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Appendicitis Acute [keywords]
- Research Priorities for the Influence of Gender on Diagnostic Imaging Choices in the Emergency Department Setting. [JOURNAL ARTICLE]
- Acad Emerg Med 2014 Nov 24.
Diagnostic imaging is a cornerstone of patient evaluation in the acute care setting, but little effort has been devoted to understanding the appropriate influence of sex and gender on imaging choices. This article provides background on this issue and a description of the working group and consensus findings reached during the diagnostic imaging breakout session at the 2014 Academic Emergency Medicine consensus conference "Gender-specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes." Our goal was to determine research priorities for how sex and gender may (or should) affect imaging choices in the acute care setting. Prior to the conference, the working group identified five areas for discussion regarding the research agenda in sex- and gender-based imaging using literature review and expert consensus. The nominal group technique was used to identify areas for discussion for common presenting complaints to the emergency department where ionizing radiation is often used for diagnosis: suspected pulmonary embolism, suspected kidney stone, lower abdominal pain with a concern for appendicitis, and chest pain concerning for coronary artery disease. The role of sex- and gender-based shared decision-making in diagnostic imaging decisions is also raised.
- Efficacy of preoperative computed tomography imaging to reduce negative appendectomies in patients undergoing surgery for left lower quadrant abdominal pain. [JOURNAL ARTICLE]
- G Chir 2014 Sep-Oct; 35(9/10):223-228.
Background. Clinical assessment of acute appendicitis can be challenging due to atypical presentation. Computed-tomography can reduce negative appendectomies but not without adverse effects. We report our experience with preoperative CT-scan in patients with suspected acute appendicitis. Patients and methods. During 3-years, 257 adult patients underwent appendectomy. We retrospectively reviewed clinical information, CT-scans, histological data. Patients were divided in four groups: Group I: low clinical probability without CT-scan; Group II: low clinical probability with CT-scan; Group III: high clinical probability without CT-scan; Group IV: high clinical probability with CT-scan. Negative appendectomies were determined from histological examination. Negative appendectomy rate was compared between groups of the same clinical probability differing on whether a pre-operative CT scan was performed or not (Group I vs II, Group III vs IV). Results. Groups I,II,III,IV included 12.4%, 18.2%, 54.5% and 14.8% of patients, respectively. The corresponding negative appendectomy rates were 18.7%, 4.3%, 4.2% and 2.6%. Odds ratio of negative appendectomy for patients without CT-scan was 5.2 (95% CI: 1.2-27.7) when there was low clinical probability and 1.6 (95% CI: 0.2-14.2) for high clinical probability. Conclusion. Patients with low clinical probability of acute appendicitis benefit the most from preoperative CT while this does not apply to patients with high clinical probability.
- Clinical results of laparoscopic appendectomy in patients with complicated and uncomplicated appendicitis. [JOURNAL ARTICLE]
- Int J Clin Exp Med 2014; 7(10):3478-3481.
Acute appendicitis is the most common surgical emergency. The aim of this study was to evaluate the clinical results of laparoscopic appendectomy (LA) for the treatment of uncomplicated and complicated appendicitis. A retrospective analysis was performed who had undergone laparoscopic appendectomy for complicated appendicitis between January 2010 to October 2013. The diagnosis of acute appendicitis was established with physical examination, laboratory tests, and ultrasound examination. The patients were analysed for age, sex, conversion rate,operation time, postoperative infectious complications and length of hospital stay. A total of 452 patients were operated with LA. There were 362 (80.1%) uncomplicated (Group I) and 90 (19.1%) complicated Group (II) appendicitis.The intraabdominal abscess rate was 14.35% in Group I and 19.5% in Group II. The wound infection and rate of incisional hernia were also higher in Group II. The postoperative complications including intraabdominal abscess, wound infection and incisional hernia after LA in complicated appendicitis found high. LA should be performed very carefully in complicated appendicitis.
- Caecal diverticulitis: a rare cause of right iliac fossa pain. [Journal Article]
- Ir Med J 2014 Oct; 107(9):291-2.
We present a case of a young boy with an unusual cause of right iliac fossa pain. His history, examination and laboratory investigations suggested a diagnosis of acute appendicitis. However preoperative abdominal CT revealed an inflamed solitary caecal diverticulum and a normal appendix. He was subsequently treated conservatively and recovered well, saving him from undergoing a general anaesthetic and abdominal surgery.
- Primary omental torsion in a 9 year old girl: a case report. [Journal Article]
- J Med Life 2014 Jun 15; 7(2):220-2.
Primary torsion of the omentus is an extremely unusual cause of acute abdomen in the pediatric population. This condition occurs from twist of the pedicle of the omental apron around its longer axis, leading to edema, ischaemia and necrosis. Here we present a rare case of a 9 year old girl referred by her general practitioner due to severe right lower quadrant abdominal pain with a presumed diagnosis of acute appendiceal inflammation. Surgical operation disclosed primary omental torsion. The infarcted segment was resected and the girl's clinical recovery was uneventful without any complication. The condition may mimic a variety of other causes of acute abdominal symptoms. In this case report, a presumed diagnosis of acute appendicitis urgently induced the decision of a surgical approach. Physicians involved in the acute pediatric care have to include this rare condition in the differential diagnosis of acute onset right-sided abdominal pain.
- Secondary peritonitis -evaluation of 204 cases and literature review. [REVIEW]
- J Med Life 2014 Jun 15; 7(2):132-138.
Even at the beginning of the new millennium, secondary peritonitis presents a common life-threatening condition associated with high mortality and morbidity.This article comments on epidemiology, diagnosis and general principles of surgical management in patients with secondary peritonitis.The demographic data, clinical findings and surgical outcome of 204 patients who had a confirmed generalized secondary peritonitis were analyzed retrospectively. Our approach was laparotomy, surgical control of contamination, antibiotic therapy and modern intensive care support. Acid peptic disease was the most common cause of perforation peritonitis 60 (29,41%), following by the perforated appendicitis 45 ( 22,06%). The faecal peritonitis and colon perforation were found in 42 patients (20,59%). The morbidity rate was 50%; 41 (40,2%) patients had more than one complication. The morbidity rate was significantly the highest in patients with colon perforation (n=38, 90%) (Hi-square=40,1; p<0,001). The overall mortality rate in our study was 8,82%. The mortality rate was significantly the highest among the patients with mesenteric ischemia in 4 patients (66,67%), followed by colon perforation in 10 cases (23,81%), and 4(6,6%) deaths due to gastro-duodenal perforation (Hi-square=45,7; p<0,001).This study has confirmed that the clinical presentation and outcome of the secondary peritonitis depend on duration of abdominal infection, the site of perforation and the general condition of the patient. Rapid surgical source control, modern intensive care and sepsis therapy may offer the chance of decreased morbidity and mortality of the intra-abdominal infections. Abbreviations Intensive Care Unit (ICU), Perforated Diverticular Disease (PDD), Inflammatory Bowel Disease (IBD), Multiple Organ Dysfunction Syndrome (MODS), Acute Respiratory Distress Syndrome (ARDS), Nonsteroidal Anti-inflammatory Drugs (NSAID), Peptic Ulcer Disease(PUD), Ultrasonography (US), Computer Tomography (CT), Colorectal Cancer (CRC), Postoperative Adhesive Disease (PAD), Acute Mesenteric Ischemia (AMI).
- Acute appendicitis can be treated with single incision laparoscopy: a systematic review of randomized controlled trials. [JOURNAL ARTICLE]
- Colorectal Dis 2014 Nov 19.
Single incision laparoscopic surgery (SILS) has been proposed as the next step in minimally invasive surgery for appendicectomy. Previous reviews have summarised the results of low evidence comparative studies suggest that the two approaches are comparable in terms of outcomes, but have proven the need for randomised controlled trials (RCTs). This review meta-analyses RCTs on this topic to evaluate the safety and efficacy of single incision laparoscopic appendectomy (SILA).A comprehensive research of electronic databases has been performed. Primary outcomes (overall and access-specific morbidity) were designed as safety issues. Secondary outcomes were pain, cosmesis, operative time, conversion rate and length of hospital stay.FOLLOWING EXCLUSIONS, 5 RCTS SATISFIED THE INCLUSION CRITERIA, INCLUDING A TOTAL OF: 761 patients (379 SILA and 382 conventional three-port laparoscopic appendectomies - CLA). No significant differences in overall morbidity, early wound morbidity or length of stay were found between SILA and conventional three-port laparoscopic appendectomy (CLA). Cosmesis and pain were not comparable due to different scales and time records. Conclusions on incisional hernia rate were not reliable due to short follow-up periods.SILA can be considered an acceptable alternative to CLA in the treatment of acute appendicitis,but an economic evaluation of the various techniques for single access must be performed before its widespread clinical introduction. Better designed RCTs are necessary to define a population in which SILA could have major benefits. This article is protected by copyright. All rights reserved.
- Acute abdomen in pregnancy due to isolated Fallopian tube torsion: The laparoscopic treatment of a rare case. [Journal Article]
- World J Clin Cases 2014 Nov 16; 2(11):724-7.
In the last years, operative laparoscopy became a standard approach in gynaecology and general surgery. Even in pregnancy its use is becoming more widely accepted. In fact, it offers advantages similar to those in no pregnant women, associated with good maternal and fetal outcomes. Around 0.2% of pregnant women require abdominal surgery. The most common indications of laparoscopy in pregnancy are cholelithiasis complications, appendicitis, persistent ovarian cyst and adnexal torsion. Authors describe a very rare case of acute abdomen due to isolated Fallopian tube torsion in a 24(th) weeks pregnant woman, managed by laparoscopic salpingectomy.
- Evaluation of procalcitonin as a biomarker of diagnosis, severity and postoperative complications in adult patients with acute appendicitis. [Journal Article]
- Med J Islam Repub Iran 2014.:50.
Delay in diagnosis and treatment of acute appendicitis (AA) results in an increased rate of perforation, postoperative morbidity, mortality and hospital length of stay. Several biochemical parameters including white blood cell (WBC) count, C-reactive protein (CRP), interleukin-6 (IL6) and Procalcitonin (PCT) have been used to further improve the clinical diagnosis of AA. The aim of this study was to assess the value of procalcitonin as a predictor of diagnosis and severity of appendicitis in order to improve the clinical decision making, since other studies have been unable to demonstrate a diagnostic value for PCT elevation in acute appendicitis.One-hundred patients who underwent open appendectomy, including 75 men and 25 women with a mean age of 28 years were included in this study. Procalcitonin values were measured by an immunofluorescent method). Serum PCT>0.5 ng/ml was considered positive. The PCT serum values were measured in four different categories, including ˂0.5ng/ml, 0.5-2 ng/ml, 2-10ng/ml and more than 10ng/ml.The sensitivity and specificity of PCT level measurement for acute appendicitis diagnosis were 44% and 100% respectively. The value of PCT increased with the severity of appendicitis and also with the presence of peritonitis and infection, at the site of surgery.Procalcitonin measurement cannot be used as a diagnostic test for adult patients with acute appendicitis and its routine use in such patients is not cost effective and conclusive. Procalcitonin values can be used as a prognostic marker and predictor of infectious complications following surgery and it can help to carry out timely surgical intervention which is highly recommended in patients with PCT values more than 0.5ng/ml.
- Surgical Site Infection and Timing of Prophylactic Antibiotics for Appendectomy. [JOURNAL ARTICLE]
- Surg Infect (Larchmt) 2014 Nov 17.
Abstract Background: Pre-operative prophylactic antibiotics may decrease the frequency of surgical site infection after appendectomy. However, the optimal timing for administration of pre-operative prophylactic antibiotics is unknown. The purpose of this study was to evaluate the effect of timing of prophylactic antibiotics on the frequency of surgical site infection after appendectomy. Methods: Medical records were reviewed retrospectively for 577 consecutive patients who had appendectomy for acute appendicitis from 2006 to 2009. Quality assurance guidelines for timing of prophylactic antibiotics before the skin incision were changed from 0 to 30 min before the skin incision (before June 2008) to 30 to 60 min before the skin incision (after June 2008). Results: Surgical site infection occurred in 28 patients (4.9%). There was no difference in frequency of surgical site infection with different timing of pre-operative prophylactic antibiotic (pre-operative time 0 to 30 min: 9 infections [3.6%]; 31 to 60 min: 13 infections [5.4%]; 61 to 120 min: 5 infections [7.0%]; >120 min: 1 infection [6.6%]). Multivariable analysis showed that surgical site infection was associated significantly with medical comorbidity but not perforated appendicitis. Conclusions: The frequency of surgical site infection was independent of timing of preoperative prophylactic antibiotics but was associated with the presence of medical comorbidity.