Acute Phlegmonous Appendicitis Research Articles

Specific features of anesthesia management in a patient with a transplanted heart

Background. The number of heart transplant patients makes 1 per 100,000 in the Russian Federation, 1.2 per 100,000 population in the Tambov Region. The medical community is poorly informed about the specific features of managing such patients during non-cardiac surgical interventions. The article presents a case report of the management of a patient with a transplanted heart undergoing surgery for acute appendicitis. Preoperative preparation, anesthesia management, surgery, and postoperative care and rehabilitation were provided taking into account the presence of a transplanted heart in the patient, according to the Guidelines developed by the experts of the V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs where the heart transplant had been performed to the patient, and standard clinical recommendations.Case Report. An 18-year-old patient diagnosed with acute phlegmonous appendicitis with a heart transplanted in 2021 for dilated cardiomyopathy underwent laparoscopic appendectomy 3 years after heart transplantation. Anesthesia was provided taking into account the presence of a denervated donor heart, a high risk of myocardial ischemia and heart ailure (low cardiac output syndrome), and the need for a timely correction of hypovolemia and hypotension. Anesthesia management was a general combined multicomponent anesthesia.Conclusion. This clinical case has shown the possibility of providing medical care to a patient with a transplanted heart at a modern level in an urban multidisciplinary hospital. Non-cardiac surgery was performed in accordance with recommendations of specialists of V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs and clinical recommendations in order to achieve optimal results and the fastest possible rehabilitation in the postoperative period.

A clinical case of surgical treatment of appendiceal stump abscess

In Ukraine, the share of patients with acute appendicitis is 89.1% of the total number of patients with acute surgical pathology. In modern surgical practice, early and late complications occupy the first place in the structure of acute surgical diseases of the abdominal organs, regardless of the age and gender of the patients, and the postoperative mortality is on average 0.15%. In the remote period after an appendectomy, despite the progress of modern surgery, a very rare complication known as inflammation of the stump of the appendix can occur. The patient, 25 years old, turned to the department of purulent surgery with complaints of a «small wound» at the site of the postoperative scar in the right inguinal area and minor purulent discharge from it. Four months ago, in July, he was operated on for acute phlegmonous appendicitis. On November 1, after physical exertion, the wound reappeared, and on November 3, the patient independently sought a consultation at the reception department of the Clinical City Hospital No3. He was examined by a surgeon and hospitalized. During the revision of the wound, a tumor‑like formation measuring 2.5x3.0x2.5 cm, as well as the parietal peritoneum, was revealed. Appendectomy was performed by the method of pouch ligation with drainage of the abdominal cavity through a separate contraperture with polyvinyl chloride drainage. After the operation, a diagnosis was established: abscess of the stump of the appendix, and external fistula of the anterior abdominal wall. The postoperative wound healed with primary tension, and the sutures were removed. The diagnosis of appendicitis may be mistakenly excluded from the clinical search due to the presence of a postoperative scar after appendectomy. A clear clinical picture of acute appendicitis or the opening of a fistula at the site of a postoperative scar in the right iliac region indicates the need for a computer tomography of the abdominal organs with contrast to establish an accurate diagnosis and choose the correct treatment tactics. The only treatment for inflammation of the appendiceal stump is a complete appendectomy with appendix removal either by open or laparoscopic surgery, which should be performed urgently to avoid further complications.

A clinical case of successful treatment of acute phlegmonous appendicitis incarcerated in a hernial sac (Amyand’s hernia)

Atypical localization of the vermiform appendix (VA) in acute appendicitis can lead to diagnostic and tactical errors in emergency abdominal surgery. The rarest and most atypical localization of the VA is within the hernial sac. This type of hernia is defined as Amyand’s hernia. The optimal scope of surgical intervention and access method (laparoscopic or open) for Amyand’s hernia have not been definitively determined. Questions remain regarding the necessity of removing an unaffected vermiform appendix, the approach to hernioplasty in destructive appendicitis, and the feasibility of using a mesh implant for hernioplasty. In cases of a sliding hernia, the destruction of the hernial sac can lead to difficulties with suturing the peritoneum, assessing the state of the strangulated testicle in men, and performing an orchidectomy. Therefore, it is imperative to establish an algorithm for the evaluation and surgical management of patients with strangulated inguinal hernias. Objective — present a clinical case of successful treatment of Amyand’s hernia with acute phlegmonous appendicitis incarcerated in a strangulated inguinal hernial sac and reactive orchoepididymitis, focusing on the selection of medical and diagnostic strategies to reduce the risk of complications. The clinical case illustrates the effective management of a patient who presented with acute phlegmonous appendicitis and purulent orchoepididymitis. These abnormalities were found to be atypically localised within the sac of a strangulated right‑sided inguinal hernia, known as Amyand’s hernia. The necessary surgical procedures included an appendectomy and an orchidectomy. Conclusions. Inflammation of the vermiform appendix in Amyand’s hernia can lead to various unpredictable purulent complications, such as acute typhlitis, purulent peritonitis, necrotizing orchoepididymitis, and Fournier’s phlegmon, necessitating extensive surgical intervention. The collective global and personal experience in treating Amyand’s hernia suggests the possibility of establishing standardised protocols for diagnosing and selecting a surgical intervention technique.

INCIDENTALLY DIAGNOSED APPENDIX DIVERTICULOSIS AFTER APPENDECTOMY

Title:
 Incıdentally Diagnosed Appendix Diverticulosis After Appendectomy
 Short Title:
 Appendix Diverticulosis
 Abstract 
 Appenix diverticulitis was first described by Kelynack in 1893. Appendix diverticulosis is a rare clinical manifestation of the appendix with a changing rate of 0.004 to 2.1% of all appendectomies. Generally diagnosed in males, and the mean age is 38. Appendix diverticulosis may be inflamed and result in appendix diverticulitis or can be incidentally diagnosed by acute appendicitis. Clinical presentation of appendix diverticulitis may be similar to acute appendicitis but clinical signs may occur slowly and mildly. 
 The thirty-five-year-old male patient was admitted to the emergency department with right lower quadrant pain. The patient has abdominal tenderness, rebound, and defense reactions with other intraabdominal infections signs. Abdominal ultrasonography was performed and appendix diameter was measured enlarged, and inflammation signs were observed in the surrounding tissue in favor of acute appendicitis. A laparoscopic appendectomy was performed. During the operation, three small herniated tissue was observed on the anti-mesenteric surface of the appendix. Acute phlegmonous appendicitis and appendix diverticulosis diagnosis were confirmed with the histopathological examination.
 Appendix diverticulosis may occur either acquired or congenital. The congenital diverticulosis is generally located on the anti-mesenteric edge and contains all layers of the appendix wall. Diagnosed appendix diverticulosis is acquired type predominantly. Appendix diverticulosis is diagnosed more commonly in patient who has cystic fibrosis or Hrschsprung’s disease. However, no relationship between colon diverticular disease and appendix diverticula has been found. There is a high risk of appendiceal neoplasms such as carcinoid tumors and mucinous adenomas. The gold standard to diagnose appendix diverticula is histopathological examination.

Eosinophil Granule Proteins Involvement in Acute Appendicitis-An Allergic Disease?

Several pieces of evidence point to an allergic component as a trigger of acute appendicitis. As the Th2 immune response is characterized by eosinophil mobilization to the target organ and release of their cationic granule proteins, it is reasonable to investigate if the degranulation of eosinophils could be associated with the local injury. The primary aim of this study is to evaluate the participation of eosinophils granules proteins in acute appendicitis, both at local and systemic levels and the secondary aim is to evaluate the diagnostic accuracy of eosinophils granules proteins for the detection of acute appendicitis, as well as for distinguishing between complicated and uncomplicated acute appendicitis. Eosinophil-derived neurotoxin (EDN), eosinophil cationic protein (ECP) and eosinophil peroxidase (EP) are the most well-known eosinophil granule proteins. From August 2021 to April 2022, we present a prospective single-center study to evaluate the EDN, ECP, and EP concentrations simultaneously in appendicular lavage fluid (ALF) and the serum of 22 patients with acute phlegmonous appendicitis (APA), 24 with acute gangrenous appendicitis (AGA), and 14 normal controls. Concerning EDN, no differences were found between groups. ECP concentrations in ALF and serum were significantly higher in the histologically confirmed acute appendicitis compared to the control groups (p < 0.0001 and p < 0.0001, respectively). In ALF, no differences were found between ECP levels in APA: 38.85 ng/mL (IQR 26.50-51.77) and AGA 51.55 ng/mL (IQR 39.55-70.09) groups (p = 0.176). In the serum, no difference was found between ECP levels at APA: 39 ng/mL (IQR 21.30-56.90) and AGA: 51.30 ng/mL (IQR 20.25-62.59) (p = 0.100). For EP, the concentrations in ALF (p < 0.001) and serum (p < 0.001) were both higher in acute appendicitis compared to the control. In ALF, no difference was found between APA: 240.28 ng/mL (IQR 191.2-341.3) and AGA: 302.5 (IQR 227.7-535.85) (p = 0.236). In the serum, no differences were found between APA: 158.4 ng/mL (IQR 111.09-222.1) and AGA: 235.27 (IQR 192.33-262.51) (p = 0.179). Globally, the ALF concentrations were higher than serum concentrations, reflecting an intense inflammatory local reaction in AA. The optimal ECP cut-off for discriminating between acute appendicitis and the controls was >11.41 ng/mL, with a sensitivity of 93.5%, but with a specificity for identifying appendicitis of 21.4%, good discriminative power (AUC = 0.880). For EP, the optimal cut-off was >93.20 ng/mL, with a sensitivity of 87%, but with a specificity of 14.3% (AUC = 0.901), excellent discriminative power. For the diagnosis of perforated AA, the discriminative power of ECP and EP serum concentrations are weak (AUC = 0.562 and AUC = 0.664, respectively). Concerning the presence of peritonitis, the discriminative power of ECP and EP serum concentrations is acceptable, respectively: AUC = 0.724 and AUC = 0.735. Serum levels of EDN (p = 0.119), ECP (p = 0.586) and EP (p = 0.08) in complicated appendicitis were similar to uncomplicated appendicitis. Serum concentrations of ECP and EP can be added to decision-making AA diagnosis. A Th2-type immune response is present in AA. These data bring forward the role of an allergic reaction in the pathogenesis of acute appendicitis.

Особливості диференціювання хірургічної патології органів черевної порожнини і тазових органів у дівчат за допомогою ультразвукового дослідження

The issue of acute appendicitis remains extremely relevant today, as it is the most common inflammatory disease of the abdominal cavity. Despite significant advances in pediatric surgery in recent decades, when mortality from acute appendicitis is an exceptional event, the number of complicated forms in children is observed in 26.4% of cases, and morphologically unconfirmed appendectomies in 8.8% of cases. In girls, the rates are higher at the age of ≤10 years. Acute appendicitis has been and remains a very common disease in underdeveloped countries. In industrialized countries, the incidence of acute appendicitis ranges from 4-6% to 12-23%, in Ukraine - 20-21 cases per 10 thousand population, mostly young people. Purpose - to state the peculiarities of differentiation of surgical pathology of the abdominal cavity and pelvic organs in girls using ultrasound examination; to develop an algorithm for diagnosing surgical pathology in girls. Materials and methods. The study was conducted on the basis of the at the Vinnytsia Regional Children's Clinical Hospital, National Pirogov Memorial Medical University (Vinnytsia, Ukraine) for the period 2019-2021. For visual differential diagnosis, girls aged 4-16 years were involved in the study: 100 healthy children (the Group 1), 100 children diagnosed with acute phlegmonous appendicitis (the Group 2), 100 children with bulky uterine appendages of various types of pathology (the Group 3). Results and conclusions. The following advantages of ultrasound have been established: high specificity of the study, low cost and absence of ionizing radiation. Ultrasound of the abdominal cavity makes it possible to diagnose acute surgical and gynecological pathology, as well as to carry out differential diagnosis of diseases simulating acute appendicitis. An algorithm for diagnosing surgical pathology in girls has been developed. Such an algorithm increases the effectiveness of ultrasound of acute appendicitis and neoplasms of the pelvic cavity, and this allows the doctor to establish the correct diagnosis in time and choose the appropriate treatment tactics. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Acute phlegmonous appendicitis in rare variant of appendix diverticulum (case report)

Background. Appendicitis-like diverticulitis is considered a rare disease and is usually the subject of clinical reports. Clinical manifestations of this pathology is similar to those of appendicitis, which is why a preoperative diagnosis is made quite rarely. When carrying out the study, we considered a clinical case of acute phlegmonous appendicitis with a rare variant of the appendix wall diverticulum.Material and methods. To assess clinical cases, a retrospective analysis of medical documentation (medical records of patients with diverticulitis in particular) was used. The assessment of clinical symptoms was accompanied by using general clinical, histological and microbiological methods.Results. Patient I., 62 years old, was diagnosed with acute appendicitis. An urgent appendectomy was carried out, during which the vermiform process was removed. It was located retrocecally, in the adhesive process and loose infiltrate. The length of the process is 7–8 cm, its diameter is 1–1,5 cm. 6 diverticula up to 0,7 cm in size are visible. When the process is cut, the pyoid contents protrudes from its lumen. In addition, the appendix removed during appendectomy was sent for pathological study. A standard histopathological study was carried out with the step-like sectioning and hematoxylin and eosin staining.Conclusion. From the results of a pathological study, it was found that the layers of the vermiform process wall with diverticula are diffusely infiltrated by polymorphonuclear leukocytes. The mucous membrane is anesthetized and had ulcerative defects. The patient was diagnosed with phlegmonous appendicitis, periappendicitis, diverticulitis.Vermiform process diverticulitis is not a common pathology, however a timely diagnosis can cause quite severe complications.

IL-5 Serum and Appendicular Lavage Fluid Concentrations Correlate with Eosinophilic Infiltration in the Appendicular Wall Supporting a Role for a Hypersensitivity Type I Reaction in Acute Appendicitis.

Appendicitis is the most common abdominal surgical emergency, but its aetiology is not fully understood. We and others have proposed that allergic responses play significant roles in its pathophysiology. Eosinophils and Interleukin (IL)-5 are involved in a hypersensitivity type I reaction. Eosinophil infiltration is common in the allergic target organ and is dependent on IL-5. In the presence of an allergic component, it is expected that the eosinophil count and IL-5 local and systemic concentrations become elevated. To address this hypothesis, we designed a prospective study that included 65 patients with acute appendicitis (grouped as acute phlegmonous or gangrenous according to the histological definition) and 18 patients with the clinical diagnosis of acute appendicitis, but with normal histological findings (control group) were enrolled. Eosinophil blood counts and appendicular wall eosinophil infiltration were determined. IL-5 levels in blood and appendicular lavage fluid were evaluated. Appendicular lavage fluid was collected by a new methodology developed and standardized by our group. Appendicular wall eosinophil infiltration was higher in acute phlegmonous appendicitis than in gangrenous appendicitis (p = 0.000). IL-5 blood levels were similar in both pathologic and control groups (p > 0.05). In the appendicular lavage fluid, the higher levels of IL-5 were observed in the phlegmonous appendicitis group (p = 0.056). We found a positive correlation between the appendicular wall eosinophilic infiltration and the IL-5 concentrations, in both the blood and the appendicular lavage fluid, supporting the IL-5 reliance in eosinophil local infiltration. We observed the highest presence of eosinophils at phlegmonous appendicitis walls. In conclusion, the present data are compatible with a hypersensitivity type I allergic reaction in the target organ, the appendix, during the phlegmonous phase of appendicitis.

Мікробіологія простого та деструктивного апендициту в дітей

The purpose - to analyze bacteriological cultures from the abdominal cavity in various forms of appendicitis, to recommend a rational scheme of antibiotic prophylaxis and empirical therapy in children diagnosed with acute appendicitis. Materials and methods. The study based on bacteriological cultures of the abdominal cavity contents of operated children (laparotomy and laparoscope) with acute appendicitis. Patients were treated in the surgical department of the Zhytomyr Regional Children’s Clinical Hospital in 1997-2020. Results. We analyze 4255 (2334 children; 54.9% - positive) abdominal content cultures of children with acute appendicitis and its complications who were treated in the period 1997-2020. A total of 4965 children were treated, of which 31.3% of children underwent laparoscopic surgery. If we analyze by years, the number of laparoscopic appendectomies compared to 2001 increased by 57.34%. In the microbiological aspect of simple appendicitis, the five leaders are: E. coli - sown in 57.97% of all positive results, Ent. faecalis - 13.36%, S. aureus - 7.6%, Klebsiella spp. - 5.76%, Str. spp - 5.63%. Whereas in destructive forms of appendicitis: E. coli - 57.83%, E. faecalis - 13.58%, Ps. aeruginosa - 8.95%, S. aureus - 8.68%, Str. spp - 3, 38%. The structure of the isolated microflora in complicated appendicitis includes: S. aureus (8.03%), E. coli (48.7%), Ent. faecalis (28.3%), Ps. aeruginosa (7.8%), other pathogens - 7.17%. Cases of mixed infection in the focus of inflammation do not exceed 10.0%. The percentage of susceptibility of pathogens, which are most often sown from the abdominal cavity, to antibiotics in different periods of observation is different. It is important to remember that adequate antibacterial therapy should cover the anaerobic spectrum in destructive forms treatment. The widest range is protected by beta-lactams, carbapenems and chloramphenicol, but the use of the latter two groups is limited in pediatric practice, especially chloramphenicol due to its toxicity. You can create beneficial combinations of metronidazole, to which aerobes are not sensitive, together with cephalosporins, which in turn do not have clinically significant antianaerobic activity. Conclusions. After analyzing the microbiological structure of simple and destructive appendicitis, it is advisable in each surgical hospital to study its own bacterial mirror. It is rational to attribute acute phlegmonous appendicitis without peritonitis to a simple (uncomplicated) form, and in the presence of peritonitis - to a destructive form of appendicitis. Simple and destructive forms of appendicitis have different microbiological picture. In the presence of postoperative complications in the microbiological picture, four pathogens are in the lead: E. coli, Ent. faecalis, S. aureus, Ps. aeruginosa. It is efficient to change treatment tactics, avoid monotherapy as such, in particular, cephalosporins, use more combinations, as well as use other groups of antibiotics, such as protected penicillins. Thus, we will be able to inhibit the growth of antibiotic resistance, reduce the frequency and intensity of postoperative complications, reduce the length of stay of the patient in the hospital. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of all the institutions mentioned in the work. Informed consent was obtained from parents (or guardians). No conflict of interests was declared by the authors.

CHANGES IN THE OPTICAL DENSITY OF VENOUS BLOOD PLASMA IN PATIENTS WITH PATHOLOGY OF DIFFERENT TISSUES OF THE ABDOMINAL CAVITY

Rapid and adequate diagnosis of infl ammatory and destructive injuries of the abdominalorgans is an urgent problem of emergency abdominal surgery. The basis of laboratorydiagnosis in emergency abdominal surgery is to determine the number of leukocytes andtheir forms, the content of C-reactive protein. But the results of such studies are nonspecific. With unclear clinical symptoms, this creates the preconditions for diagnostic errors.To avoid such errors, the determination of the optical characteristics of venous bloodplasma is used. In particular, we studied the optical density of venous blood plasma in theultraviolet spectrum. However, the informativeness of the method was about 86%. Thisneeds improvement. Previous studies of the optical density of venous blood plasma in theinfrared range have shown prospects. Therefore, we conducted new research.The aim of the study – to evaluate the possibility of using the determination of theoptical density of venous blood plasma in the infrared range for diagnosis in emergencyabdominal surgery. The aim of the work is to evaluate the possibilities of using thedetermination of the optical density of venous blood plasma for the diagnosis of acuteinfl ammatory- destructive intra- abdominal pathology.Materials and methods. 42 patients were examined. Among them were: liver abscess –3 cases, acute necrotic pancreatitis – 7, acute intestinal obstruction with intestinalnecrosis – 4, acute edematous pancreatitis – 3, acute phlegmonous appendicitis – 4, acutephlegmonous cholecystitis – 11, unclamped hernia, uncomplicated care – 6.Results. We found in the infrared spectrum a number of maxima of the values of theoptical density of blood plasma, which are localized at wavelengths λ = 365, 555, 620,715, and 770 nm (table). Indicators of optical density at these wavelengths diff ered indiff erent diseases and complications. The obtained results indicate that the optical densityof venous blood plasma in the infrared range varies, depending on the characteristics ofintra- abdominal pathology. At each of the wavelengths, the indicators for diff erent diseasesdiff ered signifi cantly. The most pronounced changes were at wavelengths λ = 365, 555.In all patients with destructive changes in organs (phlegmonous appendicitis, phlegmonouscholecystitis, necrotic pancreatitis, acute intestinal obstruction with intestinal necrosis,liver abscess) in this range were signifi cantly lower in this range. (0.05) than in patientsfrom the control group and in patients with acute edematous pancreatitis. Exceptions werepatients with pinched hernias without intestinal necrosis. The optical density of venousblood plasma in these patients did not diff er statistically signifi cantly from other patients.Conclusions. 1. Patients with diseases of the abdominal cavity at wavelengths = 365-770 nm have characteristic maxima of the optical density of venous bloodplasma, the values of which diff er depending on the type of disease. 2. At wavelengths  =365, 555 nm in patients with destructive changes in organs, the optical density of venousblood plasma is statistically signifi cantly lower (p &lt;0.05) than in most patients withoutdestructive changes in organs. 3. Determination of optical density is a promising area forimproving the diagnosis of acute surgical pathology of the abdominal cavity.

Acute phlegmonous appendicitis

Acute phlegmonous appendicitis is an outstanding topic in medicine. The issue can be approached in terms of diagnosis and the importance of practical surgery. The clinical diagnosis can be supported by macroscopic and microscopic anatomo-pathological diagnoses. The microscopic diagnosis can be established after studying morphological characteristics observed by analogy with microscopic preparations stained by traditional and special methods. Pathological microscopic preparations can be analyzed and compared with histological preparations that display normal appendix. This paper presents some best practice examples. To provide a precise explanation to medical staff, a series of images of microscopic slides were taken from patients for microscopic analysis. The creation of permanent microscopic slides was based on knowledge of the steps required for classical histological methods using standard H&amp;E staining techniques. Samples were taken from patients of both sexes, children under 16 years old, from urban and rural areas. It is important to clarify misunderstood epidemiological features of appendicitis. Perforating and non-perforating appendicitis, apparently, are separate in nature, and since the need for spontaneous resolution of appendicitis is essential. It is important to have better quality reference materials to enable the medical staff to make the correct decision; this paper seeks to add to this area of knowledge. Ensuring that the diagnosis is correct can have important implications for the management of appendicitis suspicion. This must be supplemented with histological assessments together with important personal, heredocolateral antecedents in the patient’s pathological history. For example, determinations of the lymphocytopenia and neutrophil-lymphocyte ratio can predict bacteremia better than conventional infection markers in the emergency department. Histopathological analysis remains important for such determinations.

NEW PROSPECTS OF DIAGNOSIS IN EMERGENCY ABDOMINAL SURGERY

Summary. Aim. Search for new methods for diagnosing acute surgical pathology of the abdominal cavity (ASPAC).&#x0D; Materials and methods. 39 patients: liver abscess — 4, acute appendicitis, periapendicular abscess — 3, acute appendicitis, perito-nitis — 5, acute phlegmonous appendicitis — 7, acute phlegmonous cholecystitis — 4, colon perforation, peritonitis — 3 , acute uncomplicated adhesive intestinal obstruction — 4, uncomplicated peptic ulcer — 4. Measured the optical density of venous blood plasma on a spectrophotometer SF-4A. The control was given to 8 patients (adhesive intestinal obstruction, uncomplicated peptic ulcer disease).&#x0D; Results and discussion. A number of maxima of the values of the optical density of the plasma at wavelengths λ = 3.1, 3.5, 4.3, 6.1, 6.7, 9, 17.5 micrometers were revealed. Indicators differed depending on the type of underlying disease and complications. For analysis and comparison, patients were divided into groups: abscesses, peritonitis, destructive pathology without peritonitis (appendicitis, cholecystitis) and control. At wavelengths λ = 3.1, 6.1, 6.7, 9, 17.5 micrometers, the optical density in patients with no destructive pathology is significantly lower than in patients with such pathology. In addition, the indicators differ in the presence of peritonitis, abscesses and uncomplicated destructive pathology.&#x0D; Conclusions. In the presence of acute surgical diseases of the abdominal cavity in patients, the specific maxima of the optical density of venous blood plasma in the infrared region at wavelengths λ = 3.1, 3.5, 4.3, 6.1, 6.7, 9, 17 , 5 micrometers. Changes in the parameters of optical density differ, depending on the characteristics of the underlying disease and complications and have common patterns in the perforation of hollow organs, abscesses, peritonitis, destructive uncomplicated diseases. Determination of optical density is a promising area for improving the diagnosis of ASPAC.

Peritoneal Pocket Hernia—Avoidable Complication Following TAPP with Meticulous Closure Technique of Peritoneal Flaps

The paper presents the case of a young woman, 29 years of age recently operated by TAPP for right inguinal hernia, who was readmitted to our clinic for intense pain in the lower abdominal floor and right iliac fossa with features of intestinal obstruction of 24 h of duration. Intraoperatively, we observed intestinal occlusion due to an incarcerated ileal loop at the level of a peritoneal gap of approximately 2 cm in diameter, in the flap suture area, after transabdominal preperitoneal patch technique (TAPP). Moreover, the phlegmonous appendix was encountered in the properitoneal space, fixed at the level of the polypropylene mesh. Appendectomy and peritoneal defect closure were performed, with quick postoperative recovery. In recent years, minimally invasive techniques are increasingly being adopted for the repair of inguinal hernias because in addition to the rapid recovery and aesthetic advantage they are associated with a low risk of complications, and the use of the net meshes reduces the recurrence rate to 1–6%. In the case presented, the early postoperative complication was major and rare, associating intestinal obstruction with ileal loop incarceration in a peritoneal breach with acute phlegmonous appendicitis. This complication could be easily avoidable with meticulous closure of peritoneal flap after the TAPP procedure, preventing the contact between the intraperitoneal viscera and the mesh. In any patient following laparoscopic surgery, relaparoscopy must be performed sooner rather than later for timely diagnosis and management of a complication.

Functional activity of blood neutrophiles in acute inflammatory diseases of the abdominal organs and abdominal tuberculosis

The diagnosis of various pathomorphological forms of acute appendicitis (AA), acute mesadenitis (AM), and abdominal tuberculosis (AT) remains an urgent problem in medicine. Neutrophilic granulocytes are the first link in the nonspecific immune response to inflammation, which is mediated by phagocytosis and intracellular bactericidal systems. Therefore, the research aimed to establish the features of the functional state of neutrophilic granulocytes in the blood of patients with AA, AM, and AT.Materials and methods. 30 practically healthy, 27 patients with AM, 40 patients with acute phlegmonous appendicitis were examined; 20 patients with acute gangrenous appendicitis, 30 patients with AT. The phagocytic activity of neutrophils in the test with latex granules, redox activity (spontaneous HCT test), cationic lysosomal proteins in the cytochemical test with bromine phenol blue was determined in the blood.Results. Phagocytic activity of neutrophils in patients with destructive forms of AA and AT was lower, and in the group of patients with AM – did not differ from control values. The phagocytic index of neutrophils in patients with destructive forms of AA was 1.5 times lower (p&lt;0.05), and the phagocytic number in patients with gangrenous AA was 1.7 times lower than in healthy individuals (p&lt;0.05). In patients with AM, the percentage of HCT-positive neutrophils was 1.3 times higher, in patients with destructive forms of AA and AT – 2 times higher than in healthy groups (p&lt;0.05). The number of neutrophils containing cationic lysosomal proteins was also higher in destructive forms of AA, and in AM and AT - did not differ from the value in the control group.Conclusions. It has been established that peripheral blood neutrophils in conditions of acute destructive inflammation and abdominal tuberculosis have reduced absorption capacity with simultaneous significant activation of redox processes. Cytochemical tests to detect the phagocytic and metabolic activity of blood neutrophils are available and highly informative for the diagnosis and prediction of inflammation, as well as for the differential diagnosis of bacterial and viral diseases

Проблемні питання діагностики та лікування гострого апендициту у дітей

Objective: to analyze the results of treatment of children with acute appendicitis and improve the algorithm of care. Materials and methods. The study is based on the results of treatment of 269 children with acute appendicitis and its complications, who were treated in the period 2019-2020; the microbiological part of the work was analyzed on 2334 bacteriological cultures in patients with HA in the period 1997-2019; 239 pathohistological examinations of removed appendages in the period 2019-2020. Results. The groups had different appendectomy techniques: 122 children underwent laparoscopic surgery, 147 children underwent laparotomy. In the group of children who underwent laparoscopic surgery in the structure of diagnoses: acute phlegmonous appendicitis – 51 (41.8%) children; primary peritonitis – 28 (22.9%) children; acute gangrenous-perforated appendicitis, abscess, purulent peritonitis – 24 (19.7%) children, acute gangrenous appendicitis – 16 (13.1%) children, catarrhal – 3 (2.5%) children. In 21 (17.2%) cases there was a conversion: the main reason for which was the lack of visualization of the tailbone, which led the surgeon to switch to laparotomy. Visualization of pathological changes during the ultrasound examination of the abdominal cavity occurred in 27 (31.4%) cases out of 86 performed. Intraoperative diagnosis and histopathological conclusion coincided in 65 (69%) cases. Of these: 74.5% with phlegmonous appendicitis; 68.5% with gangrenous appendicitis; 67% with gangrenous-perforated appendicitis, abscess, purulent peritonitis. In the group of children operated laparotomically in the structure of diagnoses: acute phlegmonous appendicitis – 60 (40.8%) children; acute gangrenous appendicitis – 66 (38%) children; gangrenous-perforative appendicitis, abscess, purulent peritonitis – 26 (17.7%) children. In 35 (44.3%) cases out of 79 in the preoperative ultrasound examination of the abdominal cavity, the tail was not visualized. Intraoperative diagnosis and histopathological conclusion coincided in 115 (78.2%) cases with 147. Comparing the results of treatment of both groups of children, it should be noted that in the group of children operated laparoscopically in 68.4% of cases during the ultrasound examination visualization of the tailbone was impossible. Due to the atypical location of the appendix in 17.2% of cases, which was not visualized during laparoscopy, conversion was performed. In the group of children operated laparotomically in 44.3% of cases, the tail, during the ultrasound examination, was not visualized due to the presence of destructive changes and complications in the abdominal cavity. Conclusions. Diagnosis of acute appendicitis with an atypical location and the presence of anatomical abnormalities can be complicated and affect the choice of treatment, requires a full arsenal of diagnostic capabilities of the clinic. When performing laparoscopic surgery, it is necessary to control its duration, pressure in the abdominal cavity, to conduct visual inspection of the abdominal cavity, to determine the feasibility and timeliness of conversion, which ultimately affects the safety of the patient. According to our studies, in 43% of cases of examined children in the preoperative period, the appendix was not visualized sonographically, during diagnostic laparoscopy in 11.5% (according to our studies) failed to visualize the tailbone, which required the surgeon to convert. According to the research results, the sensitivity of the Alvarado scale was 89.8%, and the specificity was 75.9%, which indicates the expediency and necessity of using the scale when examining children with suspected acute appendicitis. The informed consent of the patient was obtained for conducting the studies. Key words: children, appendicitis, acute appendicitis, laparoscopy, laparotomy.

Laparoscopic Appendectomy with Immersive Appendiceal Stump Closure in Patient with Vermiform Appendix Abnormality

Background. Acute appendicitis is a common emergency surgical pathology, with laparoscopic appendectomy being the “gold standard” in its treatment.Aim. We report a clinical case of laparoscopic appendectomy with immersive appendiceal stump closure in a patient with vermiform appendix abnormality.Materials and methods. Patient K. was emergently admitted to the Surgical Hospital of Ekaterininskaya Clinic in June 2019 with a clinical picture of acute appendicitis. Symptoms, disease anamnesis, instrumental and laboratory examinations conformed to acute appendicitis.Results and discussion. The patient was rendered an emergent surgery. Intraoperative picture corresponded to acute phlegmonous appendicitis with malformation (a wide conical base) of the vermiform appendix. Immersive appendiceal stump closure was chosen as treatment. Alternative opinions coexist on justifying a particular appendiceal stump closure strategy. Immersive treatment is our method of choice in terms of implementation and safety in the particular clinical case. Th is method requires the surgeon’s technical experience.Conclusion. A clinical case is reported of performing laparoscopic appendectomy with immersive appendiceal stump closure in a patient with vermiform appendix malformation. Despite the appendix abnormality, immersive treatment of the appendiceal stump was justified as safe in this case and entailed no complications in postoperative period.

Barium Spill from Perforated Appendix After Barium Enema

Barium appendicitis is a very rare complication of barium meals or barium enema. A 39-old man presented to our hospital with right lower abdominal pain. Nine months earlier, he had previously been diagnosed with uncomplicated acute appendicitis and received antibiotic therapy. Barium enema was performed for diarrhea 3 days ago. The radiological findings showed that a radiopaque area in the right lower quadrant was similar to the image of barium enema. Computed tomography revealed high-density contents in the appendix and swelling of the appendiceal wall. Acute appendicitis was strongly suspected, and emergency laparoscopy was performed. Intraoperative findings showed acute phlegmonous appendicitis, and laparoscopic appendectomy was performed. Histopathological examination showed inflammatory cells infiltrating and perforation in the middle wall of the appendix.

A demographic study of a series of eosinophilic appendicitis and its correlation with the clinicopathological profile in a tertiary care hospital-a 3-year study

Introduction: Acute eosinophilic appendicitis (AEA) is a rare variant of inflammation of the appendix. The histologic hallmark of this entity is the infiltration of eosinophils in the musularis layer of the appendix with edema separating the muscle fibers with very few or no neutrophilic infiltration. A retrospective study was done to determine their demographic profile, morphological diagnosis, and clinical correlation. Materials and Methods: All cases of Acute appendicitis reported at the histopathology department of Sri Muthukumaran Medical College and Research Institute, a teaching hospital from the year of Jan 2017 to Dec 2019 were included in this study. Histopathological examination is the gold standard for the diagnosis of acute appendicitis. Hence, Formalin-fixed paraffin-embedded tissue which was stained with Hematoxylin and Eosin were retrieved and used for routine morphology and diagnosis. Results: Out of 419 cases of appendicectomies studied, 27 (6.49%) cases were found to be acute eosinophilic appendicitis, 265 (63.7%) cases were acute appendicitis, 30 (7.2%) cases were reported as acute suppurative appendicitis with periappendicitis most of which showed infiltration of eosinophils along with other inflammatory cells and 97 (23.3%) cases were reported as appendix with reactive lymphoid hyperplasia. Most of the acute appendicitis showed gross edema and congested blood vessels on the serosal surface. Enterobius vermicularis worm infestation was noted in 7 (25%) cases reported as acute eosinophilic appendicitis and in 20 (7.5%) cases of acute appendicitis. Conclusion: It was inferred that the acute eosinophilic appendicitis is a condition which could be an allergic response and an early event in the evolution of acute phlegmonous appendicitis.

Acute appendicitis associated with the presence of schistosome eggs in a sailor: a case report

BackgroundSchistosomiasis is prevalent in tropical and subtropical areas and rarely reported in developed countries. Schistosomiasis often occurs as a chronic illness, which can cause liver and intestinal damage. Appendicitis is an unusual complication of schistosomiasis. We herein present a case of acute appendicitis associated with the presence of schistosome eggs in a sailor from the Philippines.Case presentationA 34-year-old Filipino man who worked as a sailor presented to our hospital with a 2-day history of acute right lower quadrant abdominal pain and fever. A physical examination revealed right lower quadrant abdominal pain with signs of peritoneal irritation, including rebound tenderness. Computed tomography revealed thickening of the appendix associated with mural calcification and fluid collection around the cecum. Based on these findings, the preoperative diagnosis was acute appendicitis. Laparoscopic appendectomy was performed. Swelling of the appendix and contaminated ascites were observed intraoperatively, but there was no evidence of appendiceal perforation. A histopathological examination showed inflammation of the appendix wall and numerous ovoid bodies present within the submucosa, many of which were calcified. Severe infiltration of lymphocytes and fibrosis were recognized around the oval bodies. The numerous oval bodies were morphologically consistent with schistosomiasis. The final diagnosis was acute phlegmonous appendicitis associated with the presence of schistosome eggs. We examined the patient for signs of adult worm activity, but the results of stool ova and parasite examinations performed twice were negative. He was discharged and returned to his country on postoperative day 9.ConclusionsThe incidence of schistosomal appendicitis, which is seldom reported in developed countries, is expected to increase in Japan in the near future. Clinicians should suspect schistosome eggs as a cause of acute appendicitis in patients who have emigrated from or are traveling from endemic areas, and when mural calcification of the appendix is observed on imaging.

Multispiral computed tomography in the detection and differential diagnosis of acute appendicitis

Purpose . To determine the possibility of MSCT in the differential diagnosis of acute appendicitis. Materials and methods . MSCT was performed on a multidetector 64-slice computer tomograph Aquilion company Toshiba with multi-phase contrast enhancement. The results of MSCT 108 (100%) patients hospitalized for emergency indications with suspected acute appendicitis in the surgical Department of the “City clinical hospital them M.E. Zhadkevich Of the Department of health of the city of Moscow” were analyzed from July 2017 to July 2018. Results . The age range of the subjects ranged from 18 to 81 years, including 53 women (49%), 55 men (51%). CT-picture of acute appendicitis was observed in 23 (21%) patients. In 85 (79%) cases, according to MSCT, no direct signs of inflammatory changes in the Appendix were determined. In this case, acute appendicitis was confirmed during surgery in 22 (20%) cases. A false positive result was obtained in one patient. In a comprehensive examination were diagnosed: acute mesenteric thrombosis -1(1%) case, acute mesadenitis - 1 (1%) case, acute pyelonephritis - 2 (2%) case, concretion of the right ureter -2 (2%) case, hemorrhage in the cyst of the right ovary -1 (1%) case, diverticulitis - 6 (5%) cases, tumors of the blind and ascending intestines - 2 (2%) case. In 68 (63%) cases, patients were discharged without surgery after intestinal colic relief. 2 (2%) patients were operated on with negative MSCT results, as the acute abdominal clinic was preserved. Acute phlegmonous appendicitis was diagnosed intraoperatively. The sensitivity of MSCT in the detection of acute appendicitis in our observations was 91.7%, specificity -98.8%, the prognostic value of the positive result-95.7%, the prognostic value of the negative result - 95.4%. Conclusion . Multispiral computed tomography is highly informative in the differential diagnosis of acute appendicitis, its use avoids unreasonable surgical interventions.