Symptoms Of Acute Appendicitis Research Articles

IMPACT OF ENDEMICITY OF ASCARIASIS ON DIAGNOSIS OF ACUTE APPENDICITIS

Objective: To determine the impact of endemicity of ascariasis in the manifestation of acute appendicitis.
 Study Design: Prospective observational study.
 Place and Duration of Study: General Surgery Department, Combined Military Hospital Skardu, from May 2012 to Apr 2015.
 Methodology: Patients presenting with symptoms of acute appendicitis were included in the study. Patients were diagnosed after taking detailed history, clinical examination and blood chemistry. All the patients underwent open appendectomy under general anesthesia. Per-operatively presence of worms was assessed in terminal ileum and after that in the lumen of the appendix initially by palpation and then by opening its lumen after it was removed. Histopathologic diagnosis could not be confirmed due to its non-availability as the surgeries were performed in a remote and resource constraint area of the country.
 Results: A total of 224 patients were included in the study. Out of these, 143 (63.8%) were male and 81 (36.1%) female patients. The mean age of patients was 22 ± 6 years. Per-operatively, 21 (9.3%) patients had worms in both ileum and appendicular lumen while 22 (9.8%) patients had worms only in the terminal ileum and there were no worms seen in either ileum or appendix in 181 (80.8%) patients.
 Conclusion: There is a relation of parasitic infestation especially Ascaris lumbricoides in the manifestation of acute appendicitis in endemic areas.

Primary malignant neoplasms of the cecal appendix: unusual findings in acute appendicitis

Introduction: To evaluate the prevalence of appendix neoplasia correlating with patient profile, histological types and frequency. Methods: Data collection was performed in the Pathology Department of a General Hospital, with the objective of identifying patients diagnosed with malignant cecal appendix tumors by histopathologic study of specimens from acute appendicitis. Results: The prevalence of malignant primary epithelial neoplasia of the appendix was 1%. Fifty percent of the cases were neuroendocrine tumors, 35% were mucinous, and 15% were adenocarcinomas. The mean age at diagnosis was 41.3 (SD, 20.4) years (range16-81), with a women/men ratio of 3:1. Discussion: Appendiceal neoplasms are rare and should be suspected manly in women over 40 years of age with suggestive symptoms of acute appendicitis. The size, location, extent, margins and presence of mucin are essential findings for the treatment of these patients.

Difficult cases of differential diagnosis of acute appendicitis

Despite the results of technological progress in medicine, which has made high-resolution methods of medical imaging available, the problem of differential diagnosis of acute appendicitis does not lose its’ relevance. This can be explained by the fact that the symptoms of acute appendicitis are variable, non-specific, and can mimic other diseases with similar symptoms.Three cases of rare diseases of the gastrointestinal tract that simulates acute appendicitis were presented. Those are primary torsion of the greater omentum with necrosis, caecum cancer with lengthy necrosis in a young patient and Crohn's disease that simulates appendicular infiltrate. All patients underwent surgery. Signs of acute appendicitis were indications for surgery. Laparoscopic resection of greater omentum was performed in the first case. In the second case caecum necrosis with peritonitis was revealed by laparoscopy. Conversion laparoscopy to laparotomy was performed. Caecum necrosis with caecum wall perforation and necrosis of terminal part of the ileum was diagnosed. right hemicolectomy with ileo-transverso anastomosis was carried out. Complicated case of Crohn’s disease was suspected. Nevertheless, the diagnosis of colorectal cancer is established by pathomorphology only. This case is interesting because of rare complication of colon cancer – the caecum and the ileum wall necrosis that was manifestation of the disease. In the third case of Crohn’s disease in a young patient the diagnosis of appendicular infiltrate and surgical policy were wrong. At the first laparotomy by McBurney was performed. A dense infiltrate was found in the right iliac fossa. The intervention was finished by local abdominal package. In the early postoperative period an intestinal fistula was formed. The patient underwent relaparotomy and right hemicolectomy with ileo-transversal anastomosis was carried out. Despite the diagnosis of Crohn's disease was questionable patomorphology and was established after half a year only by colonoscopy. The presented cases illustrate the complexity of acute appendicitis and the importance of modern approaches to diagnosis: irreplaceability of laparoscopy and the feasibility of using diagnostic scales. When the right diagnosis is not clear the intervention might be late for using methods of instrumental diagnostics.

Acute Appendicitis During Pregnancy: A Case Series of 42 Pregnant Women.

IntroductionIt is difficult to diagnose the symptoms of acute appendicitis in pregnant women due to its similarities with pregnancy physiology. In this study, we examined the diagnostic value of laboratory parameters in the diagnosis of acute appendicitis in pregnant women.Material and methodsForty-two patients who underwent appendectomy during pregnancy were evaluated. The demographic characteristics, laboratory parameters and imaging methods of the patients were examined. According to the pathology results, the patients were evaluated in two groups as normal appendix and acute appendicitis. In addition, a non-pregnant control group was formed to compare the results between the pregnant and control groups.ResultsThe mean age of the 42 patients was 30±6 years, and the pathology results were evaluated as normal in 16 (38.1%) of the patients. As imaging methods, ultrasonography was undertaken in all patients, with MRI being additionally performed in two patients. When the normal appendix and acute appendicitis groups were compared, no significant difference was observed in terms of laboratory parameters (neutrophil, lymphocyte, white blood cell and platelet counts, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, mean thrombocyte volume, red cell distribution width, and pregnancy trimesters (P>0.05). The group that had undergone appendectomy had a significantly higher rate of negative appendectomy compared to the control group (P=0.001).ConclusionLaboratory parameters alone cannot be sufficient for the diagnosis of acute appendicitis in pregnant patients. If clinical examination, laboratory parameters and USG are not sufficient for diagnosis, MRI is the imaging method that should be considered to reduce negative appendectomy rate.

Complications of appendicitis in a tertiary care centre

Background: Acute appendicitis is the most common surgical emergency. An appendicectomy is considered the gold standard of treatment for acute appendicitis because of the potential risk of disease progression to perforation, gangrene and peritonitis. The aim of this study was to determine the incidence of complications in patients diagnosed with acute appendicitis.Methods: A total number of 70 patients were studied with various symptoms of acute appendicitis and their complications, all patients were presented to PESIMSR, Kuppam from December 2016 to June 2018. Clinical assessment , investigations like WBC counts, X-ray erect abdomen, USG abdomen and pelvis and management were recorded. The incidence of complications were studied. The cases of appendicular mass was treated conservatively, except for those who do not respond to antibiotics.Results: During this study period, among 70 patients aged between 5-45 years, male were 53 and female patients were 17 and 11 patients belong to pediatric age group and 59 patients aged more than 18 years. The commonest complication was postoperative surgical site infection (20%) found in perforated appendix patients in our study. Around 76% of the patients developed complications. Among the female patients diagnosed with acute appendicitis, appendicular perforation being the most common complication and it was the postoperative surgical site infections in males.Conclusions: Acute appendicitis is the most common surgical emergency. Open appendicectomy is the most commonly done procedure in our hospital. The commonest complication is postoperative surgical site infection (20%) found in perforated appendix patients in our study.

Ingesta de proyectil de aire comprimido asociado a apendicitis aguda perforada

We report the case of a 28-year-old male patient with a history of voluntary ingestion of a metallic pellet 20 days before who was transferred to our department with typical symptoms of acute appendicitis. Under that circumstances he underwent conventional appendectomy. The analysis of the preoperative imaging tests and the intraoperative findings help to identify the association between the foreign body and acute appendicitis. Ingestion of foreign bodies, either accidental or voluntary, is an extremely uncommon cause of acute appendicitis; thus, there are few reports in the international literature. This is the first case reported in Argentina.

Enterobius vermicularis appendicitis –An unexpected guest

Background: Enterobius vermicularis appendicitis is one of the rare finding in the appendectomy specimens. It is most often an incidental finding and its role in the causation of acute appendicitis is the topic of controversy. Case Report: An Indian 27-year-old male presented with symptoms of acute appendicitis. His physical examination and laboratory investigations point towards the diagnosis of acute appendicitis following which open appendectomy was performed. Histopathological evaluation suggests Enterobius vermicularis appendicitis. Patient was given antihelminthic medications and his post-operative course was uneventful. Conclusion: All appendectomy specimens must be searched for the parasite since it has varied histopathological spectrum, and its presence helps in the initiation of appropriate medications. Keywords: Enterobius vermicularis, Appendicitis, Pinworm, Diagnosis.

SPONTANEOUS RUPTURE OF WILMS’ TUMOR PRESENTING AS ACUTE APPENDICITIS: A RARE CASE PRESENTATION

In Malaysia, incidence of Wilms’ Tumor (WT) is rare, with only 8 cases reported over four years according to the Malaysia Cancer Registry Report (2012-2016). Reports of spontaneous rupture of WT are scarce and the commonest presentation of this entity is a palpable mass in the abdomen. Herein, we report on the unusual presentation of an 11-year-old boy with typical symptoms of acute appendicitis. The child was subjected to an initial open appendicectomy and diagnosed intra-operatively with a right sided ruptured renal mass. Subsequent investigation leading to the diagnosis of a ruptured Wilms’ tumor and its treatment is discussed in this case presentation.

Predictive Value of Alvarado Score and Ultrasound in the Diagnosis of Acute Appendicitis (A prospective study

Background: Acute appendicitis is the commonest non traumatic cause of acute abdominal pain that needs surgical management .Alvarado score and ultrasonographies are the most cost effective, easy and available aids for diagnosis. The aim of the study was determining the reliability of Alvarado score and ultrasound in the diagnosis of acute appendicitis.
 Results: The study was applied with 100 cases with different types of abdominal pain at presentation with 51 males and 49 females .The sensitivity was97.3% ,specificity 90%, and accuracy 89 of combined usage of Alvarado score and U/S findings preoperatively.
 Patients and method: A prospective non-interventional study including patients admitted with suggestive history with signs and symptoms of acute appendicitis to the surgical emergency ward of Baghdad teaching hospital from July 1st 2017 to Feb 10th 2018, Alvarado score calculated and ultrasonography done for each patient enrolled in this study, then to be followed for intraoperative findings.
 Conclusions: Combined application of Alvarado score and U/S has sensitivity 94.1% ,specificity 90% and accuracy 89% . In our medical facility and emergency ward, acute appendicitis remains as one of the top acute abdominal emergencies needing surgery in patients presenting with atypical clinical finding. So diagnosis becomes difficult. So Alvarado score along with ultrasound findings are useful for increasing the reliability in emergency department for accurate diagnosis of acute appendicitis therefore there should be training for the use of U/S by emergency physician and general surgeon in the diagnosis of acute appendicitis in order to decrease the rate of negative appendectomies .

Negative Appendectomy after Histopathology: Results, Rates, and Predictive Factors

Background: Appendicitis is one of the most common causes of acute abdomen caused by an inflammation of the lining of the vermiform appendix. The management is usually emergent surgical removal. Histopathological examination of the appendectomy specimens are routinely carried out to correlate the histological findings of appendectomy specimens with the clinical diagnosis of acute appendicitis. Methods: This is a retrospective chart review study that utilized the medical records of patients who underwent appendectomy from January 1, 2016 to March 31, 2019 in King Fahad Specialist Hospital (KFSH) in Buraidah. Results: Negative Appendectomy (NA) rate in our study was 7.2% of total 488 patient. According to our findings, a positive computed tomography (CT) was the sole independent predictor of the absence of NA. The prevalence of NA increased among patients with negative CT, an Alvarado score ? 4 and those with an illness duration >1 day. Conclusions: Appendicitis can be challenging to diagnose, and misdiagnosis was mostly associated with female gender. To reduce NA rate, CT scans can be used for patients with symptoms of acute appendicitis and the improvement of the Alvarado score. Further prospective studies are needed to validate our findings and demonstrate how unnecessary appendectomies can be avoided.

Role of abdominal ultrasound and Alvarado Score in diagnosing and preventing negative laparotomies in acute appendicitis - a descriptive study

Background: Acute appendicitis is a common condition encountered by a surgeon. If left untreated it can have severe morbidity and can lead to morbidity. Symptoms of acute appendicitis mimic a number of other conditions making it difficult to accurately diagnose. This study aims to use Alvarado scoring and ultrasound abdomen to diagnose acute appendicitis and reduce negative appendectomy rates. Methods: The study was a prospective observational study conducted in the Department of General Surgery, Sree Gokulam Medical College and Research Foundation. The study constituted of 80 consecutive patient who was above the age of 14 and underwent surgery and gave consent for the study. The patients were assessed by clinical examination, Alvarado score and an ultrasound abdomen. The results of histopathology were compared with the Alvarado score and ultrasound abdomen and their accuracy was assessed. Results: The majority of patients in this study were males with 80% being in the 14-29 year age group. Ultrasound proved conclusive in predicting appendicitis 37(50%) of 80 patients with a sensitivity of 50, specificity of 16.7 and an accuracy of 47.5. ALVARADO score was more than or equal to 7 in 70(88.8%) cases. The sensitivity was 94.6 and was specificity 83.3. The predictive value of the positive test with ALVARADO Score was 98.6, with 93.8% accuracy. Combining ALVARDO score and ultrasound abdomen negative appendectomy rate was found to be 7.5% in our study. Conclusion: The aim of this study was to evaluate the use of the ALVARADO score and USG abdomen in diagnosing acute appendicitis. Clinical assessment is the mainstay of diagnosis with ALVARADO score and ultrasound significantly contributing to the more efficient diagnosis and reduction in negative laparotomies.

A Case Report on Appendicular Endometriosis

Background: Appendicular Endometriosis represents less than 1% of all pelvic endometriosis cases. It manifests with pain in right iliac fossa and bear resemblance to acute appendicitis. Definitive diagnosis is possible only after histopathological examination of excised appendix. Case presentation: We report a rare case of Appendicular Endometriosis (AE) in a 38 years old non-married female, otherwise healthy, came to emergency room with less than 24 hours lower abdominal pain associated with nausea but no vomiting. All other systemic review was unremarkable. Patient has no positive medical or surgical history. Blood investigations were normal and abdominal ultrasound US showed edematous wall thickening of the appendix with 12 mm distended lumen. Laparoscopic appendicectomy was performed with incidental finding of blood-tinged fluid in the pelvis and multiple prominent fibroids of the uterus, the appendix was inflamed, and appendectomy done. Postoperative recovery course was uneventful. The final histopathological examination confirmed endometriosis of appendix. Conclusion: AE is a rare entity and almost always diagnosed after histopathological examination. it should be included in the differential diagnosis of acute abdominal pain, especially when women of childbearing age present with clinical symptoms of acute appendicitis.

Appendicitis and COVID-19: yet another clinical dilemma

Acute appendicitis is the most common general surgery encountered in the emergency room worldwide. Management of acute appendicitis in patients who are tested positive for SARS-CoV-2 is still under debate as the full course of this novel disease is not yet mapped out. Here, we report three patients who presented with symptoms of acute appendicitis without any respiratory complaints. Three patients presented to surgical emergency room with classical symptoms and signs of acute appendicitis with modified Alvarado score of more than 6/9. Though they did not have any respiratory symptoms, they tested positive for SARS-CoV-2 by RT-PCR method. All patients underwent open appendicectomy. Open appendicectomy was preferred procedure to minimize aerosol generation and for safety of operating health care workers. Histopathology was suggestive of inflamed appendix and post-operative course was uneventful. Gastrointestinal symptoms like appendicitis could be a varied and sole presentation in patients suffering from COVID-19 infection. Conservative approach can be considered in all patients suffering from acute appendicitis and surgery can be reserved for those not responding to conservative line of management or having complications in form of perforated or gangrenous appendix and appendicular abscess. Further research may elaborate the correlation between COVID-19 and acute appendicitis.

Pericardial disease as a rare complication of pediatric appendicitis: a systematic literature search

BackgroundClassic symptoms of acute appendicitis are well known but are uncommon and often misinterpreted in pediatric patients, potentially delaying diagnosis and resulting in rare sequelae.MethodsWe conducted a comprehensive systematic literature search of case reports detailing pericardial disease as a rare complication of pediatric appendicitis through MEDLINE, Embase, and Cochrane Databases. Inclusion criteria was that the patient must be < 18 years old and present with both pericardial disease and appendicitis.ResultsOur search yielded 7 cases with an average age of 10.3 ± 3.9 years old. The cases involved cardiac tamponade, pericarditis, and/or pericardial effusion. Five cases were diagnosed with appendicitis before complicated by pericardial disease. Most cases had an infectious component, but a majority had negative pericardial fluid cultures. Pleural effusion and abdominal abscesses were other common complications of pediatric appendicitis.ConclusionAwareness of this uncommon relationship may have prognostic value as this may facilitate appropriate management of pericardial effusions, tamponade, and/or appendicitis.

Computed Tomography for Acute Appendicitis Diagnosis and Confirmation in Men : Trends and Cost Implications.

The classic findings of acute appendicitis-right lower quadrant pain, anorexia, and leukocytosis-have been well known. However, emergency medicine and surgical providers continue to rely on imaging to confirm the diagnosis. We aimed to evaluate the increase in reliance on computed tomography (CT) scans for acute appendicitis diagnosis over time. We conducted a retrospective study of patients ≥18 years presenting to UNC Hospitals with signs and symptoms of acute appendicitis who subsequently underwent appendectomy from 2011 to 2015. Demographic, clinical, laboratory, and pathologic data were reviewed. We evaluated the incidence of CT scans stratified by year, age, and sex. Within our male population, 55.2% (278/504) had classic appendicitis symptoms. Of the 278 male patients with classic appendicitis symptoms, 248 underwent CT imaging. Male patients <45 years of age were more likely to present with classic appendicitis symptoms (216/357, 60.5%) compared with patients aged 46-65 (52/108, 48.1%) or >65 (10/39, 25.6%). Of the male patients <45 years with classic appendicitis symptoms, the incidence of CT scans increased over time (68.3% in 2011, 84.2% in 2012, 92.3% in 2013, 93.9% in 2014, 92.3% in 2015). When considering the 216 CT scans that could have been avoided in our population, we calculate an approximate savings of $173 998.80 over 5 years. The incidence of CT scans for acute appendicitis confirmation has increased over time even in men. CT scans for the diagnosis or confirmation of acute appendicitis should rarely be indicated in men aged <45 years with classic appendicitis symptoms.

Enterobius vermicularis infection associated with appendicitis, Meckel’s diverticulitis, and peritonitis

Enterobius vermicularis (EV) is a tiny helminth that lives in the human cecum. Its prevalence varies widely by region and social setting. It is diagnosed easily with perianal sticky tape test and microscope visualization for eggs or worms. The treatment is mebendazole or albendazole drugs. Serious sequelae are not thought to be common, but they can include peritonitis, mesenteric abscess, intestinal perforation, enteric ulceration, enteritis, Meckel’s diverticulitis, and intussusception from ectopic worm movement. More controversial is the association of EV with appendicitis. Here, I am reporting the case of a 9-year-old child with clinical symptoms of acute appendicitis and peritonitis. A Meckel’s diverticulitis is also operatively established. Histological examination revealed EV in the lumen of the appendix and Meckel’s diverticulum. Pediatricians encounter EV in varying frequencies, but this helminth must be considered on a daily basis from doctors from all specialties in connection with a wide variety of potential, sometimes severe complications.

Preoperative Factors Associated with Appendiceal Tumors in Nonelective Appendectomy.

Background: The rates of incidental appendiceal neoplasms after appendectomy performed for acute appendicitis is <2%. To date, no large studies have investigated the preoperative risk factors or imaging findings associated with incidental appendiceal tumors that present as appendicitis. Our study aims to identify preoperative factors that are associated with an increased risk of appendiceal tumors in patients who present with signs and symptoms of acute appendicitis. Materials and Methods: Using the targeted appendectomy American College of Surgeons National Surgical Quality Improvement Program database, we identified patients who underwent nonelective appendectomy for acute appendicitis in 2016. Patients with final pathology consistent with a tumor were compared with those with only appendicitis. A nonmatched case/control method was used to pull a random sample from the appendicitis cohort using a 1:4 ratio (tumor: acute appendicitis) to obtain adequate power for comparison. Preoperative patient variables and imaging findings were investigated using stepwise logistic regression to identify variables associated with appendiceal tumor. Results: Following multivariate analysis, preoperative imaging read of "indeterminate" and "not consistent with appendicitis," female gender, increased age, and lower preoperative white blood cell (WBC) count were significant predictors of tumor causing symptoms of appendicitis. The odds of having tumor pathology were significantly increased in patients with preoperative imaging of "indeterminate" and "not consistent with appendicitis." The odds of having tumor pathology were 82% higher for females than for males, increased by 2% for every 1-year increase in age, and increased by 3% for every one-unit decrease in WBC count. Conclusion: While incidental appendiceal tumors can present as acute appendicitis, 3 patient variables and one imaging finding were identified that may increase suspicion for appendiceal tumors. Consideration should be given to patients with these associated risk factors for additional preoperative consultation in addition to the potential for intraoperative pathology consultation.

Appendiceal Mucinous Adenocarcinoma with Concurrent Tuberculous Appendix: An Unusual Overlap of Two Rare Diseases

Background: Primary tumors of the appendix are rare and present with symptoms of acute appendicitis or a palpable right lower quadrant mass. The appendix is also an uncommon site of granulomatous tuberculosis infection for gastrointestinal extra pulmonary disease. This case report highlights an unusual overlap of the two diseases and a brief review of literature.

Retrospective Diagnosis of COVID-19 in an Asymptomatic Patient Undergoing Emergency Surgery

Background: With reports of higher mortality and complications occurring in patients with perioperative 2019 novel coronarvirus disease (COVID-19), most elective surgeries have been postponed. However, evidence regarding emergency surgeries in patients with COVID-19 remains scarce. We report the case of a patient with asymptomatic perioperative COVID-19, presenting with an acute abdomen requiring surgery. Case: A 25-year-old male, with a prior nasopharyngeal swab that was negative for SARS-CoV-2, presented with classical signs and symptoms of acute appendicitis. Clinical examination and investigations were not suggestive of COVID-19 infection. He underwent laparoscopic appendicectomy with infection control precautions. Post-operatively, he was found to be positive for SARS-CoV-2 but remained asymptomatic and had an uneventful recovery. Conclusion: In asymptomatic individuals with higher risks, negative test results should be viewed cautiously. The benefits of urgent surgical interventions must be weighed against the risks of complications due to perioperative COVID-19 in these patients.

Comparison between the Alvarado score and RIPASA score for Diagnosis of Acute Appendicitis in Patients Attending to Emergency Departmentin Suez Canal University Hospital

Appendicitis is one of the most frequently experienced abdominal surgery. The acute appendicitis diagnosis is primarily in the form of symptoms and signs. Symptoms of acute appendicitis at an early stage of presentation overlap with other conditions that make the diagnosis an extremely difficult task. The Alvarado score and RIPASA score allow for risk stratification of abdominal pain patients, which links the likelihood of appendicitis to recommendations for discharge, observation, surgery.Methods: In one hundred patients with an apparent clinical picture of acute apendicitis aged 18 to 60 years, both sexes were included, diagnostic analysis was carried out in the form of a descriptive prospective study. Excluded from the study were pregnant women. Results: the sample age ranged from 22 to 60 years. The Alvarado scoring system's sensitivity and specificity were 91,7% and 48,14% respectively. The RIPASA scoring system was 96.3 and 68.4 percent respectively in terms of its sensitivity and specificity. Conclusion: The RIPASA score is currently a better diagnostic diagnostic scoring system than the Alvarado score with a higher sensitivity, specificity, positive prediction, negative prediction and diagnostic correctness.