Incidence Of Appendicitis Research Articles

Amyand’s Hernia: A Challenging Diagnosis

Background: Hernia repair surgery is a procedure frequently performed today, both in elective or outpatient settings as in an emergency context. Hernia is defined as a condition in which part of an organ or its fascia protruded through the wall of the cavity containing it. Quite often in the emergency department incarcerated hernias are found, and in most cases, the content of the hernia sac is the omentum or small intestine. In very rare instances, the appendix can be found inside the hernia sac. When the appendix is found in the hernia sac it is called an “Amyand Hernia”, regardless if it is inflamed or not, with the incidence of appendicitis in an inguinal hernia being 0.07-0.13%. Preoperative diagnosis of an Amyand hernia is a clinical and often a Radiological challenge, being in many cases misdiagnosed as an incarcerated inguinal hernia. Usually, the diagnosis of Amyand’s hernia is an incidental finding during surgical repair of an inguinal hernia. There is still no real consensus on the ideal surgical treatment approach for this pathology. Clinical Case: A 72-year-old man, with a known reducible right inguinal hernia awaiting surgical repair presented to the Emergency Department with acute abdominal pain, nausea, vomiting and a painful right groin mass. He was diagnosed with an incarcerated right inguinal hernia and taken to the operating room for emergency surgery. An open approach was performed with a transverse right inguinal incision and the inflamed appendix was identified inside the inguinal sac. The patient was submitted to an appendectomy and subsequently, using the Bassini technique, had the incarcerated inguinal hernia corrected. Conclusion: Preoperative clinical and imaging diagnosis of amyand´s hernia is rare and difficult. More prospective studies should be carried out in order to standardize the treatment of this pathology. The diagnosis of Amyand´s hernia should be in the surgeon’s mind especially in the case of a strangulated inguinal hernia, as shown in this case.

The Effect of Environmental Factors on the Incidence of Complicated Appendicitis in Mongolian Paediatric Population

Introduction: Acute appendicitis (AA) in children is the primary cause of urgent surgery in pediatric patients. Diagnosis of AA continues to be a challenge, especially in the youngest children, who often present with abdominal pain accompanied by nonspecific signs. As epidemiological data on the relationship between acute appendicitis and environmental factors are relatively few and the issue is still controversial, we conducted this study which compared two groups of patients with complicated and noncomplicated appendicitis in a sample of patients admitted to a MNCMCH. The aim of this study was to determine the risk factors for complications in acute appendicitis in the paediatric population. Methods: Our study was performed on 1003 children admitted for suspected acute appendicitis and underwent appendectomy at the MNCMCH, Ulaanbaatar Mongolia, between January 2019 and December 2019. The diagnosis was based on the results of pathological examination. The two groups of complicated (gangrenous and perforated) and noncomplicated (catarrhal and phlegmonous) acute appendicitis were compared. Results: 1003 pediatric patients (≤18 years old) were suspected of having acute appendicitis and subsequently underwent surgery. From a total of 967 patients, 56% (n = 542) were male, 44% (n = 425) were female (gender ratio was 1.3:1). The histological examination noted that 33.1% were uncomplicated, 66.9% were complicated. While the incidence of acute appendicitis was higher during winter, the highest incidence of complicated appendicitis was observed equally in winter and autumn without significant association (p = 0.541). The months of December and March were marked by the highest incidence of AA. The highest incidence of complicated appendicitis was observed during the month of December (45%) with statistically significant difference (p < 0.001). Our study of the incidence of family history, allergy and family members was noted in complicated and noncomplicated group with statistically significant difference (p < 0.001). Conclusions: Pediatric acute appendicitis incidence is increased in winter months in Mongolia. Preventive measures to decrease morbidity and mortality associated with this disease can be taken during the winter seasons from December to March. However, further large-scale studies are needed to support this conclusion.

Acute Appendicitis in Pediatric Patients With Sickle Cell Disease: Lower Incidence, More Imaging, and More False-Positives.

Patients with sickle cell disease (SCD) experience recurrent pain crises, which may mimic appendicitis. A prior study found a significantly lower rate of appendicitis in patients with SCD compared with national averages. We investigate the incidence of appendicitis and number of imaging studies for appendicitis in pediatric patients with SCD. Using a retrospective study design from a single institution, SCD and control cohorts were created. Inclusion criteria included age 0 to 21years and at least one follow-up appointment within 24 months. Length of observation was calculated from initial presentation to either inpatient admission for appendicitis or last clinic visit. Analysis of an SCD subgroup and a control subset (n= 1,596) was used to compare the number of imaging studies. Incidence rates of appendicitis and number of appendicitis studies were determined. Z-tests, binomial enumeration exact tests, and Fischer's exact tests were used. The SCD cohort included 1,064 patients between January 1, 2001, to December 31, 2014, and the control cohort included 115,109 patients without SCD between January 1, 2011, and December 31, 2011. Incidence rate of appendicitis per 10,000 patient-years was significantly lower in the SCD group compared with controls (2.9 cases versus 10.7 cases per 10,000 patient-years; P= .044). Additionally, the SCD group received significantly more ultrasounds (148 versus 60 per 10,000 patient-years; P< .0001) and CTs (94 versus 27 per 10,000 patient-years; P< .0001) for appendicitis, which remained significant when controlling for race. Patients with SCD also received more false-positive scans. Patients with SCD had a significantly lower incidence of appendicitis than controls, yet had a higher number of imaging tests performed for appendicitis. Appendicitis should be viewed as a less common cause of acute abdominal pain in SCD. This consideration should help guide imaging strategy.

APPENDECTOMY IN THE TIMES OF COVID-19: COMPARATIVE STUDY OF TWO GROUPS OF PATIENTS BETWEEN SIMILAR PERIODS OF TIME - 2019 VS 2020

Acute pathology of the cecal appendix - appendicitis, is a condition that does not take into account the pandemic period. The aim of this study is to retrospectively analyze the relationship of care for two groups of patients who underwent appendectomy in COVID-19 period and one year before, same period of time, in emergency hospital service. We performed a retrospective analysis on the patients admitted in our surgery center by comparing two groups for each period analysed: group A, for the period March-May 2019 and group B for the period March-May 2020 (corresponding to COVID-19 pandemic). We compared the groups analysing features that prove the change in age, incidence, grade (severity) of appendicitis, delay of surgery, length of surgery, postoperative complications and hospitalization time. CT scan was made for each patient. In the group B, PCR COVID-19 testing was made (all patients were negative for COVID-19). Our study consisted of 52 patients, group A-32 patients (61.53%) and group B-22 patients (38.47%). The Covid-19 pandemic influenced the incidence of appendicitis and we noted a delayed presentation which led to more complicated appendicitis than same period of the previous year. The impact also was noted on length of surgery, due to use of PPE (personal protective equipment) and also modified anatomy of the region related to inflammation. The severity of appendicitis was higher in the COVID-19 period when compared to 2019 similar period of time. Further research is required to draw more conclusions on this period.

Incidence of appendicitis during SARS-CoV-2 pandemic quarantine: report of a single area experience.

Incidence of appendicitis during SARS-CoV-2 pandemic quarantine: report of a single area experience.

Increasing incidence of complicated appendicitis during COVID-19 pandemic

BackgroundThe novel coronavirus (COVID-19) strain has resulted in restrictions potentially impacting patients presenting with acute appendicitis and their disease burden. MethodsAll acute appendicitis admissions (281 patients) between 1/1/2018-4/30/2020 were reviewed. Two groups were created: 6 weeks before (Group A) and 6 weeks after (Group B) the date elective surgeries were postponed in Massachusetts for COVID-19. Acute appendicitis incidence and disease characteristics were compared between the groups. Similar time periods from 2018 to 2019 were also compared. ResultsFifty-four appendicitis patients were categorized in Group A and thirty-seven in Group B. Those who underwent surgery were compared and revealed a 45.5% decrease (CI: 64.2,-26.7) in uncomplicated appendicitis, a 21.1% increase (CI:3.9,38.3) in perforated appendicitis and a 29% increase (CI:11.5,46.5) in gangrenous appendicitis. Significant differences in the incidence of uncomplicated and complicated appendicitis were also noted when comparing 2020 to previous years. ConclusionsThe significant increase in complicated appendicitis and simultaneous significant decrease in uncomplicated appendicitis during the COVID-19 pandemic indicate that patients are not seeking appropriate, timely surgical care.

Changes in Incidence and Management of Acute Appendicitis in Children-A Population-Based Study in the Period 2000-2015.

Recent studies suggest that the epidemiology and management of appendicitis have changed during the last decades. The purpose of this population-based study was to examine this in the pediatric population in Denmark. Data were retrieved from the Danish National Patient Registry, the Danish Civil Registration System, and the Statbank Denmark. Patients aged 0 to 17 years diagnosed with appendicitis and appendectomized during the period 2000 to 2015 were included. The primary outcome was the annual incidences of appendicitis. Secondary outcomes were the annual percent of patients with appendicitis having a laparoscopic appendectomy, delay from admission to surgery, length of postoperative hospital stay, and 30-day postoperative mortality. A total of 24,046 pediatric cases of appendicitis were identified. The annual incidence steadily declined until 2008 (-29%, all ages) and then remained stable. The surgical approach of choice changed from being open appendectomy in 2000 (97%) to laparoscopic appendectomy in 2015 (94%). Simultaneously, the duration of postoperative hospital stay declined from 41 hours (median) to 17 hours. Delay from admission until surgery did not change during the period. Only one child died within the 30-day postoperative period. In accordance with other recent studies from Western countries, we found significant changes in the incidence of acute appendicitis including a decline in all age groups except those below 5 years of age, a shift toward laparoscopic appendectomy, and decreasing time spent in the hospital during the years 2000 to 2015.

Hubungan Onset Keluhan Nyeri Perut dan Jumlah Leukosit dengan Tingkat Keparahan Apendisitis Akut pada Anak

Acute appendicitis always need surgical treatment. If appendectomy is not performed immediately, perforation of appendix and peritoneal contamination will complicate the disease. The highest incidence of appendicitis is in late teen, with 5% incidence in children under 5 years old. The aim of this study was to determine the correlation between onset of abdominal pain with the severity of pediatric acute appendicitis and to know the different of average leukocyte count of pediatric acute appendicitis between appendicitis and appendicitis complication. This study was analytical comparative and analytical correlative with retrospective approach. About 68 medical records of pediatric acute appendicitis patient in Arifin Achmad General Hospital Riau Province period January 2018 – December 2019 were analyzed. The result showed appendicitis case in children was same affected girls and boys mostly in group age 6-12 years old. Onset of abdominal pain was mostly after 48 hours of the disease. About 69.1% patient was suffering of appendicitis complication. Leukocytosis was found in 76.5% patients. Statistics analysis using unpaired t test showed p=0.00, it meant a significant different of average leukocyte count between appendicitis and appendicitis complication. IC95%=4015.7-6683.1. Statistics analysis using Somers’d correlative test show p=0.00. From this study, it can be concluded that there was a significant different of average leukocyte count between appendicitis and appendicitis complication also there was a significant correlation between onset of abdominal pain with severity of pediatric acute appendicitis with strong power correlation.

Hubungan Pola Makan dan Jumlah Leukosit dengan Jenis Apendisitis di RSUD Sungai Dareh

Influence of Lifestyle Lack of consumption of fibrous foods in the daily menu, allegedly as one of the causes of health problems namely appendicitis. Appendicitis is inflammation that occurs in the appendix or appendix. When suffering from appendicitis, sufferers can feel pain in the lower right abdomen. If left unchecked, the infection can become serious and cause appendicitis to rupture, thereby causing severe pain complaints that endanger the lives of sufferers. The incidence of appendicitis in 2014 ranks eighth as the main cause of death in the world and it is estimated that in 2020 will be the fifth leading cause of death worldwide. The purpose of this study was to determine the relationship between diet and the number of leukocytes with the type of appendicitis in Sungai Dareh District Hospital. The number of samples in this study were 32 respondents using the Accidental Sampling technique. Most of the research results were obtained 21 (65.6%) respondents had poor diet, 17 (53.1%) respondents had leukocytosis, 22 (68.8%) respondents had perforated appendicitis, and there was a relationship between eating patterns and Leukocyte count with type of appendicitis.

Do Racial/Ethnic and Economic Factors Affect the Rate of Complicated Appendicitis in Children?

Introduction Appendicitis continues to be one of the most common surgical conditions in the pediatric population. We set out to determine demographic and practice variations among children admitted with appendicitis and highlight the racial/ethnic and healthcare access role in relation to the rate of complicated appendicitis using the 2012 Kids' Inpatient Database (KID). Methodology. A retrospective cross-sectional database study was performed using the 2012 KID. All children (age 1 months to 20 years) with appendicitis were identified using the ICD-9 diagnosis codes. Children with a diagnosis of appendicitis were compared with all other discharges. Among children with appendicitis, demographic and practice variations and the rate of complicated appendicitis were evaluated. Univariate and multivariate analyses were done to analyze the data. Sample weighing was done to present national estimates. Results In 2012, a total of 89, 935 out of 2.7 million pediatric hospital discharges (3.3%) had a diagnosis of appendicitis. The incidence of appendicitis was higher in males (4.7%), 6–15-year age group (7.43%), Hispanics (5.2%), and in the Western region (5.2%) and was lower in infants (0.02%) and African American children (1.2%) (p < 0.0001). The proportion of children with peritonitis or abscess was higher in children's hospitals (48.2% vs. 29.0%; OR 2.3, 95% CI: 2.2–2.4). The risk of complicated appendicitis was inversely related to age, while racial and ethnic minority status, bottom quartile of the income group, and government insurance increased the risk. Laparoscopic appendectomy was performed more frequently at children's hospitals (84.8% vs. 74.3%; p < 0.0001). Conclusions Appendicitis is more common in Hispanics, males, older children, and in the Western region. Complicated appendicitis is more common in younger children, minority groups, low-income group, and children with government insurance. Children's hospitals manage more children with complicated appendicitis and are more likely to perform laparoscopic appendectomy.

THE EFFECT OF CLASSICAL MUSIC MOZART THERAPY ON CHANGE THE PAIN SCALE IN POST PATIENTS APPENDICITIS OPERATIONS IN THE DAHLIA ROOM RSUD BOGOR

Background : In 2013 based on the WHO (Word Health Organization) records the incidence ofappendicitis it was quite high in the world. The issues that occur mortality of appendicitis is21.000 people, for female population is more high than men. Furthermore, accordings to therecords measuremants of Kementrian Kesehatan Republik Indonesia in 2012 is 596.132 peopleand in 2013 increased to 621.435 people. In Indonesia the incidence of appendicitis infest thehighest rank between the other emergency abdomen cases from the result survey of HouseholdHealth Survey or SKRT. The profile of Kesehatan Kabupaten/Kota West Java Province in 2015was gived statement about the pattern of appendicitis at the age group ranges 5 ± 44 years old forhospitalized patients was 24,2%.Research Objective : The purpose in this research is to find out the effect of Mozart’s classicalmusic therapy towards the changes of pain scale in postoperative appendicitis patients in DahliaRoom Bogor Hospital.Research Methods : The type of this research is an experiment with quasi-experimental designand Non Equivalent Control Group design. The population in this studies are all of the post operative appendicitis patients in Dahlia Room Bogor Hospital, with 26 samples researched thatusing saturated sampling techniques, and the retrievel to complete the material informations wereused interview techniques at the preliminary studied and observation sheet when the research wasbegin. Results of the study :There is shown the differences result of the pain scale before and afterintervention group as 0,005, and the differences in the results of the pain scale before and after the control group as 1,000, and the effect of classic mozart’s music therapy towards the changes ofpain scale for post operative appendicitis in Dahlia Room Bogor Hospital as 0,007 (p &lt; 0,05).Conclusion : There is a effect of Mozart's classic music therapy toward the changes of pain scalefor postoperative appendicitis patients in Dahlia Room Bogor Hospital. The results of thisresearchmight become knowledge for post operative patients to reduce pain scale by combiningmedical and non-treatment medical.

Seasonal Variation of Appendicitis in High Altitude Region of Nepal: Five years’ Experience of a Teaching Hospital

Background: Acute appendicitis is the most common general surgical disease, worldwide. The exact etiology is still in conjecture. However, the inadequate fiber in diet, smoking, mechanical obstruction in appendiceal lumen, has been attributed as factors for appendicitis. Appendicitis presents throughout months of the year, however, incidence increases in particular months. The objective of this study is to observe the appendicitis incidence variation with months of the year in high altitude region of Nepal.&#x0D; Methods: The cross-sectional retrospective study was conducted in the Karnali Academy of Health Sciences, Jumla situated at the altitude above 2500 m from sea level. The clinical data were retrieved from the hospital record book in the Operation Theater that included age, gender, ethnicity, month of the appendectomy executed, pre-operative clinical presentation, and operative findings. The period of study was from July 2014 to March 2020. The data were entered in Microsoft Excel software and descriptive analysis was done to get mean, median percentage, standard deviation by SPSS 16.&#x0D; Results: A total of 119 appendectomies performed during 5 years period, from 2014 to 2020, in the surgery department of Karnali Academy of Health Sciences were recorded. The mean age of appendectomy was 27 years. There were 53% female (n=64) and 46% male (n=55) patients. The months in which the highest appendectomy executed were July/August/September and February with 16% (n=19), 13.4% (n=16), (n=15) 12.6% and 13.4% (n=16) respectively. The lowest incidence was 1.7% in the month of April.&#x0D; Conclusion: The incidence of appendicitis is high in the months from July to September with the lowest incidence is in the months of April and May. This information could be useful to decrease the disease-associated morbidity and mortality as well as it can be useful for hospital administration for enrolling the needed health-workers in those particular time periods.

Major Variation in the Incidence of Appendicitis Before, During and After Pregnancy: A Population-Based Cohort Study.

Previous studies indicate a low incidence of appendicitis in third-trimester pregnancy, suggesting a protecting effect of pregnancy. This large population-based cohort study analyzes the association of appendicitis with pregnancy in more detail. The aim of the study was to investigate the incidence of appendicitis and negative appendectomy before, during and after pregnancy. Cross-linking between two Swedish health registries provided data on appendectomy for all women in Sweden giving birth between 1973 and 2013. We analyzed the incidence rates (IR) of perforated and non-perforated appendicitis and negative appendectomy before, during and after pregnancy, and secular trends during the study period. Standardized incidence ratios (SIR) were estimated using age-, sex- and period-specific IR from the background population in Sweden. Some 3,888,452 pregnancies resulted in birth during the study period. An appendectomy was registered for 27,575 women in the interval starting one year before and ending two years after pregnancy. The incidence of appendicitis varied substantially during and after pregnancy. SIR for perforated appendicitis was 0.47 (95% CI 0.38-0.59) in the third trimester, 3.89 (2.92-5.18) peripartum, 2.20 (1.89-2.55) in the puerperium and 1.27 (1.19-1.36) in the year postpartum. The pattern was similar for non-perforated appendicitis. Negative appendectomy decreased postpartum. Incidence rate of non-perforated appendicitis and negative appendectomy decreased for both pregnant and non-pregnant women during the study period. The findings in this study suggest a protecting effect of pregnancy on the development of appendicitis, which is followed by a rebound effect after birth.

Geographic Association Between Incidence of Acute Appendicitis and Socioeconomic Status

Some studies based on proportions of patients with perforated appendicitis (PA) among all patients with acute appendicitis (AA) have found an association between socioeconomic status (SES) and risk of perforation. A potential limitation is their use of proportions, which assumes that incidence of AA is evenly distributed across populations at risk. This assumption may be invalid, and SES may have a more complex association with both AA and PA. To generate population-based incidences of AA and PA and to examine geographic patterns of incidence alongside geographic patterns of SES. Retrospective study of data from Washington's Comprehensive Hospital Abstract Reporting System and the 2010 US census. Geographic methods were used to identify patterns of age- and sex-standardized incidence in Washington State between 2008 and 2012. The study included all patients discharged with International Classification of Diseases, Ninth Revision codes for AA or PA. Data were analyzed between November 2016 and December 2018. Location of primary residence. Age- and sex-standardized incidence for AA and PA was generated for each census tract (CT). Global spatial autocorrelation was examined using Moran index (0.0 = completely random incidence; 1.0 = fully dependent on location). Clusters of low-incidence CTs (cold spots) and high-incidence CTs (hot spots) were identified for AA. Census-based SES data were aggregated for hot spots and cold spots and then compared. Statewide, over the 5-year study period, there were 35 730 patients with AA (including 9780 cases of PA), of whom 16 574 were women (46.4%). Median age of the cohort was 29 years (IQR, 16-48 years). Statewide incidence of AA and PA was 106 and 29 per 100 000 person-years (PY), respectively. Crude incidence was higher within the male population and peaked at age 10 to 19 years. Age- and sex-standardized incidence of AA demonstrated significant positive spatial autocorrelation (Moran index, 0.30; P < .001), but autocorrelation for PA was only half as strong (0.16; P < .001). Median incidence of AA was 118.1 per 100 000 PY among hot spots vs 86.2 per 100 000 PY among cold spots (P < .001). Socioeconomic status was higher in cold spots vs hot spots: mean proportion of college-educated adults was 56% vs 26% (P < .001), and mean per capita income was $44 691 vs $30 027 (P < .001). Age- and sex-standardized incidence of appendicitis is not randomly distributed across geographic subunits, and geographic clustering of AA is twice as strong as PA. Socioeconomic advantages, such as higher income and secondary education, are strongly associated with lower incidence of AA. These findings challenge conventional views that AA occurs randomly and has no predisposing characteristics beyond age/sex. Socioeconomic status, and likely other geographically circumscribed factors, are associated with incidence of AA.

Acute appendicitis as the cause of non-traumatic acute abdomen in a tertiary care hospital: A retrospective study

Background: In our era of improved care at primary and secondary health care centres, we wanted to study the epidemology and clinicoradilogical presentation of acute appendicitis in our tertiary care centre.Materials and Method: The age and sex incidence, position of appendix, radiological corelation with clinical diagnosis were analysed retrospectively of 132 cases of acute appendicitis out of 200 cases of acute abdomen which were treated surgically in department of general surgery Trichy SRM medical college, from October 2018 to October 2019.Results: Highest incidence of appendicitis was 61 cases (46.21 %) were in the 21-30years age group, among 32 cases 88 cases (66.67%) were male and 44 cases (34.09%) were female, Retrocaecal position was 68.18% and 95% of times radiological corelation was positive or acute appendicitis. Conclusion: Our study showed highest incidence of acute appendicitis in the age group of 21-30 yrs with male preponderance. Most common position of tip of appendix was retrocaecal and radiological corelation of diagnosis of acute appendicitis was 95%.

De Garengeot’s hernia - a case of incarcerated femoral hernia with acute gangrenous appendicitis and literature review

Introduction. De Garengeot?s hernia is a rare type of femoral hernia that contains the appendix within the hernia sac and it is found in 0.5-5% of cases. The incidence of appendicitis within the de Garengeot?s hernia is 0.08-0.13%. We present a case of de Garengeot?s hernia with a gangrenous appendicitis and an extensive literature review of published cases. Case Report. We present a case of a 68-year-old woman who underwent urgent surgery due to an incarcerated femoral hernia and preoperatively undiagnosed de Garengeot?s hernia with a gangrenous appendicitis within the femoral hernia sac. Conclusion. De Garengeot?s hernia is most commonly diagnosed intraoperatively and requires immediate surgery in order to avoid complications. There are no recommendations regarding the choice of surgical procedure for femoral defect repair.

Association between Appendectomy and Demyelinating Disorders in Subjects 40 Years and Older.

The association between appendectomy and multiple sclerosis (MS) is unknown. In this study, we explored the association between appendectomy and MS and neuromyelitis optica spectrum disorder (NMOSD). MS and NMOSD patients older than 40 were identified from neurology records from hospitals in Malaysia. The diagnoses were based on the Revised McDonald (2010) and Wingerchuk (2015) criteria. Controls were sampled from Malaysia's normal population. Individuals were interviewed telephonically or face-to-face. The age inclusion criterion (over 40) differentiated high or low lifetime risk of appendicitis, as appendicitis incidence is rare after 40. 49 MS, 71 NMOSD, and 880 controls met the inclusion criteria. Seventy-two individuals (9 MS, 4 NMOSD, 59 control) had undergone appendectomy. Appendectomy rates were 18.37% in the MS group (95% CI 7.5-29.2%), 5.6% in the NMOSD group (0.3%, 11%), and 6.7% among controls (5.1%, 8.4%), (MS vs NMOSD P = 0.036, MS vs controls P = 0.007). Binary regression analysis showed that MS was an independent risk factor for appendectomy (OR 2.938, 95% CI 1.302, 6.633, P = 0.009). NMOSD showed no association with appendectomy. MS is positively associated with appendectomy, unlike ulcerative colitis, which is negatively associated. We hypothesize that there is a commonality in the microflora in persons who have had these two illnesses.

HISTOPATHOLOGICAL SPECTRUM OF APPENDICITIS IN A TERTIARY HEALTH CARE CENTER

INTRODUCTION: Appendix in a nger like projection situated just near the caecum. It is located in the right iliac fossa of the abdomen. The most common pathology which arises is appendicitis and is mostly treated surgically. Although appendix is considered to be a vestigial organ, it accounts for immune function upto some extent. OBJECTIVES: To study and analyse the various histopathological forms of appendicitis MATERIALS AND METHODOLOGY: A descriptive study was undertaken to analyse the different histopathological forms of appendicitis over a period of one year in the Department of Pathology, Government Medical College, Omandurar Government Estate. The acquired data was fed into Microsoft Excel and analysis was done. RESULT: A total of 100 specimens were analysed during the study period. Maximum number of cases (62% of cases) were reported amongst females. The most common age group which was affected was 9 years to 19 years. The most common histopathological form of appendicitis was analysed to be acute appendicitis (76% of cases) The statistical data for various histo pathological types of appendicitis are as follows Subacute appendicitis – 10 cases ; Acute appendicitis – 76 cases ; Chronic appendicitis – 13 cases ; Granulomatous appendicitis – 1 case. CONCLUSION: The incidence of appendicitis is higher in the second decade of life and is remarkably high amongst females. Among the pathological types, incidence of acute appendicitis is the highest and that is seen in the second decade of life

Management of a Walled-off Perforated Appendix in a 39th Week Gestational Pregnancy: A Case Report

Background: One of the most common surgical problems that requires emergent intervention during pregnancy is acute appendicitis [1]. The incidence of appendicitis during pregnancy is 1 in 766 births, with 16% of the diagnoses occurring within the third trimester [1,2]. Acute appendicitis, with subsequent wall-off perforation, can pose a great risk to both the mother and the fetus. Thus, it is extremely important to recognize and correctly diagnose acute appendicitis, in all trimesters of pregnancy. Case Presentation: This case report discusses a 30-year-old G1P0 with a gestation age of 39.6 who presented to the hospital with complaint of flank pain that waxed and waned. The medical team consisting of labor and delivery nurses, obgyn attending physician and a general surgery attending. Possible etiologies for such presentation including UTI, nephrolithiasis, pyelonephritis, uterine abruption, uterine rupture or musculoskeletal causes were all effectively ruled out. MRI was then performed and suggested appendicitis with associated appendicolith. The risk of perforation and potential complication was discussed amongst the patient, obstetrician and general surgeon. The patient was given an active participation in the decision making and ultimately decided that she would like to proceed with cesarean and appendectomy. Conclusions: Given the nonclassical presentation of acute appendicitis in pregnancy, a closer evaluation for the underlying etiology is warranted. Acute appendicitis in pregnancy should not be excluded based on clinical evaluation alone, as there is great risk posed to the mother and fetus if missed. Imaging should be performed if no other underlying etiology can account for the clinical features. Any diagnostic uncertainty may delay surgical intervention resulting in risk of maternal morbidity and potential fetal mortality. In term patients, expeditious delivery followed by appendectomy may be warranted.

Accuracy of clinician gestalt in diagnosing appendicitis in children presenting to the emergency department.

Abdominal pain is a common paediatric presentation to the ED. Accurate diagnosis of acute appendicitis is challenging, with the best-performing clinical scoring systems having sensitivities between 72% and 100%. The aim of this study is to assess the diagnostic accuracy of clinician gestalt according to seniority in diagnosing paediatric acute appendicitis in ED. This is a prospective multi-centre observational study of clinician's prediction of appendicitis in children under the age of 16 years presenting to four EDs with abdominal pain over a 1 month period at each site. Clinician-estimated likelihood of acute appendicitis was compared with the final diagnosis determined by histopathology or operative findings and supplemented by telephone follow up for those without an operation. The primary outcome was diagnostic accuracy of clinician gestalt according to clinician seniority in diagnosing appendicitis. There were 381 children enrolled with completed clinician questionnaires, and 224 children had complete follow up or underwent appendicectomy. The median age was 9 years (interquartile range 6-12) and the incidence of appendicitis was 31/224 (13.8%, 95% confidence interval 9.3-18.4). The area under the curve (AUC), sensitivity, specificity, positive predictive value and negative predictive value of clinician gestalt were 0.84 (0.76-0.91), 81% (63-93%), 76% (69-82%), 35% (28-42%) and 96% (92-98%), respectively, giving an overall diagnostic accuracy of 76% (70-82%). AUC stratified by clinician seniority (junior, intermediate and senior) were 0.89 (0.80-0.98), 0.82 (0.69-0.95) and 0.76 (0.56-0.96), respectively. The diagnostic accuracy of ED clinician gestalt in paediatric appendicitis is comparable to current clinical scoring systems irrespective of seniority.