Symptoms Of Acute Appendicitis Research Articles

Idiopathic Ascites after Laparoscopic Appendicectomy: a review of literature and a case report

Introduction: Minimal access surgery, encompassing laparoscopy and robotic procedures, has become the preferred choice for a wide range of surgical interventions, receiving widespread acceptance from both surgeons and patients. However, as the utilization of these minimally invasive techniques continues to grow, surgeons are increasingly confronted with unforeseen and puzzling complications. One such rare and perplexing complication is the emergence of ascites following laparoscopic procedures, particularly when no accidental injury to the bowel or urinary system has occurred, posing a challenging and distressing scenario for the operating surgeon. Aims and Objective:We have encountered a case of idiopathic ascites following a laparoscopic appendicectomy in a 10-year-old boy. The primary objective of this study is to conduct a comprehensive literature review to identify similar case reports and publications. By doing so, we aim to enhance our understanding of the causes and principles for managing idiopathic ascites occurring after laparoscopic surgery. Methods: A 10-year-old boy was admitted to the hospital with typical symptoms of acute appendicitis. Following evaluation, a nearly bloodless and uneventful laparoscopic appendicectomy was performed. However, postoperatively, he developed ascites accompanied by scrotal swelling due to scrotal edema, and despite thorough evaluation, no identifiable cause was found. The patient was managed conservatively and fully recovered without any subsequent complications. Results: The occurrence of ascites stemming from an idiopathic allergic or inflammatory peritoneal reaction during a laparoscopic procedure is exceptionally rare. During the patient's evaluation, the paramount concern was to rule out potentially significant complications such as bowel or urinary tract injuries, which can commonly result in postoperative peritoneal fluid accumulation. After the procedure, the boy underwent a thorough evaluation, but no definitive cause for the ascites was identified, further highlighting the enigmatic nature of this condition. Conclusion: Postoperative ascites without a discernible cause following laparoscopic surgery is an unexpected complication. In such cases, the leading hypothesis points to a peritoneal inflammatory reaction induced by agents utilized during laparoscopy. J Bangladesh Coll Phys Surg 2024; 42: 194-198

A neuroendocrine tumor in a macroscopically unchanged appendix

IntroductionThe intraoperative failure to find a macroscopically visible pathological condition within the appendix or other abnormalities of abdominal organs that could explain clinical symptoms in patients eligible for appendectomy does not prejudge the absence of underlying disease in an apparently healthy appendix.AimThe aim of the study is to highlight the problem of possible hidden pathological conditions in a macroscopically unchanged appendix in patients scheduled for appendectomy.Case studyIn this article, we present a case of female patient who was qualified to laparoscopic appendectomy due to symptoms of acute appendicitis. Although intra-operatively appendix did not show any pathological signs, histopathological examination revealed neuroendocrine tumor in the organ.Results and discussionThis publication describes a case of the removal of a macroscopically unchanged appendix in a patient with clinical and laboratory signs of acute appendicitis. A neuroendocrine neoplasm was histopathologically revealed in the removed appendix. The correct eligibility for appendectomy can present great difficulties even for experienced surgeons. Failure to identify visible abnormalities in the appendix after ruling out other possible causes of clinical symptoms does not prejudge the absence of pathological conditions in this organ.ConclusionsThis clinical case shows that the removal of a morphologically normal appendix in a patient eligible for appendectomy, in the absence of other intra-abdominal pathological conditions explaining the clinical signs, is not necessarily a mistake.

APPENDICITIS INFLAMMATORY RESPONSE SCORE FOR DIAGNOSIS OF ACUTE APPENDICITIS AS COMPARED TO ALVARADO SCORE

Background: Acute appendicitis was first described by Reginald. H. Fitz in 1886. It is the most frequent cause of acute abdominal pain requiring surgical intervention. Annually appendectomy is the most common abdominal operation performed on emergency basis. Lifetime risk for developing acute appendicitis is 8.6% in men and 6.7% in women. Acute Appendicitis inciting event in most instances is obstruction of the appendix lumen. Acute Appendicitis is classified as catarrhal phlegmonus, gangrenous and perforated. This classification describes the evolutionary stage of disease. Acute appendicitis is more of a clinical diagnosis present as pain abdomen with classical migration from peri-umbilical region to right iliac fossa in 75% of patient nausea and anorexia. Clinical signs are mostly pyrexia, localized tenderness in the right iliac fossa, muscle guarding and rebound tenderness. Laboratory and radiological investigation are also important tool for the diagnosis. Scoring system have been designed to aid in the clinical assessment of patient with acute appendicitis. The most used scoring is the Alvarado score is best performing in validation studies. Alvarado score doesnt incorporate C reactive protein as a variable, many studies shows the importance of C reactive protein in assessment of patient with appendicitis. Objective: Appendicitis Inflammatory Response score as a diagnostic tool for acute appendicitis in our hospital setting. Study design: A Prospective Study. Study period: October 2016 – September 2018. Study setting: Department of General Surgery, Justice K. S. Hegde charitable hospital. Study population: Patients admitted with signs and symptoms of acute appendicitis at Justice K.S. Hegde charitable Hospital, Mangalore. Sample size: 123 patients using epiinfo software for diagnostic test with PPV 64% with article reference (12) confidence interval of 95% and power of study at 80%. Study group: Patients clinically diagnosed with acute appendicitis and giving consent for the study. Methodology: The present study was conducted in the Department of General surgery, Justice K.S. Hegde charitable Hospital Mangalore, in 123 patients, of any age, who were admitted with complaint of acute appendicitis. Patients included in the study were finally correlate with the histopathological report. Result: The maximum patients were in the age group of 11-20 year compromising around 30.9%. Most of the patients were female around 56.1%. Histopathological report showed around 82.1% as Acute appendicitis, 6.5% acute on chronic, recurrent appendicitis 8.9%, chronic appendicitis, granulomatous appendicitis & lymphoid hyperplasia of appendix were .8% each. AIR classified around 46.3% in low probability, 48% indeterminate and 5.7% in high probability group. Alvarado classified around 3.3% in unlikely, 51.2% in possible diagnosis, 37.4% acute and 8.1% in definite group. On spearman correlation coefficient there was found to be a strong positive correlation between both the scoring system and statistically significant p value of 0.0001. AIR score showed a sensitivity of 56.44% and specificity of 59.09% at score >4. Alvarado had a sensitivity of 98.02 % and specificity of 9.09% at score >4. Alvarado and AIR showed 9.90% and 6.93% at score >8 respectively. The specificity of Alvarado and AIR was 100% respectively. The AIR at a low and higher score had a high PPV and NPV, that may help in correctly diagnosing the patient with acute appendicitis and ruling out from non- appendicitis patient. Conclusion: 1. Alvarado score is better diagnostic tool for acute appendicitis as compared to the AIR score. 2. Alvarado score has higher sensitivity in score of >4 as compared to AIR. 3. AIR score with low sensitivity has low discriminatory power in ruling out patient with acute appendicitis.

Tzanaki’s Score Vs Modified Alvarado’s Score In Diagnosing Acute Appendicitis: A Comparative Study In A Tertiary Care Hospital

Introduction: Acute appendicitis is commonly diagnosed when a patient presents with pain in right iliac fossa. Various Scoring systems are used to diagnose acute appendicitis and mainly include the presenting signs and symptoms, but are not acceptable for patients. The purpose of this study was to assess effectiveness of modified Alvarado score and Tzanaki’s Score in the diagnosis of acute appendicitis. Methods: A prospective observational study was done in department of General Surgery JLN Medical College Hospital, Ajmer which incorporated 200 patients presenting with the signs and symptoms of acute appendicitis. Patients were evaluated by Modified Alvarado score and Tzanaki’s Score during admission and based on the treating surgeon’s decision, were operated. Finally, the score was compared with the diagnosis done by histopathological examination of the operated specimen. Results: The sensitivity & specificity of Modified Alvarado Score was 84.26% & 72.7% respectively with a positive predictive value of 96.15% & negative predictive value of 36.3%. The sensitivity and specificity of Tzanaki’s score was 88.2% and 72.7% respectively with a positive predictive value of 96.31% and negative predictive value of 43.24%. The diagnostic accuracy of Alvarado score was 83% and that of Tzanaki’s score was 86.5%. Conclusion: Tzanaki’s scoring system can be used as an effective modality in the diagnosis of acute appendicitis. There is increased sensitivity and diagnostic accuracy in Tzanaki’s scoring when compared to modified Alvarado score.

Diagnosis of acute appendicitis by modified Alvarado score vs. ultrasound based on histopathological findings: A comparative study

Background: Acute appendicitis commonly causes emergency surgery. Clinical examination accuracy ranges from 71-97%; despite ultrasound diagnostic improvements, accuracy depends mainly on operator experience. This study uses a modified version of the Alvarado score, excluding one laboratory finding (shift to the left of neutrophil maturation). As differential count is not routinely undertaken in the study site (Erbil), patients were scored out of 9 rather than 10 points. This study compares the diagnostic accuracy of ultrasound and modified Alvarado score in the diagnosis of acute appendicitis, to reduce appendicitis mortality and morbidity, and reduce rates of negative appendicitis. Methodology: The study design was a prospective cross-sectional comparative study, which took place in the Surgery, Radiology and Histopathology Department of Rizgary Teaching Hospital and Rozhalat Emergency Hospital, Erbil, from January 2019 to December 2021. All patients who presented to the emergency room with signs and symptoms of acute appendicitis were clinically evaluated. Patients who had a modified Alvarado score > 8 were considered positive for modified Alvarado, and those scoring 6-7 were considered negative for modified Alvarado and were considered for ultrasound examination; among the latter, those with positive ultrasound results were included in the study. Results: Among the 468 patients, 257 (54.9%) were male and 211 (45.1%) were female (1.22:1 male: female ratio), with a mean age of 23.45 ± 2.1 years (ranging from 12 to 56 years). Modified ultrasonography has a sensitivity of 82% and an accuracy of 79.9%; the modified Alvarado score had a sensitivity of 95.2% and an accuracy of 87%. There was no association between the mean age of male and female patients with the histopathological results. The most commonly affected age group was the cohort 21-30 years (51.7% of all patients). The number of patients with positive histopathology was 411; negative histopathology was recorded for 57 patients, with no association between histopathological results and gender. There was a significant association between symptoms (cough signs, localized tenderness signs, and pointing signs) and positive histopathology findings. Conclusion: Modified Alvarado score has higher sensitivity than ultrasound, while ultrasound has a higher specificity. Neither tool is superior to the other, nor both need to be used together to reduce negative appendectomy rates.

A Case with Multiple Systemic Inflammatory Syndrome Presenting with Acute Appendicitis Symptoms

A Case with Multiple Systemic Inflammatory Syndrome Presenting with Acute Appendicitis Symptoms

437 Appedicular Endometriosis – a Rare Intra-Operative Finding

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 nodule, which on histopathology revealed endometriosis. Another important fact revealed on histopathology was bleeding into the endometrial tissue. This patient underwent laparoscopic right hemicolectomy. Postoperative recovery was uneventful. Patient was discharged from the hospital on 5th postoperative day. We did literature research to find out that there have been only two cases reported in the literature of appendicular perforation caused by endometriosis.

A Comparative Study between Pre-Operative and Intra-Operative Findings among Patients with Acute Appendicitis

Background: Acute appendicitis could be due to a bacterial, viral or parasitic infection in the digestive tract, which can enlarge the tissue of the appendix wall, stools causing a blockage in the tube between the large intestine and the appendix tumors, inflammatory bowel disease, injury or trauma to the abdomen. It is a sudden and severe inflammation of the appendix. The symptoms of acute appendicitis occur suddenly and are usually severe. In severe cases, appendicectomy is often needed. Aim of the study: The aim of this study was to compare between pre-operative and intra-operative findings among patients with acute appendicitis. Methods: This cross-sectional study was conducted in the department of Surgery, North East Medical College Hospital, Sylhet, Bangladesh during the period from July 2008 to June 2009. In total 100 clinically diagnosed cases of acute appendicitis were enrolled in this study as study subjects. Proper written consents were taken from all the participants before data collection. All the pre-operative and intra-operative findings among patients were recorded and analyzed. All data were processed, analyzed and disseminated by using SPSS version 16.0 program as per necessity. Results: In this study, among total 100 cases, clinically acute appendicitis was found in 78% and burst appendix in 22% of cases. Appendix was found retrocaecal in 67%, pelvic in 30% and pracaecal, subcaecal and postileal each comprises 1% of the patients. Finally, we found a significant correlation of pre-operative diagnosis with luminal contents (P<0.0001). Besides this, the findings of this study indicated that, the clinical diagnosis was concordance with intra-diagnosis in 84% of cases and discordant in 16% of cases. Conclusion: In this current study, pre-operative clinical diagnosis was concordance with intra-operative diagnosis in majority of the cases. So, we can conclude that, the surgeon should be careful about the pre-operative assessment of the cases in ........

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.

Intestinal Obstruction for Anisakiasis: Surgical and Physical Therapy Treatment

Anisakiasis, a zoonotic disease that can lead to small intestine obstruction, has seen a significant rise in Spain. The country has become the first in Europe with an annual incidence of 8000 cases, primarily due to the popularity of consuming exotic dishes of undercooked or raw fish and the impact of climate change. The clinical presentation of anisakiasis can mimic symptoms of acute appendicitis or intestinal obstruction, leading to potential misdiagnosis. This case report describes a 37-year-old patient with no significant medical history who presented abdominal distension and intense pain in the right lower quadrant. The patient underwent surgery and received physiotherapy treatment, including therapeutic exercises and pulsed-pressure myofascial vacuum therapy, to facilitate functional recovery. The increasing incidence of anisakiasis in Spain underscores the need to consider it in the differential diagnosis of digestive diseases, given the high consumption of poorly prepared or raw fish in the region.

Normal Total Leukocyte Count in Patients Despite Acute Appendicitis Clinically and Preoperatively

Background: The main objective of this study was to ascertain the proportion of individuals diagnosed with acute appendicitis who exhibited clinically and preoperatively normal levels of total leukocyte count. Methodology: During the months of June 2021 and March 2022, researchers from the Department of Surgery at Jinnah Postgraduate Medical Center in Karachi, Pakistan, conducted a prospective observational study. All the patients presented with an impression of acute appendicitis above the age of twelve were included. Complete history, clinical examination, emergency investigations including CBC, UCEs, Ultrasound, X-Rays, Alvarado score were recorded in a predefined pro forma. Patients with low ALVARADO score and normal TLC with signs and symptoms of acute appendicitis were compared with CRP levels which directed the decision of appendectomy rather than conservative management. Per operative findings of stages of acute appendicitis such as acute inflamed, suppurative, gangrenous and perforated appendix were also noted. Appendix was sent to the laboratory and histopathological reports of the specimen were assessed. Results: Patients diagnosed with acute appendicitis and subsequently operated on totaled 270 in the study, 156 (57.78%) were having and ALVARADO score of less than 7 mostly due to normal TLC, while 114 patients (42.22%) were having ≥ 7 ALVARADO score. Preoperatively and histopathological reports of 270 patients of appendicitis 25% patents were acutely inflamed/catarrhal stage , 15.5% gangrenous, 20.59% perforated, while higher number of patients i.e. 38.91 were suppurative appendicitis. Conclusion: Most patients presenting with symptoms of acute appendicitis have normal TLC, meaning low TLC. This needs to be confirmed by caring out by proper examinations and getting inflammatory markers or in cases confirmatory CT if diagnosis can not be made clinically or by lab investigations. Keywords: Appendicitis, ALVARADO score, C-reactive protein, total leukocyte count

Socioeconomic, Laboratory and Associated Factors in Patients Suffering From Acute Appendicitis

Background: Acute appendicitis (AA) is the most common clinical condition worldwide. In Pakistan, about 400,000 appendectomies are routinely carried out in surgical departments yearly. This study aims to find the latest and updated information regarding the diagnostic accuracy of CRP levels in AA. This will help surgeons make timely decisions, thus reducing the morbidity and mortality associated with complicated appendicitis. Methods: This descriptive cross-sectional study was performed at KTH Peshawar from February to august 2018. It was designed to analyze C-reactive protein levels among acute appendicitis patients using positive and negative predictive values. Histopathologically confirmed appendicitis patients were included. Results: In the current study, 216 patients suffering from Acute appendicitis were studied observed. The symptoms duration was < 2days in 75% patients while >2 days symptoms were found in 25% population. Majority patients were poor (46%), followed by middle class (42%), and rich (12%). Obesity was only observed in 22% patients suffering from AA. Diabetes and hypertension was observed in 18% and 15% patients respectively. Diagnostic accuracy of acute appendicitis was also calculated between CRP and Histopathology findings based on age, diabetes mellitus, gender, hypertension, obesity, and period of symptoms. Conclusion: Our study concludes that the acute appendicitis symptoms appeared in less than two days. Acute appendicitis predominantly found in poor and middle class patients. Acute appendicitis should be diagnosed based mostly on its clinical symptoms. Despite the fact that CRP is a particularly helpful marker in the clinical diagnosis of acute appendicitis, general surgeons must apply their clinical judgement. The function of CRP in acute appendicitis should be examined in future research with a bigger sample size. Keywords: C-reactive protein level, Socioeconomical factors, Acute Appendicitis, Diagnostic accuracy, Histopathological.

A PROSPECTIVE STUDY OF LAPAROSCOPIC APPENDICECTOMY IN PATIENTS WITH ACUTE APPENDICITIS WITH PERFORATION

Background: Aims Laparoscopic Appendicectomy is the preferred way of managing an appendicitis with perforation. &objectives: This prospective study aims at knowing the role of laparoscopic appendicectomy in acute appendicitis with perforation. Prospective study. General Surgery In patients, Government General Materials & Methods: Study design: Source of study: Hospital, Anantapur. Duration Of study 18 months starting from December 2020 to May 2022. 50. Number of patients: Inclusion criteria- Both males and females of age 12-60 years presenting with signs and symptoms of acute appendicitis with radiological conrmation of appendicular perforation through USG/CT and consenting for treatment. Age above 60 years, acute appendic Exclusion criteria: itis with diffuse peritonitis features and with mass formation, Pregnant females , Patients not giving consent. Data were presented in the form of graphs, tables, pie Results: charts, and bar charts in the form of signs symptoms, radiological evidence, intraoperative ndings, complications and length of stay in hospital. Conclusion: - LA has been more frequently used for perforated appendicitis in adults and children by surgeons experienced in laparoscopy. laparoscopic appendicectomy in patients with perforated appendicitis is advantageous in reducing post operative morbidity and early recovery of the patient. Study proved laparoscopic appendectomy is the BEST approach in perforated appendicitis.

Acute appendicitis the first sign of appendiceal metastasis of an inoperable carcinoma of stomach-A case report and a review of literature.

Appendicitis is the most common cause of the acute abdomen and usually occurs because of the fecalith in adults and lymphoid hyperplasia in childhood. Gastric cancer metastasis to the appendix is a rare condition that might be present with symptoms of acute appendicitis. The English literature describes only thirteen cases of gastric carcinoma metastasizing to the appendix and presenting as acute appendicitis. In this report, we describe the first case of metastatic signet ring cell carcinoma of appendix presenting with clinical features of acute appendicitis.

Incidental appendiceal neoplasms: Single-centre results.

Histopathological examination of appendectomy specimens may reveal malignancies. Based on these results, either appendectomy is sufficient or sometimes a further treatment protocol can be needed. In this study, malignancy-diagnosed cases on appendectomy specimen were examined. Patients who underwent appendectomy between January 2013 and December 2018 with a pre-diagnosis of acute appendicitis were evaluated retrospectively and those cases with malignancy were included in the study. Patients' age, sex, tumor type, tumor diameter, tumor grade, tumor localization, surgical margin, Ki-67 index, state of lymphovascular invasion, state of peri-neural invasion, and follow-up period duration were recorded. On examination of 2336 appendectomy specimens, 16 patients (0.7%) were found to have neuroendocrine tumors (NET), 11 patients (0.5%) were found to have low-grade mucinous neoplasm (LAMN), and five patients (0.2%) were found to have primary appendix carcinomas. Appendix tumors usually present with acute appendicitis symptoms. Despite re-operation with right hemicolectomy (RHC) being required in the treatment of adenocarcinoma cases, appendectomy provides adequate treatment in most cases with NET and LAMN. With these tumors, which usually have a benign prognosis, it is important to perform the necessary screening in the postoperative period and not to interrupt follow-up.

Alvarado Score: A Promising Tool in Diagnosis of Acute Appendicitis

Introduction: Appendicitis is the inflammation of vermiform appendix, one of the most frequent diagnoses for emergency department visits, resulting in hospitalization. Accurate and prompt diagnosis of acute appendicitis may reduce the incidence of morbidity and mortality resulting from perforation and other gravid complications.
 Aims:To evaluate the effectiveness of Alvarado scoring system in preoperative diagnosis of acute appendicitis.
 Methods: The study of 100 patients attending to Nepalgunj Medical College and Hospital during the year August 2021 to July 2022, with symptoms of acute appendicitis were included. The Alvarado score for each patient was evaluated. All the subjects included were scheduled for open appendicectomy and the specimens were subjected for histopathological evaluation. Patients with score less than 7 were categorized as Group A, whereas greater than 7 were categorized as Group B.
 Results: Among 100 patients, there were 58 males and 42 females. Symptoms like pain in right iliac fossa (97%), nausea and vomiting (85%) and anorexia (41%) were common. Positive signs were tenderness in right iliac fossa (92%) and fever (53.5%) with leukocytosis (73%) and neutrophilia in 62 cases (88%). Of 100 patients 27 belonged to Group A, whereas 73 belonged to Group B. 17 patients out of 27 in Group A were diagnosed with acute appendicitis on histology, whereas, 10 showed negative results. 69 out of 73 subjects in Group B were diagnosed with acute appendicitis on histology, whereas 4 showed negative results on histology. The rate of negative appendectomy was significantly higher in group A than group B. The overall sensitivity, specificity, positive predictive value, negative predictive value were 80.20%, 71.42%, 84.52% and 37.03% respectively.
 Conclusion: The Alvarado score when more than 7 enables risk determination in patients presenting with abdominal pain, linking the probability of appendicitis.

Апендикулярно-генітальний синдром у дітей

The importance of preserving the reproductive potential of the population of Ukraine is due to the increase in the number of women with infertility due to infectious and inflammatory diseases of the abdominal cavity and pelvic organs, which were suffered in childhood and adolescence. Purpose - to determine and systemize of the most significant factors of appendicular-genital syndrome depending on the primary pathological focus; to develop a practically significant classification signs and an algorithm for examination and treatment of girls with combined pathology to improve the results of treatment of this group of patients. Materials and methods. It was carried out an analysis of the medical records of inpatients, girls, for the period from October 2019 to May 2022, who were hospitalized for urgent indications and operated on for acute surgical pathology of the organs of the abdominal cavity and pelvis of an inflammatory nature. The age of the patients ranged from 4 to 17 years old (average age 11.0+0.5 years old). In the process of preliminary analysis, it was found that out of 203 patients who were to be treated surgically for the clinical picture of «acute abdomen», combined appendicular-genital pathology occurred in 13 girls. Results. It was determined that the key feature of appendicular-genital syndrome is the non-specificity of the clinical picture. In the appendicular form of the disease, the symptoms of acute appendicitis predominate in the pathological state, and in the genital form, the symptoms of acute adnexitis dominate. Connective appendicular-genital pathology in the catarrhal form of inflammation of the appendix was determined in 2 (15.39%) cases, in the phlegmonous form in 8 (61.54%) cases, in the gangrenous form in 2 (15.39%) cases, in periappendicular abscess - in 1 (7.68%) case. All patients in the study group underwent surgical treatment, the extent of which in each case was determined by the surgical findings and the prevalence of the pathological process. Most (61.58%) surgical interventions were performed laparoscopically, in compliance with the principles of maximally organ-preserving techniques (appendectomy, organ detorsion, stopping bleeding, excision of cysts, sanitation of the abdominal cavity, and, if necessary, drainage of the pelvic cavity). Only in 2 (15.38%) cases was the removal of the uterine appendages during their torsion, under the conditions of their obvious necrosis and the duration of the disease more than 72 hours. Conclusions. In order to improve the quality and speed of diagnosis of the combined inflammation of the appendix and uterine appendages, as structural elements of the syndrome «acute abdomen», the preoperative examination of patients should be multidisciplinary and necessarily include an examination by a pediatric surgeon, a pediatric gynecologist, and a pediatrician, with ultrasound of the abdominal cavity, pelvis, and retroperitoneal space. Frequency occurrence of appendicular-genital syndrome in girls is on average 6.4% of the total number of patients with the syndrome «acute abdomen». During the surgical remediation of the primary focus of inflammation relative to the appendages of the uterus, the tactics should be as organ-sparing as possible with extensive use of laparoscopic techniques for mandatory visual assessment of the organs of the abdominal cavity and pelvis. Patients who underwent surgical treatment for acute appendicitis in combination with diseases of the uterine appendages should form a separate dispensary group, in which preventive examinations are recommended once every 3 months during the first postoperative year, and thereafter once every 6 months until the moment of patient’s transfer to an adult medical and preventive institution. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Prevalence of Acute Appendicitis Complications in Overweight and Obese Patients: A Cross-Sectional Case Series Study

Background: Obesity is known to increase morbidity and mortality in the general population and therefore is perceived as a risk factor for adverse post-surgical results.Aims: To find the real impact of extra weight on the course of the early postoperative complications of open appendectomy.Methods: A prospective cross-sectional case series study was conducted on 93 patients from a total 100 patients labeled with an acute abdomen with signs and symptoms of acute appendicitis. Early postoperative complications are classified according to the Clavien-Dindo-Classification (CDC) system.Results: Seventy-one (76.34%) patients went through a smooth postoperative period without complications, of which the majority belong to group A with normal body weight (n=39, 54.9%). The most common early complications were superficial surgical site infection (n=14, 15.05), deep surgical site infection (n=6, 6.45%) equally in both groups A, and B that required hospital admission and antibiotic therapy and 2 male patients (2.15%) in the group A; average weight group developed deep surgical site infection both of their intraoperative findings were perforated appendicitis.Conclusions: There is a significant relationship between the duration of hospital stay and the patient's weight (P-value=0.00541). Albeit, the results showed that patients with excess weight need to stay longer in the hospital compared to average-weight patients.

Subhepatic acute appendictits in a 10-year-old male child; typical presentation with atypical location: A case report.

Acute appendicitis, the most frequent emergency in digestive surgery, is a well-known pathology in children and young adults. Its diagnosis presents some difficulties in the elderly. Appendicitis taking place in the subhepatic space (i.e., subhepatic appendicitis) is largely not common, and it occurs as a result of intestinal malrotation and/or mal-descent of the cecum during embryonic development. In our case a 10 year old male child has presented in the emergency department of Pakistan Railway Hospital, with complaints of pain at the right iliac fossa, associated with nausea and three episodes of vomiting. The child also had decreased oral intake since developing the pain. On examination, the child had a pulkse rate of 100 beats per min and a blood pressure of 100/60mmHg. The abdomen was soft with marked tenderness at the right iliac fossa along with guarding in the lower abdomen. There was associated rebound tenderness and psoas sign was also positive. After optimization open appendectomy planned, The caecum was found to be reaching the lower border of the liver and upon mobilizing the caecum, the appendix was located in a sub-he patic retrocecal position (Image 1). The appendix was markedly inflamed and was tortuous in its course with adhesions attaching it to the wall of the caecum. It has been concluded that among 0.009 percent subhepatic acute appendicitis presentation our 10-year-old child was an addition but with typical symptoms of acute appendicitis.

Radiological Diagnosis vs. Surgical Results for Acute Appendicitis in 450 Patients at Qazi Hussain Ahmad Hospital, Nowshera

Objectives: Investigating the surgical findings of acute appendicitis against the radiological diagnosis Methods: This crosssectional study was conducted in the department of Radiology Qazi Hussain Ahmad hospital Nowshera from Jan 2019 to Dec 2019. For sample size who sample size calculator was used. Patients who reported right iliac fossa discomfort, a symptom often associated with acute appendicitis, were included in the research. Participants had to be between the ages of 12 and 65, have had abdominal discomfort, and have it focused in the right iliac fossa/ lower quadrant. Patients were sent to an experienced radiologist for Ultrasonography when they were thought to be experiencing symptoms of acute appendicitis. Patients with negligible ultrasonographic results were assessed for right lower abdominal discomfort. Those with ultra-sonographic results highly indicative of acute appendicitis were subsequently evaluated to rule out complications. Results: There were 450 participants included in our analysis, ranging in age from 6 to 55 (mean 337.8 years), and with a male to female ratio of 3.19:2. We performed 550 ultrasonographic scans on these patients and 500 regular urine examinations. Only 350 patients with suspected acute appendicitis confirmed their suspicions by imaging tests, whereas 450 patients with a confirmed clinical diagnosis had surgery. One hundred forty-four individuals had a laparoscopic appendectomy, and 300 patients underwent open surgery. Each patient had a tissue sample taken for histopathology. Sonographic findings included the presence of an appendix in 351 patients (79 percent), an uncompressible tubular structure in 351 patients (79 percent), fluid in the right iliac region in 118 (13.11%), 103 (11.44%) patients have mesenteric node enlargement, 23 (2.55%) have high-up subhepatic appendix and 24 (2.66%) have mass formation in Hyperemic swelling of the appendix occurred in 648 (72%), blackened/gangrenous appendix in 84 (9.33%), pus around the appendix in 57 (6.33%), enlarged mesenteric lymph nodes in the appendix in 210 (23.33%), perforated appendix in 58 (6.44%), early mass formation in 35 (3.88%), and subhepatic appendix in 23 (2.55%) patients. Practical implication: The results of this study will help the surgeon to make Clinical judgments of acute appendicitis. Conclusion: It is recommended to diagnose appendicitis using Ultrasonography since it is a non-invasive examination. An appropriate diagnostic approach for evaluating appendicitis complications with high sensitivity. Acute appendicitis can be accurately diagnosed 84% of the time using Ultrasonography, although there is a 15% false negative rate. Keywords: Incompressible appendicitis, tubular structure, clinical diagnosis, radiological diagnosis