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

Acute appendicitis can be a diagnostic dilemma. The classic triad of leukocytosis, pain at McBurney's point and a history compatible with appendicitis has a diagnostic accuracy rate of only 80 percent. Ultrasonography, combined with this triad, can improve the diagnostic accuracy, decreasing the negative laparotomy rate from 20 percent to less than 10 percent.
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PMID:Sonography in the diagnosis of acute appendicitis. 159 3

A case of primary T-cell lymphoma of the appendix in an 84-year-old female was reported. Appendectomy was performed as a result of the clinical diagnosis of acute appendicitis, due to the rebound tenderness of McBurney's point and thickness of the appendix wall as determined from ultra echo sonograph. Grossly, the surgical resected appendix did not have a dominant inflammatory appearance, therefore a tumor was suspected. Microscopic examination showed diffused proliferation of large and medium size lymphoma cells. Immunohistochemical examination further revealed that the lymphoma cells were positive for T-cell markers. To ensure this was a T-cell lymphoma, molecular examination was performed using paraffin-embedded tissue sections, since T-cell lymphoma of the appendix is extremely rare. Polymerase chain reaction (PCR) single-strand conformation polymorphism (SSCP) analysis demonstrated monoclonal T-cell receptor gene rearrangement. T-cell-rich B-cell lymphoma was excluded. To our knowledge, this is the first reported case of primary T-cell lymphoma of the appendix. PCR-SSCP analysis in paraffin-embedded tissue section was very useful in the diagnosis of lymphoma cell monoclonality.
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PMID:Primary T-cell non-Hodgkin's malignant lymphoma of the appendix. 1084 17

Appendicitis due to foreign bodies is rare. Foreign bodies leading to appendicitis or perforation are usually sharp, pointed objects. Lead shot can become lodged in the appendix. Few prior cases have shown a causal relationship between the presence of pellets in the appendix and acute appendicitis. We present the case of a 9-year-old white boy who presented to the emergency room with a 36-hour history of right lower quadrant pain over McBurney's point accompanied by anorexia. The patient's history was significant for consumption of pheasant meat 4 days before onset of symptoms. The pheasant had been shot with a shotgun. X-ray of the child's abdomen revealed a metallic foreign body in the right lower quadrant. Appendectomy was performed. Bird shot was found obstructing the lumen of the grossly inflamed appendix. Pathology was consistent with acute appendicitis. This case is presented as an interesting consequence of bird shot ingestion.
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PMID:Appendicitis due to bird shot ingestion: a case study. 1088 37

Endometriosis is prevalent among women of reproductive age, and is most commonly found in the gynecologic organs themselves and the surrounding pelvic peritoneum. Endometriosis of the appendix, however, is rare. Preoperative diagnosis is difficult and a definitive diagnosis is usually established following histopathological examination of the appendix. We report a case of endometriosis of the appendix in a 29-year-old woman who presented with right lower quadrant abdominal pain. Rebound tenderness was localized to McBurney's point. Her WBC count was 12,300/mm3 and her CRP was 6.497 mg/dl. Ultrasound and computed tomography detected a calcified region inside the cecum and slight thickening of the wall of the appendix. Based on these findings, the patient was diagnosed with acute appendicitis and underwent an appendectomy. The appendix appeared mildly congested, but the mucosa of the appendix was nearly normal and without macroscopic inflammation. Histopathological examination demonstrated ectopic endometrial glands and stroma in the muscularis. These stroma cells were positive for CD10 on immunohistochemical staining, establishing a diagnosis of endometriosis of the appendix. The patient had a good clinical course and no residual pain postoperatively.
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PMID:A case of endometriosis of the appendix. 2063 87

Traditionally, the diagnosis of acute appendicitis has been based mainly on a history compatible with acute appendicitis and pain at McBurney's point, and the treatment of choice in patients with right iliac fossa pain referring to acute appendicitis has been (laparoscopic) appendicectomy. In too many centers where these traditional rules are followed the accuracy of diagnosis of acute appendicitis still remains at the level of 80 to 85%. It is time to re-evaluate these general guidelines. Here, I face the issue from a few points of view the clinical value of which has not been extensively discussed in the literature but that in my opinion markedly improve the diagnostic accuracy and treatment of patients with right iliac fossa pain. Although there is a clinical suspicion of acute appendicitis, it can be excluded in adult patient, if both leucocyte count and C-reactive protein value are normal on admission to hospital and remain normal in the follow-up. In expert centers, up to 100% sensitivity and specificity have been reported for contrast-enhanced multidetector computed tomography in the diagnosis of acute appendicitis. Antibiotic treatment can be considered a safe first-line therapy in selected patients with acute appendicitis.
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PMID:Clinical suspicion of acute appendicitis - is the time ripe for more conservative treatment? 2066 30

Charles McBurney published a treatise on appendicitis in 1891, in which he described the exact point on the abdomen at which tenderness was maximal in cases of acute appendicitis--the point now known as "McBurney's point." He also described his approach to both the diagnosis and management of appendicitis, which at the time consisted of careful observation, total disuse of the stomach, and early laparotomy. Since 1891, many advances in the diagnosis of acute appendicitis have been made. Emergency physicians evaluating patients with abdominal pain may rely on laboratory studies, particularly the white blood cell count, and abdominal imaging with either ultrasound or computed tomography in addition to the history and physical examination. Despite these advances, tenderness to palpation over McBurney's point remains a key finding on abdominal examination in the assessment of patients with abdominal pain.
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PMID:Charles McBurney: McBurney's point. 2198 26

Enterobius vermicularis is a parasite that inhabits the human digestive tract. We present two pediatric patients with symptoms mimicking acute appendicitis who were found to have E. vermicularis infection. The first case is a 5-year-old female who presented with flank and abdominal pain associated with low-grade fever and anorexia. She had localized tenderness in the right lower quadrant and a leukocytosis with left shift. Intraoperative findings included a normal-appearing appendix, but ex vivo examination revealed Enterobius vermicularis. The second case is a 7-year-old female who presented with periumbilical abdominal pain, anorexia, and emesis. She had tenderness at McBurney's point, and ultrasound revealed a small echogenic focus within the appendix. Intraoperatively, the distal tip of the appendix appeared inflamed. Again, ex vivo examination revealed E. vermicularis. Enterobius vermicularis infection of the appendix can present with a clinical picture similar to acute appendicitis. In at-risk populations, it should be included in the differential diagnosis for children with right lower quadrant abdominal pain. Complete therapy requires treatment with mebendazole.
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PMID:Manifestations of pediatric appendicopathia oxyurica. 2406 79

The subhepatic position of the cecum and appendix is a result of embryological reasons. Subhepatic appendicitis can cause diagnostic dilemmas. During the dissection of an adult male cadaver aged approximately 70 years, the subhepatic position of the cecum and appendix was noted. The appendix made a "U"-shaped bend and its tip was located in the paracolic position. The cecum had appendices epiploicae, and the terminal part of the ileum was retroperitoneal and had ascended vertically to the cecum from the right iliac fossa. Functionally, the sessile part of the ileum might restrict its peristaltic movements. The abnormal position of the terminal ileum might be mistaken for an ascending colon during laparoscopic surgery. The subhepatic position of the cecum and appendix might cause confusion in the diagnosis of acute appendicitis because the tenderness in such cases is not located at the McBurney's point.
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PMID:Sessile ileum, subhepatic cecum, and uncinate appendix that might lead to a diagnostic dilemma. 2438 3