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Dagne H, Abebaw TA. Characteristics of Patients Presented with Complicated Appendicitis in Adama, Ethiopia: A Cross-Sectional Study. Open Access Emerg Med 2022; 14:573-580. [PMID: 36303879 PMCID: PMC9595057 DOI: 10.2147/oaem.s383550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Complicated appendicitis (CA) is defined as perforated appendicitis, peritonitis, peri-appendicular abscess, or appendicular mass. One-third of patients who develop appendicitis are diagnosed with CA at presentation. Studies regarding the prevalence of CA are lacking in low-income countries, and the characteristics of patients presented with CA are incoherently identified. OBJECTIVE To assess the prevalence and the significant characteristics associated with CA among patients admitted with the diagnosis of acute appendicitis at Adama Hospital Medical College. METHODS A cross-sectional study was conducted from January 1, 2018, up to December 31, 2019. From a total of 1043 patients during the study period, the charts of 431 patients were selected using a systematic random sampling technique. Data were collected by a structured checklist. Bivariate and multivariable binary logistic regression analyses were employed to assess the association of patients' characteristics with CA. RESULTS Out of 431 patients, 157 (36.4%) had CA. Characteristics of patients having a significant association with CA were found to be generalized abdominal tenderness (AOR: 27.48, 95% CI: 4.03, 187.24), diagnosis with peritonitis (AOR: 14.87, 95% CI: 4.05, 54.54), right lower quadrant (RLQ) abdominal mass (AOR: 7.79, 95% CI: 2.02, 29.99), shock (10.37, 95% CI: 3.18, 33.76), white blood cell (WBC) count >11,000 (AOR: 2.16, 95% CI: 1.02, 4.61), onset to visit interval of 8-14 days (AOR: 10.45, 95% CI: 2.4, 45.52) and ultrasound report of acute appendicitis (AOR: 0.33, 95% CI: 0.13, 0.85), appendiceal abscess (AOR: 5.05, 95% CI: 1.48, 17.31), and appendiceal mass (AOR: 6.04, 95% CI: 1.45, 25.14). CONCLUSION The prevalence of CA was very high. Generalized abdominal tenderness, RLQ abdominal mass, shock, WBC count, onset to visit interval, abdominopelvic ultrasound report, and clinical diagnosis of peritonitis were significantly associated with CA.
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Affiliation(s)
- Haset Dagne
- Maternal, and Child Health Department, Wereda 6 Health Center, Nifas Silk Lafto Sub-City, Addis Ababa, Ethiopia
| | - Tsega-Ab Abebaw
- School of Public Health, GAMBY Medical and Business College, Addis Ababa, Ethiopia
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Kim HY, Park JH, Lee YJ, Lee SS, Jeon JJ, Lee KH. Systematic Review and Meta-Analysis of CT Features for Differentiating Complicated and Uncomplicated Appendicitis. Radiology 2017; 287:104-115. [PMID: 29173071 DOI: 10.1148/radiol.2017171260] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To perform a systematic review and meta-analysis to identify computed tomographic (CT) features for differentiating complicated appendicitis in patients suspected of having appendicitis and to summarize their diagnostic accuracy. Materials and Methods Studies on diagnostic accuracy of CT features for differentiating complicated appendicitis (perforated or gangrenous appendicitis) in patients suspected of having appendicitis were searched in Ovid-MEDLINE, EMBASE, and the Cochrane Library. Overlapping descriptors used in different studies to denote the same image finding were subsumed under a single CT feature. Pooled diagnostic accuracy of the CT features was calculated by using a bivariate random effects model. CT features with pooled diagnostic odds ratios with 95% confidence intervals not including 1 were considered as informative. Results Twenty-three studies were included, and 184 overlapping descriptors for various CT findings were subsumed under 14 features. Of these, 10 features were informative for complicated appendicitis. There was a general tendency for these features to show relatively high specificity but low sensitivity. Extraluminal appendicolith, abscess, appendiceal wall enhancement defect, extraluminal air, ileus, periappendiceal fluid collection, ascites, intraluminal air, and intraluminal appendicolith showed pooled specificity greater than 70% (range, 74%-100%), but sensitivity was limited (range, 14%-59%). Periappendiceal fat stranding was the only feature that showed high sensitivity (94%; 95% confidence interval: 86%, 98%) but low specificity (40%; 95% confidence interval, 23%, 60%). Conclusion Ten informative CT features for differentiating complicated appendicitis were identified in this study, nine of which showed high specificity, but low sensitivity. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Hae Young Kim
- From the Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620 Seongnam, Korea (H.Y.K., J.H.P., Y.J.L., S.S.L., K.H.L.); and Department of Statistics, University of Seoul, Seoul, Korea (J.J.J.)
| | - Ji Hoon Park
- From the Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620 Seongnam, Korea (H.Y.K., J.H.P., Y.J.L., S.S.L., K.H.L.); and Department of Statistics, University of Seoul, Seoul, Korea (J.J.J.)
| | - Yoon Jin Lee
- From the Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620 Seongnam, Korea (H.Y.K., J.H.P., Y.J.L., S.S.L., K.H.L.); and Department of Statistics, University of Seoul, Seoul, Korea (J.J.J.)
| | - Sung Soo Lee
- From the Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620 Seongnam, Korea (H.Y.K., J.H.P., Y.J.L., S.S.L., K.H.L.); and Department of Statistics, University of Seoul, Seoul, Korea (J.J.J.)
| | - Jong-June Jeon
- From the Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620 Seongnam, Korea (H.Y.K., J.H.P., Y.J.L., S.S.L., K.H.L.); and Department of Statistics, University of Seoul, Seoul, Korea (J.J.J.)
| | - Kyoung Ho Lee
- From the Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620 Seongnam, Korea (H.Y.K., J.H.P., Y.J.L., S.S.L., K.H.L.); and Department of Statistics, University of Seoul, Seoul, Korea (J.J.J.)
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Özdemir O, Metin Y, Metin NO, Küpeli A, Kalcan S, Taşçı F. Contribution of diffusion-weighted MR imaging in follow-up of inflammatory appendiceal mass: Preliminary results and review of the literature. Eur J Radiol Open 2016; 3:207-15. [PMID: 27570803 PMCID: PMC4990663 DOI: 10.1016/j.ejro.2016.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 08/09/2016] [Indexed: 12/29/2022] Open
Abstract
Objective We aimed to search the contribution of diffusion-weighted imaging (DWI) in follow-up of patients with acute appendicitis associated inflammatory appendiceal mass (IAM). DWI was used as a monitoring imaging method to assess the response of medical treatment. Materials and methods 19 patients (mean age, 37+–13.1; age range, 19–69; M/F: 10/9), presented with clinical, laboratory and computed tomography (CT) findings suggestive of IAM were enrolled prospectively in this study. CT and DWI images were evaluated by two radiologists in consensus. b values 0, 500 and 1000 s/mm2 were used, and DWI images were analysed both qualitatively and quantitatively. Laboratory parameters were C-reactive protein value and white blood cell count. During follow-up changes in the diameter of IMA and laboratory parameters were correlated with ADC values. Conservative treatment with interval appendectomy and a total conservative approach without surgery were the treatment options during follow-up. Results We found statistically significant correlation between the ADC values, maximum IAM diameter and laboratory parameters. During follow-up five surgical procedures were performed: one patient underwent surgery for cecal adenocarcinoma and four underwent interval appendectomy. One patient developed acute relapse of IAM at the sixth month of follow-up. Conclusion DWI may be used with a significant success for follow-up of patients with IAM. As a monitoring imaging method, DWI may also aid in determining of most appropriate timing for interval appendectomy as well as may help in diagnosing alternative diagnoses (e.g. malignancy and inflammatory bowel disease) that can mimic IAM.
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Affiliation(s)
- Oğuzhan Özdemir
- Recep Tayyip Erdoğan University, Faculty of Medicine, Department of Radiology, 53100, Rize, Turkey
| | - Yavuz Metin
- Recep Tayyip Erdoğan University, Faculty of Medicine, Department of Radiology, 53100, Rize, Turkey
| | - Nurgül Orhan Metin
- Recep Tayyip Erdoğan University, Faculty of Medicine, Department of Radiology, 53100, Rize, Turkey
| | - Ali Küpeli
- Muş State Hospital, Department of Radiology, 49000, Muş, Turkey
| | - Süleyman Kalcan
- Recep Tayyip Erdoğan University, Faculty of Medicine, Department of General Surgery, 53100, Rize, Turkey
| | - Filiz Taşçı
- Recep Tayyip Erdoğan University, Faculty of Medicine, Department of Radiology, 53100, Rize, Turkey
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Kim M, Kim SJ, Cho HJ. International normalized ratio and serum C-reactive protein are feasible markers to predict complicated appendicitis. World J Emerg Surg 2016; 11:31. [PMID: 27330547 PMCID: PMC4915056 DOI: 10.1186/s13017-016-0081-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 05/25/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Diagnostic approach for complicated appendicitis is still controversial. We planned this study to analyze preoperative laboratory markers that may predict complications of appendicitis. METHODS Patients who underwent appendectomy were retrospectively recruited. They were divided into complicated appendicitis and non-complicated appendicitis groups and their preoperative laboratory results were reviewed. RESULTS A total of 234 patients were included. Elevated international normalized ratio (INR) and serum C-reactive protein (CRP) were associated with complicated appendicitis (p = 0.001). On ROC curve analysis, area under the curve (AUC) of CRP and INR were 0.796 and 0.723, respectively. CONCLUSIONS INR and CRP increased significantly in patients with complicated appendicitis. Further studies evaluating INR and CRP in patients undergoing conservative management for appendicitis are required.
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Affiliation(s)
- Maru Kim
- Department of Trauma Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Jeep Kim
- Department of Trauma Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hang Joo Cho
- Department of Trauma Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Naderan M, Babaki AES, Shoar S, Mahmoodzadeh H, Nasiri S, Khorgami Z. Risk factors for the development of complicated appendicitis in adults. ULUSAL CERRAHI DERGISI 2016; 32:37-42. [PMID: 26985166 DOI: 10.5152/ucd.2015.3031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 02/06/2015] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To investigate the patient's history and physical examination information to find out risk factors associated with complicated appendicitis. MATERIAL AND METHODS Two hundred patients who were admitted with complicated appendicitis (including abscess, phlegmon, and generalized peritonitis) were retrieved from our database. Two hundred patients with non-complicated acute appendicitis were randomly selected from the same period. These two groups were compared in terms of demographic characteristics, past medical history, and presenting symptoms. We made a multivariate analysis model using binary logistic regression and backward stepwise elimination. RESULTS Based on multivariate analysis, risk factors for complicated appendicitis included presenting with epigastric pain (OR=3.44), diarrhea (OR=23.4) or malaise (OR=49.7), history of RLQ pain within the past 6 months (OR=4.93), older age (OR=1.04), being married (OR=2.52), lack of anorexia (OR=4.63) and longer interval between onset of symptoms and admission (OR=1.46). Conversely, higher (academic) education was associated with decreased odds for complicated appendicitis (OR=0.26). CONCLUSION Our findings suggest that a surgeon's clinical assessment is more reliable to make a judgment. "Bedside evaluation" is a useful, cheap, quick and readily available method for identifying those at risk for developing complicated acute appendicitis.
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Affiliation(s)
- Mohammad Naderan
- Department of Surgery, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
| | | | - Saeed Shoar
- Department of Surgery, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
| | - Hossein Mahmoodzadeh
- Department of Surgery, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
| | - Shirzad Nasiri
- Department of Surgery, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
| | - Zhamak Khorgami
- Department of Surgery, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
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Abstract
The lifetime risk of appendicitis is 6 to 7 % [1]. When appendicitis is clinically suspected, an appendicolith can be found in 30% of the patients [2]. An appendicolith may be retained post-operatively (‘dropped appendicolith’) due to previous perforation, non-recognition during surgery or the impossibility to remove it. Abscesses that result from ectopic appendicoliths tend to occur paraceacally in the vicinity of Morrison’s pouch and should be removed to prevent abscess development and possible overt sepsis [3]. As far as we know, we describe the first documented case of an intrahepatic localization of a dropped appendicolith causing a liver abscess.
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Kitaoka K, Saito K, Tokuuye K. Important CT findings for prediction of severe appendicitis: involvement of retroperitoneal space. World J Emerg Surg 2014; 9:62. [PMID: 25587352 PMCID: PMC4293097 DOI: 10.1186/1749-7922-9-62] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 12/12/2014] [Indexed: 12/29/2022] Open
Abstract
Background Determination of the severity of appendicitis and differentiation between complicated and uncomplicated appendicitis are clinically important. Severe appendicitis frequently affects extraperitoneal spaces. We have investigated CT findings of retroperitoneal space (RPS) in patients with appendicitis to create a model for identification of complicated appendicitis. Method CT images of 223 patients with pathologically proven appendicitis were reviewed. The total number of the segments in RPS where inflammatory changes were located (RPS count) was obtained as well as appendiceal diameter, appendicolithiasis, WBC count, and CRP level. Data were analyzed to identify factors indicating complicated appendicitis. Univariate analysis was conducted to identify statistically significant variables. A multivariable logistic regression analysis was performed in order to find independent predictors of complicated appendicitis. Results Patients with complicated appendicitis were more likely to have higher RPS count (P < 0.001), appendicolithiasis (P = 0.002), higher CRP level (P < 0.001), and greater appendix diameter (P < 0.001) than patients with uncomplicated appendicitis. Statistical analysis showed RPS count was the most helpful predictor of complicated appendicitis. Conclusion Radiologists and surgeons should be aware of the importance of CT findings in RPS when treating patients with appendicitis. Complicated appendicitis can be predicted by RPS count, diameter of the appendix, appendicolithiasis, and CRP level.
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Affiliation(s)
- Kumiko Kitaoka
- Department of Radiology Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023 Japan
| | - Kazuhiro Saito
- Department of Radiology Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023 Japan
| | - Koichi Tokuuye
- Department of Radiology Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023 Japan
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Martin M, Lubrano J, Azizi A, Paquette B, Badet N, Delabrousse E. Inflammatory appendix mass in patients with acute appendicitis: CT diagnosis and clinical relevance. Emerg Radiol 2014; 22:7-12. [PMID: 25038932 DOI: 10.1007/s10140-014-1256-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 07/09/2014] [Indexed: 02/07/2023]
Abstract
The purpose of our study was to analyze the clinical relevance of computerized tomography (CT) in providing the diagnosis of inflammatory appendix mass (IAM) in patients with acute appendicitis. The CT images of 134 patients were reviewed. Two groups of patients were made according to the presence (group 1; n = 21) or the absence (group 2; n = 113) of IAM. Clinical signs of patients, CT features, complications at surgery, and histological examinations were noted. Inter-observer agreement was assessed by using kappa statistics. Twenty-one patients presenting with CT features of IAM were diagnosed. An excellent inter-observer agreement (κ = 0.94) was assessed for the diagnosis of IAM. No significant statistical difference in the age distribution was observed between patients with IAM (mean age 55) and patients without (mean age 45) (p = 0.2232). No clinical sign showed a statistically significant association with the presence of IAM (p = 0.707) or with complication encountered at surgery (p = 0.180). Delay to CT examination was 5.4 days in patients presenting with CT features of IAM and of 1.7 days for patients presenting without (p = 0.0001). Conversely to acute appendicitis complicated by simple perforation (p = 0.153) or peri-appendicular abscess (p = 0.501), acute appendicitis presenting with IAM showed a statistically significant association with complications encountered at surgery (p = 0.0003) and the need for conversion to open surgery (p = 0.001). Performing CT in complicated acute appendicitis provides the diagnosis of IAM. Distinction of IAM appeared to be of clinical relevance, since immediate surgery in IAM was statistically associated with surgical complications and conversion to open surgery in our study.
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Affiliation(s)
- M Martin
- Department of Radiology, Besançon University Hospital, 3 Boulevard Fleming, 25030, Besançon, France
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Lien WC, Lee WC, Wang HP, Chen YC, Liu KL, Chen CJ. Male Gender is a Risk Factor for Recurrent Appendicitis Following Nonoperative Treatment. World J Surg 2011; 35:1636-42. [DOI: 10.1007/s00268-011-1132-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Fraser JD, Aguayo P, Sharp SW, Snyder CL, Rivard DC, Cully BE, Sharp RJ, Ostlie DJ, St Peter SD. Accuracy of computed tomography in predicting appendiceal perforation. J Pediatr Surg 2010; 45:231-4; discussion 234-4. [PMID: 20105609 DOI: 10.1016/j.jpedsurg.2009.10.040] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Accepted: 10/06/2009] [Indexed: 12/11/2022]
Abstract
BACKGROUND Some surgeons use nonoperative management with or without interval appendectomy for patients who present with perforated appendicitis. These strategies depend on accurately delineating perforation by computed tomography (CT). Since 2005, our institution has used an evidence-based definition for perforation as a hole in the appendix or fecalith in the abdomen. This has been shown to clearly separate those with a high risk of abscess from those without. To quantify the ability of CT to identify which patients would meet these criteria for perforation, we tested 6 surgeons and 2 radiologists who evaluated blinded CT scans. METHODS A junior and senior surgical residents, 2 staff interventional radiologists, and 4 attending pediatric surgeons with 3 to 30 years of experience reviewed 200 CT scans of pediatric patients who had undergone a laparoscopic appendectomy. All CT scans were reviewed electronically, and the reviewers were blinded to the results, outcome, and intraoperative findings. None of the patients had a well-formed abscess on CT. The reviewers were asked to decide only on perforated or nonperforated appendicitis according to our intraoperative definition. Clinical admission data were reviewed and compared between groups. RESULTS In total, the reviewers were correct 72% of the time with an overall sensitivity of 62% and a specificity of 81%. The overall positive predictive value was 67%, and the negative predictive value was 77%. CONCLUSIONS This study shows that in the absence of a well-formed abscess, the triage of patient care based on a preoperative diagnosis of perforation from CT may be imprudent and subject a portion of the population to an unnecessarily prolonged course of care.
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Affiliation(s)
- Jason D Fraser
- Department of Surgery, The Children's Mercy Hospital, Kansas City, MO 64108, USA
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Vons C. Peut-on traiter une appendicite aiguë par des antibiotiques et dans quelles conditions ? ACTA ACUST UNITED AC 2009; 146 Spec No 1:17-21. [PMID: 19846094 DOI: 10.1016/j.jchir.2009.08.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abularrage CJ, Bloom S, Bruno DA, Goldfarb A, Abularrage JJ, Chahine AA. Laparoscopic drainage of postappendectomy- retained fecalith and intra-abdominal abscess in the pediatric population. J Laparoendosc Adv Surg Tech A 2008; 18:644-50. [PMID: 18721024 DOI: 10.1089/lap.2007.0190] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Retained fecalith after an appendectomy is an uncommon complication frequently associated with intra-abdominal abscess. Treatment options include percutaneous, open, or laparoscopic drainage of the abscess and retrieval of the fecalith, as antibiotics and drainage alone are usually insufficient. Laparoscopy offers the advantages of enhanced visualization of the abdomen, improved cosmesis, and a quicker return to normal daily activities. The principles of laparoscopic treatment include the careful identification of all anatomic landmarks, as the abscesses are frequently adherent to intra-abdominal structures compromising the safety of the operation. In this paper, we present 2 cases of laparoscopic drainage of an intra-abdominal abscess with retrieval of a fecalith in pediatric patients 1 and 6 weeks after an initial appendectomy and a review the literature.
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McKay R, Shepherd J. The use of the clinical scoring system by Alvarado in the decision to perform computed tomography for acute appendicitis in the ED. Am J Emerg Med 2007; 25:489-93. [PMID: 17543650 DOI: 10.1016/j.ajem.2006.08.020] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Accepted: 08/13/2006] [Indexed: 12/29/2022] Open
Abstract
STUDY OBJECTIVE Appendicitis is part of the differential of an acute abdomen and can be a difficult diagnosis to make. Strategies to suggest which patients presenting to the emergency department (ED) should undergo computed tomography (CT) scan to confirm appendicitis have not been addressed. We develop guidelines for CT scanning based on Alvarado clinical scores for patients with suspected and confirmed cases of appendicitis. METHODS A retrospective review of 150 charts of patients aged 7 and older who presented with abdominal pain to the ED of a 392-bed acute care facility over a 6-month period were evaluated by ED physicians and underwent CT to rule out appendicitis. Patient demographics, presenting signs, and symptoms were documented. Using the scoring system for appendicitis, developed by Alvarado, each chart was retrospectively scored. The Alvarado scores were correlated with positive pathology findings, as well as Alvarado scores with a negative CT scan. Equivocal scores, having neither high sensitivity nor specificity for appendicitis were calculated. RESULTS Computed tomography scans with Alvarado scores of 3 or lower were performed in 37% (55/150) of patients to rule out appendicitis. The sensitivity of Alvarado scores 3 or lower for not having appendicitis was 96.2% (53/55), and the specificity 67% (2/3). Patients with Alvarado scores 7 or higher had an incidence of acute appendicitis of 77.7% (28/36). The sensitivity of Alvarado scores 7 or higher for appendicitis was 77% (28/36), and the specificity 100% (8/8). The sensitivity of equivocal Alvarado scores, defined as scores of 4 to 6, for acute appendicitis was 35.6% (21/59), and the specificity 94% (36/38). The sensitivity and specificity of CT scans in patients with equivocal Alvarado scores remained high, at 90.4% and 95%, respectively. CONCLUSIONS In the equivocal clinical presentation of appendicitis as defined by Alvarado scores of 4 to 6, adjunctive CT is recommended to confirm the diagnosis in the ED setting. If clinical presentation suggests acute appendicitis by an Alvarado score of 7 or higher, surgical consultation is recommended. Computed tomography is not indicated in patients with Alvarado scores of 3 or lower to diagnose acute appendicitis.
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Affiliation(s)
- Robert McKay
- Saint Vincent Health Center, Erie, PA 16544, USA.
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Tsai HM, Shan YS, Lin PW, Lin XZ, Chen CY. Clinical analysis of the predictive factors for recurrent appendicitis after initial nonoperative treatment of perforated appendicitis. Am J Surg 2006; 192:311-6. [PMID: 16920424 DOI: 10.1016/j.amjsurg.2005.08.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2005] [Revised: 08/08/2005] [Accepted: 08/08/2005] [Indexed: 12/24/2022]
Abstract
BACKGROUND The purpose of this study was to study the clinical symptoms, laboratory data, and the characteristics of computed tomography (CT) imaging of nonoperated perforated appendicitis for predicting the recurrence of appendicitis. METHODS Thirty-five patients with nonoperated perforated appendicitis were retrospectively reviewed for this study. During a median follow-up period of 1155 days, 7 patients had to receive an appendectomy owing to recurrent appendicitis. Accordingly, the patients were divided into 2 groups: the recurrence and the nonrecurrence group. The clinical characteristics between these 2 groups were compared. RESULTS Both of the 2 patients who had a past history of appendicitis suffered recurrent appendicitis (the recurrence versus the nonrecurrence group, P<.05). The only CT imaging relating to the recurrence of appendicitis is the presence of calcified appendicolith (the recurrence versus the nonrecurrence group, P<.001). CONCLUSIONS It is most likely that appendicitis will recur if a calcified appendicolith on CT imaging or a past history of appendicitis is presented. Interval appendectomy may be reserved only for those patients who possess one of these risk factors of recurrent appendicitis.
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Affiliation(s)
- Hong-Ming Tsai
- Department of Radiology, National Cheng Kung University, Tainan, Taiwan
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Affiliation(s)
- M G Sarr
- Mayo Clinic College of Medicine, 200 First Street S. W., Rochester, MN 55905, USA.
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