Cases Of Perforated Appendicitis Research Articles

Therapeutic effectiveness of modified endoscopic retrograde appendicitis therapy for acute appendicitis of different severities in children

Objective: To investigate the effects of modified endoscopic retrograde appendicitis therapy (mERAT) on the treatment of children with different severities of acute appendicitis. Methods: This study was a case-control study. A total of 586 children with acute appendicitis, who were admitted to the Pediatric Department of Second Affiliated Hospital of Air Force Medical University between January 2019 and November 2023, were selected as the research subjects. According to the severity of the disease, the patients were divided into simple appendicitis group, suppurative appendicitis group and perforated appendicitis group. The baseline data, hospitalization treatment and costs, outcomes, and recurrence in each group were analyzed, and the difference in the effectiveness of mERAT between the groups were compared by Kruskal-Wallis H test and χ2 test. Results: Among 586 children, there were 338 males and 248 females. The age at onset was 7.0 (4.6, 9.4) years. There were 475 cases of simple appendicitis, 78 cases of suppurative appendicitis, and 33 cases of perforated appendicitis. There were no significant differences in age and gender among the three groups (F=0.59, χ2=3.31, both P>0.05). However, there were statistically significant differences in body temperature, white blood cell counts, neutrophil percentage, lymphocyte percentage, nausea or vomiting, right lower abdominal pain, umbilical pain, right lower abdominal tenderness, and right lower abdominal rebound pain (H=7.56, 161.52, 169.11, and 169.61, χ2=12.05, 13.82, 12.05, 7.74, 20.35, and 94.61, all P<0.05). Also, the treatment time, postoperative hospital stay, total hospital stay, and cost showed statistically significant differences (H=4.70, 33.66, 34.99, 30.37, all P<0.05). There was no significant difference in the initial treatment success rate (98.1% (466/475) vs. 98.7% (77/78) vs. 90.9% (30/33), P=0.057). During the 30 (23, 36) months of follow-up, the recurrence rate was 7.9% (35/433) in the simple appendicitis group, 20.8% (15/72) in the suppurative appendicitis group, and 30.0% (9/30) in the perforated appendicitis group, with a statistically significant difference (χ2=23.56, P<0.001). Among the children with recurrent appendicitis, 15 cases still chose mERAT, of them 11 cases (31.2%) had simple appendicitis, 2 cases (2/15) had suppurative appendicitis, and 2 cases (2/9) had perforated appendicitis.The latest time to recurrence in the 3 groups was 32, 35 and 10 months, respectively. Conclusion: Treatment with mERAT has a good effect in pediatric simple appendicitis, but has a higher recurrence rate despite a better initial treatment success rate in suppurative appendicitis and perforated appendicitis.

425 Appendicular Endometriosis- A rare presentation

Abstract Endometriosis is a known gynaecological condition in young women of reproductive age group. It presents with many different symptom complexes, most common presentation being pain abdomen especially during menstruation. Pelvis is the most common site for endometrial deposits. Gastrointestinal endometriosis is rare. Appendicular endometriosis is rarer. There have been only a few case reports of endometriosis causing appendicitis. We came across a case of perforation peritonitis in a young girl with a background history of endometriosis. Patient presented with sign and symptoms of acute appendicitis and on USS was found to have inflamed appendix. During diagnostic laparoscopy she was found to have gangrenous perforated appendix and a hard caecal nodule, which on histopathology revealed endometriosis. Another important fact revealed on histopathology is bleeding into the endometrial tissue. This patient underwent laparoscopic right hemicolectomy. Post – operative recovery was well and uneventful. Patient was discharged from the hospital on 5th day post operation. We did a literature research to find out that there have been only two cases of perforated appendicitis mentioned in literature. While endometriosis is a common disease and may lead to appendicitis but it is not very common for it to present it as perforation peritonitis.

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.

Medications and the risk of perforated appendicitis: an adverse event report system (FAERS) database analysis

ABSTRACT Objective Different classes of medication have been reported in the literature to be associated with an increased risk of gastrointestinal perforation. However, little is known about the risk of drug-induced perforated appendicitis. Methods We analyzed the Food and Drug Administration Adverse Event Reporting System (FAERS), a large national database of reported adverse events associated with post-market FDA-approved medications from January 2011 to October 2021. Patients of any age group with appendiceal perforation were included. Duplicated reports and other anatomical areas of gastrointestinal tract perforation outside the appendix were excluded. Results During the study period, 474 event cases met inclusion criteria, of which 284 were females. Most reports of perforation occurred in patients 40–49 years (n = 110) and 50–59 years (n = 144). Cases of perforated appendicitis occurred in patients being treated for multiple sclerosis (31.5%) and rheumatoid arthritis (17.1%). Perforation occurred in patients receiving interferon beta 1a (23.6%), adalimumab (17.9%), etanercept (14.1%), natalizumab (12.2%), clozapine (10.1%), infliximab (9.9%), bevacizumab (7.2%), and calcium chloride (4.9%). Sixteen fatal outcomes were reported. Conclusion Findings from the FAERS database highlight the risk of appendiceal perforation in the context of different classes of drugs. Larger pharmacovigilance studies are needed to confirm these observations.

A Rare Complication of Perforated Appendicitis: A Case of Necrotizing Fasciitis

Acute appendicitis is considered one of the most common surgical emergencies with low morbidity and mortality. However, delay in the diagnosis may lead to perforation of the appendix. Hence, complications may arise, including necrotizing fasciitis, a rare complication of a perforated appendix. We present a case of perforated appendicitis complicated by necrotizing fasciitis leading to rapid deterioration.A 75-year-old male patient presented to our emergency room with a three-day history of right lower quadrant abdominal pain and abdominal distention. On admission, computed tomography (CT) scan showed a perforated appendix and peri-appendicular abscess. An exploratory laparotomy was performed. The appendix was resected and the wound closed. The patient was recovering well and tolerating food after the procedure. However, the patient developed progressive erythema/swelling over the right flank with new-onset leukocytosis. The diagnosis of necrotizing fasciitis was suspected and confirmed by careful evaluation and laboratory/radiological tests. Antibiotics were changed to clindamycin and piperacillin/tazobactam, and the patient was taken back to the operation room (OR) for surgical debridement. Postoperatively, the patient was shifted to the intensive care unit (ICU). He developed hearing impairment, which improved after the cessation of clindamycin. He was discharged in good condition after three weeks of hospital stay.This case report highlights the importance of maintaining a high index of suspicion for necrotizing soft tissue infection in immunocompromised patients with perforated appendicitis and being cautious when prescribing clindamycin to patients at risk of hearing loss.

Infantile appendicitis: Importance of diagnostic accuracy and a lowered threshold for computed tomography

Appendicitis in the infant population is rare and often misdiagnosed. It can be associated with perforation and sepsis and necessitates expedient identification when present in a sick infant. We describe a case of perforated appendicitis in a 10-month-old infant after diagnostic workup ruled out common causes of colicky abdominal pain. We highlight documented recommendations for workup and management of neonatal and infantile appendicitis. We show that the consensus in literature is prompt diagnosis and surgical intervention for the best chance at preventing morbid outcomes that increase mortality.

Role of Delayed Primary Skin Closure in Preventing Superficial Abdominal Wound Infections in Peritonitis Patients

Background: The commonest complication encountered postoperatively is wound infection despite the use ofprophylactic antibiotics and following meticulous surgical techniques. The rate of surgical site infection is higher in caseof contaminated surgeries as compared to elective surgeries.Objectives: To determine whether delayed primary skin closure of contaminated and dirty abdominal incisions reducesthe rate of surgical site infections (SSI)(superficial abdominal) compared with primary skin closure.Methods: 50 patients who were above 18 years of age, admitted to our hospital through the emergency department andunderwent exploratory laparotomy for perforated viscera, and the intraabdominal collection was included in this study.Results: The cause of perforation was, 8(32%) cases of perforated appendicitis, traumatic perforation(8), ileal perforation(5)and duodenal perforation(4). In group A 17(68%) patients had wound infection and 10 (40%) had wound infection ingroup B. The distribution of wound infection in each respective subgroup with p-value. There was significant differencein stitch abscess formation and wound discharge between two groups (p-value&lt; 0.05) i.e., 7(28%) patients of group A,developed stitch abscess while 6 patients developed wound discharge. However, no patient in group B developed stitchabscess and wound discharge. 1(4%) patient developed erythema in group A, while it was none in any patients of group B.Conclusion: Delayed primary closure is better than primary closure in minimizing wound infection. But all patients whowere grouped in delayed primary closure who underwent secondary closure had to stay more in hospital which is notcost-effective

Clinical Value of Abdominal Ultrasonography in the Diagnosis of Acute Abdomen in Children.

In order to study the practical application value of abdominal ultrasonography in the diagnosis and treatment of acute abdomen in children, this study uses the method of collecting clinical actual cases and scientific analysis to estimate the clinical diagnostic value of high-frequency ultrasound and low-frequency ultrasound. In order to further clarify its curative effect and treatment advantages, a retrospective analysis of medical records was conducted, and 95 children with acute abdominal pain and suspected appendicitis who were admitted to a hospital from September 2021 to November 2021 were reviewed. ATIL HD15000 color Doppler ultrasound was used for diagnosis. The results are as follows: the sensitivity, specificity, positive predictive value, and negative predictive value of low-frequency probe in the diagnosis of intussusception in children were 83.61%, 73.33%, 92.73%, and 52.38%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value in the diagnosis of mesenteric lymphadenitis were 80.00%, 81.97%, 52.17%, and 94.34%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of high-frequency probe in the diagnosis of intussusception in children were 93.44%, 80.00%, 95.00%, and 75.00%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value in the diagnosis of mesenteric lymphadenitis were 93.33%, 95.08%, 82.35%, and 98.31%, respectively. Among the children with appendicitis confirmed by operation and pathology, 69 cases were detected by high-frequency ultrasound and 4 cases were missed (including 3 cases of acute simple appendicitis and 1 case of perforated appendicitis). The false negative was 4%, there was no false positive, and the sensitivity, specificity and accuracy were 95%, 100%, and 96%. In the same cases, 28 cases were detected by low-frequency ultrasound, 45 cases were missed, the false negative was 61%, and there was no false positive. The sensitivity, specificity, and accuracy were 39%, 100%, and 53%. The sensitivity, accuracy, and false negative of high-frequency ultrasound in the diagnosis of acute appendicitis were significantly higher than that of low-frequency ultrasound. This study shows that ultrasound has high accuracy, sensitivity, and specificity in the diagnosis of acute appendicitis. Low-frequency ultrasound can show the whole picture of the disease and the situation in the abdominal cavity, which can better guide the clinical treatment. Color Doppler hemodynamics is a useful supplement to two-dimensional ultrasound, and ultrasound also plays a positive role in the differential diagnosis of acute appendicitis in children.

Postoperative hyperlipasemia in perforated appendicitis in children.

The objective of this study was to assess the hyperlipasemia cases detected in the postoperative period of perforated appendicitis. A retrospective analysis of the perforated appendicitis cases occurred in our institution over a 7-year period (2013-2019) was carried out. Only cases where preoperative and postoperative serum lipase levels were available were included. The variables collected were statistically assessed by means of a descriptive, univariate analysis. A total of 88 patients were studied. They were divided into 3 groups according to postoperative lipase levels - 57 were allocated to Group 1 (lipase: 70-194.0 U/L, normal range), 20 were allocated to Group 2 (lipase: 195-582 U/L), and 11 were allocated to Group 3 (lipase: >582 U/L, which triples normal levels). Statistically significant differences were found in the following variables: sex, postoperative abscess, postoperative subocclusion/intestinal occlusion, preoperative lipase levels, days of parenteral nutrition, days of ICU stay, and days of hospital stay. Postoperative lipase had a moderate correlation with preoperative lipase, and none of the cases met acute pancreatitis diagnostic criteria. Hyperlipasemia in the postoperative period of perforated appendicitis is not associated with developing clinical pancreatitis, but it is associated with worse progression in terms of increased complications, such as subocclusion/intestinal occlusion and intra-abdominal abscess, and longer ICU stay, hospital stay, and parenteral nutrition. There is a moderate correlation between preoperative and postoperative lipase, which means they could both prove useful as prognostic markers.

Simple versus complicated appendicitis

Aim of this study is to understand appendicitis in its various presentations. We encounter patients in different stages of the disease. One end of the spectrum is presenting with simple acute appendicitis while other extreme is represented by serious cases of perforated appendicitis. In between cases with various stages of complications could be seen. Simple appendicitis progresses towards complicated one in its natural course. Rise in intraluminal pressure leads to gangrenous perforation. Expertise of the treating surgeon lies in timely detection and intervention. Desired and favorable results are possible to achieve with judicious use of gastrointestinal surgical techniques by the expert. Present study reviews the literature, different research papers and studies available. My own clinical experience in the understanding of appendicitis and its management has enabled me to shape up the article.

Perforated Appendicitis During a Pandemic: The Downstream Effect of COVID-19 in Children

IntroductionCoronavirus Disease-19 (COVID-19) was declared a pandemic in March 2020. States issued stay-at-home orders and hospitals cancelled non-emergent surgeries. During this time, we anecdotally noticed more admissions for perforated appendicitis. Therefore, we hypothesized that during the months following the COVID-19 pandemic declaration, more children were presenting with perforated appendicitis.Materials and MethodsThis is a retrospective cohort study reviewing pediatric patients admitted at a single institution with acute and/or perforated appendicitis between October 2019 to May 2020. Interval appendectomies were excluded. COVID-19 months were designated as March, April, and May 2020. Additional analysis of March, April, and May 2019 was performed for comparison purposes. Analyzed data included demographics, symptoms, white blood cell count, imaging findings, procedures performed, and perforation status. Statistical analysis was performed.ResultsDuring the study period, 285 patients were admitted with the diagnosis of acute appendicitis with 95 patients being perforated. We identified a significant increase in perforated appendicitis cases in the three COVID-19 months compared with the preceding five months (45.6% vs 26.4%; P <0.001). In addition, a similar significant increase was identified when comparing to the same months a year prior (P = 0.003). No significant difference in duration of pain was identified (P=0.926).ConclusionThe COVID-19 pandemic and its associated stay-at-home orders have had downstream effects on healthcare. Our review has demonstrated a significant increase in the number of children presenting with perforated appendicitis following these stay-at-home ordinances. These results demonstrate that further investigations into the issues surrounding access to healthcare, especially during this pandemic, are warranted.

Perforated Appendicitis Treated By Open Versus Laparoscopic Surgery- A Comparative Study

Background: Acute appendicitis is the most common surgical emergency of the abdomen. Perforated appendicitis often has higher morbidity and mortality. Laparoscopic Appendectomy (LA) is safe and effective procedure for the simple appendicitis compared to Open Appendectomy (OA) but it is not considered as the first line approach in case of perforated appendicitis and its role is still controversial and is under investigation. Hence this study was carried out to compare the outcomes of LA over OA in proven cases of perforated appendicitis.&#x0D; Methods: A hospital based comparative study was conducted among 60 patients with the diagnosis of perforated appendicitis who underwent LA and OA, for a duration of 18 months in Manipal Teaching Hospital, Pokhara. Data were collected using semi-structured questionnaire and were analyzed by descriptive and inferential statistics with SPSS version 25.0.&#x0D; Results: The study showed no significant statistical difference in operative time in LA compared to OA (66±18.11 minutes vs. 66.67±25.269 minutes, p = 0.9). Moreover it shows less post-operative pain (p = 0.003), shorter length of hospital stay (5.3±1.8 days vs. 7.3±3.31 days, p = 0.005), faster return of peristalsis (1.43±0.504 days vs 1.80±0.805 days, p = 0.037) and faster reinstitution of liquid diet(1.43±0.504 days vs 1.80±0.805 days, p = 0.037), less incidence of wound infection (5 in 30 = 16.66% vs. 12 in 30 = 40%, p = 0.042) and faster subjective full recovery(1.9±0.759 weeks vs. 2.9±0.89 weeks, p ˂ 0.0001) of LA patient compared to OA which is statistically significant.&#x0D; Conclusion: LA is safe and effective procedure than OA for perforated appendicitis.

How COVID-19 pandemic influences paediatric acute appendicitis cases?

As a result of the COVID-19 pandemic, the management of paediatric appendicitis has changed (open instead of laparoscopic appendectomy, antibiotic treatment). The number of complicated appendicitis cases increased worldwide. Our aim was to study the effect of the COVID-19 pandemic on paediatric acute appendicitis: has there been more perforated cases? Children operated because of acute appendicitis between 2012 and 2020 were studied. Cases from the year 2020 were analysed monthly. Patients were divided into perforated and non-perforated appendicitis groups according to their histological findings. COVID-19 status of patients in 2020 was studied. Chi2 test for trend and Fisher's exact test were used for statistical analysis. In the study period, 1343 appendectomies were performed. The majority of our cases were non-perforated (1166/1343). The rate of perforated appendicitis cases has been increasing from 2015 (p = 0.0002). The number of perforated cases was higher in COVID-19 positive patients (5/8) then in negative ones (15/92) (p = 0.0075). In line with the international trend, more perforated appendicitis cases were treated in our departement in 2020. However, this increase started in 2015, and there is no correlation with the COVID-19 pandemic. The cause of the increased number of perforated cases in COVID-19 positive appendicitis patients is unknown. The causes of the high proportion of perforated cases in COVID-19 positive patients and the rising rate of perforated appendicitis cases since 2015 need further studies. Orv Hetil. 2021; 162(16): 608-610.

Role of Ultrasound in the Assessment of Pediatric Non-Traumatic Gastrointestinal Emergencies

Background: Non-traumatic gastrointestinal emergencies in the children and neonatal patients and the presenting characteristics ultrasound features on the longitudinal and axial axes are a dilemma for the radiologist in the emergency room. The most frequent emergencies are appendicitis, intussusceptions, hypertrophic pyloric stenosis, and volvulus due to intestinal malrotation. Objectives: this work aimed to assess the role of ultrasound in the assessment of pediatric non-traumatic gastrointestinal emergencies. Patients and Methods: A retrospective analysis of 205 ultrasound examinations performed for neonatal and children patients with fever, abdominal pain, vomiting and diarrhea were evaluated. Results: Of 205 cases, 19 cases of intussusceptions, 49 cases of appendicitis, 2 cases associated with abscess, 1 gangrenous appendicitis with absence a color Doppler, 30 cases of perforated appendicitis and 3 cases of volvulus were found. Conclusions: Acute abdominal pain is one of the most common complaints in childhood, and one that frequently requires rapid diagnosis and treatment in the emergency department. Although acute abdominal pain is typically self-limiting and benign, there are potentially life-threatening conditions that require urgent management, such as appendicitis, intussusception, or bowel obstruction. Meticulous history taking and repeated physical examinations are essential to determine the cause of acute abdominal pain and to identify children with surgical conditions.

Prevalence of Appendicoliths Detected at CT in Adults With Suspected Appendicitis.

OBJECTIVE. With heightened interest in nonoperative antibiotic management of uncomplicated appendicitis, appendicoliths become a more relevant issue, and because of higher failure rates their presence may be considered a contraindication. The purpose of this study was to investigate the prevalence of appendicoliths at CT in adults with suspected appendicitis. MATERIALS AND METHODS. Among adults undergoing MDCT for suspected appendicitis, 248 patients (134 women, 114 men; mean age, 35.2 years) consecutively registered over a 3-year period constituted a cohort with surgically proven appendicitis. A cohort of 248 patients (175 women, 73 men; mean age, 37.7 years) without appendicitis consecutively registered over a 1-year period served as control subjects. CT examinations were reviewed for the presence, size, and attenuation of appendicoliths and whether the appendicoliths were obstructing. In the cohort with appendicitis, degree of inflammation (3-point scale) and likelihood for perforation (5-point scale) were scored. RESULTS. The prevalence of appendicoliths at CT was 38.7% (96/248) among patients with appendicitis and 4.4% (11/248) among control subjects (p < .001). Among the 96 patients with appendicitis who had visible appendicoliths, mean width, length, and maximum attenuation of the dominant appendicolith were 6.0 mm, 8.2 mm, and 313 HU, respectively. In 70.8% (68/96) of patients appendicoliths were obstructing, and 32.3% (31/96) of patients had more than one appendicolith. Inflammation (1.75 vs 1.43) and likelihood of perforation (2.07 vs 1.51) (p < .05) scores were higher among patients with appendicitis who had appendicoliths. Extraluminal appendicoliths were seen in five cases of perforated appendicitis. CONCLUSION. Appendicoliths were identified at CT in nearly 40% of adults with proven appendicitis, compared with slightly more than 4% of those without appendicitis, and were associated with increased inflammation and risk of perforation.

A study to assess the role of raised total leucocyte count in diagnosis of acute appendicitis

Introduction: Total Leucocyte Count (TLC) is an easily available and commonly performed investigation and studies have reported various degrees of leucocytosis in patients with acute appendicitis. This study was performed with the aim to assess the diagnostic validity of raised TLC count in acute appendicitis.Methods: This was a cross sectional study conducted from 2013 to 2015, in the Department of General Surgery, Indira Gandhi Medical College, Shimla. A clinical diagnosis of acute appendicitis was made based on detailed history taking, clinical examination, and laboratory investigations including TLC count. 50 patients with acute appendicitis were enrolled in the study by convenience sampling, after taking a written, informed consent. Appendicectomy specimen were sent for histopathological examination (HPE).Results: The mean age of the patients was 26.48 ± 12.28 years. 29 (58%) patients were male, and 21 (42%) were female. The negative appendicectomy rate in the present study was 14%. 7 (14%) were normal appendices, 31 (62%) inflamed appendices, 4 (8%) perforated appendices, and 8 (16%) gangrenous appendices as per HPE report. In our study, there were 12 (24%) cases of complicated appendicitis i.e., 8 (16%) cases of gangrenous appendicitis and 4 (8%) cases of perforated appendicitis). TLC had a sensitivity 76.74%, specificity 51.14%, positive predictive value 91.66%, and negative predictive value 28.57%.Conclusion: In our study, TLC was found to have low sensitivity and specificity for acute appendicitis. Hence, used alone, TLC may not be diagnostic of acute appendicitis. However, used in conjunction with other laboratory parameters, it will lead to improvement of diagnostic accuracy.

Parakolik lenf nodu: Pediyatrik perfore apandisitte yeni bir tanı belirteci olabilir mi?

Objective: Acute appendicitis is the most common reason for emergency abdominal surgery in pediatric population. Ultrasonography (US) is a widely used modality to diagnose acute appendicitis. Despite its success in diagnosing acute appendicitis, US have been reported to have a poor diagnostic accuracy to detect perforated appendicitis. We have frequently encountered lymph nodes around transvers colon in pediatric perforated appendicitis cases. We mainly aim to evaluate the accuracy of paracolic lymph node presence as a new diagnostic marker for perforated appendicitis. Materials and Methods: We have evaluated the US reports and/or images of the patients referred to radiology department with a clinical suspicion of acute appendicitis. Paracolic lymph node presence and sonographic findings indicating perforated appendicitis were recorded. Patients were divided into three subgroups according to their final diagnosis: Acute appendicitis, perforated appendicitis, others. Results: Mean age of the population was 14.9±2.3 years. There were 300 acute appendicitis cases, 71 perforated appendicitis cases, and 92 other diagnosis cases (4 lymphoid hyperplasia, 88 normal appendix). Rates of lymph node presence in paracolic area were 41/300 (13.6%) in acute appendicitis subgroup, 58/71 (81.6%) in perforated appendicitis subgroup, and 4/92 (4.34%) in other diagnosis subgroup. A longest diameter of a paracolic lymph node > 8.5 mm seemed to be a good predictor for perforated appendicitis diagnosis (sensitivity 85%, specificity 77%). Conclusion: we showed a statistically significant association between paracolic lymph node presence and perforated appendicitis. This sign can serve to confirm perforated appendicitis diagnosis over simple appendicitis.

Amyand's hernia with perforated appendicitis complicated by post-operative bowel Necrosis in an extremely preterm infant

Amyand's hernia is an exceedingly rare condition in which the appendix is found in an inguinal hernia. The appendix can be normal, inflamed, infected, or perforated. Here, we present a case of perforated appendicitis in an Amyand's hernia in an extremely preterm infant with subsequent post-operative complications including necrotic bowel and venous thrombosis of the mesentery. This article stresses the importance of complications that can arise in Amyand's hernia, especially in an extremely preterm infant.

Shigillosis with Acute Appendicitis and Peritonitis: A Case Report

Shigellosis is a form of bacterial diarrhea caused by gram-negative bacteria Shigella species. It is common in developing countries and results from contaminated food, poor sanitation conditions, or direct person to person contact. Shigella can cause infection in all age groups. High-risk group include very young, elderly, and immunocompromised person. Shigella species is relatively resistant to acid in the stomach, and few organisms are required to cause the disease. Once ingested, it multiplies in the small intestine and enters the colon. In the colon, it produces shigella enterotoxins and serotype toxin 1, resulting in watery or bloody diarrhea. Clinical presentation of shigellosis may vary over a wide spectrum from mild diarrhea to severe dysentery. We report the case of 7 years old previously healthy boy, who presented to our hospital with abdominal pain, vomiting, and constipation. On examination, we noticed abdominal tenderness with guarding at the right lower quadrant. With the diagnosis of acute appendicitis, open appendectomy was performed. Exploration of the abdominal cavity revealed perforated appendicitis and generalized peritonitis. Shigella sonnei was isolated from the peritoneal fluid culture. The patient completely recovered without any complications. Surgical complications, including appendicitis, could have developed during shigellosis. There are few reported cases of perforated appendicitis associated with Shigella. Prompt surgical intervention can be beneficial to prevent morbidity and mortality if it is performed early in the course of the disease.

Case of perforated appendicitis within an umbilical hernia.

Case of perforated appendicitis within an umbilical hernia.