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Acute appendicitis is one of the most common surgical emergencies worldwide. Over the past 30 years, imaging has become central to the diagnosis of appendicitis, reducing both negative appendicectomy rate and healthcare expenses. ...
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Acute appendicitis is one of the most common surgical emergencies worldwide. Over the past 30 years, imaging has become central to the diagnosis of appendicitis, reducing both negative appendicectomy rate and healthcare expenses. Appendicitis can be challenging in many ways for radiologists with various clinical presentations, complications and differential diagnoses. The aim of this review is to present a step-by-step reasoning with key findings, tips and tricks leading to the diagnosis of appendicitis and its complications.
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Background: Stump appendicitis is an underreported and poorly defined condition. It is the development of obstruction and inflammation of the residual appendix after appendectomy. This is a review of the basic clinical, pathologic...
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Background: Stump appendicitis is an underreported and poorly defined condition. It is the development of obstruction and inflammation of the residual appendix after appendectomy. This is a review of the basic clinical, pathological, and surgical significance of stump appendicitis, and the "critical view" required for prevention. Data sources: PubMed MEDLINE search was performed using terms "stump appendicitis" and "retained appendix" to obtain reported cases of stump appendicitis. Sixty-one cases were identified. Each case was charted based on 14 variables. Data were analyzed. Conclusions: Stump appendicitis warrants early detection. Patients can present with abdominal pain, nausea, and vomiting. A prior history of appendectomy can delay the diagnosis. A diagnosis can be made with an abdominal ultrasound or computed tomography scan. If treated early, laparoscopic or open completion appendectomy can be performed. If diagnosis is delayed and perforation is found, extensive resection is often required. A "critical view," as described in this article, is key for prevention.
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A case of stump appendicitis in a 41-year-old man is presented. Initial appendicectomy for suppurative appendicitis had been performed 14 months earlier. An ultrasound scan suggested the diagnosis of stump appendicitis despite the...
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A case of stump appendicitis in a 41-year-old man is presented. Initial appendicectomy for suppurative appendicitis had been performed 14 months earlier. An ultrasound scan suggested the diagnosis of stump appendicitis despite the hindsight of previous appendicectomy. A literature review on the subject is provided. Stump appendicitis should be considered in the differential diagnosis of recurrent lower abdominal symptoms any time following initial appendicectomy. Knowledge of a difficult approach at initial surgery may raise the level of suspicion.
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Aims While patients presenting with clinical signs and symptoms of acute appendicitis (AA) often receive surgical intervention shortly after presentation, certain patients may instead receive non‐operative management initially, w...
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Aims While patients presenting with clinical signs and symptoms of acute appendicitis (AA) often receive surgical intervention shortly after presentation, certain patients may instead receive non‐operative management initially, with appendectomy later. The histology of such interval appendicitis (IA) has only been described in small series. Also, we have noticed a recent increase in the incidence of IA specimens at our institution. Methods and results We identified appendectomy specimens in our department during 2018 with available haematoxylin and eosin slides and electronic clinical data, and evaluated multiple histological findings. Cases were then divided into AA and IA, based on clinical history (AA if the patient presented to the hospital within 1?week of symptom onset and underwent appendectomy within 48?h; IA if appendectomy was delayed at least 1?week). Changes between groups were compared. The cohort included 165 cases (125 AA, 40 IA). Findings significantly more common in AA included mucosal acute inflammation, mural acute inflammation and acute serositis. Findings significantly more common in IA included Crohn‐like mural inflammation, mural fibrosis, goblet cell hyperplasia, granulomas, xanthogranulomatous inflammation, haemosiderin‐laden macrophages and granulation tissue. The rate of IA in 2018 (24%) was noticeably higher than in previous years. Conclusion Acute inflammatory changes are more common in AA but can remain present in IA. Mural fibrosis, serosal adhesions, haemosiderin‐laden macrophages and granulation tissue suggest IA. Granulomas and xanthogranulomatous inflammation can also be seen in IA, and Crohn‐like mural inflammation is not uncommon. These histological patterns can guide signout and prevent diagnostic errors, particularly when clinical information is unavailable.
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Appendicitis is a common condition in childhood and adolescence that frequently requires urgent surgical intervention. For almost two centuries appendicitis has been recognized as a medical problem with a surgical solution. Curren...
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Appendicitis is a common condition in childhood and adolescence that frequently requires urgent surgical intervention. For almost two centuries appendicitis has been recognized as a medical problem with a surgical solution. Currently the appendix can be removed with a minimally invasive approach, low anesthetic and surgical risk, and swift hospital discharge. Despite these advances, surgery and anesthesia have associated risks including postoperative infection, bleeding, hernia and organ injury among others. In addition, surgery requires time off of school and work to recover and associated healthcare costs can be significant. In both adult and pediatric populations, quality data suggesting a nonoperative approach is suggesting a change to the traditional surgical paradigm. Adults studies have demonstrated both safety and efficacy in the nonoperative management of acute appendicitis. In selected children with uncomplicated appendicitis, initial nonoperative management has been shown to be safe with fewer complications, fewer disability days and less healthcare costs while avoiding the risks inherent to surgery. Ongoing randomized controlled clinical trials in both the United States and Europe seek to further demonstrate the safety of nonoperative management and assist physicians with educating patients about the risk profile of their treatment decision. In complicated appendicitis presenting with abscess or acute appendiceal phlegmon, an initial nonoperative strategy with or without abscess drainage followed by interval appendectomy is the current state of the art though the utility of interval appendectomy is questioned.
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Appendicitis is a common diagnosis in children being evaluated in the emergency department. After diagnosis, standard treatment has been surgical appendectomy; however, in recent years there is a growing body of evidence evaluatin...
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Appendicitis is a common diagnosis in children being evaluated in the emergency department. After diagnosis, standard treatment has been surgical appendectomy; however, in recent years there is a growing body of evidence evaluating the possibility of nonoperative management in both children and adults. This review will present the current state of the pediatric literature that suggests patients may be successfully treated with antibiotics alone (ie, without surgery), but that a proportion of these patients will have recurrent appendicitis. Given that the literature regarding the option of antibiotic-only management compared with surgery is not yet definitive, there are many factors for providers to discuss with families and patients when considering treatment for acute appendicitis.
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Acute appendicitis is a common condition emergency physician encounter during pediatric emergency visits. With a reported incidence of 1 in 50,000 appendectomies, stump appendicitis, an acute inflammation of the residual appendicu...
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Acute appendicitis is a common condition emergency physician encounter during pediatric emergency visits. With a reported incidence of 1 in 50,000 appendectomies, stump appendicitis, an acute inflammation of the residual appendicular tissue, is a rare post-operative complication. The diagnosis of stump appendicitis is time-critical to prevent associated morbidities of abscess formation, perforation and sepsis. Another atypical presentation of appendicitis includes recurrent appendicitis, which is recognized as one or more previous episodes of similar clinical presentation as acute appendicitis, but symptoms subside within 24 to 48 hours. Intervals between attacks may vary from weeks to years during which the patient may be asymptomatic. Although recurrent appendicitis is rare, emergency physicians should be aware of this possibility and to not assume that previous appendectomy precludes recurrent appendicitis. This case highlights the importance of considering such unusual condition in a patient presenting with recurrent right-sided abdominal pain. (C) 2020 Elsevier Inc. All rights reserved.
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Objective: When someone plans a vacation, one of the last things taken into consideration is the possibility of contracting an illness while away. Unfortunately, if people develop abdominal pain while planning for a vacation, they...
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Objective: When someone plans a vacation, one of the last things taken into consideration is the possibility of contracting an illness while away. Unfortunately, if people develop abdominal pain while planning for a vacation, they usually proceed with the vacation and do not consider getting medical attention for their pain. The purpose of this study was to examine the effect of being on vacation and its association with ruptured appendicitis.Methods: From January 1, 2007 to December 31, 2008, the incidence of ruptured appendicitis cases at Florida Hospital-Celebration Health, located 5 miles from Walt Disney World, was compared with that of Florida Hospital-Orlando, approximately 30 miles away from Walt Disney World. We evaluated whether patients "on vacation" versus residents of Orlando have an increased incidence of ruptured appendicitis.Results: Of patients treated for presumed appendicitis, 60.59% at Florida Hospital-Celebration Health had ruptured appendicitis during this time versus 20.42% at Florida Hospital-Orlando. Of those 266 patients seen at Florida Hospital-Celebration Health, 155 were on vacation versus only 21 at Florida Hospital-Orlando.Conclusion: Although there is not -a direct cause and effect, it is clear that there is a higher incidence of ruptured appendicitis in patients on vacation versus in the regular community in the Orlando, Florida area.
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Although the appendix is the most commonly resected and examined intra-abdominal organ, the pathogenesis and aetiology of acute nonspecific appendicitis (the commonest diagnosis made in the appendix) remains enigmatic. This review...
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Although the appendix is the most commonly resected and examined intra-abdominal organ, the pathogenesis and aetiology of acute nonspecific appendicitis (the commonest diagnosis made in the appendix) remains enigmatic. This review encompasses the pathology and diagnosis of acute non-specific appendicitis, as well as controversialissues such as the diagnosis of chronic appendicitis, the implications of granuloma-tous appendicitis, and the significance of a morphologically unremarkable appendectomy specimen in the clinical context of appendicitis. The pathological features, pertinent diagnostic techniques, and clinical significance of several specific bacterial, viral, fungal, and parasitic infections affecting the appendix are presented, including adenovirus, cytomegalovirus, Yers-inia species, Actinomyces, Mycobacteria species, Histoptasma, Enterobius vermicularis, schistosomiasis, and Stronyloides stercoralis.
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BackgroundThere is no consensus on the ideal management of complicated appendicitis. MethodsThe New York State Planning and Research Cooperative database was used to identify all patients admitted with complicated appendicitis and...
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BackgroundThere is no consensus on the ideal management of complicated appendicitis. MethodsThe New York State Planning and Research Cooperative database was used to identify all patients admitted with complicated appendicitis and undergoing appendectomy within 1-year. Primary outcome was any complication. Secondary outcomes included length of stay (LOS), hospital charges, and laparoscopy use. Outcomes were compared in appendectomy before or after 48h from admission. Results31,167 patients ≥18yo were identified for analysis, 28,015(89.9%) underwent early appendectomy. Early appendectomy patients were more likely to be White (69.8% vs. 64.2% p?收起
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