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

To identify differences between correctly diagnosed appendicitis and misdiagnosed cases that resulted in litigation between 1982 and 1989 retrospective review of malpractice claims was conducted. A total of emergency department (ED) charts at the time of the initial ED visit were reviewed and compared with 66 concurrent controls. Missed cases appeared less acutely ill, had fewer complaints of right lower quadrant pain, received fewer rectal examinations, received intramuscular (IM) narcotic pain medication for undiagnosed abdominal pain or symptoms, and more often received an ED discharge diagnosis of gastroenteritis. Misdiagnosed patients had a 91% incidence of ruptured appendix, more extensive surgical procedures, and more postoperative complications. Data were analyzed using the Pearson's chi 2 Test, Mann-Whitney U Test, and stepwise discriminant analysis. Significance was defined as P < or = .05. Misdiagnosis of acute appendicitis is more likely to occur with patients who present atypically, are not thoroughly examined (as indexed by documentation of a rectal examination), are given IM narcotic pain medication and then discharged from the ED, are diagnosed as having gastroenteritis (despite the absence of the typical diagnostic criteria), and with patients who do not receive appropriate discharge or follow-up instructions.
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PMID:Misdiagnosis of acute appendicitis: common features discovered in cases after litigation. 803 44

Autoantibodies specific to the cytoplasmic components of neutrophils and monocytes are associated with vasculitis and other idiopathic inflammatory disorders. In this study, using enzyme-linked immunosorbent assay (ELISA) and immunofluorescence assays, sera from patients with acute and chronic infection were examined for the presence of anti-neutrophil and anti-monocyte antibodies: cystic fibrosis (n = 23), acute appendicitis (n = 22), tuberculosis (n = 26), acute gastroenteritis (n = 38), bronchiectasis (n = 9) and chronic granulomatous disease (n = 6). Sera from patients with Wegener's granulomatosis (n = 14), rheumatoid factor positive (n = 15) and healthy volunteers (n = 20) were used as positive and negative controls. In patients with chronic infection, using an ELISA assay, antibodies reactive with neutrophil or monocyte components (% reacting with monocyte components in parenthesis) were found in: 70% (39%) of patients with cystic fibrosis, 4% (38%) of patients with tuberculosis, 0% (33%) of patients with bronchiectasis and 0% (17%) of patients with chronic granulomatous disease. When these sera were examined using an immunofluorescence assay, all of the positive samples were found to react with the cytoplasmic component of neutrophils or monocytes. In patients with acute infection no antibodies (either IgG or IgM) were detected against neutrophils or monocytes. These findings imply that antibodies directed against neutrophil cytoplasmic components are predominantly associated with chronic pyogenic infection and antibodies specific to monocyte cytoplasmic components are predominantly associated with chronic granulomatous infection. This mirrors the findings in idiopathic inflammatory disease where anti-monocyte antibodies are associated with granulomatous disorders such as sarcoidosis, and anti-neutrophil antibodies are associated with neutrophilic disorders such as ulcerative colitis. These results suggest that chronic stimulation of phagocytes by infectious agents may result in the generation of a humoral response against phagocyte cytoplasmic components. This furthers our understanding of humoral immune responses against phagocytic cell components during infection.
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PMID:Anti-phagocyte antibodies and infection. 975 9

Nontyphoidal salmonellosis has a wide variety of clinical presentations. With the aim of describing the detailed clinical presentations of gastroenteritis caused by nontyphoidal Salmonella spp., findings for 126 patients (1-94 years of age; 37.0 years on average) were analyzed. Nontyphoidal salmonellosis is prevalent from April to October in Akita, when the mean atmospheric temperature exceeds 10 degrees C. On physical examination, 3 patients had rebound tenderness and muscle guarding on their abdominal wall; 1 of these patients underwent surgery for associated acute appendicitis. Elderly patients tended to be more seriously affected, resulting in severe dehydration. Elevation of the serum C-reactive protein (CRP) level correlated well with a decline in the platelet count. Although nontyphoidal salmonellosis is a common cause of acute gastroenteritis, thorough investigation and meticulous care are required so that conditions requiring surgical treatment or those that are potentially fatal are not overlooked.
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PMID:Analysis of physical and laboratory findings in nontyphoidal salmonellosis. 1237 86

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

The authors describe a rare case report of a female patient with acute appendicitis, where the course was masked by gastroenteritis complicated with sepsis with a simultaneous course of imported infection with Salmonella type C (Kentucky). The attention is drawn to the fact that even such frequent abdominal emergency as appendicitis is, may cause diagnostic hesitations, if it is masked by a simultaneous alimentary infection. In spite of the application of a broad scope of examination methods a final decision of indication for laparotomy depends on clinical findings of the examining surgeon.
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PMID:[Appendicitis and salmonellosis, a coincidence or etiopathogenically related?]. 1468 57

Gastroenteritis due to Escherichia coli O157:H7 occurs in young children and is associated with consumption of under cooked beef. Approximately 5-10% of patients will develop hemolytic uremic syndrome (HUS): renal failure, microangiopathic hemolytic anemia, and thrombocytopenia. A 6-year-old boy was admitted with abdominal pain, guaiac positive stool, decreased urine output and elevated creatinine levels. Hemodialysis was initiated upon rapid progression to anuria. On hospital day # 5 he developed acute abdominal pain, which was different from his initial assessment. Exam revealed focal tenderness in the right lower quadrant with localized guarding and rebound. Ultrasound demonstrated a dilated, fluid filled tubular structure in the RLQ concerning for appendicitis. Based on these findings the patient was taken to the operating room for a laparoscopic appendectomy. The patient had undergone dialysis the previous day and was preoperatively treated with DDAVP to minimize the risk of bleeding. The procedure occurred without complication and final pathology confirmed acute appendicitis. This case highlights the unique clinical scenario in which patients with HUS require operative intervention. Surgical procedures can be performed on these patients, however, all precautions should be taken to minimize the risk of bleeding, including the use of preoperative DDAVP.
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PMID:Acute appendicitis in a patient with hemolytic uremic syndrome: an unusual clinical scenario. 1741 Mar 68

Aeromonas species is an infrequent pathogen causing travelers' diarrhea and gastroenteritis. No human case of appendicitis has been reported as a complication of Aeromonas infection until now. We describe a case of acute appendicitis associated with Aeromonas sobria infection acquired in Cebu, Philippines.
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PMID:Appendicitis associated with travelers' diarrhea caused by Aeromonas sobria. 1933 14

Acute abdomen can be defined as a medical emergency in which there is sudden and severe pain in abdomen with accompanying signs and symptoms that focus on an abdominal involvement. It accounts for about 8 % of all children attending the emergency department. The goal of emergency management is to identify and treat any life-threatening medical or surgical disease condition and relief from pain. In mild cases often the cause is gastritis or gastroenteritis, colic, constipation, pharyngo-tonsilitis, viral syndromes or acute febrile illnesses. The common surgical causes are malrotation and Volvulus (in early infancy), intussusception, acute appendicitis, and typhoid and ischemic enteritis with perforation. Lower lobe pneumonia, diabetic ketoacidosis and acute porphyria should be considered in patients with moderate-severe pain with little localizing findings in abdomen. The approach to management in ED should include, in order of priority, a rapid cardiopulmonary assessment to ensure hemodynamic stability, focused history and examination, surgical consult and radiologic examination to exclude life threatening surgical conditions, pain relief and specific diagnosis. In a sick patient the initial steps include rapid IV access and normal saline 20 ml/kg (in the presence of shock/hypovolemia), adequate analgesia, nothing per oral/IV fluids, Ryle's tube aspiration and surgical consultation. An ultrasound abdomen is the first investigation in almost all cases with moderate and severe pain with localizing abdominal findings. In patients with significant abdominal trauma or features of pancreatitis, a Contrast enhanced computerized tomography (CECT) abdomen will be a better initial modality. Continuous monitoring and repeated physical examinations should be done in all cases. Specific management varies according to the specific etiology.
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PMID:Emergency management of acute abdomen in children. 2345 44

Intussusception is commonly seen in infants. It is occasionally found in adults usually due to carcinomas, colonic diverticuli, polyps and rarely Meckel's diverticulum. An adult male presented with upper abdominal pain, nausea, anorexia and loose stools. The initial investigative workup was unremarkable and patient responded to treatment given for acute gastroenteritis. After 3 days, the pain recurred in right iliac fossa with rebound tenderness and leukocytosis. Surgery was performed with provisional diagnoses of acute appendicitis and/or acute Meckel's diverticulitis. Per-operative findings revealed invaginated Meckel's diverticulum causing non-obstructing intussusception.
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PMID:Invaginated Meckel's diverticulum: a rare cause of small intestine intussusception in adults. 2355 42

The Helicobacter genus includes Gram negative bacteria which were originally considered to belong to the Campylobacter genus. They have been classified in a separate genus since 1989 because they have different biochemical characteristics, with more than 24 species having been identified and more still being studied.H. pylori is the best known. It has an important etiopathogenic role in peptic ulcer disease and gastric cancer. Enterohepatic Helicobacters (EHH) other than H. pylori colonize the bowel, biliary tree and liver of animals and human beings with pathogenic potential. The difficulties existing to correctly isolate these microorganisms limit the description of their true prevalence and of the diseases they cause. Many studies have tried to discover the different clinical implications of EHH. Diseases like chronic liver disease, autoimmune hepatitis, hepatocarcinoma, autoimmune hepatobiliary disease, biliary lithiasis, cholangiocarcinoma and gallbladder cancer, Meckel&#180;s diverticulum, acute appendicitis and inflammatory bowel disease have been related with different EHH species with different results, although their prevalence is greater than in healthy subjects. However, these data are currently not sufficient to draw definitive conclusions. Finally, the best known role of EHH in bowel disease is production of acute and chronic diarrhea pictures initially referred to as Campylobacter. H. pullorum has been identified in patients with acute gastroenteritis. The correct identification of EHH as producers of infectious gastroenteritis is found in its antibiotic susceptibility. It is generally macrolide-susceptible and quinolone-resistant.
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PMID:Enterohepatic Helicobacter other than Helicobacter pylori. 2427 45


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