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Appendicitis Acute [keywords]
- [Caecal diverticulitis in a young woman with suspected acute appendicitis.] [JOURNAL ARTICLE]
- Ugeskr Laeger 2013 Dec 9; 175(50A)
Colonic diverticular disease is common amongst the western population in the left hemicolon while right-sided involvement is rare. This case concerns a 20-year-old female, who was hospitalized with suspected acute appendicitis. Perioperative findings included an intramural tumour at the base of the appendix, and an ileocaecal resection was performed. Histopathological examinations revealed a single inflamed diverticulum of the caecum. The case illustrates the pre- and perioperatively differential diagnostic problems of caecal diverticulitis, which can lead to more radical surgery than needed.
- Appendicectomies performed >48 hours after admission to a dedicated acute general surgical unit. [JOURNAL ARTICLE]
- Ann R Coll Surg Engl 2014 Nov; 96(8):614-617.
Acute general surgical units (AGSUs) are changing the way in which acute appendicitis is managed. In the AGSU at John Hunter Hospital, some patients wait more than 48 hours from admission to undergo an appendicectomy, usually because they are not unwell enough to precipitate an operation before that time. We analysed this subgroup of appendicectomy patients to determine how effectively they are being managed and how this might be improved.A retrospective review of prospectively collected data was conducted of all patients who received an appendicectomy while admitted under the AGSU at John Hunter Hospital in the five years between January 2009 and December 2013.A total of 1,039 appendicectomies were performed in the study period, with 81 patients (7.8%) waiting >48 hours for their operation (delayed appendicectomy group). Overall, the negative appendicectomy (NA) rate was 21.6%; the NA rate in delayed appendicectomies was 50.62% and a non-therapeutic operation occurred in 47% of this group (n=38). No significant difference was found in the incidence of perforation/gangrenous appendicitis between patients having surgery in <48 hours and the delayed appendicectomy groups (11.2% vs 9.9%, p=0.85). A combination of negative diagnostic imaging result, a normal white cell count and normal C-reactive protein (ie a negative 'triple test') was the best predictor of a negative appendicectomy (p=0.0158, negative predictive value: 0.91, 95% confidence interval: 0.59-0.99), in the delayed appendicectomy group.In the delayed appendicectomy group, the incidence of perforation/gangrenous appendicitis was not significantly different from that found in patients having appendicectomy performed sooner. However, the NA and non-therapeutic operation rates were unacceptably high. An appendix triple test can improve diagnostic accuracy significantly without an unacceptable rise in the rates of perforation/gangrenous appendicitis.
- Liver Abscess Secondary to Acute Appendicitis: How a Chicken Bone Started It All. [JOURNAL ARTICLE]
- Am Surg 2014 Nov; 80(11):320-321.
- Acute Appendicitis in the Elderly: Diagnosis and Management Still a Challenge. [JOURNAL ARTICLE]
- Am Surg 2014 Nov; 80(11):295-297.
- Clinical features of complicated acute appendicitis. [Journal Article]
- J Med Assoc Thai 2014 Aug; 97(8):835-40.
To identify the clinical features associated with complicated (gangrenous or perforation) acute appendicitis in the patients who underwent appendectomy.A consecutive series of adult patients with acute appendicitis who underwent appendectomy at Songklanagarind Hospital between 2005 and 2010 were retrospectively analyzed.Nine hundred twenty four patients were evaluated. Median (interquartile range) age was 34.9 (22.4, 50.1) years. There were 669 (72.4%) simple acute appendicitis and 255 (27.6%) complicated acute appendicitis. Multivariate analyses showed that age >60 years (OR 1.93, 95% CI 1.23-3.02), duration of symptoms >12 hours (OR 3.29, 95% CI 2.25-4.8), anorexia (OR 1.69, 95% CI 1.2-2.37), body temperature >38 degreesC (OR 2.38, 95% CI 1.59-3.58), generalized tenderness (OR 5.36, 95% CI 2.4-11.95), guarding (OR 1.5 95% CI 1.08-2.08), bandemia (OR 1.65, 95% CI 1.16-2.34), pyuria (OR 1.66, 95% CI 1.07-2.57), urine specific gravity >1.020 (OR 1.66, 95% CI 1.18-2.33), and duration from visit to surgery >12 hours (OR 1.82, 95% CI 1.18-2.82) were related to complicated acute appendicitis.Ten clinical features can be used to predict the risk of complicated acute appendicitis. However, the strong factors are duration of symptoms, body temperature, and generalized tenderness. They should be the useful tools for acute appendicitis management, especially in limited resources situation.
- Value of gadolinium-enhanced MRI in detection of acute appendicitis in children and adolescents. [Journal Article]
- AJR Am J Roentgenol 2014 Nov; 203(5):W543-8.
OBJECTIVE.The aim of this study was to determine both the value of gadolinium-enhanced MRI in children with suspected acute appendicitis and the best sequences for detecting acute appendicitis, to thereby decrease imaging time. MATERIALS AND
METHODS.This was a retrospective review of pediatric patients with suspected appendicitis who had undergone MRI at our institution between 2010 and 2011 after an indeterminate ultrasound examination. MRI examinations included T1-weighted unenhanced and contrast-enhanced, T2-weighted, and balanced steady-state free precession (SSFP) sequences in axial and coronal planes. Sequences were reviewed together and individually by five radiologists who were blinded to the final diagnosis. Radiologists were asked to score their confidence of appendicitis diagnosis using a 5-point scale. The diagnostic performance of each MR sequence was obtained by comparing the mean area under the curve (AUC) using receiver operating characteristic (ROC) analysis.
RESULTS.A total of 49 patients with clinically suspected appendicitis were included, of whom 16 received a diagnosis of appendicitis. The mean AUCs for reviewing all sequences together, contrast-enhanced sequences alone, T2-weighted sequences alone, and balanced SSFP alone were 0.984, 0.979, 0.944, and 0.910, respectively. No significant difference was observed between reviewing all sequences together versus contrast-enhanced sequences alone (p = 0.90) and T2-weighted sequences alone (p = 0.23). A significant difference was observed between contrast-enhanced sequences and balanced SSFP (p < 0.03).
CONCLUSION.Gadolinium-enhanced images and T2-weighted images are most helpful in the assessment of acute appendicitis in the pediatric population. These findings have led to protocol modifications that have reduced imaging time.
- Accuracy and radiation dose reduction of a limited abdominopelvic CT in the diagnosis of acute appendicitis. [JOURNAL ARTICLE]
- Abdom Imaging 2014 Oct 21.
To determine the accuracy and radiation dose reduction of a limited abdominopelvic CT from the bottom of T10 to the top of the pubic symphysis in patients with suspected acute appendicitis.We performed a HIPAA compliant and IRB-approved retrospective study of adult patients who underwent CT abdomen/pelvis for suspected appendicitis. The Z-axis length and whole body effective doses of the original full scan and theoretical limited scan from the bottom of T10 to the top of the pubic symphysis were recorded. Images were reviewed to determine if the appendix or entire cecum would be visualized and if any cases of appendicitis or alternative diagnoses would be missed with the limited scan.235 patients (89 male, mean age 44.6 years) were included. The limited scan resulted in a mean Z-axis length reduction of 5.1 cm superiorly, 6.1 cm inferiorly, and a total reduction of 11.2 cm (24%). The mean whole body effective dose was 11.8 and 9.1 mSv for the original and limited scans, respectively (23% reduction). The entire appendix or cecum was visualized in all cases. Appendicitis was present in 24 cases and an alternative diagnosis was made in 75. No cases of appendicitis or alternative diagnoses were missed using the limited scan.A limited range CT from the bottom of T10 to the top of the pubic symphysis is as accurate as full abdominopelvic CT in evaluating patients with suspected acute appendicitis and results in approximately 23% dose reduction.
- [Treatment with antibiotics for uncomplicated acute appendicitis: strategy and its value]. [English Abstract, Journal Article]
- Beijing Da Xue Xue Bao 2014 Oct 18; 46(5):715-9.
To establish the characteristics of uncomplicated acute appendicitis (UAA) and assess the efficacy of antibiotics by comparison with emergency appendicectomy for treatment.A retrospective clinical analysis was made on 742 cases of acute appendicitis. Several characteristics of UAA were identified. Following these rules 46 UAA patients were enrolled to receive antibiotic treatment for at least 48 h.follow-up was carried out for 6 months.Statistical analysis indicated that high level white blood cell count (>20×10(9)/L,P=0.000, OR=2.717), local or diffuse muscle guarding (P=0.031, OR=1.649), intraluminal stercolith (P=0.000, OR=2.939) and periappendiceal fluid (P=0.005, OR=3.273) were independent risk factors of complicated acute appendicitis. With none of these factors we enrolled 46 UAA patients. Of the 46 patients, 44(95.65%) were treated successfully with antibiotics. 2(4.35%) patients were unexpectedly identified to have complicated appendicitis at surgery. Recurrent appendicitis occurred in 5(11.36%) patients after 6 months. There was no difference in duration of pain and duration of hospital stay between antibiotic treatment group and appendicectomy group.Although antibiotic treatment may fail in some UAA cases, and there is a risk of recurrence, antibiotic treatment still appears to be a safe first-line therapy for UAA patients.
- Kikuchi- fujimoto disease of mesenteric lymph nodes mimicking acute appendicitis. [Journal Article]
- JNMA J Nepal Med Assoc 2013 Oct-Dec; 52(192):627-30.
Kikuchi-Fujimoto disease, or histiocytic necrotising lymphadenopathy of unknown aetiology, is a rare, benign and self-limiting cause of lymphadenopathy often involving the cervical nodes, and rarely presenting with mesenteric lymphadenopathy. We present a 26-year-old Caucasian male, who presented with right iliac fossa pain and low grade pyrexia, mimicking acute appendicitis. He underwent a laparatomy and an extended right hemi-colectomy for a caecal mass. Histology of the specimen showed lymph nodes with extensive areas of necrosis, with abnormal architecture suggesting Kikuchi-Fujimoto lymphadenopathy. This was further confirmed by immunohistochemistry. In this context maintenance of a high index of suspicion of this condition can avoid major surgical interventions. We describe the management of our case of Kikuchi-Fujimoto's disease involving the mesenteric nodes and provide an up to date review of the pertinent literature on this subject.abdominal mass; Kikuchi- Fujimoto disease; mesenteric lymphadenopathy; necrotising lymphadenitis.
- The utility of acoustic radiation force impulse imaging in diagnosing acute appendicitis and staging its severity. [JOURNAL ARTICLE]
- Diagn Interv Radiol 2014 Aug 28.
The aim of this study was to investigate the feasibility of using acoustic radiation force impulse (ARFI) imaging to diagnose acute appendicitis.Abdominal ultrasonography (US) and ARFI imaging were performed in 53 patients that presented with right lower quadrant pain, and the results were compared with those obtained in 52 healthy subjects. Qualitative evaluation of the patients was conducted by Virtual Touch™ tissue imaging (VTI), while quantitative evaluation was performed by Virtual Touch™ tissue quantification (VTQ) measuring the shear wave velocity (SWV). The severity of appendix inflammation was observed and rated using ARFI imaging in patients diagnosed with acute appendicitis. Alvarado scores were determined for all patients presenting with right lower quadrant pain. All patients diagnosed with appendicitis received appendectomies. The sensitivity and specificity of ARFI imaging relative to US was determined upon confirming the diagnosis of acute appendicitis via histopathological analysis.The Alvarado score had a sensitivity and specificity of 70.8% and 20%, respectively, in detecting acute appendicitis. Abdominal US had 83.3% sensitivity and 80% specificity, while ARFI imaging had 100% sensitivity and 98% specificity, in diagnosing acute appendicitis. The median SWV value was 1.11 m/s (range, 0.6-1.56 m/s) for healthy appendix and 3.07 m/s (range, 1.37-4.78 m/s) for acute appendicitis.ARFI imaging may be useful in guiding the clinical management of acute appendicitis, by helping its diagnosis and determining the severity of appendix inflammation.