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

Appendicitis due to foreign bodies is rare. Foreign bodies leading to appendicitis or perforation are usually sharp, pointed objects. Lead shot can become lodged in the appendix. Few prior cases have shown a causal relationship between the presence of pellets in the appendix and acute appendicitis. We present the case of a 9-year-old white boy who presented to the emergency room with a 36-hour history of right lower quadrant pain over McBurney's point accompanied by anorexia. The patient's history was significant for consumption of pheasant meat 4 days before onset of symptoms. The pheasant had been shot with a shotgun. X-ray of the child's abdomen revealed a metallic foreign body in the right lower quadrant. Appendectomy was performed. Bird shot was found obstructing the lumen of the grossly inflamed appendix. Pathology was consistent with acute appendicitis. This case is presented as an interesting consequence of bird shot ingestion.
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PMID:Appendicitis due to bird shot ingestion: a case study. 1088 37

A patient with a fulminant amebic colitis coexisting with intestinal tuberculosis had a sudden onset of crampy abdominal pain, mucoid diarrhea, anorexia, fever and vomiting with signs of positive peritoneal irritation. Fulminant amebic colitis occurring together with intestinal tuberculosis is an uncommon event and may present an interesting patho-etiological relationship. The diagnosis was proven by histopathologic examination of resected specimen. Subtotal colectomy including segmental resection of ileum, about 80 cm in length, followed by exteriorization of both ends, was performed in an emergency basis. Despite all measures, the patient died on the sixth postoperative day. The exact relationship of fulminant amebic colitis and intestinal tuberculosis is speculative but the possibility of a cause and effect relationship exists. Fulminant amebic colitis may readily be confused with other types of inflammatory bowel disease, such as idiopathic ulcerative colitis, Crohn's disease, perforated diverticulitis and appendicitis with perforation. This report draws attention to the resurgence of tuberculosis and amebiasis in Korea, and the need for the high degree of caution required to detect it.
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PMID:Toxic amebic colitis coexisting with intestinal tuberculosis. 1119

We report a case of a female patient with a picture of "atypical appendicitis," with 3 days of abdominal pain, localized to the right lower quadrant with no nausea, vomiting, diarrhea, or anorexia. On examination she was febrile to 38.4 degrees C, had tenderness at McBurney's point, and a leukocyte count of 11,200. A computerized axial tomography (CAT) scan was obtained showing changes consistent with appendicitis. On laparoscopic exploration the patient was found to have cecal masses. Definitive surgical treatment was deferred until after adequate evaluation of the colon. Postoperative colonoscopy demonstrated cecal diverticulitis. Management of cecal diverticulitis found during laparotomy for presumed appendicitis has included right hemicolectomy, ileocolic resection or appendectomy, and conservative treatment with antibiotics. The laparoscopic approach in a patient with an equivocal history and physical examination allows for definitive workup of inflammatory cecal masses found during surgery for appendicitis.
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PMID:Cecal diverticulitis: a case report and review of the current literature. 1199 78

Vomiting or its lesser stages-anorexia, nausea-is a prime symptom of the most serious surgically curable diseases of childhood. In the newborn, when vomitus is green, abdomen scaphoid, and erect roentgen view shows air-fluid levels in stomach and duodenum with gas beyond, partial duodenal obstruction is present and midgut volvulus with malrotation is likely enough to justify immediate exploration. In infancy, vomiting is a clear sign of intussusception when associated with intermittent colicky pain, palpable mass and "currant-jelly" feces. These symptoms are not always present, and if there is blood in the feces, barium enema study must follow. In further doubt, exploration may be justified. In childhood, a common early symptom of appendicitis is vomiting accompanied by pain without any complete remission. Constipation is frequent but diarrhea may occur and contribute to an impression of gastroenteritis. Complete and repeated physical examination, with a history of the above symptoms, should lead to correct diagnosis.
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PMID:Vomiting as a symptom of serious disease in infants and children. 1382 64

The objective of this work was to conduct a truly rural-based study to evaluate, from our own rural data devoid of influence from urban-based studies, the management of appendiceal masses in a typical peripheral hospital in Nigeria. The study aimed to highlight the results of neglected appendicitis in our community and the occasional difficulty of making a correct preoperative diagnosis. It also sought to draw the attention of the health care practitioner in our community to the importance of continued enlightenment of the people regarding the need to seek medical treatment early. This was a retrospective study, with the setting at St. Victoria Specialist Hospital, Ekwulobia, Anambra State, Nigeria, a rural hospital serving its community. A series of 30 patients who were managed for an appendiceal mass between January 1, 1992 and December 31, 2001, a 10-year period, were included in the study. We identified the cases by reviewing the surgical register. The relevant case notes were retrieved from the Records Department. The following data were extracted for each patient: age and sex; how early the patient presented; the history and presentation of the patient; whether the diagnosis was made before or during surgery; the treatment modality; length of hospital stay; and outcome. The results showed that 13 patients (43.3%) presented more than 1 week after the onset of symptoms. The age range was 15 to 60 years (average 27 years); 13 patients (43.3%) were in the age range of 40-49 years. Twenty men and ten women were treated, giving a male/female ratio of 2:1. The main clinical features were fever, anorexia, pain, tenderness, and a palpable mass in the right iliac fossa. The problem was diagnosed before surgery in 23 patients (76.7%) and during surgery in 7 (23.3%). Treatment modalities were conservative + interval appendectomy in 18 patients (60%); open and close + conservative + interval appendectomy in 3 patients (10%); immediate appendectomy without burying the stump in 2 cases (6.7%); right hemicolectomy (in one 40-year-old woman and one 55-year-old man); and incision and drainage of an appendiceal abscess in 5 patients (16.7%). No deaths were recorded. The study showed that appendical masses are most prevalent during the fifth decade of life and are rare before age 10 and after age 60. More men are affected than women, and most cases can be diagnosed before surgery, although some patients must await more sophisticated diagnostic tools or surgical exploration for diagnosis.
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PMID:Management of appendiceal masses in a peripheral hospital in Nigeria: review of thirty cases. 1450 9

The most common reason for performing abdominal surgery is appendicitis, which affects up to 12% of the population (Lemone & Burke, 2000). Appendicitis is acute inflammation of the vermiform appendix that is typically manifested by localised pain in the right lower quadrant of the abdomen (Holmes, 2001; Lemone & Burke, 2000; McCance & Huether, 2002; Wagner, McKinney & Carpenter, 1996). Abdominal pain is a very common complaint. However, pain in the lower right quadrant cannot be used as the gold standard in a nursing assessment as an indication of appendicitis. Approximately one third of patients with appendicitis will have pain that is spread across the abdomen similar to gastritis (Mattice, 1999). Therefore a more in depth nursing assessment is required. This paper looks at accurately assessing the other signs and symptoms of appendicitis. These may include changes in vital signs, behaviour and body positioning and a history of anorexia, nausea and vomiting. Unveiling appendicitis requires the performance of an accurate and thorough abdominal pain assessment. This competent assessment will assist in preventing complications such as perforation and peritonitis and ensure a better patient outcome (Wagner, et al., 1996; Wright, 1997).
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PMID:Unveiling appendicitis. 1464 15

Appendicitis is the most common surgical abdominal emergency in the pediatric population, but is rarely considered in children less than 3 years of age. The goal of this study was to identify the presenting symptoms and signs in this age group and examine their subsequent management and outcome. A 28-year experience of a single pediatric surgeon in academic practice was reviewed; 27 children less than 3 years old (mean 23 months) comprised 2.3% of all children with appendicitis in his series. The most common presenting symptoms were vomiting (27), fever (23), pain (21), anorexia (15), and diarrhea (11). The average duration of symptoms was 3 days, with 4 or more days in 9 children. Eighteen children were seen by a physician before the correct diagnosis was made; 14 were initially treated for an upper respiratory tract infection, otitis media, or a urinary tract infection. The most common presenting signs were abdominal tenderness (27), peritonitis (24), temperature 38.0 degrees C or more (21), abdominal distension (18), Leukocytosis (<12.0 x 10(3)/mm(3)) was found in 18, tenderness was localized to the right lower quadrant (RLQ) in 14 and was diffuse in 10. Abdominal radiographs demonstrated findings of a small-bowel obstruction (SBO) in 14 of 21 patients, a fecalith in 2, and a pneumoperitoneum in 1. Contrast enemas were performed in 6 children, 5 of whom had a phlegmon or an abscess. Perforated appendicitis was found in all 27 patients. An appendectomy was performed in 25 and a RLQ drain was placed in 18. Postoperative antibiotics were administered to 17 children for an average of 6 days. Two patients underwent interval appendectomies, 1 following treatment with IV antibiotics and 1 following surgical drainage. The average time to resume oral intake was 7 days and the average hospital stay was 21 (median 15) days. Sixteen patients had 22 complications, which included 6 wound infections, 4 abscesses, 4 wound dehiscences, 3 pneumonias, 2 SBOs, 2 incisional hernias, and 1 enterocutaneous fistula. Perforated appendicitis was found in all children less than 3 years old, resulting in very high morbidity (59% complications), which may be attributed to the 3-5-day delay in diagnosis. Although appendicitis is uncommon in this age group, it should be seriously considered in the differential diagnosis of children under the age of 3 years who present with the triad of abdominal pain, tenderness, and vomiting.
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PMID:Appendicitis in children less than 3 years of age: a 28-year review. 1473 Mar 82

Classic symptoms of appendicitis include right lower quadrant pain on palpation, loss of appetite, nausea and vomiting. However, only about half of patients present with these characteristic symptoms. The remainder of patients must undergo some type of diagnostic study to verify or rule out appendicitis. This article describes the types of medical imaging that are used to evaluate possible appendicitis, including conventional abdominal radiography, ultrasound, computed tomography and nuclear medicine imaging.
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PMID:Appendicitis imaging. 1633 40

Omental infarction is a rare entity in children that is usually diagnosed during surgery for suspected appendicitis. We report the clinical case of an obese boy presenting with abdominal pain and right-sided tenderness without fever, anorexia, or leukocytosis. Abdominal ultrasonography suggested omental infarction, and computed tomography confirmed the diagnosis. Nonoperative management was adopted with rapid and uneventful recovery. Nonoperative treatment of omental infarction is safe and effective; accurate diagnosis is therefore crucial to enable a conservative approach. Suggestive clinical features and diagnostic workup are addressed.
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PMID:Nonoperative management of omental infarction: a case report in a child. 1701 Dec 89

Acute abdominal pain can represent a spectrum of conditions from benign and self-limited disease to surgical emergencies. Evaluating abdominal pain requires an approach that relies on the likelihood of disease, patient history, physical examination, laboratory tests, and imaging studies. The location of pain is a useful starting point and will guide further evaluation. For example, right lower quadrant pain strongly suggests appendicitis. Certain elements of the history and physical examination are helpful (e.g., constipation and abdominal distension strongly suggest bowel obstruction), whereas others are of little value (e.g., anorexia has little predictive value for appendicitis). The American College of Radiology has recommended different imaging studies for assessing abdominal pain based on pain location. Ultrasonography is recommended to assess right upper quadrant pain, and computed tomography is recommended for right and left lower quadrant pain. It is also important to consider special populations such as women, who are at risk of genitourinary disease, which may cause abdominal pain; and the elderly, who may present with atypical symptoms of a disease.
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PMID:Evaluation of acute abdominal pain in adults. 1844 63


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