Common Cause Of Acute Abdomen Research Articles

Vascular complications during appendectomy: severe adhesion of the appendix to the right iliac artery: a case report

IntroductionAppendicitis is a common cause of acute abdomen. Rarely, it may form adhesions to nearby structures, complicating surgeries, especially when involving vascular structures such as the internal iliac artery, potentially causing severe intraoperative hemorrhage.Case presentationA 65-year-old Middle Eastern male presented with abdominal pain and anorexia for 5 days. Examination and imaging confirmed acute appendicitis with complications. Additionally, a large pelvic mass was noted. During surgery, severe bleeding was encountered due to an adhesion between the appendix and the right internal iliac artery, managed by ligating the artery. The patient recovered well and was discharged in stable condition. Histopathology confirmed the diagnosis.ConclusionThis case highlights a rare vascular complication of appendectomy due to abnormal adhesions between the appendix and the internal iliac artery, associated with a large pelvic mass. This study emphasizes the need for thorough preoperative evaluation and careful surgical planning in patients with unusual anatomical variations or specific underlying conditions such as neurofibromatosis. Early recognition and strategic management of vascular adhesions are essential to optimize patient outcomes in appendectomies complicated by such rare scenarios.

Spectrum of exploratory laparotomy for acute abdomen in a central Gujarat tertiary care centre

Background: Exploratory laparotomy is one of commonest emergency surgeries performed in the world. Despite technological advance imaging, the fundamental technique of exploratory laparotomy has remained unchanged over years. Studies quantifying the spectrum of laparotomy in central Gujarat are lacking. Methods: A retrospective study of 249 patients of emergency exploratory laparotomy for acute abdomen in SSG Hospital Baroda from May 2022 to May 2024 was done and data involving clinical presentation, imaging, operative findings and post- operative course were studied and analysed. The cases were divided into gastro-intestinal perforation, gastro-intestinal obstruction and miscellaneous cause. Results: The most common cause of exploratory laparotomy in study was perforation peritonitis including 59 ileal, 16 jejunal, 49 pre-pyloric, 29 duodenal, 1 body of stomach, 17 appendicular and 8 colon. With post op major complications like burst-11%, leak-5%, pneumonia-5%, multi-organ failure-6.5% and ileus 5%, wound infection 18%. The overall mortality was 15%. Out of 58 cases of laparotomy for obstruction including adhesions (29.3%), obstructed inguinal hernia (12%), tuberculosis (32%), malignancy (13.8%), internal hernia (12.6%). The miscellaneous causes were ruptured liver abscess (9), rupture ectopic pregnancy (2), twisted ovarian tumour (1). Conclusions: Acute abdomen remains a significant surgical problem. Peptic perforation remains a common cause of acute abdomen with high morbidity and mortality, despite improves medical management, though there is a declining trend in incidence, tuberculosis remains an important cause.

A comparative study of Appendicitis inflammatory response (AIR) score with Alvarado score in diagnosis of acute appendicitis at KCMC Hospital

Background: Acute appendicitis is an acute inflammation of the appendix, most resulted from obstruction of the lumen of the appendix. It is one of the most common causes of acute abdomen. Although a very common and long-known phenomenon, appendicitis remains a diagnostic challenge for most surgeons. Objective: To compare the validity of Appendicitis Inflammatory Response Score with Alvarado score in diagnosis of acute appendicitis at KCMC Hospital. Methods: A prospective hospital based cross sectional study done over a period of six months (September 2016 to March 2017). Patients were admitted to general surgical ward after the diagnosis of acute appendicitis reached and all parameters included in the AIR score and Alvarado score were prospectively recorded on patients presenting symptoms of acute appendicitis. All removed appendix specimens were sent for histopathological examination. Data was entered and analyzed using statistical package of social sciences version 20. Results: A total of 35 patients enrolled in this study, 57% male, male to female ratio 1.3:1, mean age of 27(14-49) years. 31 patients confirmed histologicaly to have features of acute appendicitis, among these inflamed appendicitis were 51.6%. And advanced appendicitis 48.4% and negative appendicectomy rate was 11.4%. The sensitivity and specificity of both AIR and Alvarado score were 54.4%, 77.4% and 75%, 75%. PPV and NPV were 94.4%, 96% and 17.6%, 30% respectively. Conclusion: From our study we have seen Alvarado score is a better assessment tool that is accurate helping in diagnosis of acute appendicitis. Its high sensitivity and ROC is greater than that of the AIR score. We conclude that AS has outperform AIR score in accuracy in diagnosis of AA.

A Case of Acute Appendicitis Complicated by Necrotizing Fasciitis Requiring Abdominal Wall Reconstruction

Acute appendicitis represents one of the most common causes of acute abdomen that may warrant emergency surgery. Necrotizing fasciitis complicated by acute appendicitis is considered a rare complication with life-threatening implications. A 65-year-old man presented with abdominal pain, where a scan, revealed a perforated appendicitis complicated by an anterior abdominal wall collection. He underwent percutaneous drainage, but subsequently developed extensive necrotizing fasciitis requiring extensive debridement and reconstruction. The rapid progression of necrotizing fasciitis calls for early recognition and prompt intervention. The key management principles employed were broad spectrum antibiotics and aggressive surgical debridement. This case demonstrated the use of vacuum-assisted closure dressing and multidisciplinary care in wound healing and coverage. To ensure early diagnosis and intervention for acute appendicitis complicated by necrotizing fasciitis, a high degree of clinical suspicion and awareness of this complication is required.

Evaluation of the clinical effects of atropine in combination with remifentanil in children undergoing surgery for acute appendicitis.

Acute appendicitis (AA) is the most common cause of acute abdomen in children. Anesthesia significantly influences the surgical treatment of AA in children, making the scientific and effective selection of anesthetics crucial. To assess the clinical effect of atropine (ATR) in combination with remifentanil (REMI) in children undergoing surgery for AA. In total, 108 cases of pediatric AA treated between May 2020 and May 2023 were selected, 58 of which received ATR + REMI [research group (RG)] and 50 who received REMI [control group (CG)]. Comparative analyses were conducted on the time to loss of eyelash reflex, pain resolution time, recovery time from anesthesia, incidence of adverse events (AEs; respiratory depression, hypoxemia, bradycardia, nausea and vomiting, and hypotension), intraoperative responses (head shaking, limb activity, orientation recovery, safe departure time from the operating room), hemodynamic parameters [oxygen saturation (SPO2), mean arterial pressure, heart rate, and respiratory rate], postoperative sedation score (Ramsay score), and pain level [the Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Scale]. Compared with the CG, the RG showed significantly shorter time to loss of eyelash reflex, pain resolution, recovery from anesthesia, and safe departure from the operating room. Furthermore, the incidence rates of overall AEs (head shaking, limb activity, etc.) were lower, and influences on intraoperative hemodynamic parameters and stress response indexes were fewer. The Ramsay score at 30 min after extubation and the FLACC score at 60 min after extubation were significantly lower in the RG than in the CG. ATR + REMI is superior to REMI alone in children undergoing AA surgery, with a lower incidence of AEs, fewer influences on hemodynamics and stress responses, and better post-anesthesia recovery.

Observation on the Effect of Rapid Rehabilitation Nursing with Integrated Medical Care in Perioperative Period of Laparoscopic Appendicitis in Children.

Acute appendicitis is one of the most common causes of acute abdomen in pediatric surgery. The purpose of this study was to observe the effects of integrated rapid rehabilitation nursing in children with laparoscopic appendectomy (LA) during the perioperative period. A total of 200 children with appendicitis who underwent LA in our hospital from January 2022 to January 2023 were retrospectively selected as the study subjects. According to the nursing mode, they were divided into a control group (n = 100) and an observation group (n = 100). The control group was treated with routine nursing intervention, and the observation group was treated with an integrated rapid rehabilitation nursing intervention. Perioperative indices (operation time, first postoperative exhaust time, length of hospital stay) were recorded and compared between the two groups. The visual analog scale (VAS) was used to score the two groups at 6 h, 12 h, 24 h, and 48 h after surgery, and the pain degree of the children was quantitatively evaluated. The levels of serum stress response indices (cortisol (Cor), norepinephrine (NE), and adrenocorticotropic hormone (ACTH)) in the two groups were measured. The incidence of postoperative complications, improvement of postoperative quality of life, and nursing satisfaction were compared between the two groups. The operation time, first postoperative exhaust time, and hospitalization time in the observation group were significantly shorter than those in the control group (p < 0.05), and the VAS scores of the patients in the observation group were lower than those in the control group at each time point of 6 h, 12 h, 24 h, and 48 h after surgery (p < 0.05). One hour after surgery, the serum Cor, NE, and ACTH levels of the two groups of patients were significantly higher than those before surgery, and the levels for the observation group were significantly lower than those of the control group (p < 0.05). After treatment, the quality of life scores of patients in both groups was significantly higher than before treatment, and the quality of life scores of patients in the observation group was significantly higher than that of the control group (p < 0.05). The postoperative complication rate of the observation group was 3.00% (3/100), which was significantly lower than that of the control group (13.00% (13/100)) (χ2 = 6.793, p = 0.009). The nursing satisfaction of the observation group was 95.00% (95/100), which was significantly higher than that of the control group (79.00% (79/100)) (χ2 = 11.317, p = 0.001). The integrated rapid rehabilitation nursing management mode is an intervention that can effectively alleviate the effects of LA on stress reactions and pain in children with appendicitis. It can effectively reduce the incidence of postoperative complications and improve the patient's nursing satisfaction, allowing children with appendicitis to recover as soon as possible after surgery, and can improve patients' quality of life. It helps to improve the overall clinical efficacy, and the treatment process is simple to operate, relatively safe and reliable, has high use value, and is worthy of further promotion in clinical treatment.

Risk-Benefit Comparison Between Endoloop and Endostapler Devices for the Closure of Appendiceal Stumps in Laparoscopic Appendectomy.

Introduction Acute appendicitis is a common cause of acute abdomen and the most frequent surgical emergency in the world. Since the nineteenth century, surgical resolution has been the most accepted treatment worldwide, and laparoscopic appendectomy is currently preferred as the treatment of choice because it has several benefits. The closure of the appendiceal stump is the most crucial step during appendectomy since its inadequate management can cause post-surgical complications. Throughout recent years, several methods have been proposed to perform this closure. This study was performed to compare the post-surgical outcomes of the use of endoloop and endostapler devices. Methods This is a retrospective study of 290 patients aged 18 to 83 who underwent laparoscopic appendectomy between 2016 and 2020. Demographic data, clinical history, tomographic findings, and laboratory data were collected, as well as appendicular base management technique, severity degree of appendicitis at hospital admission, postoperative complications at 30 days, hospital readmission, and in-hospital stay. Statistical tests and binary logistic regression analyses were used to identify risk factors, with a significance level of p<0.05. Results Demographic data and clinical history did not show statistically significant differences. The presence of a pre-surgical abscess with tomography was 1.58 times higher in the endostapler group. Post-surgical results showed that the use of endostapler devices represented a 2.7 times higher risk of post-surgical abscess. The endostapler group was also found to have 1.87 times the risk of post-surgical sepsis. Conclusion Our study shows that the use of an endoloop reduces the risk of postoperative abscess by 16.5% and protects against the development of post-surgical sepsis by 30%.

Small Bowel Perforation Due to an Unusual Foreign Body

Gastrointestinal perforation is one of the most common causes of acute abdomen presenting to the casualty. However, gastrointestinal perforation due to ingestion of foreign body is rare and is usually encountered in children, psychiatric patients and in alcoholics. Most of the foreign bodies pass through the GI tract without any complications. Only about 1% are known to cause complications such as perforation. Fish or chicken bones, dentures, toy parts, coins, toothpicks are the most commonly encountered foreign bodies. In this report, we present a case of a 60-year-old male who presented to the emergency department with acute abdomen secondary to ingestion of an unusual foreign body that lead to perforation and underwent exploratory laparotomy for removal of the foreign body.&#x0D; Gastrointestinal perforation is one of the most common causes of acute abdomen presenting to the casualty that needs a timely surgical intervention.[1] Important sites of gastrointestinal perforation are stomach, duodenum, small bowel (jejunum, small intestine), appendix, colon and rectum.&#x0D; The most common causes of gastrointestinal perforation include peptic ulcer disease, diverticulitis, carcinomas, IBD, ischemia of bowel wall and infrequently foreign bodies.[2]&#x0D; Foreign body ingestion as seen in children is unintentional and can be deliberate in psychiatric patients.[3] In general, many of these foreign bodies travel through the gastrointestinal tract without causing complications. Only about 1% cases of ingested foreign bodies cause complications such as hollow viscus obstruction and/ or perforation which are usually life threatening and have poorer outcomes if diagnosis is delayed.[4,5] CT is the imaging tool of choice. Such conditions require immediate surgical intervention such as exploratory laparotomy or laparoscopic or endoscopic removal can be attempted in case of stomach or duodenal foreign bodies.&#x0D; Here in the following case report, we present an atypical case who arrived at the emergency room with acute abdomen following a foreign body consumption and underwent exploratory laparotomy for retrieval of foreign body.

Etiology of Intestinal Obstruction - Correlation between Pre-operative and Per-operative Findings with Histopathology

Background: Intestinal obstruction is one of the most common causes of acute abdomen and often requires surgical intervention. However, pre-operative and per-operative diagnosis often do not correlate with postoperative histopathology done in suspected cases. Therefore, the study was designed to identify the etiology of intestinal obstruction correlating to pre-operative and per-operative findings with postoperative histopathological findings in suspected cases. Methods: A cross sectional study was conducted at the department of General Surgery, Mymensingh Medical College &amp; Hospital, Mymensingh for 18 months following ethical approval from Institutional Review Board (IRB) of Mymensingh Medical College. During the study period, all patients with suspected intestinal obstruction admitted in Department of Surgery were included based on selection criteria. Total 103 patients were assessed in pre-operative and per-operatively. Histopathological examination was done in suspected cases where diagnosis could not be confirmed without histopathology. Data collection was done with a data collection form. After collection of all the required data, final analysis was carried out by using the SPSS version 21.0. Results: Among 103 cases of intestinal obstruction, mean age was 45.50±14.37 SD (years) with male female ratio-1.78:1. About 66% came from rural areas and 34% were from urban areas. Abdominal pain was the commonest symptom present among the cases which was observed in 91.3% cases. Others common symptoms were vomiting, abdominal distension absolute and relative constipation in 72.8%, 69.9%, 12.6% and 63.1% cases respectively, while abdominal tenderness was the commonest sign present in all cases. Among study population, 68.9% was small bowel obstruction and 31.1% was obstruction in large bowel. According to per-operative findings 22.3% cases were suspected as malignant. Finally 24.3% cases were proved as malignant in subsequent histopathological examination and 75.7% cases

Laparoscopic value in the management of acute abdomen during pregnancy

Background Acute abdominal pain during pregnancy represents a challenging pathology in diagnosis and treatment. This study aimed to evaluate the value of laparoscopy in managing pregnant patients presented with acute abdomen. Materials and methods From June 2022 to June 2023, 45 pregnant females presented with acute abdominal pain were prospectively analyzed. These patients were treated laparoscopically, aiming for diagnostic and treatment purposes. Intra- and Postoperative evaluations for the laparoscopic value were assessed for all possible complications early, during the hospital stay and until the first postoperative 30 days. Results Inflammation 82.2%, including acute appendicitis 89.7%, and cholecystitis 10.3%, were found to be the most common causes of acute abdomen. No intraoperative or postoperative morbidity, including infection, sepsis, or wound dehiscence, was reported until the first 30 days. Similarly, no postoperative mortality was detected. Moreover, no cases had abortions during their conception time. Conclusion Laparoscopic value exceeds the treatment advantages but has a significant role in diagnosing the etiologies of acute abdomen during pregnancy. Laparoscopy could successfully treat different pathologies during pregnancy. No restriction for the time of conception regarding the use of laparoscopy was reported. Further comparative studies regarding laparoscopic use during pregnancy should be conducted.

Perforated Subhepatic Appendix Presenting as a Gas under Diaphragm: Clinical Diagnostic Challenges for Surgical Residents: A Case Report

This study addresses the rarity of the subhepatic location of the appendix, found in only 0.08% of cases, and the infrequent occurrence of perforated appendicitis presenting with gas under the diaphragm. When these two uncommon conditions coincide in the context of one of the common causes of acute abdomen, namely acute appendicitis, it poses a diagnostic challenge for surgical residents in training. The case presented involves a patient with generalized abdominal pain, soft abdomen, and tenderness over all quadrants, particularly the right upper quadrant. Her chest x-ray findings indicated free gas under the right hemi-dome of the diaphragm and an inconclusive ultrasound for acute appendicitis, computed tomography confirmed the subhepatic appendix and pneumoperitoneum. Operative intervention revealed a perforated subhepatic appendix, and the patient recovered well, being discharged on the 4th postoperative day. The clinical discussion emphasizes the ability of surgical residents to safely perform appendectomies but highlights the crucial role of experienced surgeons in managing cases with atypical presentations. The conclusion underscores the diagnostic challenges posed by atypical presentations of acute appendicitis in a clinical setting.

Prevalence of Neuroendocrine Tumours (NET) in Patients Undergoing Appendicectomy for Acute Appendicitis: A Tertiary Care Study.

Introduction Acute appendicitis is one of the common causes of acute abdomen in adults, which is managed widely with appendicectomy. Neuroendocrine tumours are the most common appendiceal tumours diagnosed incidentally on appendicectomy specimens. Methods Demographic data, presenting complaints, indications for appendicectomy, and the histology findings based on histopathological reports of the patients who have undergone appendicectomy for appendicitis at surgical units of Teaching Hospital, Jaffna, from 1st of January 2019 to 31st of December 2022 were retrospectively analyzed. Results Of the 1341 histopathology reports, 0.2% (n=3) were neuroendocrine tumours (NET). The mean age of the patients with NET was 48.6, and 66.6% of them were females. All three NETs identified in appendicectomy specimens were well differentiated and smaller than 2 cm. All three had negative resection margins and were managed only with appendicectomy. Conclusion NETs of the appendix are the commonest appendiceal neoplasms. The majority of them are diagnosed incidentally in appendicectomy specimens. Surgical management of the tumours is either by appendicectomy or hemicolectomy, which depends mainly on tumor size. Surgical decisions should be tailor-made to the patients based on multi-disciplinary team decisions.

The relationship between abnormal urinalysis findings and appendicitis location.

Acute appendicitis is a common cause of acute abdomen in general surgery and early diagnosis is crucial for prognosis. Abnormal urinalysis results have been associated with appendicitis in some studies, with reports of microscopic hematuria or pyuria in laboratory tests. The aim of this article is to evaluate the relationship between laboratory findings of hematuria, pyuria, and the location of acute appendicitis. This retrospective study included 577 patients who underwent appendectomy for suspected acute appendicitis between January 1, 2018, and December 31, 2022, at the general surgery clinic of Samsun Training and Research Hospital. Among the 577 patients, 247 were female and 330 were male, with a median age of 34years. A statistically significant difference was observed between appendicitis location and erythrocyte values (p = 0.009), specifically in paraileal and retrocecal locations. There was a statistically significant difference between appendicitis location and leukocyte values (p < 0.001), with significant differences found in paraileal, promontoric, and retrocecal locations. A statistically significant difference was observed between appendicitis location and leukocyte esterase values (p = 0.002), specifically in paraileal and retrocecal locations. Abnormal urinalysis findings are not uncommon in patients with acute appendicitis. Our study demonstrated a significant correlation between tit erythrocyte, tit leukocyte, and tit leukocyte esterase positivity with appendicitis locations. Therefore, we believe that pathological findings in urine tests of patients undergoing surgery with a preliminary diagnosis of appendicitis can provide valuable information to surgeons regarding the location of the appendix, ultimately aiding in optimizing the timing and cost of the operation.

Epiploic appendagitis: an uncommon and nonsurgical cause of abdominal pain

Epiploic appendagitis (AE) is arare cause of acute abdomen and is often misdiagnosed as other common causes of acute abdomen, such as acute appendicitis, cholecystitis or diverticulitis due to its low incidence and its nonspecific clinical picture. This study presents the clinical course of AE and typical radiological features for an early and correct diagnosis in order to emphasize the importance of an early and correct diagnosis of AE. This is aretrospective review of 43patients diagnosed with AE between June 2010 and September 2022 at the Charité- University Hospital Berlin, Campus Benjamin Franklin. The medical records were reviewed regarding clinical und radiological features, anatomical location of the AE und treatment methods. Atotal of 43patients (29male, 11female) were diagnosed with AE and almost all patients presented with abdominal pain, except in 8cases (18.6%). Specific findings in computer tomography (CT) with atypical picture of AE were found in 33patients (76.7%). AE was mostly localized in the left colon: 12 were found in the sigmoid colon (27.9%), 16 in the descending colon (37.2%) and 5 at the junction of the descending colon and the sigmoid colon (11.6%). Of the patients 28 (65.1%) were admitted for conservative treatment and the rest of the patients were treated as outpatients. No patient underwent surgery, all were treated with analgesics (NSAID) and 17patients received antibiotics in addition. AE is aself-limiting disease and acommon mimic of other serious causes of abdominal pain. Due to the emergence of the widespread use of imaging modalities, an early diagnosis of AE and a conservative approach as first choice of treatment in patients with AE could be established.

Acute Appendicitis in Children: Evaluation of the Diagnostic Efficacy of Ultrasonography and Computed Tomography.

Acute appendicitis (AA), the most common cause of acute abdomen in childhood, can result in significant morbidity and mortality if not diagnosed and treated in a timely manner. Diagnosis of AA is more difficult in children due to the limited communication skills, in comparison to adults. The aim of this study is to evaluate the diagnostic accuracy of abdominal ultrasonography (US) and computed tomography (CT) in the diagnosis of AA in children. Pediatric patients who were operated on with the diagnosis of AA between January 2016 and December 2021 were retrospectively reviewed. Preoperative abdominal US and CT findings of the patients and postoperative pathology results were recorded. A total of 263 patients with a mean age of 11.3 years were included in the study. There were 164 (62.3%) males and 99 (37.7%) females. Histopathology revealed AA in 215 (81.7%) patients. Preoperatively, US and CT were performed in 139 (52.8%) and 137 (54.5%), respectively. Both imaging methods were applied to 13 (5.1%) patients. US had a sensitivity and specificity rate of 77.2% and 52.6%, respectively. Positive predictive value (PPV) was found to be 81.2%, whereas negative predictive value (NPV) was 46.5% for US. The diagnostic accuracy rate of US was found as 70.5%. CT had a sensitivity and specificity rate of 88.1% and 57.1%, respectively.PPV was found to be 88.8%, whereas NPV was 55.1% for CT. The diagnostic accuracy rate of CT was found as 81.8%. In case of suspicion of AA, US may be the first choice because it is inexpensiveand easily accessible. However, considering patient incompatibility and subjective factors in children, US may sometimes be insufficient. We think that CT should be performed as an advanced examination method in cases where US is not compatible with the patient's condition, not clinic.

Acute surgical abdomen during the COVID-19 pandemic: a retrospective study on clinical and therapeutic challenges

Background As with other medical specialties throughout the epidemic, general surgical clinics’ treatment protocols have changed because of the COVID-19 pandemic, which has become a serious danger to healthcare systems. The presence of severe COVID-19 in young individuals and among medical workers has exacerbated the psychological burden on clinicians treating patients suspected of having or being infected with SARS-CoV-2, even if comorbidities and older age are statistically linked to higher death rates. Patients and methods A retrospective comparative study included patients who were admitted to the emergency room (ER), surgical, or managing conservatory for acute surgical abdomen. All subjects were divided into three groups. 1186 patients; out of them, 490 cases were examined before the pandemic, 334 cases were examined during the pandemic, and 362 cases were examined after vaccination. Results Before the pandemic, the commonest cause of acute abdomen was appendicitis (21.8%), strangulated hernia (21%), and cholecystectomy (17.8%). During the pandemic, the commonest cause of acute abdomen was appendicitis (21.8%), cholecystectomy (16.8%), and Mesenteric venous occlusion (MVO)/Mesenteric Artial occlusion (MAO) (13.8%). After the pandemic, the commonest causes of acute abdomen were cholecystectomy (25.4%), appendicitis (24.6%), and exploration abdomen (11.9%). The time of management differed significantly among the studied groups. The highest requirement for immediate intervention was attributed to the before pandemic group, while during the pandemic group was associated with conservative management, and after conservative management. Conclusion The Sars-Cov-2 pandemic highly affected the clinical presentation, aetiology, diagnostic and paraclinical investigations, and therapeutic management, as well as the changes in emergency practice procedures.

Akut apandisit tanısında doğruluk: Fizik muayene ile görüntüleme yöntemlerinin karşılaştırılması

Abstract&#x0D; Background&#x0D; Acute appendicitis is one of the most common causes of acute abdomen. In case of delay in the diagnosis process, perforation develops, and the patient's morbidity and mortality increase. In our study, we evaluated the effectiveness of laboratory, radiological, and physical examination findings in diagnosing acute appendicitis.&#x0D; Methods&#x0D; A total of 488 patients hospitalized with a prediagnosis of acute appendicitis were included in the study. 162 patients constituted the unoperated and 326 patients constituted the operated group (Groups 1 and 2). The two groups were compared in terms of age, gender, and ultrasonographic findings, as well as Alvarado score parameters. &#x0D; Results&#x0D; In logistic regression analysis, which included only Alvarado parameters, anorexia was the most valuable parameter in predicting surgery (p=0.000). The Alvarado score was found to be the most useful parameter in making the surgery decision (p

Post-myomectomy omental infarction: a case report

BackgroundOmental Infarction (OI) is uncommon and mimics common causes of acute abdomen. It is important to differentiate it from other abdominal conditions that require emergency management. It was first reported in literature in 1896 and about 400 cases have been reported till date.Case presentationWe reported on a 41 year-old Para 0+0 Ibo house wife who presented with 10 years history of supra-pubic mass and five months history of excessive menstrual flow. After physical examination, a diagnosis of symptomatic uterine fibroid was made. She had myomectomy and the raw surface created after the excision of the myomas was covered with omentum. Wound infection developed on the 8th post-operative day leading to a wound breakdown and later partial extrusion of infarcted omental tissue through the dehisced wound. During re-exploration, the infarcted omental tissue was extracted and the residual abdominal abscess was drained. Surgical site wound infection occurred on the 3rd day after re-operation and a sub-acute intestinal obstruction developed on the 4th day thereafter which responded to conservative management.ConclusionCareful surgical technique is imperative when utilizing the omentum for reconstructive abdominal surgery. Torsion of the omentum and creation of excess tension while using the omentum for reconstructive procedures should be avoided and increase awareness of this uncommon disease condition by the surgeon is also important. This case is to report a rare finding of omental infarction following myomectomy.

Is There an Increased Risk of Intra-Abdominal Abscesses After Laparoscopic Appendectomy? Laparoscopic Versus Open Appendectomy: A Single-Institution Experience

Background: Acute appendicitis is the most common cause of acute abdomen. Currently, larger numbers of appendectomies are being performed laparoscopically. The aim of this study was to compare laparoscopic appendectomies to open surgery in terms of intra- and post-operative complications, including the risk of intra-abdominal abscess formation, operative time, time of initiating oral diet, and the length of hospital stay in our institution.&#x0D; Methods: The study group of 283 patients having undergone appendectomies between January 2013 and Jan 2016 was divided into two subgroups as ‘open’ and ‘laparoscopic’. The data regarding the surgical outcomes of these groups were evaluated retrospectively and statistically analyzed.&#x0D; Results: In terms of postoperative complications, intra-abdominal abscesses were found to be higher in the laparoscopic group (p=.045). On the other hand, surgical site infection (SSI) rates were found to be higher in the open group (but did not reach statistical significance). Operative time was affected by the surgeon’s expertise and was found to be shorter in the laparoscopic group (p&lt;0.05). The time of initiating oral diet was sooner in the laparoscopic group compared to the open group (p=0.043), and the overall length of hospital stay was shorter in the laparoscopic group (p=0.0001).&#x0D; Conclusions: Laparoscopic appendectomy is associated with early return to a normal diet, fewer wound complications, and a shorter hospital stay, but also with a slightly higher rate of intra-abdominal abscesses. Notably, it is now the standard method of acute appendicitis management in some centers.

Study of outcomes of perforated appendicitis in adults: a prospective cohort study.

The aim was to study the intraoperative features and postoperative outcomes of appendicular perforation in adults. First, to study the incidence, clinical presentation, and complications of perforated appendicitis in a tertiary care hospital. Second, to study morbidity and mortality in an operated case of perforated appendicitis. This prospective observational study was conducted at a tertiary care centre in a government setup from August 2017 to July 2019. Data were collected from patients (N=126) who had an intraoperative finding of perforated appendicitis. The inclusion criteria are as follows: patients over the age of 12 with a perforated appendix, as well as any patients with intraoperative findings like perforated appendicitis, gangrenous perforated appendicitis, or a disintegrated appendix. The exclusion criteria are as follows: all patients with appendicitis below 12 years of age with perforated appendicitis; all patients with appendicitis with intraoperative findings of acute nonperforated appendicitis; and all patients with intraoperative findings of an appendicular lump or mass. Perforation was found in 13.8% of the cases of acute appendicitis in this study. With a mean age of 32.5 years, the most common age of presentation in perforated appendicitis was 21-30 years. The most prevalent presenting symptom in all patients (100%) was abdominal pain, followed by vomiting (64.3%) and fever (38.9%). Patients with perforated appendicitis had a 72.2% complication rate. Peritoneal pollution of more than 150ml was linked to a 100% increase in morbidity and mortality (54.5%). The mean duration of the hospital stay in patients with a perforated appendix was 7.28±5 days. Surgical site infection (42%) was the most common early complication, followed by wound dehiscence (16.6%), intestinal obstruction (1.6%), and faecal fistula (1.6%). The most common late complications were intestinal obstruction (2.4%), intra-abdominal abscess (1.6%), and incisional hernia (1.6%). The mortality rate in patients with perforated appendicitis was 4.8%. To conclude, prehospital delay was an important factor contributing to appendicular perforation and leading to adverse outcomes. A higher rate of morbidity and prolonged duration of hospital stay were seen in patients with delayed presentation, with features of generalised peritonitis and perforation of the base of the appendix. Delayed presentations in as elderly population with underlying co-morbid conditions associated with severe peritoneal contamination were associated with higher mortality (26%) in perforated appendicitis. Conventional surgery and open procedures remain the preferred approach in a government setup like ours where laparoscopy may not be available during odd hours. Since this study was done over a short duration, certain long-term outcomes could not be assessed. Hence, there is still a need for further studies.