Features Of Acute Appendicitis Research Articles

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.

Incidence of post open appendectomy incisional hernia in Erbil City

Background: since acute appendicitis is the most common presenting diseases in the surgical emergency departments, Appendectomy regarded as a common emergency surgical procedure that is done by the surgeons in the general surgery specialty. The complication of an incisional hernia development after open appendectomy is rare, found in about 0.12% of the appendectomy operations; interstitial type of incisional hernia complication following open appendectomy surgery is extremely rare condition, small number of reports found to deal with the incisional hernia development at the site of appendectomy in a range of (0.4-0.7%).
 Objective: To assess the incidence of incisional hernia following open appendectomy in Erbil province – Kurdistan region- Iraq.
 Patients and Methods: This retrospective study involved 598 cases between the period of first of July 2015 to 30th of April 2020, the cases presented with features of acute appendicitis, after admission and complete history taking, surgical intervention (open appendectomy) has been done for all of them, follow up for the diagnosis of the post appendectomy incisional hernia development done throughout revising the files and ID s of the patients and contacting them or their close relatives via personal mobile numbers, others re-consulted us for any operation site discomforts, any patient with suspicion of operation site problems asked to return to the outpatient surgical room for follow up and excluding or confirmation of operation site incisional hernia. The patients followed up for about 2-3 years after the operation days and contacting period with the patients or their close relatives to exclude incisional hernia development at open appendectomy site took about 6 months.
 Results: Out of 598 cases included in this retrospective study, 286 cases were male and 312 cases were female, the ages ranged between 5 and 91 years old with a mean and Standard Deviation (SD) 24.13, the age group of up to 10 years old included 13 cases, 2nd decade age group included 258 cases, while the third age group (21 – 30 years old) was included 167 cases. Risk factors for development of incisional hernia assessed among all cases, 56.85% of all cases had at least one of the risk factors and the remaining 43.15% devoid of any risk factors, the risk factors distributed among constipation (19.4%), pregnancy among female patients (18.9%), followed by diabetes mellitus, chronic cough and heavy working occupations (4.85% ,4.52% and 3.34% respectively), and BPH and anemia with other immunocompromised risk factors made only about 5.8%, only three patients (0.5%) developed incisional hernia after open appendectomy.
 Conclusion: Post open appendectomy incisional hernia is rare in patients without risk factors of wound dehiscence, with minimizing the risk factors of incisional hernia and wound dehiscence, the incidence of open appendectomy wound incisional hernia can be minimized to lowest rate.

Is acute Appendicitis as an extra Pulmonary Manifestation of Covid-19 infection?

Background; Coronavirus disease-19 (COVID-19) is an infectious respiratory disease. The first confirmed case of 2019-nCoV infection in Albania was reported in Tirana on 08 March 2020, when a patient and his adult son who had come from Florence, Italy tested positive. Patients with COVID-19 can be presented with a series of signs and symptoms. Acute abdomen as a presentation of COVID-19 is rare. The diagnosis of COVID-19 should be suspected and investigated in every case of acute abdomen.
 Case presentation: We report a case of a 42-year-old male who presented with features of acute appendicitis. SARS-CoV-2 polymerase chain reaction test result was positive for COVID-19. Abdominal ultrasonography and his computed tomography of the chest and abdomen showed a perforated appendix and no infiltrates or abnormalities of COVID-19. The diagnosis of our case was appendicitis with COVID-19 without pneumonia. He was admitted and treated with antibiotic therapy and supportive care. He had an improvement in his health condition which made it possible to leave the hospital on the third day of hospitalization.
 Conclusion: Based on our clinical case and literature data, we suggest that clinicians should suspect the diagnosis of acute appendicitis in patients with COVID 19. So the case of acute abdomen pain must be completed with a SARS-CoV-2 test. Therefore we recommend additional studies to reinforce the idea of ​​linking SARS COV 2 infection with acute appendicitis.

Evaluation of radiological and temporal characteristics of acute appendicitis on the non-enhanced computed tomography images.

To investigate the relationships and interactions between temporal and radiological features of gangrene and perforation of inflamed appendices. A total of 402 patients were included who underwent laparoscopic appendectomies between January 1, 2016 and March 30, 2020 and had pathologically proved acute appendicitis and preoperative non-enhanced CT examinations. The radiological features (appendix diameter, appendicolith, appendiceal intraluminal gas, periappendiceal gas, periappendiceal fat stranding/fluid, and short axial diameter of the mesenteric lymph nodes) were obtained from the preoperative CT images of 382 patients with visible appendices. Clinical parameters and temporal variables (pre-CT delay, preoperative delay, estimated complication delay, symptom delay, and system delay) were recorded. Among simple/suppurative, gangrenous, and perforated appendicitis, the radiological characteristics except for short axial diameters of lymph nodes, and the temporal variables other than system delay were significantly different. The Cox regression analysis identified the appendicolith as the independent risk factor for both gangrene and perforation of inflamed appendices by using the preoperative delay or estimated complication delay. By the preoperative delay, the median time for gangrene and perforation was 76.23 (95%CI 73.89-78.58) h and 77.55 (95%CI 74.12-80.98) h, respectively, if appendicolith was present. If estimated complication delay was used as the elapsed time and the appendicolith was perceptible, the median time for gangrene and perforation and was 72.33 (95%CI 62.93-81.74) h and 75.07 (95%CI 69.48-80.65) h, respectively. There were interactions between the time evolution and radiological features of acute appendicitis. The evaluation of gangrene and perforation rate of acute appendicitis could be benefitted from combining the preoperative delay/estimated complication delay with CT characteristics in the preoperative urgent radiological analysis.

Acute appendicitis in twin appendices: case report

<p class="abstract">A double appendix is a rare congenital malformation with a frequency ranging from 0.004 to 0.009% and only a small percentage of instances presenting as appendicitis. Although the cause of appendiceal duplication is unknown, it poses a difficult clinical picture in patients with right lower quadrant pain. In this case report, we presented two cases of operative treatment of acute appendicitis in a doubled vermiform appendix in 4 and 17 years old male patients. Both cases did not have any pertinent prior medical condition and presented with shifting right lower quadrant (RLQ) abdominal pain associated with nausea, vomiting and anorexia. Clinical exam, laboratory investigations as well as imaging findings were consistent with features of acute appendicitis. In both patients, the diagnosis of the duplicated appendices was unsuspected until two tubular structures arising from the cecal wall were discovered intraoperatively and confirmed on histopathological examination after appendectomy of the two appendices was performed. Hence, in all situations where acute appendicitis is suspected clinically and radiologically, surgeons must maintain a high level of suspicion for the potential of duplicated appendices to avoid missing the duplication and resulting post-operative difficulties and medicolegal concerns.</p>

APPENDICITIS IN PREGNANCY : OUR CLINICAL EXPERIENCE AT A TERTIARY CARE CENTRE

Objective: Acute appendicitis is a common surgical condition presented to emergency. In this study we evaluated the clinical presentation, management and outcome of acute appendicitis complicating pregnancy at a tertiary care centre. Material And Methods: A total of 20 cases of pregnant women who were diagnosed as a case of acute appendicitis were studied from January 2018 to December 2020. Results: Total number of patients diagnosed with acute appendicitis were 20. There were 10 (50%) patients in rst trimester , 6 (30%) in second and 4 (20%) in the third trimester. Abdominal pain was the most common symptom seen in all patients. 12 (60%) patients were multigravida whereas 8 (40%) patients were primigravida. Duration of abdominal pain was 6 hours to 5 days with median of 30 hours. Right lower quadrant was the most common site of pain. Rebound tenderness was seen in 14 (70%) patients. Total leucocyte was raised in 14 (70%)cases. Ultrasound was done in all patients showing viable fetus and features of acute appendicitis in 12 (60%) cases. Surgery was done in 16 (80%) cases. Midline laparatomy was done in 3 patients whereas 4 (20%) patients were managed conservatively with antibiotics. Postoperative tocolytics were given in 6 patients. Postoperative complications such as wound infections seen in 5 cases and pelvic abscess in 1 case. Fetal loss was seen in 2 (10%)cases. Conclusion: Diagnosis of acute appendicitis during pregnancy can be difcult due to anatomical and biochemical changes during pregnancy. Correct diagnosis can be achieved by taking proper history, clinical examination and relevant investigations. Surgery remains the treatment of choice.

Inflammatory myo-fibroblastic tumor of appendix: A rare clinical entity.

IntroductionInflammatory myo-fibroblastic tumor of appendix is one of the rarest clinical findings and less has been described in the literatures. So, we aimed to present the clinical case that we encountered at our institute.Presentation of a caseA 29-year-old lady presented with history of pain at the periumbilical area for one day which shifted to right iliac fossa. Clinical examination revealed tenderness and rebound at right iliac fossa with increased total leucocyte count and ultrasonography abdomen showed swollen appendix. Intraoperatively, a lump around 4 × 3 cm was evident at the tip of appendix with cut section revealing pus along with fecalith. Appendectomy was done with no spillage of the content within the peritoneal cavity. Histopathology revealed inflammatory myo-fibroblastic tumor of appendix. Patient is on regular follow up.DiscussionInflammatory myo-fibroblastic tumor of appendix is one of the rarest clinical findings that mimics malignancy. Presentation could be that of acute appendicitis and in most instances, diagnosis is made intraoperatively. Surgical removal is the mainstay of treatment with regular follow up of the patient for chances of recurrences. Histologically, edematous stroma consisting of inflammatory infiltrates composed of lymphocytes, plasma cells, eosinophils and focal formation of lymphoid follicles along with the proliferation of scattered spindle to ovoid cells with proliferating blood vessels with unremarkable over lying epithelium is evident. Myo-fibroblastic origin can be confirmed by immunostaining with smooth muscle specific vimentin and actin.ConclusionInflammatory myo-fibroblastic tumor of appendix can present with features of acute appendicitis and may mimic malignancy. Appendectomy with regular follow up is mandated if such clinical cases are encountered.

English

BACKGROUND Appendicitis is the most common indication for intra-abdominal surgery, especially in adolescents and young adults. In about 15 – 25 % of appendices removed at surgery because of suspected symptoms, histological features of acute appendicitis are absent. The cause of acute abdominal pain in these patients can be due to mast cells which may play a role in pathogenesis of appendicitis-like pain. Demonstration of mast cell in tissue can be done by toluidine blue staining or immunohistochemistry (IHC) marker CD 117. We wanted to evaluate whether the degree of distribution of mast cells has any relation with clinical findings and evaluate its usefulness as a diagnostic marker for histological diagnosis of acute appendicitis. METHODS This is a descriptive study done in 120 cases of appendicectomy specimens from clinically diagnosed cases of acute appendicitis received in a tertiary care center in South India in which 60 where histology positive and others were histology negative. Mast cell distribution in each group was compared using toluidine blue stain and CD 117. Collected data was entered in Microsoft excel and analysed using the statistical software SPSS version 16. RESULTS Mast cell distribution was significant in all layers of histologically negative acute appendicitis in comparison with histology positive cases. Mucosa has maximum mast cells distribution. CONCLUSIONS Mast cells play an important role in the clinical symptoms of patients even when there were no features of acute inflammation. In those cases, mast cells can be demonstrated by simple toluidine blue staining or IHC markers. This is one of the less studied areas, and the clinicopathological discrepancy can be solved by giving mast cell distribution along with histopathology diagnosis. KEYWORDS Appendicitis, Histologically Negative Acute Appendicitis, Mast Cells, Toluidine Blue, CD 117

English

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

A Clinical Study and Management of Appendicular Mass

Background: Appendicular mass, a common surgical clinical entity is noticed in about 2–6% of patients and present with features of acute appendicitis. Treatment of appendicular mass is often cited as being controversial. Earlier, these patients were managed conservatively which was then followed by an interval appendicectomy carried out 4–6 weeks later. The need for interval appendicectomy has also been questioned. Early surgery on the other hand has an advantage of being curative in the index admission and ensures early return to work and higher compliance. A true controversy exists as to which is the best approach towards this problem and the opinion is divided about the management of an appendicular mass. The present study is designed to evaluate feasibility and safety of immediate appendicectomy in appendicular mass in our hospital by comparing the results of an equal number of patients treated conservatively. Title: Management of appendicular mass: comparative study between different modalities. Aim: To study the effective management of appendicular mass. Materials and Methods: This study is prospective interventional study and included patients aged between 15 to 70 years diagnosed with appendicular mass. Data collected included history, clinical presentation, investigation, diagnosis, surgery, complications and length of hospital stay. Results: A total of 30 patients were admitted with diagnosis of appendicular mass, 15 pts were treated with ochsnersherren regimen out of which 6 were treated with interval appendectomy and other 15 patients were treated with open appendectomy. Conculsion: Patients with appendicular mass who were treated with open appendectomy had longer duration of hospital stay associated with wound infection when compared to that of patients treated with ochsnersherren regimen and interval appendectomy. Therefore this study favors ochsnersherren regimen as preferred approach for the treatment of appendicular mass.

Omental Infarction: A Review of 3 Cases

Omental infarction is an unusual cause of abdominal pain presenting in both adults and children; though it is rare in both [1, 2]. The difficulty is in the initial diagnosis where it can present in a number of different ways and may mask an underlying surgical condition [3, 4]. Most cases are managed without surgery, however; continuing or worsening pain may push a surgical approach. We present 3 cases of omental infarction, all with characteristic radiological findings. One had accompanying radiological features of acute appendicitis, another continued abdominal pain and the third with symptoms responding well to analgesia. The first and second patients required laparoscopic intervention, while the third was managed conservatively.

Acute Perforated Appendicitis: Clinical Profile and Analysis of Risk Factors

Introduction: The incidence of complicated acute appendicitis, including perforated or gangrenous appendicitis, remains considerably high (28-29%) despite the availability of modern imaging. Acute perforated appendicitis is associated with increased postoperative morbidity and mortality. The aim of the study was to analyze the clinico-pathological profile and outcomes for suspected perforated acute appendicitis and to determine the factors influencing the risk of perforated appendicitis.
 Materials and Methods: This was a prospective observational study conducted at Nepalgunj Medical College and Teaching Hospital from November 2016 to August 2018. Patients with suspected appendicle perforation were included. The diagnosis was confirmed atlaparotomy. History, physical findings, biochemical and radiological findings were noted.
 Results: There were 74 patients. The maximum number of patients were in the age group of 0-20 and 21-40 years with a male dominance (M:F 1.9:1). The common presenting features were pain starting in right iliac fossa and becoming generalized with features of peritonitis. Majority presented late to the hospital with the mean duration of 6.35±2.46 days. 17 (22.97%) patients had deranged renal function test at presentation. All patients underwent laparotomy and appendicectomy. The commonest site of perforation was the tip of appendix (58.08%). 27(52.94%) had generalized purulent peritonitis. All had features of acute appendicitis on histological examination. Of the 75 patients only 17 (22.97%) patients had fecolith. 21 (28.37%) had postoperative complications, commonest being surgical site infection (25.67%). Five (6.67%) patients died after surgery. The common cause of death was septic shock with multiorgan failure. Only one patient died due to myocardial infarction. The complications and mortality were common in those patients whose presentation was late i. e after 72 hours from the onset of symptoms, whose renal function was deranged, age > 60, and who had pyoperitoneum.
 CONCLUSION: Acute perforated appendix is not uncommon. Males are more common with younger people commonly getting affected. Delayed presentation, pyoperitoneum, age >60 are the common risk factors associated with morbidity and mortality.

Superior mesenteric venous thrombophlebitis: A rare complication of a common disease

We would like to report a case of acute appendicitis complicated with superior mesenteric venous (SMV) thrombophlebitis. A 61‐year‐old gentleman presented with abdominal pain and high fever with elevated white cell count and slightly deranged liver function and clotting profile. Besides features of acute appendicitis, a thrombus in superior mesenteric vein was demonstrated on computed tomography (CT). Patient was treated with emergency laparoscopic appendectomy, a course of antibiotics and subcutaneous enoxaparin. CT 2 months after operation showed features of resolving SMV thrombophlebitis. Mesenteric venous thrombophlebitis is difficult to diagnose as the clinical presentation is often nonspecific and it depends on the site and timing of thrombus formation. Such rare complication has to be suspected if the patient presents late or when there were high fever and deranged liver function. Prompt appendectomy and antibiotics therapy remain the essential components of treatment for acute appendicitis. The need of additional anticoagulation therapy and its optimal duration for SMV thrombophlebitis remains unclear. Nevertheless, the use of anticoagulation therapy should be weighed against the risk of bleeding complication.

Clinical and histopathological analysis of the patients undergoing appendectomy

Background: Acute appendicitis is one of the most common surgical emergencies, but the diagnosis is difficult even with the sophisticated diagnostic tools. The aim of this study is to analyze the clinical and histopathological features of acute appendicitis and to see how reliable the clinical scoring system modified Alvarado score in our setup.Materials and Methods: This was a retrospective observational study of patients who underwent appendectomy at KIST Medical College and Teaching Hospital during two years. The clinical characteristics of the patients in terms of modified Alvarado scoring were outlined. The diagnosis of acute appendicitis was confirmed by histopathological examination. The data were tabulated in MS-Excel and statistically analyzed using SPSS statistics software, version 21.Results: Among 118 patients, who underwent appendectomy, 69 were male and 49 were female with male to female ratio of 1.41:1 and mean age of 27.46±12.724 years.The clinical diagnosis of acute appendicitis was more likely (MAS 7-9) in 56 patients, less likely (4–6) in 44 patients and unlikely (MAS 1-3) in 18 patients. The highest incidence of acute appendicitis was observed in 19-40 years and the lowest incidence in 61 years or above. After histopathological examination, 52 patients out of 56 in the more likely group had acute appendicitis and 4 patients had non-inflamed appendices. 7 patients out of 62 in the less likely and unlikely groups had acute appendicitis and 55 patients had non-inflamed appendices. The overall negative appendectomy rate was 9.32 percent.Conclusion: Our clinical practice of using modified Alvarado score in the diagnosis of acute appendicitis is effective, easy and non-invasive.

A Prospective Study on the Diagnostic Value of Hyperbilirubinemia as a Predictive Factor for Appendicular Perforation in Acute Appendicitis.

BackgroundAppendicitis is one of the most common surgical emergency in general surgical practices. Early and prompt diagnosis is necessary to avoid life-threatening complications associated with it. The diagnosis is mainly clinically aided by imaging techniques. The physiological obstruction of the bile flow associated with appendicular pathology leads to hyperbilirubinemia, which can be used as a predictive factor of appendicular perforation.MethodThis prospective study was conducted in the department of general surgery in Madras Medical College and Rajiv Gandhi Government Hospital, Chennai, from January 2012 to November 2012. A total of 378 patients with the features of acute appendicitis or appendicular perforation admitted in the emergency surgical ward were included.ResultsOut of 378 of the study population, 18% had appendicular perforation and 82% had acute appendicitis. Out of 67 perforations, 60 patients have hyperbilirubinemia (90%) whereas out of 311 patients with appendicitis, only 89 (29%) of them had elevated bilirubin. Hyperbilirubinemia with a cutoff point of 0.9 mg% for appendicitis patients has a sensitivity of 89.6%, specificity of 71.4%, a positive predictive value of 27%, and a negative predictive value of 96.9%. Hyperbilirubinemia with a cutoff point of >1.3 mg% for appendicular perforation has a sensitivity of 80%, specificity of 89%, a positive predictive value of 93%, and a negative predictive value of 96%.ConclusionsHyperbilirubinemia with bilirubin levels more than 1.3 mg% are highly predictive of appendicular perforation and, hence, aid in prompt diagnosis. This can be combined with a clinical diagnosis and imaging for an accurate and precise diagnosis.

Mucocele of the appendix: A case report and review of literature

Mucocele represents mucinous dilation of the lumen of vermiform appendix resulting from obstruction or increase secretion. It is a rare disease with an incidence of 0.2–0.7% of all appendectomies and 8–10% of all appendiceal tumours. The clinical presentation is atypical with most cases usually asymptomatic. Mucocele of the appendix indicates dilation of the appendix lumen irrespective of the aetiology. Four types of appendiceal mucocele are defined by the cause of obstruction: retention cysts, epithelial hyperplasia, mucinous cystadenoma and mucinous cystadenocarcinoma. Mucocele of the appendix is a rare condition of the appendix that requires high index of suspicion for a definitive preoperative diagnosis. The treatment for appendiceal mucocele is typically surgical resection. We report a case of a 37-year-old woman with recurrent right iliac fossa pain of 20 years duration. Abdomen was full, moved with respiration with a positive pointing sign. There was marked right iliac fossa tenderness with rebound tenderness and guarding. She had an abdominopelvic ultrasonography that revealed features of acute appendicitis. She had surgery with intraoperative finding of marked distension of the appendix from the tip to the base with necrosis at the base, a right hemicolectomy was done.

Ingested Pin Causing Acute Appendicitis In A Child

Ingested foreign body (FB) can occasionally lodge into the vermiform appendix leading to its inflammation. A 4-year-old girl presented with features of acute appendicitis. On X ray abdomen a metallic pin was seen in right lower abdomen. Patient had open appendicectomy and a metallic pin was found penetrating both walls of appendix near its tip. Postoperative recovery was uneventful.

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

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

Feasibilty of early surgical intervention for acute appendicitis in gravid patients

Background: Acute appendicitis is the most common surgical non-obstetric pathology during pregnancy. Unnecessary hesitation and hence delay in surgical intervention for acute appendicitis in pregnancy is common. In this background, while attempting early suspicion and surgical intervention (appendectomy) in our patients, we encountered no mortality and no significant morbidity in the in immediate postoperative period. Materials and Methods: This prospective study was carried over a period of 3.5 years from June 2012 to November 2015, in the department of surgery, GMC (Government Medical College) Srinagar. Patients included were only those who had features of acute appendicitis on clinical grounds and/or imaging studies (ultrasound). Objective: Our aim was to study the feasibility of early suspicion and surgical intervention in patients with features of acute appendicitis in pregnancy. Results: The mean age of the patients was 28.84 years, ranging from 21 to 38 years. The mean gestational age of our patient cohort was 17.4 weeks (6-35 weeks). Majority of the patients presented in the 2nd trimester (55.9%) followed by 1st trimester (29.4%). The Alvarado score of the patients ranged from 5 to 9 (mean 6.76). WBC (white blood cell count) of our patients ranged from 5800 to 22400 (average 14150). Neutrophill count ranged from 64.4% to 92.2% (mean 79.20%). USG diagonosed 20 patients as acute appendicitis (58.82%) and 14 patients as negative for appendicitis (41.2%) with a sensitivity of 60.6% and specificity of 71.42 %. Intraoperatively 31 patients (22 inflamed and 9 perforated) had features of acute appendicitis, one had early lump formation, and two had grossly normal appendix. All patients were followed up strictly for 2 months postoperatively and no obstetrical complication was recorded. Conclusion: Diagnosis of acute appendicitis in pregnancy can be difficult; however, surgical intervention should be performed with any suspicion. Fetal morbidity and mortality are high in the presence of perforation and generalized peritonitis. For minimizing the unnecessary delay in diagnosis and surgery, high clinical suspicion can only be supplemented and not replaced by imaging studies. Ultrasound is not only safe in pregnancy but also easily available and affordable. The decision to perform laparotomy should be based on clinical findings and diagnostic imaging. Delays over 24 hours for intervention increase the risk of perforation. We noted no immediate fetal or other major complications in our patients, hence we recommend early surgical intervention in patients with suspicion of acute appendicitis in pregnancy. There is also need for some unequivocal diagnostic scoring system which should be highly predictive of acute appendicitis in pregnancy, early in the course of disease before giving way to complications.

Duplication of Vermiform Appendix.

The vermiform appendix is a tubular, narrow, worm-shaped part of the alimentary canal that lies near the ileocecal junction and communicates with the caecum. Duplication of the vermiform appendix is rare, with a reported incidence of 0.004%. Till now, fewer than 100 cases have been reported. We present a case of an 8-year-old male child with duplex appendix who presented to the emergency department of our institution with features of acute appendicitis.