Download the Free Unbound MEDLINE PubMed App to your smartphone or tablet.
Available for iPhone, iPad, iPod touch, and Android.
Appendicitis Acute [keywords]
- Does abdominal pain duration affect the accuracy of first-line MRI for pediatric appendicitis? [JOURNAL ARTICLE]
- Abdom Imaging 2014 Aug 19.
To compare the accuracy of first-line MRI for pediatric appendicitis between children with different durations of abdominal pain.Between November 2012 and September 2013, 364 pediatric patients underwent MRI for clinically suspected appendicitis. Patients were stratified into one group with pain lasting less than or equal to 1 day and pain longer than 1 day.In patients with early abdominal pain, appendicitis occurred in 83 of 208 patients (39.9%) vs. 49 of 156 patients with pain longer than 1 day (31.4%, p = 0.09). Sensitivity and specificity of MRI in patients with early abdominal pain were 97.6% (95% CI [91.6%-99.3%]) and 94.4% (95% CI [88.9%-97.3%]), respectively, vs. 93.9% (95% CI [83.5%-97.9%]) and 97.2% (95% CI [92.1%-99.4%]), respectively, in patients with pain longer than 1 day in duration (p = 0.36 and p = 0.35 for sensitivity and specificity, respectively).First-line MRI is accurate for acute appendicitis in children presenting with early abdominal pain, and may be appropriate as the initial examination in children. Further prospective studies are needed to compare MRI vs. ultrasound as the initial examination in children with early abdominal pain to help further delineate a diagnostic imaging algorithm.
- Appendicitis in double cecal appendix: Case report. [Journal Article]
- World J Clin Cases 2014 Aug 16; 2(8):391-4.
Double cecal appendix is a rare anatomical variation. Approximately 100 cases have been reported worldwide. It is usually diagnosed incidentally during emergency appendectomies due to inflammatory processes in the cecal appendix.male, white, 36 years old, obese, presenting with pain in the lower abdomen for 24 h followed by nausea, vomiting and mild fever. He was subjected to additional tests, with the leukogram showing leukocytosis and abdominal ultrasonography depicting cecal appendix with thickened wall, locally associated with small quantities of liquid and intestinal loop obstruction. He underwent laparotomy, revealing acute appendicitis. Another intestinal loop obstruction was identified next to the ileum, leading to recognizing another cecal appendix after local dissection. Double appendectomy and segmental iliectomy were performed although not needed. Results of the anatomopathological examination of the surgical samples showed acute inflammation in the two cecal appendices. So, performing a routine retroperitoneal release and a complete cecum evaluation during such surgical procedures is recommended and suggested due to the possibility of not identifying a second cecal appendix.
- Management of children with possible appendicitis: A survey of emergency physicians in Australia and New Zealand. [JOURNAL ARTICLE]
- Emerg Med Australas 2014 Aug 6.
To describe current practice in managing children with possible acute appendicitis in EDs in Australia and New Zealand as the basis for a clinical practice guideline (CPG).An anonymous survey was distributed to consultant emergency physicians working at PREDICT (Paediatric Research in Emergency Departments International Collaborative) sites in Australia and New Zealand in April 2013. A second, site-based survey was distributed to the PREDICT representatives at each of the 13 sites.The response rate was 100% (13/13) for the site-based survey and 82% (145/176) for the physician survey. Most respondents agreed that right lower quadrant (RLQ) tenderness (94%), anorexia (92%), migration of abdominal pain to the RLQ (86%), rebound tenderness in the RLQ (60%) and RLQ tenderness produced on coughing, hopping or percussion (63%) were valuable symptoms and signs in diagnosing appendicitis. The responses regarding nausea and vomiting and fever were less consistent. Less than 50% regarded blood tests (C-reactive protein, white cell count) as relevant for the diagnosis of appendicitis. Most physicians (61%) agreed there was a role for a validated CPG for possible appendicitis in children, although only 3/13 sites reported use of such a CPG.This survey of senior emergency physicians across Australia and New Zealand demonstrated congruence in several clinical markers and disagreements in others in the approach to diagnosing children with possible appendicitis. Whereas emergency physicians would like a validated CPG, this survey has highlighted some critical issues. Particularly, the low regard for blood tests, integral to published diagnostic scoring systems, will be a challenge for the development and introduction of such a CPG in Australia and New Zealand.
- Post-Appendectomy Surgical Site Infection Rate after Using an Antimicrobial Film Incise Drape: A Prospective Study. [JOURNAL ARTICLE]
- Surg Infect (Larchmt) 2014 Aug 15.
Abstract Background: An appendectomy is a contaminated or potentially dirty surgical procedure that can be associated with surgical site infection (SSI). Methods: A single-center unblinded prospective cohort study examined the role of antimicrobial incise film drapes in lowering the rate of SSI after appendectomy. Any patient aged 12 years or older who was scheduled for open appendectomy for acute appendicitis was included. Patients were assigned to two groups. Group 1 (n=52) had the standard five-minute skin preparation with 10% povidone-iodine soap followed by the application of an antimicrobial film incise drape, and group 2 (n=39) had the standard skin preparation alone. Results: Six (11.5%) of the 52 patients who had the antimicrobial film incise drape and two (5.1%) of the 39 patients who did not have the drape developed SSI (p=NS). Of the six patients in the antimicrobial film group with post-operative SSI, three had a perforated appendix, two had a gangrenous appendix, and one had an inflamed appendix. In group 2, one patient had an inflamed appendix and the other had a perforated appendix. The median length of stay in the hospital was two days (range 1-11 days) for both groups. Conclusion: Our study did not support the view that antimicrobial film incise drapes can lower the rate of post-appendectomy SSI. Moreover, the length of stay was not minimized by the use of these drapes.
- Cecal endometriosis presenting as acute appendicitis. [Journal Article]
- Case Rep Surg 2014.:519631.
The aim of our paper is to show the diagnosis of Coecal endometriosis as an infrequent reason of right iliac fossa pain. cecal endometriosis manifesting with right lower quadrant pain is difficult to diagnose, and it may even sometimes require laparotomy for diagnosis and treatment. We report here a case of cecal endometriosis causing clinically resembled acute appendicitis. In our patient, a diagnosis of cecal endometriosis was made postoperatively by microscopic examination of excised right colon, and the patient symptoms and general condition were improved after the surgery (open right hemicolectomy and ileocolic anastomosis).
- Complicated acute appendicitis within a right inguinal hernia sac (Amyand's hernia): report of a case. [Journal Article]
- Hippokratia 2014 Jan; 18(1):74-6.
The term Amyand's hernia refers to a rare clinical situation characterized by the presence of a normal or inflammed appendix within the sac of an inguinal hernia. The situation may be asymptomatic or may present as an incarcerated hernia in case of strangulation or acute appendicitis occurring inside the hernia sac.We present the case of a right Amyand's hernia on a 88-years-old male that presented to our emergency department with a severely tender and swollen inguinal mass that was diagnosed as a strangulated inguinal hernia - inguinal abcess and underwent emergency operation. The intraoperative findings included a severely inflamed and perforated appendix along with healthy part of the caecum inside the sac. Appendectomy with subsequent primary hernia repair without mesh was performed with excellent outcome.Because of the fact that most of such rare cases are managed by urgent surgery with no preoperative diagnosis, every surgeon should be prepared for the possibility of coping with such an unexpected situation.
- CIRCULATING LEUCINE-RICH α-2-GLYCOPROTEIN glycoprotein 1 TO DETECT ACUTE APPENDICITIS IN PATIENTS WITH ACUTE ABDOMINAL PAIN. [Journal Article]
- Emerg Med J 2014 Sep; 31(9):787.
Circulating leucine-rich α-2-glycoprotein-1 (LRG1) protein has been found in the plasma and urine of patients with acute appendicitis (AA) and may be useful for diagnosis. The present study aimed to investigate whether circulating LRGI mRNA levels also improve the early diagnosis of AA.A prospective study was conducted between December 2011 and October 2012 on patients presenting to the ED with acute abdominal pain (<7 days of symptom onset). AA was confirmed if there were histopathological findings of an inflammed or necrotic appendix in appendicectomy specimens. Real-time polymerase chain reaction was used to analyze whole blood LRG1 mRNA level taken from these patients within 24 hours of arrival (mean 12.4 h). The primary outcome was AA.Eighty-four consecutive patients (40 (47.6%) with AA and 44 (52.4%) without AA; mean age 35 years; 41.6% males) were recruited. Median whole blood LRG1 mRNA levels were higher in AA patients than in non-AA patients (2.2 (95% CI 1.3-2.6) vs 1.3 (95% CI 0.8-1.8)×10(5)copies/ml, p=0.0122). Of 40 AA patients, 13 (32.5%) were diagnosed as complicated AA, and had median LRG mRNA level higher than in patients with simple AA (3.2 (95% CI 2.2-4.1) vs 1.6 (95% CI 1.1-2.5)×10(5) copies/ml, p=0.0479). At a LRG1 mRNA cutoff of 1.9×10(5) copies/ml, the optimal sensitivity and specificity were 57.5% and 72.7% respectively. At this cutoff, the odds ratio for AA was 3.6 (95% CI 1.5-9.0; p=0.0047).Whole blood LRG1 mRNA levels may be useful to diagnose simple and complicated AA from other causes of abdominal pain.This research study was supported by a Direct Grant for Research from the Chinese University of Hong Kong (reference no.: 2041642) (HK$18000).
- Antibiotic therapy for acute appendicitis in adults. Fewer immediate complications than with surgery, but more subsequent failures. [Journal Article]
- Prescrire Int 2014 Jun; 23(150):158-60.
Appendectomy is the standard treatment for acute appendicitis. Since the 1990s, antibiotic therapy has sometimes been proposed as an alternative to immediate appendectomy. How effective are antibiotics in adults with uncomplicated acute appendicitis, and what is the risk of complications? To answer these questions, we conducted a review of the literature using the standard Prescrire methodology. A systematic review with meta-analysis included four randomised trials of antibiotics versus immediate appendectomy, in 900 patients hospitalised with uncomplicated appendicitis. The studies included only patients with few severe symptoms, thus undermining the strength of the results. Antibiotic therapy was usually administered intravenously first, then orally. The antibiotics used were amoxicillin + clavulanic acid, cefotaxime, or a fluoroquinolone. Metronidazole or tinidazole was often added. The total duration of antibiotic treatment was 8 to 15 days. The overall incidence of complications of appendicitis (perforation, peritonitis and surgical wound infections) was 25% in the immediate appendectomy group versus 18% in the antibiotic group. The frequency of perforations and peritonitis did not differ between the groups. All symptoms of appendicitis disappeared, without relapse or rehospitalisation during the first month, in 78% of patients in the antibiotic group. After one year of follow-up, 63% of patients treated with antibiotics were asymptomatic and had no complications or recurrences. In another systematic review of five randomised trials, outcome at one year was optimal in 73% of patients treated with antibiotics alone versus 97% of patients who had immediate appendectomy. In practice, in early 2014, appendectomy remains the first-line treatment for uncomplicated acute appendicitis. In some still poorly characterised patients, the harm-benefit balance of antibiotic therapy is probably better than that of immediate appendectomy. When informed of the risks, some patients are likely to choose antibiotic therapy.
- HBV & HCV - awareness in acute abdomen emergency cases. [Journal Article]
- J Clin Diagn Res 2014 Jun; 8(6):NM01-2.
A study was conducted on 100 cases of Acute abdomen admitted in surgery department of Govt Medical college and Rajendra Hospital, Patiala, India. Study group included patients with different abdominal emergencies, e.g. gastrointestinal perforation, intestinal obstruction, acute appendicitis, acute cholecystitis, pancreatitis etc. Out of these, three cases were positive for HBsAg alone, one for anti Hepatitis C-Virus (HCV) alone and one was positive for both HBsAg and anti HCV.
- Omental torsion. [Journal Article, Review]
- J Clin Diagn Res 2014 Jun; 8(6):NE01-2.
Torsion of greater omentum is one of the rare causes of acute abdominal pain. It can be primary or secondary. Primary Omental Torsion (POT) occurs because a mobile, thicken segment of omentum rotates around a proximal fixed point in the absence of any associated or secondary intra-abdominal pathology. Secondary omental torsion is associated with a number of pre-existing conditions most common among them is inguinal hernia, other causes include tumours, cysts, internal or external herniation, foci of intra-abdominal inflammation and postsurgical wound or scarring. Torsion of omentum causes twisting of omentum along its long axis resulting in impaired blood supply. This rare condition is more predominant in middle-aged males. It clinically mimics acute appendicitis. It should be kept in mind as a differential diagnosis for acute abdomen. Laparoscopy can aid in diagnosis and management but explorative laparotomy is the definitive and therapeutic procedure of choice. However the condition is not life threatening as omentectomy reduces the inflammation and focus of adhesions within the abdomen.