Download the Free Unbound MEDLINE PubMed App to your smartphone or tablet.
Available for iPhone, iPad, iPod touch, and Android.
Appendicitis Acute [keywords]
- Ultrasound-guided transrectal drainage of deep pelvic abscesses in children: a modified and simplified technique. [JOURNAL ARTICLE]
- Pediatr Radiol 2014 Sep 14.
Appendicitis is a common cause of acute surgical abdomen in children and often presents after perforation. Intra-abdominal abscesses can be drained percutaneously via transabdominal, transgluteal or, in the case of deep pelvis abscess, via transrectal approach.To describe a modification of previously described techniques for transrectal drainage procedures, which involves the use of a transvaginal probe and a modified enema tip as a guide for the one-step trocar technique. We also aimed to evaluate the safety and effectiveness of this modified technique for drainage of deep pelvic abscesses in children.A retrospective review of medical records was performed to identify all patients who underwent transrectal abscess drainage at our pediatric institution during a 5-year period. Surgical and radiologic procedure notes and imaging studies were evaluated. The data were analyzed to determine technical and clinical success rates, and to evaluate for any procedure-related complication.The study population consisted of 46 patients with a mean age of 10.9 years. Of the 46 children, 20 underwent transrectal abscess drainage solely using transrectal US for guidance; 2 also underwent minimal fluoroscopy at the time of transrectal drainage. Fifteen children required placement of one or more percutaneous transabdominal drains at the same time as transrectal catheter placement, and nine required addition percutaneous drainage catheters placed at another time. All transrectal drainage procedures were technically and clinically successful. There were no procedure-related complications.The described modified technique for US-guided transrectal drainage of deep pelvic abscesses resulting from perforated appendicitis in children is safe, effective and relatively easy to perform, with the added benefit of omitting radiation exposure in children.
- Comamonas testosteroni: An Unusual Bacteria Associated with Acute Appendicitis. [Journal Article]
- Balkan Med J 2013 Dec; 30(4):447-8.
- Single site multiport umbilical laparoscopic appendicectomy versus conventional multiport laparoscopic appendicectomy in acute settings. [Journal Article]
- Ann R Coll Surg Engl 2014 Sep; 96(6):452-7.
Although conventional multiport laparoscopic appendicectomy (CMLA) is preferred for managing acute appendicitis, the recently developed transumbilical laparoscopic approach is rapidly gaining popularity. However, its wide dissemination seems restricted by technical/technological issues. In this regard, a newly developed method of single site multiport umbilical laparoscopic appendicectomy (SMULA) was compared prospectively with CMLA to assess the former's efficacy and the technical advantages in acute scenarios.Overall, 430 patients were studied: 212 in the SMULA group and 218 in the CMLA group. The same surgeon performed all the procedures using routine laparoscopic instruments. The SMULA technique entailed three ports inserted directly at the umbilical mound through three distinct strategically placed mini-incisions without raising the umbilical flap. The CMLA involved the traditional three-port technique.Both groups were comparable in terms of demographic criteria, indications for surgery, intraoperative blood loss, time to ambulation, length of hospital stay and umbilical morbidity. Although the mean operative time was marginally longer in the SMULA group (43.35 minutes, standard deviation [SD]: 21.16 minutes) than in the CMLA group (42.28 minutes, SD: 21.41 minutes), this did not reach statistical significance. Conversely, the mean pain scores on day 0 and the cosmetic outcomes differed significantly and favoured the SMULA technique. None of the patients developed port site hernias over the follow-up period (mean 2.9 years).The favourable outcomes for the SMULA technique are likely to be due to the three small segregated incisions at one place and better trocar ergonomics. The SMULA technique is safe in an acute setting and may be considered of value among the options for transumbilical appendicectomy.
- Laparoscopic versus open appendectomy in the management of acute appendicitis in children: a multicenter retrospective study. [Journal Article]
- Minerva Pediatr 2014 Aug; 66(4):281-5.
Acute appendicitis is one of the most common indications for emergency surgery in children. Open appendectomy (OA) has been the gold standard treatment for over 100 years. In the last three decades, the introduction of minimally invasive techniques, such as laparoscopic appendectomy (LA) and transumbilical laparoscopically assisted appendectomy (TULAA), has changed the approach to the disease. However, there is still no agreement with benefits of these new therapeutic options, especially in children. The aim of this retrospective study is comparing the outcomes of OA, LA and TULAA in the paediatric patient.Children suffering from acute appendicitis were treated with LA or TULAA in the Department of Paediatric Surgery and with OA in the Department of General Surgery. Data were abstracted from database of both centers' archives. Operator, operating time, length of hospitalization (LOH), intra- and postoperative complications and histological finding were analyzed.We recruited 196 patients: 46 treated with LA, 62 with TULAA and 88 with OA. Operative time was significantly shorter in OA. The three techniques had the same incidence of intraoperative and postoperative complications. The incidence of wound infection was higher with the TULAA approach. LOH was significantly shorter in the TULAA group. There was no correlation between LOH and histological finding.We demonstrated that LA, TULAA and OA are similar in most respects and are equally safe modalities in paediatric patients. Further randomized controlled studies are necessary.
- Hospitalization time after open appendectomy by three different surgical techniques. [Journal Article]
- Arq Bras Cir Dig 2014 Sep; 27(3):188-90.
The choice of surgical technique to approach the appendicular stump depends mostly on skill and personal preference of the surgeon or on the protocol used in the service, and the influence of this choice in hospitalization time is not evaluated.To evaluate the relation between surgical technique and postoperative hospitalization time in patients presenting with acute appendicitis.Retrospective analysis of 180 patients who underwent open appendectomy. These where divided into three groups according to surgical technique: conventional appendectomy (simple ligation of the stump), tobacco pouch suture and Parker-Kerr suture. Data where crossed with hospitalization time (until three days, from four to six days and over seven days).A hundred and eighty patients with age from 15 to 85 years where included. From these, 95 underwent conventional technique, had an average hospitalization time of 3,9 days and seven had complications (surgical site infection, seroma, suture dehiscence and evisceration). In 67 patients, tobacco pouch suture was chosen and had average hospitalization time of 3,7 days and two complications (infection and seroma). In 18 Parker-Kerr suture was made, with average hospitalization time of 2,6 days, with no complication. Contingency coefficient between the variables hospitalization time and technique was 0,255 and Cramér's V was 0,186.There was tendency to larger hospitalization time and larger number of complications in conventional appendectomy, whereas in patients where Parker-Kerr suture was performed, hospitalization time was significantly smaller.
- Acute appendicitis in kidney transplantation. [Letter]
- Ann Transplant 2014.:434-5.
- Suprapubic single incision laparoscopic appendectomy. [JOURNAL ARTICLE]
- J Surg Res 2014 Aug 4.
The single incision method through the umbilicus is commonly used for laparoscopic appendectomy. To obtain a better cosmetic outcome and less surgical complexity, we have designed a new single-incision laparoscopic appendectomy technique performed above the pubic symphysis.Between January 2011 and January 2012, patients with uncomplicated acute or chronic appendicitis, excluding those with abscess, perforation, peritonitis, and previous pelvic surgery, underwent this innovative laparoscopic appendectomy. During each operation, a multichannel trocar composed of a small wound protector and a size 6 sterile glove was deployed after a 2 cm transverse incision was made 1-2 cm above the pubic hair area.Of the 42 patients, 24 were male and 18 were female. Their mean age was 30 ± 11 y. The mean operative time was 58 ± 11 min, mean time to first flatus postoperatively was 17 ± 8 h, and mean postoperative length of hospital stay was 3 ± 1 d. No complications occurred during surgery. No patient required conversion to either multiport or open appendectomy. Postoperative wound inflammation was observed in one case (2.3%).Our results suggested that suprapubic single-incision laparoscopic appendectomy seems to be safe and feasible for selected patients, in consideration of cosmetic outcomes.
- Abdominal tuberculosis with an acute abdomen: our clinical experience. [Journal Article]
- J Clin Diagn Res 2014 Jul; 8(7):NC07-9.
Tuberculosis is an important cause of morbidity in India. Abdominal Tuberculosis is a great mimicker and is difficult to diagnose. This prospective observational study is based on those patients who were diagnosed to be suffering from Abdominal Tuberculosis only after they presented with an acute abdomen. This study aims to document the nature of different types of acute presentation in Abdominal Tuberculosis according to involved sites and surgical pathology. The study also discusses the indications and extent of surgical intervention.Seventy new cases of Abdominal Tuberculosis (out of 718 cases of acute abdomen) were diagnosed and treated over a period of three years in the surgical ward of Calcutta National Medical College. Macroscopic appearance of abdominal tissues during surgery suggested the diagnosis of tuberculosis. The diagnosis was confirmed by histopathology and tissue culture. All patients were subsequently treated with a full course of antitubercular drugs (ATD).The clinical presentations of acute abdomen included acute intestinal obstruction, perforative peritonitis and acute appendicitis etc. Terminal ileum and ileocaecal region were predominantly involved. The most common pathology was intestinal stricture with or without perforation. Most of the patients (approx 78.5%) required emergency surgery as a therapeutic intervention. A two-stage procedure was preferred in peritonitis and sepsis. Most of the remaining patients (12.8%) required surgery after initial conservative treatment for the first few days. Undiagnosed Abdominal Tuberculosis represents a notable percentage (10%) of patients who present with an acute abdomen as a surgical emergency.Abdominal Tuberculosis is very difficult to diagnose and diagnosis is often delayed till an acute abdomen is presented with. Almost all patients needed surgical intervention. Irrespective of surgery, all patients of abdominal tuberculosis require a full ATD.
- Diagnostic markers in acute appendicitis. [JOURNAL ARTICLE]
- Am J Surg 2014 Jul 29.
An adequate medical history combined with clinical examination is usually enough to make the diagnosis of acute appendicitis. The aim of this study was to determine the value of elevated white cell count (WCC), C-reactive protein (CRP), and bilirubin as diagnostic markers of acute appendicitis.A retrospective analysis was carried out on consecutive patients who underwent appendicectomy over a 3-year period. All data including patients' age, sex, blood test results, and appendix histology were summarized. Sensitivities, specificities, positive, and negative predictive values of WCC, CRP, and bilirubin were calculated separately or in combination for all patients.A total of 447 patients were included. There is a significant difference in the results between patients with negative and positive appendicitis with regards to CRP (32 vs 73; P < .001), mean total WCC (10.9 vs 14.0; P < .001), and the mean levels of bilirubin (10.9 vs 17.2; P < .001).The diagnosis of appendicitis remains multifactorial and blood tests may help to guide the surgeon in the decision making.