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

In acute appendicitis, the most difficult group of patients to evaluate is that of women of childbearing age. The results of a recent report showed that women of this age group with acute appendicitis tend to have the onset of symptoms in the luteal phase of the menstrual cycle. In view of this, and since some forms of pelvic inflammatory disease tend to have the onset of symptoms in the menstrual phase of the cycle, a study was undertaken to determine if menstrual history might be of value in differentiating acute appendicitis and PID. In comparing the onset of symptoms of five groups--1, perforated or gangrenous appendicitis; 2, acute suppurative appendicitis; 3, normal appendix; 4, normal appendix with PID (a subgroup of group 3), and 5, PID only--no difference was found in the percentage of patients presenting in each phase of the menstrual cycle among the groups. The incidence of disease (per day) appeared to remain the same between phases of the cycle in each group, suggesting that patients in all groups present in a random manner in relation to the menstrual cycle. We conclude that the menstrual history does not appear helpful in differentiating acute appendicitis and pelvic inflammatory disease in women of childbearing age.
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PMID:An assessment of the value of the menstrual history in differentiating acute appendicitis from pelvic inflammatory disease. 646 25

Barium enema examination is a well known and useful adjunctive technique for the diagnosis of acute appendicitis when its clinical presentation is atypical. The combination of a mass effect on the cecum and nonfilling of the appendix have been considered virtually pathognomonic radiographic findings. These appearances on barium enema examination may also be encountered in patients with small-bowel obstruction, acute enterocolitis, pelvic hemorrhage and adhesions, and pelvic inflammatory disease. In three of five cases, these radiographic findings contributed to the decision to perform laparotomy, at which a histologically normal appendix was removed. The value of the barium enema examination in suspected but atypical acute appendicitis must be tempered by the recognition that occasionally other diseases with acute presentations produce similar findings.
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PMID:Nonspecificity of barium enema findings in acute appendicitis. 661 Mar 41

The accurate diagnosis of acute lower abdominal pain continues to be a problem. In Israel, a diagnostic sign often sought as indicating pelvic peritonitis is a rectal temperature of greater than 1.0 C higher than the simultaneous oral temperature. We established that in each of the 20 emergency rooms surveyed both oral and rectal temperatures are measured as part of the admission procedure for patients with acute lower abdominal pain. The charts of three groups of 100 patients with acute lower abdominal pain were studied retrospectively. A rectal temperature of greater than 1.0 C higher than the oral was found in about 10% of each group. Both oral and rectal temperatures were raised in 56, 69 and 37% of each group, respectively. The rectal temperature alone was elevated in 8.5% of patients with appendicitis or pelvic inflammatory disease (PID), as well as in 6% of patients with undiagnosed abdominal pain. Oral temperatures alone were elevated in 4.5% of patients with acute appendicitis or PID and also in 13% of patients with undiagnosed abdominal pain. These differences were not significant. We conclude that the common Israeli practice of measuring both rectal and oral temperatures in patients with acute lower abdominal pain gives no more information than the measurement of either one.
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PMID:Rectal temperature in the diagnosis of acute lower abdominal pain. 686 54

A pelvic abscess is the end stage in the progression of a genital tract infection and is frequently preventable. The abscess may fill the pelvis and occasionally the lower abdomen, and is usually posterior to the uterus and bound by the sigmoid colon, loops of small bowel, cul-de-sac, and sidewalls of the pelvis. A tubo-ovarian abscess may occur in the acute stage of pelvic inflammatory disease (PID) but is more common with chronic or subacute PID. An abscess occurs when pus from the fallopian tube spills onto the ovary and infects it at the site of follicular rupture or by direct penetration. Pelvic and abdominal pain which is bilateral and aggravated by motion and intercourse, and fever possibly exceeding 103 degrees fahrenheit with leucocytosis, tachycardia, and prostration are the most common symptoms of pelvic abscess. The pelvic examination may reveal all gradations of pathology, but because of the degree of guarding and tenderness it elicits, the abscess may elude the examiner. The rectal examination, computerized tomography, and ultrasonography are useful in diagnosis. Other disorders such as acute appendicitis and ecoptic pregnancy may be mistaken for abscess. Patients with pelvic abscesses should be immediately admitted to hospital regardless of the size of the abscess because the broad-spectrum anerobic antibiotic coverage needed is most effectively provided there. Preservation of normal tubal function is rarely possible in patients developing tubal abscesses. Bed rest, fluid and electrolyte replacement, nasogastric suction when indicated, and antibiotics are the basis of medical treatment. Controversy exists regarding appropriate antibiotic therapy, but the probable presence of anaerobic organisms should be kept in mind. Patients with pelvic abscesses are frequently given a triple antibiotic regimen including clindamycin, gentamicin, and aqueous penicillin. Guidelines for the failure of medical management in patients with a pelvic abscess include persistent fever, increase in size of abscess, persistent ileus, suspicion of rupture, septic shock, and uncertainty of the diagnosis. A posterior colpotomy is preferable to a laparotomy if surgical treatment is necessary, but it is only suitable for selected patients. Removal of a pelvic abscess frequently involves a total abdominal hysterectomy. Operating instructions and diagrams are included. Rupture of a pelvic abscess is life threatening and requires immediate surgery.
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PMID:Medical and surgical management of the pelvic abscess. 733 45

The diagnosis of abdominal infections and inflammations often presents considerable difficulty, and various imaging techniques may be required to localize them accurately. At present, radiolabelled leucocytes offer the most widely accepted radionuclide method for imaging inflammation. Because of the many advantages of technetium-99m (99mTc) over indium-111 (111In), 99mTc-HMPAO-leucocyte scintigraphy is preferred for the investigation of acute abdominal sepsis and inflammatory bowel disease, and 111In-leucocyte scintigraphy for more chronic infections and renal sepsis. The 99mTc-HMPAO-labelled leucocytes technique is highly accurate within the first few hours postinjection, and is therefore useful also in acutely ill patients. It is sensitive in detecting abdominal abscesses in all locations except the liver and spleen. By whole body imaging, unsuspected sites and types of infection can be found. 99mTc-HMPAO-leucocyte scan is valuable also in the investigation of acute cholecystitis in problematic situations in which ultrasound is known to give misleading results, especially in acute acalculous cholecystitis. In inflammatory bowel disease it can reliably assess disease activity, but a normal scintigraphy does not exclude mild inflammation. Leucocyte scan is useful also in suspected acute appendicitis, acute diverticulitis, pelvic inflammatory disease, aortic graft infection, etc. But infection and inflammation cannot reliably be differentiated, which may cause misinterpretations in the early postoperative period. Radionuclide techniques have an important role to play in the investigation of abdominal sepsis if the nuclear medicine department can offer instant investigations when the clinical problem is acute.
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PMID:Investigation of suspected intra-abdominal sepsis: the contribution of nuclear medicine. 797 41

A retrospective study was performed to evaluate the usefulness of various historical, clinical, and laboratory findings in differentiating acute appendicitis from pelvic inflammatory disease (PID) in women of childbearing age. The records of all female patients presenting to the emergency department with abdominal pain who were found to have histologically proven appendicitis (n = 80) or PID confirmed on endocervical culture (n = 71) were reviewed. Clinically useful indicators favoring appendicitis included the presence of anorexia and the onset of pain later than day 14 of the menstrual cycle. Indicators favoring PID included a history of vaginal discharge, urinary symptoms, prior PID, tenderness outside the right lower quadrant, cervical motion tenderness, vaginal discharge on pelvic examination, and positive urinalysis. Despite these indicators, differentiating acute appendicitis from PID remains difficult.
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PMID:Differentiating acute appendicitis from pelvic inflammatory disease in women of childbearing age. 824 May 53

Four different major clinical complications were identified in a retrospective analysis of 2495 in-vitro fertilization (IVF) cycles resulting in oocyte retrieval. The severe form of ovarian hyperstimulation syndrome (OHSS) occurred in 18 patients, giving a prevalence for this complication of 0.7%. Seven (39%) of these 18 patients had previously been diagnosed as having polycystic ovaries. Eleven patients were admitted with moderate OHSS. Adnexal torsion was diagnosed in two patients. Ovariectomy was considered necessary in both cases. Complications of the transvaginal procedure occurred in seven cases (0.3%): one patient had an acute appendicitis with puncture holes in the appendix, six patients were admitted shortly after oocyte retrieval with a pelvic inflammatory disease. Of the 624 pregnancies obtained, 13 were ectopic, giving an ectopic pregnancy rate of 2.1%. It is concluded that serious clinical complications of IVF treatment are rare. However, patients should be counselled for the occurrence of serious procedure-related complications before entering an IVF programme.
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PMID:The incidence of major clinical complications in a Dutch transport IVF programme. 908 Feb 31

A total of 10 young women with suspected acute appendicitis were studied. We investigated the value of laparoscopy in the diagnostic evaluation for possible appendicitis in women of reproductive age. At laparoscopy, appendicitis was diagnosed in seven patients (acute-6, subacute-1). Three women had a normal appendix and a pelvic inflammatory disease, a ruptured ovarian cyst and an ovarian cyst with torsion. Laparoscopic appendectomy was performed in 7 cases; a conversion to open operation were because of torsion of ovarian cyst; a laparoscopic cystectomy was necessary. There were no intraoperative and postoperative complications (no wound infections). Reintroduction of normal diet and discharge from hospital occurred earlier after laparoscopic than open surgery. It is concluded that diagnostic laparoscopy permits earlier definitive diagnosis and prompt institution of appropriate therapy for disease of the female reproductive tract that simulates appendicitis; laparoscopic appendectomy is practical and may have advantages over conventional operation (reduction of wound infections and earlier return to normal activities).
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PMID:[Laparoscopic appendectomy: the indications, limits and results]. 945 6

The symptom of lower abdominal pain in women is extremely common and does not always indicate the presence of serious illness. However, women with certain serious conditions such as pelvic inflammatory disease (PID), acute appendicitis, ectopic pregnancy and other complications of pregnancy may present initially with this symptom. Therefore, in managing women with lower abdominal pain care should be taken to exclude any serious condition before dismissing the patient. PID is a condition in which there is infection of the reproductive tract of women above the internal os of the cervix. This usually occurs as a result of an ascending cervical infection caused by Neisseria gonorrhoeae, Chlamydia trachomatis and anaerobic bacteria. The immediate and long term effects of PID include salpingitis, pelvic abscess, peritonitis, infertility and predisposition to tubal ectopic pregnancy. Women with lower abdominal pain should be assessed carefully and if PID is the cause they should be treated for gonococcal, chlamydial and anaerobic bacterial infection. Other gynaecological and surgical causes of lower abdominal pain and the immediate complications of PID require urgent referral to a specialist. PID is associated with significant morbidity and mortality.
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PMID:Syndromic management of sexually transmitted diseases. Part 4--The management of lower abdominal pain in women. 1018 53

Although perforation of the appendix is considered a risk factor for female tubal infertility, the epidemiologic evidence supporting this relation is inconsistent. Risk factors for tubal infertility were compared for 121 women with documented primary tubal infertility attending in vitro fertilization clinics in Toronto, Canada, from July to December 1998 and 490 controls who were pregnant during the same time period. Self-administered questionnaires and review of medical records were used to assess exposures. The authors found that neither history of acute appendicitis nor perforation of the appendix was a statistically significant risk factor for tubal infertility. The crude odds ratio for perforated appendicitis was 3.4 (95% confidence interval (CI): 0.9, 12.9), and the adjusted odds ratio was 1.4 (95% CI: 0.3, 6.2). In addition to increased age and annual income, cigarette smoking (odds ratio (OR) = 2.0, 95% CI: 1.2, 3.2), history of endometriosis (OR = 6.0, 95% CI: 2.8,12.8), and history of pelvic inflammatory disease (OR = 6.0, 95% CI: 2.8, 12.8) were significantly associated with tubal infertility in multivariate analysis. These data do not provide substantial evidence that perforation of the appendix is an important risk factor for female tubal infertility.
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PMID:Association of perforation of the appendix with female tubal infertility. 1125 64


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