Tenderness In Right Iliac Fossa Research Articles

VERY RARE COMBINATION OF PATENT VITELLOINTESTINAL DUCT WITH PATENT URACHUS

Introduction - The vitelline duct is the embryological narrow channel connecting the yolk sac with the intestine. During the foetal life, vitelline duct tends to obliterates itself till to disappear. The partial failure of this obliteration can lead to the development of a duct, a ligament, or a diverticulum known as a Meckel's diverticulum. A Patent omphalomesenteric duct occurs because of the complete lack of vitelline duct.[3] The urachus is an embryological remnant of the allantois. Between the fourth and fth month of gestation, the foetal bladder tends to descend gradually and its apical portion creates the urachus. The urachus obliterates itself, becoming the median umbilical ligament. Its persistence after intrauterine life can manifest as urachal remnants. A patent urachus is because of complete lack of obliteration of urachus [1,3]. The incidence of these anomalies PU was 1-2 per 10000 while PVD is 1 in 5000 to 8000 deliveries [1,3,5]. The association of both anomalies is very rare [7]. Case discussion- A 12-years-old male presented with complaints of pain in abdomen, multiple episodes of vomiting. Patient was tachycardiac with tenderness in right iliac fossa with palpable lump with ultrasonography suggestive of perforated appendix with lump formation and was managed conservatively and asked for interval appendicectomy with CECT abdomen. CECT was suggestive of normal and compressible appendix with infected urachal cyst. But after 4weeks patient had similar complaints hence posted for emergency operation with McBurney's incision not by midline incision to avoid injury to urachal cyst. Intra operative ndings-1) patent Vitello intestinal duct 2) patent urachus 3)15cc pus discharge near umbilical end of urachus 4) normal appendix and small bowel. Resection of Vitello intestinal duct and urachus with ileoileal anastomosis done and specimen sent for histopathology which was suggestive of patent vitello intestinal duct with changes of gangrene. The Patent Vitello Conclusionintestinal duct with patent urachus is very rarely seen in combination and its diagnosis may be missed preoperatively and should be kept as a possibility in patients with patent urachus with or without infection

APPENDICEAL INFLAMMATORY MYOFIBROBLASTIC TUMOUR: A RARE POSTOPERATIVE FINDING

Introduction- Inammatory myobroblastic tumour (IMT), which usually affects children and young adults, is a rare neoplastic lesion of unknown aetiology.[1–5]Once thought to be reactive, now these lesions are considered to be neoplastic.[2] Denitive diagnosis of IMT is conrmed by histopathological analysis and immunohistochemical tests of surgically removed specimen.[1–5] According to the World Health Organization, IMT is a distinctive lesion composed of myobroblastic spindle cells accompanied by an inammatory inltrate of plasma cells, lymphocytes, and eosinophils.[1–6] Inammatory myobroblastic tumour is a relatively new histopathological term. In the literature, this entity was formerly known as inammatory pseudotumor, plasma cell granuloma, plasma cell pseudo-tumour, pseudo-sarcomatous myobroblastic proliferation, reactive pseudo-sarcomatous response, omental-mesenteric myxoid hamartoma, and inammatory brosarcoma. This unication of descriptive terms was achieved on the basis of considerable morphological and clinical overlap, combined with both clinical and genetic evidenc of its neoplastic nature.[2,3,5,7] IMT was rst described in 1937 as a primary lung tumour [1,2,3,5,7] but it was subsequently recognized that virtually any anatomical site can be involved.[1,4,6,7] Most of the extrapulmonary IMTs are localized in the mesentery of the small intestine, omentum, and retroperitoneum.[1,4] To this date, IMTs of the gastrointestinal tract are rare.[1,3,8] Most of these reported cases are adolescent or adult males.[2,3] A 13 years old male patient presented to surgery casualty wi Case Report- th complaints of pain in abdomen vomiting for 4 days on clinical examination patient have tachycardia and tenderness in right iliac fossa. Initial USG A+P was suggestive of perforated appendix with early lump formation. Patient was managed conservatively and discharged after 3 days. But after 2 weeks patient again presented with similar complaints and progressively increasing lump in right lower abdomen. Lump was 15x8cm in right iliac fossa extending to hypogastric and right lumbar region rm to hard in consistency with mild tenderness on deep palpation. Ultrasound of abdomen suggestive of organised haematoma. CECT abdomen and pelvis suggestive of inamed appendix with suspicious perforation and well-dened heterogenous collection of max volume 340cc could represent organised haematoma. Patient was posted for elective exploratory laparotomy with intra op ndings of 1) mass of size 15x10x8cm located in right lower quadrant 2) whole specimen weighed 350gms 3) appendix showed diffuse inammation and adherent to mass. Appendicectomy along with excision of mass was done and sent for histopathology. HPE Report-Benign spindle cell lesion highly suggestive of inammatory myobroblastic tumour. IMT is a rare lesion that can represent a Conclusion- n unexpected intra-operative nding at emergency surgery. Generally, IMTs have a good outcome but they have a tendency for local recurrence and small risk of distant metastasis. IMT can be observed in appendices even though it is rare. Complete surgical resection should be the method for curative treatment. Denitive diagnosis of IMT is conrmed by histopathological analysis and immunohistochemical tests of surgically removed specimen.

Accuracy Evaluation of Pediatric Appendicitis Scoring (PAS) Method in Differentiating Nonspecific Abdominal Pain from Appendicitis

Background: This study aimed at evaluating the accuracy of the pediatric appendicitis scoring method in differentiating nonspecific abdominal pain (NSAP) from appendicitis. Methods: This cross-sectional study was conducted on 391 children who were hospitalized in the emergency ward due to acute abdominal pain suspected of appendicitis. Pediatric Appendicitis Score (PAS), C-reactive protein (CRP), and appendicitis pathology results of patients undergoing surgery were recorded. Results: The results showed that the no significant difference was found among patients in the three experimental groups (appendicitis, specific abdominal pain except appendicitis, and NSAP) with respect to temperature (p = 0.212), but the other variables were significantly different. Findings showed that high CRP frequency, pain migration to right lower quadrant (RLQ), tenderness in right iliac fossa (RIF), anorexia, leukocytosis, high neutrophil, and mean tenderness in RLQ in the appendicitis group were higher than those in the other two groups (p = 0.001). The PAS questionnaire can also be used as a reliable questionnaire with appropriate sensitivity (0.929) and specificity (0.993), and this questionnaire along with detailed clinical examinations could reduce the rate of negative appendectomy to less than 1%. Conclusions: This study showed high accuracy of PAS in diagnosing children with appendicitis and differentiating appendicitis from cases of NSAP and specific abdominal pain other than appendicitis. The PAS system could also significantly reduce cases of negative appendicitis. Although high CRP had an excellent ability to diagnose appendicitis, its accuracy was lower than PAS.

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.

Serum C-Reactive Protein A Helpful Marker in Diagnosis of Acute Appendicitis

Objective: evaluate the diagnostic accuracy of serum C-reactive protein levels in acute appendicitis (AA) Methodology: Two hundred suspicious cases of AA presenting with pain in right iliac fossa in addition to nausea/vomiting, direct tenderness in right iliac fossa of either gender in adult population were included. Intravenous blood sample was drawn for CRP evaluation. Appendectomy was performed in all these cases, and histopathological examination was done to confirm presence/absence of AA. Both the reports were evaluated and AA was considered positive if CRP levels are >6 μg/dl. A 2x2 table was drawn to analyze diagnostic accuracy of CRP. Results: The mean age was 27.11+10.42 years, 80.5% (n=161) cases were diagnosed as acute appendicitis on histopathology. The diagnostic accuracy of serum C-Reactive Protein levels shows 81.63% for sensitivity, 73.58% for specificity, 89.55% had positive predictive value, 50.09% negative predictive value while 79.50% had accuracy rate. Conclusion: serum C-reactive protein levels is a useful marker for diagnosing acute appendicitis and may be used in rural areas where USG and CT scan facility is not available. Keywords: Acute appendicitis, diagnosis, serum C-reactive protein, diagnostic accuracy

Determine the Accuracy & Use of Ultrasound Guidance and Alvarado Score for Diagnosing Acute Appendicitis

Background: Appendicitis is one of the most common and frequently encountered operations in surgical emergencies. It is the most frequent cause of acute abdominal pain. Early and accurate diagnosis can reduce the rate of negative appendectomy (surgical removal of appendix) and helps to provide better treatment with no extra cost and complications. Aim: The objective of this study was to examine the accuracy and use of ultrasonography and Alvarado score system for diagnosing Acute Appendicitis. Place and Duration of Study: Radiology Department Hayatabad Medical Complex, Peshawarfor duration of six months from January 2021 to June 2021. Methods: In this cross-sectional observational study, 130 patients of abdominal pain having ages of 10 years to 70 years were included. All patients had diagnosis with Alvarado scoring system and ultrasound for identifying Acute Appendicitis. Patients’ detailed history including age, sex and histopathology and ultrasonographic results were recorded. All statistically data was analyzed by SPSS version 17. P-value <0.05 was considered as significant. Results: Out of 130 patients, 95 (73.08%) patients were men and 35 (26.92%) patients were women. 15 (11.54%) patients were ages less than 20 years, 75 (57.70%) patients having ages between 20 to 39 years, 32 (24.62%) patients were aged between 40 to 59 years and 8 (6.15%) patients were ages of >59 years. Symptoms observed in all patients such as anorexia, nausea and vomiting, tenderness in right iliac fossa, rebound tenderness, elevated temperature as 71.54%, 53.85%, 100%, 95.39% and 84.62% respectively. In all 130 patients 122 (93.85%) had found acute appendicitis by using ultrasound. As per histopathology results 95 % had acute appendicitis and 5 % had chronic or normal appendicitis. Conclusion: It is concluded that Alvarado Score system along with noninvasive ultrasound guidance resulted accurately and helps to reduce the rate of negative appendectomy, complications and infections with no extra cost. The combine role of Alvarado score and ultrasonography can helps to provide better treatment in acute appendicitis. Keywords: Alvarado score system, Histopathology findings, ultrasound results, Appendicitis.

Positive Predictive Value of Serum Amylase in Predicting Acute Appendicitis taking Histopathology as Gold Standard

Background: Worldwide acute appendicitis is one of the most commonly encountered abdominal emergencies. Despite recent advances in imaging and laboratory parameters, the diagnosis still remains clinical. This study was carried out to determine positive predictive value of serum amylase in diagnosing acute appendicitis taking into account histopathology as gold standard. Methods: Total 103 patients of both genders aged between 15-40 years presenting with pain and tenderness in right iliac fossa and vomiting having raised serum amylase > 85U/L were included. These patients underwent appendectomy followed by histopathology of excised tissue. Diagnosis of appendicitis was confirmed on histopathology postoperatively and results of increased serum amylase levels were interpreted accordingly as true positive/ false positive. Informed consent was taken from all enrolled patients. Results: Mean age of the enrolled patients was 27.8±7.5 years. There were 59 (57.3%) male and 44 (42.7%) female patients, with a male to female ratio of 1.3:1. The BMI of enrolled patients ranged from 22.0 Kg/m2 to 34.4 Kg/m2 with a mean of 26.9±3.4 Kg/m2. Diagnosis of appendicitis was confirmed in 93 (90.3%) patients on histopathology. Thus there were 93 true positive and 10 false positive cases. It yielded a positive predictive value of 90.3% for serum amylase in predicting acute appendicitis taking histopathology as gold standard. Similar positive predictive value was noted across various subgroups based on age, gender and BMI. Conclusion: In the present study, the positive predictive value of raised serum amylase was found to be 90.3% in predicting acute appendicitis which along with simplicity and routine availability of the test and low cost advocate the preferred use of this novel biomarker in the diagnostic workup of such patients in future surgical practice. Keywords: Appendicitis, Serum Amylase, Positive Predictive Value

Comparative Study between Modified Alvarado Score and Abdominal Ultrasound Diagnostic Value of Acute Appendicitis in Children

Background: Diagnosis of acute appendicitis depends mainly on clinical diagnosis. However, the high negative rate remains a challenge and different aids for diagnosis had been proposed. The aim of the work: The current work aimed to assess the sensitivity of Modified Alvarado Score [MAS] in diagnosis of acute appendicitis. Patients and Methods: One hundred children with clinical manifestations of acute appendicitis were included. Patients were categorized into two groups according to MAS: [group A] included 50 patients with [MAS] ≥ 7 regardless of sonography results. The second group [group B] included another 50 patients with MAS . Results: Tenderness in right iliac fossa was the most frequent sign in the study population [98%]. Histopathology revealed positive results among 49 patients [47 in group A and 2 in group B] with significant difference between groups A and B. The overall sensitivity and specificity of ultrasonography were 89.4% and 33.3% respectively and were 96.0% and 20.0% respectively of MAS score. Conclusion: In acute appendicitis, MAS is a good diagnostic [sensitive] tool. Sensitivity increased when combined with ultrasound, as the number of negative appendectomies was reduced.

Endometriosis of the appendix presenting as acute appendicitis

Acute appendicitis is a surgical emergency and accounts for 27.5% of the surgical cases. It is a very common cause of non-gynecologic lower abdominal pain and may occur simultaneously with a variety of gynecologic diseases. We report a case of a 24 years old female, who presented to the surgical emergency department with complaints of acute pain in abdomen for the last 1 day with tenderness in right iliac fossa. Laboratory reports showed leucocytosis with neutrophilia, with presence of toxic granules. A provisional diagnosis of appendicitis was made and the patient was operated. The appendectomy specimen on histopathological examination showed ectopic endometrial glands and stroma in the serosa, based on which a diagnosis of appendiceal endometriosis was given. This case emphasizes the importance of considering the diagnosis of appendiceal endometriosis in a young female of child bearing age with a clinical diagnosis of appendicitis. Keywords: Appendicitis, Endometriosis, Endometrial glands, Stroma.

Amoebic Colitis Presenting as Subacute Intestinal Obstruction with Perforation

Infestation with Entamoeba histolytica is worldwide, especially in developing areas. Presented case study included amoebic colitis in a 45 years old man complaining of abdominal distension and non-passage of stools since three days. Abdominal region was diffusely distended and tender in right iliac fossa. Plain abdominal radiography revealed prominent gut loops and minimal intergut free fluid. At laparotomy, malrotation of gut was present. Histopathological examination of intestinal samples confirmed final diagnosis of amoebic colitis post-operatively.

An unusual presentation and management of incarcerated Richter’s type of Spigelian hernia: a rare case report and review of literature

Spigelian hernias (SH) are one of the rare forms of ventral abdominal hernias which constitutes about 1-2%. SH occurs through the defect in the anterior abdominal wall adjacent to the semilunar line which occurs in the lower abdomen where the posterior sheath is deficient. The usual presentation of SH is a painful mass in mid abdomen above anterior superior iliac spine (ASIS). The diagnosis is made by means of ultrasound and computed tomography (CT). We report 69 years old female who is a known case of Parkinson’s disease and on medication presented with 2 days of sudden-onset right iliac fossa (RIF) associated with intermittent nausea, vomiting and also abdominal distension. O/E: Abdomen soft, tenderness in RIF with swelling above the line of ASIS. With the diagnosis of lateral abdominal wall hernia we took a CT scan that shows obstructed SH. Immediately she underwent surgery, intra-operative picture shows intraparietal hernia with Richter’s type and viable bowel. Abdominal wall is very weak and flimsy with no proper differentiation between the layers. Preperitoneal mesh repair was performed. The post-operative (post op) period was uneventful. Till now there was only 6 type of Richter’s SH reported. In this article we discuss a brief knowledge of SH and the management part of SH. We hope that this article will benefit among the surgeons in treating with SH.

Pediatric appendicitis- five year experience at tertiary care pediatric surgery department: a cohort study

Background: Acute appendicitis is one of the most common abdominal surgical condition in pediatric population. It accounts for 1-8% of children presenting in pediatric surgical emergency. The aim of this study was to evaluate pediatric appendectomy in our department.Methods: It was a hospital based prospective cohort study spanning over a period of 5 years, where all diagnosed cases of pediatric appendicitis were enrolled. Demographic profile, clinical features and operative findings were analyzed. Patients were kept on regular follow-up and complications were noted.Results: During the study period 146 patients were enrolled for the study. Male: female ratio was 1:1. Maximum patients belonged to age group of 11-15 years (42%). Pain in abdomen and fever were the most common presenting symptoms. Tenderness in right iliac fossa was the most common clinical sign (89.72%) and inflamed appendix was the most common operative finding in the study (83.91%).Conclusions: The diagnosis of acute appendicitis is based on clinical examination. Atypical symptoms may lead to delay in the diagnosis and management. Imaging and lab investigations are supportive. Early recognition of symptoms, access to healthcare facility with a surgeon can significantly reduce the morbidity and complication rates in pediatric age group.

An Uncommon and a Rare Presentation of Acute Appendicitis with Calculus Cholecystitis in a 12-Year-Old Girl: A Case Report

Acute appendicitis is very common general surgical emergency in teenagers while cholecystitis is common in middle-aged females but cholecystitis at the age of twelve year is very rare and along with acute appendicitis is even rarer. We describe a case of 12-year-old female who came to the outpa- tient department of Abbasi Shaheed Hospital with the complain of on and off pain in the right iliac fossa for the last one year. Abdominal examination was positive for rebound tenderness in right iliac fossa at the McBurney's point. Computed Tomography scan of whole abdomen showed gallstones with normal looking appendix. Impression of acute calculus cholecystitis with recurrent acute appen- dicitis was made. Laparoscopy along with laparoscopic cholecystectomy was planned. On Laparoscopy appendix was found to be inflamed so laparoscopic cholecystectomy along with laparoscopic appendectomy was done via the same ports. Acute appendicitis along with cholecystitis due to cholelithiasis is very uncommon and very few cases have been reported in literature.

Evaluation of modified Alvarado scoring system in acute appendicitis at Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India

Background: Despite of much advancement in modern diagnostic technology, decision making in patients with acute appendicitis is still a challenge worldwide. Many diagnostic scoring systems have been developed. Of them modified Alvarado scoring system (MASS) has been reported to be a cheap and quick diagnostic tool which minimizes negative appendectomy rate. The present study was aimed to evaluate the efficacy of MASS in diagnosing acute appendicitis and correlating the same with histopathological results.Methods: This prospective cohort study conducted from November 2012 to April 2014, over a period of 18 months at Vydehi Institute of Medical Sciences and Research Centre, Bangalore. 100 patients with symptoms of acute appendicitis were enrolled in the study. They were diagnosed using MASS. Patients with a score of 7 to 10 were taken up for surgery. Patients with a score below 7, but with high suspicion of acute appendicitis by the surgeon were taken up for surgery. Following surgery all appendix specimens were sent for histopathologic examination.Results: A total number of 100 patients were participated in the study. Of them patients under the age group of 21-30 years were more affected with acute appendicitis (51%). Male predominance was observed in the study (74%). The common symptom observed in all patients (100%) was tenderness in right Iliac fossa (RIF). Out of 100 patients, 79% of the patients were presented with a modified Alvarado score of ≥7 and 21% presented with a score of <7. The sensitivity and specificity of the MASS in this study was 89.66% and 92.31% in both males and females respectively. The positive predictive value was 98.73%, negative predictive value was 57.41% and the NAR was 6.75% and 30.76% in male and female patients respectively.Conclusions: The observations of the study confirm that use of MASS in patients suspected to have acute appendicitis provides a high degree of diagnostic accuracy and subsequently reduces the negative appendicectomy and complication rates.

ACUTE ABDOMINAL PAIN IN CHILDREN

Objective: To determine the clinical outcomes of acute abdominal pain andevaluation of symptoms and signs in children admitted in pediatric surgery department.Design: Cohort study. Place and Duration of study: This study was conducted in Departmentof Paediatric Surgery Shaikh Zayed Hospital, Lahore between August 2010 to August 2012.Patients and methods: Children aged 2 to 14 years who presented to emergency departmentwith complaint of acute abdominal pain of less than 5 days duration and admitted in pediatricsurgery department were included. Presenting symptoms, signs, hospital course of patientsand discharge diagnosis were recoded. Data was analyzed by SPSS. Results: Out of 73104patients who were seen in Paediatric emergency 1420 (1.94%) were referred for surgicalevaluation. Out of these 157 children were admitted. Six patients left against medical adviceso 151 patients were studied. Patients were divided into acute appendicitis, non-specificpain abdomen and miscellaneous categories on the basis of discharge diagnosis. Acuteappendicitis was diagnosed in 61(40.4%) patients. The patients who were admitted and nocause of pain abdomen could be found in them, were included in non-specific pain abdomengroup. NSPA group had 39 (25.8%) patients. Rests of the 51 (33.8%) patients were includedin miscellaneous group. Anorexia, fever, pain in right lower quadrant, tenderness in right iliacfossa, guarding, rebound tenderness and tachycardia were all significantly higher in patientswith acute appendicitis. Conclusion: Most of the children with acute abdominal pain wouldnot require surgery. Detailed history and thorough physical examination are cornerstone of thediagnosis.

Erythema Nodosum: An Atypical Presentation of Abdominal Tuberculosis

Background & Aims: Erythema nodosum (EN) is a reaction pattern to infection and sometimes to drugs. Histological features suggest that this is an immunological reaction with immune complex deposition within the dermal vessels. Our case is a rare example where EN is associated with extrapulmonary tuberculosis (TB), suggesting a clear evidence of immunological reaction rather than a primary bacterial event. Case: An 11 years old child presented with complaints of high grade fever, generalized lymphadenopathy, painful nodules over shins and loose stools alternating with constipation since the last 15 days with weight loss. Mild tenderness in right iliac fossa was present. Investigations revealed leucocytosis with raised ESR, strongly positive TST and induced sputum negative for AFB. USG and CECT abdomen showed necrotic lymphnodes with omental and IC junction thickening. Lymph node biopsy revealed caseating granulomas. Patient was started on 4 drug antituberculous therapy (ATT). On discharge marked improvement in symptoms were present. Conclusion: Consider strong possibility of extra pulmonary TB presenting as EN especially in developing countries like India in absence of overt signs of TB. The most important step in the management of EN is the treatment of underlying disorder. ATT should be started presumptively for EN with a positive TST result with or without a positively identified focus of infection.

Fecalith of appendix

A 8 year old boy presented with pain right lower abdomen, vomiting and fever .Abdominal examination revealing tenderness in right iliac fossa, with positive rebound tenderness and Rovsing's sign.Xray abdomen was normal. Ultrasonography showed a non compressible tube like structure in the right lower quadrant and the positive probe tenderness suggestive of appendicitis. The patient underwent appendectomy. There was large fecalith 4.1×1.2×1 centimeter present near base. Histopathology was consistent with appendicitis. Figure 1 Figure 1: showing appendix with fecalith Fecalith associated appendicitis is obstructive appendicitis. The appendicolith or coprolith are calcified deposits within lumen of appendix. About 30% of children having appendicitis have associated fecalith. Sometimes it is an incidental finding but when associated with abdominal pain ,there is a 90% probability of having appendicitis and 50% have increased risk of perforation of appendix. Giant fecaliths are rarely seen. CORRESPONDENCE TO Imtiaz Wani Post Graduate Scholar , Amira Kadal,Srinagar Kashmir, India ,190009 Cell.No 9419904864 e-mail: imtazwani@yahoo.com

Le polype fibroïde inflammatoire, une tumeur rare de l’appendice

We report the rare occurrence of an inflammatory fibroid polyp of the appendix. The lesion was diagnosed in a 33-year-old woman presenting with abdominal pain, fever and localized tenderness in right iliac fossa on abdominal palpation. CT-scan showed an 8 cm appendiceal mass and a laparoscopic appendectomy was consequently performed. On microscopic examination, the tumor consisted of spindle cells dispersed in a loose fibromyxoid stroma containing numerous blood cells and inflammatory cells with abundant eosinophils. On immunohistochemistry, the spindle tumor cells were positive for vimentin, fascin and focally for CD34 and CD35. They were negative for smooth muscle actin, desmin, CD21, CD23, CD117 and S100 protein. Inflammatory fibroid polyp is a rare benign mesenchymal tumor of the gastrointestinal tract rarely reported in the appendix. This tumor shares some common pathologic features with the myofibroblatic inflammatory tumor but they are two different entities. The pathogenesis of this tumor remains unclear but fascin and CD35 immunoreactivity of the tumor cells suggests a probable dendritic cell origin.

Evaluation of the Alvarado score in the diagnosis of acute appendicitis

This study has been performed in the Emergency center, Clinical centre of Serbia, during the period 01.03.2007-01.09.2007. We performed this study on 57 patients with diagnosis suspected for acute appendicitis (ages 16-70). Parameters that make the Alvarado score are the following: migration of pain, anorexia, nausea or vomiting, right lower abdominal quadrant tenderness, rebound tenderness in right iliac fossa, elevated temperature, leukocytosis, shift to the left of neutrophils. The aim of the work is to evaluate the Alvarado scoring system in diagnosis of the acute appendicitis. With all the patients Alvarado score has been determinate preoperatively, and diagnosis was confirmed by intraoperative finding and histopatological examination of the removed appendix. All the patients with score 7 or more were surgically managed. Specificity (positive predictive value) was 92.59 % in males and 76.67 % in females. The negative appendectomy rate was 7.41 % with the males and 23.33 % with the females. The values of the Alvarado score are significantly higher in the patients with acute appendicitis, compared with the patients of the other diseases. With the application of the Alvarado scoring system we can decrease postoperative morbidity and mortality.

Sensitivity and specificity of clinical features used in Alvarado scoring system

Introduction: Alvarado score is one of the scoring systems for diagnosis of appendicitis. Objective: To assess the sensitivity and specificity of clinical features used in Alvarado score. Subjects and methods: A prospective study of 171 patients with pain in the right iliac fossa presenting to emergency at BPKIHS, Dharan, Nepal was conducted. The sensitivity and specificity of clinical features and lab parameters used in Alvarado score were evaluated comparing with final diagnosis based on operative and histopathological findings. Results: The sensitivity of clinical parameter were: migrating right iliac fossa pain- 99.1%, anorexia- 45.7%, nausea/vomiting- 73.7%, right iliac fossa tenderness- 100%, fever- 24.5%, rebound tenderness in right iliac fossa- 89.8%, leucocytosis (>10,000)- 84.7% and a neutrophilic shift to the left (>75%)- 68.6%. The specificity of clinical parameters were: migrating right iliac fossa pain- 45.3%, anorexia- 86.7%, nausea/vomiting- 54.7%, right iliac fossa tenderness- 1.8%, fever- 81.1%, rebound tenderness in right iliac fossa- 64.1%, leucocytosis (>10,000)- 83.1% and a neutrophilic shift to the left (>75%)- 71.6%.Conclusion: Migrating right iliac fossa pain, right iliac fossa tenderness and rebound tenderness in right iliac fossa had a high sensitivity, leucocytosis (>10,000) had both high sensitivity and high specificity. Thus, in our set up, use of Alvarado score appears helpful for diagnosis of appendicitis Keywords: Alvarado score; sensitivity; specificityDOI: 10.3126/hren.v9i1.4355Health Renaissance, 2011: Vol.9 No.1:12-14