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

A prospective study was conducted on 107 patients with negative findings at appendectomy. The operation was unnecessary in 94 of the patients. A cause for the symptoms could be found in 43 patients, 32 during operation and 11 later by investigation or by a second operation. Diagnosis remained unclear in 64 patients. There are many diseases that mimic acute appendicitis, and based on the disease entities encountered in this series, the surgeon must examine the abdominal organs carefully if the appendix is normal. The financial loss of negative appendectomy was substantial in our study, and the total early and late complication rate was 14 percent. Patients with negative appendectomy should be regularly followed up to 1 year, since 9.3 percent of patients had a diagnosis made later by investigation, and 12.1 percent had moderate to severe pain on follow-up. Possible means to cut down the negative appendectomy rate without increasing the perforation rate have been suggested herein for further evaluation.
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PMID:Negative findings at appendectomy. 647 29

The essence of the problem, as previously reported, indicated that few complications of acute appendicitis occur as long as the infection is contained within the appendix, but once the invading bacteria have penetrated the peritoneal appendicular surface or have invaded the regional circulation, any one or more of a series of serious complications can develop. Thus, rightfully, emphasis has been placed upon early removal of the inflamed appendix before penetration has occurred as the best method of preventing complications. We have shown that early appendectomy is predicated on early diagnosis and that diagnostic delay is not limited to extremes of age. The diagnosis may be obscured by an accurate, although misleading, history of prior acute attacks, by precident acute disease, such as viral gastroenteritis and by unimpressive symptoms blunted by intercurrent chronic illness, such as diabetes mellitus. If the elements of periumbilical pain, anorexia, nausea or vomiting and the migration of pain to the right lower abdominal quadrant are contained within the clinical history, one must suspect transmural progression of acute appendicitis; frequent inpatient examinations will allow earliest diagnosis and, thereby, fewest perforations and their attendant serious complications. Misdiagnosis is common. Any patient observed for an ostensibly nonsurgical acute condition of the abdomen who fails to improve markedly during a brief course of appropriate specific or supportive therapy must be thoroughly re-evaluated as a potential surgical candidate. Despite the proliferation of accessible laboratory tests and imaging procedures, the early diagnosis of appendicitis rests upon the clinical skills of the physician. A high index of suspicion is crucial. As Doctor Warfield M. Firor, former senior surgeon commented: "Pain and tenderness at any point where the appendix can lie must raise the diagnostic possibility of appendicitis."
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PMID:Reasons for delay of the diagnosis of acute appendicitis. 670 39

In 942 emergency appendectomies, the clinical data of 77 patients with inflammatory changes confined to the mucosa of the vermiform appendix were compared with data from 622 patients with diffuse acute appendicitis and 243 patients without evidence of inflammation in the appendix. In all cases, routine histologic sections of the specimens were reviewed. Of the 77 patients with mucosal appendiceal inflammation, 50 were female and 50% were under 17 years of age. In several clinical aspects, such as incidence of nausea, vomiting, migration of pain, and localized muscular rigidity, there existed significant differences between patients with mucosal inflammation and patients with diffuse appendicitis. Conversely, no statistically significant differences were found between patients with mucosal inflammation and patients without evident appendiceal inflammation. These results in addition to the frequent finding of histologically indistinguishable changes in appendices removed incidentally suggest that the condition is not responsible for the actual complaint.
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PMID:Clinical significance of mucosal inflammation of the vermiform appendix. 683 Mar 43

A 40-year-old woman presented with acute epigastric pain with vomiting. Within 24 hours, the pain spread to the right periumbilical region. Tc-99m disofenin hepatobiliary scan failed to demonstrate the gallbladder on a 60-minute view. The presumative diagnosis of acute cholecystitis was thought to be confirmed on this basis by the patient's physicians. However, a 75-minute view demonstrated filling of the gallbladder. In hepatobiliary scanning for acute abdominal pain, delayed views (2 to 24 hours) are recommended when the gallbladder is not visualized on the 60-minute view. If the gallbladder is visualized, cystic duct obstruction can be excluded and diagnoses such as pancreatitis, acalculous cholecystitis, and acute appendicitis should be investigated.
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PMID:Hepatobiliary scan with delayed gallbladder visualization in a case of acute appendicitis. 720 Aug 46

Ninety four children were operated for torsion of testicle hydatids. A conclusion is made that in certain patients differential diagnosis of acute appendicitis is necessary. Irradiation of pain into the abdomen due to close connection of testicle hydatid nerves with nervous plexuses of the retroperitoneal space is one of the causes of possible errors. Thorough palpation of the scrotum organs, novocain blockade of the spermatic cord in doubtful cases help to make correct diagnosis and avoid useless laparotomy. Torsion of the uterine tube hydatid in girls can be a cause of the local aseptic inflammation of the peritoneum and can simulate the clinical picture of acute appendicitis. Revision of fimbriated ends is shown to be important in the absence of alterations in the vermiform process and hemorrhagic exudate.
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PMID:[Differential diagnosis of torsion of the hydatid of Morgagni and of acute appendicitis in children]. 742 77

The existence of chronic appendicitis is controversial. In this prospective study, we investigated possible changes in the innervation of the appendix under different pathological conditions and correlated histological findings with clinical observation. Thirty appendectomy specimens and 14 appendices obtained from organ donors or patients who underwent right hemicolectomy were immediately fixed in Bouin's solution and processed for immunocytochemistry using an antiserum directed against the panneuronal marker protein gene product 9.5 (PGP 9.5). The density of PGP 9.5 immunostaining was evaluated by digitized morphometry. Significant differences in the density of the PGP 9.5-immunoreactive area were detected in the mucosal layer. In the nonacute appendicitis group, PGP 9.5 was increased (10.99 +/- 3.15%) as compared to acute appendicitis (3.89 +/- 1.77%) and controls (4.98 +/- 1.25%). The significant increase of PGP 9.5 in nonacute appendicitis may suggest axonal sprouting leading to hyperinnervation of the mucosa. This may be a neuronal factor in the pathophysiology of the disease and pain symptoms.
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PMID:Changes of protein gene product 9.5 (PGP 9.5) immunoreactive nerves in inflamed appendix. 753 35

Due to controversial evaluation of the contribution of clinical signs for the diagnosing of non-specific inflammatory bowel disease, as well as due to the lack of similar data, we tried to find our own answer to the question as to whether the clinical signs of ulcerative colitis (UC) and Crohn's disease (MC) are helpful, unhelpful, or even confusing for the diagnosis. A group of patients with MC and UC was analyzed from this aspect. Individuals in their twenties and thirties prevailed in the sample, mostly intellectual workers, the number of males and females was equal. Our attempt to analyze all the available diagnostic methods originated in an observation that a long period of health problems precedes the diagnosis of MC, namely 1.5 y in males and as long as 4 y in females. Other striking information was that surgery represented the initial treatment in 66% of cases and the correct diagnosis was made peroperatively only in 56% of cases. We compared our results with those of the OMGE study, one of the largest projects which evaluated positively the contribution of clinical signs to the diagnosing of MC and UC. We found that the main signs of CU have not changed in the last century, and some additional signs occur rather due to complications than due to the disease per se. Frequency of pain increased by 25% in our patients, and approximately 1/3 of it represented intermittent pain caused by tenesms. Pain in MC must be properly analyzed in order to discriminate acute appendicitis. Other indicators did not differ from the OMGE study. In accordance with its results, we confirmed the importance of correct evaluation of clinical signs for the diagnosis and differential diagnosis of UC and MC. The number of diagnostic methods still increases. Their validity must be continuously re-evaluated, however the clinical examination in the dynamic process stays to be of crucial value.
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PMID:[What is the value of clinical symptoms in the diagnosis of nonspecific inflammatory bowel disease?]. 763 12

Scoring systems seem to be ideal for supporting diagnosis of acute appendicitis because they are non invasive, require no special equipment and can be used in clinical routine. Several scores for appendicitis have been developed with good results in the original publications. Unfortunately these good results could not be reproduced on a German data base. Therefore we developed a new score using multivariate statistics and a quality controlled prospective data base. The score covers 8 variables: tenderness, rebound tenderness, micturition, type of pain, leucocytes, age, relocation of pain, rigidity. Independent evaluation of the score on a Dutch database resulted in a negative appendicectomy rate of 21% and a missing appendicitis rate of 2%. The results are encouraging, so that further testing and clinical application can be recommended.
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PMID:[Diagnostic score for acute appendicitis]. 763 68

There are many differences between acute appendicitis in the older child and the infants. An understanding of the under three years of age child's response to intra-abdominal infection in contrast to that of the older child and an appreciation for the supportive treatment of the child are vitally important in further lowering the morbidity of young children with acute appendicitis. The purpose of the present study was to investigate the factors contributing to the high perforation rate seen in this age group. A retrospective analysis was done in 88 patients under the age of three who underwent appendectomy. These patients ranged from 4 and 35 months in age. There were 51 (77.4%) male patients. The main complaints were fever, pain and vomiting. Duration of symptoms was more than 24 hours in 80%. Abdominal radiographs showed signs of small bowel obstruction. Peritonitis was found in the majority of the cases (90%). overall morbidity was 31.8% and mortality 1.1%. These data suggest that duration of symptoms is directly proportional to complications rate.
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PMID:[Appendicitis in children under 3]. 771 61

In a prospective controlled study the effect of antibiotics as the only treatment in acute appendicitis was evaluated. Of 40 patients admitted with a duration of abdominal pain of less than 72 h, 20 received antibiotics intravenously for 2 days followed by oral treatment for 8 days and 20 considered as controls were randomized to surgery. All patients treated conservatively were discharged within 2 days, except one who required surgery after 12 h because of peritonitis secondary to perforated appendicitis. Seven patients were readmitted within 1 year as a result of recurrent appendicitis and underwent surgery, when appendicitis was confirmed. The diagnostic accuracy within the operated group was 85 per cent. One patient had perforated appendicitis at operation. Antibiotic treatment in patients with acute appendicitis was as effective as surgery. The patients had less pain and required less analgesia, but the recurrence rate was high.
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PMID:Randomized controlled trial of appendicectomy versus antibiotic therapy for acute appendicitis. 764 84


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