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

Starting with one case of acute granulomatous appendicitis of their own observation, the authors review the scant literature on the subject (only 23 published cases to date) and advocate systematic appendicectomy in all isolated appendicular localizations of Crohn's disease. On the grounds that no post-appendicectomy fistulization has ever been reported in such patients, the authors recommend prophylactic appendicectomy also in the far more frequent cases of acute ileitis, to forestall the possibility of evolution into chronic Crohn's disease and the risk of missing a nongranulomatous acute appendicitis appearing with the same clinical symptoms.
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PMID:[Acute granulomatous appendicitis. (Contribution to preventive appendectomy in acute ileitis)]. 39 53

Fourteen patients with primary Crohn's disease of the appendix have been seen in a 12 year period. These patients represent 12.8% of the total number undergoing surgical resection because of Crohn's disease. Twenty-three cases of appendiceal Crohn's disease have been previously reported in the literature. A correct preoperative diagnosis is rarely made; the usual diagnosis is that of acute appendicitis or appendiceal abscess. The removed appendix in twelve of our 14 cases had marked thickening of the wall with transmural fibrosis and often with granulomatous inflammation. The enlarged appendix had an external appearance similar to that of ileal Crohn's disease, and we consider a correct surgical diagnosis might be possible with better awareness of its existence. The diagnosis might be suspected earlier when the clinical course of apparent appendicitis is protracted or atypical. Contrary to the previous estimation of high recurrence rate, this series and the cumulative evidence in the literature show a relatively low rate at 14%. The feared fistula formation following the removal of the appendix has not been seen in either our series or the literature. These patients, however, merit long-term follow-up.
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PMID:Primary Crohn's disease of the appendix: report of 14 cases and review of the literature. 42 64

22 cases of primary involvement of the appendix in Crohn's disease are reported in the literature. During the last 3 years we observed 4 cases. In three patients typical clinical signs of acute appendicitis were present. One case was found occasionally. The follow-up was 5-30 months. During this time none of our patients showed symptoms of granulomatous enterocolitis in other regions of the bowel. Reviewing the literature 3 of 26 patients (11.5%) showed lesions typical for Crohn's disease elsewhere in the intestine 3-48 months after appendectomy. But two cases had a follow-up of 5 years which time is considered indispensable before one can admit that the disease is really limited to the appendix.
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PMID:[Crohn's disease of the appendix]. 42 89

Two cases are reported of Crohn's disease localized to the appendix and manifested as acute appendicitis; after appendectomy a fistula developed. In none of 18 patients with Crohn's disease reported by other authors, where the appendix was the primary site, did a fistula develop postoperatively. When the appendix is the primary site of Crohn's disease the presence of mild inflammation of adjacent organs such as the terminal ileum may be mistakenly attributed to ordinary appendicitis. If, at exploratory laparotomy performed on a tentative diagnosis of appendicitis, Crohn's disease is suspected in the adjacent intestine, it is proposed that appendectomy should be followed by at least 10 days of total parenteral nutrition to minimize the risk of a fistula developing.
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PMID:Crohn's disease of the appendix, manifested as acute appendicitis with postoperative fistula. 45 56

An analysis of the medical records of 103 women with Crohn's disease points up the following observations. There is a slight increase in spontaneous abortions and a substantial degree of subfertility. The obstetric experience is the same as in the normal obstetric population and the effects of the disease on pregnancy and of pregnancy on the disease are minimal. Features seemingly unrelated to Crohn's disease and of a gynecologic nature may be present months before the onset of the main bowel inflammation. These features consist of abscesses, fistulas, ulcers, fissures, and infections involving not only the internal pelvic organs but also the vulvovagina, perineum, labia, rectovaginal septum, rectum, and anus. The onset of Crohn's disease may be acute and present the picture of an abdomen requiring surgical treatment. A tender, low abdominal, adnexal, or pelvic mass may incorrectly be diagnosed as acute appendicitis, pelvic inflammatory disease, or ovarian cyst, and lead to surgery. In 23 instances the diagnosis of Crohn's disease was established only after laparotomy. A total of 27 appendectomies were performed and none of these patients had acute appendicitis. Four pelvic abscesses developed after the appendectomies. To avoid the pitfalls of misdiagnosis and mismanagement, the nature of Crohn's disease should be understood and the gynecologic aspects of the disease recognized.
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PMID:Crohn's disease: "its gynecologic aspect". 64

Most of the cases of Crohn's disease reported in Japan were originally treated surgically as acute appendicitis and, after appendectomy, they were diagnosed as acute terminal ileitis or acute Crohn's disease, which should belong to a category different from typical Crohn's disease, according to the international nomenclature by the Council for International Organization of Medical Sciences in 1973. Reviewing our university hospital records from 1954 to 1974, the incidence of typical Crohn's disease and idiopathic proctocolitis has been increasing, while the patients with intestinal tuberculosis have been decreasing. Clinical and histopathological features of operated three groups of our patients with Crohn's disease of the small intestine, non-specific ulcers of the small intestine and prestomal ileitis were comparatively studied. Furthermore, 9 cases of operated Crohn's disease of the colon and 23 cases of operated idiopathic proctocolitis were similarly evaluated. The importance of diagnosing Crohn's disease as a whole from both clinical and histopathological stand points of view was emphasized, and main differential diagnostic criteria between Crohn's disease and idiopathic proctocolitis were discussed.
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PMID:Crohn's disease, non-specific ulcers of the small intestine, and idiopathic proctocolitis in a Japanese university hospital from 1954 to 1974. 96 37

A patient over 40 years of age who complains of lower abdominal pain, constipation or diarrhea or both, and increased flatulence should be suspected of having diverticulosis. When pain becomes more severe and persistent, diverticulitis must be considered. Diagnosis depends on roentgen demonstration of the presence of diverticula. Sigmoidoscopy and barium enema study are essential to exclude coexisting disease but in diverticulitis may need to be postponed until severe local and systemic signs of inflammation have subsided. A number of diseases can simulate diverticulitis, and differential diagnosis may present considerable difficulty. Irritable colon syndrome and acute appendicitis may be indistinguishable clinically from diverticulitis. Differentiation from carcinoma is usually not difficult, but exclusion of coexistent carcinoma may be impossible except by resection. Ulcerative colitis is also easily distinguished except when, rarely, it coexists. Crohn's disease of the colon is less easily differentiated, especially in patients over 40, in whom the two diseases often coexist. Other colonic diseases, such as ischemic colitis, and pelvic inflammatory diseases usually show characteristic features which make them readily distinguishable from diverticulitis.
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PMID:Diagnosis and differential diagnosis of colonic diverticulitis. 103 35

A patient is reported who initially presented with findings simulating acute appendicitis and who was subsequently found to have Crohn's disease isolated to the appendix. Although the hazard of appendectomy in Crohn's disease is well known, it is interesting that none of the known patients with isolated appendiceal Crohn's disease has developed a fistula. Three of the 15 reported cases of Crohn's disease solely involving the appendix developed granulomatous changes involving other regions of the bowel as long as four years following the initial diagnosis. Because of the rarity of this condition, however, specific conclusions regarding the likehood of future recurrence cannot be drawn. We stress increased physician awareness of this entity in order to emphasize long-term follow-up for such patients.
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PMID:Crohn's disease of the appendix presenting as acute appendicitis. 127 33

Twelve patients who underwent laparotomy for suspected acute appendicitis were found to have Crohn's disease of the terminal ileum. Appendectomy was performed in all although in only four patients was the appendix grossly inflamed. Postoperative complications, either abscess or fistula, developed in four patients (33%). Careful investigation of the records revealed some preoperative diagnostic clues: a history of recurrent abdominal pain and/or diarrhea (83%), physical examination revealing normal temperature (50%), and laboratory results compatible with a chronic process such as microcytic anemia (33%) and hypoproteinemia/hypoalbuminemia/hypocholesterolemia (50%). As the differential diagnosis between Crohn's disease and appendicitis is difficult and the surgical approach to the appendix in the presence of Crohn's disease is controversial, we illuminate some practical points in the preoperative evaluation of these patients and deal with the question of whether appendectomy should be performed in these patients.
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PMID:Preoperative clues to Crohn's disease in suspected, acute appendicitis. Report of 12 cases and review of the literature. 129 36

The authors studied the data concerning 101 patients who had undergone erroneous laparotomy for suspected acute surgical disease; these accounted for 0.4% of all the patients who were operated on for emergency indications in the same period. Eleven patients died. The operation was undertaken for an erroneous diagnosis of acute appendicitis (32 patients), acute cholecystitis (18), perforating gastric ulcer (15), peritonitis of unknown etiology (14), acute intestinal obstruction (5), strangulated hernia (3), destructive pancreatitis (3), tumor of the large intestine complicated by obstruction (3), abdominal abscess (2), thrombosis of the mesenteric vessels (1), ovarian apoplexy (1), closed abdominal trauma with injury to the viscera (4 patients). Diseases simulating the clinical picture of "acute abdomen" but not requiring an emergency operation were as follows: female reproductive (20 patients), pancreatic (11), renal diseases (11), hepatitis, cirrhosis of the liver (10), cardiovascular (9), pulmonary diseases (5), mesoadenitis (5), Crohn's disease (3), chronic colitis (3), carcinomatosis of the peritoneum (3), herpes zoster (3), and other diseases and injuries (20 patients). The main causes of the diagnostic and tactical errors were objective difficulties in the differential diagnosis due to similar symptomatology, as well as errors in the examination of the patient and haste in making a decision to make an operation.
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PMID:[Erroneous laparotomy in emergency surgery]. 177 33


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