Signs Of Appendicitis Research Articles

Incidence and clinical features of endometriosis in 2484 consecutive female patients undergoing appendectomy for suspected appendicitis—a retrospective analysis

IntroductionEndometriosis is a common condition affecting 5 to 10% of women of childbearing age. The true incidence of endometriosis of the appendix is currently unknown. Since symptoms often overlap with those of acute appendicitis, endometriosis of the appendix presents a diagnostic challenge in the emergency department.This large retrospective study investigates the incidence and perioperative clinical, radiologic, and laboratory findings, as well as possible differences between patients with and without endometriosis.MethodsData from consecutive patients who underwent appendectomy for suspected appendicitis without a history of endometriosis were analyzed. Perioperative clinical, laboratory, perioperative, and histopathologic findings were compared between women with and without endometriosis.ResultsBetween January 2008 and June 2023, 2484 consecutive patients without a history of endometriosis underwent urgent appendectomy for suspected appendicitis. Endometriosis was detected on histopathologic examination in 17 (0.7%) patients. Signs of appendicitis were found less frequently on ultrasound in the endometriosis group compared to the non-endometriosis group (23.4% vs. 61.5%; p = 0.002; OR = 0.193; 95% CI 0.063–0.593). There were no differences in physical examination findings, duration of symptoms, degree of inflammation, surgical outcomes, or complication rates.ConclusionThe incidence of endometriosis of the appendix in patients undergoing appendectomy for suspected appendicitis was higher than suggested by data from autopsy series and populations with biopsy-proven endometriosis. Patients with endometriosis of the appendix were less likely to have a positive ultrasound finding, but perioperative and histopathologic findings and severity of inflammation did not differ from patients without endometriosis, presenting diagnostic challenges for clinicians.

An Update on Acute Appendicitis in Lebanon: Insights From a Single-Center Retrospective Study.

Background Acute appendicitis is the most common surgical emergency worldwide with scarce reports about its prevalence in the Middle East. To date, no epidemiological article has described the incidence of appendicitis in Lebanon. Our primary objective was to estimate the rate of appendicitis in a single center in Lebanon. Our secondary objectives included identifying differences between simple and complicated appendicitis regarding demographics, pre and postoperative characteristics, and symptoms and signs of appendicitis. Methodology A retrospective study was conducted at a single central university hospital in Lebanon. Patients with a clear diagnosis of acute appendicitis were included. Pregnant women, lactating women, patients with organ dysfunction, and patients younger than 18 years old or older than 80 years old were excluded. We reviewed and collected the data of patients who presented to the hospital between November 2018 and November 2019 and November 2020 and November 2021. Results A total of 95 patients were included in our study, with 35 women and 60 men. The mean body mass index of patients with simple appendicitis was 19.14 ± 9.66 kg/m2 compared to 18.97 ± 10.37 kg/m2 in patients with complicated appendicitis (p = 0.94).A total of 42.3% of patients who used antibiotics 24 hours after the operation had simple appendicitis, whereas 20.8% had complicated appendicitis (p = 0.004). Conclusions Antibiotic usage and thelength of hospital staywere correlated with the severity of appendicitis, as reported in the literature. Further randomized studies with a larger number of patients and covering several hospitals in Lebanon are warranted.

An unusual case of difficult appendicectomy

Vermiform appendix is a tubular lymphoid organ situated about 2 cm below the ileocecal junction on the caecum. The different anatomical positions of the appendix is due to differential growth of the caecum at the time of development. Appendix is now considered to be an important part of the immune system with a distinct function within the gut associated lymphoid tissue and also has a role in bowel repair. Acute appendicitis is probably the most common surgical emergency in the world. Post-ileal appendicitis does not have usual symptoms and signs of appendicitis which makes it difficult for diagnosis and increases the rate of complications. We presented such a case of post-ileal appendicitis which led to a difficult appendicectomy.

P179 Distinct ultrasound characteristics of the appendix in patients with ulcerative colitis: a prospective, cross-sectional cohort study

Abstract Background Increasing evidence suggests a role for the vermiform appendix in onset and relapse of ulcerative colitis (UC). Consequently, appendectomy is increasingly being seen as a potential alternative treatment. As a recent study suggests that patients with histological appendiceal inflammation are most likely to respond, pre-operative identification of ulcerative appendicitis could be beneficial1. Intestinal ultrasound (IUS) is increasingly utilized in the diagnosis and follow-up of patients with UC. The objective of this study was to characterize the appendix by IUS in UC patients with active and quiescent disease and healthy controls. Methods In this cross-sectional prospective observational cohort study, we performed appendiceal IUS on UC patients with active (A) disease (FCP>250 and SCCAI>5) and quiescent (Q) disease (FCP<150 and SCCAI<5), followed by age-, body mass index- and gender- matched healthy (H) controls. During IUS, the appendix was identified as a bowel structure with cecal origin and a blind-ending tip. IUS still images and cineloops were centrally and blindly read by an IUS expert (>1000 examinations). Primary outcomes were signs of appendicitis on IUS, defined as a <6 mm transverse appendiceal diameter3 (average of a cross-sectional and longitudinal measurement), hyperaemia (using the modified Limberg score2), presence of peri-appendiceal fat and fluid, and compressibility. Results Out of 95 (A n=35, Q n=30, H n=30) included patients, the majority (n=58, 61.1%) had a visible appendix on IUS, which was similar among cohorts (p=0.56). The appendiceal diameter measured >6.0mm in a significantly higher proportion of active UC patients (A: 45.5%, Q: 5.6%, H: 0.0%, p=0.01). An increased diameter occurred irrespective of disease extent (42.9% of E1/E2 endoscopic active patients). Although the appendiceal diameter was higher for UC patients (Q-H p= 0.02, A-H p< 0.01), no significant difference between A and Q patients was found (p=0.15, Fig. 1). A higher proportion of UC patients had incompressibility when compared to healthy controls (Fig. 2a, p= 0.02). Hypervascularity was present in 54.5% of active UC (Fig. 2b, p= 0.02). Fig 1. Box plot of appendiceal diameter (mm) among cohorts Fig 2 (a, b). Bar charts of incompressibility (a) and hypervascularity (b) among cohorts a b Conclusion Appendiceal IUS was feasible in UC patients. Characteristics of appendiceal inflammation of IUS were reported for UC patients, as both the transverse appendiceal diameter and incompressibility rates were significantly higher in UC patients when compared to healthy controls. Correlating appendiceal IUS findings to histological inflammation could contribute to identifying UC patients most likely to benefit from appendectomy.

TP10.2.2Adherence to the new Royal College of Surgeons (RCS) guidance pertaining to acute appendicitis management during COVID-19

AimsThe mainstay of acute appendicitis treatment is a surgical approach. However, in the tumultuous COVID-19 era, the approach to acute appendicitis management has altered.We sought to assess the applicability of the new RCS COVID-19 guidance after resolution of the global pandemic.MethodsA retrospective study was conducted on 244 patients presenting between 01/03/2020 and 17/07/2020. Three sources of data were sought: patients presenting to A&E with signs of appendicitis, operative logs for patients who underwent removal of their appendix and all CT/US scans where the clinician had queried appendicitis in the request.Results139 patients were treated conservatively with antibiotics (57.0%). 35 (25.2%) represented within 6 months. Conservative treatment was successful in 92.1% of cases.65 appendectomies were completed during that time. 45 cases presented acutely whereby the surgical management of acute appendicitis was the primary choice. The decision to operate was due to: 13 (20%) because the patient was 16 or younger. 4 cases presenting with signs of severe sepsis. 4 cases had a complicated appendicitis on their imaging results. 22 (33.8%) cases were completed without initial conservative management. 9 (3.7%) cases failed conservative treatment thus requiring surgical management.11 (4.5%) cases represented within 6 months due to recurrent appendicitis despite successful antibiotic treatment. Therefore, the recurrence rate following conservative treatment was 7.9%.ConclusionsThere was mixed adherence to the new guidance. Surgical management remains the best approach towards acute appendicitis. However, excellent results can still be achieved with appropriately targeted antibiotic therapy.

Comparison of Alvarado score and pediatric appendicitis score for clinical diagnosis of acute appendicitis in children\u2014a prospective study

BackgroundAcute appendicitis is the most common surgical condition of children. Differential diagnosis of an acutely inflamed appendix in children includes a vast variety of diseases which can present with the same symptoms and signs as acute appendicitis. It is an important factor for delay in diagnosis. Many scoring systems are being used to reach a diagnosis within time and to reduce the rate of negative appendectomies.The purpose of this study was to compare both scoring systems (Alvarado and pediatric appendicitis scoring system) and to know which one is better to establish an early correct diagnosis of acute appendicitis in pediatrics, thus decreasing the morbidity and burden on hospital resources. Although many studies had been completed at the international level for comparing both of these scoring systems, the pediatric population in our region was still awaiting such an effort.So a prospective cohort study was designed. A total of 180 patients were recruited with 95% confidence level and 5% margin of error. Every enrolled patient was awarded clinical scores according to both the Alvarado scoring system and the pediatric appendicitis scoring system. Patients having a score of 7 or more by both scoring systems were considered “seven or more than seven group” and their appendectomies were performed and histopathology reports were reviewed. Patients having a score of 7 in one system and less than 7 in the other/both were considered “less than seven group” and were admitted in the ward for further clinical evaluation and observation.ResultsAt cutoff 7, the Alvarado score showed a sensitivity of 85.5%, specificity of 70%, PPV of 96.5%, NPV of 33.3%, and diagnostic accuracy of 84.11% while the pediatric appendicitis score showed a sensitivity of 93.8%, specificity of 70%, PPV of 96.8%, NPV of 53.8, and diagnostic accuracy of 91.59%.ConclusionThe pediatric appendicitis score (PAS) is superior in diagnosing acute appendicitis in the pediatric population than the Alvarado score as indicated by the values of diagnostic accuracy. So it can be a good diagnostic tool for pediatric patients presenting with clinical symptoms and signs of appendicitis.

Acute Appendicitis Associated with CT Intraluminal Hyperattenuation

Introduction: The appendix is identified as blind ending tubular structure arising from caecum and has variable intraluminal contents and position. Acute appendicitis is one of the common indications for emergency imaging studies. Aim: To describe the importance of appendix hyperattenuation and densities. Material and Methods: Contrast enhanced computed tomography images of abdomen from 120 patients with surgically/pathological proven acute appendicitis, were examined retrospectively. The images were reviewed in axial, coronal and sagittal reformations for assessing the intraluminal contents (hyperdensity and appendicolith), maximum transverse diameter and single wall thickness of appendix, periappendiceal fat stranding and other parameters related to acute appendicitis. In addition, reviewing 100 pre- and post-contrast CT scans of other abdominal conditions as a control group for documenting hyperdense appendix, appendicolith and other signs of appendicitis. Results: The hyperdense appendix sign was found in 5 patients in our study, not found in any patient of the control group (P value = 0.039, is statistically), appendicolith was found in 25% in patients with acute appendicitis, in 3% in control group (statistically significant, p < 0.0001). Conclusion: The hyperdense appendix and appendicolith have strong association with acute appendicitis in the appropriate clinical setting.

Primary appendectomy in appendicular masses of children: an institutional experience

Background: Early appendectomy (EA) for appendicular mass (AM) has been found to be a safer alternative in various studies in adults, while very few studies report such advantages in pediatric population. The purpose of this study was to assess the safety, efficacy and practical implications of EA in pediatric patients with AM.Methods: All patients with acute appendicitis or its complications that underwent EA between January 2016 and December 2018 were retrospectively reviewed. AM was defined if any or combination of the following criteria were satisfied with other signs of appendicitis: palpable mass in right iliac fossa (RIF), sonologically identified mass in RIF, per-operatively confirmed as a mass by surgeon.Results: 37 patients (among a total of 642 patients) were determined to have AM per-operatively and were included in the analysis. 29.7% (n=11) had a contained appendicular abscess. Age group ranged from 4-12 years (mean 7.8 years). The key per-operative findings were fecolith (21.6%), gangrenous appendix (56.8%), difficult adhesiolysis (48.6%), and full thickness bowel injury (2.7%). Postoperatively, wound infection in 9 (24.3%), intra-abdominal abscess in 1 (2.7%), prolonged ileus in 2 (5.4%) and sepsis in 2 (5.4%) were managed medically.Conclusions: EA approach in AM is a safe option in children as it avoids misdiagnosis, treats complicated appendicitis early, avoids second admission, and has shorter hospital stay with better compliance. Failures of non-operative management and potentially lethal complications of complicated appendicitis are also eliminated.

The Use of Machine Learning Approaches for the Diagnosis of Acute Appendicitis.

Acute appendicitis is one of the most common emergency diseases in general surgery clinics. It is more common, especially between the ages of 10 and 30 years. Additionally, approximately 7% of the entire population is diagnosed with acute appendicitis at some time in their lives and requires surgery. The study aims to develop an easy, fast, and accurate estimation method for early acute appendicitis diagnosis using machine learning algorithms. Retrospective clinical records were analyzed with predictive data mining models. The predictive success of the models obtained by various machine learning algorithms was compared. A total of 595 clinical records were used in the study, including 348 males (58.49%) and 247 females (41.51%). It was found that the gradient boosted trees algorithm achieves the best success with an accurate prediction success of 95.31%. In this study, an estimation method based on machine learning was developed to identify individuals with acute appendicitis. It is thought that this method will benefit patients with signs of appendicitis, especially in emergency departments in hospitals.

Apendicitis poscolonoscopia: reporte de caso y revisión de la literatura

Presentamos el caso de una paciente de 83 años sin antecedentes de importancia, a quien se le realizó una colonoscopia de tamización 3 h antes del inicio de la sintomatología. La paciente consultó al servicio de urgencias por presentar dolor en la fosa ilíaca derecha de 12 h de evolución. En efecto, durante el examen físico, se encontró un dolor localizado en la fosa ilíaca derecha.&#x0D; Ante la sospecha de una complicación relacionada con la colonoscopia, se ordenó una tomografía de abdomen, la cual mostró signos tomográficos de apendicitis. Se realizó entonces una apendicetomía por laparoscopia, sin complicaciones, pero se evidenció un apéndice cecal perforado.

Bedside ultrasound for diagnosis of appendicitis in preterm infants

Objective To investigate the sonographic features of appendicitis in preterm infants. Methods A total of 28 cases of premature infants with acute appendicitis diagnosed by bedside abdominal ultrasound in the First Hospital of Jilin University from November 2012 to January 2019 were recruited. Basic clinical information, abdominal ultrasound images, surgical results, management and outcomes were collected and analyzed. Descriptive statistical methods were used for data analysis. Results Among the 28 cases, 21 (75.0%) were males and seven (25.0%) were females. All of them were diagnosed as having acute appendicitis with perforation according to the bedside ultrasound. Five (17.8%) presented direct signs of appendicitis, i.e. partial structure of the appendix and perforation site. The other 23 (82.2%) showed indirect signs, including heterogeneous echotexture or hypoechoic patterns between the liver and right kidney in six cases, heterogeneously hypoechoic areas between the bowels in the right lower abdomen in seven cases, and dissociative effusion between the bowels in the right lower abdomen with poor sound transmission and disorder of surrounding intestinal structure in ten cases. Twenty-one out of the 28 cases (75.0%) exhibited bowel wall thickening at right lower abdomen, absence of intestinal peristalsis and effusion echoes between the intestines with poor sound transmission. Emergent surgeries were performed and diagnoses of appendicitis with perforation were confirmed. All the 21 cases were discharged after full recovery. Seven cases (25.0%) showed confined cystic images and received conservative treatment. One of them developed adhesive intestinal obstruction during follow-ups and underwent surgical treatment, during which local formations of wrapping after appendiceal perforation and obstruction due to surrounding intestinal adhesion were observed. The other six cases recovered after conservative management with gradually reduced peritoneal effusion, normal omental echo patterns and improved inflammatory indicators and abdominal symptoms, and no ileus occurred during follow-ups after discharge. Conclusions Symptoms of appendicitis in preterm infants are non-specific, and perforation is more likely to be seen. Bedside ultrasonography mainly shows indirect signs of appendicitis, and direct signs in some infants. Bedside ultrasound can be an essential tool for the diagnosis of these conditions with high accuracy. Key words: Appendicitis; Point-of-care testing; Ultrasonography; Infant, premature

Role of liver function test parameters in acute appendicitis and its complication: a prospective study

Background: Although acute appendicitis is the most common surgically correctable cause of abdominal pain, the diagnosis is challenging. There may not be classical symptoms and signs of appendicitis always. Accurate diagnosis can be aided by biochemical testings and radiological evaluation and expectant management. These might delay laparotomy and lead to complications of appendicitis and increase the morbidity. Recent research literatures have shown that hyperbilirubinemia is a diagnostic tool for gangrenous/perforation of appendix. This study is designed to evaluate the association between the derangement of liver function test and severity of acute appendicitis and it’s complications like gangrene and perforation of appendix.Methods: This was an observational prospective study on 66 consecutive cases of acute appendicitis done in the department of general surgery, VIMSAR, Burla. After taking informed consent, all patients included in the study were subjected to abdominal ultrasound and blood sample taken for routine blood examination, LFT and after appendicectomy histopathology examination report were collected. A master chat prepared from above data and stastical analysis done.Results: The LFT parameters are deranged in pathological appendix and more specifically the total bilirubin level but the sensitivity, specificity and PPV are specifically high for gangrenous and perforated appendix.Conclusions: LFT can be added as adjunctive test to the investigation of acute appendicitis and its complications and earlier diagnosis of the complications of acute appendicitis and timelier management. It can also help in prevention of negative appendicectomies.

Atypical presentation of a de Garengeot Hernia: A Case Report

Introduction: An inflamed appendix found within a femoral hernia, a de Garengeot hernia, is a rare occurrence which can present with a variety of different symptoms and be a challenge to surgical management. Case Presentation: We present the case of a 59-year-old female who presented with migratory right lower quadrant pain and was found to have a de Garengeot hernia diagnosed pre-operatively on CT imaging. She was taken to the OR for an urgent laparoscopic appendectomy with closure of the femoral hernia sack. Given this is not a true repair, the patient was scheduled for an elective femoral hernia repair subsequently. Discussion: This is the first report of a de Garengeot hernia from the Toronto area. Our case is the first of its kind to present with typical signs of appendicitis without any obvious bulge in the groin. Conclusion: This case report describes two very common acute surgical presentations, appendicitis and incarcerated hernia, seen simultaneously with only one rare pathology.

Twisted "appendix epiploica" as extraordinary cause of discomfort at the right lower abdomen and rare differential diagnosis of acute appendicitis - a representative case

Introduction Appendicitis can be considered the most frequent cause of discomfort at the right lower abdomen. Simultaneously, it is the most frequent indication for a surgical intervention. In addition, there is a broad spectrum of differential diagnoses, which can lead to a very challenging finding-specific management in good time as found out in the presented case. Case description A 44-year old female patient was transfered to the surgical department because of discomfort of the right lower abdomen with changing intensity which had persisted since the day before. Patient showed a reduced but stable clinical status (normosomic nutritional status; no relevant accompanying diseases). Previous oral nutrition was normal. Clinical examination revealed pain by palpation at the right lower abdomen. Laboratory parameters: White blood cell count, 8.2Gpt/L; CrP, 10.4mg/L; urine with no pathological finding; no increased serum β-HCG level. Transabdominal ultrasound as orienting initial imaging detected free fluid around the cecum and along the right iliac vessels (appendiceal diameter, approximately 6.5mm) – in summary, no sign of appendicitis with certainty. Because of a persisting symptomatology, indication for a surgical intervention was derived (intraoperatively, laparoscopic appendectomy and partial resection of the greater omentum). Postoperative course was uneventful (no general/specific complications, wound healing was properly, initiation of oral nutrition and mobilization were well tolerated). Pathohistological investigation revealed lipofibromatosis of the appendage of the cecum with attached necrotic fat tissue and hemostasis, which can be associated with the diagnosis of a twisted appendix epiploica (no hint for malignant tumor growth). Results and Conclusions The finding as presented occurs very rarely (approximately, 0.2%), which was initially misinterpreted as appendicitis with regard to symptomatology, ultrasound and laboratory findings. A definite diagnosis became only possible during the postoperative course by pathohistological investigation (suspicion already raised by intraoperative inspection aspects). Taking the final diagnosis into account, the question of a necessary indication for surgical intervention can be brought up, which can not be circumvented in case of unclear findings and medical history according to the surgical policy (“case of doubt“). However, as a consequence a more intense and extended diagnostic including a well developed clinical experience level as well as the clinical suspicion can be derived and concluded. This was an exciting and instructive case from a didactic point of view (relevant also for medical students) with rare occurrence in daily clinical practice, which includes the whole spectrum of differential diagnoses of i) unclear discomfort at the right lower abdomen in general and ii) acute appendicitis specifically.

Appendicoliths: the neglected stones

Introductions: Cases of colic of the vermiform appendix have been rarely described or diagnosed. Appendicoliths cause acute appendicitis and appendicular perforation. It is still not clear whether appendicoliths cause appendicular colic in the absence of acute appendicitis.&#x0D; Methods: A cross sectional study that included appendectomy done for recurrent appendicitis or chronic right iliac fossa pain. Histology reports were reviewed. The presence of an appendicolith in the report was noted.&#x0D; Results: Thirty-two cases of recurrent appendicitis and chronic right iliac fossa pain were included. Twenty-four patients (75%) had fecoliths in the histology specimens. Eight patients (25%) who presented with appendicular colic without signs of appendicitis were further evaluated.&#x0D; Conclusions: Majority of patients with chronic or colicky right iliac fossa pain had appendicoliths.

Diagnostic accuracy of hyperbilirubinemia in predicting perforated appendicitis

Background: Appendicitis is one of the commonest causes of abdominal pain requiring emergency surgery. Often, it is difficult to reach a proper diagnosis. There may not be classical symptoms and signs of appendicitis. Accurate diagnosis can be aided by additional testing or expectant management or both. These might delay interventions and lead to appendiceal perforation with increased morbidity, mortality and hospital stay. Studies have shown that simple appendicitis has got mortality of 0.3% and perforated appendicitis 6%. Hyperbilirubinemia is a new diagnostic tool for predicting perforation of appendix. The aim of the study is to establish the role of hyperbilirubinemia as a new diagnostic tool to predict perforated appendicitis.Methods: This is a prospective study conducted on 100 consecutive cases of acute appendicitis admitted to the emergency ward. These were subjected to investigations to support the diagnosis. These cases were also subjected to liver function tests and clinical diagnosis was confirmed pre-operative investigations and post-operatively by histopathological examination. Their clinical and investigative data were compiled and analyzed. Statistical analysis was performed using either chi square test or fisher's exact test. The level of significance was set at P &lt;0.05.Results: Total serum bilirubin including both direct and indirect was found to be significantly increased in case of acute suppurative appendicitis. Serum bilirubin was much higher (P &lt;0.000) in cases of gangrenous/perforated appendicitis.Conclusions: Serum bilirubin is an important adjunct in diagnosing the presence of gangrenous/perforated appendicitis.

Huge Atypical Appendicitis in a 14-Year-Old Male: A Case Report

Normal appendix is 4 to 5 mm in diameter and approximately 8 cm in length; although it may be up to 30 cm long. Appendicitis is the inflammation of the appendix and is the most common cause of acute abdominal pain. Right lower quadrant pain, nausea, vomiting and fever are common signs of appendicitis but 20% to 33% of patients with suspected appendicitis present with atypical features. Case presentation: we presented a 14-year-old boy with abdominal pain predominantly in hypogastric area and LLQ (Left Lower Quadrant) that after ultrasound and CT study a large appendix 22 mm in diameter and 17 cm in length was detected. Conclusion: appendix position and size is very variable and appendicitis could be presented by different clinical features. In this case, the patient was presented with LLQ pain rather than RLQ (Right Lower Quadrant) pain due to its large size and elongation to the left side.

A Feasibility Study of Real-Time Remote CT Reading for Suspected Acute Appendicitis Using an iPhone

We aimed to evaluate the feasibility of an iPhone-based remote control system as a real-time remote computed tomography (CT) reading tool for suspected appendicitis using a third-generation (3G) network under suboptimal illumination. One hundred twenty abdominal CT scans were selected; 60 had no signs of appendicitis, whereas the remaining 60 had signs of appendicitis. The 16 raters reviewed the images using the liquid crystal display (LCD) monitor of a picture archiving and communication system (PACS) workstation, as well as using an iPhone connected to the PACS workstation via a remote control system. We graded the probability of the presence of acute appendicitis for each examination using a five-point Likert scale. The overall sensitivity and specificity for the diagnosis of suspected appendicitis using the iPhone and the LCD monitor were high, and they were not significantly different (sensitivity P = 1.00, specificity P = 0.14). The average areas under the receiver operating characteristic curves for all CT readings with the iPhone and LCD monitor were 0.978 (confidence interval 0.965-0.991) and 0.974 (0.960-0.988), respectively, and the two devices did not have significantly different diagnostic performances (P = 0.55). The inter-rater agreement for both devices was very good; the kappa value for the iPhone was 0.809 (0.793-0.826), and that for the LCD monitor was 0.817 (0.801-0.834). Each rater had moderate-to-very good intra-observer agreement between the two devices. We verified the feasibility of an iPhone-based remote control system as a real-time remote CT reading tool for identifying suspected appendicitis using a 3G network and suboptimal illumination.

The role of MRI in Clinically Suspected Appendicitis During Pregnancy

A 31 years female with approximately 20 weeks of gestation attends the emergency department of the Hospital de Clinicas de Porto Alegre (HCPA) reporting pain in the lower abdomen radiating to the right iliac fossa. After clinical and laboratory examination, the clinical diagnosis of appendicitis was suspected, and then performed magnetic resonance imaging (MRI) of the abdomen for diagnostic reasons. The MRI of the abdomen was performed and revealed signs of appendicitis. The intraoperative findings were purulent fluid in the right iliac fossa and appendix with necrotic appearance without signs of perforation. The pathological diagnosis was acute suppurative appendicitis, with periviscerite signals. In pregnant women the enlarged uterus can alter the position of the abdominal contentes and thus make sonography and clinical diagnosis more difficult. CT can be performed in such cases, but it involves a considerable amount of radiation. A typical dose for an abdominal CT examination is on the order of 10 mSv. The routine use of diagnostic CT for benign diseases, as in appendicitis, raises the question whether the diagnosis can be obtained by other radiologic means, especially in pregnant women and even more when the fetus is in the direct beam. The International Commission on Radiological Protection recently published a report on radiation and pregnancy. They recommended that if the expected dose for the fetus is high, one should question whether the diagnosis could be obtained without using ionizing radiation. MRI has been described as a valuable technique for the evaluation of patients with suspected acute appendicitis.

Appendicitis in Pregnancy: How Vestigial is this?

Introduction Appendicitis is the inflammation of appendix, rarely associated with pregnancy with an estimated frequency of one per fifteen hundred pregnancies [1,2]. Appendectomy is a most common non obstetrical surgical procedure in a pregnant patient [1]. The accurate diagnosis of acute appendicitis in pregnancy is usually obscured due to gestational physiological changes. Delay in diagnosis enhances risk of appendiceal perforation, hence rising maternal and fetal morbidity and mortality. Symptoms and signs of appendicitis in pregnancy are quite enigmatic as they often vary with the varying trimester of pregnancy due to changing anatomical location of appendix with consequent enlargement of uterus. Appendicitis occurs most commonly in the first and second trimester but can occur at any gestation [1]. Here we are presenting two cases of acute appendicitis with pregnancy, out of which 1 patient died. Appendicitis is a rare pregnancy associated surgical emergency, with appendectomy as the most frequent non obstetrical surgical procedure performed in pregnancy. Diagnostic delay increases maternal and fetal morbidity and mortality thereby highlighting the need for a prompt diagnosis and surgery. Two cases of appendicitis with pregnancy are being reported with abdominal pain as common presenting feature. One of these patients had fatal outcome probably due to delayed presentation, the other, however, was successfully managed with early surgical intervention leading to normal maternal and fetal outcome. Early surgical intervention in such cases merely on the basis of high index of suspicion is being emphasized. Abstract