Acute Inflammation Of Appendix Research Articles

Comparative study between clinical diagnosis using modified Alvarado score and ultrasound imaging in decreasing negative appendectomy rate

Background: Acute appendicitis is the acute inflammation of appendix which is the most common cause of acute surgical emergencies. Appendicitis can mimic other pathologies. Removing normal appendix is an economical burden both on patients and health resources. Misdiagnosis and delay in surgery can lead to complications like perforation and finally peritonitis.Methods: This was prospective comparative study carried out in 200 patients over the period of 2 years. Patients with clinical features of acute appendicitis and fitting in inclusion and exclusion criteria were selected. Detailed history was noted and clinical examination was done. Necessary investigations were done, modified Alvarado score was calculated and all were subjected to ultrasonography of abdomen and pelvis. Intra operative findings were noted about nature of appendix and histopathology findings were noted.Results: The sensitivity of ultrasound is 78.19% and specificity is 50%. The sensitivity of modified Alvarado scoring system is 78.7% and specificity is 25%. Negative appendicectomy rate in the study was 6%.Conclusions: Modified Alvarado score has slightly higher sensitivity and ultrasound imaging has higher specificity of in the diagnosis of acute appendicitis and in decreasing negative appendicectomy rates. Ultrasound imaging provides good supportive diagnosis in cases of low or equivocal modified Alvarado scores.

Videolaparoscopic and morphological parallels in diagnosis of different forms of acute appendicitis

To compare results of macroscopic assessment and materials of histological examination of 1635 appendices removed using videolaparoscopy in patients with acute appendicitis. All patients have been treated in N.V.Sklifosovsky Research Institute of Emergency Care for the period from 2002 to 2014. Intraoperative macroscopic assessment of appendix's inflammatory changes was performed using some conventional signs. Сatarrhal, phlegmonous and gangrenous changes were suspected in 77 (4.7%), 1432 (87.5%) and 126 (7.7%) cases respectively. Histological examination revealed catarrhal, phlegmonous and gangrenous changes in 86 (5.3%), 1338 (81.8%) and 115 (7.0%) cases respectively. In 65 (4.0%) patients changes were estimated as chronic, 31 (1.9%) patients had not inflammation. Intraoperatively suspected diagnosis of different forms of appendicitis was confirmed by histological survey in 94.1%. Most cases of matched intraoperative and histological diagnosis were observed in case of phlegmonous appendicitis (88.2%). Only 5.9% of patients had not acute inflammation of appendix that may be explained by overdiagnosis and excess of indications for appendectomy.

A prospective study of 70 cases evaluating the role of hyperbilirubinemia in acute inflammation of appendix

Acute Appendicitis is the most common general surgical emergency, and early surgical intervention improves outcomes. Despite the increased use of ultrasonography, computed tomography scanning and laparoscopy, the rate of misdiagnosis of appendicitis has remained constant (15.3%), as has the rate of appendiceal perforation.In an age accustomed to early and accurate preoperative diagnosis, acute appendicitis remains an enigmatic challenge and a reminder of the art of surgical diagnosis.Aim:To evaluate the role of hyperbilirubinemia in AppendicitisMaterial and methods:A prospective study of 70 clinically suspected cases of appendicitis admitted in surgical unit-6, Lata mangeshkar hospital, Nagpur were subjected to investigations to confirm the diagnosis from April 2011- April 2012. Data collected included total leucocyte count, liver function test and ultrasound. Subsequently these cases were operated and clinical diagnosis was confirmed by histopathology.Results:Out of 70 cases, 41 were males and 29 were females. Their age ranged from 12 years to 60 years with average of 26.9 years. Duration of symptoms ranged from 1 day to maximum 8 days. All the cases diagnosed as acute appendicitis clinically. Per operatively, all cases had inflamed appendix. Among 70 cases, SB was raised in 42 (60%) cases where as 28 (40%) cases had normal SB level. It ranged from 1.2 mg/dL to 4.0 mg/dL. The average level of SB was 1.648 mg/dL.Conclusion:Our study concludes that there was hyperbilirubinemia in 60% of the patients of acute appendicitis. Elevated serum bilirubin ranged from 1.2mg/dL - 4 mg/dL and was of mixed type. When compared to other studies there was no complicated appendicitis encountered in our study.