Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “APPENDICITIS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 163 records · Page 9Linked to original sources
PubMed1987

Early appendectomy for perforated appendicitis in children should not be abandoned.

Appendectomy for the diagnosis of appendicitis was prospectively performed upon 133 children from 1 July 1982 to 30 June 1985 with no mortality. The pathologic diagnosis revealed 11 normal appendices (8.3 per cent), 54 instances of acute appendicitis (40.6 per cent), 16 instances of gangrenous appendicitis (12.0 per cent) and 52 instances of perforated appendicitis (39.1 per cent). There were no complications in those patients with normal appendices, acute appendicitis and gangrenous appendicitis and the mean length of hospitalization for these groups was 3.27, 3.37 and 4.75 days, respectively. The mean length of hospitalization for patients with perforated appendicitis was significantly longer, 9.45 days (p less than 0.05). Thirteen complications developed in 11 patients with perforated appendicitis. Eight patients required a reoperation (a major morbidity rate of 15.4 per cent). There was only one readmission which occurred three and one-half weeks after discharge for intestinal obstruction. Early appendectomy in children with a presumed diagnosis of either acute or perforated appendicitis resulted in low morbidity rates and is more cost effective than nonoperative management proposed by others due to shorter hospitalization and no planned readmission.

Acute Disease↗
PubMed1994

Diagnostic ultrasound for suspected appendicitis: does the added cost produce a better outcome?

Acute appendicitis is one of the most common abdominal surgical emergencies in North America. Although the treatment of appendicitis has remained the same for over 250 years, diagnostic techniques have changed immensely. Most recently, graded compression ultrasonography has received much support. In an attempt to determine whether ultrasonography has improved the outcome in acute appendicitis, we retrospectively reviewed the records of all patients undergoing appendectomy and/or ultrasound for suspected appendicitis during two separate 12-month periods. We began using ultrasound in the diagnosis of appendicitis in 1987; therefore, 1986 was used as our pre-ultrasound year; 1989 was used as our comparison year because ultrasound had become widely applied in the diagnosis of acute appendicitis by this time. Data was tabulated on all patients undergoing appendectomy in both study years, as well as those also undergoing ultrasonography in 1989. The populations in 1986 and 1989 were similar for all data tabulated. The diagnostic accuracy rate actually decreased after the implementation of ultrasonography (85.6% vs 77.0%, P < 0.05). This trend was seen in both male and female patients, reaching statistical significance in the male population (P < 0.05). The incidence of perforation and complications were not statistically decreased after the implementation of ultrasound. Ultrasound did not decrease the length of hospital stay, and in addition added approximately $48,000 to the treatment cost of appendicitis in 1989. Thus, despite adding cost, ultrasonography for appendicitis did not improve our ability to diagnose or accurately treat appendicitis.

Acute Disease↗
PubMed1994

Tc-99 hexamethylpropyleneamineoxide scanning for the detection of acute appendicitis.

BACKGROUND: Patients with acute lower abdominal pain remain a diagnostic challenge. Although acute appendicitis is the most common surgical disorder, its accurate and timely diagnosis can be difficult. Historically, females of childbearing age are the most difficult patient group in whom to make the diagnosis of acute appendicitis; they have reported negative laparotomy rates ranging from 30 to 50 percent. Tc-99 hexamethylpropyleneamineoxide (HMPAO) labeled leukocyte scan has previously been shown to be very accurate in the detection of acute appendicitis. STUDY DESIGN: One year ago, a blinded study using Tc-99 HMPAO labeled leukocyte scan was reported for the detection of acute appendicitis. That study consisted of 27 patients who presented with abdominal pain. The present report is a follow-up study of 37 additional patients in whom the Tc-99 HMPAO leukocyte scan was used to diagnose or discount acute appendicitis. RESULTS: Twenty-seven patients had histologically proved acute appendicitis. Twenty-three of these were correctly diagnosed using the leukocyte scan, for a sensitivity rate of 85 percent. The overall specificity rate was 93 percent, with an overall accuracy rate of 89 percent. Thirty-one of 64 patients were females of reproductive age and represented 56 percent of all patients in the study with appendicitis. In this group, the Tc-99 HMPAO leukocyte scan had a sensitivity rate of 87 percent, specificity rate of 92 percent, and an overall accuracy rate of 89 percent. The Tc-99 HMPAO leukocyte scan also proved to be valuable in the diagnosis of other intra-abdominal inflammatory conditions. Eight scans interpreted as negative for acute appendicitis were positive for other conditions, including five that were positive for diverticulitis, one for a tumor, one for a tubo-ovarian abscess, and one for a small intestinal infarction. CONCLUSIONS: The Tc-99 HMPAO leukocyte scan is a highly accurate, diagnostic, and minimally invasive test of use in patients with abdominal pain of unclear cause, in which the differential diagnosis includes acute appendicitis. It is of particular value in females of childbearing age, in whom the cause of lower abdominal pain is unclear.

Abdominal Pain↗
PubMed1998

When it's not appendicitis.

Other pathology besides appendicitis may be found in patients with right lower quadrant pain. This has led some to advocate diagnostic laparoscopy/laparoscopic appendectomy for all such cases. This policy would substantially raise the costs of care without a priori proof of its efficacy. However, a selective approach on when to proceed with diagnostic laparoscopy will depend on the frequency of finding unexpected, nonappendiceal pathology. To determine this, we reviewed our experience with 202 appendectomies. For females < 50 years old, 33 per cent had normal appendices, 12 per cent had periappendicitis, 47 per cent had acute appendicitis, 12 per cent had perforated appendicitis, and 26 per cent had other nonappendiceal pathology. For males < 50 years old, 13 per cent had normal appendices, 8 per cent had periappendicitis, 67 per cent had acute appendicitis, 15 per cent had perforated appendicitis, and 5 per cent had other pathology. For patients > 50 years old, 7 per cent had normal appendices, 13 per cent had periappendicitis, 33 per cent had acute appendicitis, 60 per cent had perforated appendicitis, and 20 per cent other pathology. Other nonappendiceal pathology was found in 42 per cent of females < 50 with normal appendices, 57 per cent with periappendicitis, and 14 per cent with acute/perforated appendicitis. In males < 50 years, 50 per cent of those with normal appendices, 10 per cent of those with periappendicitis, and 0.7 per cent of those with acute appendicitis had nonappendiceal pathology. In conclusion, women of childbearing age and patients > 50 years old have a significant incidence of nonappendiceal pathology. In this group of patients, a diagnostic laparoscopy appears justifiable to identify the cause of the abdominal pain.

Abdominal Pain↗
PubMed1998

White blood cell count is a poor predictor of severity of disease in the diagnosis of appendicitis.

The white blood cell (WBC) count is considered to be a useful test in the diagnosis of appendicitis. The purpose of this study was to examine the clinical features of patients with normal WBC appendicitis and also to determine whether a higher WBC count correlates with a more advanced stage of appendicitis. Patients with pathologically confirmed appendicitis from January 1989 to December 1994 were included in the study (n = 1919). The age, gender, temperature, length of hospital stay, and severity of disease (1 = acute appendicitis; 2 = gangrenous appendicitis; 3 = perforated appendicitis with abscess formation; 4 = appendicitis with diffuse peritonitis) were compared for patients with a normal WBC count (range, 3.8-10.9) versus those who had an elevated WBC count. A normal WBC count was seen in 11 per cent of patients (n = 209). There was no difference in age, temperature, gender, or severity of disease in the patients with a normal WBC count compared with those with an elevated WBC count (P > 0.05). The severity of disease of patients with a normal WBC count were: 1 = 58 per cent; 2 = 13 per cent; 3 = 7 per cent; and 4 = 22 per cent. For patients with an elevated WBC count the scores were: 1 = 57 per cent; 2 = 17 per cent; 3 = 13 per cent; and 4 = 14 per cent. The proportion of gangrenous and perforated appendicitis in the patients with a normal WBC count is the same as in the patients with an elevated WBC count.

Abscess↗
PubMed2006

Plasma total anti-oxidant capacity correlates inversely with the extent of acute appendicitis: a case control study.

BACKGROUND: The role of free oxygen radicals in inflammatory conditions is well known. Free radicals cause lipid peroxidation of cellular membranes resulting in cell death. The purpose of this study was to investigate the levels of total anti-oxidant status (TAS), as a marker of anti-oxidant defense system and malondialdehyde (MDA), as a marker of oxidative stress, in the plasma of patients with acute appendicitis. METHODS: Fifty-one adult patients with a median age of 31 years who underwent operations with a preoperative diagnosis of acute appendicitis were included in this prospective study. Blood samples for C-reactive protein (CRP), MDA and TAS were collected preoperatively. Groups were compared by using the Mann-Whitney U test. RESULTS: There were 27 patients with acute phlagmenous appendicitis and 19 patients with advanced appendicitis (10 gangrenous and 9 perforated appendicitis), while 5 negative explorations were documented. No significant differences in WBC counts and MDA levels between groups were encountered. Plasma CRP was significantly higher in patients with perforated appendicitis, but not in the other groups. In advanced appendicitis group, TAS level was significantly lower than the other groups. On the other hand, plasma TAS level in acute phlagmenous appendicitis group was significantly higher. CONCLUSION: A decrease in plasma total anti-oxidant capacity might be a predictor of the progression of inflammation to the perforation in acute appendicitis.

Journal Article↗
PubMed1985

Is childhood appendicitis familial?

Family history of appendicitis was studied in 135 children with histologic confirmation of acute appendicitis and in 212 control children without appendicitis, matched by age, sex, and admission date. Parents of patients with appendicitis were approximately 10% more likely than parents of control children to have a positive history of this disease, a difference that could have easily arisen by chance. In contrast, seven patients with appendicitis had siblings with a history of appendicitis, whereas only 0.64 would have been expected on the basis of the proportion among the control group. A significant positive trend was also noted between the proportion of family members with a history of appendicitis and risk for this disease in children. These results indicate some familial tendency for appendicitis, although not to the extent suggested by previous studies.

Adolescent↗
PubMed1998

Is there a role for abdominal computed tomographic scans in appendicitis?

OBJECTIVE: To better define the effectiveness of abdominal computed tomographic scanning (ACTS) in adult patients with suspected appendicitis. DESIGN: Retrospective analysis. SETTING: A community teaching hospital. PATIENTS: Ninety-seven patients with appendicitis in the differential diagnosis, whose clinical findings were insufficient to perform surgery or to discharge from the hospital, during a 14-month period. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Accuracy of ACTS, rate of appendectomies that show no appendicitis (negative appendectomy rate), and frequency of ACTS as a definitive diagnostic test. RESULTS: Forty-nine of the 50 patients with appendicitis were correctly diagnosed by ACTS. Forty-three of the 47 patients without appendicitis were correctly diagnosed by ACTS. Positive predictive value was 92%, negative predictive value was 98%, and accuracy was 96%. The ACTS group had a negative appendectomy rate of 5.8% (3/52), lower than the hospital rate of 14% for the preceding 3 years. The ACTS established an alternative diagnosis in 16 patients, allowed 10 other patients to be discharged early or not admitted, and was the critical diagnostic test in 30 of the patients with appendicitis. Therefore, the ACTS played a definitive role in the treatment of 56 (57.7%) of the 97 patients. CONCLUSIONS: The ACTS was an accurate test in the diagnosis of appendicitis and was of significant benefit in 57.7% of the patients studied. However, it was difficult to predict which patients were most likely to benefit. Expanded selective use of ACTS for patients with clinically indeterminate appendicitis may result in a lower negative appendectomy rate and fewer patient admissions for observation.

Acute Disease↗
PubMed2003

Decline in admission rates for acute appendicitis in England.

BACKGROUND: The incidence of acute appendicitis declined in western countries between the 1930s and the early 1990s. The aim of this study was to determine time trends in hospital admissions for acute appendicitis in England between 1989-1990 and 1999-2000, and in population mortality rates for appendicitis from 1979 to 1999. METHODS: : Hospital Episode Statistics for admissions were obtained from the Department of Health and mortality data from the Office for National Statistics. RESULTS: Between 1989-1990 and 1999-2000, age-standardized hospital admission rates for acute appendicitis decreased by 12.5 per cent in male patients and by 18.8 per cent in female patients. The proportions of admissions that resulted in operation remained stable. Admission rates for non-specific mesenteric lymphadenitis fell. Admission rates for abdominal pain increased between 1989-1990 and 1995-1996, at which time the International Classification of Diseases codes changed. Between 1995-1996 and 1999-2000, admission rates for abdominal pain declined. Analysis of age-specific admission rates for acute appendicitis and abdominal pain from 1989-1990 to 1995-1996 showed that the decline in acute appendicitis could not be accounted for by a change in diagnostic practice. Mortality rates for acute appendicitis remained stable over the study period. CONCLUSION: Admission rates for acute appendicitis declined over the study period. This decline cannot be explained by reclassification.

Acute Disease↗
PubMed1996

Preoperative administration of antibiotics in patients with suspected acute appendicitis.

The effectiveness of administering antibiotics preoperatively to patients with suspected appendicitis was evaluated over a 2-year period in 105 consecutive patients who presented with right lower quadrant (RLQ) tenderness and a white blood cell (WBC) count of over 10,000/mm3 or a temperature of over 37 degrees C. All the patients were preoperatively administered cefazolin (CEZ), cefotiam (CTM), or fosfomycin (FOM) except those with apparent peritonitis, which resulted in the recovery of 41 patients (39%). Of the remaining 64 patients, 14 (13%) had catarrhal appendicitis, 34 (32%), phlegmonous appendicitis, and 16 (15%), gangrenous appendicitis. Preoperatively, there were no significant differences among these groups in the WBC count or temperature. Following the administration of antibiotics, both these parameters decreased significantly in the patients with catarrhal appendicitis, although a slight RLQ tenderness persisted; in those with phlegmonous appendicitis, the WBC count decreased significantly, but the temperature remained elevated, with slight rebound tenderness in the RLQ; and in those with gangrenous appendicitis, there were no significant differences between the pre- and postoperative data in WBC count or temperature, and the abdominal symptoms did not change. These results show the value of administering antibiotics within 24h of the onset of symptoms indicative of acute appendicitis to allow time to evaluate the patients' condition, decide the operative indications, and prevent unnecessary laparotomy.

Acute Disease↗
PubMed2001

Results of laparoscopic vs. conventional appendectomy in complicated appendicitis.

BACKGROUND: Although many trials show some advantages of laparoscopic appendectomy over open appendectomy, the value of laparoscopic appendectomy is still controversial. Specifically the question of whether there are benefits of laparoscopic appendectomy over open appendectomy in complicated appendicitis remains to be answered. METHODS: Of 1,106 consecutive appendectomies (717 laparoscopic appendectomies, 330 open appendectomies, and 59 conversions) between 1989 and 1999, the results of 299 patients with complicated appendicitis (defined by perforation, abscess, or peritonitis) were analyzed retrospectively to compare the complications of laparoscopic appendectomy and conversion (intention-to-treat group) with those of open appendectomy. RESULTS: Complicated appendicitis (n = 299) was treated by laparoscopic appendectomy in 171 patients, by open appendectomy in 82 patients, and by conversion in 46 patients. Laparoscopic appendectomy and conversion showed fewer abdominal wall complications than open appendectomy (13/217; 6 percent vs. 15/82; 18.3 percent; P < 0.003), which led to a decrease of the total complication rate in the intention-to-treat group (21/217; 9.7 percent vs. 19/82; 23.1 percent; P = 0.004). The rate of intra-abdominal abscess formation was nearly the same after laparoscopic appendectomy (4.1 percent) and open appendectomy (4.9 percent). The total complication rate was higher in complicated appendicitis than in acute appendicitis (P < 0.005) but was independent of the laparoscopic technique. The conversion rate was higher in complicated appendicitis than in acute appendicitis (21.2 vs. 2.3 percent; P < 0.001). CONCLUSION: In comparison with open appendectomy, laparoscopic appendectomy (by itself and in an intention-to-treat view) leads to a significant reduction of early postoperative complications in complicated appendicitis and therefore should be considered as the procedure of choice.

Abscess↗
PubMedDate not supplied

Comparison between technetium 99m hexamethylpropyleneamine oxide labeled white blood cell abdominal scan and abdominal sonography to detect appendicitis in adult patients with atypical clinical presentation.

BACKGROUND: Acute appendicitis is much more serious in the elderly, and early diagnosis is very important. However, the diagnosis of acute appendicitis in older patients is often difficult because these patients may present with atypical clinical manifestations. METHODS: We conducted a prospective study to evaluate and compare the value of technetium 99m hexamethylpropyleneamine oxide (Tc 99m HMPAO) labeled white blood cell (WBC) abdominal scan and abdominal sonography in the diagnosis of acute appendicitis in older patients with an atypical clinical presentation. Forty-nine patients (age > 50 years) with acute abdominal pain and suspected appendicitis, but with atypical findings, were included in this study. RESULTS: Twenty-seven patients received laparotomy for final surgical and pathologic diagnoses. The remaining 22 patients did not receive surgery and showed no evidence of appendicitis after at least 1 month of follow-up. Two patients had false-positive WBC scan findings and two patients had false-negative WBC scan findings. The overall sensitivity, specificity, and accuracy for WBC scans in diagnosing appendicitis were 92.0%, 91.7%, and 91.8%, respectively. The overall sensitivity, specificity, and accuracy for abdominal sonography in diagnosing appendicitis were 84.0%, 95.8%, and 89.8%, respectively. CONCLUSION: The Tc 99m HMPAO WBC scan provides a more sensitive and accurate method for diagnosing appendicitis in older patients with equivocal clinical examinations when compared with abdominal sonography.

Abdomen↗
PubMedDate not supplied

Resolving appendicitis: role of CT.

BACKGROUND: We assessed the role of computed tomography (CT) in the resolution of appendicitis. METHODS: This was a retrospective study over 2.5 years involving 155 patients and 172 CT scans for suspected appendicitis in an emergency setting. RESULTS: Sixty-nine studies were positive for appendicitis by CT criteria. Of these, 53 underwent surgery: 48 were positive for appendicitis, four had other pathologies (two with colon cancer, one with colitis, one with infectious enteritis), and one had a normal appendix that was removed. Three of the 69 patients were released or left the emergency room against medical advice. Twelve patients demonstrated acute appendicitis by CT criteria but were treated conservatively because their clinical conditions were stable; four of those patients had follow-up CT that showed resolution of findings. Six patients were followed clinically, without recurrence of symptoms, and two were lost to follow-up. CONCLUSION: Resolving appendicitis is an entity that should be considered in a patient who has signs positive for appendicitis on CT but is doing well clinically. CT positive for appendicitis does not necessarily indicate surgery, and the decision for operation should depend on clinical and radiologic features.

Acute Disease↗
PubMed2000

Sonography in acute appendicitis: diagnostic utility and influence upon management and outcome.

A study is made of the diagnostic utility of echography in clinically suspected appendicitis, and its influence upon patient management and outcome. A total of 374 consecutive patients with possible appendicitis were prospectively evaluated by ultrasound. Two groups were established: group A (high clinical probability, > or =0.70) and group B (moderate clinical probability, 0.20-0.60). In group-A patients (n = 105, 28%), prevalence of appendicitis = 0.90) underwent surgery regardless of the echographic findings. In group B (n = 269, 72%), prevalence of appendicitis = 0.28) surgery was performed in the event of positive echography, whereas negative echographic findings did not definitively discard appendicitis. The diagnostic utility of echography was evaluated by applying the Pauker-Kasirer threshold approach to clinical decision making. The influence of ultrasound upon outcome was in turn evaluated by contrasting the total appendectomized patients (190 of 374) with a series of 181 individuals subjected to appendectomy prior to the introduction of echography. The probability of appendicitis in the presence of positive echography was 0.95 in group A (sensitivity = 0.92) and 0.89 in group B (sensitivity = 0.91). The probability of appendicitis in the event of negative ultrasound was 0.58 in group A (specificity = 0.55) and 0.03 in group B (specificity = 0.95) . In 46% of cases the echographic findings led to a change in therapeutic regimen. In addition, the incidence of negative appendectomies was significantly reduced (19.3 vs 11.6% with echography; p = 0.03), as was the delay in establishing a diagnosis (under 6 h in 68.5 vs 84.2% with echography; p = 0.002) and the number of medical acts required (three in 71.3 vs 84.1% with echography; p = 0.001). There was no significant reduction in the incidence of perforated appendicitis (17.1 vs 17.9% with echography), in the number of postoperative complications (13.8 vs 7.6% with echography), or in the days of hospital stay (4.44 vs 4.80 with echography). Echography proved useful in group B, and was generally of little utility in group A. The technique had a positive influence on treatment, with management reorientation in a considerable number of patients, and on outcome, since ultrasound contributed to establishing an earlier diagnosis, with a reduction of unnecessary appendectomies.

Acute Disease↗
PubMed1994

Acute appendicitis in patients over the age of 65 years; comparison of clinical and computer based decision making.

The role of clinical and computer based decision in the diagnosis of acute appendicitis in the elderly was studied in connection with the Research Committee of the World Organization of Gastroenterology (OMGE) survey of acute abdominal pain. A total of 220 patients over the age of 65 years presenting with acute abdominal pain were included in the study at the Central Hospital of Savonlinna and at the University Hospital of Tampere. Twenty-two preoperative clinical history variables, 14 clinical signs and three tests were evaluated in a single variable and multivariate analysis to find the best combination of predictors of acute appendicitis in the aged. In order to sum up the contributions of independent diagnostic factors, a diagnostic score (DS) was built: DS = 2.81 x (rectal digital tenderness; 1 = yes, 0 = no) + 2.54 x (rigidity; 1 = yes, 0 = no) + 2.06 x (renal tenderness; 1 = no, 0 = yes) + 2.33 x (bowel sounds; 1 = normal, 2 = absent/abnormal) - 8.13. The sensitivity of preoperative clinical decision in detecting acute appendicitis in the aged was 0.79 with a specificity of 0.92, an efficiency of 0.90 and usefulness index (UI) of 0.56. At a cut-off level of -2.78 the DS reached a sensitivity of 0.84 in detecting acute appendicitis with a specificity of 0.87, an efficiency of 0.87 and UI of 0.68. When the patients with a DS value between -2.78 and -0.45 were considered as non-defined (n = 28, follow-up required before the decision to operate), the sensitivity of the computer-aided diagnosis in detecting acute appendicitis in the elderly was 0.77 with a specificity of 0.97, an efficiency of 0.96 and UI of 0.57. In the elderly patients where a leucocyte count was available (n = 157), location of pain, rectal digital tenderness and leucocyte count predicted significantly acute appendicitis. At a cut-off level of -2.62 the DS reached a sensitivity of 0.81 in detecting acute appendicitis with a specificity of 0.92, an efficiency of 0.91 and UI of 0.59. When the patients with a DS value between -2.62 and 0.06 were considered as nondefined (n = 12, follow-up required before the decision to operate), the sensitivity of the computer-aided diagnosis (leucocyte count available) in detecting acute appendicitis in the elderly improved to 0.86 with a specificity of 0.94, an efficiency of 0.93 and UI of 0.69. In our study the diagnostic scoring system for the elderly performed well considering the simple nature of its structure.(ABSTRACT TRUNCATED AT 400 WORDS)

Abdominal Pain↗
PubMed1990

Experimental model of acute appendicitis in the rabbit with determination of leucine amino peptidase (LAP) and acid phosphatase (acid-P) activities in portal blood samples.

The activities of leucine amino peptidase (LAP) and acid phosphatase (Acid-P), conceivable markers of acute appendicitis, were determined in the portal blood of rabbits with acute appendicitis. An experimental model of acute appendicitis was established using No.-O silk ties to block the base of the appendix. The clinical and histopathological picture of acute appendicitis was seen after 12 hr in all the rabbits in the model group (9/9) and in none of the control group. Catheterization of the superior mesenteric vein was performed in rabbits with acute appendicitis, and portal blood samples were taken at 0, 6, and 12 hr for assay of LAP and Acid-P activities. No statistically significant difference between the experimental group and the control group, in the activities of LAP and Acid-P, was found at any time interval. The experimental model of acute appendicitis in the rabbit which is described here is simple and carries a high rate of success. This is probably the first report of using continuous catheterization and repeated sampling of portal blood, for the measurement of enzyme activities, in an experimental model of acute appendicitis. It was concluded that serum LAP and Acid-P activities cannot be used as markers for acute appendicitis.

Acid Phosphatase↗
PubMed1993

Idiopathic granulomatous appendicitis, or Crohn's disease of the appendix revisited.

Idiopathic granulomatous appendicitis has been categorized as primary Crohn's disease of the appendix based on its pathologic features, although the clinical course of this condition simulates acute appendicitis. In this study we report the clinical and pathologic features of 10 cases of idiopathic granulomatous appendicitis and compare the histopathology to 14 appendices inflamed by Crohn's disease. The patients comprised six women and four men with an age range of 15 to 48 years (mean, 29 years). Six patients had acute onset of right lower quadrant abdominal pain while in three patients the presentation was subacute; one patient was asymptomatic. Focal neutrophilic infiltration of crypts with crypt abscesses, mucosal erosion and ulceration, fissures, transmural lymphoid aggregates, and mural fibrosis were comparable in idiopathic granulomatous appendicitis and Crohn's disease affecting the appendix. Fistulization occurred more commonly in Crohn's disease. Idiopathic granulomatous appendicitis contained 19.7 granulomas per tissue section (range, 2.75 to 71.0) compared with 0.3 granulomas per tissue section (range, 0 to 3.0) for appendices affected by Crohn's disease. No patient with granulomatous appendicitis treated by simple appendectomy had recurrence of disease at mean follow-up of 4.5 years. Our morphologic data support the clinical contention that idiopathic granulomatous appendicitis is nosologically distinct from Crohn's disease. Ironically, the presence of numerous granulomas is the histopathologic feature distinguishing idiopathic granulomatous appendicitis from Crohn's disease.

Adolescent↗
PubMed2005

Can ruptured appendicitis be detected preoperatively in the ED?

PURPOSE: The purpose of this study is to determine which clinical symptoms/signs and computed tomography (CT) signs can help in distinguishing ruptured from simple appendicitis. MATERIALS AND METHODS: The medical records and CT findings of 202 consecutive patients with surgically proven acute appendicitis were retrospectively reviewed and compared between 2 groups with and without appendiceal rupture. RESULTS: Longer duration of symptoms ( P < .001), peritoneal sign ( P = .004), and higher C-reactive protein ( P < .001) are significant clinical factors for predicting appendiceal rupture in acute appendicitis. Abscess, extraluminal air, wall defect, peritoneal enhancement, extraluminal appendolith, phlegmon, localized fluid, fascial thickening, ascites, stool impaction, and 4 patterns of bowel wall thickening ( P < .001 to P = .047) are significant CT signs for predicting appendiceal rupture. The appendiceal diameter is larger in patients with ruptured appendicitis than in those with simple appendicitis (13.2 +/- 3.2 vs 11.3 +/- 2.4 mm, P < .001). The appendolith size is larger in patients with ruptured appendicitis than in those with simple appendicitis (7.1 +/- 4.4 vs 5.1 +/- 2.8 mm, P = .018). CONCLUSION: Besides some clinical findings, CT scan can accurately determine appendiceal rupture in acute appendicitis and can further demonstrate the presence of local inflammatory mass, facilitating management decision in the emergency department (ED).

Adolescent↗