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

When to operate immediately, when to observe, and when not to operate at all represent major challenges in the management of a child with an acute abdomen. This article is an overview of the subject from symptom to diagnosis, evaluation, and preparation for the surgical intervention. Tables provide examples of conditions requiring prompt surgical intervention and relative surgical urgency; pathologies suitable for (initial) nonsurgical management; and clinical pictures where surgical intervention is not indicated. Factors that influence the timing of operation are provided, as is the differential diagnosis between intestinal strangulation and obstruction. Brief notes highlight four important causes of acute abdomen in children acute appendicitis, malrotation with volvulus, Meckel's diverticulum, and intussusception. These as well as other intraabdominal pathologies are illustrated by means of surgical photographs. The acute abdomen is a clinical diagnosis. Other diagnostic modalities have merely supporting roles. The decision to operate is based primarily on the results of a good history and thorough physical examination(s).
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PMID:Acute abdomen. When to operate immediately and when to observe. 915 57

Although Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal (GI) tract, complications in adults are rare, especially in the elderly. Intestinal obstruction is the most common complication in the adult, and inflammation mimicking acute appendicitis may also occur. Lower GI bleeding as a result of Meckel's diverticulum with ectopic gastric mucosa is distinctly unusual among the elderly, with most previous case reports involving patients under the age of 40. The case we report involved a 91-year-old man with massive lower GI hemorrhage found to be due to a Meckel's diverticulum with ectopic gastric mucosa.
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PMID:Massive gastrointestinal bleeding from Meckel's diverticulum in a 91-year-old man. 971 22

There are few reports of the sonographic appearance of Meckel's diverticulum. We present a case of torsion of a Meckel's diverticulum that was suggested by sonography and confirmed pathologically. We discuss the sonographic differential diagnosis, which includes acute appendicitis, enteric duplication cyst and intestinal volvulus.
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PMID:Torsion of a Meckel's diverticulum: sonographic findings. 971 31

Among 588 small bowel mechanical obstructions operated since January 1982 until December 1996 at the Flajani Surgery Department and Emergency Department of the San Camillo Hospital in Rome, 3 male patients were operated for intestinal obstruction due to Meckel's diverticulum. In one case, obstruction was caused by a small bowel volvulus rolling on a Meckel's diverticulum, whose gangrenous extremity was "blocked" on caecum. In the other two cases, intestinal loops were incarcerated into an internal hernial ring constituted by the same diverticulum whose inflamed extremity was fixed to corresponding mesentery. We examined embryologic and clinical aspects of the pathology here considered, particularly its complications, obstruction being the most common in adult age. Diagnosis is often misunderstood, since a complicated Meckel's diverticulum simulates many other abdominal pathologies. A straight radiography and an ultrasonography of the abdomen may be useful to reach the correct diagnosis. We performed diverticulectomy, using a linear stapler and we underline the opportunity of this method. In young age laparoscopy resection is considered the gold treatment of this pathology by some authors. We didn't observe any mortality, although one of our patients was in a severe septic condition. It is necessary to examine the last ileal 100 centimetres when a suspected acute appendicitis is not initially found by operation. The opportunity of a promptly performed operation is underlined to prevent that such a benign pathology may induce also exitus.
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PMID:[Intestinal obstruction due to Meckel's diverticulum. Description of three cases]. 988 69

Meckel's diverticulitis is a rare disease. In addition to physical examination, abdominal ultrasound can help to pinpoint the diagnosis. By presenting a case report we would like to demonstrate the typical ultrasonographic findings in acute Meckel's diverticulitis and differentiate it from acute appendicitis. A 60-year-old patient was admitted to our hospital with the diagnosis of acute appendicitis. Abdominal ultrasound was performed and a blind ending, liquid-filled segment of small bowel in the right lower quadrant of the abdomen found. This segment was not compressible, no peristalsis was evident, nor was there any anatomical association with the cecum. Locally we found free fluid and hints of inflamed mesenteric fatty tissue. A perforated Meckel's diverticulum was diagnosed and confirmed intraoperatively. The major ultrasonographic difference between an inflamed Meckel's diverticulum and acute appendicitis is its anatomical location. In contrast to the appendix there is no association with the cecum. A diameter of up to 40 mm and a well-defined wall of small bowel with 3 definite layers visible by ultrasound may help to distinguish between a Meckel's diverticulum and the appendix.
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PMID:[Ultrasound diagnosis of Meckel diverticulitis in adults]. 1121 72

The incidence of tumours within a Meckel's diverticulum is 0.5-3.2%. Their pre-operative diagnosis is rare. We report a case of an incidentally found gastrointestinal stromal tumour within a Meckel's diverticulum in a patient presenting with acute appendicitis. The tumour was demonstrated pre-operatively by ultrasound and CT.
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PMID:Stromal tumour within a Meckel's diverticulum: CT and ultrasound findings. 1177 73

The era of videoendoscopic surgery in emergency surgery practice has facilitated a wide range of endoscopic operative procedures. In our unit the diagnosis of acute abdomen is made after sequential clinical and laboratory examination, and diagnostic laparoscopy is advocated. Laparoscopy-assisted resection of complicated Meckel's diverticulum in two adult patients was performed, and the results are discussed. Between December 1996 and June 2000, 98 patients underwent diagnostic laparoscopy at the Cerrahpasa Medical Faculty Emergency Surgery Unit of Istanbul University because of signs and symptoms of acute abdomen. Among these, we have diagnosed one case of intestinal obstruction due to a volvulus around Meckel's diverticulum and one of acute abdomen masquerading as acute appendicitis but actually involving omphalomesenteric duct cyst torsion. Both of these patients underwent diagnostic laparoscopy and laparoscopy-assisted Meckel's diverticulectomy. Diagnostic laparoscopies were performed on 46 male (47%) and 52 female (53%) patients. In all cases, laparoscopy successfully confirmed the diagnosis. Although in 27 patients the interventions were converted to open procedures, the operations were completed laparoscopically in 71 patients. Two of these patients underwent laparoscopy-assisted Meckel's diverticulectomy and their postoperative periods were uneventful. Both patients were discharged from the hospital on their fourth postoperative day. Diagnostic laparoscopy is a safe and effective method for diagnosis of acute abdomen. In emergency surgery practices in developing countries, advanced laparoscopy should be performed to reduce expenses. Laparoscopy-assisted Meckel's diverticulectomy is a safe and economic procedure and can be performed in adults for treatment of complicated cases without staplers.
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PMID:Laparoscopy-assisted resection of complicated Meckel's diverticulum in adults. 1249 56

We report the laparoscopic resection of a perforated Meckel's diverticulum (MD) found in a 14-year-old boy who presented with abdominal pain and nausea. There was rebound tenderness in the right lower quadrant of the abdomen, which appeared suspicious for acute appendicitis. The patient was referred to the operating room, and laparoscopic appendectomy was performed. With the appendix showing no macroscopic signs of inflammation, laparoscopy was continued and a perforated MD was identified 50 cm proximal to the ileocecal valve. The findings included pus and localized peritonitis between the ileal loops adjacent to the perforation site. The diverticulum was longitudinally resected with an Endo-Gia stapler. The histopathologic workup confirmed the diagnosis of a perforated MD. The patient completely recovered and was discharged 8 days after the procedures. At this writing, he is completely asymptomatic 6 months later. We conclude from our observation that laparoscopic resection of a perforated MD can be performed safely even when localized peritonitis is present. Inspection of the small intestine should be performed to exclude a symptomatic or perforated MD when the appendix does not show any signs of acute appendicitis.
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PMID:Laparoscopic resection of perforated Meckel's diverticulum in a patient with clinical symptoms of acute appendicitis. 1208 34

This case reports the concomitant findings of carcinoid tumor within a Meckel's diverticulum presenting as an acute abdomen in an adult male. Most Meckel's diverticula remain asymptomatic throughout life, and symptomatic diverticula are virtually nonexistent in older adults. Meckel's diverticulitis is clinically indistinguishable from acute appendicitis, and abnormal or symptomatic diverticula are generally resected. Surgical treatment of Meckel's diverticula is recommended for children during exploration. However, resection is controversial in asymptomatic adults. Carcinoid tumors are the most common primary tumor of the small bowel. The duration of symptoms before diagnosis varies from 2 to 20 years, and half of all patients have incurable abdominal disease at first-look surgery. Metastatic events occur most commonly in the liver with a generally poor prognosis. Surgical resection is the treatment of choice. Both Meckel's diverticula and carcinoid tumor are rare clinical entities, and carcinoid tumors occurring within a Meckel's diverticulum are even more uncommon. Thus, the natural history is difficult to predict and treatment recommendations vary. Solitary, localized, asymptomatic nodules less than 1 cm are generally managed with diverticulectomy or segmental resection. Larger or multiple lesions require wide excision of bowel and mesentery, and hepatic resection may be required for metastatic disease.
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PMID:Meckel's diverticulitis secondary to carcinoid tumor: an unusual presentation of the acute abdomen in an adult. 1497 61

Gangrene of Meckel's diverticulum is uncommon and its pre-operative diagnosis is difficult. We report three cases with different presentations--simulating acute appendicitis, intestinal obstruction, and strangulation of the bowel.
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PMID:Gangrene of Meckel's diverticulum. 1503 41


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