Common Cause Of Acute Abdomen Research Articles

Evaluation of Diagnostic Accuracy of Contrastenhanced Computed Tomography in Acute Abdomen: A Cross-sectional Study

Introduction: Acute abdomen is one of the most frequent causes of presentation to the Emergency Department (ED). The clinicians favour radiological examinations to reach the proper final diagnosis after thorough physical examinations, lab investigations, and clinical interpretation. Contrast-enhanced Computed Tomography (CECT) imaging aids in preventing delayed necessary treatment or unnecessary surgery. Aim: To investigate the specificity and sensitivity of CECT in cases of the acute abdomen using histopathological, clinical, and intraoperative surgical findings as gold standards. Materials and Methods: A cross-sectional study was conducted in the Department of Radiology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India, from September 2020- 2022. Evaluation of 115 patients was done based on inclusion (Patients presenting with clinical symptoms of acute abdomen and undergoing CECT Abdomen, followed by a clinical, biochemical, surgical, or histopathological examination) and exclusion criteria. Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and accuracy of CECT was calculated. The data was analysed using Statistical Package for Social Sciences (SPSS) version 22. Results: The study included 115 patients with ages ranging from 9-88 years. An increased incidence in males was observed, M:F ratio of 1.4:1. The most common age group was 31-40 years (n-25; 21.7%), followed by 41-50 years (n-20; 17.4%). Cholecystitis was the most common cause of acute abdomen, accounting for 22.6% (n-26) of total cases followed by appendicitis. The overall accuracy rate of CECT was 93% with an accuracy of 98-99% in cases of cholecystitis appendicitis, pancreatitis, ovarian cyst, and bowel obstruction. Conclusion: CECT shows higher sensitivity and specificity in identifying different aetiology of acute abdomen. It also helps in optimal decision-making for management and improved outcomes.

Is there a correlation between the diagnostic test results and the histopathological diagnoses of acute appendicitis in a Turkish hospital in Somalia?

Appendicitis is the most common cause of acute abdomen. This study aimed to investigate the demographic and clinical data of the patients diagnosed with acute appendicitis in the emergency department of a Turkish tertiary care center in Somalia. The association between the diagnostic test results and the histopathological diagnoses was also analyzed. Data of the patients diagnosed with acute appendicitis at the emergency department between the 1st of January 2021 and the 31st of December 2021 period were retrospectively reviewed. The demographic data, clinical features, laboratory test results and radiological and histopathological findings of the participants were retrieved from the hospital’s electronic medical records for patients in the database. Overall, 83 patients were included. Among those, 59 (71.1%) were male, and the mean patient age was 22±8.2. The mean values of the leukocyte and neutrophil counts and the C-reactive protein levels were higher than the normal range. The laboratory test, abdominal ultrasonography, and enhanced computerized tomography results were compared with the histopathological findings. Only the neutrophil-lymphocyte ratio was found (to be) significant in the diagnosis of complicated appendicitis. The clinical data, laboratory tests, and radiological imaging findings should be evaluated together to diagnose acute appendicitis. Prompt diagnosis is essential for the prevention of postoperative complications and mortality. A statistically significant difference was found in the comparison of the lymphocyte counts, NLR values, and histopathological findings (p=0.01 and p=0.008).

Unusual Case of Acute Abdomen in a Patient on Maintenance Hemodialysis

ABSTRACT Acute abdominal pain is not a frequent presentation in the emergency department in patients on maintenance hemodialysis (HD). Common causes of acute abdomen in these patients are bowel infarction, pancreatitis, and peritonitis. Splenic infarction presenting as acute abdomen is a rare entity. We report a case where a 38-year-old female on HD presented with acute abdomen and was found to have splenic infarction. On further evaluation, she was found to have infective endocarditis of the aortic valve as a complication of catheter-related bloodstream infection due to nontunneled catheter. The management of the patient comprised of prompt removal of catheter and intravenous antibiotics.

Management of Acute Cholecystitis in Elderly (≥65 years old) Patients: A Retrospective Study Comparing Early versus Delayed Cholecystectomy

Aim: Acute cholecystitis is the most common causes of acute abdomen in elderly population. This study aimed to present the early postoperative period (≤ 30 days) outcomes of elderly patients (≥ 65 years old) with acute cholecystitis who underwent early or delayed cholecystectomy. Methods: Between January 2016 and December 2020, 74 patients aged 65 and over underwent cholecystectomy for acute cholecystitis were included in the study. The patients were divided into two groups as early (time between diagnosis and cholecystectomy 7 days or less, n= 43, 58.1%) or delayed (time between diagnosis and cholecystectomy over 7 days, n= 31, 41.9%) cholecystectomy. Demographic characteristics, preoperative laboratory and radiological findings, and perioperative data of patients were evaluated, and the groups were compared. Results: The median age of patients was 73 (65-90) years, and 39 (52.7%) were male. Sixty-one (82.4%) patients underwent laparoscopic, 8 open (10.8%) and 5 (6.8%) conversion cholecystectomy. The rate of laparoscopic cholecystectomy was higher in the delayed group (n= 29, 93.5%) than in the early group (n= 32, 74.4%), but no statistically significant difference was detected (p=.06). The rate of open cholecystectomy was statistically significantly higher in the early group (n=8, 18.6%) than in the delayed group (n=0) (P=.017), the conversion rate was similar between the groups (p=1). There was no significant difference between the groups in terms of intraoperative complications (p=1). The length of hospital stay was statistically significantly longer in the early compared to the delayed group 5 (1-21) days and 2 (1-12) days, respectively, p< .001). Conclusion: There was no statistical difference regarding intraoperative complications in patients underwent early or delayed cholecystectomy. We believe that the patient's clinical presentation and early or delayed cholecystectomy experience of the team are vital in determining the timing of cholecystectomy, as well as the severity of acute cholecystitis.

ABDOME AGUDO EM UNIDADE DE TERAPIA INTENSIVA: ETIOLOGIA, COMORBIDADES E SEVERIDADE DE 1.523 PACIENTES

ABSTRACT BACKGROUND: Clinical features and outcomes of patients admitted to the intensive care unit due to acute abdomen are important to be investigated. AIMS: To evaluate the outcomes of critically ill subjects with acute abdomen according to etiology, comorbidity and severity. METHODS: Outcomes of 1,523 patients (878 women, mean age 66±18 years) consecutively admitted to a specialized gastrointestinal intensive care unit with different causes of acute abdomen from January 2012 to December 2019, were retrospectively evaluated according to etiology, comorbidity and severity. RESULTS: The most common causes of acute abdomen were obstructive and inflammatory, particularly large bowel obstruction (27%), small bowel obstruction (18%) and acute pancreatitis (17%). Overall mortality was 13%. Surgery was required in 34% of patients. Median length of stay in the hospital was 9 [1-101] days. On univariate analysis mortality was significantly associated with age, APACHE II, Charlson comorbidity index, requirement for surgery and malignancy (p<0.0001), but only APACHE II, Charlson comorbidity index and surgical interventional remained significant on multivariate analysis. CONCLUSIONS: Critically ill patients admitted to the intensive care unit with acute abdomen constitute a heterogeneous group of subjects with different prognosis. Mortality is more related to the severity of the disease, comorbidity and need for surgery than to the etiology of the acute abdomen.

A CASE SERIES OF 5 RARE ABDOMINAL EMERGENCIES

Gastrointestinal perforation is a common cause of acute abdomen due to peritonitis. The etiology and pathophysiology of gastrointestinal perforations is varied and can range from a small prepyloric perforation that is relatively clean to transection of small or large bowel with spillage of contents in peritoneum with gross contamination. Some of these are more common than others. Here we present 6 cases of rare perforations presenting to us in the casualty, their management and postoperative course in hospital. Methods: We will be assessing the cases of patients, their history, clinical presentation, radiological imaging who presented with acute abdomen secondary to bowel perforation and were intraoperatively diagnosed to have a rare pathology and assess the management and postoperative outcomes. Results: In this case series, 5 rare cases of GI perforations are highlighted including rare cases of posterior gastric perforation, DJ transection, jejunal transection, jejunal perforation, large mesenteric tear and sigmoid colon perforation. All these cases required a different approach in managing intraoperatively. Conclusion: Gastrointestinal perforation is a common cause of acute abdomen and requires emergency surgical intervention. CT imaging has become a fundamental part of the preoperative evaluation and can determine site and cause of perforation.Gastrointestinal tract perforations can occur due to various causes, and most of these perforations are emergency conditions that require early recognition and timely surgical treatment the mainstay of treatment for bowel perforation is surgery. Atypical presentation of perforation can be a challenge to surgeons andshould be prepared to deal with it.

Outcome of rupture liver abscess in tertiary care center

Background: Liver abscess is common clinical condition encountered in outpatient and emergency setting however; rupture of it can lead to higher morbidity and mortality of patients. Despite different and easily accessible modalities are available to diagnose the condition early, still ruptured liver abscess presents with a common cause of acute abdomen in surgical emergency.Methods: This was a retrospective study carried in Sarojini Naidu Medical College, Agra, between 2019 and 2021. All patients with ruptured liver abscess (ultrasound diagnosed) were included in this study, and those patients having other causes of peritonitis were excluded.Results: Out of the fourty patients assessed, all patients were male (100%). The most affected age group was 31-40 years (50%) followed by 41-50 years (30%). Right hypochondrium pain was the most common presenting complaint. 80% have history of chronic alcohol intake. Twenty patients (50%) had presented with signs of toxemia. Only right lobe of the liver was affected the most in 28 patients (70%). Escherichia coli was the most common organism isolated in our study in 21patients (52.5%). A total of 16 patients (40%) had diabetes in our study and total of 7 (17.5%) patients had mortality in our study.Conclusions: Ruptured liver abscess can be diagnosed in emergency setting and is preventable if early intervention is done. It carries high morbidity and mortality so early diagnosis and prompt treatment can reduce the risk of it.

Decision-making changes for patients and medical personnel in the management of acute appendicitis during the COVID-19 pandemic

BackgroundAcute appendicitis is the most common cause of acute abdomen. During the pandemic, to contain the spread of COVID-19, there were some integral changes in the medical processes based on the pandemic prevention policy, especially regarding emergency surgery. This study was conducted to investigate whether this pandemic also impacted the decision-making for both patients and medical personnel along with the treatment outcomes.MethodsPatients of age 18 years or older who were diagnosed clinically and radiologically with acute appendicitis between Jan 1, 2017, and Dec 31, 202,0 were reviewed. The data of 1991 cases were collected and used for this study. Two groups were formed, one group before and the other group after the outbreak. The gathered data included gender, age, appendiceal fecalith, outcomes of treatment, and long-term outcomes of non-operation (8 months follow-up). We also collected details of surgical cases from the above two groups. This data also included age, gender, appendiceal fecalith, fever, jaundice, length of onset before presenting to an emergency department (ED), anesthesia, surgery, white cell count, pathology, complications, and length of stay. We compared the above data respectively and analyzed the differences.ResultsCompared to the period before the outbreak, patient visits for acute appendicitis remarkably dropped (19.8%), but surgical cases showed no change (dropped by roughly 5%). There were significant differences (P < 0.05) in failure of non-operation(after the pandemic 8.31% vs. before pandemic 3.22%), interval appendectomy(after pandemic 6.29% vs. before pandemic 12.84%), recurrence(after pandemic 23.27% vs. before pandemic 14.46%), and outcomes of recurrence. There was a significant difference (P < 0.05) in anesthesia method, surgery way, and complications( before pandemic 4.15% vs. after pandemic9.89% P < 0.05) in patients who underwent the surgery. There was no statistical difference (P > 0.05) concerning age, gender, fever, jaundice, appendiceal fecalith, white cell count, and length of onset before presenting to the ED.ConclusionThe current pandemic prevention policy is very effective, but some decision-making processes of doctor-patient have changed in the context of COVID-19 pandemic, that further influenced some treatment outcomes and might lead to a potential economic burden. It is essential to address the undue concern of everyone and optimize the treatment process.

Intussusception in a 9-Year-Old Boy

Intussusception is a common cause of acute abdomen in children. Older children may have subacute or chronic presentation compared to infants. Although, in most children, it is idiopathic, a pathological lead-point should be considered particularly in older children. A high index of suspicion should be maintained. Diagnosis can be difficult but findings on a plain radiograph may be helpful. Early diagnosis and prompt treatment are important for an optimal outcome. We present the case of a 9-year-old child with intussusception secondary to an intra-abdominal mass, followed by a discussion on the most common causes of secondary intussusception. The pertinent literature is reviewed.

Gastric perforation and renal vein thrombosis in acute pancreatitis: a case report

BackgroundAcute pancreatitis is one of the most common causes of acute abdomen. It is associated with multiple complications. Gastric perforation and isolated renal vein thrombosis are two infrequent complications. We present a case of acute pancreatitis with gastric perforation and isolated renal vein thrombosis in the same patient.Case presentationA 28-year-old gentleman with chronic alcohol intake presented with complaints of abdominal pain and not responding to analgesics. Biochemical investigations revealed elevated amylase and lipase level. Contrast-enhanced computed tomography (CECT) showed necrotizing pancreatitis with necrotic collection in the lesser sac. On oral contrast, active contrast extravasation from gastric perforation was picked up. Renal vein and splenic vein thrombosis was observed.ConclusionsGastric perforation and renal vein thrombosis are two infrequent complications of acute pancreatitis. High-end radiological suspicion is needed to reduce the associated morbidity and mortality.

Clinical Profile of Acute Pancreatitis

Background and objectives: Acute pancreatitis is a disorder that has a wide-ranging presentation, etiology, multifactorial pathogenesisandclinicalconsequencesfrommildselflimitingtoseverelife threatening. The aim of this study is to evaluate demographic characteristics, etiology, clinical presentation and its management.&#x0D; Materials and methods: This retrospective study was carried out in Department of Surgery of National Medical College and Teaching Hospital. A total of45 patients with diagnosis as acute pancreatitis over period of March 2020 to February 2022 were included in this study. History and detailed clinical examination was performed as per the working proforma which included. Chi square test were used for correlation analysis. Data analysis was done using SPSS (Statistical Package for social sciences), version 25.&#x0D; Results: Most of acute pancreatitis were seen in 20-39 years of age group with mean age of 39.7 years. 66.6% patients were female. Gall stone was the most common cause (71.1% patients) of pancreatitis. Abdominal pain was the most common mode of presentation, and tenderness the most common sign. Most of the patients were managed conservatively. Median hospital stay was 9 days.&#x0D; Conclusion: Acute pancreatitis is a common cause of acute abdomen in patients presenting to the emergency department. Gall stone is the most common cause of acute pancreatitis .Clinical diagnosis along with biochemical and radiological findings are required for diagnosis .The management is mainly conservative.

Evaluating the efficacy of urinary trypsinogen-2 Dipstick test in diagnosing acute pancreatitis

Acute Pancreatitis (AP) is a very common cause of acute abdomen in emergency department. The disease may vary from mild self-limiting symptoms to multi organ failure and has high mortality rate. Although most of the cases are treated by mild symptomatic treatment but severe cases require intensive monitoring, so early diagnosis and goal directed treatment is very essential to reduce mortality and morbidity of disease. The present study aims to know the efficacy of urinary trypsinogen-2 dipstick test in early diagnosis of acute pancreatitis. The prospective study sample included 98 patients who were presented to emergency department of Maharaja Krishna Chandra Gajapati Medical College &amp; Hospital (MKCGMCH), Berhampur between August 2018 and July 2020 with acute severe pain abdomen suggestive of acute pancreatitis. Urine sample were obtained and results were recorded. Blood sample of all the patients were sent for serum amylase, lipase. Urinary Trypsinogen (UT)-2 dipstick test, based on principle of immunochromatographic, was done at the time of admission and serum amylase and lipase were sent for all patients. Serum Lipase was done through Calorimetric Method and Serum Amylase was done through Coupled Enzymatic Assay Method. Ultrasonography (USG) and Contrast-Enhanced Computed tomography (CECT) abdomen were sent after 4-5 days of admission and final diagnosis was made on the basis of CECT report. Of 98 patients, 47 cases were final diagnosed to have acute pancreatitis. Sensitivity and specificity of Urinary Trypsinogen (UT)-2 was found to be 91.48% and 94.11% respectively and Positive Predictive Value (PPV) and Negative Predictive Value (NPV) was found to be 93.47% and 92.30% respectively. Sensitivity, specificity, PPV and NPV of Serum Amylase was found to be 76.5%, 74.5%, 74.5% and 74.5% respectively and similarly, sensitivity, specificity, PPV and NPV was found to be 80.85%, 72.5%, 73.1% and 80.4% respectively. Urinary Trypsinogen (UT)-2 Dipstick test has high sensitivity, specificity, PPV and NPV and therefore can be used reliably in emergency setting for diagnosis and thereby start a goal directed treatment and thus, reduce the mortality and morbidity of the disease.

EP-570 Rare case of pre-pyloric perforation of stomach secondary to foreign body ingestion

Abstract Background Gastrointestinal perforation remains a common cause of acute abdomen in clinical practice. However, pre-pyloric perforation secondary to ingested foreign body (FB) in the adult population is rare. Nearly 80–90% of ingested foreign bodies will pass through the GI system spontaneously with only 1% requiring surgery. We report a rare incidence of pre-pyloric perforation in a patient unaware of ingestion of any foreign body. Case presentation A 59 year old female with no medical history, presented to the ED department with severe epigastric pain, vomiting and fever. She had a peritonitic abdomen and corroborative inflammatory markers. An urgent computed tomography scan demonstrated a 7×5cm collection near the transverse colon and a linear streak of hyperdense material near the collection. Patient had no recollection of ingestion of FB. Diagnostic laparoscopy followed by laparotomy, revealed inflammation and necrotic adipose tissue between the transverse colon and stomach walling of a purulent cavity. A 2cm shard of glass was retrieved. Examination of the posterior wall of the stomach eventually located the site of perforation. Generous washout, debridement and suture repair with omental plug was performed. She made an uneventful recovery. Conclusion Sharp objects do not pass via the pylorus easily and can cause perforation in the proximal part of gastrointestinal tract. Any features of complication mandates exploration and examination of the posterior surface of the stomach is quintessential

Serum bilirubin as a diagnostic marker in acute appendicitis

Background- Acute Appendicitis is the most common cause of acute abdomen. The initial diagnosis of acute appendicitis is based on clinical history and physical examination. Objectives- To determine the relationship between hyperbilirubinemia and acute appendicitis and to evaluate the usefulness of Serum Bilirubin as a diagnostic marker for acute appendicitis. Methods-It was Prospective study. Patients admitted with clinical diagnosis of acute appendicitis under the Department of Surgery in Vinayaka Mission’s KirupanandaVariyar Medical College and Hospital, Salem from January 2020 to October 2021. Convenient Sampling (Non-Probability) was used. The sample size was 100. Chi- square or Fischer exact test was used as test of significance. SPSS (Version 16.0) was used. Results-The mean Age among the subjects was 25.04 years ranging from 8 to 70 years. Among the subjects, 59 (59%) were Males and 41 (41%) were Females. Among the subjects, 81 (81%) had Acute Appendicitis and 19 (19%) had Appendicular Perforation.the patients with Direct bilirubin &gt; 0.3 mg/dl, 15 (18.75%) had Appendicular Perforation and among the patients with Direct bilirubin &lt; 0.3 mg/dl, 4 (20%) had Appendicular Perforation. There is no difference in Appendicular Perforation among patients with Direct bilirubin &gt; 0.3 mg/dl and &lt;0.3 mg/dl (18.75% vs 20%).

Emergency Laparoscopic Appendectomy In Ghana: The 37 Military Hospital Method

Summary: Emergency laparoscopic appendectomy is evolving as the method of preference for the management of acute appendicitis. Appendicitis is one of the common causes of acute abdomen diagnosed in the emergency unit in Ghana and open appendectomyhas been the preferred method for most surgeons. Increasing patient preference for laparoscopy in Ghana will soon require an increase in the practice of emergency laparoscopic appendectomy in many centres. The number and sizes of ports as well as thesite of placement, together with the technique of appendectomy, determines the uniqueness of the method of laparoscopic appendectomy. A simplified easy to apply method of laparoscopic appendectomy is needed to encourage its use in emergency centres.Methods: The paper describes a 3-port method of laparoscopic appendectomy which combines the principles of open appendectomy and basic laparoscopy. Patient positioning and the operative removal of the appendix is similar to what as is done in open appendectomy. Pneumoperitoneum is achieved by open access through the umbilicus. Two additional ports are placed below the iliac crest for a good cosmetic effect. The amount of consumable used usage is comparable to that of open appendectomy. Discusion: The question of a gold standard procedure for laparoscopic appendix still persists. The key criteria in the choice of any method should be the success rate, affordability, resource availability and suitability. The method described meets the above criteria in a low resource environment. It offers opportunity for the practice of laparoscopic appendectomy in institutions that practice open appendectomy. The sites of port placement makes the method especially suitable for population that are keloid prone. The use of the same principle for mesappendix and appendix excision as in open appendectomy helps improve the learning curve. Modifying the 10mm port into a retrieval bag at the end of the procedure presents gives the same effect as a conventional retrieval bag without an additional risk of infection.Conclusion: The method has an inherent easy learning curve and is expected to help scale up the conversion from open to laparoscopic appendectomy.

Surgical Management of Acute Abdomen in Adult Patients: Experience from a Private Hospital in Addis Ababa, Ethiopia.

Acute abdomen is a major surgical problem in Ethiopia with surgery for acute abdominal conditions accounting for roughly one-third of total emergency operations in many centers. This study was conducted with the aim of studying the pattern and outcome of surgically managed acute abdominal cases in a private general hospital in Addis Ababa, Ethiopia. This was a retrospective cross-sectional study of acute abdominal cases in adult patients operated at Teklehaimanot General Hospital between January 1, 2018 and August 1, 2019. A total of 267 patients' medical records were reviewed. The male to female ratio was 1.5:1 and majority of patients were between the age range of 20 to 40 years with mean age of 36±16 years. The average duration of symptoms before arrival was 71.1±84.4 hours (range 3 to 504 hours) and only 85 (31.8%) of patients reached to the Hospital within 24 hours or less of onset of symptoms. Acute appendicitis was the most common cause of acute abdomen; observed in 193 (72.3%) of the cases. Overall post-operative complication rate was 14.8% and post-operative mortality rate was 1.9%. It was found that delayed presentation (OR 2.01, 95% CI 1.64-7.84), old age (OR 1.51, 95% CI 1.89-3.59), and tachycardia at presentation (OR 2.85, 95% CI 1.03-6.82) were major predictors of morbidity and mortality in operated patients. In this study acute appendicitis accounted for the majority of cases operated for acute abdomen. Length of post-operative hospital stay, early post-operative complication rate, and overall mortality rate were found to be significantly lower in our series than other reports.

A Comparative Analysis of Pre Operative and Operative Findings in Non Traumatic Acute Abdomen: A Prospective Observational Study

Acute abdomen remains the important cause of morbidity and mortality in emergency. It requires careful history taking and thorough evaluation of symptoms, clinical examination and judicious use of radiological investigation which simplify the evaluation of disease. Aim and Objectives: To assess the accuracy of radiological diagnosis in comparison to postoperative diagnosis in non-traumatic cases of acute abdomen. Materials and Method: A prospective observational study of non-traumatic acute abdomen was carried out at Sahyadri Narayana Multispeciality Hospital, Shimoga, Karnataka. Total of 78 cases of acute abdomen patients were evaluated and operated over a period from December 2018 to February 2020 and included in the study group. Pediatric age group (12 years and below), traumatic cases (blunt and penetrating), acute abdomen in pregnancy and gynecological causes of acute abdomen, urological cases, and conservatively managed cases were excluded from the study. Detailed history was taken and relevant physical examination performed. All patients underwent hematological and biochemical investigations, appropriate radiological investigation (USG, AXR and CT-scan) were performed based on clinical suspicion. Clinical and radiological diagnosis based on clinical examinations and radiological investigations was compared with post-operative diagnosis based on operative findings. Result: The most common age group was 20-60 years with male preponderance. Pain in abdomen was commonest symptom followed by vomiting, anorexia and fever. Tenderness was commonest clinical sign observed followed by rebound tenderness, tachycardia and guarding/rigidity. Acute appendicitis was the most common cause of acute abdomen followed by perforation peritonitis and intestinal obstruction. The overall diagnostic accuracy of clinical examination in acute abdomen was 81.8% and if radiological imaging techniques combined with this, the accuracy raised up to 94%. Conclusion: The study strongly suggested that with thorough history taking and proper clinical examination, clinical diagnosis was successfully achieved in 82% of patients. Radiological investigations help in confirming clinical suspicions and giving added information of underlying pathology with accuracy of 94%. Keywords: Abdomen Injury; Radiological Investigations; Trauma; Diagnostic Test; Perforation.

Antibiotic treatment for appendicitis in Norway and Sweden: a nationwide survey on treatment practices

BackgroundAppendicitis is one of the most common causes of acute abdomen. Uncomplicated appendicitis is as an inflamed appendix without perforation, gangrene or abscess formation. Recent trials show that one can safely treat uncomplicated appendicitis with antibiotics, given patient approval and appropriate follow-up. A recent study has also indicated no difference between antibiotic treatment and placebo. Our aim was to investigate if Norwegian and Swedish surgical departments treat uncomplicated appendicitis with antibiotics and to explore their opinions on this treatment practice.MethodsA questionnaire was distributed to all heads of department in hospitals that treat appendicitis in Norway and Sweden. Answers were collected using a REDCap survey. Answers were compared between centers and nations and the results were presented anonymously.ResultsWe sent the questionnaire to 94 eligible recipients and received 61 (65%) answers. In total, 8/61 (13%) departments stated that they have established antibiotic treatment as sole treatment for uncomplicated appendicitis. Almost half of the responders stated that they have used antibiotics sporadically to treat uncomplicated appendicitis. Lack of evidence and guidelines were noted as reasons why antibiotic treatment has not been implemented as sole treatment.ConclusionsMost Norwegian and Swedish departments have not implemented antibiotic treatment as the sole treatment for uncomplicated appendicitis. Despite several recent large trials on this subject, lack of evidence and guidelines was the most frequently reported reason in our survey.

The Role of Neutrophil Lymphocyte Ratio in Predicting Acute Appendicitis in Adult

Introduction: Acute appendicitis is one of the most common causes of acute abdomen with lifetime occurrence of approximately 7% and with perforation of 17-20%. There are various scoring systems and investigations which are used to ruling in the conditions but none of these are 100% accurate. The aim of this study was to observe relationship between neutrophil lymphocyte ratio (NLR) and simple and complicated acute appendicitis. Methods: This is a prospective observational study conducted for a period of 12 months. Clinical, laboratory and USG parameters were used to diagnose acute. HPE findings were taken as final diagnosis and the objective of the study compared. Results: Total of 100 patients were evaluated in this study. The mean age of the patients with acute appendicitis in this study was 30 years .The mean Alvarado score in this study was 7 and the mean NLR was 6.6. In this study, 24% of case who had TLC of more than 10000 per cubic millimeter had complicated appendicitis (p=0.685). 16% of total cases had complicated acute appendicitis with neutrophil percentage between 81%-90%, 20% with NLR &gt;8 had complicated acute appendicitis and 20% with NLR &gt;8 had HPE proven complicated acute appendicitis (p=0.001) Conclusion: Both neutrophil percentage and NLR were statistically significant in differentiating complicated acute appendicitis from simple acute appendicitis than total leucocyte count alone as shown by study.

Comparison of scoring systems regarding the gender as a parameter with the traditional scoring systems for predicting appendicitis.

Although acute appendicitis remains the most common cause of acute abdomen in General Surgery practice, negative appendectomy rates are still high in particularly female patients. Appendicitis scoring systems considering gender can help the clinician to reduce negative appendectomy rates in females. This present study aims to compare the Lintula, Ripasa, Fenyo-Lindberg scoring systems, which use gender as a variable, with the Alvarado, Karaman, scoring systems to evaluate which CSS is more successful in the differential diagnosis of appendicitis in females. We analyzed the records of the patients operated on with a prediagnosis of acute appendicitis in our clinic between 2020 and 2021, retrospectively. Alvarado, adult appendicitis score (AAS), appendicitis inflammatory response score (AIRS), Ripasa, Karaman, Lintula, and Fenyo Lindberg scores were calculated for each patient. The patients were divided into two groups as male and female, according to gender. Receiver operator characteristic (ROC) curve analysis was used to identify the best cut-off value and assess the performance of the test score for appendicitis. Three hundred and sixty-three patients were included in the study. One hundred seventy-two (47.4%) of the patients were male, and 191 (52.6%) were female. Alvarado and AAS were the most valuable score in female (AUC: 0.805, sensitivity: 0.63, specificity: 0.83; and area under curve (AUC): 0.794, Sensitivity 0.71, Specificity: 0.76, respectively), male group (AUC: 0.828, Sensitivity: 0.71, Specificity: 0.83; and AUC: 0.834, Sensitivity 0.74, Specificity: 0.77, respectively), and when patients were not categorized by gender (AUC: 0.818, Sensitivity: 0.67 Specificity: 0.83; and AUC: 0.794, Sensitivity 0.71, Specificity: 0.76, respectively). Although the Alvarado scoring system is the first defined appendicitis scoring system, it seems as superior to the many scoring systems defined after it in predicting appendicitis, even in female patients.