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

Hollow viscus injuries are usually managed with few complications. However, if their diagnosis is delayed, or if reparative suture closure should fail, the patient is placed at risk of multiple organ failure. This article presents diagnostic approaches, emphasizing imaging modalities, and therapeutic strategies for three clinical scenarios of hollow viscus perforation: 1) acute appendicitis, 2) gastroduodenal peptic ulcer disease, and 3) trauma.
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PMID:Traumatic and nontraumatic perforation of hollow viscera. 943 40

Ultrasound is useful in the assessment of patients with possible appendicitis. A diagnosis of appendicitis can be made in patients with persistent right lower quadrant pain when a non-compressible appendix greater than 6 mm in diameter is shown. When a normal appendix is affected by an adjacent lesion, reactive inflammation can cause secondary enlargement of the appendix. This article reviews ultrasound findings in conditions which can clinically mimic acute appendicitis. Examples of Crohn's disease, tuboovarian abscess, typhilitis, sigmoid diverticulitis, perforated sigmoid neoplasm, perforated peptic ulcer, perforated acute cholecystitis, caecal carcinoma and appendiceal tumours are included.
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PMID:Diseases that simulate acute appendicitis on ultrasound. 953 8

Despite the marked decline in mortality of acute appendicitis over the past 50 years, the rate of perforation and negative appendectomy remains unchanged. The most effective means of controlling human suffering and economic cost associated with appendicitis is the identification and correction of factors responsible for perforation. Negative appendectomy rates have been relatively stable over the decades. Progress in diagnosis and diagnostic imaging still has not provided a foolproof non-invasive test to rule out the presence of appendicitis accurately. Clinical assessment determines the treatment and the clinical observation should be done by the surgeon. The use of H2-receptor antagonists has not reduced emergency admission of patients with duodenal ulcer. Mortality associated with perforated peptic ulcer remains high in spite of advances in surgical management. The patients with acute obstructed cholecystitis usually reach the surgeon with more advanced stage of the disease which results in increased morbidity and subsequently increased cost for undergoing cholecystectomy. If the patient develops severe diffuse peritonitis, the mortality could reach 30%. This is in spite of aggressive surgical treatment, potent antibiotics, modern intensive care and diagnostic procedures. To improve the results, more advanced treatment to avoid the development of peritonitis and more effective antibiotics to control the inflammation will be needed.
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PMID:[Common abdominal emergency cases a the end of the 20th century]. 967 12

Application of ioddicerynum while performance of an urgent operative intervention in 63 patients with an acute appendicitis, perforated gastroduodenal ulcer and an old postoperative abscess of anterior abdominal wall had permitted to lower the occurrence frequency for postoperative purulent complications by two times.
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PMID:[The possibilities of application of iodinedicerinum in urgent surgery]. 1085 16

In a 12-month prospective study 370 patients with acute abdominal pain were admitted to a single surgical unit of a large teaching hospital. The most common diagnoses were appendicitis (23.5 percent), Non-specific abdominal pain (NSAP) (21.4 percent), acute intestinal obstruction (10.8 percent), gynaecological causes (9.5 percent, and peptic ulcer (9.2 percent). Emergency operations were performed in 146 patients (39.5 percent). Appendicectomy was the commonest operation (77 cases or 52.7 percent) and there was a high incidence of complicated appendicitis (41.6 percent). Eleven patients (3.0 percent) died within 30 days of admission (8 postoperative and 3 non-operative deaths). The clinical spectrum of the acute abdomen in this study shows that surgeons in developing countries are not facing surgical challenges similar to those of their counterparts in developed countries and the most important diagnostic distinction surgeons in both localities have to make is that between acute appendicitis and non-specific abdominal pain.
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PMID:Clinical spectrum of acute abdominal pain in Accra, Ghana. 1087 24

A retrospective analysis was undertaken on 229 cases of acute surgical abdomen surgically managed at Yirgalem hospital from January to December 1997. Small intestinal obstruction ranked the first and it was mainly due to small intestinal volvulus. Acute appendicitis was the second in the rank. Large intestinal obstruction was the third and it was mainly due to sigmoid volvulus. Typhoid perforation, primary peritonitis, perforated gastroduodenal ulcer, abdominal tuberculosis and empyema of the gallbladder in that order were the other observed causes of acute surgical abdomen. Analysis based on the specific causes of acute abdomen is of great value for early diagnosis and prompt treatment in clinical practice.
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PMID:Pattern of acute abdomen in Yirgalem Hospital, southern Ethiopia. 1112 97

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

Diagnostic efficiency and the means to achieve it constitute one of the main parameters that evaluates quality of hospital care within an institution. In addition, concerning surgery acute appendicitis is without doubt the most frequent pathology we face at our service. Therefore, we conceived of a way to determine degree of concordance and other parameters of diagnostic efficiency for this disease. This is an analytic, longitudinal study that took into account the cases of acute appendicitis out of the most frequent pathologies of surgical acute abdomen (acute appendicitis, perforated peptic ulcer, intestinal occlusion, and acute cholecystitis) from April 1 to June 17, 2002 for a total of two hundred cases. To establish correlation, main symptoms and signs upon admission were recorded, as well as presumptive, operatory, histopathologic, and laparoscopic diagnoses in cases in which such procedures were performed. Other aspects were also considered as efficiency parameters, namely Kappa correlation index, sensitivity, specificity, positive and negative predictive values, and positive and negative verisimilitude reasons. Clinical-surgical correlation found was very good, with Kappa value of 0.92. Clinical-pathological concordance was good also, with Kappa value of 0.71. The same can be said concerning the surgical-anatomopathologic case, with a value of 0.79. Regarding laparoscopy, both clinical-laparoscopic and surgical-laparoscopic concordances were poor, with Kappa value of 0.15. Also, concordance between laparoscopic and anatomopathologic diagnoses was weak, with a value of 0.25. Diagnostic efficiency in acute appendicitis was good, contrary to laparoscopic efficiency as diagnostic evidence.
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PMID:[Diagnostic efficiency in acute appendicitis]. 1461 8

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

This study was conducted to verify the status of patients with negative appendicectomies in our practice and thus assess possible ways of reducing it. Of a total of 554 appendicectomies done in UMTH from January 1997 to December 2001, 27 (4.9 %) of these appendices were reported at histology as normal. 21 (77.8 %) were females and 6 (22.2 %) were males giving a female to male ratio of 3.5 to 1. The age range of the female patients was between 18 and 47 years with a mean 28.8 (SD) of (8.2) years. The age range of the male patients was between 11 and 47 years with a mean 31.5 (SD) of (12.6) years. The diagnostic alternatives depict the common scenario: Gynaecological conditions, urinary problems, peptic ulcer disease and non specific abdominal pain which are some of the major known differential diagnosis of acute appendicitis. Therefore careful clinical assessment of the patient should be depended upon for the diagnosis of appendicitis especially in our environment where sophisticated aids to diagnosis remains scarce.
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PMID:The status of patients with negative appendicectomies in Maiduguri. 1675 62


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