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PubMed1996

[Ultrasound diagnosis of acute appendicitis--possibilities and limits of the method--results of prospective and retrospective clinical studies].

AIM: In the diagnosis of appendicitis high-resolution ultrasound has become "gold standard" among the imaging methods. The ranking of the method and its dependence on the experience of the examiner, the quality of different ultrasound machines and the time of the examination, were examined in a trial during a 7-year period. METHOD: In 905 patients examination by the surgeon was followed by ultrasound. The results were compared with clinical or histological diagnosis. RESULTS: In a prospective study we examined sonographical 367 patients with the diagnosis of "appendicitis" at admission. The sensitivity was 75.3%, the specificity 96.2%. In a retrospective analysis of 538 patients with appendectomy, the sensitivity was 50.5% and the specificity 95.4% in pre-operative diagnosis. If the examination was done by a less experienced examiner (less than 500 ultrasound examinations/year) the sensitivity was 45.1% and specificity 93.6%; an experienced doctor (500-1000 ultrasound examinations/year) achieved 57.9 and 92.9% and a highly qualified investigator (more than 1000 ultrasound examinations/year) a sensitivity of 73.9% and a specificity of 97%. If the examination was realised with high frequency ultrasonic scanning (10 MHz), sensitivity (73.9%) and specificity (96.3%) could be increased. Essential for an exact diagnosis was a short-term period between ultrasound examination and intra-abdominal diagnosis. CONCLUSION: Optimal sonographical appendicitis diagnosis must be based on a combination of a qualified examiner, high-resolution ultrasound and short-term follow-up.

Acute Disease↗
PubMed1989

[Routine sonography in suspected appendicitis. A trial of 24-hour screening at a general hospital].

A prospective study was conducted to determine the diagnostic value of sonography in suspected acute appendicitis. From September 1987 until May 1988, the end of the study, 152 patients suspected of having "acute appendicitis" were admitted to hospital. In contrast to other recently published studies conducted by a few highly qualified examiners, we dimed at determining whether this method is useful as a 24-hour-screening performed ba y number of more or less qualified examiners. In the beginning, the patients were examined with a 3.5 MHz scanner, later on exclusively with 5 MHz linear and sector scanners. 150 cases could be evaluated, 96 of which underwent surgery. We found 35 sonographically correct results, 89 correctly negative, 4 false positive and 13 false negative diagnoses. This means a sensitivity of 73% and a specificity of 96% for the sonographical diagnostic method. In 20 cases (13%) sonography led to other diagnoses. A large majority of these findings can be detected by less experienced examiners. The goal of a 24-hour-screening could not be reached because there a competent examiner was not always available at night. It became clear that clinically obvious cases do not require sonographic conformation. The value of sonography lies with doubtful cases of appendicitis: if the ultrasound examination is negative, appendectomy can be postponed; if sonography leads to other differential diagnoses, appropriate therapy can be started immediately.

Adolescent↗
PubMed1988

[What does ultrasound study contribute in acute appendicitis (using dosed compression)?].

The value of ultrasound in diagnosing acute appendicitis has been examined in a prospective study of 103 patients. Only those patients with an uncertain diagnosis of acute appendicitis were included in the study. We used a 5 or 7.5 MHz linear array transducer applying graded compression. An acutely inflammatory appendix appeared as a tubular structure with a diameter of 3 to 12 mm. The sensitivity of the examination in our material was 82%, the specificity 97%. The main reason for the relatively low sensitivity were cases with a retrocaecal position of the appendix. Ultrasound can be recommended as a highly specific but less sensitive imaging method for the diagnosis of acute appendicitis in clinically equivocal cases.

Abscess↗
PubMed1991

Chronic recurrent appendicitis. A clinicopathologic study of 47 cases.

As part of a retrospective study 47 appendices from patients with a clinical and morphologic diagnosis of chronic recurrent appendicitis were studied by morphologic and immunohistochemical methods. Appendices with chronic recurrent appendicitis histologically show chronic active inflammation with increased numbers of immunocompetent cells, mostly T lymphocytes and subsequent scarring. In addition, there is an increase in the number of neural cells. Apparently the secretion of neurotropic inflammatory mediators, especially by activated and degranulating eosinophils, leads to a stimulation of nociceptive receptors and thus to the clinical symptoms. The diagnosis of recurrent chronic appendicitis is thus warranted in these cases not only clinically but also on the basis of histologic and immunohistochemical findings.

Adolescent↗
PubMed1986

[Antibiotic treatment of perforated appendicitis in childhood--a prospective study].

A prospective randomised study (I) was carried out on 130 children undergoing laparotomy for perforated appendicitis. The present study evaluates the therapeutic effectiveness of different antibiotic regimens in modifying the rate of post-operative complications (intraabdominal abscess, ileus, wound infiltration or abscess). During the first year of this study two treatment groups were used. Group A consisted of 29 children treated with Sulfometrol/Trimethoprim; the rate of postoperative complications was 44.8%. Group B consisted of 36 children treated with mezlocillin, the rate of complications being 13.8%. However, the same treatment with mezlocillin during the second year of the prospective study showed an increase of this rte to 39% (28 children--group C). The final group of 37 children was treated during the second year with mezlocillin and metronidazole (group D). The postoperative rate of complications was 10.8%. A retrospective analysis of further 80 children (study II) with perforated appendicitis treated with mezlocillin and metronidazole showed a consistent low rate of postoperative complications at 10.2%. In 6.8% of children studied, an operative intervention was necessary (four cases of ileus, four wound abscesses). The mean postoperative hospitalisation period decreased from 22.7 days in group A to 15.2 days in group D and finally to 14 days in study II. The present study shows that an effective and persistent attenuation of the rate of postoperative complications after perforated appendicitis in children depends on an early onset of therapy and on the appropriate choice of antibiotic drugs that are effective against aerobic and anaerobic microorganisms.

Anti-Bacterial Agents↗
PubMed1990

[Sonography in suspected appendicitis: a decisive factor in diagnosis and therapy? Results of a prospective study of 669 patients].

The appendectomy-rate in the Federal Republic of Germany is decreasing. German surgeons have begun to refuse appendectomy if there are no signs of acute inflammation. Preoperative assessment of patients with right lower quadrant pain has acquired new significance. The authors report on 2 years of experience with routine use of high-resolution ultrasonography in 669 cases of suspected acute appendicitis. Only 101 patients (= 15.1%) turned out to be suffering from acute appendicitis. Ultrasonography evaluation was found to have a sensitivity of 84.2%, a specificity of 96.8% and an overall accuracy of 94.9%. Ultrasonography was also useful in detecting mimicking diseases of acute appendicitis. Sonography should help to rule out severe disease in the frequent cases of functional abdominal pain.

Acute Disease↗
PubMed1992

Rapid C-reactive protein (CRP) measurements in the diagnosis of acute appendicitis.

C-reactive protein (CRP) has been measured in plasma of patients with acute appendicitis and in controls without appendicitis to test the accuracy and diagnostic performance of a new rapid test kit for CRP (NycoCard CRP). The values obtained for CRP by the rapid test correlated well (Rs = 0.92) with the reference method for measuring CRP. The sensitivity, specificity and predictive values were calculated at different cut-off values. At values > 10 mg l-1 a sensitivity of 58% and a negative predictive value of 72% were found. Higher values of sensitivity were observed for men than for women, 69% and 44% respectively. Patients with acute appendicitis who had had symptoms for more than 24 h, had elevated CRP values (cut-off > 10 mg l-1) in more than 80% of cases. Our study shows that the rapid CRP test and the reference CRP test gave an almost identical result.

Acute Disease↗
PubMedDate not supplied

Febrile neutropenia as the presenting sign of appendicitis in an adolescent with acute myelogenous leukemia.

The diagnosis and management of a surgical abdomen in patients with acute leukemia is quite difficult because of the complications and treatment of disease itself. A 13-year-old boy with acute myelogenous leukemia developed 2 episodes of febrile neutropenia during induction therapy. The second one was treated with a 5-day course of parenteral antimicrobial therapy, but the patient then presented with right lower quadrant abdominal tenderness, guarding, and rebound tenderness. Abdominal ultrasonography and computed tomography revealed appendicitis. Conservative medical management was unsuccessful, and appendectomy was performed 5 days after appendicitis was diagnosed. The patient's clinical manifestations resolved 5 days later. The case illustrates that fever may be the first manifestation of appendicitis in a child with acute myelogenous leukaemia who is neutropenic. Surgery is acceptable as first-line treatment in such cases.

Abdomen, Acute↗
PubMed1998

Diagnostic laparoscopy in 1043 patients with suspected acute appendicitis.

OBJECTIVE: To evaluate the efficacy of diagnostic laparoscopy in patients with suspected acute appendicitis, the number of complications associated with the laparoscopic technique, and the effect of leaving a macroscopically normal-looking appendix in place. DESIGN: Three prospective protocols. SETTING: Three departments of surgery, one in Norway and two in Sweden. SUBJECTS: 1043 patients aged 15 years or over. INTERVENTIONS: Diagnostic laparoscopy in patients with signs and symptoms of acute appendicitis who were to be operated on. MAIN OUTCOME MEASURES: Morbidity, mortality, and histological appearance of removed appendices, and outcome whether or not the patient was operated on. RESULTS: 819 patients had appendectomies (61% laparoscopically and 39% by conversion to open operation) with a total complication rate of 10%. In 211 patients a diagnostic laparoscopy was done as a single procedure. There were 181 women in this group and 86 of them had gynaecological disorders. The complication rate was 2% among these 211 patients and after a follow up of two years no patients had been readmitted for appendicectomy. 13 patients were subjected to other open procedures. The overall mortality was 0.4%. CONCLUSION: Diagnostic laparoscopy is safe and can be recommended in patients with suspected acute appendicitis, particularly in women. A macroscopically normal-looking appendix can be left in place.

Acute Disease↗
PubMed1999

Value of diagnostic laparoscopy in fertile women with suspected appendicitis.

OBJECTIVE: To assess the value of diagnostic laparoscopy in women of child-bearing age with suspected appendicitis. DESIGN: Prospective, non-randomised study. SETTING: University hospital, Sweden. SUBJECTS: 94 women aged between 15 and 40 years with suspected appendicitis. INTERVENTION: Diagnostic laparoscopy. If necessary, the appendix was removed either laparoscopically or by open operation. The outcomes were compared with those during 1994, during which all appendicectomies were done through a laparotomy. MAIN OUTCOME MEASURES: Rates of unnecessary appendicectomy, operating time, and length of hospital stay. RESULTS: 77 had diagnostic laparoscopy, and 17 primary open appendicectomy. 73 appendixes were removed; 53 open and 20 laparoscopically. 12 appendicectomies (13%) were unnecessary compared with 27/80 (34%) during the year 1994. The duration of the open operation was significantly shorter (mean (SD) 35 (14) minutes) than the laparoscopic one (78 (18) minutes) (p<0.001), and there were no differences in duration of postoperative hospital stay. No patients developed complications. CONCLUSIONS: Diagnostic laparoscopy is safe and helpful in suspected cases of appendicitis and could substantially reduce the rate of unnecessary appendicectomies. However, the data suggest that laparoscopic appendicectomy offers no advantages over primary open appendicectomy in terms of postoperative course.

Adolescent↗
PubMed2002

Laparoscopic appendectomy for acute and recurrent appendicitis: retrospective analysis of a single-group 5-year experience.

BACKGROUND AND PURPOSE: Twenty years after the first report of laparoscopic appendectomy (LA), its role in the treatment of appendicitis is still under debate. We report herein a retrospective analysis of our cases of LA in the last 5 years, during which we adopted a policy of an almost uniform laparoscopic approach on a rather selected population composed mainly of women with acute or recurrent lower quadrant abdominal pain. PATIENTS AND METHODS: Laparoscopic appendectomy was performed on 33 male and 98 female patients. The mean age at operation was 25.7+/-11.4 years (range 11-59 years). Acute appendicitis with localized or diffuse peritonitis was present in 34 cases. In the remaining 97 patients, the operation was performed for acute or recurring symptoms of lower quadrant abdominal pain. RESULTS: There were no conversions to open surgery. The operating time was 45+/-17 minutes (range 30-110 minutes). The pathology examination of the removed appendices showed acute appendicitis in 34 cases and chronic inflammation in the remaining 97 patients. In one case, histology revealed a coexisting mucinous carcinoid that extended to the perivisceral fat, and a completion right hemicolectomy was performed. Complications were minor in most cases. Reoperation for deep abdominal abscess or hematoma was required in three cases. The mean hospital stay was 2.59+/-1.58 days (range 24 hours-11 days). CONCLUSION: In our hands, LA has proven to be safe and effective. The laparoscopic operation has significant advantages in terms of lower invasiveness and better diagnostic capability. It is especially useful in women of child-bearing age, in whom it may be considered the procedure of choice.

Acute Disease↗
PubMed1998

Interval appendectomy for perforated appendicitis in children.

To determine the efficacy, safety, and cost of managing perforated appendicitis with intravenous antibiotics followed by an interval appendectomy, the charts of 87 children with ruptured appendicitis were retrospectively reviewed. These patients were treated with intravenous fluid resuscitation and antibiotics (consisting of clindamycin and ceftazidime) and underwent appendectomy, either on that admission (n = 46) or as a delayed interval procedure (n = 41). Antibiotics in all cases were discontinued either at home or in the hospital after the child was a febrile for 48 hours with normal white and differential blood cell counts, and the two groups were compared. Seven patients (17%) "failed" the interval appendectomy protocol. All but one "failure" was due to the development or persistence for >72 hours of a bowel obstruction. The data are described below as percent or mean +/- 1 standard deviation. [table: see text] We conclude that antibiotics and interval appendectomy is a safe effective alternative for the management of perforated appendicitis. When successful, hospitalization, charges, and morbidity are less with this approach. A persistent bowel obstruction for 72 hours is an indication to proceed with appendectomy on admission.

Adolescent↗
PubMed1996

Appendicitis after laparoscopic appendectomy: a warning.

Surgical options for appendicitis have increased, just as they have with cholecystitis. The laparoscope can now be utilized in place of the standard open operation for treatment of appendicitis. Like laparoscopic cholecystectomy, laparoscopic appendectomy can be associated with increased morbidities, not usually seen with open surgery. We present a case of the unusual complication of recurrent appendicitis in a generous appendiceal remnant after laparoscopic appendectomy.

Adult↗
PubMed2002

Ovarian hyperstimulation syndrome complicated by peritonitis due to perforated appendicitis.

We describe a case of ovarian hyperstimulation syndrome (OHSS) complicated by peritonitis due to perforated appendicitis. A 29-year-old woman presented with abdominal distension after ovarian stimulation with HMG followed by ovulation induction with HCG. Massive ascites with swollen ovaries was observed on ultrasound, and she was admitted on the diagnosis of OHSS. Daily infusion of serum albumin and low dose dopamine failed to increase her urine output and her abdominal symptoms became increasingly deteriorated after her urine pregnancy test turned out to be positive. Paracentesis performed for alleviation of her abdominal distension revealed infected, foul-smelling fluid. An emergency laparotomy was performed, and the definite diagnosis was made as panperitonitis due to perforated appendicitis with right tubal pregnancy. Appendectomy, right tubectomy and vigorous irrigation with drainage were performed. The case implies that OHSS might not only mask typical manifestations of appendicitis, but could also compromise concurrent intraperitoneal infection.

Adult↗
PubMed1985

Acute appendicitis not associated with social class among children.

Acute appendicitis has previously been found to be associated with social class. In an attempt to confirm this, 125 patients with histologically verified acute appendicitis were compared with 1802 control children, randomly selected from the schools of the City of Helsinki. Social class determination was based on father's occupation in families with two parents, and on mother's occupation in single provider families. No association with social class was found. The proportion of single provider families was around 25% among both cases and controls. Appendicitis patients are one potential source of control groups in epidemiological studies.

Acute Disease↗
PubMed1989

Nonperforative appendicitis: a continuing surgical dilemma.

Acute appendicitis continues as a medical challenge with newer approaches failing to improve diagnostic accuracy. The role of antibiotics in acute nonperforative appendicitis (NPA) remains unclear. In 175 patients studied at two hospitals, preoperative guidelines were used to exclude perforative appendicitis. Nevertheless, 14% of patients were found to have this condition. Surgeon's reports significantly underestimated the diagnosis when compared with the pathologists' reports. Antibiotic prophylaxis in 122 patients with NPA was studied prospectively comparing ceftizoxime (CTZ), cefamandole (CFM), and placebo (PLA). Ceftizoxime decreased the infection rate compared with PLA (0 vs. 8; P less than .01). Use of antibiotics (CTZ or CFM) resulted in decreased infections when compared with PLA (3 vs. 8; P less than .01) and fewer days of hospitalization (3.8 vs. 5.4 d, P less than .005). Analysis of infection risk factors showed no correlations except for failure to administer antibiotics and the finding of a gangrenous appendix. Operative culture results had no predictive value for either infection or pathogen identification. It is recommended that all patients undergoing surgery for NPA be given 1 d of antibiotic prophylaxis.

Acute Disease↗
PubMed2000

Reducing negative appendectomy: evaluation of ultrasonography and computer tomography in acute appendicitis.

OBJECTIVE: To study the sensitivity and the specificity for ultrasonography and computed tomography in patients with suspected appendicitis, and their value to the clinician. MAIN OUTCOME MEASURES: The negative appendectomy rate and the sensitivity and the specificity for ultrasonography and computed tomography in patients with suspected appendicitis. RESULT: The diagnostic accuracy was 88% (men 95%, women 80%). Two hundred and thirty-nine patients were examined by ultrasonography preoperatively. The sensitivity for ultrasonography was 0.82 and the specificity was 0.97. Forty-nine patients were examined by computed tomography preoperatively. The sensitivity for computer tomography was 0.88 and the specificity was 0.95. CONCLUSIONS: We conclude that ultrasound and computed tomography investigations on patients with suspected appendicitis are of great value. Computed tomography seems to have a higher sensitivity than ultrasound and a high specificity. In fertile women, where unnecessary surgery is best avoided, we believe that computed tomography investigation or ultrasound examination are better alternatives to surgical intervention.

Adult↗
PubMed1995

Perforated appendicitis and ectopic pregnancy following in-vitro fertilization.

This report describes a case of perforated appendicitis and ectopic pregnancy following in-vitro fertilization (IVF) and embryo transfer. Perforated appendicitis was a coincidental event following IVF and embryo transfer. Immediate diagnosis and treatment of the perforated appendicitis saved the life of the patient. The ectopic pregnancy was completely resolved with two doses of methotrexate administration.

Adult↗