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

Diverticular disease of the appendix involves about 1 per cent of all appendices removed. Considering the large number, the subject appears to have been neglected in medical literature. Since the symptomatology is similar to that of appendicits and diverticula are frequently very small, they could go unnoticed. A comparison of 30 cases of diverticular disease and 30 cases of acute appendicitis reveals a few fine differences. The patients with diverticular disease are at least a decade older, the duration of pain in these patients is longer, and the diverticula and appendix may or may not be inflamed.
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PMID:Diverticular disease of the appendix. 40 91

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

Three case histories illustrate the diagnostic dilemma encountered whenever a patient with CF who is receiving antibiotics is evaluated for abdominal pain. Although acute appendicitis with perforation and abscess formation is not a common complication of CF, it occurs more frequently than is generally appreciated. The large number of abdominal situations in CF which can cause pain confused with but not typical of acute appendicitis. The true underlying condition is further masked by the concurrent use of antibiotics for pulmonary infection. A higher index of suspicion is needed to rule out acute appendicitis in a patient with cystic fibrosis and abdominal pain. A greater awaremess of the possibility of occult appendiceal abscess may help to avoid this complication.
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PMID:Occult appendiceal abscess complicating cystic fibrosis. 126 60

A case of right iliac osteomyelitis initially misdiagnosed and treated as acute appendicitis is reported. Deep-seated right lower quadrant pain persisted and a gluteal abscess appeared in the immediate post-operative period. The gluteal abscess was incised and it continued to discharge pus until appropriate diagnosis and treatment was instituted. Pain due to iliac osteomyelitis is deep-seated and may radiate to the thighs or lumbar region. Compression and distraction of the pelvis elicits pain in the affected ilium.
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PMID:Abnormal syndrome of iliac osteomyelitis presenting as acute appendicitis. 139

Amongst 876 cases suffering from ascariasis 662 cases were managed conservatively and 214 cases were treated by surgery. Surgical complications were found to be more common in males in the age group of 6-10 years. Principal clinical features included pain abdomen (99.54%), constipation (80.25%), vomiting (67.46%), abdominal distension (47.03%), palpable worm masses in abdomen (35.50%), visible peristalsis (27.63%), worms in vomitus (24.20%) and palpable worm clumps on rectal examination (20.09%). Principal clinical diagnosis were worm colics (48.74%), sub-acute intestinal obstruction (27.74%), acute intestinal obstruction (11.42%) and acute intestinal obstruction with strangulation (5.71%); rest of the cases included worm cholecystitis (2.63%), obstructive jaundice (1.71%), bile peritonitis (0.91%), intestinal perforation (0.68%) and acute appendicitis (0.46%). Surgical procedures performed were milking of worms (34.12%), resection anastomosis of small intestine (23.36%), enterotomy with removal of worms (16.36%), cholecystectomy with T-tube drainage (12.15%), cholecystectomy (8.41%), appendectomy (1.87%), resection anastomosis with excision of Meckel's diverticulum (1.40%), repair of intestinal perforation with peritoneal toilet (1.40%) and cholecystectomy with choledochoduodenostomy (0.93%). In surgically managed patients 35 cases died of septicaemia and in conservatively managed cases 3 died of encephalitis with an overall mortality of 4.34%.
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PMID:Surgical manifestations and management of ascariasis in Kashmir. 140 71

This article discusses the findings of a study of pre-adolescent children to determine if the mode of presentation of appendicitis had changed over the past 10 years, if the incidence of perforations decreased with age, and if diagnosis related groups (DRGs) impacted the length of hospital stay. The charts of 42 children under the age of 12 years who were discharged from two inner-city hospitals with a diagnosis of acute appendicitis from 1980 to 1989 were reviewed. There were 20 blacks and 22 whites, 26 males and 16 females with an average age of 7.31 years (range: 2 to 11 years). Over 95% of patients presented with right lower quadrant pain, 78% with guarding, 80% with a positive psoas sign, 93% with a positive Rovsing's sign, and 65% with rectal tenderness. Over 85% of patients had a history of nausea, vomiting, and anorexia. The mean duration of pain was 52.8 hours and the mean temperature was 99.6 degrees F. The mean white blood cell count was 18,176 +/- 4682 for whites versus 14,615 +/- 5459 for blacks. At surgery 15/42 (36%) of patients had a perforation, 11 of whom had positive wound cultures. Escherichia coli was recovered in all 11 of these patients. The average duration of pain in the perforated group was 50.9 hours, and the average age was 7 years. Eleven of these patients had normal bowel sounds on admission. Only 31% of the total cohort had a fecalith identified by pathology. The average postoperative length of stay was 6.5 +/- 2.5 days before the initiation of DRGs and 7.5 +/- 3 days afterward.
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PMID:Appendicitis in children: a continuing clinical challenge. 140 59

Patients with acute appendicitis who present with an atypical clinical picture are frequently subjected to a series of laboratory and x ray tests and sometimes to prolonged observation before surgery. There is a significant number of normal appendixes found at laparotomy, particularly in some subgroups of patients such as the immunocompromised, the elderly, and the young woman. Laparoscopy was done in 38 patients with right lower quadrant pain of undetermined cause after extensive diagnostic efforts. This group of patients included men and women with an even distribution of ages between 20 and 78 years. Laparoscopy was done under local anesthesia to better establish the site of pain if no obvious pathology could be visualized. Acute appendicitis was confirmed in only 26.3 per cent of the cases, and a wide variety of nonappendiceal diseases were identified, the majority of them requiring no surgery. Diagnostic laparoscopy performed under local anesthesia should be considered in patients suspected to have acute appendicitis, regardless of age and sex, who present with an atypical picture and who still offer diagnostic doubts after other available conventional tests.
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PMID:The role of laparoscopy in the diagnosis of acute appendicitis. 141 36

On the basis of the experience with treatment of 19,346 patients with acute appendicitis, the authors have established that pain in the right inguinal region, rigidity of muscles of the anterior abdominal wall, and a Volkovich-Kocher symptom were the most informative symptoms. The Shchetkin-Blumberg symptom caused by the development of an inflammatory process in the peritoneum is not an appendicular symptom; the Rovzing, Voskresensky, Obraztsov symptoms, not being the specific symptoms of acute appendicitis, are of essential informative value only in combination with the other symptoms of the disease.
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PMID:[Significance of the separate symptoms in acute appendicitis]. 151 23

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

Diverticulitis affects the right side of the colon more commonly than the left side in the Far East. A consecutive series of 35 patients (mean age 44 years) with right sided diverticulitis seen at this hospital is presented. All had localised pain in the right iliac fossa but systemic upset was uncommon. All but one were thought to have acute appendicitis. Thirty one were explored through a right iliac fossa incision but in more than half this had to be closed and a full laparotomy performed. A correct diagnosis was then made at the time of surgery in 28 (80%). Five patients underwent simple diverticulectomy, the remainder having a right hemicolectomy. On histological analysis most (26) had a single false diverticulum. All patients made a satisfactory recovery from surgery.
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PMID:Diverticulitis of the right colon--experience from Hong Kong. 158


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