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

Twelve children with abdominal complaints had lymphoid hyperplasia of the bowel presenting in an acute or chronic form. The etiology is obscure. An infectious process is thought to precipitate the acute form of the disease. Parasites were identified in two patients with the chronic disease. The acute form, with involvement of the appendix or terminal ileum, presents commonly as acute appendicitis. Because of its self-limiting nature, appendectomy with perservation of the terminal ileum is appropriate. When intussusception is present, resection of the ileum is advisable. The chronic form, which is also common in the terminal ileum, produces disabling symptoms, recurrent intussusception, chronic anemia, and weight loss and is, therefore, amenable to surgical resection.
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PMID:Lymphoid hyperplasia of the bowel and its surgical significance in children. 100 12

Sickle crises frequently manifest as abdominal pain that may simulate intra-abdominal infection. To establish parameters to distinguish these, we retrospectively studied 53 patients with sickle-cell anemia who had abdominal pain (genotype SS 62%, SC 15%, SA 11%, S-other 11%; 30% men and 70% women; mean age 23). A vaso-occlusive crises was responsible for the pain in 57 per cent; 23 per cent had a surgical entity and 20 per cent had a nonsurgical genitourinary disorder. Of the surgical conditions, 9 of 12 patients (95%) had cholecystitis and 4 of 12 patients (33%) had acute appendicitis (one patient had both). Vaso-occlusive crises were diffuse in 15 of 30 patients (50%), compared with proven surgical conditions, and was more often associated with remote pain such as limbs and chest (23 of 30 [77%] P less than 0.005). The pain of vaso-occlusive crises simulated prior crises in 21 of 30 patients (70%) compared with 1 of 12 patients (8%) who had surgical abdominal pain (P less than 0.005). A precipitating event (especially upper respiratory infection) was found in 50 per cent of abdominal vaso-occlusive crises versus 0 per cent of surgical abdomens (P less than 0.010). The pain was relieved with hydration and oxygen in 97 per cent of sickle crises within 48 hours versus 0 per cent of surgical abdomens (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The presentation and management of the acute abdomen in the patient with sickle-cell anemia. 281 19

A three and one-half-year-old girl and a 12-year-old boy presented with features of the two clinical presentations of Castleman's disease or giant lymph node hyperplasia. The girl presented with anemia, fever, night sweats, hypergammaglobulinemia, and a palpable abdominal mass. Her symptoms were consistent with those seen in the plasma-cell type of this disease. The boy presented with acute appendicitis and a left hilar mass was noted on his chest radiograph. His asymptomatic presentation was typical of the hyaline-vascular form. Both patients are well without evidence of recurrence four years following resection. Castleman's disease is a benign disorder of lymph nodes that occurs rarely in children. Since the original report in 1954 we could find only 18 cases in the 16-year and younger age group and our patient with the symptomatic form represents the youngest patient reported in the English literature. The management requires surgical resection of the enlarged nodes both for diagnosis and therapy since the enlarged nodes can mimic malignant tumors of the lymphoid system. No recurrences have been reported in pediatric patients.
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PMID:Castleman's disease in children. 374

In 1978-1988 operations were performed on 92 children: 35 with diverticulitis, 7 with intestinal intussusception, 5 with hemorrhage from an ulcer of the diverticulum, 13 with strangulation or mechanical ileus, 2 with strangulated Littre's hernia, one with torsion of the omentum, 22 with secondary diverticulitis, and in 7 children Meckel's diverticulum was a chance finding during other operations in the cavities. Boys accounted for 60.9' (56) of cases. There were 12 children under one year of age, nine from 1 to 3 years, 17 from 3 to 5 years, 17 from 5 to 7 years, and 12 children aged from 7 to 10 years. The clinical manifestations depended on the pathological changes developing in Meckel's diverticulum. A clinical picture of acute appendicitis developed in diverticulitis, six children had a typical picture of intussusception, and one child had a picture of acute abdomen. Anemia and a stool with dark blood were encountered in hemorrhage from a diverticular ulcer. Seven out of 13 children with ileus had a pronounced clinical picture, in the remaining 5 it was unclear and resembled that of acute appendicitis. Meckel's diverticulum was suspected before the operation in 17 (9.95%) patients. The Volkovich-Dyakonov laparotomy approach was used in 64 children, a pararectal incision in 9, a transrectal incision in 15, a median incision in one patient, hernio-laparotomy was conducted in one and Shpizi's operation in 2 children. Diverticulectomy was accomplished by the oblique-transverse method in 79 children, by the wedge techniques in 5, by the purse-string method in 2 patients, and resection of the intestine with the diverticulum was conducted in 5 children.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Meckel's diverticulum in children]. 767 99

The diagnosis of delayed rupture of the spleen may be difficult to make because of the presumed triviality of the precipitating injury, an unpredictable time lag between the injury and the development of symptoms, and the possibility of atypical signs and symptoms remote from the bleeding spleen. The clinician may confuse the signs and symptoms with those of acute appendicitis or with some other cause. The authors present two case histories to illustrate the diagnostic difficulties caused by delayed rupture of the spleen. Whenever the acute surgical abdomen is present with concomitant anemia, the diagnosis of delayed rupture of the spleen should be considered.
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PMID:Delayed splenic rupture: an unusual cause of the acute surgical abdomen. 843 73

The clinical course of patients with hematological disease, especially after treatment, is often complicated by gastrointestinal infections. Between 1986 and 1990 a total of 18 patients affected with hematologic disease and presenting with an acute abdomen were admitted to the surgery department at the University of Rome "La Sapienza". Most patients were affected with acute or chronic myeloid leukemia (61%) and lymphoma. Five patients with acute appendicitis, three with necrotizing enterocolitis, three with spontaneous hemoperitoneum, three with cholecystitis, two splenic infarctions and two intestinal occlusions were diagnosed. Symptoms were often vague and non specific and blood counts revealed neutropenia in all but two patients, while anemia was characteristic in spontaneous hemoperitoneum and in neutropenic enterocolitis. Fungemia occurred in only two cases while bacteremia was present in seven. The most critical patients were those affected by neutropenic enterocolitis and acute cholecystitis. Sonography was meaningful in the diagnosis of hemoperitoneum, splenic infarct and acute cholecystitis. All patients underwent surgical procedures within 48 hours of admission to the department. In all cases peritoneal washing was performed and at least one peritoneal drainage was left. In all cases of necrotizing enterocolitis, intestinal resections, either ileal or colonic, were followed by an immediate anastomosis in two layers. Intensive hematological and antibiotic post surgical care was performed in all patients. Seven patients presented minor complications (38.8%), and only one died (5.5%). Emergency surgical treatment may be safely carried out in patients with hematological diseases presenting with an acute abdomen. Intensive postsurgical care is mandatory for the recovery of patients and the patient's critical condition should not be a deterrent to surgical intervention.
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PMID:The surgical choice in neutropenic patients with hematological disorders and acute abdominal complications. 847 83

To determine the pattern of antibiotic therapy and clinical outcome a prospective survey of all patients operated on for acute generalized peritonitis was undertaken. The male to female ratio was 1.7:1, and the mean age was 27.6 +/- 18.3 years. Operative findings were typhoid ilea perforation in 75 (38.1%), complicated acute intestinal obstruction in 44 (22.3%), complicated and uncomplicated acute appendicitis in 34 (17.3%), peptic ulcer perforation in 18 (9%) and traumatic intestinal injury in 11 (5.6%), representing the majority of the patients. A combination of chloramphenicol, gentamicin and metronidazole was given to 80 (40.6%), ampiclox, gentamicin and metronidazole to 72 (36.5%), ampiclox and gentamicin to 21 (10.6%) and other combinations to 5. A single antibiotic was administered in 13 (6.6%), that is clavulanate-amoxicillin, ampiclox, and cefuroxime. Antibiotics were changed in 37 patients (18.8%): to amoxicillin-clavulanate in 13, cefuroxime in 11, ceftriazone in 7, cefuroxime and metronidazole in 4 and amoxicillin-clavulanate and metronidazole in 2 patients. Postoperative complications were mainly wound infection in 105 (42.6%), wound dehiscence in 33 (16.7%), residual intra-abdominal sepsis in 19 (9.6%), residual intra-abdominal abscess in 17 (8.6%), postoperative chest infection in 14 (7%), incisional hernia in 11 (5.6%), anaemia in 6, faecal fistula in 5 and there was a mortality of 15.7%.
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PMID:Pattern of antibiotic therapy and clinical outcome in acute generalized peritonitis in semi-urban and rural Nigerians. 1656 39

Diverticular disease of the right colon is not common, especially in western countries. It occurs in two different clinical forms, known as the "usual" and "hidden" variants. The diagnosis is not always easy, especially in the latter variant, because sometimes barium enema and CT scan are unable to distinguish this form from cancer. The final diagnosis is only intraoperative. In our experience, from 1994 to 2004, we observed 4 cases of complicated right-sided diverticulitis. Three of these patients had symptoms mimicking acute appendicitis, such as fever and abdominal pain. Only 2 of them underwent surgical treatment consisting of a right standard hemicolectomy. The 4th patient had no inflammatory symptoms, but had a history of right-sided abdominal pain and diarrhoea. Laboratory data showed only hypochromic anaemia. Barium enema and CT scan highlighted a vegetating mass in the ascending colon causing irregular severe stenosis of the lumen and hyperdensity of mesocolic fatty tissue. Surgical treatment consisted in a right hemicolectomy. Macroscopically, the mass involved the caecum and ascending colon. Enlarged lymph-nodes were present in the thickness of the mesocolon, but not in other districts. Histological examination revealed diffuse diverticular disease complicated by perforation of many diverticula into the mesocolon.
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PMID:Diverticular disease of right colon. Clinical variants and personal experience. 1673 70

Extramedullary hematopoiesis (EMH) is rarely found in the gastrointestinal tract. To our knowledge, EMH involving the appendix was not described. We report a case with a previous history of idiopathic myelofibrosis, which presented with clinical findings of acute appendicitis that necessitate appendectomy after the relief of his anemia. Microscopic examination and immunohistochemistry revealed foci of EMH throughout the mucosa and the submucosa. In the latter, small clusters of hematopoietic cells were also detected in a few dilated vascular structures. The histopathological features of acute appendicitis were not observed. Our case supports that EMH might develop in organs that are not involved in hematopoiesis. Although in gastrointestinal system, obstruction and bleeding are the most common symptomatic manifestations, this case emphasizes that EMH might also present clinically as acute appendicitis. The absence of histopathological features of acute appendicitis raises the possibility that local production of some mediators from hematopoietic precursor cells might contribute to this clinical presentation.
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PMID:Extramedullary hematopoiesis mimicking acute appendicitis: a rare complication of idiopathic myelofibrosis. 1673 96

Jejunoileal diverticulosis is a rare entity. Jejunoileal diverticulosis is not a disease that surgeons see often in clinical practice; however, it should remain on the differential diagnosis for any patient with an acute abdomen or gastrointestinal bleeding of unknown origin. It can present with a wide range of clinical scenarios and when patients experience chronic symptoms such as bloating, abdominal pain, nausea, bacterial overgrowth, or malabsorption, medical therapy is successful in most patients. However, when patients present with acute symptoms of bleeding, inflammation, perforation, or obstruction, surgical resection and primary anastomosis is often the treatment of choice. If patients are asymptomatic, they are better left alone, even when discovered incidentally in the operating room. In closing, the possibility of a patient having jejunal diverticular disease should be suspected whenever the symptoms of obscure abdominal pain, anemia, dilated jejunal loops on abdominal radiographs, a history of colonic diverticuli, and a history of acute appendicitis.
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PMID:Acquired jejunoileal diverticulosis and its complications: a review of the literature. 1880 76


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