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

Those having chronic and recurrent appendicitis represent a small portion of patients with disorders of the appendix. We present a series of nine patients who underwent appendectomy for chronic or recurrent appendicitis at The Johns Hopkins Hospital, Baltimore, Maryland, between July 1984 and October 1992. There were seven women and two men (median age of 30 years, range of 15 to 63 years). All patients presented with pain in the right lower quadrant or lower abdomen of three or more weeks duration (mean of 16.0 +/- 8.4 months, range of three weeks to seven years), had no alternative diagnosis to account for the symptoms, had pathologic evidence of chronic inflammation or fibrosis of the appendix and had complete relief of the symptoms after appendectomy. Although the patients presented herein had clinical and pathologic evidence for recurrent or chronic appendicitis, careful review of the course of each patient before surgical referral revealed at least one episode of acute pain in the abdomen consistent with acute appendicitis managed by nonoperative means. This suggests that, while recurrent acute appendicitis and chronic appendicitis do occur, they can be avoided by the accurate diagnosis and operative management of acute appendicitis. We conclude that acute appendicitis can resolve spontaneously and recur repeatedly in the same individual; in the evaluation of a patient with abdominal pain, a history of prior similar episodes of pain should never dissuade one from considering the diagnosis of acute appendicitis, and recurrent acute appendicitis and chronic appendicitis should be considered in the differential diagnosis of recurrent pain in the lower abdomen.
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PMID:Chronic and recurrent appendicitis are uncommon entities often misdiagnosed. 814 38

Therapy for children with appendiceal abscess remains controversial. The authors present two such cases initially treated conservatively, without interval appendectomy, that later had recurrent appendicitis. An 8-year-old boy presented with fever, abdominal pain, and a right-lower-quadrant abscess (noted by ultrasonography). During laparotomy, the abscess was drained and the appendix was not found. He was lost to follow-up but returned 2 1/2 years later with perforated appendicitis. An appendectomy was performed, and image-guided drainage of a postoperative abscess was required. A 10-year-old girl presented with fever and right-lower-quadrant pain. Computed tomography showed a multiloculated mass. During laparotomy, the cecum was found to be densely adherent to the pelvic organs and bowel, so the surrounding abscess was drained. Interval appendectomy was refused. The patient returned 8 months later with recurrent acute appendicitis and an appendiceal abscess requiring appendectomy and drainage. Although initial drainage alone of appendiceal abscess is efficacious, the authors strongly advocate interval appendectomy as a critical component of the complete management of this entity.
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PMID:Recurrent appendicitis after initial conservative management of appendiceal abscess. 893 62

The objective of this study was to determine computed tomography (CT) appearance of recurrent and chronic appendicitis. In 100 consecutive appendiceal CT examinations of proven appendicitis, 18 patients met criteria for recurrent (multiple discrete episodes) or chronic (continuous symptoms > 3 weeks, pathological findings) appendicitis. CT findings were reviewed. Ten patients had recurrent appendicitis, 3 had chronic appendicitis, 3 had both, and 2 had pathological chronic appendicitis. CT findings in 18 recurrent/chronic cases were identical to 82 acute appendicitis cases, including pericecal stranding (both 100%), dilated (> 6 mm) appendix (88.9% versus 93.9%), apical thickening (66.7% versus 69.5%), adenopathy (66.7% versus 61.0%), appendolith(s) (50% versus 42.7%), arrowhead (27.8% versus 22.0%), abscess (11.1% versus 11.0%), phlegmon (11.1% versus 6.1%), and fluid (5.6% versus 19.5%). CT findings in recurrent and chronic appendicitis are the same as those in acute appendicitis. Appendiceal CT can be beneficial for evaluating patients with suspected recurrent or chronic appendicitis.
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PMID:The computed tomography appearance of recurrent and chronic appendicitis. 945 9

Recurrent appendicitis is defined when patients with recurring similar right iliac fossa pain had acute appendicitis confirmed at the time of operation and the pain completely subsided after surgery. We conducted a retrospective study on our patients with appendicitis. There were 290 patients with appendicitis over a two-year period and 33 patients (11%) had reported recurring pain prior to the presentation. Majority had one prior episode but 15% had multiple episodes of right iliac fossa pain. Fifty-eight percent of the episode occur within six months of the presentation. We conclude that recurrent appendicitis should be considered as a differential diagnosis in patients with recurrent right iliac fossa pain.
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PMID:Recurrent appendicitis as a cause of recurrent right iliac fossa pain. 1497 75

In recent years, several reports have underlined the possible existence of chronic appendicitis. Up to 38% of spontaneously resolving acute appendicitis may recur. We studied 41 patients operated on between July 2000 and June 2001 for chronic and recurrent appendicitis at a teaching hospital in the city of Nairobi. The patients comprised 17.8% of all patients undergoing surgery for appendicitis during the study period. The majority (65.9%) were females. The faecolith rate was 51.2%. About half of appendices removed for these symptoms were normal at histology. Nearly 70% of the normal appendices contained faecoliths. Symptoms resolved in 90% of faecolith-containing appendices and 87.5% of non-faecolith-containing appendices that were normal on histology.
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PMID:Appendicectomy for recurrent and chronic appendicitis. 1732 97

Appendicectomy in patients with recurrent appendicitis can be difficult due to an adherent and inflamed appendix. We describe the technique and results of subserosal appendicular stripping (SAA). Over a four-year period, 49 patients who were diagnosed with recurrent appendicitis required SAA. They had prior admission for acute appendicitis which resolved with antibiotic treatment. Persistent symptoms necessitated surgery. SAA was necessary in these patients due to an inflamed, adherent appendix with extensive serosal adhesions. The appendix was delivered out from the serosa following retrograde ligation of the appendicular base. The adherent serosa was left intact. Average patient age was 23 years. All had persistent symptoms for more than one week with a history of one or more previous attacks. No surgical complications were observed except transient serosal bleeding in the first case managed by gentle diathermy. We advocate SAA as a modification of appendicectomy in patients with recurrent appendicitis where the appendix is inflamed and adherent.
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PMID:Subserosal appendicular stripping. 1744 70

Although 3 retrospective studies from the Netherlands conclude that interval appendectomy should only be performed when indicated, i.e. when patients present with recurrent acute appendicitis or persistent pain, there is still no consensus in the literature regarding the management of these patients. This is probably due to the lack of sound studies needed to change the standard treatment and because surgeons prefer to adhere to the traditional strategy of interval appendectomy, although it is based on even less valid arguments. The risk of recurrent appendicitis is low, especially in adult patients. In this setting, the disease is generally less severe, and performing interval appendectomy only as indicated does not increase the risk ofcomplications. In contrast, routine interval appendectomy is associated with increased morbidity, longer hospital stays and greater costs. Colon malignancy, however, should be ruled out in patients over 40 years. It is still unclear whether the conservative strategy should also be preferred for paediatric patients, who may have a higher risk of recurrence. Faster and better diagnosis may further reduce the incidence ofappendiceal mass or abscess.
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PMID:[Interval appendectomy as routine therapy or only as indicated: the controversy continues]. 1762 67

Urgent appendectomy has become the basis of management for acute appendicitis because of the disparity in morbidity and mortality rates between perforated and nonperforated appendicitis. Immediate surgery results in the confirmation of diagnosis and the control of sepsis without the risk of recurrent appendicitis. However, when notified by the emergency room of the diagnosis, many surgeons are opting to begin antibiotics and intravenous fluids and to schedule the appendectomy at their convenience. We hypothesize that using intravenous antibiotics and hydration to delay appendectomy until "normal business hours" has a negative impact on patient morbidity and mortality. During a 23-month period, the medical records of 81 patients at a single institution who underwent appendectomy were reviewed. All patients had preoperative CT scans and all operations were performed by one of two surgeons. Group A included those patients who underwent appendectomy within 10 hours of CT diagnosis and group B included those appendectomies performed greater than 10 hours after diagnosis. Wound complications, antibiotic use, total analgesic requirements, length of operation, and hospital length of stay were used for comparison. The average time to operation (3.18 vs 15.85 hours), operative time (54.1 vs 55.7 minutes), length of stay (2.65 vs 2.09 days), wound infections (4 vs 0), and antibiotic use at discharge (19 vs 3) for group A and B were not statistically different. This data suggests that delaying operative intervention for acute appendicitis to accommodate a surgeon's preference or to maximize a hospital's efficiency does not pose a significant risk to the patient.
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PMID:Is acute appendicitis a surgical emergency? 1765 2

Emergency appendectomy at presentation has been the standard of care for acute appendicitis. We examined the use of antibiotics as an alternative treatment. From September 2002 to August 2003, 170 consecutive patients diagnosed with acute appendicitis without abscess were reviewed retrospectively. Patients were divided into two groups: Group I (n=151) underwent emergency appendectomy and Group II (n=19) received antibiotics alone. The mode of treatment was at the attending surgeon's discretion. The overall complication rate was eight per cent for Group I and 10 per cent for Group II patients (P = 0.22). Group II patients suffered no complications during antibiotic treatment, and any complications that did occur developed after subsequent appendectomy. One Group II patient had recurrent appendicitis (5%). The length of stay was 2.61 +/- 0.21 days for Group I and 2.95 +/- 0.38 days for Group II patients (P = 0.57). Patients with acute appendicitis may be treated safely with antibiotics alone without emergency appendectomy.
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PMID:Can acute appendicitis be treated by antibiotics alone? 1809 55

We report on two cases of recurrent appendicitis after conservative management consisting of antibiotics and percutaneous drainage of perityphlitic abscess. The first patient presented 13 years after acute appendicitis with a perityphlitic abscess that was treated operatively. This patient refused to undergo interval appendectomy after the initial event. The second patient with appendicitis and perityphlitic abscess was equally managed conservatively initially but presented with reperforated appendicitis and diffuse peritonitis 1 week before scheduled interval appendectomy and also had to undergo surgery. Based on our experience with these two cases, we conclude that interval appendectomy after the recommended period of 6-12 weeks might not be appropriate and may better be managed by performing it in the case of a recurrence.
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PMID:Recurrent appendicitis after conservative management of perityphlitic abscess: report of two cases. 2009 22


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