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PubMed2000

Acute appendicitis caused by amebiasis.

We report a case of appendicitis caused by amebiasis in a 45-year-old Japanese man. He presented to our hospital with bloody stools in June 1998. Sigmoidoscopy disclosed erosion, and a biopsy of the erosion showed colitis caused by Entamoeba histolytica infection. Four months later, he was admitted to our hospital with a small elastic mass and severe pain in the lower quadrant of the abdomen, which was diagnosed as acute appendicitis. He underwent appendectomy. Histopathological examination revealed numerous E. histolytica trophozoites, and we diagnosed acute appendicitis caused by E. histolytica. The patient has been free of symptoms, colonoscopy has revealed no erosion, and biopsy has revealed no E. histolytica for 12 months after the operation.

Appendicitis↗

PubMed2004

Appendicitis in incarcerated femoral hernia.

BACKGROUND: Femoral hernia can rarely present with the content of appendicitis. We report on an elderly female who was admitted to our emergency department with a painful groin mass. METHODS: An 85-year-old woman presented with a 7-day history of right groin pain and swelling. She also had complaints of nausea, vomiting, and right lower quadrant abdominal pain. Physical examination revealed a right groin mass in the femoral region, which was painful on examination. Abdominal examination ended with normal findings except bilateral lower quadrant tenderness. Ultrasonographic examination revealed a hernia sac containing suspected aperistaltic bowel segment with edematous wall. RESULTS: The patient underwent surgery. During exploration of the right groin region, a strangulated femoral hernia sac containing appendicitis was detected. CONCLUSION: Surgeons should be aware of the existence of this kind of atypical presentation of appendicitis.

Abdominal Pain↗

PubMed2005

Procalcitonin as a predictor of severe appendicitis in children.

The aim of this study was to assess the diagnostic value of procalcitonin (PCT) in 212 children with appendicitis and compare it with that of the standard diagnostic modalities, C-reactive protein (CRP) level, leukocyte count, and abdominal ultrasound findings, in relation to the surgical and histological findings of the appendix. A PCT value of >0.5 ng/ml was found to be indicative of perforation or gangrene with 73.4% sensitivity and 94.6% specificity, a CRP level of >50 mg/l and a leukocyte count of >10(4)/mm3 were useful diagnostic markers for perforation, while abdominal ultrasonography had a sensitivity of 82.8% and a specificity of 91.2% for detecting appendicitis with imaging findings. PCT measurement seems to be a useful adjunctive tool for diagnosing acute necrotizing appendicitis or perforation, and surgical exploration will probably be required in patients with PCT values >0.5 ng/ml.

Appendicitis↗

PubMed1981

Clinical significance of elevated serum and urine amylase levels in patients with appendicitis.

During the 45 month period beginning January 1977, 251 patients with a pathologically confirmed diagnosis of acute appendicitis underwent celiotomy at the Medical College of Virginia Hospital. A preoperative serum or urine amylase determination was recorded in 155 of the patients (62 percent). Of this group, 15 patients (10 percent) had elevation of serum amylase or 2 hour urine amylase. Hyperamylasemia or hyperamylasuria directly led to misdiagnosis or treatment delay in 5 of the 15 patients. Appendiceal rupture occurred in three patients, two of whom had prolonged (greater than 1 month) hospitalizations directly attributable to the misdiagnosis. As a result of this study, we conclude that (1) acute appendicitis and elevated amylase levels may occur concurrently, (2) hyperamylasemia or hyperamylasuria should not dissuade the surgeon from early operation if other clinical features suggest appendicitis, and (3) abdominal pain and elevation of amylase level define significant intraabdominal disease, not specifically pancreatic disease.

Adolescent↗

PubMed1984

Role of obstruction in the pathogenesis of acute appendicitis.

The role of obstruction in the pathogenesis of acute appendicitis was studied by measuring the pressure in the appendix perioperatively in 24 patients operated on with an appendectomy because of suspected acute appendicitis. The technique used involved inserting a fine needle through the apex into the appendix lumen and measuring the hydrostatic pressure required to inject saline solution. In three patients with a gangrenous appendix found at operation, and in two patients with a phlegmonous appendix, there were signs of obstruction of the appendix lumen as revealed by increased pressure within it. In 14 patients with a phlegmonous appendix found at operation, no signs of obstruction were found. These experimental data suggest that obstruction is not an important causative agent of acute appendicitis, but might develop as a result of the inflammatory process.

Appendectomy↗

PubMed1994

Peritoneal cultures and antibiotic therapy in pediatric perforated appendicitis.

We retrospectively reviewed 70 cases of perforated appendicitis in children to examine the relationship between postoperative antibiotic selection and culture results from the peritoneal cavity. Initial antibiotic therapy chosen for the children consisted of a three-drug combination in 54 (77%) patients. Peritoneal cultures were performed in 58 (83%) patients. Escherichia coli and Bacteriodes fragilis were the most common bacterial isolates from the peritoneal culture. Only 7 (10%) patients had their antibiotic regimen changed after the culture results were available, of which 2 changes brought drug therapy into compliance with the cultures and 5 changes were inappropriate with respect to the peritoneal cultures. Of the remaining 51 patients with culture data available, 39 should have had changes to bring the antibiotic therapy into compliance with the observed culture results. These data indicate that surgeons select antibiotic therapy for perforated appendicitis in children based on assumptions of which organisms should be present in the infection and not on culture data. There appears to be no clinical usefulness to the routine culturing of the peritoneal cavity in children with perforated appendicitis.

Anti-Bacterial Agents↗

PubMed1993

A clinical comparison of cefepime and metronidazole versus gentamicin and clindamycin in the antibiotic management of surgically treated advanced appendicitis.

Many antibiotics and antibiotic combinations are used for the treatment of peritonitis because of advanced (gangrenous or perforated) appendicitis. An aminoglycoside combined with an antianaerobe antibiotic is one standard treatment, but there is concern about the potential nephrotoxicity of the aminoglycoside and the necessity for monitoring aminoglycoside blood levels. Cefepime, a new broad-spectrum cephalosporin with a prolonged serum half-life, has excellent activity against gram-positive and gram-negative bacteria, including Pseudomonas aeruginosa. Its spectrum of activity is similar to the aminoglycosides, but it has less potential for inducing renal injury. A double-blind, randomized study compared cefepime, 2 grams every 12 hours IVPB plus metronidazole 0.5 grams every eight hours IVPB (C/M) with gentamicin 1.5 milligrams per kilograms of IVPB plus clindamycin 0.9 grams q eight hours IVPB (G/C), administered up to 14 days, in 96 surgically treated patients with gangrenous or perforated appendicitis. Fifty patients had advanced appendicitis (nine gangrenous and 41 perforated) in the C/M group and 46 patients (six gangrenous and 40 perforated) in the G/C group. The mean number of days of postoperative fever (C/M, 4.4 +/- 2.7 versus G/C, 5.0 +/- 2.2), postoperative hospitalization (C/M, 2.0 +/- 1.9 versus G/C, 2.0 +/- 2.1) and antibiotic therapy (C/M, 6.3 +/- 1.9 versus G/C, 6.9 +/- 1.9) was similar in the two treatment groups. There were 11 treatment failures (C/M, three; G/C, eight; p = 0.13), six of which were probably a result of enterococci. No deaths occurred. Our study results show that the efficacy of cefepime plus metronidazole is equivalent to that of clindamycin plus gentamicin.

Adolescent↗

PubMed1992

The necessity of prophylactic antibiotics in uncomplicated appendicitis during childhood.

A prospective, randomized, clinical study was done to evaluate the place of prophylactic antibiotics in uncomplicated childhood appendicitis. One hundred patients with uncomplicated appendicitis were randomly assigned to one of four groups, each consisting of 25 cases. Group 1 patients did not receive prophylactic antibiotic. Group 2, group 3, and group 4 patients received ornidazole, penicillin plus tobramycin, and piperacillin, respectively. The use of prophylactic antibiotics did not yield better results than the use of placebos. The rarity of infectious complications after uncomplicated appendicectomy may be unique for children. Although the need for antibiotic prophylaxis is well documented in adults, the rarity of infectious complications makes it highly questionable in the treatment of uncomplicated appendicitis in children.

Acute Disease↗

PubMed1994

Thoracic empyema in a patient with acute appendicitis: a rare association.

Thoracic empyema and appendicitis rarely are concomitant. This is the first report of ultrasonography and computed tomography being used preoperatively to establish the diagnosis of ruptured appendicitis in a child with thoracic empyema. The perforated appendicitis was identified after gastrointestinal flora were cultured from the thoracostomy drainage of the empyema.

Acute Disease↗

PubMed1988

The lack of importance of Lanwei point in the diagnosis of acute appendicitis.

Fifty patients with a presumptive diagnosis of acute appendicitis based on usual Western medicine criteria (e.g., McBurney point tenderness, increase WBC, history of nausea, etc.) were examined prospectively for tenderness of the Lanwei acupoint, just prior to the administration of general anesthesia, to evaluate this well known 'Appendix' point as a useful aid to diagnosing appendicitis. The presence or absence of tenderness was statistically not a good indicator of appendicitis.

Acupuncture Therapy↗

PubMed1993

Ultrasound documentation of spontaneously resolving appendicitis.

Diagnostic ultrasound has been reported to be a highly specific technique for the confirmation of acute appendicitis. The authors report the case of a 27-year-old male who presented with clinical, laboratory, and classic ultrasound findings indicating early acute appendicitis. The patient's condition resolved spontaneously without operative intervention, and repeat sonography 2 weeks later was entirely normal. Ultrasound examination may allow documentation of spontaneously resolving appendicitis.

Acute Disease↗

PubMed1994

Delayed appendicitis from an ingested foreign body.

An unusual case of acute appendicitis induced by a metal drill bit that was ingested by a 27-year-old man 3 years before presentation is reported. This foreign body lodged in the patient's appendix and developed a fecalith coating. When this fecalith coating enlarged enough to obstruct the appendiceal lumen, the patient presented with classic acute appendicitis. Foreign body-induced appendicitis is reviewed.

Acute Disease↗

PubMed1996

Technetium-99m IgG immunodetection of acute appendicitis in rats.

The efficacy of Tc-99m-labeled intact polyvalent human immune globulin (IgG) for the early localization and detection of acute appendicitis was evaluated by an animal model. Acute appendicitis was surgically produced in adult Sprague-Dawley white rats by ligating a 3-cm segment of the caecum and inoculating with E. coli. After 4-5 days, nuclear scintigraphy was performed following intravenous injection of 5 mCi of Tc-99m IgG via the tail vein. Appendiceal and colonic infections were clearly visualized by Tc-99m IgG scans within 30 min postinjection and confirmed by autopsy and tissue distribution data. With the exception of the liver, the kidneys, and the urinary bladder, abdominal tissue background activity was minimal. These findings suggest that Tc-99m-labeled intact IgG may have potential clinical application in the early detection and diagnosis of acute appendicitis in emergency medicine.

Acute Disease↗

PubMed2003

Is delayed operative treatment worth the trouble with perforated appendicitis is children?

BACKGROUND: Approximately 30% to 50% of appendicitis in children is already perforated at presentation. The optimal management of these children remains controversial. METHODS: Ninety-six children (aged 2 to 16 years) were treated for perforated appendicitis. Seventy-one underwent immediate appendectomy and drainage of abscess, if present (group I). In the other 25 an attempt was made to treat with intravenous antibiotics, combined with transrectal (4) or percutaneous (2) drainage of abscess. This treatment was successful in 16 patients (group II), who underwent appendectomy 6 to 8 weeks later, and unsuccessful in 9 patients (group III), who underwent appendectomy 3 to 12 days later. RESULTS: The mean length of stay was as follows: group I, 6.7 days; group II, 8.9 days; and group III, 10.9 days (not significant). The white blood cell count (WBC) at presentation was group I, 18.6 K; group II, 17.9 K; group III, 18.8 K. The percent fall of WBC on day 4 was group I, 55%; group II, 25.5%; group III, 17% (P >0.05 versus groups I and II). Twenty of 71 patients in group I (28%) developed wound infection (5), pelvic abscess (14), and pancreatitis (1), while 2 of 16 (12.5%) of group II and 1 of 9 (11%) of group III patients required readmission (both P <0.05 versus group I). CONCLUSIONS: These data show that initial antibiotic treatment of perforated appendicitis in children, followed by interval appendectomy, is useful for a select group who present with little or no peritonitis, slightly elevated temperature, and WBC that falls at least 25% within 3 to 4 days.

Acute Disease↗

PubMed2005

A systematic review of whether oral contrast is necessary for the computed tomography diagnosis of appendicitis in adults.

BACKGROUND: There are several methods of contrast administration when performing computed tomography (CT) scanning for suspected appendicitis. In this systematic review we evaluated the diagnostic performance of CT with and without contrast material. METHODS: Twenty-three reports were identified using a Medline search. RESULTS: The aggregated diagnostic performance characteristics of all modes of CT scanning were excellent with a range of sensitivity (83--97%), specificity (93--98%), positive predictive value (86--98%), negative predictive value (94--99%), and accuracy (92--97%). The diagnostic performance of CT without oral contrast was similar (sensitivity, 95% vs. 92% [not statistically significant]; negative predictive value, 96% for both protocols) or surprisingly better (specificity, 97% vs. 94%; positive predictive value, 97% vs. 89%; accuracy, 96% vs. 92%; P<.0001) than with oral contrast. CONCLUSIONS: Noncontrast CT techniques to diagnose appendicitis showed equivalent or better diagnostic performance compared with CT scanning with oral contrast. A prospective comparative trial of CT with and without oral contrast for appendicitis should be performed to assess the adequacy of this modality.

Appendicitis↗

PubMed2005

[Acute appendicitis in children: is there an histo-clinical correlation?].

Diagnosis of appendicitis in children represents a continuing diagnostic dilemma for emergency room physicians and paediatric surgeons. If unnecessary surgery should be avoided, delayed diagnosis and treatment of appendicitis is responsible for complications. Use of a diagnostic clinical score may improve the management of children with abdominal pain. A prospective evaluation of an appendicitis score is presented here.

Abdominal Pain↗

PubMedDate not supplied

When should we order a CT scan and when should we rely on the results to diagnose an acute appendicitis?

OBJECTIVE: The objective of this study was to retrospectively analyze the last 100 consecutive emergency appendectomies performed in the authors' institution, which is a community-based teaching hospital, and look at the accuracy of the CT scan in the diagnosis of acute appendicitis. DESIGN: Retrospective clinical study. SETTING: A 600-bed community-based teaching hospital. METHODS: The last 100 consecutive emergency appendectomies, which were performed at New York Methodist Hospital in 2004, were retrospectively analyzed. The collected data included the demographics of the patients, relevant history, physical examination, laboratory and radiological tests, and pathology results. The statistical analyses were performed using the JMP version 3.2 software (SAS Institute Inc., Cary, North Carolina). An alpha value of 0.05 was used in all statistical analyses, and p values were considered as being statistically significant at or below the alpha value of 0.05. RESULTS: There was no statistically significant correlation between the acute appendicitis and some of the typical presenting symptoms and signs of acute appendicitis (rebound tenderness, low-grade fever, elevated white blood cell count, and anorexia). The sensitivity, specificity, positive predictive value, and negative predictive value of the CT scan in this retrospective analysis were 96%, 75%, 98.5%, and 50%, respectively, with an overall efficiency of 95%. However, the sensitivity, specificity, positive predictive value, and negative predictive value of the CT scan increased after reevaluation of the false-positive, false-negative, and inconclusive CT results by an experienced radiologist in a blind fashion (97%, 100%, 100%, and 71%, respectively). The correlation between the CT scan and the pathology result was statistically significant when the CT result was positive or negative (p = 0.0001). CONCLUSION: The CT scan is indicated when the clinical presentation is equivocal, and it will be helpful if the result is positive or interpreted as negative only by an experienced radiology attending.

Acute Disease↗

PubMed2004

Insurance status and race represent independent predictors of undergoing laparoscopic surgery for appendicitis: secondary data analysis of 145,546 patients.

BACKGROUND: Studies have shown that racial and socioeconomic differences lead to inequality in access to health care. It is unknown whether insurance status and race affect the choice of surgical treatment for patients presenting with appendicitis. STUDY DESIGN: Patients with primary ICD-9 procedure codes for laparoscopic and open appendectomy were selected from the 1998, 1999, and 2000 Nationwide (US) Inpatient Samples. The primary predictor variables were insurance status (private, Medicare, Medicaid, other) and race (Caucasian, African American, Hispanic, other). Multiple logistic regression models were used to assess whether insurance status and race are associated with the choice of surgical procedure for patients presenting with appendicitis. RESULTS: Discharge abstracts of 145,546 patients were used for our analyses. There were 32,407 patients (22.3%) who underwent laparoscopic appendectomy and 113,139 patients (77.7%) who had open appendectomy. Although 24.2% of privately insured patients underwent laparoscopic appendectomy, only 16.9% of Medicare patients, 17.4% of Medicaid patients, and 19.6% of patients in the "other" insurance category were treated using the laparoscopic procedure (p < 0.001). Caucasian patients underwent laparoscopic surgery in 24.8%, African Americans in 18.6%, Hispanics in 19.6%, and other ethnicities in 18.8% of patients (p < 0.001). Compared with the Medicaid subset, and after adjusting for potential confounders such as age, gender, race, patient comorbidity, median ZIP code income, hospital location and teaching status, and presence of abscess or perforation, privately insured patients (odds ratio [OR] = 1.26, 95% [CI [1.20, 1.33], p < 0.001) and Medicare patients (OR = 1.17, 95% CI [1.05, 1.30], p = 0.004) were significantly more likely to undergo laparoscopic surgery. Caucasian patients (OR = 1.42, 95% CI [1.33, 1.51], p < 0.001) and Hispanics (OR = 1.12, 95% CI [1.04, 1.20], p = 0.002) were significantly more likely to have laparoscopic appendectomy, compared with African Americans, even after adjusting for the previously mentioned confounders and insurance status. CONCLUSIONS: Even after adjusting for potential confounders, insurance status and race are marked independent predictors of having laparoscopic surgery in patients treated for appendicitis in this sample.

Adult↗