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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 was once thought to be rare among rural blacks. It is now known that appendicitis is relatively common among Africans and in Africa. At the University College Hospital, Ibadan, Nigeria, appendicitis is the most common cause of acute abdomen on the surgical service.One hundred and eighty-one cases of appendicitis were operated on in a two-year period from June 1975 to June 1977. A retrospective analysis of 47 fully documented cases showed that wrong diagnosis occurred more often in females than in males. There was a high incidence of perforation (31.9 percent) in this series. Deaths occurred in perforated cases and cases complicated by typhoid perforation of the terminal ileum. Parasites and their ova were often present in the lumen of some appendices.The age group most affected was 16 to 20 years. This disease affected low, middle and upper income groups in our society. Chronic, recurrent appendicitis was frequently diagnosed (31.9 percent) and history of recurrent right lower quadrant pain as far back as three months was often elicited from these patients.
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PMID:Appendicitis in a tropical African population. 53 24

A case of torsion of a normal right ovary and tube in an 8-year-old child is presented. True infarction of the adnexa can be prevented only by considering this diagnosis early in the course of right lower quadrant pain. It is recommended that a routine exploration of the pelvis be carried out in any patient explored for acute appendicitis in whom that diagnosis cannot be made at the operating table.
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PMID:Torsion of normal uterine adnexa in childhood: case report. 66 81

From February 1990 to December 1991, 16 laparoscopic procedures were performed for right lower quadrant pain. There were nine men and seven women, aged 16 to 47 years (mean, 27.2 years). All procedures were performed by surgical chief residents with prior experience in laparoscopic cholecystectomy, first-assisted by an attending surgeon. The appendix was visualized and a definitive diagnosis was made in all patients. One patient with acute salpingitis underwent diagnostic laparoscopy only; two patients underwent laparotomy (perforated appendicitis, perforated diverticulitis). A fourth patient had an acute torsion of an ovarian cyst managed laparoscopically. Laparoscopic appendectomy was successfully performed in 12 patients (acute appendicitis, 9; fibrosis or chronic inflammation, 2; normal appendix, 1). Mean operative time for laparoscopic appendectomy was 95.7 minutes, and mean postoperative stay was 2.5 days. The authors conclude that operative time, diagnostic accuracy, and complication rates for laparoscopic appendectomy are acceptable. Within the context of a training program, laparoscopic appendectomy provides an opportunity for surgical residents to expand laparoscopic skills.
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PMID:Laparoscopic appendectomy. Initial experience in a teaching program. 138 42

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

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

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

Using a data base of 7,000 acute abdominal pains, we here described the assessed clinical manifestations of the main diseases responsible for right lower quadrant pain. However, percentages of sensibilities have been replaced by adverbs or adjectives, applying a scale of equivalence. The possible modifications of the positive predictive values have been also replaced by verbs or typical expressions. We first described the acute appendicitis syndrome (which covered congestive endoappendicitis and suppurated appendicitis) with the clinical shades or the gathered and gangrenous forms or even of the diffuse peritonitis. Features of the acute appendicitis contrast with those of the so called "non specified abdominal pains" (a new entity), and those of the subacute or chronic appendicitis. We found a good correlation between clinical and pathological findings. One of the difficulties has been to determine if a subgroup of subacute appendicitis should be or not included into the acute appendicitis.
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PMID:[Quantified symptomatology of acute appendicitis in adults. The signs and their value]. 159 20

The results of prospectively determined scoring system for the diagnosis of appendicitis (sex, age, duration of symptoms, contracture, hyperleucocytosis) are reported. Between 1984 and 1989, 492 patients with suspected appendicitis were examined. Among the 208 operated patients, 169 had acute appendicitis (81.25 percent). Diagnosis of the abdominal pain was established in one of 3 patients without appendicitis (105/323; non operated patients or operated patients with normal appendix). Eighty-five percent of the non operated patients and 92 percent of the patients operated on with normal appendix have been followed (mean follow-up 26 months). Ten percent of the non operated patients (24/237) have been operated on during follow up; 13.9 percent of the operated patients with normal appendix (5/36) and 22.8 percent of the non operated patients (54/237) still complained of persistent right lower quadrant pain (no significative difference). In conclusion, a clinical scoring system is of help in suspected acute appendicitis. This attitude requires the cooperation of the general practitioner and must be well explained to families of patients.
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PMID:[Prospective study of a predictive scoring system for the diagnosis of appendicitis in patients with right lower quadrant pain. Long-term outcome]. 176 68

Inflammation of the appendix is a common cause of acute abdominal pain. The etiology and pathophysiology of appendicitis have been well described. The initiating factor often is obstruction of the appendiceal lumen by inspissated stool, barium, food, parasites, or hyperplastic lymphoid tissue. Two patients have been identified who developed appendicitis temporally related to blunt abdominal trauma, without other clear etiology. Although absolute documentation of trauma as an etiologic factor in these cases is difficult, theoretical mechanisms for the occurrence are discussed. In the setting of right lower quadrant pain following mild to moderate blunt abdominal trauma, acute appendicitis should be considered as a possibility.
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PMID:Acute appendicitis following blunt abdominal trauma. Incidence or coincidence? 163 93


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