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Query: UMLS:C0085693 (acute appendicitis)
 3,606 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Diagnostic laparoscopy in 96 pregnant women with suspected acute appendicitis revealed inflammation of the vermiform process only in two (2.1%) of them. In 81 cases acute surgical diseases of the abdominal organs were not found, extrauterine pregnancy was revealed in 9 and other diseases of the abdominal organs were detected in 4 cases. The threat of abortion was mistaken for acute appendicitis most frequently. Unjustified operation in such cases intensifies still more the signs of the threat of abortion. Analysis allows the assertion that the laparoscopic method should be decisive in the examination of pregnant women with a doubtful clinical diagnosis in suspected acute appendicitis. Laparoscopy is indicated when the reserves of the generally accepted clinical methods and noninvasive instrumental examination do not allow the diagnosis of acute appendicitis to be established or excluded; it is also recommended in establishing the exact diagnosis and determining the approach and volume of an operative intervention when there is a clinical picture of an acute surgical disease of the abdominal cavity.
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PMID:[Laparoscopy in the diagnosis of acute appendicitis in pregnant women]. 138 16

Recent work by epidemiologists and microbiologists has uncovered several hitherto unrecognized food-borne bacterial pathogens of public health significance. One of these, Listeria monocytogenes, has attracted considerable attention because of two major cheese-related outbreaks of listeriosis that were characterized by cases of meningitis, abortion, and perinatal septicemia. Thus far, L. monocytogenes has been responsible for well over 300 reported cases of food-borne listeriosis, including about 100 deaths, and has cost the dairy industry alone more than 66 million dollars as a result of product recalls. The ability of L. monocytogenes to grow at refrigeration temperatures, coupled with appearance of the pathogen in raw and processed meats, as well as poultry, vegetables, and seafood, makes this bacterium a serious threat to susceptible consumers and to the entire food industry. Yersinia enterocolitica, another psychrotrophic food-borne pathogen of recent concern, was linked to several outbreaks of yersiniosis associated with consumption of both raw and pasteurized milk, as well as contaminated water. Food-borne infections involving Y. enterocolitica typically result in enterocolitis, which may be mistaken for acute appendicitis. Unfortunately, inadvertent removal of healthy appendixes from victims of food-borne yersiniosis is all too common. Although known for many years, Campylobacter jejuni has only recently been recognized as a food-borne pathogen and a leading cause of gastroenteritis in the United States. Notable outbreaks of campylobacteriosis linked to consumption of raw milk, cake icing, eggs, poultry, and beef have underscored the need for thorough cooking and proper handling of raw products.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:"New" food-borne pathogens of public health significance. 250 76

Pelvic inflammations account for approximately 1/4 of the economic resources expended for maternity care in Chile. The use of IUDs has replaced abortion as the primary cause of pelvic inflammation. Sexually transmitted diseases are increasing but have not yet become a major cause of pelvic inflammations. A retrospective study was conducted of women hospitalized for pelvic inflammations in the septic unit of a hospital in Santiago, Chile, in 1980-83. Among the 313 women admitted with a diagnosis of pelvic inflammation, ages ranged from 17 to 57 and averaged 30.4 years. 11.1% were nulligestes, 25.2% were primiparas, 55.5% were multiparas, and 7.9% were grand multiparas. 45 of the 313 reported an induced abortion prior to the pelvic complication. 126 women (40.2%) reported use of an IUD. 36 women had postpartum infections, and no risk factor was identified for the remainder. The major clinical symptoms were abdominal pain in 67.7%, fever in 48.5%, metrorrhagia in 14.0%, and palpable mass on gynecological examination in 52.3%. Sonography was performed in 92 cases and laparoscopy in 20. Use of laparoscopy increased greatly after the study period and has proven to be extremely valuable in diagnosis. 121 of the 313 patients were treated medically and 192 were treated medically and surgically. The average hospital stay was 8.8 days, with a maximum of 80 days and a minimum of 1 day. The admission diagnosis was incorrect in 138 cases and correct in 175. A purulent acute appendicitis was discovered in 1 patient with a presumed tubo-ovarian abscess. The mortality rate was 1.2%.
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PMID:[Pelvic inflammations]. 297 91

A clinical study of 22 cases of ovarian hemorrhage suggests that intraabdominal hemorrhage of 100 ml and above should be surgically treated. The study also found polycystic tendency and increased peripheral blood white blood cell count. 13 cases which were pathologically treated were diagnosed to be corpus luteum hemorrhage. Out of 26 cases with ovarian hemorrhage seen at Almeida Hospital in Oita, Japan, between 1976 and 1987, 4 cases were eliminated from the study because of pregnancy. No significant difference was found in terms of number of pregnancies or number of child births. 19 of 22 cases belonged to the age group 20-34. Hemorrhage occurred in 9 cases during the premenstrual period, from the 22nd day to the 28th day. It occurred after induced abortion in 5 cases. All 22 women complained of lower abdominal pain. 15 were diagnosed to have puncture of Douglas pouch. In 16 out 22 cases hemorrhage occurred in the left ovary. This is due to the fact what many with right side abdominal pain had already been operated elsewhere because of suspected appendicitis. No fever over 38 degrees celsius was found, but 8 cases had a slight temperature. 5 of 22 cases showed a peripheral blood white blood cell count over 10,000. This combination of two factors proved to be not so reliable in distinguishing between acute appendicitis and ovarian hemorrhage. 9 out of 11 cases which were diagnosed to have intraabdominal hemorrhage of 100 ml and above were still hemorrhaging at the time of operation. Therefore, hemorrhage of 100 ml, not 200 ml and above as in the past, should be surgically treated.
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PMID:[Idiopathic ovarian hemorrhage]. 336 Nov 83

A case of acute appendicitis in a 26-year-old woman apparently caused by a Copper-T IUD inserted 4 years previously is reported. Only 6 previous cases of this rare complication are recorded in the world literature. The woman was admitted as an emergency with a 12 hour history of epigastric pain radiating to the right iliac fossa and right lumbar region and associated with nausea and vomiting. The woman had had 2 children and 1 miscarriage. At admission her axillary temperature was 37.6 degrees Centigrade and her rectal temperature was 38.8 degrees Centigrade. She was tender in the right iliac fossa. On vaginal examination she was noted to have an IUD in situ. The woman had become pregnant and an abortion was performed. The IUD was not recovered. The possibility that the IUD had perforated the uterus was not considered, and 1 month following the termination a 2nd IUD (a Lippes Loop) was inserted. A diagnosis of acute appendicitis was made. The abdomen was opened through a McBurney incision. There was an inflammatory mass which included omentum involving the appendix with dense adhesions to the caecum. After dissection, a short and inflamed appendix was found with an IUD emerging from its proximal third. An appendectomy was performed. The right tube and ovary were noted to be mildly inflamed. The uterus appeared normal. No perforation site was observed, and the abdomen was closed. In this case it seemed likely that the IUD had perforated the uterus at the time of its initial insertion. The manner in which the device reached the appendix is unknown. In any instance of a "missing" IUD, an abdominal X-ray, ultrasound, or hysterography is indicated to exclude perforation and/or migration. If perforation of the uterus has occurred, the IUD should be recovered either by laparoscopy or, if necessary, laparotomy.
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PMID:Appendicitis caused by an intrauterine contraceptive device. 379 Sep 29

In a series of 48,482 pregnancies laparotomy was undertaken 74 times for conditions not associated with pregnancy (1 in 655 pregnancies). It showed no abnormality in 26 cases; ovarian cysts and acute appendicitis were the commonest pathological findings. The preoperative diagnosis was proved correct in 53% of cases, and in 66.2% laparotomy proved to be necessary for an alternative diagnosis.The fetal loss rate after surgery was 23%. Spontaneous abortion was more likely in the presence of peritonitis, with fluid in the peritoneal cavity, or when operative procedures involving the ovary were performed within the first trimester. The risk of precipitating labour following diagnostic laparotomy is negligible, provided no unnecessary surgical manoeuvres are undertaken.
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PMID:Laparotomy during pregnancy: an assessment of diagnostic accuracy and fetal wastage. 472 Jul 68

Abdominal pain and fever after an uncomplicated elective abortion usually point to incomplete abortion and endometritis. We treated a woman for acute suppurative appendicitis one week after such an abortion. When fever, nausea, vomiting and pain are not relieved by the standard doses of medication, acute appendicitis must be added to the usual gynecologic differential diagnoses.
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PMID:Ruptured appendix after elective abortion. A case report. 622 52

Abdominal pain in pregnancy is most commonly caused by complications of the pregnancy, e.g., abortion, ectopic pregnancy and abruptio placentae. A careful history and methodical physical examination and, if necessary, simple ultrasonographic investigations will reveal the cause in most of these conditions. In a few cases of abdominal pain in pregnancy a gynaecological condition, such as torsion of an ovarian cyst, or a nongynaecological (medical or surgical) one is the cause. Some of these conditions are serious, e.g., acute appendicitis, and unless the correct diagnosis is made and the appropriate management promptly instituted both the mother and her baby may suffer tragic consequences. Moreover, these conditions are more likely to be misdiagnosed during pregnancy. This is because the anatomical and physiological changes which occur in pregnancy tend to change and obtund the expected clinical features and laboratory data which are used to diagnose these conditions. Their early diagnosis therefore requires a high index of suspicion together with awareness of the ways in which they may present in pregnancy.
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PMID:Abdominal pain in pregnancy. 794 66

This is a review of the epidemiological, diagnostic and therapeutic aspects of acute abdominal conditions during pregnancy. We emphasize the recent changes in surgical criteria that have appeared since the advent of laparoscopic surgery. The incidence of acute appendicitis during pregnancy is 1 in every 1,500 while approximately 4.5% of pregnant women have asymptomatic cholelithiasis and 0.05% acute cholecystitis. Up to 40% of these patients will require surgery during gestation and it is well known that abdominal interventions in this period carry out a higher risk of miscarriage or premature labor. We analyze the most common causes of acute abdomen during pregnancy as well as the special considerations of conservative treatment, open surgery and laparoscopic surgery. We also review the technical aspects of laparoscopic procedures and the safety guidelines by the Society of American Gastrointestinal Endoscopic Surgeons. It is concluded that the laparoscopic approach is safe and effective in the diagnosis and treatment of acute abdominal pathology during pregnancy. The advantages over conventional open surgery have made many surgeons and gynecologists change their criteria in favor of laparoscopy and this is now often their first choice of treatment.
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PMID:[Analysis of the increasing role of laparoscopy in the management of acute abdomen in pregnancy]. 1182

Ectopic pregnancies can be very difficult to diagnose at initial admission. This paper reviewed the morbidity and mortality associated with misdiagnosis of ectopic gestation over a 15-year period (1985-99) at Ile-Ife, Nigeria. There were 380 confirmed ectopic pregnancies of 35 857 live births, giving an incidence of 10.5 per 1000 live births. Of the 380 cases, 38 (10%) were misdiagnosed initially at presentation. Mistaken diagnoses include pelvic inflammatory diseases, cholera, acute appendicitis, typhoid enteritis, incomplete septic abortion, uterine fibroid with menorrhagia, malaria, gastroenteritis, peptic ulcer and intestinal obstruction. There were five maternal deaths among the 38 misdiagnosed cases compared to two maternal deaths among the 342 initially correctly diagnosed cases. Significant morbidity included prolonged hospital stay, increased hospital costs and an enterocutaneous fistula. To improve the chances of correct diagnosis at initial admission, accurate menstrual and sexual history should be obtained. Facilities for improved diagnosis such as serum beta HCG and transvaginal ultrasonography should be provided. Colleagues from other specialities should be educated to increase their suspicion of ectopic pregnancy in any woman of childbearing age and perform the appropriate investigations.
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PMID:Mortality and morbidity associated with misdiagnosis of ectopic pregnancy in a defined Nigerian population. 1252 28


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