Cases Of Acute Appendicitis Research Articles

Role of Ultrasonography in the Diagnosis of Acute Appendicitis

Introduction: Acute appendicitis is still prevalent as a major surgical emergency. Due to the fast progress of the ailment, surgery is often the most sensible approach to manage it. But any surgery comes with its fair share of risk. If the diagnosis of the disease can be made more accurate prior to surgery, the error rate of negative appendectomy can be greatly reduced. Aim of the study: The aim of the study was to evaluate the role of ultrasonography in the diagnosing acute appendicitis. Methods: This prospective cross-sectional study was conducted at the Department of Surgery, Faridpur Medical College Hospital, Faridpur, Bangladesh. The study duration was 6 months, from November 2013 to April 2014. A total of 100 cases were selected from those admitted to the emergency department of the study hospital with pain in the right lower quadrant of the abdomen for the purpose of this study. Result: Among the 100 participants of the study, histopathological diagnosis showed that 86% were acute appendicitis cases and 14% had normal appendicitis. Gender or age had no significant association with histopathological diagnosis, but male prevalence was observed in the study, with a high prevalence of young adults. The original site of pain was periumbilical pain shifted to the right iliac fossa for half the participants. Pain duration was between 18-24 hours for 36% of the cases. All participants presented with pain, fever, anorexia, and nausea had a high prevalence among participants. The sensitivity and specificity of high-resolution ultra-sonogram were 84.9% and 85.7% respectively. Conclusion: Appendicitis is a disease of the young, and can occur in participants of both genders. Histopathological diagnosis has no significant association with patient age or gender. Ultra-sonogram has high sensitivity and specificity ratio in diagnosing acute appendicitis and also has a high positive predictive value but low negative predictive value.

Estimating the potential overdiagnosis and overtreatment of acute appendicitis in Thailand using a secondary data analysis of service utilization before, during and after the COVID-19 lockdown policy.

Acute appendicitis is one of the most common surgical emergencies; however, optimal diagnosis and treatment of acute appendicitis remains challenging. We used the coronavirus disease 2019 (COVID-19) lockdown policy as a natural experiment to explore potential overdiagnosis and overtreatment of acute appendicitis in Thailand. The aim of this study was to estimate the potential overdiagnosis and overtreatment of acute appendicitis in Thailand by examining service utilization before, during, and after the COVID-19 lockdown policy. A secondary data analysis of patients admitted with acute appendicitis under the Universal Coverage Scheme (UCS) in Thailand over a 6-year period between 2016 and 2021 was conducted. The trend of acute appendicitis was plotted using a 14-day rolling average of daily cases. Patient characteristics, clinical management, and outcomes were descriptively presented and compared among three study periods, namely pre-pandemic, lockdown, and post-lockdown. The number of overall acute appendicitis cases decreased from 25,407 during pre-pandemic to 22,006 during lockdown (13.4% reduction) and 21,245 during post-lockdown (16.4% reduction). This reduction was mostly due to a lower incidence of uncomplicated acute appendicitis, whereas cases of generalized peritonitis were scarcely affected by the pandemic. There was an increasing trend towards the usage of diagnostic computerized tomography for acute appendicitis but no significant difference in treatment modalities and complication rates. The stable rates of generalized peritonitis and complications during the COVID-19 lockdown, despite fewer admissions overall, suggest that there may have been overdiagnosis and overtreatment of acute appendicitis in Thailand. Policy makers could use these findings to improve clinical practice for acute appendicitis in Thailand and support the efficient utilization of surgical services in the future, especially during pandemics.

Perforated appendicitis in infancy

Acute appendicitis is the major indication for abdominal surgery in the pediatric population. It represents 1–2% of all patients admitted into pediatric surgical wards. The clinical manifestations are varied and sometimes atypical due to the nature of the differing pathophysiology and the communicative capabilities of the patients based on age and development. We share a case of acute appendicitis that first presented to our emergency department and admitted under general pediatric medicine; later surgically treated and confirmed using histopathology. The patient's health record was reviewed for the following: demographics, visits, imaging modalities, management, outcome, and histopathology. Our 2-month-old patient was admitted under the general pediatric team who treated him at first under the assumption of incomplete Kawasaki disease. A consultation to pediatric surgery for an infected urachus lead to an Ultrasound and CT-scan studies being done. This was followed by exploratory laparotomy and appendectomy due to the need for drainage and further assessment. The findings which were further confirmed by histopathological specimens were suggestive of acute appendicitis with peri-appendiceal abscess Acute appendicitis in infants is a challenging diagnosis, A high level of suspicion and having knowledge of the red flags specific to abdominal pain and appendicitis in infants could significantly aid in improving diagnostic skills. In addition, early imaging using US in addition to CT is paramount in insuring early recognition and optimal outcomes

Role of hyponatremia in differentiating complicated appendicitis from uncomplicated appendicitis: a comparative study.

Some studies suggest that serum sodium level may decrease at a greater degree in complicated acute appendicitis (CA) because of the increased severity of inflammation. This study aimed to determine the predictive value of some inflammatory markers and hyponatremia in differentiating CA from uncomplicated acute appendicitis (UCA). In this retrospective cohort study, the data of patients who underwent urgent appendectomy in Department of General Surgery, Eskisehir Osmangazi University from January 01, 2016 to January 01, 2021, were analyzed. Patients were divided according to appendicitis type, UCA and CA. In this study, 10.2% (n = 79) of 772 acute appendicitis cases were CA. Multiple logistic regression analysis revealed that high age (p = 0.001), male sex (p = 0.014), high leukocyte count (p = 0.045), low lymphocyte count (p = 0.023) and hyponatremia (p <0.001) were independently associated with CA. Patients with hyponatremia (sodium level ≤134 mEq/L) had 3.050-fold higher risk for CA than patients with normal sodium level (odds ratio: 3.050, 95% confidence interval: 1.668-5.576). The results of the ROC analysis performed to assess the role of sodium level in detecting CA showed a sensitivity of 27.8% and a specificity of 92.1% (cut-off: 133.5 meq/L) (p = 0.001; area under the curve: 0.612 [0.539-0.684]). Clinicians should be aware of the higher likelihood of CA occurrence in patients with appendicitis in whom hyponatremia, leukocytosis, or lymphopenia is detected in the laboratory examination.

Comparative Study Between Karaman Score and Modified Alvarado Score for Predictability in Avoiding Negative Appendectomy in the Suspected Cases of Acute Appendicitis

Objective: To compare the diagnostic accuracy between the Karaman score and the Modified Alvarado score for predictability in avoiding a negative appendectomy in suspected cases of acute appendicitis. Material and methods: This comparative study was done at the general surgery department of JPMC Karachi, from February 2022 to August 2022. All the patients diagnosed as the cases of acute appendicitis undergoing surgical treatment, aged more than 14 years and of either gender, were included. Both the Karaman and the Alvarado scoring systems were implemented in order to assign points to each of the study subjects. The Alvarado score is comprised of eight different parameters, while the Karama score only makes use of six different parameters. After evaluating the patient on both scores, the decision to perform surgery was primarily based on the surgeon's clinical judgement after considering all clinical, laboratory, and radiological findings. Postoperative histopathology reports were collected, and the scores of both Alvarado and Karaman score were compared. Patients were operated and monitored throughout the stay in hospital up to discharge. Afterwards, for each score, sensitivity, specificity, and positive and negative predictive values were determined. All the data was collected via a study proforma, and SPSS version 26 was used for the data analysis. Results: In this study, 180 cases of appendicitis undergoing surgical treatment were studied, their mean age was 27.03 ± 10.12 years, and their mean BMI was 19.88 ± 3.43 kg/m2. Males accounted for 80.0% of all study participants. As per histological findings, acute appendicitis was found in 78.9% of the cases, 14.4% of the patients had gangrenous appendicitis, while 6.5% of the cases had a normal appendix. Histopathological evaluation was statistically significant according to the appendicitis identification by Karaman scoring system and Alvarado scoring system (p-0.001). Although both scoring systems showed almost similar diagnostic accuracy, the Karaman scoring system showed sensitivity (98%), specificity (75%), PPV (98%), NPV (75%), and accuracy (96%), while the Alvarado scoring system showed sensitivity (97%), specificity (58%), PPV (97%), NPV (63%), and accuracy (95%). Conclusion: In the study conclusion, the Karaman score and Alvarado scoring systems both were observed to be the good predictive to distinguishing acute appendicitis in avoiding the negative appendectomy. Both showed almost similar and high sensitivity and accuracy by taking histopathology is gold standard. Keywords: Appendicitis, Karaman score, Alvarado score, Accuracy

Impact of COVID-19 on Surgical Cases of Acute Appendicitis

Introduction: The COVID-19 pandemic has had a substantial effect on healthcare. Several studies have explored its burden on diseases in terms of management, complication, and outcome, as well as morbidity and mortality. With acute appendicitis being one of the most commonly encountered diseases in the emergency setting, and appendectomy procedure being the standard of care, we have set out in this study to explore the impact of COVID-19 on cases admitted for surgical management of acute appendicitis. Methods: A retrospective study with descriptive analysis was performed, comprising of 359 patients, divided into two groups, comparing patients admitted Pre-COVID-19 “A” (n = 179) to those admitted during the COVID-19 pandemic “B” (n = 180) in terms of admission parameters (WBC and temperature), length of symptoms, intraoperative findings, use of drains, postoperative complication, and length of stay. Results: Three hundred and fifty-nine patients were analyzed. There were 230 male patients and 129 female patients, with a mean age of (A: 25.89 vs B: 27.65). Admission parameters included WBC (A: 13.78 SD 4.57 vs B: 13.85 SD 4.33), temperature (A: 37.2 SD 0.61 vs B: 37.0 SD 0.56). Intraoperative findings: perforated appendix (A: 11.7% vs B 15%). Use of drains (A: 7.3% vs B: 5%). Postoperative complication (A: 6.1% vs B: 7.2%). Hospital stay duration was highest in the 2-7 day period among both groups. Conclusion: We found no significant difference in presentation, management, complication, and outcome of patients admitted for surgical management of acute appendicitis Pre-COVID-19 compared with those admitted during the COVID-19 pandemic.

Impact of the COVID-19 pandemic and restrictive measures on acute appendicitis: Do not let your guard down.

The COVID-19 pandemic has altered the usual dynamics of consultation and presentation for acute appendicitis (AA). The aim of this study was to evaluate the impact of the pandemic and restrictive measures on the cases of AA. A retrospective study of patients diagnosed with AA between December 2019 and July 2020 was conducted. Patients were classified into two groups; one that underwent treatment in the 16 weeks before the implementation of lockdown in Argentina (Group 1) and another that underwent treatment in the 16 weeks after (Group 2). Demographic, clinical and surgical variables were evaluated. Overall, 91 patients underwent surgery, 61 and 30 patients in each group, showing a 51% drop in the incidence. The second group delayed seeking medical care longer (mean 46 h vs. 27 h, P < 0.05), had a higher rate of perforated appendicitis (30% vs. 11%, P < 0.05) and a higher rate of complicated appendicitis (56.6% vs. 18%, P < 0.01). These results were associated with a longer operative time (43.7 ± 15.5 min vs. 36.1 ± 11.1 min, P < 0.05) and a longer mean length of hospital stay (1.9 days vs. 1.4 days, P < 0.01); however, no increase in the quantity and severity of post-operative complications was observed. COVID-19 pandemic and restrictive social measures led to fewer consultations for abdominal pain, resulting in a lower number of AA diagnosed. In addition, a longer delay in seeking medical care was observed, leading to more advanced disease, longer operative time and length of hospital stay.

8 Comparison of One-year Outcomes by Management Type in Patients Presenting to the Emergency Department With Uncomplicated Acute Appendicitis

There are approximately 300,000 cases of acute appendicitis in the US annually. Laparoscopic appendectomy is currently the most widely preferred method for acute appendicitis. However, non-operative management for appendicitis has been cited as a viable alternative to appendectomy. Our objective was to compare ED patients with uncomplicated acute appendicitis who received appendectomy versus no surgery for one-year outcomes including surgery rates, ED revisits, repeat hospitalizations, and cost.

Evidence-based optimisation of empirical antibiotic regimens in paediatric complicated appendicitis: a retrospective study of 94 patients.

Acute appendicitis is the most frequent surgical emergency in the paediatric population. Complicated appendicitis accounts for 30% of cases and is inextricably linked to postoperative infectious complications. A study at our institution showed that amoxicillin-clavulanate resistant Escherichia coli in complicated appendicitis was significantly linked to postoperative infectious complications. These findings led to a change in the empirical antibiotic protocol (amoxicillin-clavulanate changed to ceftriaxone + metronidazole as of 2017), intending to reduce postoperative infectious complications in complicated appendicitis in our institution. This study aimed to analyse the microbiology and resistance profiles of pathogens of complicated appendicitis at our institution since implementing the new antibiotic protocol and the postoperative infectious complications rate. We designed a retrospective comparative cohort study. During the defined study period (01 January 2017 to 31 July 2020), medical records were analysed for cases of acute appendicitis, complicated appendicitis and postoperative infectious complications, retaining only those who fulfilled inclusion criteria. Postoperative outcomes, microbiology and antibiotic resistance of peritoneal swabs were analysed. During the study period, 95 patients presented with a complicated appendicitis, and 11 (12%) developed postoperative infectious complications. The most frequent pathogens found in complicated appendicitis were E. coli (66%), Streptococcus anginosus (45%), and Bacteroides fragilis (22%). Pseudomonas aeruginosa was present in 17% of complicated appendicitis. Pathogens involved in postoperative infectious complications mirrored the distribution found in complicated appendicitis without postoperative infectious complications. Antibiotic susceptibility analysis showed that 10 (15%) of E. coli strains were resistant to amoxicillin-clavulanate but sensitive to ceftriaxone + metronidazole, with only one strain responsible for causing a postoperative infectious complication. Six additional strains of E. coli (9%) were resistant to amoxicillin-clavulanate and our empirical antibiotic regimen but were not associated with an increase in postoperative infectious complications. Compared with our previous study, there was a decrease in postoperative infectious complications from 16% to 12%. Postoperative infectious complications caused by amoxicillin-clavulanate-resistant E. coli decreased from 28% to 9%. This retrospective study demonstrated a decrease in the rate of postoperative infectious complications due to amoxicillin-clavulanate-resistant E. coli in complicated appendicitis. These findings accentuate the need to implement evidence-based treatment protocols based on local microbiology profiles and resistance rates to optimise post-operative antibiotics in complicated appendicitis.

AN OBSERVATIONAL STUDY TO FIND RELATIONSHIP OF ACUTE APPENDICITIS TO MENSTRUATION CYCLE IN NORTHERN AND NORTHEASTERN PART OF INDIA

Background. Diagnosing acute appendicitis correctly in a female patient is a challenge for a practicing surgeon. Rate of misdiagnosis of acute appendicitis is very high among female patients. There are many studies carried out to find incidence of acute appendicitis as per various phases of menstruation cycle but the results were conflicting. Objective. The study was conducted to find the relationship of acute appendicitis with the different phases of the menstruation cycle. Methods. This research was an observational study carried out in two regional hospitals in northern and north-eastern part of India. Duration of study was 24 months between 01 June 2019 and 31 May 2021. Inclusion Criteria were for all female patients, non-pregnant and menstruating, who were histopathologically confirmed as acute appendicitis. All pathologically proven negative appendectomy patients were excluded from this study. All female patients taking oral contraceptive pills (OCP) were excluded from the study. Results. A total of 96 females were hospitalized in both hospitals during the study period; 12 of them did not attain menarche (12.5%), 6 had menopause (6.3%) and 78 were menstruating (81.25%). Of those 78 patients, who had physiological menstrual cycles, 6 were in menstrual phase (7.6%), 18 were in proliferative phase (23%), and 54 in luteal phase (69.2%). In our study, there were only 6 cases of acute appendicitis during menstruation. therefore, the expected ratio of cases was 6/14=0.42. The corresponding expected rate for the proliferative phase was 2.78×9=25 cases, whereas for the luteal phase it was 2.78×14=38.92. The expected ratio was 18/25=0.72 for the proliferative phase and 54/39=1.38 for the luteal phase. There was a significant increase in number of cases of acute appendicitis among the menstruating women in luteal phase with p value &lt;0.05. Mean age of the study participants was 28.31±9.56. Conclusions. According to the result of the study, the incidence of acute appendicitis significantly differs in different phases of menstruation cycle with highest incidence in luteal phase. Hence, female hormones (estrogen and progesterone) are significant in causing acute appendicitis.

AN OBSERVATIONAL STUDY OF OUTCOME OF CASES OF UNCOMPLICATED ACUTE APPENDICITIS OPERATED WITHIN 12 HOURS VERSUS AFTER 12 HOURS OF PRESENTATION

Objective Ÿ To minimize number of operations during the night. Ÿ To evaluate ill effects of delaying appendectomy in acute appendicitis. Study Design: Observational study Setting: Tertiary care hospital Patients: In this study we have taken 250 cases of uncomplicated acute appendicitis which got operated at our study setting. Out of these, 125 patients were operated within 12 hours of hospital presentation and the other 125 patients were operated after 12 hours of hospital presentation. Among 125 patients of early group 68 patients were operated with open appendectomy and 57 patients were operated with laparoscopic appendectomy. Similarly, in late group, 46 patients were operated with open method and 79 patients were operated with laparoscopic method. Results:These results suggest that there is no signicant difference between uncomplicated acute appendicitis operated within 12 hours or after 12 hours of hospitalisation when compared in terms of average duration of surgery, post-operative total leucocyte count, time to start feeding after surgery, hospital stay and complications. Conclusions: We can conclude that appendectomy for uncomplicated appendicitis can be delayed safely for more than 12 hours. Delayed appendectomy after hospitalisation for uncomplicated appendicitis does not increase the morbidity of the patient.

A Case of Toxic Megacolon and Acute Appendicitis in HIV/AIDS

A 33-year-old African man with HIV/AIDS presented with an acute abdomen associated with rectal bleeding. Colonic decompression, appendicectomy and post operative antiviral therapy for a diagnosed CMV colitis/ megacolon and appendicitis complicating AIDS was effective and avoided the morbidity and high mortality from an emergency subtotal colectomy and ileostomy.

Diagnostic Accuracy of Fact in Clinically Suspected Cases of Acute Appendicitis in Adolescents and Adults, Taking Surgical Findings as Gold Standard

Objective: to evaluate the diagnostic accuracy of FACT in clinically suspected cases of Acute Appendicitis in adolescents and adults, taking surgical findings as gold standard. Methods: A total of 335 patients referred from emergency department with clinical suspicion of acute appendicitis were enrolled at Radiology Department, Services Hospital Lahore, from April, 2016 to October, 2016. FACT was performed using multi-slice CT. The cases underwent surgery and the results were recorded. The results of Focused Abdominal Computed Tomography and surgery were compared taking surgical findings as gold standard. Results: The mean age of patients in our study was 23.01 ± 5.479. We found 278 true-positives, 50 true-negatives, 04 false-negatives results, with sensitivity of 98.6%, a specificity of 94.3%, a PPV of 98.9%, a NPV of 92.6%, and an accuracy of 98%. An alternate diagnosis was made by FACT in 40 patients (11.9%). Conclusion: FACT (focused non-enhanced abdominal computed tomography) is a highly accurate imaging modality for diagnosis of acute appendicitis in adolescents and adults. Keywords: Focused Abdominal CT, Acute Appendicitis, FACT, Diagnostic Acuuracy

Clinical profile of acute appendicitis at the National Referral Hospital in Bhutan

Introduction: Acute appendicitis poses a diagnostic challenge in a low-resource setting like ours. Without timely and appropriate management, acute appendicitis can lead to prolonged morbidity and mortality. We describe the clinical profile of acute appendicitis at the national referral hospital in Bhutan. Method: This was a cross-sectional descriptive study of all cases of acute appendicitis managed at the National Referral Hospital, Bhutan from 1st January-31st December 2016. Data related to patients’ symptoms, clinical examination and ultrasonographic findings, treatment details, length of hospital stay, and histopathology report were analyzed. Results: Of the 3291 surgical admissions, there were 173 patients with acute appendicitis contributing to 5.3% of the total surgical burden. The median age was 27 years (IQR 20, 39), 60.1% were males. 96.5% and 91.9% of the patients presented with right iliac fossa pain and tenderness respectively. While 74.6%(n=129) had primary surgery, 18.9%(n=32) were managed conservatively. Of the 32 patients, 37.5%(n=12) had surgery after failed conservative management. Seventy-five percent presented with intraoperative features of complicated appendicitis. The negative appendectomy rate was 2.2%. The median length of hospital stay was three days (range 3–60). Ultrasonographic diagnosis compared to histopathological confirmation had a sensitivity of 87.8%, kappa agreement of 87.3%, and specificity of 66.7%. Conclusion: Acute appendicitis is a common surgical emergency. Ultrasonography in the diagnosis of acute appendicitis was useful in a low-resource setting. A high proportion of complicated acute appendicitis in our setting needs effective interventional strategies.

Does Multisystem Inflammatory Syndrome Only Mimic Acute Appendicitis in Children or Can It Coexist: When Should We Suspect MIS-C?

Background and Objectives: Acute abdominal pain in children has been noticed to be a primary reason to seek medical attention in multisystem inflammatory disorder (MIS-C), which can prevail separately or together with acute appendicitis. Our aim was to distinguish regular appendicitis cases from MIS-C and to suggest the best clinical and laboratory criteria for it. Materials and methods: Cases of patients, admitted to the Pediatric Surgery Department over a six-month period in 2021, were retrospectively analyzed. Confirmed MIS-C or acute appendicitis cases were selected. MIS-C cases were either separate/with no found inflammation in the appendix or together with acute appendicitis. Acute appendicitis cases were either regular cases or with a positive COVID-19 test. Four groups were formed and compared: A-acute appendicitis, B-MIS-C with acute appendicitis, C-MIS-C only and D-acute appendicitis with COVID-19. Results: A total of 76 cases were overall analyzed: A-36, B-6, C-29 and D-5. The most significant differences were found in duration of disease A—1.4 days, B—4.5 days, C—4 days, D—4 days (p < 0.0001), C reactive protein (CRP) values A-19.3 mg/L B-112.5 m/L, C-143.8 mg/L and D-141 mg/L (p < 0.0001), presence of febrile fever A-13.9%, B-66.7%, C-96.6% and D-40% (p < 0.0001) and other system involvement: A 0%, B 100%, C 100% and D 20%. A combination of these factors was entered into a ROC curve and was found to have a possibility to predict MIS-C in our analyzed cases (with or without acute appendicitis) with an AUC = 0.983, p < 0.0001, sensitivity of 94.3% and specificity of 92.7% when at least three criteria were met. Conclusions: MIS-C could be suspected even when clinical data and performed tests suggest acute appendicitis especially when at least three out of four signs are present: CRP > 55.8 mg, symptoms last 3 days or longer, febrile fever is present, and any kind of other system involvement is noticed, especially with a known prior recent COVID-19 contact, infection or a positive COVID-19 antibody IgG test.

Comparison of Single-Dermatome Laparoscopic Appendectomy With Standard Laparoscopic Appendectomy in Terms of Postoperative Pain and Patient Satisfaction: A Randomized Controlled Trial.

Laparoscopic appendectomy (LA), used since 1980, is a common surgical technique for acute appendicitis (AA) treatment. Laparoscopic surgical techniques can achieve higher patient satisfaction than conventional open surgery techniques. However, many patients complain of severe pain after laparoscopic abdominal surgeries. In this study, we compared single-dermatome laparoscopic appendectomy (SDLA), wherein all trocars were placed at the same dermatome field, with standard laparoscopic appendectomy (SLA), wherein trocars were placed at multiple dermatome sites, in terms of postoperative pain and patient satisfaction. The study was designed as a double-blind randomized controlled trial. Patients who underwent LA for AA between May 2019 and December 2019 were included in the study and randomized into 2 groups, wherein patients were included sequentially. The first group was operated with SLA surgery, whereas the second group was operated with SDLA surgery. All patients were assessed in terms of visual analog scale (VAS) scores, hemodynamic parameters, and patient satisfaction at postoperative 1, 2, 4, 6, 12, and 24 hours. In the SLA technique, VAS values at postoperative 1, 2, and 4 hours were significantly higher than in the SDLA ( P =0.009; P <0.05). No significant difference was observed between the surgical techniques in terms of VAS levels at postoperative 6, 12, and 24 hours ( P >0.05). In the SDLA group, patient satisfaction was significantly higher than in the SLA group ( P =0.024; P <0.05). In our study, SDLA caused less pain in AA cases during postoperative period than SLA. Further, the SDLA method achieved higher patient satisfaction during the postoperative period than the SLA method.

Ectopic Schistosomiasis Presenting as Ruptured Appendicitis with Periappendiceal Abscess Formation: An Alternative Pathogenetic Perspective

Schistosomiasis is still a public health burden in the Philippines. Chronic infection with Schistosoma japonicum, the only species endemic in the Philippines, clinically manifests itself in a wide variety of pathologies usually correlated with the anatomical site of adult worm activity and deposition of eggs. One of the documented ectopic sites for Schistosoma ova is the appendix. A rare sequela of this is acute appendicitis and an even rarer consequence is progression to appendiceal rupture leading to acute peritonitis. We present a case of a 27-year-old Filipino residing in Davao City but born in Agusan Province who initially complained of right lower quadrant abdominal pain but presented at the emergency room with generalized abdominal tenderness with signs of peritoneal irritation. Exploratory laparotomy with an infraumbilical incision revealed ruptured appendicitis with periappendiceal abscess formation and appendectomy was subsequently done. Schistosoma infection of the appendix was subsequently established by histopathological analysis. Furthermore, features observed suggest an atypical pathogenetic process contrary to the putative pathogenesis of most cases of acute appendicitis.

Analysis of High-quality Nursing in 102 Cases of Acute Appendicitis

Analysis of High-quality Nursing in 102 Cases of Acute Appendicitis

Interval laparoscopic appendectomy after laparotomy drainage for acute appendicitis with abscess: A case report.

IntroductionImmediate appendectomy for acute appendicitis with abscess has a high frequency of ileocecal resection and postoperative complications compared with interval appendectomy after conservative treatment. The optimal approach to acute appendicitis with abscess remains controversial.Presentation of caseA 69-year-old woman was referred to our hospital for abdominal pain. A computed tomography scan revealed an enlarged abscess around the cecum. The diagnosis was perforated appendicitis with abscess, and conservative treatment was performed. Percutaneous drainage was difficult because the abscess was near the intestinal tract. Because of the persistence of symptoms on the fourth day of hospitalization, laparotomy drainage was performed, and the patient's condition improved afterwards. Colonoscopy was performed on an outpatient follow-up to rule out malignant tumors of the colon. Interval laparoscopic appendectomy was performed 3 months after discharge to prevent appendicitis. The postoperative course was uneventful.DiscussionFor this case of acute appendicitis with abscess, conservative treatment such as antibiotic therapy and laparotomy drainage was performed. Laparotomy drainage enabled us to approach the abscess directly and minimized the risk of its spread into the abdominal cavity compared to the laparoscopic approach. Interval laparoscopic appendectomy was more effective and easier for this case of appendectomy, wherein adhesions to the abdominal wall were expected compared to laparotomy.ConclusionConservative treatment approaches, such as drainage and antibiotic therapy, can be first-line for appendicitis with abscesses. Interval laparoscopic appendectomy can be useful to resect the appendix and observe the abdominal cavity.

Acute appendicitis in a child with “artificial” mobile cecum due to neonatal high jejunal atresia surgery

Acute appendicitis cases with “congenital” mobile cecum due to intestinal malrotation have already been reported. However, cases of acute appendicitis involving “artificial” mobile cecum in which the intestinal tract was made non-rotational by surgery in the neonatal period have not been described, and the degree of adhesion in the ileocecal and ascending colon region has remained unclear. Presentation of the case: An 11-year-old girl with artificial non-rotation of the intestinal tract made at surgery for multiple high jejunal atresia in the neonatal period was diagnosed with acute appendicitis based on contrast-enhanced computed tomography (CT) of the abdomen. Transumbilical laparoscopic-assisted appendectomy (TULAA) revealed the ileocecal region was located in the lower middle abdomen and showed good mobility without adhesions, but the right abdominal wall where the colon was released showed adhesions. Acute appendicitis could be diagnosed from CT and appendectomy successfully performed in a patient with “congenital” mobile cecum. As with congenital cases, this “artificial” mobile cecum case could be diagnosed from CT and TULAA performed properly without adhesions on the right colon even after rare neonatal surgery. As diagnostic imaging techniques have improved, appendectomy is not always necessary in surgery for intestinal malrotation in newborns or infants. • We performed creation of artificial mobile cecum in high jejunal atresia surgery. • TULAA was performed successfully on a child after neonatal artificial mobile cecum. • Preventive appendectomy may not be necessary in malrotation surgeries.