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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Acute appendicitis is a well known clinical entity, but many physicians are unwilling to accept appendicitis as a chronic or recurrent illness. Of 225 patients undergoing appendectomy, sixteen (7 per cent) had findings suggestive of chronic, recurrent, or subacute appendicitis. Four patients had chronic abdominal pain and histologic findings of chronic inflammation. Nine patients had previous episodes similar to that which resulted in appendectomy. All had acute suppurative appendicitis pathologically. Three patients had only one episode of abdominal pain, but had pathologic evidence of subacute inflammation. Because this study was retrospective, we suspect that the true incidence of recurrent appendicitis is significantly greater, as reported by others. Indications for operation must be strict, for unless there are specific signs and symptoms of appendiceal disease, appendectomy will often be of no benefit.
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PMID:Chronic and recurrent appendicitis. 43 29

Recurrent appendicitis and chronic appendicitis are the subjects of much controversy, but long-standing inflammation of the appendix and surrounding tissues has been reported in rare instances. We have described two patients, both with recurrent episodes of abdominal pain, who subsequently were shown to have chronic appendiceal disease. Appendiceal disease should be considered in the differential diagnosis in patients with recurrent abdominal pain.
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PMID:Recurrent abdominal pain due to chronic appendiceal disease. 206 39

In a prospective controlled study the effect of antibiotics as the only treatment in acute appendicitis was evaluated. Of 40 patients admitted with a duration of abdominal pain of less than 72 h, 20 received antibiotics intravenously for 2 days followed by oral treatment for 8 days and 20 considered as controls were randomized to surgery. All patients treated conservatively were discharged within 2 days, except one who required surgery after 12 h because of peritonitis secondary to perforated appendicitis. Seven patients were readmitted within 1 year as a result of recurrent appendicitis and underwent surgery, when appendicitis was confirmed. The diagnostic accuracy within the operated group was 85 per cent. One patient had perforated appendicitis at operation. Antibiotic treatment in patients with acute appendicitis was as effective as surgery. The patients had less pain and required less analgesia, but the recurrence rate was high.
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PMID:Randomized controlled trial of appendicectomy versus antibiotic therapy for acute appendicitis. 764 84

The role of Enterobius vermicularis in appendicitis has been disputed. The aims of this retrospective study were to determine the prevalence of E. vermicularis in surgically removed appendices and to relate this to the age and sex of the patient, the time of the year, the presence of symptoms and the histological findings. The study included all appendices received in this laboratory during the 5 year period from 1984 through to 1988. There were 1867 appendices during this period of which 1108 were acutely inflamed and 759 were not inflamed (although 149 of these showed other pathological changes). The mean age distribution of all patients was 22.8 years. Enterobius vermicularis was identified in 63 appendices (3.4%). Infestation was more frequent in female (4.6%) than in male (1.9%) patients. The peak age was 12.8 years in females and 12.1 years in males. Of 63 patients who had E. vermicularis, 98% presented with symptoms of acute or recurrent appendicitis, yet 40 had no histological evidence of appendicitis or mucosal invasion by the parasite and only four had other possible explanations for abdominal pain. In an analysis of the subgroup of 147 patients who had incidental appendectomy at the time of laparotomy for other reasons, only one had E. vermicularis. It is concluded that E. vermicularis occurs more frequently in uninflamed appendices. It may be a cause of symptoms resembling acute appendicitis although the mechanism for this does not involve mucosal invasion by the parasite.
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PMID:Enterobius vermicularis: a possible cause of symptoms resembling appendicitis. 794 67

A case of right lower quadrant pain in a 53-year-old postmenopausal female who underwent appendectomy 21 years previously is presented. Recurrent appendicitis with rupture was noted in the appendiceal stump on exploratory celiotomy after diagnosis by computed tomography scan. Although rare, pathology of the appendiceal stump, whether inverted or not, is a real entity that can be encountered on laparotomy. Malignancy and hemorrhage can also occur in the appendiceal remnant, but the large number of disorders that can cause acute right lower quadrant abdominal pain makes appendiceal stump pathology extremely difficult to detect preoperatively. Because of the extensive differential diagnosis, timely operative intervention for clinical peritonitis in this region should not be delayed.
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PMID:Delayed pathology of the appendiceal stump: a case report of stump appendicitis and review. 797 78

Episodic abdominal pain, a common clinical problem, can be a diagnostic and therapeutic conundrum when the surgeon encounters it acutely in the emergency department. Appendicitis is often excluded from the differential diagnosis because the natural history of appendicitis is usually appreciated as acute, progressing to some degree of peritonitis quite rapidly and inevitably. However, recurrent and chronic forms of appendicitis occur also and can mislead the clinician. Herein, we describe two patients with recurrent appendicitis that were misinterpreted as other abdominal conditions, and we review the literature implicating recurrent and chronic appendicitis as disease processes, distinct from acute appendicitis, that occur with an incidence of approximately 10 per cent and 1 per cent, respectively.
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PMID:Recurrent and chronic appendicitis: the other inflammatory conditions of the appendix. 811 86

Those having chronic and recurrent appendicitis represent a small portion of patients with disorders of the appendix. We present a series of nine patients who underwent appendectomy for chronic or recurrent appendicitis at The Johns Hopkins Hospital, Baltimore, Maryland, between July 1984 and October 1992. There were seven women and two men (median age of 30 years, range of 15 to 63 years). All patients presented with pain in the right lower quadrant or lower abdomen of three or more weeks duration (mean of 16.0 +/- 8.4 months, range of three weeks to seven years), had no alternative diagnosis to account for the symptoms, had pathologic evidence of chronic inflammation or fibrosis of the appendix and had complete relief of the symptoms after appendectomy. Although the patients presented herein had clinical and pathologic evidence for recurrent or chronic appendicitis, careful review of the course of each patient before surgical referral revealed at least one episode of acute pain in the abdomen consistent with acute appendicitis managed by nonoperative means. This suggests that, while recurrent acute appendicitis and chronic appendicitis do occur, they can be avoided by the accurate diagnosis and operative management of acute appendicitis. We conclude that acute appendicitis can resolve spontaneously and recur repeatedly in the same individual; in the evaluation of a patient with abdominal pain, a history of prior similar episodes of pain should never dissuade one from considering the diagnosis of acute appendicitis, and recurrent acute appendicitis and chronic appendicitis should be considered in the differential diagnosis of recurrent pain in the lower abdomen.
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PMID:Chronic and recurrent appendicitis are uncommon entities often misdiagnosed. 814 38

Therapy for children with appendiceal abscess remains controversial. The authors present two such cases initially treated conservatively, without interval appendectomy, that later had recurrent appendicitis. An 8-year-old boy presented with fever, abdominal pain, and a right-lower-quadrant abscess (noted by ultrasonography). During laparotomy, the abscess was drained and the appendix was not found. He was lost to follow-up but returned 2 1/2 years later with perforated appendicitis. An appendectomy was performed, and image-guided drainage of a postoperative abscess was required. A 10-year-old girl presented with fever and right-lower-quadrant pain. Computed tomography showed a multiloculated mass. During laparotomy, the cecum was found to be densely adherent to the pelvic organs and bowel, so the surrounding abscess was drained. Interval appendectomy was refused. The patient returned 8 months later with recurrent acute appendicitis and an appendiceal abscess requiring appendectomy and drainage. Although initial drainage alone of appendiceal abscess is efficacious, the authors strongly advocate interval appendectomy as a critical component of the complete management of this entity.
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PMID:Recurrent appendicitis after initial conservative management of appendiceal abscess. 893 62

A prospective, observational study was performed to define the laparoscopic appearance of chronic or recurrent appendicitis, and to evaluate a new, simplified technique for laparoscopic appendectomy. Chronic appendicitis was assumed in 42 women with long-term or recurrent lower abdominal pain, and appendectomy was performed when two or all three of the following pathologic changes, which were highly predictive of the diagnosis, were present: vascular injection of appendiceal peritoneum, periappendiceal adhesions, and induration of the appendix. After thorough periappendiceal adhesiolysis, a catgut no. 2 endoloop was placed around the base of the appendix and mesoappendix. The appendix was skeletonized, crushed distal to the ligature, regrasped further distally while simultaneously closing the appendiceal lumen, and cut in the crushed area. It was removed retrograde through the left suprapubic 10-mm port. Iodine was applied to the stump. No major intraoperative or postoperative complications occurred. During mean observation of 12.6 months, 74% of women were free of abdominal pain, 12% had partial relief in a mean of 15.4 months' observation, and 12% experienced no change in abdominal pain. This technique is safe, simple, and effective when chronic or recurrent appendicitis is assumed during diagnostic laparoscopy for chronic lower abdominal pain.
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PMID:Gynecologically indicated single-endoloop laparoscopic appendectomy. 966 50

In this study we aimed to show that performing interval appendectomy is unnecessary in the management of appendiceal mass in children. Between 1990 and 1996, 866 patients were treated for appendicitis. Abdominal ultrasonography (USG) was performed in patients who were admitted with abdominal pain, vomiting, and fever accompanying a mass in the right lower quadrant. Seventeen patients (12 boys and 5 girls, with a mean age of 9.5 years) with a mass in the appendiceal lodge and no abscess formation were treated conservatively. Appendectomy was performed on any patients with perforated or unperforated appendicitis who had an appendiceal abscess with a mass in the right iliac fossa. Three-agent antibiotic therapy was administered for at least 1 week. These patients were discharged after a mean hospital time of 9.7 days if regression of the mass was seen ultrasonographically. They were followed up for 1-60 months by physical examination and USG, and 11 of the 17 also underwent barium enema. USG demonstrated disappearance of the mass and barium enema showed a normal appendix in 10 of the 11 patients. No recurrent appendicitis was detected during follow-up for 1-7 years. This study shows that appendiceal masses that are perforated, but localized with no fluid content revealed by USG, can be treated conservatively even if they are detected late.
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PMID:The management of appendiceal mass in children: is interval appendectomy necessary? 1151 Jun 1


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