Clinical Features Of Acute Appendicitis Research Articles

Treatment outcome of appendicitis in Azare

Objectives: Appendicitis is and has remained one of the most common abdominal surgical emergencies the world over. Its procedure and appendectomy is also a very common and regularly done surgical procedure and, thus, a very important disease to describe in totality. Hence, we set out to describe the pattern of presentation and management outcome of this condition in our environment. Materials and Methods: Data were collected retrospectively of all patients with the clinical diagnosis of appendicitis during the study period and analyzed. Results: A total of 62 patients had a clinical diagnosis of appendicitis over the period under review. M: F was 1:1.1. Age ranged from 3 years to 47 years with a mean of 21.50 ± 10.07. All (100%) patients presented with right iliac fossa pain. Other symptoms were anorexia (45.2%), nausea (61.3%), and vomiting (40.3%). All (100%) of patients went on to have an appendectomy. Twelve (19.40%) patients had surgical site infection and 2 (3.20%) developed enterocutaneous fistula. Duration of hospital stay ranged from 1 to 30 days. One patient who had uncontrolled diabetes mellitus died giving a mortality rate of 1.6. Conclusion: Typical clinical features of acute appendicitis were lower abdominal quadrant pain associated with nausea, anorexia, and vomiting. It goes without saying that diagnosis can still be made comfortably on clinical grounds and treatment outcome is generally good.

Acute appendicitis the first sign of appendiceal metastasis of an inoperable carcinoma of stomach-A case report and a review of literature.

Appendicitis is the most common cause of the acute abdomen and usually occurs because of the fecalith in adults and lymphoid hyperplasia in childhood. Gastric cancer metastasis to the appendix is a rare condition that might be present with symptoms of acute appendicitis. The English literature describes only thirteen cases of gastric carcinoma metastasizing to the appendix and presenting as acute appendicitis. In this report, we describe the first case of metastatic signet ring cell carcinoma of appendix presenting with clinical features of acute appendicitis.

Clinical, Radiological and Pathological Appraisal of Acute Appendicitis in Al Qassim, Saudi Arabia: A Single-Center Retrospective Analysis.

BackgroundAcute appendicitis can occur at any age but is rare among people of extreme age; it is more common in teenagers and young adults. Traditionally diagnosis is made on clinical grounds. In recent times imaging techniques have been deployed to improve diagnosis and reduce negative appendicectomy rates. The aim of the study was to describe the common clinical features of acute appendicitis among our patients, highlight the role of medical imaging, and compare all these with the histological report of the excised appendix.MethodsA 24-months retrospective review of all patients who underwent appendicectomy (July 1, 2019-June 30, 2021) for suspected acute appendicitis was performed. Medical records numbers of patients who had appendicectomies were retrieved from the operating room register. These numbers were used to access the hospital's electronic medical records database for the patients' records. These records were reviewed for biodata, clinical features, laboratory, medical imaging findings, and histological reports.ResultIn this hospital, 354 appendicectomies were performed. Only 336 had complete data set suitable for further review. There were more males (N=257; 76.5%) than females (N=79, 23.5%), yielding a male to female ratio of 4:1. There were also more Saudi citizens (n=266, 79.2%), with the predominant age group being 11-30 years. Abdominal pain was the predominant symptom (100%) and was localized to the right iliac region in 331 (98.7%) of patients. Other symptoms recorded were anorexia (n=247, 73.5%), vomiting (n=190, 56.5%), and nausea (n=93, 27.7%). Atypical symptoms included diarrhoea (n=27, 8%) and constipation (n=12, 3.6%). Acute appendicitis, complicated appendicitis, and no appendicitis were the reported histological disposition in 174 (51.8%), 124 (36.9%), and 38 (11.3%) cases respectively. Abdominal CT scan had a higher sensitivity (98.6% vs 70.5%), higher diagnostic odd ratio (2.5 vs 1.4) and a lower miss (false negative) rate (1.4% vs 29.5%) compared to ultrasonography. However, the CT scan, from this study, has a rather low specificity (3.4%) and high false positive rates (96.5%). Open (n=205; 61%) and laparoscopic (n=131;39%) approaches were used for the appendicectomies. In our study, 44 patients were diagnosed with the decision to operate based on clinical grounds; and of this, 42 (95.4%; n=44) had confirmatory histology reports of appendicitis. Also, 38 patients had negative appendicectomy; giving a negative appendicectomy rate of 11.3%. This high rate may be due to the lower specificity and high false positive rate observed in this study. The post-operative complication rate was 21.4%, and this was solely due to surgical site infection, and this was more common with the open approach (p=0.001).ConclusionSuspected acute appendicitis was the sole indication for our appendicectomies. A computerized tomography scan was a more reliable diagnostic tool than ultrasonography. Despite the fact that acute appendicitis is majorly a clinical diagnosis, and good clinical acumen is an excellent skill in the management of patients, we observed an overreliance on medical imaging for diagnosis. Open appendicectomies were more common, and surgical site infection was the sole complication of surgery. There was a relatively high negative appendicectomy rate for an image-assisted diagnosis.

Neurogenic Appendicitis: A Reappraisal of the Clinicopathological Features and Pathogenesis.

In 1921; Masson and Maresch first coined the term “neurogenic appendicitis (NA)” to describe “neuroma-like” lesions in the appendix. To date, our knowledge about NA is limited; therefore, we conducted a comprehensive analysis of the literature (1921 to 2020) to examine the clinicopathological features of NA. We also addressed the pathophysiology of acute abdominal pain and fibrosis in this entity. We performed a meta-analysis study by searching the PubMed database, using several keywords, such as: “appendix,” “neurogenic,” “obliterative,” “neuroma,” “fibrous obliteration,” “appendicopathy,” and “appendicitis.” Our study revealed that patients with NA usually present clinically with features of acute appendicitis, bud2t they have grossly unremarkable appendices. Histologically, the central appendiceal neuroma was the most common histological variant of NA, followed by the submucosal and intramucosal variants. To conclude, NA represents a form of neuroinflammation. The possibility of NA should be considered in patients with clinical features of acute appendicitis who intraoperatively show a grossly unremarkable appendix. Neuroinflammation and neuropeptides play roles in the development of pain and fibrosis in NA.

Factors predictive of complicated appendicitis in children

Background: Clinical features of acute appendicitis are often overlapping with other abdominal pathology in children. This increases the risk of complicated appendicitis (CA). It is still difficult to identify CA preoperatively. The study aims to identify pre operative risk factors in children for CA.Methods: A prospective study was conducted in pediatric surgery unit of department of general surgery of a university hospital of Kathmandu, Nepal. All children up to 16 years diagnosed and operated for appendicitis were included in the study. Based on intraoperative findings and histopathological examination (HPE), patients were grouped in simple appendicitis (SA) and CA. Pre-operative clinical and laboratory variables of between simple and CA were compared. P£0.05 was considered as significant.Results: A total of 73 children were included out of which 61 (83.6%) had SA and 12 (16.4%) had CA. Mean age of participants was 12.8±2.9 years. More than half (64.4%) of the participants were male. The median duration of symptoms was 2 days. In bivariate analysis, gender, serum Na, duration of symptoms and rebound tenderness were significantly associated with severity of appendicitis. In multivariate analysis, rebound tenderness (OR-15.36) and duration of symptoms (OR-9.96) were found to be associated with CA.Conclusions: Male patients, rebound tenderness, longer duration of symptoms and hyponatremia can be used to predict CA. Duration of symptoms and rebound tenderness are independent risk factors for CA.

English

BACKGROUND Accurate clinical diagnosis and timely surgical intervention are the two important events that help the surgeon in the management of acute appendicitis. Two diagnostic score systems that help in avoiding the removal of normal appendix are reviewed in this study. The purpose of this study was to evaluate the sensitivity and specificity of Alvarado score (AS) and Appendicitis inflammatory response scores (AIRS) in the diagnosis of acute appendicitis (AA) and correlate their efficacy in the management of acute appendicitis as per the diagnostic scores used. METHODS This was a cross-sectional clinical study. 73 patients who attended the emergency ward for clinical features of acute appendicitis were included in the study. Clinical examination included the diagnostic tools 1. The Alvarado score, 2. Appendicitis Inflammatory Response score. Based on their score a provisional diagnosis was made among the patients. All the data was classified and analysed. RESULTS The positive predictive value was 63/73 (86.30 %) with Alvarado diagnostic tool and 66/73 (90.41 %) with AIS diagnostic tool. The false positive values using Alvarado system was 06.84 % and 04.10 % with AIS system. The true negative rate of diagnosis of acute appendicitis in this study was 09.58 %. CONCLUSIONS Both Alvarado and AIS diagnostic tools were simple and accurate in the early diagnosis of acute appendicitis in the adult population. Both the tools are highly sensitive and specific in nature. KEYWORDS Appendix, Acute Appendicitis, Perforation, USG, Laparotomy and Alvarado Score

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

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

Laparoscopic diverticulectomy for a gangrenous Meckel's diverticulitis mimicking acute appendicitis in an adult

Johann Friedrich Meckel was the first to feature the anatomy and embryology of a diverticulum in 1809, as an incomplete obliteration of the omphalomesenteric duct, and named this as Meckel's diverticulum. Since then, lots of facts have been gained about its presentations and treatments. When a surgeon encounters a Meckel's diverticulitis with a normal base instead of an inflamed appendix in a patient with acute pain in the right iliac fossa, diverticulectomy should suffice. We present a patient with clinical features of acute appendicitis but was found to have torsion and gangrene of a Meckels diverticulum. This was successfully managed by laparoscopic diverticulectomy with a hand-sewn technique. Laparoscopy has utility in the treatment of complicated Meckel's diverticulitis.

A comparative study on surgical site infection in cases of open and laparoscopic appendicectomy

Background: Diagnosis of acute appendicitis is mostly based on clinical features pointing towards appendicitis. Several biochemical parameters, such as the white blood cell (WBC) count, and neutrophil percentage, are currently used to aid clinical diagnosis. Without immediate surgery, appendicitis may progress to perforation of the appendix. This study was carried out to determine rate of SSI in open versus laparoscopic appendicectomy for acute appendicitis and to identify independent risk factors for SSI.Methods: Appendicitis is a common cause of pain in right iliac fossa worldwide. The present study was carried out in the Department of General Surgery, Acharya Vinoba Bhave Rural Hospital, affiliated to Jawaharlal Nehru Medical College, Sawangi, Wardha, from August 2015 to July 2017. This study was conducted after the due clearance from Institutional Ethical committee. Total 132 patients admitted to the surgery ward with acute lower abdominal pain with clinical features of acute appendicitis on clinical examination, were studied prospectively.Results: In the present study, maximum patients were seen in less than 20 years of age and next commonest age group of presentation was 21-30 years. The male to female sex ratio was 1:1.3 in the laparoscopic appendectomy group while in the open appendectomy group was 1.81:1. The incidence of complicated intra-operative findings and mean white blood cell count was more in the open appendectomy group. The mean operative time, days for use of analgesics, time taken to return to soft diet and length of hospital stay for laparoscopic appendectomy group was less than the open appendectomy group. There were more cases of surgical site infection in the patients operated by open approach than laparoscopic approach.Conclusions: Wound class II versus III and NNIS index were found to be significantly associated with surgical site infection.

A clinico pathological study of acute appendicitis with special reference to ultrasonography

Background: Acute appendicitis is one of the commonest conditions treated at emergency, despite of advances in diagnostic medicine and therapeutics, the diagnosis of appendicitis remains essentially clinical, requiring clinical acumen and surgical knowledge. Maximum incidence noted in second and third decade of life with male predominance. Ultrasonograpy is shown to be effective in the diagnosis of acute appendicitis with a sensitivity of 84 to 89% and specificity of 92 to 98%. Objectives of the study was to study the clinical features of acute appendicitis regarding Alvarado score. Role of USG and HPE Examination in supporting the clinical diagnosis of acute appendicitis and the morbidity, mortality of emergency appendicectomy.Methods: 100 patients who were admitted to VIMS hospital, Bellary, from November 2004 to April 2006 with a clinical suspicion of acute appendicitis were included in the present study. Ultrasonography and Histopathological Examination was done in all cases and results were correlated with final analysis. Results were analyzed using 'Z’ test, Chi-squire test, sensitivity and specificity.Results: In present study of 100 cases 77 were males and 23 Females patient. Out of which 60 are in 15 to 30 years, 21 patients are 10 to 15 years followed by 13 in the age group of 30-40 years. All are undergone appendicectomy. 11 patents undergone Elective, and 89 emergency appendicectomy. Ultrasound was coming positive in 92 cases and negative in 8 cases. The sensitivity and specificity of 95.7% and 80% Respectively. HPE was done in all 100 cases 95 were positive 5 were negative with sensitivity of 96.8% and specificity of 80%.Conclusions: Appendicitis is commonest in 2nd and 3rd decade followed by 4th decade with a male preponderance, Ultrasonography is useful in females to rule out any gynecological pathology. Patients who come early within 2 to 3 days of symptoms of acute appendicitis, emergency appendicectomy is the treatment of the choice and were will be less morbidity and mortality, post operatively.

Incidence of right-sided colonic tumors (non-appendiceal) in patient's ≥40 years of age presenting with features of acute appendicitis

IntroductionNon-appendiceal tumors can mimic and present with clinical features of acute appendicitis in patients of age 40 years or above. The aim of this prospective study is to investigate the incidence of right-sided (non-appendiceal) colonic tumors in patients presenting with clinical features of acute appendicitis. MethodsA prospective data analysis of 1662 patients using appendectomy database was performed from 2005 to 2011. Patients above age 40 years or older were included. Patients were compared for demographic data, clinical presentation, radiological findings, operative technique & findings, histo-pathological findings and postoperative complications. The primary outcome was incidence of right-sided colonic (non-appendiceal) tumors presenting with features of acute appendicitis. Secondary outcomes measured were, role of diagnostic radiology, negative appendectomy rate, length of stay and changing trends in operative techniques. ResultsFrom 1662 patients initially reviewed, only 179 patients (10.77%) age 40 years or above mean (56 ± 11.75), median 54 (40–89), with clinical features of acute appendicitis were included in the final analysis. F:M ratio was (1:1.06). CT scan showed in only 1 patient (1.25%, OR = 0.806, p = 0.695), suspicion of cecal tumor and underwent right hemicolectomy. Histological examination of specimen showed, 2 patients (1.11%, OR = 1.10, p = 0.47) had primary appendiceal tumors, in which one patient was histologically reported as appendiceal mucocele (mucinous cystadenoma with low-grade dysplasia), while the other one had appendeceal carcinoid (Goblet cell carcinoid). In the other tumor group one patient had metastatic involvement of appendix from ovarian tumor. The time to appendectomy in radiological group was delayed by (9.2 ± 3.7 h). 131 (73.1%) had laparoscopic while 48 (26.81%) underwent open appendectomy. The negative appendectomy rate was (1.12%) and 30 days complication rate was (11.73%, p = 0.27). Mean length of stay was 3.54 ± 2.1 days. ConclusionRight-sided colonic (cecal) tumors rarely present with features of acute appendicitis. Only those patients with atypical presentation and findings should have pre-operative radiological evaluation.

Alternative diagnosis for pain in patients who underwent appendectomies for normal appendices and the incidence of negative appendectomies

Background and objectives: Some gastrointestinal and genitourinary tract pathologies can simulate clinical features of acute appendicitis; we aim to determine the alternative diagnosis for the pain in which appendicitis was considered, and to find the incidence of negative appendectomies in our practice. Methods: An observational study, including 558 patients, who underwent an appendectomy at Al Sulaimaniyah Teaching Hospital (STH) from the 2nd of January to the 30th of June 2009. Only patients who underwent urgent appendectomy and the specimen subjected to tissue examination were included. Appendices were labeled acutely inflamed when, macroscopically there were injections of mucosa, fibrinous or purulent film, edematous or necrotic changes of the wall and blood or pus on opening the appendix. Results: Most of the patients were young between 20-40 years age with median age of 22 ±7.7 years. Other pathologies presented in patients with macroscopically normal appendices, included 35 (6.27%) patients had purulent peritoneal fluids occured in young female with tubo-ovarian infections, 12 (2.15%) patients had mesenteric lymphadenitis and 37 (6.63%) patients had rupture Graafian follicles. Histologically normal appendix was present in 178 (31.89 %) patients, 61 (10.93%) of them were males and 117 (20.96%) were females. Conclusion: Normal appendectomies were found in 32 % of the patients, more frequently in young female patients, undergoing early (within 6 hrs since the pain) appendectomy, with the most common alternative diagnosis of tubo-ovarian infections. Keywords: Acute appendicitis, alternative diagnosis, normal appendix.

Acute amebic appendicitis: Report of a rare case

Acute appendicitis of amebic origin is considered a rare cause of acute appendicitis. We report a case of amebic appendicitis presenting with fever, severe pain in the right lower quadrant of the abdomen and rebound tenderness. Lab investigations revealed neutrophilic leukocytosis. The patient underwent appendectomy. Histopathological examination revealed numerous Entameba histolytica trophozoites in the mucosa of the appendix. Acute appendicitis of amebic origin does not appear frequently. Appendicular amebiasis can give the clinical features of acute appendicitis and should be treated accordingly.

Laparoscopic Management of Appendiceal Intussusception Caused by Fecaliths

Appendiceal intussusception is a rare condition of abdominal pain. It develops as a result of various anatomic or pathologic conditions, such as polyps, worms, carcinomas, mucoceles, or fecaliths. Furthermore, an accurate preoperative diagnosis of appendiceal intussusception may be difficult. However, recently developed radiologic modalities, such as multidetector CT and laparoscopy, can considerably aid preoperative diagnosis and provide a means of adopting optimal minimally invasive surgery. Here, the authors describe the case of a 30-yr-old woman with the clinical features of acute appendicitis, who was preoperatively diagnosed as having appendiceal intussusception with fecaliths and who was managed by using a laparoscopic partial cecectomy.

Enterobius Vermicularis infection of the appendix as a cause of acute appendicitis in a Greek adolescent: a case report

Gastrointestinal infection due to Enterobius vermicularis occurs worldwide and is considered to be the most common helminth infection. The simple presence of E. vermicularis in the appendix usually produces symptoms of acute appendicitis. The association of this parasitic infestation with acute appendicitis varies from 0.2%–41.8% worldwide. We present a case of a 15 year old female with enterobiasis of appendix presented with clinical features of acute appendicitis. The appendix was surgically removed and the specimen was pathologically diagnosed to contain of E. vermicularis in non-inflamed and histologically normal appendix. Even if this condition is not uncommon in the Greek population, to the best of our knowledge this is the first report presented in the English literature.

Current clinical features of acute appendicitis in adult in Yaounde, Cameroon

Our study on acute appendicitis in adults aimed to report current data in Yaounde, Cameroon. This retrospective study included 323 patients, with 185 men against 138 women (sex ratio: 1.37). Mean age was 28.3 years old. Incidence was of 4.6%. Symptoms appeared within a delay of 3 to 4 days and consisted of the triad: abdominal pain (97.5%), vomiting (44%) and anorexia (39.9%). 99.7% of the patients presented with hyperthermia whereas defence on palpation in the right iliac fossa was noted in 307 patients. Rectal examination was evocative in 92.7% of the cases. Hypemeutrophilia was found in 84.9% of the patients. Plain abdominal radiography (PAR) orientated the diagnosis in 74.3% of cases; echography was very useful in abscesses (6,5%). 96.7% of the patients underwent surgery within an average time of 48 hours. McBurney incision was performed in 232 cases. Appendice in the inner latero caecal position was predominant in 243 cases. In seven cases (2.2%), appendice was normal; 2 Meckel's diverticula were discovered (0.6%). We carried out 309 anterograde appendectomies, 317 irvaginations of the appendicular root and 14 epiplooplasties. 302 histological exams were performed; catarrhal appendicitis were ranking first: 167 cases. Morbidity reached 14.2% dominated by sepsis (71.7%). The mortality rate was 0.6%. A better diagnostic approach together with a better sensitisation of the population may shorten surgical delays inducing a decrease of morbidity of acute appendicitis in Cameroon.

First-Year Experience of Laparoscopic Appendicectomy at the Royal Hospital for Sick Children of Edinburgh

ABSTRACT Purpose: A prospective review was carried out to compare laparoscopic and open appendicectomy in children over a 12-month period. Patients and Methods: One hundred thirty-two patients with clinical features of acute appendicitis underwent emergency appendicectomy. Thirty-six patients underwent laparoscopic appendicectomy and 96 had an open procedure, depending on the availability of a pediatric surgeon with laparoscopic experience. There was no difference in age, weight, operating time, pathologic findings, or postoperative stay between the two groups. Results: The postoperative morphine requirement was reduced in the laparoscopic group. Patients in this group were also able to tolerate normal diet earlier. Conclusion: In pediatric centers with laparoscopic surgical expertise, laparoscopic appendicectomy can be safely introduced for the management of acute appendicitis.

Transitional cell papillary bladder neoplasm in a girl: An unusual presentation

An 8-year-old girl presented with the clinical features of acute appendicitis. The removed appendix was normal but the abdominal pain persisted. There were no urinary symptoms and bacteriological examination of the urine was negative. An ultrasound scan showed an intravesical tumor that was subsequently excised. Histology showed a grade 1 transitional cell papillary bladder carcinoma of low grade malignancy. All previously reported cases have presented with urinary tract symptoms, usually hematuria.