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Query: UMLS:C0031154 (peritonitis)
 15,372 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The practice of coelioscopic approach in acute appendicitis is still very much debated. A study of the results of 73 patients carried out over two and half years leads one to conclude to the interest of this technique also for the treatment of appendicular peritonitis. Full exploration of the abdominal cavity, easy discovery of ectopic appendix, treatment of associated lesions, extended peritoneal washing, are the observed advantages together with reduced length of hospitalisation and few post-operative complications, in particular parietals problems and obstructions at long term. The experience of the surgeon becomes of prime importance to reduce operating time, frequency of open-surgery converting and complications.
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PMID:[Value of appendectomy by celioscopy: apropos of a series of 73 cases]. 807 5

The authors present a retrospective analysis of 1,379 pediatric laparoscopic appendectomies. The patients' average age was 10 years (range, 2 to 16 years). On gross examination, 90% of the appendixes appeared inflamed; on microscopic examination, 93% had evidence of acute appendicitis. The incidence of appendiceal peritonitis was 16%. Nonappendiceal lesions were identified in 10% of patients. The incidence of minor intraoperative events was 2.1%, and the postoperative complication rate was 1.5%; 0.7% of patients required a subsequent laparotomy or additional laparoscopic procedure. There were no deaths. The children were discharged after a 2-day (average) hospitalization and returned to unrestricted activities 1 week after surgery. The advantages of laparoscopic appendectomy are its easy and rapid localization of the appendix, the ability to explore the entire abdominal cavity, the ability to lavage completely the contaminated peritoneal cavity, and a reduction in the incidence of intraperitoneal abscesses and postoperative adhesions. Laparoscopic appendectomy offers reduced parietal scarring, a shorter hospital stay, and an earlier return to normal activities, even in cases of complicated acute appendicitis. Our experience confirms that laparoscopic appendectomy is safe and effective in children.
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PMID:Laparoscopic appendectomy in children: report of 1,379 cases. 807 22

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

While diagnostic laparoscopy is a well established tool, therapeutic laparoscopy for acute abdominal disorders has recently been made possible by video-endoscopic techniques. From July 1989 to April 1992, 243 laparoscopic interventions were carried out in patients with an acute abdomen. After a pilot phase, patients with acute appendicitis were entered into a randomized trial, those with acute cholecystitis were operated within the next day list. Among the 243 operations were 202 appendectomies, 12 closures of perforated peptic ulcers, 4 successful interventions for intestinal obstruction, 4 irrigations for intraabdominal abscesses and 35 further operations, some of which had to be finished as laparotomies. Laparoscopic appendectomy was less painful but technically more difficult. In cases which needed bowel resection for ischemic necrosis or diverticular disease, conversion to open surgery had to be performed. Laparoscopic treatment of acute abdominal disorders including peritonitis can be effective and beneficial in one out of two patients. Adequate surgical training, expertise and respect to the safety of the patient are mandatory. The application of endoscopic suture devices will further enlarge the spectrum of laparoscopic treatment options for the acute abdomen.
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PMID:[Value of laparoscopy in diagnosis and therapy of the acute abdomen]. 814 45

From October 1990 to October 1992 the first 23 laparoscopically operated patients were recorded. 11 patients retrospectively including a supplementary questioning to missing data, 12 patients prospectively with a follow-up 6-8 weeks later. They were compared with 35 from April 1991 to April 1992 conventionally operated and prospectively observed patients. Laparoscopy was performed on patients with subacute clinical signs. The median age was comparable. Acute appendicitis was histologically confirmed in 18% of the laparoscopically and in 80% of the conventionally operated patients. Operating time was in mean 110 minutes for laparoscopic and 65 minutes for open appendectomy. The postoperative complications for laparoscopy included 4 Douglas abscesses (2 x open and 2 x pararectal revisions), one peritonitis due to a defect Roeder-loop and an haematoma of the abdominal wall. One case of wound infection (3%), one pericoecal abscess which needed an ileoascendostomy and a postoperative fatigue syndrome were recorded for open appendectomy. The postoperative return to normal diet was faster for laparoscopy. Return to normal bowel habits, the need of analgesia and the nominal analogue scales concerning pain, quality of sleep, well-being and appetite showed no obvious differences between the two operation methods. The postoperative stay was on average 6.7 days for laparoscopy and 5.6 days for the open operation. The results show the severe complications which may happen when introducing this new operation method. The laparoscopic appendectomy should only be performed electively in subacute appendicitis or when diagnostic exploration shows an inflamed appendix. Careful rinsing of the operation site and perioperative antibiotic treatment are mandatory. We made good experiences when using a stapler for the removal of the appendix.
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PMID:[Does laparoscopic appendectomy have advantages? Laparoscopic appendectomy in comparison with conventional appendectomy--an observational study during introduction of laparoscopy]. 814 46

A total of 110 consecutive patients presenting to one surgical firm with suspected acute appendicitis underwent peritoneal aspiration cytology. Aspiration was successful in 108 patients and 44 were positive. Patients with a positive result underwent emergency surgery; 42 had histologically proven acute appendicitis and two peritonitis of other causes. Seven patients with a negative result underwent appendicectomy; four had acute appendicitis and three a normal appendix. Peritoneal aspiration cytology had a sensitivity for acute appendicitis of 91 per cent and a specificity of 94 per cent. The positive predictive value of the test was 95 per cent and the negative predictive value 94 per cent. The negative appendicectomy rate was 10 per cent overall and 11 per cent in women of reproductive age. Peritoneal aspiration cytology is a useful diagnostic test in the management of patients with suspected acute appendicitis.
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PMID:Peritoneal aspiration cytology as a diagnostic aid in acute appendicitis. 792 80

Familial Mediterranean fever (FMF) also known as hereditary polyserositis, is an inherited disorder commonly found in Armenians, Turks, Arabs, Balkans, and Jews originating from North African countries. The diagnosis of FMF is based on clinical findings and family history, as no specific diagnostic test is yet available. One of its main clinical features is recurrent acute episodes of peritonitis. During such an episode, physical examination and laboratory findings may be similar to those for acute appendicitis. Therefore up to two-thirds of FMF patients undergo emergency appendectomy, with the appendix being normal in most cases. As laparoscopic appendectomy has proved to be safe and advantageous, and to prevent misdiagnosis and unnecessary emergency surgery, we performed elective laparoscopic appendectomy in 13 FMF patients ranging in age from 8 to 32 years. They had been suffering from the disease for 1 to 12 years (mean 3.8) and had had an average of 3.5 yearly episodes of FMF peritonitis. All procedures were concluded by laparoscopy without conversion to open surgery. The average postoperative hospital stay was 3.07 days. The only complication was superficial wound infection in one patient (7.6%), and the mean time to regain full normal activity was 8.5 days. We conclude that elective laparoscopic appendectomy in FMF patients is safe. It helps to exclude appendicitis as a cause for peritonitis in these patients and may prevent unnecessary emergency surgery.
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PMID:Elective laparoscopic appendectomy in patients with familial Mediterranean fever. 819 70

Our experience in using the phonoenterographic procedure in measuring the sounds produced by the intestinal motility in 75 patients is reported: 30 underwent surgery, won acute appendicitis, 20 appendicular peritonitis and 25 underwent surgery without abdominal pathology. We performed in all patients a temporary record of 3 minutes of duration, one spectrogram and one sonogram before the surgery and after surgery in the following 6, 12 and 24 hours. We obtained the number of sounds recorded by our informatic program, and also its intensity measure in dB and frequency in Hz. The procedure we have used can distinguished the characteristics of the intestinal sound of each patient and allow to show a qualitative and quantitative activity, different in the three group of patients. The number of sounds is bigger in the patients with non digestive abdominal pathology and smaller in patients with peritonitis. In general, the lesser number of sounds the lesser intensity and a more grave tones.
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PMID:[Study of intestinal motility in the child with acute appendicitis using phonoenterography]. 821 6

Experience in the treatment of 137 children with a most severe and complicated course of generalized purulent peritonitis of appendicular genesis is generalized. It is shown that such patients must be concentrated in centers of pediatric surgery providing the possibility of applying a complex of diagnostic examinations and therapeutic measures, including purposeful antibiotic therapy, differentiated immunocorrection, and effective detoxification. The detoxification and immunocorrection effect of discrete plasmapheresis with two-stage "washing out" of the red cells is illustrated in the discussion of 22 cases. It is pointed out that in operations for generalized purulent peritonitis the abdominal cavity must not only be cleansed but also drained adequately and intubation of the intestine must be carried out with aspiration of its content for 3-5 days and application of enterosorption through an intestinal tube. A complex of organizational and therapeutic measures made it possible to reduce considerably the mortality rate in acute appendicitis and its complications in the Moscow Region.
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PMID:[Treatment of generalized purulent appendicular peritonitis in children]. 826 67

Acute appendicitis, particularly pelvic, may cause a suppurative process that spontaneously drains to the bladder and an appendicovesical fistula may result. The pelvic appendix and the bladder may occasionally become fused in an inflammatory and necrotic focus, directly creating a fistula. A case of vesicointestinal fistula secondary to appendiceal pelvic peritonitis is described and the cases reported in the literature are reviewed.
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PMID:[Appendico-vesical fistula secondary to acute appendicitis. Review of the literature]. 833 79


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