating right iliac fossa peritonism in appendicitis. The methods used were cat's eye symptom (pain on going over a bump in the road), cough sign, right iliac fossa tenderness, percussion tenderness, rebound tenderness and guarding. A series of 100 consecutive patients with a median age of 25 years (range 4-81 years), presenting with right iliac fossa pain were studied prospectively; the male:female ratio was 39:61. In all, 58 patients underwent operation, 44 had appendicitis confirmed on histology. Fourteen patients had a normal appendix removed; 11 were women aged between 16 and 45 years. Cat's eye symptom and cough sign were sensitive indicators of appendicitis (sensitivity 0.80 and 0.82, respectively), but were not specific (specificity 0.52 and 0.50, respectively) and therefore inaccurate (accuracy 64%). Percussion tenderness was less sensitive (sensitivity 0.57) but more specific (specificity 0.86). Rebound tenderness proved to be sensitive (sensitivity 0.82), specific (specificity 0.89) and accurate (accuracy 86%). Thus, rebound tenderness had a positive predictive value of 86% compared with 56% and 57% for cough sign and cat's eye symptom, respectively. In the difficult diagnostic group of young women, the positive predictive value of rebound tenderness was 88% compared with 58% and 56% for cat's eye symptom and cough sign. Appendicitis remains a difficult diagnosis, particularly in young women. Rebound tenderness still has an important role to play in clinical assessment.

Abdominal Pain↗
PubMed1996

[Acute appendicitis in patients over 70 years of age].

OBJECTIVES: We assessed preoperative diagnosis of appendicitis and perforations in elderly patients in our unit to determine whether the overall higher rate of appendectomy in France (3 to 4 times higher than in anglo-saxon countries) has an effect. METHODS: We analyzed retrospectively the cases of all patients over 70 years of age who undervent appendectomy for histologically confirmed appendicitis between February 1, 1990 and 31 January 1995. RESULTS: There were 20 patients (15 women 5 men) in the study group (age range 70-89 years). The site of abdominal pain was atypical in 10 cases (50%) and acute bowel occlusion occurred in 9 (45%). The diagnosis of appendicitis was made before surgery in 10 patients; surgery was performed within 24 hours of admission in only 8. The high rate of perforations (70%) was not correlated with age. Complications occurred in 70% of the cases and were related to perforation (p < 0.02) and an American Society of Anesthesia (ASA) score > 2 (p < 0.05). CONCLUSION: Acute appendicitis in the elderly patient is a serious condition. The atypical nature of the clinical presentation in half of the patients often requires computed tomography or laparoscopy for diagnosis.

Acute Disease↗
PubMed1996

Laparoscopic compared with open appendicectomy for acute appendicitis: a prospective study.

OBJECTIVE: To assess the benefits of laparoscopic appendicectomy over open appendicectomy and to evaluate the impact of the severity of appendicitis and of peritonitis on the advantages of the laparoscopic approach. DESIGN: Prospective unrandomised study. SETTING: University hospital, Italy. SUBJECTS: 137 consecutive patients with acute appendicitis, 60 of whom were treated by open and 77 by laparoscopic appendicectomy. Patients were subdivided according to the severity of appendicitis and the presence of peritonitis. MAIN OUTCOME MEASURES: Duration of operation, consumption of analgesics, duration of hospital stay, overall complications, wound infection. RESULTS: Hospital stay (median 2.5 days, range 1-18 compared with 4, range 2-22 p < 0.0001). and wound infection (3/77 (4%) compared with 13/60 (22%), p 0.02) were significantly lower after laparoscopic operation. The incidence of wound infection was significantly lower when subgroups were analysed separately. CONCLUSIONS: Hospital stay and wound infection rates were significantly lower after laparoscopic appendicectomy. With the exception of the wound infection rate, the variables studied may differ depending on the severity of the appendicitis and the presence of peritonitis. Result of comparative studies should be carefully interpreted when the two groups are not stratified for these features.

Acute Disease↗
PubMed1995

Acute appendicitis in females--a clinical study of 366 cases.

A study was carried out on 366 female patients admitted consecutively to Asir Central Hospital with clinical diagnosis of acute appendicitis during the period between 1988 through 1991. In this study, 271 patients had histopathologically proven appendicitis for a diagnostic accuracy of 74%. Ninety-five (26%) patients did not have appendicitis, however, 27 (7.4%) of them had other disorders indicating surgical intervention. Consequently, 18.6% of the patients studied had negative laparotomy. This study showed insignificant (P > 0.05) relation between age, site of pain and its duration, presence of urinary symptoms, post-operative complications and hospitalization in one hand, and the final diagnosis on the other hand. The marital status, the presence of gynaecological symptoms, white blood cells count, neutrophils and lymphocytes percentages were, however, significantly related to the final diagnosis (P < 0.05). A conservative approach with in-hospital observation and repeated clinical examination of the doubted appendicitis cases are recommended so as to reduce the rate of the negative laparotomy with its considerable complications.

Acute Disease↗
PubMed1996

[Ultrasonographic diagnosis of acute appendicitis].

128 patients aged from 2 to 18 with symptoms of acute appendicitis were studied prospectively. Surgical procedure was performed in 58 patients (i.e. appendectomy). In 5 patients surgical findings were catarrhal inflammation, in 14 phlegmonous, in 9 gangrenous, in 15 perforated and in 13 no inflammation occurred. In 2 cases abscess periappendiceal was found intraoperatively. We considered as visualized only those appendices that were intraoperatively found at places ultrasonographically described. Ultrasonographic visualization was successful in 91.37%. The most relevant criteria for ultrasonic evaluation of the inflammation is noncompressibility noted in 97.67% of cases of appendicitis. The second criteria is thickened wall noted in 86.04% of patients. Ultrasonographic diagnosis of the abdominal fluid collections is confident: sensitivity 0.85, specificity 0.91. The diagnostic value of ultrasound findings in acute appendicitis is high: sensitivity 0.87, specificity 0.84. That is why routine ultrasound diagnostic examination in acute atypical appendicitis is recommended.

Acute Disease↗
PubMed1997

Ultrasonography in the diagnosis of acute appendicitis.

The purpose of this study was to assess our results of using graded compression ultrasonography (US) to confirm the diagnosis of acute appendicitis. Graded compression US was performed on 94 patients who presented at the Lehigh Valley Hospital, Allentown, Pennsylvania with an equivocal clinical picture of acute appendicitis. When used to diagnose acute appendicitis, US provided a specificity of 93.7%, sensitivity of 74.2%, and accuracy of 87.2%. We conclude that graded compression US was useful to rule out the diagnosis of acute appendicitis and helped to avoid unnecessary appendectomies and reduced negative laparotomies. Our results proved to be comparable to previously reported studies.

Acute Disease↗
PubMed1996

[The role of Enterobius vermicularis in etiopathogenesis of appendicitis].

The authors present 14 cases of enterobiasis of appendix observed between 1991-94, on a total of 1093 appendectomies. The presence of the parasite was associated, in the majority of cases, to a chronic appendicitis. The symptomatology imitates an attack of acute appendicitis, but the true nature of the disease is diagnosed only through a histological examination. There is probably an etiopathogenic relationship between. E. vermicularis and chronic appendicitis, whereas the relationship between the parasite and acute appendicitis is rare and very disputed.

Adolescent↗
PubMed1997

Evaluation of plasma serotonin concentration in acute appendicitis.

BACKGROUND: Due to lack of reliable biochemical/radiological markers, the diagnosis of acute appendicitis is based only on clinical features. METHODS: We estimated plasma serotonin levels in 48 patients with acute appendicitis (histologically proven), 27 patients with abdominal pain of other etiologies, and 20 healthy controls. RESULTS: The plasma serotonin levels were (mean +/- SD) 36.6 +/- 12.5 nmol/L, 12.5 +/- 3.6 nmol/L and 10.4 +/- 3.5 nmol/L in the three groups, respectively. The levels in patients with acute appendicitis were significantly higher (p < 0.001) than in the other groups, giving 93.8% sensitivity and 95.7% specificity to the test. CONCLUSION: Plasma serotonin level is a reliable marker of acute appendicitis, especially in the first 48 hours.

Abdominal Pain↗