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

A patient over 40 years of age who complains of lower abdominal pain, constipation or diarrhea or both, and increased flatulence should be suspected of having diverticulosis. When pain becomes more severe and persistent, diverticulitis must be considered. Diagnosis depends on roentgen demonstration of the presence of diverticula. Sigmoidoscopy and barium enema study are essential to exclude coexisting disease but in diverticulitis may need to be postponed until severe local and systemic signs of inflammation have subsided. A number of diseases can simulate diverticulitis, and differential diagnosis may present considerable difficulty. Irritable colon syndrome and acute appendicitis may be indistinguishable clinically from diverticulitis. Differentiation from carcinoma is usually not difficult, but exclusion of coexistent carcinoma may be impossible except by resection. Ulcerative colitis is also easily distinguished except when, rarely, it coexists. Crohn's disease of the colon is less easily differentiated, especially in patients over 40, in whom the two diseases often coexist. Other colonic diseases, such as ischemic colitis, and pelvic inflammatory diseases usually show characteristic features which make them readily distinguishable from diverticulitis.
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PMID:Diagnosis and differential diagnosis of colonic diverticulitis. 103 35

Twelve patients who underwent laparotomy for suspected acute appendicitis were found to have Crohn's disease of the terminal ileum. Appendectomy was performed in all although in only four patients was the appendix grossly inflamed. Postoperative complications, either abscess or fistula, developed in four patients (33%). Careful investigation of the records revealed some preoperative diagnostic clues: a history of recurrent abdominal pain and/or diarrhea (83%), physical examination revealing normal temperature (50%), and laboratory results compatible with a chronic process such as microcytic anemia (33%) and hypoproteinemia/hypoalbuminemia/hypocholesterolemia (50%). As the differential diagnosis between Crohn's disease and appendicitis is difficult and the surgical approach to the appendix in the presence of Crohn's disease is controversial, we illuminate some practical points in the preoperative evaluation of these patients and deal with the question of whether appendectomy should be performed in these patients.
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PMID:Preoperative clues to Crohn's disease in suspected, acute appendicitis. Report of 12 cases and review of the literature. 129 36

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

Primary pneumococcal peritonitis is an uncommon condition 1st identified in 1885. It occurs when peritoneal inflammation is present in the absence of an intraabdominal source of infection. In the preantibiotic era, the condition accounted for 2% of childhood abdominal emergencies largely among girls aged 2-10 years. Mortality was 42-100%, with death sometimes occurring within 48 hours of the onset of symptoms. This condition now present in female adults, is associated with IUD use, and is comparatively common in India. Consideration should therefore be given to the existence of primary pneumococcal peritonitis when diagnosing and managing abdominal emergencies. The pneumococcus may enter the peritoneal cavity via the female genital tract, blood, or through transmural spread from the gastrointestinal tract. No evidence supports a relationship between type of IUD and/or length of time in place, and the onset of peritonitis. Given pneumococcus' commensal existence in the upper respiratory tract, urogenital sex may facilitate its entrance to the peritoneal cavity through the female genital tract. Abdominal pain, diarrhea, and vomiting generally present, while the patient may also be pyrexial and dehydrated. In diagnosing this condition, the practitioner may confuse it with acute appendicitis, pelvic inflammatory disease, or gastroenteritis if in the early stages of peritonitis. Diagnosis is often confirmed only thorough laparotomy, but abdominal paracentesis and/or abdominal ultrasound may also be employed as diagnostic aids. Laparotomy and a regime of antibiotics is the preferred treatment. 2 case studies are discussed.
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PMID:Primary pneumococcal peritonitis. 159 42

Between 1982 and 1989, 78 children with diarrhoea-associated haemolytic uraemic syndrome (HUS) were referred to this hospital. Most presented with abdominal pain, bloody diarrhoea and vomiting. Seven had severe gastrointestinal involvement, four of whom required resection for bowel perforation or necrosis. One also developed an oesophageal stricture, a previously unreported complication of HUS. These seven children had a high incidence of other complications including hypertension, and cerebral and pancreatic involvement. One died from severe cerebral involvement, one has a residual neurological deficit and one has residual renal impairment. Severe gastrointestinal involvement did not significantly affect the long-term outcome. Simple haematological indices helped predict severe gut involvement. Four of the 78 children had undergone appendicectomy before the diagnosis of HUS was made. The operative findings were in no case typical of primary acute appendicitis, although histological examination did confirm inflammation of the appendix in two patients. Diagnosis is difficult in early disease, but increased awareness may help prevent unnecessary appendicectomy.
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PMID:Oesophageal and severe gut involvement in the haemolytic uraemic syndrome. 177 28

In cases of clinical suspicion of an acute appendicitis sonography uncovers another disease as the real cause of the symptoms in about one-quarter of such cases. Bacterial ileocaecitis is most frequently diagnosed (11.6% of N = 786). In special bacteriological stool cultures, Yersinia enterocolitica and Campylobacter jejuni were identified, whereas Salmonella enteritidis was a rarer finding. The typical sonographic manifestation of bacterial ileocaecitis compared against Crohn's disease of the ileocaecal region is described. These two diseases can be differentiated against each other by means of sonography; likewise, it is also possible to distinguish them from appendicitis. Since stool cultures--which are not always prepared if diarrhoea is only mild or completely absent--are received relatively late in acute cases, knowledge of the sonographic manifestation of bacterial ileo caecitis can help save many an unnecessary laparotomy.
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PMID:[Bacterial ileocecitis: a "new" disease]. 179 86

786 patients with suspected acute appendicitis or appendiceal mass were examined by ultrasonography to distinguish appendicitis from bacterial enteritis. 533 of these patients were described before. In 91 (11.6%) ultrasonography revealed the characteristic picture associated with bacterial enteritis of the ileocaecal region-enlarged mesenteric lymph nodes and mural thickening of the terminal ileum and caecum--but no image of an inflamed appendix. In 64 of these a bacterial infection was confirmed (Yersinia enterocolitica in 28, Campylobacter jejuni in 24, Salmonella enteritidis in 11, Yersinia pseudotuberculosis in one). In the other 27, bacteriological tests were negative (17) or not performed (10). Only 34 of 91 had diarrhoea. Six of the 91 patients underwent surgery, in all of them the removed appendix was normal. The other 85 patients recovered with conservative treatment. In 38 a planned appendicectomy was cancelled because of the sonographic findings. Bacterial enteritis limited to the ileocaecal region (bacterial ileocecitis) appears to be responsible for an appreciable number of unnecessary appendicectomies. It has characteristic sonographic features which distinguish it from appendicitis.
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PMID:[Bacterial ileocecitis, a "new" disease]. 195 44

Gastrointestinal complications of Legionnaires' disease are frequently reported. These include diarrhoea, paralytic ileus, acute appendicitis and jaundice. We would like to report the previously unrecorded and life-threatening complication of acalculous cholecystitis.
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PMID:Acalculous cholecystitis complicating Legionnaires' disease. 210 46

533 consecutive patients with suspected acute appendicitis or appendiceal mass were examined by ultrasonography to distinguish acute appendicitis from bacterial enteritis. In 61 (11.4%) ultrasonography revealed the characteristic picture associated with bacterial enteritis of the ileocaecal region--enlarged mesenteric lymph nodes and mural thickening of the terminal ileum and caecum--but no image of the appendix. In 41 of these a bacterial infection was confirmed: infection due to Yersinia enterocolitica in 21, Campylobacter jejuni in 15, Salmonella B in 3, Salmonella C in 1, and Yersinia pseudotuberculosis in 1. In the other 20 bacteriological tests were negative (10) or not done (10). Oral barium studies, done in 15 patients, showed thickening of the terminal ileum in all of them. Only 22 of the 61 patients had diarrhoea. Yersinia enteritis clinically simulated an appendiceal mass in 17 of 22 patients, 6 of the 61 patients underwent surgery, and in all of them the appendix removed was normal. The other 55 patients recovered with conservative treatment. In 26 a planned appendicectomy was cancelled because of the sonographic findings. Bacterial enteritis limited to the ileocaecal region (bacterial ileocaecitis) seems to be responsible for an appreciable number of unnecessary appendicetomies. It has characteristic sonographic features that distinguish it from appendicitis.
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PMID:Incidence and sonographic diagnosis of bacterial ileocaecitis masquerading as appendicitis. 197 35

This retrospective study of 132 patients less than 12 years of age with Appendectomy done for Acute Appendicitis showed histological confirmation in 106 patients (80.3%) and a "negative appendix" rate of 19.7%. The appendix was perforated in 31 patients (23.5%). In those patients with confirmed Acute Appendicitis, males predominate (1.7 males: 1 female) and the peak incidence was in those 9 years of age or more. Abdominal pain was present in all patients except a 13 month old infant. Abdominal tenderness was also elicited in all patients except one. Fever was present in 83 patients (78.3%), vomiting in 82 patients (77.4%) and diarrhoea in 19 patients (17.9%). There were 2 deaths in this review, giving a mortality rate of 1.9%. Postoperative complications include wound infection (13.2%), pelvic abscess (0.9%), ileus (0.9%) and adhesion obstruction (0.9%).
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PMID:Acute appendicitis in Singapore children--some clinical aspects. 263 19


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