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Query: UMLS:C0003615 (appendicitis)
 4,439 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 72-year-old man was hospitalized for exacerbation of chronic obstructive pulmonary disease and was treated with oral prednisone and 7 days of moxifloxacin. Five days after completing the antibiotic course, he developed watery diarrhea and diffuse, crampy abdominal pain. On presentation he was afebrile, and abdominal examination revealed diffuse tenderness without peritoneal signs. Stool tested positive for Clostridium difficile toxin A by enzyme-linked immunosorbent assay. Despite starting oral metronidazole, the patient developed a fever of 101.2 degrees F 36 hours after his initial episode of diarrhea, 12 hours after admission. His abdominal pain intensified and became localized to the right and left lower quadrants. Computed tomography scan revealed both a thickened cecal wall and an edematous appendix with ileocecal stranding consistent with appendicitis. Appendectomy was performed, and the appendix was found to be suppurative in appearance and nonperforated. The cecum had mild edema and erythema, whereas the colon and rectum were grossly unaffected. Pathology examination revealed exudative material in the appendiceal lumen and a diffuse transmural inflammatory cell infiltrate. The patient had an uneventful recovery and continued to improve on oral metronidazole. Although Clostridium difficile colitis and appendicitis are each very common independently, C. difficile as an etiology of appendicitis is exceedingly rare. A review of the literature revealed 2 prior cases. We speculate that this association is underdiagnosed, because milder cases might respond to antibiotic therapy alone, and severe cases might involve the entire colon and require total colectomy. In each scenario, the involvement of the appendix might be overlooked.
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PMID:Acute appendicitis in the setting of Clostridium difficile colitis: case report and review of the literature. 1767 42

Appendicectomy is one of the commoner operations with a lifetime risk as high as 12% or 23% in males or females, respectively. Since the 1940s intra-operative intra-peritoneal swabs have commonly been taken from the appendix site, the spectrum of infecting organisms and their antibiotic sensitivity may be gauged from the culture results. This approach remains common but in recent years, studies have claimed that intra-peritoneal swabs are unnecessary; however, they relied upon retrospective patient groups predating wider use of laparoscopic appendicectomy, increasing numbers of immunocompromised people at risk of appendicitis and the clinical/medicolegal significance of increasing risk of antibiotic-associated Clostridium difficile colitis. Therefore, a key-word literature research was done to identify relevant publications from 1930 to June 2009. Newer features relating to intra-peritoneal swabs in appendicectomy have been discussed against this background information for periabdominal appendicectomy with or without appendicular perforation, laparoscopic appendicectomy and appendicectomy in the growing numbers of immunocompromised patients. All studies questioning the use of intra-peritoneal swabs were open, non-randomised, and retrospective with incompletely matched control groups, non-standardised swab collection techniques, and consequently lacked power to inform surgical practice. They concluded that an appropriately powered randomised, blinded, prospective, controlled clinical trial is needed to test for absolute efficacy in the use of peritoneal swabs in patient management. Until controlled trial data becomes available, it may be wise to continue peritoneal swabs at least in high-risk patients to decrease clinical and medicolegal risk.
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PMID:Peritoneal fluid culture in appendicitis: review in changing times. 2062 Dec 8

A fit and well 16-year-old girl presented to the emergency department with signs and symptoms suggestive of appendicitis. A transabdominal ultrasound scan revealed a normal appendix but there was significant free fluid in the pelvis. Consequently, a CT scan of her abdomen was performed which showed mucosal oedema and inflammation involving virtually the entire length of her large bowel (the 'accordion sign'). Clostridium difficile colitis was thus suspected; however, the toxin was not detected in her stool. The patient was treated conservatively with intravenous fluids and antibiotics and had an uneventful recovery. She was subsequently discharged home 3 days later with a full recovery. In this case, the radiological appearance of the accordion sign which is traditionally known to be pathognomonic of pseudomembranous colitis, reveals that it may also be indicative of severe colonic luminal inflammation.
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PMID:An unexpected CT finding in a patient with abdominal pain. 2334 75

Infectious and inflammatory diseases comprise some of the most common gastrointestinal disorders resulting in hospitalization in the United States. Accordingly, they occupy a significant proportion of the workload of the acute care surgeon. This article discusses the diagnosis, management, and treatment of appendicitis, acute cholecystitis/cholangitis, acute pancreatitis, diverticulitis, and Clostridium difficile colitis.
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PMID:Acute inflammatory surgical disease. 2426 93

Clostridium difficile colitis has been the most recognized bacterial enterocolitis for years and other bacteria such as Staphylococcus colitis has been relegated. Staphylococcus enterocolitis following antibiotics had been one of the most frequent complications in surgical patients in the 1950s and 1960s and now reappear with more resistance such as methicillin-resistantStaphylococcus aureus(MRSA) colitis which brings a new challenge. A 32-year-old Hispanic female with a history of type I diabetes mellitus presenting with altered sensorium and a 2-day history of watery, nonbloody diarrhea, intractable emesis, and diffuse crampy abdominal pain. About a month before the presentation, the patient had a soft-tissue laceration on the left foot requiring a 7-day course of cephalexin and clindamycin that healed appropriately. On physical examination, she was tachycardic with heart rate of 110 bpm and tachypneic with respiratory rate of 28, somnolent but arousable with the Glasgow Coma Scale >12. The abdomen was soft, tender diffusely to palpation without rebound or guarding. On the biochemical analysis, her blood glucose was 968 mg/dL with anion gap metabolic acidosis (AG 46). In the intensive care unit, she initiated on intravenous (IV) fluids, insulin, and IV antibiotics for suspicion of colitis. Clostridium difficile testing was negative, but stool cultures grew MRSA for which she was started on vancomycin and TMP-SMX. Due to continued abdominal pain on antibiotics, computed tomography of the abdomen with contrast showed acute appendicitis with inflammatory debris and without perforation or abscess requiring laparoscopic appendectomy. Our case presented with diabetic ketoacidosis (DKA), which complicates the etiology of abdominal pain on admission for the clinician masking-MRSA colitis associated with a rare complication of appendicitis double challenge and difficult to diagnose as most DKA patients present with abdominal pain. This is the first case report describing MRSA enterocolitis in patient with DKA complicated by acute appendicitis.
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PMID:Unusual Presentation of Methicillin-Resistant Staphylococcus aureus Colitis Complicated with Acute Appendicitis. 3216