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At least 19 recordsLinked to original sources
PubMed2026

Repeated scoring with the adult appendicitis score improves the sensitivity and the specificity of appendicitis diagnosis in patients with early equivocal signs of appendicitis: a secondary analysis.

PURPOSE: The utilization of computed tomography in the early stage of acute appendicitis may result in overdiagnosis and unnecessarily expose patients to ionising radiation. The Adult Appendicitis Score (AAS) can be used to select patients for imaging. Observation and re-scoring in the DIAMOND trial reduced the need for imaging. Now, we wanted to determine if the change in AAS (∆AAS) can serve as a diagnostic tool to select patients for imaging even more precisely. METHODS: Eighty-eight patients with early equivocal appendicitis participated in the observation arm of the DIAMOND trial. The data for these patients were reanalysed, and ∆AAS during the observation was calculated. The baseline AAS, final AAS, and the change in C-reactive protein (∆CRP) were selected as reference standards. RESULTS: Eighty-three patients with complete data were included in the analysis. The AUROC (Area Under the Receiver Operating Characteristic) values are as follows: ∆AAS, 0.932 (95% CI 0.868-0.996); baseline AAS, 0.629 (95% CI 0.498-0.760); final AAS, 0.936 (95% CI 0.886-0.987); and ∆CRP, 0.796 (95% CI 0.696-0.897). Using receiver operating characteristic curves, we established the thresholds for low (AAS ≤ -2), intermediate (AAS -1 to 0), and high (AAS ≥ 1) probability of appendicitis. The negative predictive value for the low-probability group and the positive predictive value for the high-probability group concerning acute appendicitis were 97% and 94%, respectively. CONCLUSION: Patients with equivocal signs of appendicitis may benefit from short observation and the calculation of ∆AAS to reduce overdiagnosis and exposure to excessive imaging. REGISTRATION: The DIAMOND trial was officially registered on ClinicalTrials.gov (NCT02742402) on April 13, 2016.

Adult↗
PubMed2000

Appendicolith revealed on CT in children with suspected appendicitis: how specific is it in the diagnosis of appendicitis?

OBJECTIVE: The purpose of this study was to determine the sensitivity, specificity, and positive and negative predictive values of a diagnosis of appendicitis when CT without enteric contrast material reveals an appendicolith in children with suspected appendicitis. MATERIALS AND METHODS: A retrospective review of children who underwent abdominal CT for suspected appendicitis over a 25-month period was performed to identify patients with an appendicolith. An age-matched group of patients examined for trauma served as controls. RESULTS: CT was performed in 104 children. Appendicitis was present in 60 (58%) of 104 children; 39 (65%) of 60 had an appendicolith. Appendicitis was not present in 44 (42%) of 104; six (14%) of 44 had an appendicolith. An appendicolith detected on CT had a sensitivity of 65% and a specificity of 86% for the radiologist diagnosing appendicitis. An appendicolith had a positive predictive value of 74% and a negative predictive value of 26%. Among the control population, two (3%) of 74 children had an appendicolith. This number was statistically significant compared with children in the study group with an appendicolith and abdominal pain, but without appendicitis (p = 0.02). CONCLUSION: Although an appendicolith is significantly associated with appendicitis, the detection of an isolated appendicolith on CT is not sufficiently specific to be the sole basis for the diagnosis of acute appendicitis.

Adolescent↗
PubMed1990

Ultrasound study of acute appendicitis in children with emphasis upon the diagnosis of retrocecal appendicitis.

Acute appendicitis in children frequently presents equivocal clinical manifestations. Delay of the proper diagnosis and unnecessary laparotomies are common. Abdominal ultrasound has proved to be useful in the diagnosis of acute appendicitis in adults. We have performed a preoperative ultrasound study in 368 children with acute appendicitis. Among the, 92 had a retrocecal appendicitis. Ultrasound established the correct diagnosis in 92.6% of patients, and in 94.5% of those with a retrocecal appendicitis. At our institution an abdominal sonography is performed on any child with a doubtful clinical diagnosis of acute appendicitis, helping the surgeon to take the decision to perform a laparotomy.

Acute Disease↗
PubMed1999

Rapid diagnostic imaging of acute, nonclassic appendicitis by leukoscintigraphy with sulesomab, a technetium 99m-labeled antigranulocyte antibody Fab' fragment. LeukoScan Appendicitis Clinical Trial Group.

BACKGROUND: The purpose of this study was to evaluate the safety and efficacy of a technetium 99m-labeled antigranulocyte antibody Fab' fragment (sulesomab) as a diagnostic imaging agent in patients with suspected acute, nonclassic appendicitis. METHODS: This prospective multicenter trial involved 141 children and adults with suspected acute, nonclassic appendicitis. The investigators interpreted planar images acquired 15 to 30 minutes and 1, 2, and 4 hours after injection and also by single-photon emission computed tomography (SPECT). The imaging results were confirmed surgically, whereas nonsurgical patients were considered as not having appendicitis (intent to treat). RESULTS: Sulesomab had a sensitivity of 91% (29/32 patients) and a negative predictive rate of 97% for acute appendicitis. It detected additional abnormalities in 7 of 9 patients with other inflammatory abdominal disease and had a specificity of 92% (91/99 patients) and a positive predictive value of 80% for surgically confirmed right-lower-quadrant disease. In positive studies, 26% were identified by planar imaging at 15 to 30 minutes, 46% by 1 hour, 63% by 2 hours, and 71% by 4 hours; 29% required SPECT to detect the abnormality. Scanning time was 5 to 10 minutes per planar image and about 45 minutes for a SPECT study. Investigators found that sulesomab would have changed clinical management or reduced additional diagnostic studies in 64% of the patients. Adverse events were infrequent, minor, and self-limiting (9/141 patients, 6%). No human antimurine antibody response occurred in 48 evaluable patients. CONCLUSIONS: Sulesomab is safe, well-tolerated, and with no apparent immunogenicity. Focal inflammation or infection in the setting of suspected atypical appendicitis is rapidly and accurately detected. Management decisions incorporating sulesomab imaging potentially provide clear patient benefits, especially by correctly predicting surgery to be unnecessary in 97% of patients without acute appendicitis.

Abdominal Pain↗
PubMed2001

[Diagnosis in suspected appendicitis. Can ultrasonography rule out acute appendicitis?].

INTRODUCTION: Acute appendicitis is often difficult to confirm and even harder to rule out by physical examination. In order to assess the diagnostic reliability of sonography we compared the results of physical (p) and sonographic (s) examination. METHOD: One hundred and fifty consecutive patients presenting with right lower quadrant abdominal pain were evaluated in a prospective study. Based on the respective findings patients were classified into three groups: I: appendicitis confirmed; II: appendicitis ruled out; III: equivocal findings. The results were compared with the discharge diagnoses established by histologic examination or clinical observation. RESULTS: Ultrasonography showed significantly higher sensitivity (group I s vs group I p: 95% vs 45%) and specificity (group I s vs group I p: 100% vs 75%) in confirming as well as in ruling out acute appendicitis (group II s vs group II p: sensitivity 73% vs 53%; specificity 100% vs 81%) than physical examination alone. Owing to additional sonographic findings the group with indeterminate abdominal pain was much smaller after ultrasound examination (group III s vs group III p: 35 vs 69 patients). CONCLUSIONS: After discussing the literature and sonomorphologic criteria that distinguish an inflamed from a normal appendix, we conclude that ultrasonography is a valuable tool in confirming as well as in ruling out acute appendicitis.

Acute Disease↗
PubMedDate not supplied

Sometimes it really is appendicitis: case of a CML patient with acute appendicitis.

We report on the case of a 24-year-old white man with a history of chronic leukemia treated with unrelated bone marrow transplantation and chemotherapy who was correctly diagnosed with appendicitis rather than typhlitis. The approach to diagnosing an acute abdomen in the leukemic patient is discussed, with particular focus on appendicitis vs. typhlitis. A focused CT scan proved to be instrumental in making the correct diagnosis of appendicitis in our patient. The literature on this topic for the past 30 years is reviewed. The purpose of our report is to demonstrate that despite the recent trend toward diagnosing RLQ pain as typhlitis which requires medical management, there are still instances where it 'really is' appendicitis. Appendicitis, therefore, must always be ruled out in the leukemic patient.

Acute Disease↗
PubMed1999

Can oral metronidazole substitute parenteral drug therapy in acute appendicitis? A new policy in the management of simple or complicated appendicitis with localized peritonitis: a randomized controlled clinical trial.

To demonstrate the efficacy of oral metronidazole (OM) in simple or complicated appendicitis with localized peritonitis, a randomized prospective study was carried out in 1083 patients, ranging in age from 4 to 50 years (mean age, 21.38). The patients were randomly divided into two groups. The study group (SG) (524 patients) received OM (500 mg for adults, 7-10 mg/kg if less than 15 years) 2-3 hours before operation. The drug was continued 4 to 5 hours after operation, every 8 hours, for three doses if the appendix was mild to severely inflamed. In the case of complicated appendicitis (114 patients), the same dose was given for 3 to 6 days, depending on the absence or presence of pus. Ceftizoxime was administered to the control group (CG) (559 patients) 2 to 3 hours before operation and then postoperatively every 6 hours for three doses if the appendix was mild to severely inflamed. The complicated cases in the CG (120 patients) received a combination of penicillin, chloramphenicol, and gentamicin for 3 to 6 days, depending on the absence or presence of pus. The serum concentration of metronidazole measured in 43 patients was at bactericidal level in 40 (mean +/- SD standard deviation, 10.65 +/- 4.89 microg/mL). The rate of wound infection was not significantly different in the SG and the CG with the same degree of pathology (3.17% vs 2.96% if uncomplicated; 15.78% vs 14.16% if complicated, respectively). Pelvic collection occurred in four adults and one child in the CG with perforated appendicitis (4.16%). The same complication developed in two adults and two children in the SG with perforated appendicitis (3.5%). All six adults and one of the children in the SG had to be re-explored, whereas the remaining two children responded to conservative management (OM and gentamicin). In uncomplicated cases, hospital stay and hospital charge were both almost the same in both groups. However, length of hospitalization was nearly 1 day shorter and hospital cost per day was about 30 per cent less in complicated cases in the SG as compared with the CG. Conclusively, OM may not only substitute parenteral antibiotics in acute appendicitis as a prophylactic agent, but it may also be used as a cost-effective drug and is more convenient to the patient.

Acute Disease↗
PubMedDate not supplied

Cecal apical changes with appendicitis: diagnosing appendicitis when the appendix is borderline abnormal or not seen.

In most cases, CT of appendicitis shows a distended appendix with periappendiceal inflammation. A distended appendix, however, is not always visualized. In these patients, identifying changes at the anatomic cecal apex can secure a diagnosis of appendicitis. Cecal apical changes with appendicitis include focal cecal apical thickening, the arrowhead sign, and the cecal bar. This pictorial essay describes and illustrates the spectrum of CT appearances of cecal apical changes that can be seen with appendicitis.

Adolescent↗
PubMedDate not supplied

[Parasitic appendicitis. Apropos of 4 cases of acute appendicitis].

The authors present 4 observations of acute appendicitis with the presence of parasites at the micropathological examination. To this end, they study the literature in order to try to show the frequency of parasitic appendicitis on the one hand and what it does on the other, which is still controversial in the physiopathological of appendicitis. According to the authors, an aetiology of parasitic involvement is evident in 1.9% to 25% cases of appendicitis. The most frequent intestinal parasites in this area are the pinworms (54.78%), the whipworms (13%) and the ascaris (9%).

Acute Disease↗
PubMed1978

Acute appendicitis in a child associated with prolonged appendiceal retention of barium (barium appendicitis).

An instance of acute appendicitis in a child associated with prolonged retention of barium by the appendix and formation of a barolith was presented. Previous reports have implicated barium in the etiology of appendicitis and suggest routine roentgenographic follow-up of all cases in which barium enters the appendix. Considering the frequency of this observation and the lack of an established relationship between prolonged retention of barium and appendicitis, this suggestion seems unwarranted.

Acute Disease↗
PubMed2001

Ulcerative colitis of the appendix ('ulcerative appendicitis') mimicking acute appendicitis.

Appendiceal involvement in ulcerative colitis may occur in the setting of either diffuse or distal disease, and is usually diagnosed incidentally at the time of proctocolectomy. The present patient had a rare case of 'ulcerative appendicitis' occurring on a background of clinically quiescent ulcerative colitis, and presented with the signs and symptoms of acute appendicitis.

Acute Disease↗