RIF Pain Research Articles

Rare cases of appendicitis presented in KIMS Amalapuram, India: a clinical study

RIF pain is a hall mark of acute appendicitis until proven otherwise decision making in a case of acute appendicitis may be difficult for junior surgeons hence we aimed at analysis in RIF pain. Out of 120 cases we found 3 rare entities they are PMP, CT of appendix and perforated appendix in LIF. Pseudomyxomaperinei and carcinoid tumour are rare presentations. Despite the current standard of treatment modalities as extensive surgical resection combined with chemotherapy, PMP and CT frequently recurs with treatment options being limited at recurrence and with severe impact on quality of life. Perforated appendix in LIF is also a rare presentation which needs appendicectomy, perforation closer with omental patch.

ACUTE APPENDICITIS

Objectives: The objective of this study was to compare the efficacy of ClinicalEvaluation and modified Alvarado scoring system in diagnosing acute appendicitis. StudyDesign: Cross sectional study. Place and Duration of Study: This study was conducted atSurgical Unit III of Civil Hospital Karachi from May 2010 to October 2010. Methodology: Thisstudy consisted of eighty patients. Patients were divided in two groups. Group A for completeclinical evaluation comprising of 40 patients and Group B for modified Alvarado scoring systemcomprising of 40 patients. Inclusion criteria were all patients presenting with RIF pain, nausea,vomiting, fever and/or anorexia, diagnosed as having acute appendicitis preoperatively andundergoing emergency appendectomy during this period, age >12 years and both gender.Exclusion criteria included not willing for surgery, General anesthesia problem, pregnant femalepatients and those who did not give written consent. Results: A total of 80 patients were includedin the study, placed alternatively into two groups of 40 patients each with majority being male(n = 61, 76.3%). The mean age was 22.46 years. The positive predictive value for patients ofGroup A was 92.5% while for Group B was 77.5%. When diagnostic accuracy was compared onthe basis of Gender for the two groups, the positive predictive value for male patients of GroupA and B was 90.09% and 89.28% respectively, but for females the positive predictive valueof Group A and B was 100% and 50% respectively. Conclusion: We conclude that modifiedAlvarado score can be used safely and effectively in diagnosing acute appendicitis in adultmales especially as the score increases from seven to nine.

PWE-396 Diagnostic laparoscopy and the outcome of macroscopically normal appendicectomy in female patients with right iliac fossa pain

<h3>Introduction</h3> Right iliac fossa pain (RIF) pain, caused by suspected acute appendicitis continues to prove diagnostically challenging with 15–30% of appendices removed being macroscopically normal. Diagnostic laparoscopy (DL) is being used as both diagnostic and therapeutic procedure particularly in female patients. The aim of this study was to assess the rate of macroscopically negative appendicectomies (MNA) and complications in a cohort of female patients who had DL for suspected appendicitis. Furthermore to follow up the re-admissions rates in those who did not have appendicectomy in the absence of positive findings. <h3>Method</h3> A retrospective study of consecutive female patients admitted with acute abdominal pain that underwent DL for suspected acute appendicitis with an 18-month follow-up. An electronic structured proforma was used to collect data related to white cell count (WCC), C-reactive protein (CRP), ultrasonography (US), operative findings, histology, morbidity and mortality were collated. <h3>Results</h3> In total of the 159 patients were included in the study (mean age 30; 16–76). On admission 118 patients (74%) had a raised WCC (&gt;11), of which 84% (91/119) had a raised CRP (&gt;10). 48 patients underwent US, with 26 having a radiological diagnosis of appendicitis prior to laparoscopy. 146 patients underwent laparoscopic appendicectomy. At laparoscopy 120 patients had a macroscopic diagnosis of acute appendicitis, while 26 of the patients that underwent appendicectomy had MNA, although there was a decision to proceed to appendicectomy. Therefore 13 patients only had a DL. There were no complications in the MNA group of appendicetomies, although complications in the appendicitis group included ileus (1.6%, 2/120) and drainage of pelvic abscess (0.8%, 1/120). Histopathological diagnosis of appendicitis was confirmed in 99% of appendectomies (145/146). One patient had a macroscopically inflamed appendix removed that was normal. One patient who only had diagnostic laparoscopy was later diagnosed with inflammatory bowel disease. While 4 patients who underwent laparoscopy where re-admitted at least twice, and one patient four times during the follow-up period. However none underwent further laparoscopy. <h3>Conclusion</h3> Although there has been some consensus that laparoscopic appendicectomy should be undertaken for the MNA, there has also been suggestion that this maybe associated with increased morbidity. We have shown that often at laparoscopy a macroscopically normal appendix histologically is acute appendicitis. There is no increase complication rate in this group. Furthermore future readmissions may be avoided in this group of female patients with RIF pain. <h3>Disclosure of interest</h3> None Declared.

An evaluation of the relationship between Enterobius vermicularis infestation and acute appendicitis in a paediatric population – A retrospective cohort study

BackgroundEnterobius vermicularis is an often unexpected finding in appendectomy specimen, most commonly seen in paediatric cases. Predicting the presence of E. vermicularis in the setting of appendectomy is important to avoid unnecessary appendectomy and associated morbidity. We sought to identify the incidence of E. vermicularis in a paediatric population undergoing appendectomy for clinically suspected acute appendicitis and identify predictive factors for E. vermicularis. MethodsThis study was performed in an 800-bed University Teaching Hospital, in the Republic of Ireland. We identified all paediatric appendectomies performed at our institute from January to December 2012 using prospectively maintained operating theatre logbooks. In-hospital Histopathology database, medical notes and operative findings were reviewed for each patient and relevant data recorded. Statistical analysis was performed using IBM SPSS, version 21. ResultsIn total 182 paediatric appendectomies were performed during the year 2012 for clinically suspected acute appendicitis. Demographics included: Mean age 11.14 years (3–16), gender 1M: 1F. 58.8% of procedures were completed laparoscopically, 39% open and 2.2% were converted. The negative appendectomy rate was 22.5%. The annual incidence of E. vermicularis in acute appendicitis specimen from a paediatric cohort at our institute was 7% (1 in 14). In specimen containing E. vermicularis, 69% had no evidence of appendicitis and of those that had, no gangrene or perforation was seen. The presence of E. vermicularis in paediatric patients with RIF pain may be predicted by Eosinophilia (p = 0.016), normal WCC (p = 0.034) and normal Neutrophil count (p = 0.014). ConclusionsE. vermicularis is responsible for 7% of acute appendicitis. It is responsible for a significantly higher negative appendectomy rate which if predicted may avoid unnecessary appendectomy and associated morbidity.

55. Appendiceal ectopic deciduosis: A case report

Background Decidua refers to a metaplastic change in the endometrium due to the effects of progesterone during pregnancy. Ectopic decidua has been observed commonly in the ovaries, uterus, and cervix, however, other sites within the peritoneal cavity are considered rare. We report a case of ectopic decidua in appendix in a 26 year old pregnant lady mimicking an acute appendicitis with RIF pain, fever, and leucocytosis. The symptoms resolved following appendicectomy. Histopathologic findings showed serosal decidual tissue in the distal appendix with mild neutrophil infiltration but without evidence of acute appendicitis. Conclusion Ectopic appendiceal decidua is rare but it may mimic acute appendicitis.

Ultrasound scanning of RIF pain may increase time to surgery and inpatient length of stay

Ultrasound scanning of RIF pain may increase time to surgery and inpatient length of stay

Does ultrasound scanning RIF pain have a role in the investigation of suspected acute appendicitis

Does ultrasound scanning RIF pain have a role in the investigation of suspected acute appendicitis

English

BACKGROUND: The aim of this study was to evaluate the safety, feasibility, and cosmetic result of a novel approach i.e. conventional appendectomy via the trans umbilical route using routine open surgery instruments. PATIENTS AND METHODS: This retrospective study included 40 selected cases during period from Jan 2011 to April 2013 in Shimoga Institute of Medical Sciences, Shimoga, Karnataka. Inclusion criteria were a thin built patient with lax abdominal wall, acute classical presentation in early stage of appendicitis, cases posted for interval appendicectomies, recurrent attacks of appendicitis or appendicular dyspepsia and also patients with positive clinical, laboratory and clear cut ultrasonography findings. Excluded from study group were those patients who presented few days later after acute attack, or with complications of mass formation /abscess, undiagnosed obscure causes of RIF pain with no classic history or findings and patients with pelvic peritonitis. RESULTS: Conventional appendicectomy was safely performed in 32 out of 40 cases studied, through single incision trans umbilical route. In remaining 8 cases an additional right iliac fossa incision with muscle cutting had to be employed for dissection of adhesions and retrocaecal /subhepatic positions of inflamed appendix and auto appendectomy with fecolith dislodgement which was observed intraoperatively in 2 cases. The calculated conversion rate was about 20 %. The mean operative time was almost same compared to routine surgery by Mc Burney incision (25 min v/s 22 min). The average hospital stay was 4 days. All patients were followed up for 3-6 months. 8 cases reported with seroma and mild infection from umbilicus which resolved spontaneously with conservative treatment. The estimated infection rate was 9 % in our study. None of the patients had any incisional hernia postoperatively. CONCLUSION: Although Laparoscopy has largely superseded open surgery in diagnosis and treatment of acute appendicitis, open surgery with minimal invisible scar can still be undertaken at primary and secondary care level cost effectively with conventional open surgery instruments, by this novel technique in properly selected cases.

Emergency department diagnosis of women presenting with lower abdominal pain: Appendicitis or gynaecological?

s / International Journal of Surgery 10 (2012) S1–S52 S49 ABSTRACTS Conclusion: Improved success rate and LOS in three specialties suggests effective recommendations and increased experience, while the worsening colorectal results raise sustainability issues. Further ERAS amendments are required. 0738: OUTCOMES FOR SURGICAL FEMALE PATIENTS ADMITTED TO A SURGICAL ASSESSMENT UNIT WITH RIGHT ILIAC FOSSA PAIN IS IT TIME FOR A MULTIDISCIPLINARY APPROACH? J. Hall, A. Kaye, S. Fallis, G. Barsoum, H. Youssef. Heart of England NHS Foundation Trust, Birmingham, UK Aims: Female patients presentingwith RIF pain forma large proportion of all surgical emergencies. Some 40% are treated conservatively for ‘non-specific abdominal pain' (NSAP). This study investigates diagnostic and treatment outcomes of women presenting with RIF and lower abdominal pain. Methods: From January 2010 April 2011, details of women aged 16 60 years attending AE 7 open), diagnoses: 40 appendicitis; 5 other surgical; 21 gynae and 21 NAD. 153/308 (50%) were managed conservatively, diagnoses: 112 NSAP, 11 gynae, 11 urological, 5 musculoskeletal and 14 other surgical. 63/308 (20%) were referred to OG 4 self-discharged. Conclusions: 28% of patients were managed surgically and 46% conservatively. 31% had gynaecological pathology compared with 19% confirmed surgical pathology and 44% non-specific pathology. This suggests an MDT approach, including general surgeons and gynaecologists, would be optimal. 0904: EMERGENCY DEPARTMENT DIAGNOSIS OF WOMEN PRESENTING WITH LOWER ABDOMINAL PAIN: APPENDICITIS OR GYNAECOLOGICAL? Annakan Navaratnam, Joshua Balogun-Lynch , Patrick Roberts . Chelsea and Westminster Hospital, London, UK; 2 Imperial College School of Medicine,