Common Cause Of Acute Abdomen Research Articles

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.
 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.
 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<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).
 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.

Clinical, Biochemical, and Radiological Correlation in the Severity of Acute Pancreatitis: A Retrospective Study.

To analyze the etiologies and the varying clinical presentationsand to validate the clinical, biochemical, and radiological signs with severity and prognosis of acute pancreatitis. A retrospective study of 1316 patients diagnosed with acute pancreatitis in an industrial hospital inJamshedpur, Jharkhand, was conducted, and their clinicoradiological profiles, etiological factors, and outcomes were studied. A total of 1316 cases were enrolled, out of which maximum cases (411 [31.23%]) were from the age group of 30-44 years, and the mean and median age were 44.54 and47 years, respectively. A total of 731 (55.45%) patients had social habits (i.e., alcohol and smoking), and 585 (44.45%) patients did not have any social habits. Based on the etiology of acute pancreatitis (AP), the majority of cases were due to alcoholism (710 [53.95%]) followed by gallstone (343 [26.06%]) and idiopathicpancreatitis(217 [16.48%]). As per the severity of AP, most patients showed mild pancreatitis (937 [71.20%]) followed by moderate (312 [23.71%])and severe pancreatitis (67 [05.09%]). Mild and moderate pancreatitis patients were shown in 85 and 28 cases,respectively, suggestive of chronic pancreatitis after repeated episodes of AP. But severe pancreatitis shown in 19 cases had hypocalcemia + shock + multi-organ dysfunction syndrome (MODS). In mild, moderate, and severe AP, the mortality rateswere 19 (02.03%), 44 (14.10%), and 21 (31.34%), respectively. Overall, 1232 (93.62%) of AP cases recovered and were discharged in stable condition, but 84 (06.38%) cases expired. AP is a common cause of acute abdomen in patients presenting to the surgical emergency department. The management is mainly conservative with surgery limited to only a few selected cases, depending upon the severity of the disease.

HUBUNGAN DIAMETER APENDIKS BERDASARKAN USG DENGAN SKOR ALVARADO PADA APENDISITIS AKUT

Appendicitis is the most common cause of acute abdomen and the most common surgical emergency. Signs and symptoms that are not always clear in every patient make it difficult to establish a diagnosis. This study aims to determine the relationship of the Alvarado score with the size of the diameter of the appendix based on ultrasound which can help in diagnosing cases of appendicitis. This research is an analytic observational study with a retrospective cohort study approach with a total sample of 52 people who have complied with the specified criteria and were selected by non-probability sampling technique. The data used for this study were the Alvarado score and the size of the diameter of the appendix based on the patient's ultrasound taken from secondary data. The Pearson correlation test conducted has shown a negative relationship between the Alvarado score and the size of the appendix diameter based on ultrasound with a p-value is 0,078>0.05. Based on this study, it can be concluded that there is no corellation between the size of the appendix diameter based on ultrasound and the Alvarado score in appendicitis patients of RSUD Ulin Banjarmasin

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.