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

Of 6,099 children treated for malignancy, 16 (ages 3.5 to 18 years) developed acute appendicitis between 1962 and 1989. Fourteen had leukemia (ALL 10, AML 4). One each had rhabdomyosarcoma and Ewing's sarcoma. Active malignancy at diagnosis was noted in 10, 4 of whom had severe neutropenia (absolute neutrophil count less than 500/mm3). Of all the leukemics (2,794/6,099), abdominal pain during induction was a frequent complaint. The incidence of appendicitis, however, was low (0.5%). Nine of the 16 patients presented classically, facilitating prompt diagnosis and treatment. Six diagnoses were delayed. Three of these patients presented atypically with vague, nonlocalized pain, abdominal distention, lack of abdominal guarding, fever, dehydration, diarrhea, and unusual symptoms such as upper gastrointestinal bleeding. In each of these 6 patients the appendix was ruptured. Delays led to complications and deaths. Three patients required perioperative transfusions to treat excessive bleeding and two patients with ruptured appendicitis developed wound abscesses. Two patients died; in one, ruptured appendix was diagnosed only at autopsy. The other patient died of uncontrolled sepsis. Typhlitis occurring during induction chemotherapy may present similarly and is the main differential diagnosis. Typhlitis will usually improve with medical treatment alone. Nausea and vomiting (13/16), right lower quadrant pain (13/16), guarding (14/16), tachycardia (12/16), fever (10/16), and rebound tenderness (10/16) were the most frequent signs and symptoms of appendicitis. Persistent localized abdominal pain and guarding, lack of improvement with medical treatment, clinical deterioration, and the development of a mass were our indications for laparotomy. Despite major improvements in therapy, there is still a 37.5% error rate in our ability to accurately diagnose appendicitis in pediatric cancer patients.
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PMID:Acute appendicitis in children with leukemia and other malignancies: still a diagnostic dilemma. 152 62

A seven year old boy with a history of cyclic neutropenia (CN) was admitted to the hospital after developing fever and chills following a bicycle accident. After admission, he had a rapidly deteriorating hospital course leading to shock and death. At autopsy, acute appendicitis with resultant peritonitis and sepsis was diagnosed. The peculiar clinical and microscopic aspects of this case will be presented and contrasted with the more usual signs and symptoms of this cyclic disease.
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PMID:Cyclic neutropenia: a case of asymptomatic appendicitis. 260 79

Cecal diverticulitis is an uncommon entity. Its operative treatment represents 0.2% of procedures performed for an acute abdomen. The clinical presentation is often indistinguishable from acute appendicitis. At operation, it may be confused with cecal carcinoma. The surgeon must be aware of this condition and be prepared to choose the most appropriate treatment. Local excision has been advocated as the treatment of choice. The authors review 18 cases seen over a 10-year period. In no case was the correct diagnosis made preoperatively. Intraoperatively, a correct diagnosis was made in 12 of the 18. Carcinoma was the next most frequent intraoperative diagnosis (four cases). Twelve of the 18 patients were treated by standard or limited right hemicolectomy. One patient died early in the series of sepsis caused by a perforated diverticulum and one patient had a life-threatening complication. Right hemicolectomy appears to be a safe and effective treatment option for cecal diverticulitis.
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PMID:Cecal diverticulitis. 273 55

In an attempt to reduce postoperative sepsis, a series of randomised, double-blind studies was begun in 1982, using cefotaxime as backbone therapy. Up to 1985 (stages I and II), the best results were obtained using a combination of cefotaxime (75 mg/kg intravenously in 3 doses at 12-hourly intervals) plus metronidazole (10 mg/kg intravenously in 3 doses), both drugs administered 1 hour before surgery (preoperatively) or at anaesthetic induction (peroperatively). In 300 consecutive cases, the wound infection rates were 1% in uncomplicated acute appendicitis and 5% in perforated/gangrenous appendices. The present study (stage III) reports the findings in 401 consecutive patients: 215 treated with the above regimen, either pre- or perioperatively (group 1) and 186 who additionally had peritoneal lavage with cefotaxime 2 g/L during surgery (group 2). There were 16 wound infections overall, 2 among patients administered prophylaxis preoperatively and 14 in those administered prophylaxis perioperatively. All produced mixed cultures, with Escherichia coli, Streptococcus milleri and Bacteroides fragilis predominating. The overall figures for postoperative sepsis are 12/215 (5.6%) in the non-lavage group and 8/186 (4.3%) in the lavage group. Among patients with a perforated and/or gangrenous appendix, the wound infection rate was 8/72 (11.1%) in the non-lavage group (group 1) and 4/66 (6.1%) in the lavage group (group 2). Each group had 2 cases of pelvic abscess.
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PMID:Cefotaxime lavage in children undergoing appendicectomy. 289 96

Sulbactam is a beta-lactamase inhibitor that, when combined with ampicillin, gives the latter antibiotic a broad spectrum of activity, making it suitable for use as a prophylactic agent in acute appendicitis. In a single-blind, randomized trial, the efficacy of sulbactam plus ampicillin was compared with that of metronidazole plus cefotaxime. Thirty-five children undergoing appendectomy received intravenous sulbactam and ampicillin, while 38 children received metronidazole and cefotaxime. Single doses were given unless the appendix was considered gangrenous or perforated, in which case the drugs were administered for 72 hr. There were three wound infections in the group given sulbactam and ampicillin and five in the group given metronidazole and cefotaxime. The combination of sulbactam and ampicillin was well tolerated and appeared to be at least as effective as that of metronidazole and cefotaxime in the prevention of sepsis following appendectomy.
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PMID:A randomized comparative study of sulbactam plus ampicillin vs. metronidazole plus cefotaxime in the management of acute appendicitis in children. 302 17

A prospective study was performed on 635 patients with appendicitis operated on by 7 trainees and 119 patients operated on by 6 senior surgeons with more than 8 years of surgical experience. In patients with normal appendices, postoperative sepsis was extremely low. For early and late appendicitis, the infection rates of the trainees decreased as experiences accumulated, but they were still higher than that of the senior surgeons. The difference in infection rates in acute appendicitis did not reach statistical significance between any of the training stages and between the various stages and the rate of the senior surgeons. The differences in infection rates in late appendicitis between stage 1 and stage 3 was significant, as was the difference in infection rates between stage 1 and the infection rate of the senior surgeons. Therefore, we have concluded that overall, the limited experience of trainees is related to the rate of postoperative sepsis in late appendicitis, although the infection rates of individual trainees vary a lot.
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PMID:Influence of surgeons' experience on postoperative sepsis. 334 56

A prospective study was conducted on 344 children aged from 3 months to 16 years with acute appendicitis. Most children presented with typical features of acute appendicitis (70%) or peritonitis (28%). Atypical presentation was uncommon and occurred only in seven young children, masquerading as intestinal obstruction, gastroenteritis or urinary tract infection. Prolonged delay in surgery was associated with a rise in incidence of late appendicitis (gangrenous and perforated appendicitis). This rise was especially marked 37 h after onset of symptoms. The main causes of delay were inability of the parents and primary care medical practitioners to recognize the disease early. Surgeons contributed very little to the delay. High risk factors for postappendectomy sepsis were young children under 6 years old, late appendicitis, obese patients, inferior systemic antibiotic regimes and inexperienced surgeons. Young children had high postoperative sepsis mainly because of the high incidence of late appendicitis due to their inability to express their symptoms properly. They were not especially prone to postappendectomy sepsis; they had the same degree of appendicitis compared with older children. Measures to decrease the postappendectomy morbidity are suggested.
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PMID:Acute appendicitis in children. 343 36

The treatment of acute leukemia in childhood has been increasingly successful. Infectious complications are the major cause of morbidity and mortality among these patients receiving aggressive chemotherapy. In particular, neutropenic enterocolitis or typhlitis has had a reported mortality of 50% to 100%. The authors reviewed a series of 77 previously untreated patients with acute myelogenous leukemia begun on treatment from March 1976 to June 1984 to better define the characteristics of typhlitis and its optimum management. Twenty-five patients had episodes of typhlitis, characterized by fever, abdominal pain, and tenderness, occurring during periods of neutropenia. Ten of these patients had watery diarrhea as a major additional symptom, and nine patients had a significant episode of gastrointestinal bleeding. In seven instances, blood culture results were positive, all for intestinal flora. The episodes of typhlitis occurred most frequently during the induction therapy (19 patients). Five patients experienced typhlitis during maintenance therapy, and one patient had acute appendicitis. Two patients had typhlitis during their reinduction therapy, and of note, one had had abdominal symptoms during her initial induction. All patients were treated initially with broad-spectrum antibiotics and bowel rest. Four criteria have been used for surgical intervention: (1) persistent gastrointestinal bleeding after resolution of neutropenia and thrombocytopenia and correction of clotting abnormalities; (2) evidence of free intraperitoneal perforation; (3) clinical deterioration requiring support with vasopressors, or large volumes of fluid, suggesting uncontrolled sepsis; and (4) development of symptoms of an intra-abdominal process, in the absence of neutropenia, which would normally require surgery. Using these criteria, five patients required surgical intervention for typhlitis or its sequelae and one for acute appendicitis. There was one perioperative death resulting from miliary tuberculosis. Among the 21 patients managed medically, there was 1 death resulting from typhlitis in a patient in whom surgery was deferred because of her multiple failures to enter remission.
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PMID:The medical and surgical management of typhlitis in children with acute nonlymphocytic (myelogenous) leukemia. 348 59

Thirty two consecutive children who underwent surgery for suspected acute appendicitis, were treated with prophylactic metronidazole suppositories. A serum sample was taken at surgery to determine the serum concentration of the drug. After a preoperative dose of 15-20 mg/kg the minimal bactericidal concentration was achieved in almost all cases at the time of anesthetic induction. This drug showed an optimal biodisponibility when used rectally and no side-effects was noted. Neither a wound-infection, nor a wound-sepsis was reported and a satisfactory outcome was registered. We conclude that rectal dosing with metronidazole is effective for prophylactic wound infection in acute appendicitis.
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PMID:[Effectiveness of rectal metromidazole in acute infantile appendicitis]. 378 49

All patients greater than 50 years of age (N = 96) admitted with a pre- or postoperative diagnosis of acute appendicitis from 1971 to 1980 were reviewed. A comparative series of 91 patients aged 25 to 50 years was similarly reviewed. Noninflammatory diseases of the appendix and incidental appendectomies were excluded. Detailed study of symptoms, clinical presentation, laboratory evaluation, radiographic evaluation, concomitant diseases, hospital course, surgical findings, complications, and mortality were completed. Comparison of patients aged 25 to 50 to patients older than 50 years revealed a statistically significant increased incidence of perforation in the older group (p less than 0.0001). Sixty-five per cent of the older group showed greater incidence of perforation. Further analysis of this series yields the hypothesis that the increased incidence of perforation is related to a significant decrease in the frequency of classic presentation in the greater-than-50 age group, a significant decrease in frequency of correct admission diagnosis and a significant delay between admission and surgical procedure in the older group. A more rapid pathophysiologic progression of appendicitis with increasing age was noted. A much higher percentage of older patients was undiagnosed until the surgical procedure. In this group, there was a longer duration of symptoms, less frequent classic presentation, and decreased frequency of right lower quadrant guarding and tenderness as compared to patients with correct diagnosis prior to surgery. Complications were much more frequent in older patients and higher still in those with perforation. Analysis of findings by decade of life revealed an anticipated high incidence of perforated appendicitis in patients greater than 50, but also showed a continuation of the high incidence of perforation into the decade 40 to 50. There were three deaths in the entire study group (1.6%) all occurring in the older age group with postoperative sepsis.
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PMID:Appendicitis in mature patients. 400 82


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