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

Diagnostic laparoscopy began in a surgical unit in a developing country in 1972. The developers of this technique aimed to hasten diagnosis, reduce patient distress, and improve bed utilization in an overcrowded teaching hospital wherein simple investigations such as x-rays took weeks to materialize. Over a period of 18 years reaching to 1990, 3,200 diagnostic laparoscopies were performed on adults under local anesthesia with no mortality, a complication rate of 0.09%, an 84% diagnosis rate, and 74% undergoing histologic biopsies targeting a wide spectrum of pathology. The equipment cost spread out over the 3,200 patients works out to 30 rupees (0.60 dollar) per patient. With the availability of noninvasive diagnostic aids such as ultrasound, computed tomography, and magnetic resonance imaging used US, CT, MRI under the control of target biopsy, the role of diagnostic laparoscopy has altered. Since 1990, clinicians have had the sophistication of the video camera and the pneumoperitoneum insufflator. Diagnostic laparoscopy is used for the evaluation of liver and peritoneal pathology, abdominal tuberculosis, malignancy, acute abdomen, and abdominal trauma. It often is a prelude to laparoscopic treatment of the underlying pathology, specifically in cases of acute appendicitis.
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PMID:Diagnostic laparoscopy. 1295 80

Negative-pressure pulmonary edema after endotracheal intubation is an uncommon and potentially serious complication of patients undergoing general anesthesia for different surgical procedures. We report a case of a healthy 20-year-old male patient with the diagnosis of acute appendicitis. The patient was submitted to appendectomy under general anesthesia and developed negative-pressure pulmonary edema immediately after extubation. The present paper reports this potentially serious complication illustrating the main radiological findings consistent with alveolar hemorrhage in this setting and the treatment performed.
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PMID:Negative pressure post-extubation pulmonary edema complicating appendectomy in a young patient: case report. 1547 96

A ProSeal laryngeal mask airway was used for anaesthesia for laparoscopic surgery in a 26 y old male patient with acute appendicitis. Perioperative aspiration of gastric contents resulted in severe ARDS. Invasive therapeutic options including ECMO had to be used to obtain full recovery. After critical evaluation of the chain of causation it must be postulated that an improper airway was chosen for an intervention that comprises a high risk of aspiration per se. Further risk factors were a long period of fasting, untimely removal of the mask before the patient regained full consciousness, the late confirmation of the diagnosis and the hesitant initial therapy. Since PLMA provides a higher airway occlusion pressure compared to the classic laryngeal mask airway (CLMA), the use of this device may be justified for elective laparoscopic surgery. In emergency patients with increased risk of regurgitation endotracheal intubation still remains the gold standard.
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PMID:[Severe ARDS following perioperative aspiration of gastric content associated with the use of a "ProSeal" laryngeal mask airway]. 1607 59

Results of treatment of 10 patients aged from 16 to 62 years with omentum torsion were analyzed. The majority of them were hospitalized 1.5 -- 3 days after disease beginning. The main symptom was pains in the right half of the abdomen. Clinical picture was characterized by slow progress and late manifestation of peritoneal symptoms. All the patients underwent surgery under general anesthesia. Eight of them were suspected for acute appendicitis, 2 -- for acute cholecystitis. Five patients were operated during the first 2 hours, others -- from 6 hrs 40 min to 20 hrs after hospitalization. In all the patients segmental torsion of the right side of the omentum on 360-720 degrees was revealed. Nine patients had abdominal hemorrhagic effusion. Resection of the affected part of the omentum with additional appendectomy in 5 cases was performed. Destruction in the appendix was revealed only in one patient. There were no complications and lethal outcomes. Problems of diagnostic and surgical policy are discussed.
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PMID:[On omentum torsion]. 1609 95

The authors present a case of a 32 year old pregnant woman who is admitted to the Obstetric clinic in the 16th gestational week with a pain in the ileoceacal region of the abdomen and vomitting. The woman has clinical signs of acute abdomen. A clinical diagnosis of acute appendicitis was suggested. During the operation under general anesthesia was found a phlegmonous inflammation of a Mekel diverticulus with perforation as well as local peritonitis and a catharal inflammation of the appendix. The appendix and the Mekel diverticle were removed during the operation. No comlications were observed during the post operative period. No fetal distress was observed during and after the operation Three months later the same patient was admitted to the obstetric clinic in the 32nd gestational week with a diagnosis Threatened premature delivery in ml VIII status post resection of a Mekel diverticle and appendectomy. The patient had pain to the right of the umbilicus and vomiting. The labor was induced and a viable premature infant was born. Two days after delivery there was again a clinical symptoms and signs of an acute abdomen due to ileus. A strangulation of the terminal ileum was found due to adhesions A Debridman and a lavage were performed No complications were observed during the postoperative period. The authors discuss the difficulties which might ensue when the diagnosis acute abdomen is made in a pregnant woman
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PMID:[A case report of two incidents of acute abdomen in a woman during pregnancy and in the early puerperium]. 1663 7

The clinical finding of a mass in the right iliac fossa during the course of diagnosis of acute appendicitis may affect the management approach. A mass is sometimes only evident when the abdomen is examined under anesthesia. This study was conducted to assess the significance of examination under anesthesia and analyze the outcome of laparoscopic exploration and its correlation with the finding of a mass that can be felt only under anesthesia. We conducted a prospective study over 12 months on patients diagnosed with acute appendicitis who were treated with laparoscopic approach. There were 179 patients (101 females) who underwent laparoscopic appendicectomy; 20 cases (11%) were converted to open appendicectomy. Examination under anesthesia revealed a mass in 20 patients (11%). The rate of conversion to open operation was 65% (13 patients) in those who had palpable mass and 4% (7 patients) in those who had no mass (P<0.0001). This study has shown that most patients with a mass found under anesthesia will need conversion of the laparoscopic procedure to an open operation. The recommendation from this study therefore is that all patients planned to have a laparoscopic appendicectomy should have examination under anesthesia; if a mass is found, then the procedure should be converted to open operation from the beginning.
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PMID:Examination under anesthesia prior laparoscopic appendicectomy: does it change the approach? 1731 50

We report all the procedures performed in pregnant patients in our institute. There were 2 cases of laparoscopic mesh repair (for posterolateral diaphragmatic Bochdalek hernia and laparoscopic Heller cardiomyotomy) and 1 laparoscopic cystectomy for torsion of an ovarian cyst; 7 laparoscopic appendectomies (6 for acute appendicitis and 1 for perforated appendix); and 9 laparoscopic cholecystectomies (8 for acute cholecystitis and 1 for gallbladder empyema). All these patients were in their second trimester of pregnancy. All the laparoscopic procedures were successful: there was no mortality, morbidity, or conversions. There were no complications for either mother or child related to general anesthesia. The changes in physiology of the pregnant patient have to be adequately addressed and proper precautions taken to ensure safety. The second trimester is the ideal time to do laparoscopic surgery, though procedures have been performed in all trimesters. Our initial experience is satisfactory, although more data are essential to standardize laparoscopic procedures in pregnancy. We conclude that laparoscopic surgery is proving to be as safe as open surgery in pregnancy.
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PMID:Safety and efficacy of laparoscopic surgery in pregnancy: experience of a single institution. 1748 45

We investigated the adjustments related to spinal anesthesia in Japan. There were 23 cases. Seventeen cases resulted in death, 3 cases did in central nerve injury and 3 cases did in peripheral nerve injuries. In 17 cases whose origin was inadequate patient control, 15 patients were younger than 15 years old. In 14 cases in which the patient was younger than 15 years old, acute appendicitis was connected. Continuous monitoring is necessary to prevent malpractice during and after operation.
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PMID:Analysis of lawsuits on malpractice related to spinal anesthesia in Japan--change in the causes of anesthetic malpractice related to judicial precedents. 1934 73

Natural Orifice Transluminal Endoscopic Surgery is a new method of mini invasive surgery, which involves passing surgical instruments, and a tiny camera, through a natural orifice, such as the mouth, vagina, urethra or rectum, what provides the access to the desired organ. The procedure is approved due to its benefits - less pain, quicker recoveries, fewer complications and no scar - as it lets us avoid major incisions through the skin, muscle and nerves of the abdomen. Besides that the transluminal access is considered to be the most safe and feasible for clinical application. Here are discussed the two operations of Transvaginal Appendectomy performed in Caucasus - Academician N. Kipshidze University Hospital in Tbilisi. The first patient - a 28-year woman, weight - 72 kg, height - 180 cm, married, has one child - was submitted to the hospital with anamnesis of 48 hours acute appendicitis, typical clinical semiotics and laboratory records. In the second case the patient was a 22-year old woman, height - 170 cm, weight - 68 kg, married, with 2 children. She was hospitalized with 24 hours acute appendicitis anamnesis and typical clinical semiotics and laboratory records. Both operations were performed under general anesthesia, using Karl Storz GmbH & Co. equipment. The duration of the first procedure was 76 minutes and the second operation lasted for 88 minutes. The operations were made without any technical difficulties or complications. None of the patients had the need of non-narcotic analgesia during the post-operational period. No gynecological or surgical problems or any complications were detected during the observation period. The patients had superior postoperative evolution, so the stationary stay made up 36 hours after the first operation and 30 hours after the second. Essentially NOTES is a new trend in endoscopic surgery - the non-scar surgery with major advantages compared to the conventional - the NOTES takes endoscopic surgery one step further in terms of reducing pain and avoiding long hospitalization and is much more effective. The doctors hope to have more developed and flexible endoscopic surgical tools as they are planning to perform more complicated procedures in the future. Taking in consideration the appropriate experience of the operator the procedure is safe, more physiological and precise. Natural-orifice surgery becomes more familiar and as more procedures are successfully performed, the acceptance of it will grow. We consider NOTES is a challenge in surgery and in the nearest future in case of suitable technical support it will replace not only conventional medicine but laparoscopic too.
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PMID:New trend in endoscopic surgery: transvaginal appendectomy NOTES (Natural Orifice Transluminal Endoscopic Surgery). 1935 10

Two hundred and seventy-seven patients were admitted with acute appendicitis to KKUH during a 5 year period. There were 189 males (68%) and 88 females (32%). Of these, 51 patients (18.4%) had appendicular mass diagnosed clinically or under anaesthesia. Twenty five were males and twenty six females. All patients with appendicular mass underwent exploration and six were found to have abscess formation. All patients had their appendix removed. There was no mortality. Three patients developed wound infection, one a pelvic collection and one had sub-acute intestinal obstruction, giving a complication rate of 9.8%. We feel a surgical approach for appendicular mass, in a specialised centre dealing with paediatric surgical patients, is a safe alternative to the classical textbook conservative approach. It also has the benefit of reducing the hospital stay and requires no readmission for interval appendectomy, for which many patients fail to return.
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PMID:Surgery for appendicular mass. 1986 67


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