Development Of Acute Appendicitis Research Articles

Detection of SARS-CoV-2 RNA in the mucosa of the appendices of children with COVID-19

Determination of SARS-CoV-2 RNA in appendices of children with COVID-19 by fluorescence in situ hybridization (FISH). A retrospective analysis of case histories and morphological analysis using FISH of appendices of pediatric patients with established clinical diagnosis of acute appendicitis and confirmed infection with SARS-CoV-2 was performed. The material was divided into 3 groups: 1st -appendices obtained during appendectomy in children with established clinical diagnosis of «coronavirus infection» (COVID-19, PCR+) (n=42; mean age 10.8 years); 2nd - appendices of children (n=55; mean age 9.7 years) with acute appendicitis obtained before the onset of the COVID-19 pandemic; 3rd (control) group (n=38; mean age 10.3 years) - autopsy material of the appendices (intact). In all samples of the appendices of the 1st group, a positive SARS-CoV-2 viral RNA signal was noted in the cytoplasm of most epithelial cells and single immunocompetent cells. The signal intensity remained the same in all slides, regardless of age. In all samples obtained from patients without COVID-19 (groups 2 and 3), confocal microscopy did not reveal a signal, which indicates successful adaptation of the FISH method in this study and excludes the false positive results. In the epithelium of the appendices of children of different age with COVID-19, the FISH method revealed SARS-CoV-2 RNA, which does not exclude the association between viral invasion and the development of acute appendicitis.

Childhood Obesity and Its Relation To The Development of Acute Appendicitis

Acute appendicitis is caused by the inflammation of the appendix and is the disease associated with the largest number of cases of emergency surgery in pediatrics and involves 1% to 2% of children who consult the emergency service, on the other hand, the Obesity is a multicausal, chronic and systemic disease, not only present in countries with great economic development, but also involved in all ethnic groups, ages and social classes, for this reason, the relationship between these two pathologies should be better studied especially from the pediatric approach. In patients with childhood obesity, the diagnosis of appendicitis is usually difficult and challenging despite advances in imaging diagnosis and in the treatment of acute appendicitis. In this age group, misdiagnosis is common, which is associated with a high incidence of complications, increased morbidity and mortality and prolonged hospitalizations that allow the development of this disease.

Acute Appendicitis With Appendiceal Intususseption

Intussusception of the appendix is the introduction of the appendix into the lumen of the cecum may be accompanied by the development of acute appendicitis, or proceed without it. The combination of intussusception and acute inflammation of the appendix makes the diagnosis of appendicitis difficult due to the absence of classic clinical symptoms. The article presents the case of successful treatment of a patient with an untypical clinical presentation of acute appendicitis that developed in an invaginated vermiform appendix.

Strangle hernia in the children! not always, amyand hernia with appendicitis

The diagnosis of acute appendicitis is sometimes difficult to make. Among the atypical presentations is Amyand’s hernia. This is the development of acute appendicitis within an abdominal hernia.

Hemorrhagic duodenal ulcer and subsequent acute appendicitis following lobectomy for lung cancer

A 62-year-old Vietnamese male presented for an elective video-assisted thoracoscopic surgery lobectomy for treatment of a suspicious lung mass. Postoperatively, he developed a hemorrhagic duodenal ulcer requiring endoscopic hemostasis. Interestingly, he subsequently became septic secondary to perforated acute appendicitis necessitating laparoscopic appendectomy. Surgery can evoke a physiological stress response and may be a causative factor in the pathogenesis of stress ulcers in surgical patients. A recent article has found an association between the development of acute appendicitis in patients with a history of peptic ulcer disease. The pathological mechanism responsible for this association may be the result of an imbalance of the autonomic nervous system and neuromusculature spasms at the ceco-appendiceal junction.

The Place of Atopy in the Aetiology of Acute Appendicitis in Children.

Appendicitis, the most common cause of abdominal pain requiring surgery in children, refers to inflammation of the vermiform appendix. The aetiology of appendicitis is multifactorial, although it is affected by several precursor factors. The purpose of this study was to investigate whether allergic diseases cause a predisposition to appendicitis. One hundred and sixteen patients who underwent surgery for acute appendicitis and who had a diagnosis of acute appendicitis confirmed pathologically, and a control group of 124 individuals of similar ages and genders, were enrolled. The level of inflammation of appendiceal material in cases diagnosed with acute appendicitis was classified pathologically. The skin prick test (SPT) was used to determine allergic sensitization. A significant difference was determined between the patient and control groups in terms of skin prick positivity (p < 0.05). While there are several known factors implicated in the causation of acute appendicitis, the cause cannot be identified in some cases. We think that atopy may also be a risk factor in the development of acute appendicitis.

Acute Appendicitis Following Colonoscopy

Background: Acute appendicitis after colonoscopy is a rare sequela and may be incidental or a true complication of colonoscopy. This review explores the cause and effect relationships between colonoscopy and the development of acute appendicitis. Methods: We conducted a systematic review of the literature to identify articles up to July 2011. The following time intervals were collated from documented cases to evaluate the natural history of postcolonoscopy appendicitis: time from colonoscopy to symptom onset, time from symptom onset to presentation (preadmission delay), and time from symptom onset to surgery. Postadmission delay was then estimated. Discussion: Paucity of published cases on postcolonoscopy appendicitis may be the result of acute appendicitis being incidental after colonoscopy or because of under-recognition of this complication. The close association between colonoscopy and the onset of symptoms of acute appendicitis suggests a relationship between the procedure and pathology. However, at present, the data available are inadequate to give firm details on the natural history of acute appendicitis after colonoscopy. Shared symptomatology and examination findings between postcolonoscopy appendicitis and common colonoscopic complications such as colonic perforation and postpolypectomy syndrome result in delayed diagnosis. Our findings suggest that delayed surgical intervention is associated with increased morbidity and mortality and is clinician dependent in a majority of cases. Conclusion: Regardless of whether postcolonoscopy appendicitis represents an incidental finding or true complication of colonoscopy, consideration of acute appendicitis as a differential diagnosis of the acute abdomen after colonoscopy is important.

Acute leukemic appendicitis in a patient with acute promyelocytic leukemia

Leukemic and lymphomatous infiltration of the appendix is a rare complication. We present the case of a 31-year-old male with acute promyelocytic leukemia who developed acute abdomen on day 11 of induction chemotherapy with idarubicin and cytarabine. After appropriate work-up, a clinical diagnosis of acute appendicitis was made. Despite severe pancytopenia, he successfully underwent laparoscopic appendectomy. The final pathology revealed leukemic infiltration of the appendix. It is hypothesized that the leukemic infiltration may play a role in the development of acute appendicitis. Further, this case demonstrates the need to maintain a high index of suspicion and prompt surgical intervention for surgical pathologies in neutropenic patients.

Acute Appendicitis in Neutropenic Patients with Acute Leukemia

BackgroundIn neutropenic patients with acute leukemia, acute abdomen which is usually attributed to typhlitis may be encountered. However, the diagnosis of acute appendicitis is rarely described or confirmed.Methods and MaterialsA retrospective study of acute appendicitis in adult patients with acute leukemia was conducted at the Riyadh Armed Forces Hospital between January 1991 and December 2002 and then the study was continued at King Faisal Specialist Hospital and Research Centre in Riyadh between January 2004 and December 2006.ResultsAcute appendicitis developed in three out of 408 patients with acute leukemia treated at both institutions. The incidence of acute appendicitis in adult patients with acute leukemia was 0.74%. Acute appendicitis was encountered during the neutropenic periods following the courses of cytotoxic chemotherapy given to control the leukemia. The three study patients were males and they presented with the classical clinical manifestations of acute appendicitis and they underwent successful appendicectomies. The radiological investigations were helpful in confirming the clinical diagnoses. Compared to the control group of patients, the study patients developed acute leukemia at a younger age and they also had higher rates of: infectious complications, relapse and mortality but lower rate of cytogenetic abnormalities and extramedullary disease.ConclusionsThe development of acute appendicitis in neutropenic patients with acute leukemia is an extremely rare event. The combination of the classical clinical manifestations as well as the compatible radiological features is essential diagnostically. Taking a decision to operate on these immunocompromised patients during the periods of severe pancytopenia is a real challenge to surgeons and hematologists. However, surgical intervention may be associated with long term complications such as relapse of the leukemia, infectious complications and decreased survival.

Impact of Time in the Development of Acute Appendicitis

Background: The aim of this study was to elucidate the natural history of appendicitis. Methods: Data was collected prospectively from consecutive patients admitted to hospital for acute abdominal pain. The degree of appendiceal inflammation in relation to preoperative duration of pain was analysed. Results: The study comprised 253 patients operated on for acute appendicitis that could recall the onset of abdominal pain. There was a longer duration of pre-hospital pain in patients, irrespective of age, with perforated appendicitis compared to patients with phlegmonous or gangrenous appendicitis (p < 0.001). In the multivariate analysis, patient age and preoperative duration of pain were independent risk factors for perforation. Conclusion: Patient delay in presentation is the predominant factor determining the incidence of complicated appendicitis, and this delay is not influenced by age or gender.

Appendicitis during locoregional thermoradiotherapy of advanced or recurrent rectal and cervical cancer, a report of two cases

Introduction : Local tumour control after irradiation alone for advanced, inoperable carcinomas of the bladder and rectum or inoperable recurrent cervical carcinoma is usually disappointing. Both preclinical and clinical studies reported improvements by adding hyperthermia to radiotherapy. Reports for phase II/ III trials do not indicate any enhanced side effects. However, two cases of acute suppurating appendicitis were observed in a series of patients treated with deep regional hyperthermia. Materials, methods and results : Eighty patients with advanced, inoperable, or recurrent rectal or recurrent cervical tumours were treated with deep regional hyperthermia (313 sessions) in addition to radiotherapy between September 1995 and October 1998. The treatment for two of these patients (2.5%) had to be discontinued after the fourth/second hyperthermia treatments at 19.8/10.8Gy total dose, respectively, for symptoms of pain in the right pelvis and elevated rectal temperature. Both patients underwent laparotomy and were found to have suppurative appendicitis. In addition to the retrocoecal location in both patients, evidence of preexisting chronic appendicitis, and appendiceal faecalith were observed in each patient. Conclusion : The development of acute appendicitis in 2.5% of patients during a course of deep regional thermoradiotherapy for pelvic tumour is much higher than the expected incidence of appendicitis in the general population (< 10/00) (Korner et al. 1997). An enhanced risk of suppurative appendicitis in patients undergoing pelvic thermoradiotherapy cannot be excluded, especially in retrocoecal located appendices with obstructed appendix lumen from preexisting chronic appendicitis or faecalith.

Ethnicity and familial factors in the etiology of acute appendicitis.

The role of various socioeconomic, ethnic, and family factors in the development of acute appendicitis (AA) was studied in two generational groups totaling 2,331 individuals. Univariate analyses revealed that ethnicity, residence, family history, and education are associated with AA. However, only two, ethnicity and education, were retained following multiple forward, stepwise logistic regression. Caucasians, in contrast to Mongoloids and Uzbeks and those with high education showed significantly higher probabilities of undergoing an appendectomy. Odds ratios comparing Caucasians to Uzbeks and low education to high education were 1.6 and 0.7, respectively. Results confirm an association of higher AA frequency with higher socioeconomic status but do not explain the ethnic differences in the incidence of AA. Examination of aggregation of AA in 782 families indicates a familial factor in predisposition. Although this analysis suggests that genetic factors contribute significantly to the development of AA, only segregation analysis will allow more definitive conclusions. © 1994 Wiley-Liss, Inc.

Coproliths.

The purpose of this paper is again to remind the radiologist to be “coprolith-conscious.” Coproliths were not diagnosed in our department before 1949. In the first five years after we had become “coprolith” conscious, however, 42 cases were seen, of which 35 were diagnosed preoperatively and 8 postoperatively because the surgeon requested an x-ray study of the removed appendix. This report will be limited to the cases with a preoperative diagnosis. The word “coprolith” is derived from the Greek, meaning “dung stone.” It is used, according to the suggestion of Thomas (1), to emphasize the radiopacity of the concretion and thus distinguish fecaliths which are visible roentgenographically from others frequently found in the appendix. In his study of a large series of fecaliths, only 25 per cent contained enough calcium to be visualized on an abdominal film. The first mention of appendiceal stone was made in 1813 by Wegeler (2). The first report of a correct preoperative x-ray diagnosis was that of Weisflog (3) in 1906. Seelig (4) in 1908 introduced the term “coprolith” and was the first to describe this condition in the American literature. Since that time, there has been a multitude of reports. An extensive review of the literature is unnecessary in view of the excellent analyses of Felson and Bernhard (5) and Laforet et al. (6), in 1947 and 1951, respectively. The mechanism of coprolith development proposed by Kelly and Hurdon (7) in 1905 is the most widely accepted. They propose that impairment of the normal peristaltic return of fecal content from the appendix results in inspissation. Subsequent irritation and accompanying bacterial activity due to the fecal mass cause a low-grade inflammation with mucus secretion. The inorganic salts, mainly calcium phosphate, contained in the mucus are precipitated on the surface of the fecal nucleus, producing an increase in size. Wangensteen and Bowers (8) suggest that the appendix frequently behaves as a closed loop in relation to the intestinal canal, permitting entry but preventing free extrusion of the fecal stream; the coprolith is then formed in the lumen by stasis upon the fecal nucleus. These authors stress the closed loop phenomenon as the initiating factor in appendicitis and regard inflammation and suppuration as consequences of the obstruction. This explains why a patient may have a coprolith for some time before the development of acute appendicitis. Maver and Wells (9) studied the chemical composition of a number of coproliths and found the content to be as follows: material soluble in fat solvents (mainly soaps with considerable coprosterol), 50 per cent; inorganic material (mainly calcium phosphate), 25 per cent; organic residue (mainly vegetable fibers), 20 per cent. Approximately 130 cases of coproliths have been reported to date. The frequency of their occurrence as given in the literature varies considerably according to the material from which the cases are selected.