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Query: UMLS:C0000727 (acute abdomen)
 3,084 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Forty-nine patients (age > 50 years) with an acute abdomen and suspected appendicitis, but with atypical findings, were included in the study. After the intravenous injection of 99Tcm-hexamethylpropylene amine oxime (99Tcm-HMPAO) labelled white blood cells (WBCs), serial anterior images of the abdomen and pelvis were obtained after 30, 60, 120 and 240 min. Any abnormal localization of WBC accumulation in the right lower quadrant of the abdomen equal to or greater than bone marrow activity was considered positive. Twenty-five patients had positive WBC scans, all of whom underwent laparotomy. Twenty-three of these patients were shown to have appendicitis; the other 2 did not. The other 24 patients had a negative WBC scan, 2 of whom underwent laparotomy and were shown to have appendicitis; the other 22 patients did not undergo surgery and showed no evidence of appendicitis during follow-up. The overall sensitivity, specificity, accuracy, positive and negative predictive values of WBC scans for diagnosing appendicitis were as follows: 92.0%, 91.7%, 91.8%, 92.0% and 91.7% respectively. In conclusion, 99Tcm-HMPAO-labelled WBC scans provide a rapid and highly accurate method for diagnosing appendicitis in older patients with equivocal clinical findings.
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PMID:99Tcm-HMPAO-labelled white blood cell scans to detect acute appendicitis in older patients with an atypical clinical presentation. 925 35

Surgeons should be aware of a very unusual cause of post-cesarean section peritonitis. This rare form of peritonitis is caused by the spillage of vernix caseosa material into the peritoneal cavity. The exact mechanism of the development of peritonitis in these few cases is unknown. Clinically, vernix caseosa peritonitis should be considered in the post-cesarean section acute abdomen after excluding the more common causes of peritonitis such as appendicitis and perforated viscus. Intraoperatively, the presence of cheese-like yellow patches limited to the serosal layer of visceral organs is the most characteristic feature. Histopathological examination of these serosal patches reveal the desquamated anuclear squamous cells confirming the diagnosis. Postoperative treatment with antibiotics should be continued. The addition of steroids (only after confirming the diagnosis pathologically) has a significant effect on improving the clinical outcome.
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PMID:Vernix caseosa: an unusual cause of post-cesarean section peritonitis. 912 20

The child with an acute abdomen presents the perfect opportunity to take advantage of the benefits of minimal-access surgery. There are a wide variety of conditions, acquired and congenital, for which minimal-access techniques provide the distinct advantages of a cost-effective diagnosis and therapy with minimal discomfort for the patient. In the present report, the management of children with abdominal pain of unclear etiology is outlined, along with discussions of the value of minimal-access surgery in appendicitis and other conditions. Several algorithms are provided as a guideline for suggested approaches to management.
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PMID:Acute abdomen. The role of laparoscopy. 915 58

The outcome for children with common surgical conditions that cause an acute abdomen is discussed. These conditions include appendicitis, intussusception, malrotation, inflammatory bowel disease, intestinal obstructions, and nonorganic pain. Emphasis is placed on surgical intervention and disease processes that significantly affect outcome. The outcome of many of the diseases discussed is strongly influenced by the timing of diagnosis and treatment. These children should have prompt care and intervention to prevent morbidity and mortality. In addition, many children who present with common pediatric surgical emergencies have other medical conditions and are best treated in an environment that has a multidisciplinary team to handle their care and decrease the long-term complications.
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PMID:Acute abdomen. Outcomes. 915 62

From 1989 to 1995 high-resolution ultrasonography (US) was performed in 3,546 children (age: 1-17 years) with clinically suspected appendicitis. A total of 518 patients underwent laparotomy; 420 had histologically proven acute or perforated appendicitis (prevalence 11.8%). In these children, the sensitivity, specificity and overall accuracy of US examination were 90%, 97% and 96% respectively. The use of US in clinically doubtful acute abdomen may allow earlier diagnosis of acute appendicitis; in 1995 the rate of unnecessary appendectomy was reduced to 13%.
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PMID:[Appendicitis in childhood]. 934 Jun 74

Leukaemic and lymphomatous infiltration of the appendix is rare and even rarer is acute appendicitis as the initial manifestation. From our routine biopsy material we collected four cases of haematological malignancies presenting as acute appendicitis or acute abdomen, caused or accompanied by tumoral infiltration of the appendix. Appendicitis was the initial manifestation that allowed diagnosis of the underlying disease. The clinical histories and histological examinations of the appendices and of one autopsy are described. We report the first detailed description of acute myeloid leukaemia involving the appendix, and three cases of lymphomatous infiltration of the appendix presenting with appendicitis, and give an overview of the literature. In these days of budgetary cuts in national health services, where one may be tempted not to have seemingly commonplace cases of appendicitis histologically verified, our cases emphasize that careful histopathological examination of all appendectomy specimens should be mandatory. Despite the fact that leukaemia and lymphoma of the appendix are rare, our cases illustrate that these must be included in the differential diagnosis of acute appendicitis and that physicians and surgeons have to be aware of these conditions.
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PMID:Leukaemia and lymphoma of the appendix presenting as acute appendicitis or acute abdomen. Four case reports with a review of the literature. 939 90

This retrospective study of 645 black patients, carried out over a five year period, showed that appendicitis is twice as common in males as in females and that it occurs predominantly in young people (median age 20 years). The classical presentation of periumbilical pain (16%) was outnumbered by right iliac fossa pain (36%) and non-specific pain (27%). The majority perforated (43%) and appendiceal inflammation was second commonest (37%). The negative appendicectomy rate was 8.8% and there was a diagnostic error of 14%. Mortality was two per cent mainly from patients complicated by peritonitis. Hospital stay was 7 +/- 7 days, with the longest stay following peritonitis. A diagnosis of appendicitis should always be entertained in an African patient presenting with an acute abdomen and, where the diagnosis is in doubt, a laparotomy should be performed.
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PMID:Appendicitis among African patients at King Edward VIII Hospital, Durban, South Africa: a review. 964 Aug 28

The presentation of an acute abdomen in children with a ventriculoperitoneal shunt requires skillful diagnostic workup. Apart from complications caused by the shunt, primary abdominal pathological conditions must be taken into consideration, particularly in the older child. A series of 6 children with a ventriculoperitoneal shunt had to be treated surgically for appendicitis. Their medical records were analyzed retrospectively. Despite difficulties with the initial diagnosis, the time from admission to final diagnosis and operation was relatively short. An accurate history, careful evaluation of the clinical signs and, above all, ultrasound of the abdomen were helpful in decision making. During the operation the shunts were left in place. Only 1 patient developed a cerebrospinal fluid pseudocyst in the early postoperative period, which made a conversion into a ventriculoatrial shunt necessary. No ascending infection occurred, even when the abdominal tip of the shunt came in close contact with the focus of inflammation. An acute abdomen due to shunt infection should be managed conservatively and by removal of the shunt from the abdomen, thus avoiding an unnecessary laparotomy. On the other hand, a primary intraabdominal disease requires surgical treatment, during which the shunt system can be left in place.
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PMID:Appendicitis in children with a ventriculoperitoneal shunt. 969 25

Over a period of three years, 122 patients who presented with acute abdomen, and had normal abdominal x-rays on admission were examined with Ultrasonography (U/S) in order to evaluate the use of Abdominal Ultrasonography in patients with negative x-ray findings. Sonographic evaluation was undertaken with Siemen's equipment (Sonoline S1-2) with a 3.5 MHz sector transducer for the abdominal organs and 5 or 7.5 MHz sector transducer for the abdominal organs and 5 or 7.5 MHz linear array for the intestines and right iliac fossa. Analysis included features or organ inflammation, bowel wall changes, and motility and collections. Ultrasound guided aspiration and drainage were done when necessary. Surgical confirmation was obtained in 86 out of the 122 cases. The commonest finding were appendicitis, intestinal obstruction and gynaecological pathologies. Ultrasound correctly identified 76 out of the 86 positive cases (88%). The sensitivity, specificity, positive predictive valve and negative predictive valves were 88%, 78%, 96% and 83% respectively. There were seven (7) false negative findings, and three (3) false positive cases. Pancreatitis was the commonest cause of false negative findings. The study clearly shows that ultrasound imaging can identify the underlying pathology in 88% of patients with acute abdomen with negative, plain abdominal x-ray findings. Ultrasound guided interventional procedures can also be done without delay.
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PMID:The value of ultrasonography in the x-ray negative non-traumatic acute abdomen. 971 10

We report on the case of a 24-year-old white man with a history of chronic leukemia treated with unrelated bone marrow transplantation and chemotherapy who was correctly diagnosed with appendicitis rather than typhlitis. The approach to diagnosing an acute abdomen in the leukemic patient is discussed, with particular focus on appendicitis vs. typhlitis. A focused CT scan proved to be instrumental in making the correct diagnosis of appendicitis in our patient. The literature on this topic for the past 30 years is reviewed. The purpose of our report is to demonstrate that despite the recent trend toward diagnosing RLQ pain as typhlitis which requires medical management, there are still instances where it 'really is' appendicitis. Appendicitis, therefore, must always be ruled out in the leukemic patient.
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PMID:Sometimes it really is appendicitis: case of a CML patient with acute appendicitis. 976 Jan 55


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