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PubMed2006

Effects of delaying appendectomy for acute appendicitis for 12 to 24 hours.

OBJECTIVE: To determine whether delaying appendectomy for 12 hours to avoid disturbing the operating room schedule and to minimize the number of operations during the night negatively affects the outcome of patients with acute appendicitis. DESIGN: Retrospective study. SETTING: Large teaching community hospital. PATIENTS: The medical records of 380 patients who underwent appendectomies between January 1, 2002, and December 31, 2004, were reviewed. Patients proven to have an inflamed appendix on the pathological report were divided into 2 groups. The early group comprised patients who had undergone appendectomies within 12 hours of presentation to the emergency department, including patients with generalized sepsis. The late group comprised patients who had undergone appendectomies more than 12 to 24 hours after presentation. MAIN OUTCOME MEASURES: Length of stay, operative time, and the rate of perforations and complications. INTERVENTIONS: Laparoscopic or open appendectomies. RESULTS: There were 309 patients included in our study. There were no statistically significant differences between the early and late groups in the length of stay, operative time, the percentage of advanced appendicitis, or the rate of complications. CONCLUSIONS: In selected patients, delaying appendectomies for acute appendicitis for 12 to 24 hours after presentation does not significantly increase the rate of perforations, operative time, or length of stay. It decreases the use of the nursing staff, anesthesia team, and surgical house staff during the night shifts, and it decreases the interruption of the regular operating room schedule.

Acute Disease↗
PubMed1975

Appendicitis. A critical review of diagnosis and treatment in 1,000 cases.

One thousand cases of appendicitis seen from 1963 to 1973 were reviewed. The overall negative appendectomy rate was 20%, but in women between ages 20 and 40 it exceeded 40%. Two thirds of the negative appendectomies were due to nonsurgical lesions. Mesenteric adenitis, gastroenteritis, and abdominal pain of unknown cause accounted for one third of the errors in females and two thirds in males. These diseases were best distinguished from appendicitis on the basis of temperature and white blood cell count. The remainder of the errors in females were due to pelvic inflammatory disease or other gynecologic diagnosis and were best distinguished from appendicitis on the basis of history and physical findings. The rate of perforation was 21% overall. The incidence of wound infection was 8.5%. Use of systemic antibiotics did not affect the wound infection rate.

Adolescent↗
PubMed1976

Basilar pneumonia simulating acute appendicitis in children.

Twelve children with acute abdominal pain, which was suspected of being acute appendicitis, were subsequently found to have lower lobe pneumonia. Diagnostic barium enema or operative exploration failed to demonstrate any appendiceal abnormality. The abdominal symptoms and the ileus subsided soon after the initiation of antibiotic therapy. Contrary to common belief, it was observed that left-sided pneumonia is capable of mimicking appendicitis almost as frequently as right-sided pneumonia. Since the likelihood of acute appendicitis accompanying pneumonia is small, operative intervention is rarely indicated and should be undertaken only after careful and intensive investigation.

Abdomen, Acute↗
PubMed1977

The value of the barium enema in the diagnosis of acute appendicitis.

Contrary to popular belief, the barium enema is a safe diagnostic tool in the management of acute appendicitis. This is a survey of our experience over three years with 489 cases of suspected acute appendicitis. Two hundred eighteen barium enema examinations were done. The barium enema has a high degree of pathological correlation (97.14%). It has reduced negative surgical exploration in women between 11 and 40 years of age. This group traditionally represents the greatest diagnostic challenge in appendicitis. As a result, our negative exploration rate has been reduced to a figure below the average for this disease. We recommend its performance in all patients who pose a diagnostic dilemma.

Acute Disease↗
PubMed1979

Appendicitis in acute leukemia.

The cases of five children with acute leukemia complicated by appendicitis were reviewed. All but one child had typical signs and symptoms of acute appendicitis, though four children were receiving prednisone. All five children underwent appendectomy, and all survived the immediate postoperative period. One child had a spontaneous remission following appendectomy. Two of three children in relapse suffered serious postoperative complications. Our experience supports the surgical management of appendicitis in acute leukemia.

Acute Disease↗
PubMed1981

Specific diseases mimicking appendicitis in childhood.

Of 1,039 children who underwent exploratory surgery with a preoperative diagnosis of acute appendicitis, 112 (11%) did not have suppurative, gangrenous, or perforated appendices. A specific disease other than appendicitis was found in 43 of these 112 children. Three fourths of these children (32/43) had their pathologic process diagnosed at the time of operation: one fourth (11/43) had the diagnosis made postoperatively on the basis of culture, histologic examination, roentgenograms, laboratory studies, or repeated exploratory surgery. More than half (24/43) required operation to treat the disease encountered. Although most of these children had diseases of the adjacent ileum and cecum or the pelvic adnexae, a number had disease outside the immediate operative field. A nonindurated appendix encountered at the time of operation for childhood appendicitis requires a thorough intra-abdominal exploration to exclude another disease that requires operative therapy.

Abdomen↗
PubMed1986

Acute appendicitis in women of childbearing age.

To find a way to decrease the incidence of laparotomies negative for appendicitis, we studied 108 female patients between the ages of 15 and 45 years who had undergone appendectomy with the diagnosis of acute appendicitis. Of these 108 patients, 56 had acute appendicitis and 52 had normal appendixes. The patients between the ages of 15 and 25 years had a 59% incidence of negative laparotomies, in comparison with those patients between 36 and 45 years old, who had an incidence of 22%. In patients with normal appendixes, 18 had no intra-abdominal pathologic findings. Twenty had pelvic inflammatory disease, and nine had ovarian abnormalities. There were no differences in the clinical symptoms, vital signs, roentgenographic findings, or other laboratory studies between the two groups. There were no in-hospital perforated appendixes in the patients who were operated on within 48 hours of admission. To decrease the incidence of negative appendectomies, we recommend in-house observation and simultaneous examination of the patient by the surgeon and a gynecologist.

Acute Disease↗
PubMed1987

The treatment of complicated appendicitis in children. What is the gold standard?

From 1976 to 1985, 233 consecutive children were treated for appendicitis by a standardized protocol. Forty-nine percent of these cases were complicated: 11% by gangrene, 33% by perforation, and 4% by perforations with well-developed abscesses. Treatment of gangrenous and perforated appendicitis consisted of administration of ampicillin sodium, gentamicin sulfate, and clindamycin phosphate; appendectomy; and saline peritoneal irrigation. Transperitoneal drainage was not used. Skin and subcutaneous tissues were left open for delayed primary wound closure. Perforations with well-developed abscesses were treated with triple antibiotic therapy and interval appendectomy. The only infectious complication was one intra-abdominal abscess. There were no wound infections or deaths. The rate of infectious complications was 0.9%, and the overall morbidity was 4.4%. This standardized treatment of complicated appendicitis in children prevents wound infection and significantly decreases the incidence of intra-abdominal abscess formation and mortality.

Abscess↗
PubMed1991

Does the retrocecal position of the vermiform appendix alter the clinical course of acute appendicitis? A prospective analysis.

Ninety-four adult patients undergoing appendectomy for acute appendicitis were prospectively studied during a 2-year period. Patients were divided into retrocecal (group 1; n = 27 [29%]) and anterior (group 2; n = 67 [71%]) groups according to the position of the appendix. There was no statistical difference between the two groups in duration of symptoms, presenting signs and symptoms, and initial white blood cell count. Furthermore, retrocecal appendicitis was not associated with a higher rate of perforation or increased morbidity. We conclude that the retrocecal position of the appendix does not alter the presentation of appendicitis.

Acute Disease↗
PubMed1993

Cytomegalovirus appendicitis in a patient with human immunodeficiency virus infection. Case report and review of the literature.

We report a case of chronic abdominal pain with subsequent development of acute right lower quadrant tenderness in a patient infected with the human immunodeficiency virus. Ultrasonography and computed tomography revealed an enlarged appendix. On subsequent laparotomy, the patient was found to have appendicitis due to cytomegalovirus. Six additional cases of this infection were identified in a review of the literature. The course of cytomegalovirus appendicitis in these patients was prolonged and atypical compared with noncompromised patients with acute appendicitis. Because perforation may occur, surgery is advocated when this diagnosis is suspected in the patient infected with human immunodeficiency virus.

Adult↗
PubMed1996

Management of complicated appendicitis. A rational approach based on clinical course.

OBJECTIVE: To better define the appropriate management of children with complicated appendicitis, using an outcome approach based on clinical parameters. DESIGN: Retrospective study. SETTING: A 500-bed tertiary care university-based hospital. PATIENTS: Fifty-six consecutively admitted children (age <19 years) with a diagnosis of complicated appendicitis (gangrenous or perforated) confirmed at laparotomy. INTERVENTION: All children were managed postoperatively using an institutionally established protocol requiring hospitalization and broad-spectrum intravenous antibiotics until three criteria were met permitting discharge: (1) resolution of fever for 24 hours; (2) normalization of white blood cell count; and (3) normal results of clinical examination. MAIN OUTCOME MEASURES: Length of stay, costs, and infectious complications. RESULTS: Overall, infectious complications occurred in only two patients (3.5%). No complications occurred in any patient who met the criteria for discharge. The average length of stay for all patients was 5.1+/-3.0 days (range, 3 to 18 days). Using this approach instead of current standards reported in the literature resulted in an estimated savings of over $4000 per patient and $224000 for the entire cohort. CONCLUSIONS: Postoperative management of complicated appendicitis can be safely based on a defined clinical algorithm that should replace empirical therapy as the "gold standard."

Adolescent↗
PubMed1977

Villous adenoma causing acute appendicitis.

Acute appendicitis is the most common of surgical emergencies. However, it is very unusual to find a benign neoplastic lesion causing appendicitis. Adenomas of the caecum or the appendix are rare and very few cases of these associated with appendicular inflammation have been described. This report presents a case of acute appendicitis with perforation resulting from obstruction by an adenoma. The management of the condition is discussed.

Acute Disease↗
PubMed1985

Acute appendicitis in the over-sixty age group.

58 (37 per cent) of the 155 patients over the age of 60 years presenting with appendicitis at East Birmingham Hospital from 1970 to 1982 were found to have perforated appendices; the corresponding proportion under the age of 60 was 346 out of 3608 patients (10 per cent), the difference being statistically significant (P less than 0.001). The delay before surgery and the length of in-patient treatment were significantly longer in the group who perforated, and the mortality was greater, although not achieving significance. Examination of the yearly incidence reveals neither an increasing trend of appendicitis in elderly patients, nor an increase in the perforation rate over the period studied. Delay, at all stages, appears to be the major factor responsible for the higher rate of perforation in this age group; only by an increased awareness of appendicitis in the elderly can this risk be minimized.

Acute Disease↗
PubMed1992

Role of sequential leucocyte counts and C-reactive protein measurements in acute appendicitis.

The accurate clinical diagnosis of acute appendicitis is difficult, and many techniques have been suggested to improve diagnostic accuracy such as laparoscopy, ultrasonography and barium enema examination. In this study serial total leucocyte counts and serial C-reactive protein (CRP) concentrations in acute appendicitis were measured. The sensitivity and specificity of serial leucocyte counts in acute appendicitis were 92 and 100 per cent, and for CRP concentrations 69 and 75 per cent, respectively. The sensitivity and specificity of serial total leucocyte counts fulfilled the criteria for a diagnostic test. It is suggested that in patients with equivocal clinical findings, clinical observation combined with serial leucocyte counts may improve decision making.

Acute Disease↗
PubMed1995

Degenerated uterine leiomyoma mimicking acute appendicitis: sonographic diagnosis.

The present study reviews four cases in which degenerated uterine leiomyomas mimicked appendicitis clinically. The correct diagnosis was made prospectively by sonography in each case. Appendicitis was excluded by graded compression sonography and an exophytic uterine leiomyoma was identified at the point of maximal symptoms. The leiomyomas demonstrated central hypoechoic foci, but no detectable Doppler flow indicating necrosis. Although the phenomenon of a degenerated uterine leiomyoma mimicking appendicitis clinically is known, sonographic diagnosis has not been reported previously. The importance of making this diagnosis sonographically is that management of a degenerated leiomyoma is conservative and unnecessary surgery could be avoided.

Acute Disease↗
PubMed1993

Acute appendicitis is rarely the initial presentation of cecal cancer in the elderly patient.

Acute appendicitis is rarely the initial presentation of carcinoma of the cecum in elderly patients. A 20-year retrospective review of all patients 65 years of age or older presenting with proven acute appendicitis at the Montefiore Medical Center confirms this opinion. In only 1.8% of patients was acute appendicitis the initial presentation of an underlying carcinoma of the cecum.

Acute Disease↗
PubMed1996

Peritoneal interleukin-8 in acute appendicitis.

Interleukin-8 (IL-8) is a chemoattractant that is highly selective for neutrophils. This study was designed to investigate the presence of IL-8 in peritoneal fluid of patients with acute appendicitis. The clinical circumstances underlying the secretion of IL-8 by mesothelium and its mechanism of activation have not been defined. In an in vitro model for bacterial peritonitis the role of bacteria in activating human mesothelial cells to secrete IL-8 was studied. Cultured human mesothelium was incubated with various species of pathogenic bacteria, isolated from peritoneal exudate fluids of patients with appendicitis. The amount of IL-8 secreted by the cultured mesothelial cells was determined in an IL-8 ELISA, as IL-8 was present in the original peritoneal fluid of these patients. Peritoneal fluids from patients with a perforated appendix were found to contain a significantly higher concentration of IL-8 compared to peritoneal fluids from patients with nonperforating appendicitis (121.6 (57.8) ng/ml versus 0.2 (0.07) ng/ml, respectively; mean (SEM), P < or = 0.01). Species of Bacteroïdes and Fusobacterium necrophorum induced IL-8 secretion from cultured mesothelial monolayers to levels comparable to those found in peritoneal fluids in vivo. Heat-killed bacteria and bacterial supernatant were also able to stimulate mesothelium to secrete IL-8. The results suggest that in the early phase of bacterial peritonitis the influx of PMN is regulated by bacteria-induced IL-8 secretion by the mesothelium lining the peritoneal cavity.

Acute Disease↗
PubMed1995

Laparoscopic versus conventional surgery for suspected appendicitis in women.

The diagnosis of appendicitis remains uncertain in female patients and laparoscopy has been suggested as a valid diagnostic tool. The laparoscopic approach has recently also been proposed for the treatment of acute appendicitis, though its real value is still under debate. A clinical and economic prospective evaluation of laparoscopic surgery over a 1-year period in female patients is reported. The study involved 38 patients presenting with signs of appendicitis and assigned to open (18) or laparoscopic surgery (20). The two groups were comparable as regards age and clinical presentation of the disease. The duration of the procedures was similar (60 min). Morbidity was comparable (3 vs 2). The ratio of negative appendectomy (50% vs 44%) was also similar, but the laparoscopic approach enabled a higher number of certain diagnoses (9/10 vs 3/8 p > 0.05). No significant differences were observed in the median postoperative stay (3 days for laparoscopy and 4 for surgery) or in the days needed to return to normal activity (15 vs 18). The cosmetic satisfaction was higher for the laparoscopic patients. The cost of the laparoscopic approach, however, was much higher than for conventional surgery. Our results suggest that laparoscopy is a useful diagnostic tool in female patients, but that laparoscopic appendectomy should be considered with some caution in times of restricted financial resources.

Acute Disease↗