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

Differentiating acute appendicitis from other causes of acute abdominal pain in children frequently remains unsatisfactory. To determine whether initial historical and physical examination findings might predict final diagnoses, 246 patients with complaints of nontraumatic and nonrecurrent acute abdominal pain were studied. All were between three and 18 years of age and had presented to a hospital-based pediatric emergency department. Each family was telephoned an average of 5.1 days after the visit to determine the patient's subsequent clinical course; operative notes and pathology reports were reviewed for patients receiving surgery. Of these patients with acute abdominal pain, both fever and vomiting were present in 18 of the 24 who eventually had diagnoses of appendicitis, compared with 49 of 222 patients with other final diagnoses (P less than 0.01, with negative predictive value 0.97, sensitivity 0.75, and specificity 0.78, but positive predictive value only 0.27). The duration of the pain at presentation and the frequency of other symptoms (eg, diarrhea, dysuria, anorexia, and lethargy) were unrelated, however, to final diagnosis, as was the duration of the pain and whether abdominal tenderness initially was localized or generalized. Nonruptured appendicitis was generally indistinguishable from ruptured appendicitis preoperatively, by both duration and symptoms. Boys were found more likely to have appendicitis (with or without rupture) than girls (18/118 or 15%, vs. 6/128 or 5%, P less than 0.05). In conclusion, fever and vomiting were noted at presentation more frequently in children with appendicitis than in children with other causes of acute abdominal pain.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Diagnosing appendicitis in children with acute abdominal pain. 318 19

Appendicitis is the first 3 years of life is uncommon and most cases are perforated at laparotomy. Case records at the Adelaide Children's Hospital were reviewed over a 12-year period. The findings were that acute appendicitis in this age group is commonly associated with respiratory symptoms and diarrhoea, the appendix was gangrenous or perforated in 92% of cases, and there was a significant delay in diagnosis. It is concluded that full evaluation of any child of this age with fever, vomiting, abdominal pain and tenderness is mandatory, and should include rectal examination, abdominal radiographs, differential white cell count and urinary examination. Examination under sedation may be necessary.
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PMID:Appendicitis in the first three years of life. 327 Mar 21

An infected urachal cyst classically presents with a tender lower midline abdominal mass and systemic signs of infection, including fever, malaise, and leukocytosis. At times, the findings may be clinically confused with those of acute appendicitis, Meckel's diverticulitis, or peritonitis. Sonography aids in differentiating these entities by identifying the localized cystic mass containing debris, located anteriorly in the low mid-abdomen, extending from the region of the bladder to the umbilicus. We present an unusual case of an infected urachal cyst in a 6-year-old boy who presented with lower abdominal pain, fever, intermittent diarrhea, polyuria and dysuria, a firm, fixed left lower quadrant tender mass, and an elevated white blood cell count.
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PMID:An unusual presentation of an infected urachal cyst. Review of urachal anomalies. 327 61

Yersinia enterocolitica was isolated from the feces of 29 patients over a three-year period following the introduction of a selective culture medium. Y. enterocolitica was the third most common enteric pathogen after Campylobacter jejuni and Salmonella in this series of 3795 specimens from a predominantly adult population. The isolation rate of Y. enterocolitica was 0.9% and this represented 15.8% of positive cultures. The usual symptoms of Yersinia infection were diarrhea (93%) and abdominal pain (72%), often associated with tenderness in the right iliac fossa and fever. Fourteen patients required admission to hospital and four came to surgery for possible appendicitis. Acute terminal ileitis and mesenteric lymphadenitis were noted in each case. Two patients who were HLA-B27 positive had a reactive arthritis as their dominant complaint. In conclusion, Y. enterocolitica has emerged as a common cause of diarrhea in adults. It is an important cause of symptoms resembling those of acute appendicitis and is occasionally complicated by reactive arthritis.
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PMID:Clinical aspects of infection with Yersinia enterocolitica in adults. 330 48

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

A 43-year-old man, with a chief complaint of abdominal pain and a palpable mass in the lower abdomen, was admitted to this hospital. He had 2-3 episodes of diarrhea monthly for several years. Laparotomy revealed the mass resembling sarcoma, invaded the ileum and bladder and also it had disseminated lesions in the other intraabdominal organs. Resected tissues showed actinomycotic abscess. AB-PC was administered post-operatively, with a satisfactory prognosis. On the 71 patients with abdominal actinomycosis who underwent laparotomy during the past 32 years in Japan, 42 were males and 28 females. Many of them were in their forties or fifties. Some literatures mention the ileocecal region as the usual site of following perforated appendicitis. As far as this review is concerned, however, the transverse colon was as frequently affected as the ileocecal region and it was only in 13 patients that acute appendicitis preceded the infection. Abdominal actinomycosis is not an uncommon disease and should be taken into consideration in the differential diagnosis of the abdominal mass.
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PMID:[A case of abdominal actinomycosis]. 360 May 98

Stool specimens of 478 children with enteritic symptoms were screened for enteropathogenic bacteria over a 5-month period. 28 cases of infection due to Campylobacter jejuni were found. The incidence of Campylobacter enteritis exceeded that of salmonella and shigella infections recorded over the same period (17 and 11 cases, respectively). Infected children-aged between 2 months and 15 1/2 years-presented with symptoms of mild gastroenteritis. 18 patients had bloody diarrhoea, whilst 4 children aged between 4 and 9 years with abdominal pain showed a clinical picture mimicking acute appendicitis. Two severely dehydrated infants required parenteral fluids, but in the remaining cases dietetic treatment alone proved satisfactory.
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PMID:[Epidemiology and clinical aspects of Campylobacter enteritis in childhood]. 389 Mar 73

In a review of 22 years of clinical experience, we found seven previously healthy children with primary peritonitis. The diagnosis was made at laparotomy in all patients. Their symptoms included diffuse abdominal pain, fever, vomiting, and diarrhea. Abdominal tenderness was maximal in the right lower quadrant in five children, which led to confusion with the diagnosis of acute appendicitis. Streptococcus pneumoniae was identified as the etiologic agent in three patients and group A beta-hemolytic Streptococcus in one patient. The remaining three patients all had prior antibiotic therapy, and peritoneal fluid cultures were sterile. All children had a prompt response to treatment with antibiotics and recovered without complications. Long-term follow-up (4 1/2 to 15 years) was available for three patients; all three remained healthy.
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PMID:Primary peritonitis in previously healthy children. 638 16

Complications after ineffective medical management are indications for surgical treatment in Crohn's disease and ulcerative colitis. Immediate intervention is necessary in perforation, bleeding and intestinal obstruction, but abscess, fistulation, chronic bowel obstruction and an inflammatory tumor need also surgery without longer delay. Acute ileitis terminalis imitating acute appendicitis is an exceptional case of Crohn's disease. Local recurrence, severe abdominal pain, diarrhoea, retardation of growth and development, and risk of malignant change may be reasons for elective surgery. As development of recurrence after operation is frequent and the results of colectomy and proctocolectomy with ileostomy are not always satisfactory some caution to surgery in ulcerative colitis and Crohn's disease in childhood is advisable.
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PMID:[Surgical indications in Crohn's disease and ulcerative colitis in childhood]. 660 Dec 4

The incidence of campylobacter gastroenteritis in the population of Nottingham over a period of 3 years was studied. There was a seasonal variation with the highest number of cases occurring in the summer months. Campylobacter sp. were isolated from the stools of a total of 780 patients over this period. Of these 160 patients with gastroenteritis required admission to hospital. These patients' illness had an acute onset, and the predominant features were diarrhoea, severe abdominal pain, nausea and bright red blood with the stool. However not all the patients had diarrhoea. More than a third of the patients studied were less than 10 years old. The mean duration of symptoms was 4 days and the average stay in hospital was 5 days; some patients required prolonged admission (14 days). In a few cases campylobacter enteritis mimicked other clinical conditions including acute appendicitis. This study emphasises the importance of campylobacter enteritis as a cause of gastroenteritis in the community and the degree of morbidity associated with this illness.
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PMID:Campylobacter enteritis in Nottingham. 668 Nov 61


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