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

Clinical diagnosis of appendicitis is usually made on the basis of history, physical examination and laboratory studies. Approximately 30-45% of patients with suspected appendicitis present with atypical clinical and laboratory findings. Recently graded compression ultrasound and thin section unenhanced helical CT have been used to establish diagnosis for patients with suspected acute appendicitis. The purpose of this study was to determine the diagnostic accuracy of thin section unenhanced helical CT protocol in adult patients with suspected acute appendicitis. CT scans obtained when patients presented with right lower quadrant pain and the clinical impression was equivocal for appendicitis were evaluated. Of 296 patients referred for CT, 123 patients subsequently underwent surgery. Appendicitis had been correctly predicted in 104 of 108 patients surgically proven to have appendicitis. Unenhanced helical CT in the diagnosis of acute appendicitis had a sensitivity of 96%, specificity of 98%, positive predictive value of 97% and negative predictive value of 98%. If no definite inflammatory changes are detected, on the basis of our experience we recommend that the patient be monitored clinically, and that thin section unenhanced helical CT is the optimal technique to detect acute appendicitis in adult patients.
Br J Radiol 2002 Sep
PMID:Diagnostic value of unenhanced helical CT in adult patients with suspected acute appendicitis. 1220 Feb 38

Acute appendicitis has extremely varied clinical presentations. A delayed or missed diagnosis may result in severe adverse consequences. Helical CT is evolving as an important diagnostic aid, but the CT signs can be varied and can easily be overlooked by the unwary. This pictorial review illustrates the spectrum of radiological signs and appearances of appendicitis on helical CT.
Br J Radiol 2002 Sep
PMID:Appendicitis: spectrum of appearances on helical CT. 1220 Feb 49

A short cut review was carried out to establish whether a single white cell count has clinical utility in the diagnosis of acute appendicitis in children. Altogether 100 papers were found using the reported search, of which four presented the best evidence to answer the clinical question. The author, date, and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.
Emerg Med J 2002 Sep
PMID:Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. White cell count and diagnosing appendicitis in children. 1220 92

A short cut review was carried out to establish whether a single white cell count has clinical utility in the diagnosis of acute appendicitis in adults. Altogether 176 papers were found using the reported search, of which five presented the best evidence to answer the clinical question. The author, date, and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.
Emerg Med J 2002 Sep
PMID:Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. White cell count and diagnosing appendicitis in adults. 1220 94

Nontyphoidal salmonellosis has a wide variety of clinical presentations. With the aim of describing the detailed clinical presentations of gastroenteritis caused by nontyphoidal Salmonella spp., findings for 126 patients (1-94 years of age; 37.0 years on average) were analyzed. Nontyphoidal salmonellosis is prevalent from April to October in Akita, when the mean atmospheric temperature exceeds 10 degrees C. On physical examination, 3 patients had rebound tenderness and muscle guarding on their abdominal wall; 1 of these patients underwent surgery for associated acute appendicitis. Elderly patients tended to be more seriously affected, resulting in severe dehydration. Elevation of the serum C-reactive protein (CRP) level correlated well with a decline in the platelet count. Although nontyphoidal salmonellosis is a common cause of acute gastroenteritis, thorough investigation and meticulous care are required so that conditions requiring surgical treatment or those that are potentially fatal are not overlooked.
J Infect Chemother 2002 Sep
PMID:Analysis of physical and laboratory findings in nontyphoidal salmonellosis. 1237 86

The authors report a rare clinical case of coincidence appendicitis and Fallopian tube torsion. A 14-years-old girl is presented with acute pelvic pain, dysuria and diarrhoea. Acute appendicitis and right side Fallopian tube torsion were detected by laparotomy. Symptoms, differential diagnoses, etiology and diagnostic procedures are discussed.
Rozhl Chir 2002 Sep
PMID:[Fallopian tube torsion in appendicitis--case report]. 1251 7

Ectopic pregnancies can be very difficult to diagnose at initial admission. This paper reviewed the morbidity and mortality associated with misdiagnosis of ectopic gestation over a 15-year period (1985-99) at Ile-Ife, Nigeria. There were 380 confirmed ectopic pregnancies of 35 857 live births, giving an incidence of 10.5 per 1000 live births. Of the 380 cases, 38 (10%) were misdiagnosed initially at presentation. Mistaken diagnoses include pelvic inflammatory diseases, cholera, acute appendicitis, typhoid enteritis, incomplete septic abortion, uterine fibroid with menorrhagia, malaria, gastroenteritis, peptic ulcer and intestinal obstruction. There were five maternal deaths among the 38 misdiagnosed cases compared to two maternal deaths among the 342 initially correctly diagnosed cases. Significant morbidity included prolonged hospital stay, increased hospital costs and an enterocutaneous fistula. To improve the chances of correct diagnosis at initial admission, accurate menstrual and sexual history should be obtained. Facilities for improved diagnosis such as serum beta HCG and transvaginal ultrasonography should be provided. Colleagues from other specialities should be educated to increase their suspicion of ectopic pregnancy in any woman of childbearing age and perform the appropriate investigations.
J Obstet Gynaecol 2002 Sep
PMID:Mortality and morbidity associated with misdiagnosis of ectopic pregnancy in a defined Nigerian population. 1252 28

Perforation of the gallbladder with resultant spillage of gallstones is not an uncommon occurrence. Spillage is reported to occur in 6% to 40% of laparoscopic cholecystectomies. Although not generally considered a significant problem, retained gallstones may cause serious complications years after the operation, with a clinical presentation that often is confusing. We report two cases of unusual complications from spilled gallstones. The first patient presented with clinical and radiologic findings of acute appendicitis 8 years after the laparoscopic cholecystectomy. The second patient presented with spontaneous erosion of spilled gallstones through the back 2 years and 9 months after the laparoscopic cholecystectomy. The literature is reviewed, and the management of spilled gallstones is discussed briefly. Although the complication rate is low, every effort should be made to retrieve spilled gallstones, and the event should be recorded in detail in the operative record. Obligatory conversion to an open procedure is not necessary.
Surg Endosc 2003 Sep
PMID:Unusual presentations of spilled gallstones. 1280 56

Acute appendicitis, the most common cause of abdominal surgical emergency, shows a different pathogenesis, clinical course and outcome in the elderly. Age-specific factors are effective on preoperative clinical diagnosis and on the stage of this infectious disease. We aimed to present our experience with a series of elderly patients with appendicitis who were subjected to appendectomy. Operative and hospital records of patients with appendicitis were retrospectively reviewed. Patients who were 50 years of age or older were the main constituents of the study. Demographic features, preoperative clinical diagnosis, abdominal interventions, and postoperative morbidity and mortality were analysed as the main criteria. A total of 109 older patients have constituted 4.3% of our appendectomy cases. Besides right lower quadrant transversal incisions, surgery was performed via vertical incisions in 28.4% of cases with a diagnosis of acute abdomen. In the elderly, the perforation rate was significantly higher than in paediatric and adult patients (P<0.001). The proportion of the elderly among perforated cases was significantly increased when compared with non-perforated cases (12.9 versus 2.9%; P<0.001). Postoperative morbidity was noted in 35.8% of elderly patients, in 73.8% of perforated, and in 11.9% of non-perforated cases (P<0.001). The mortality rate was 5.5% in the elderly group, 11.9% in patients with perforated, and 1.5% in patients with non-perforated appendicitis. No mortality was noted in patients younger than 50 years. The precise diagnosis of appendicitis is relatively low in the elderly. Despite the uncommon occurrence of appendicitis, the perforation rate is still unfavourable. Postoperative morbidity and mortality is unacceptably high. Advancing age adversely affects clinical diagnosis, the stage of disease and the outcome of patients. Perforated appendicitis and septic progression is the main cause of undesirable outcomes.
Eur J Emerg Med 2003 Sep
PMID:Age-related clinical features in older patients with acute appendicitis. 1297 95

In 74,000 obstetrical patients at Los Angeles County Hospital the incidence of acute appendicitis in pregnancy was 0.05 per cent. In a study of 36 cases of clinically diagnosed appendicitis in pregnancy between 1956 and 1960, it was shown that the fetal and maternal morbidity and mortality were decreased when a definite operative procedure was done early. The difficulty in diagnosis is increased by the necessary consideration of pyelonephritis and twisted ovarian cyst. Rupture of the appendix increased hazards to maternal and fetal survival. It was noted also that threatened premature labor may indicate a ruptured appendix. Emergency operation with the use of antibiotics in such cases was effective therapy. The incidence of premature delivery was proportionate to the delay in operating. If operation was performed in less than eight hours after admission to the hospital, there was no maternal or fetal loss. A delay greater than eight hours resulted in a 17 per cent fetal loss in premature delivery and 4 per cent fetal loss of infants at term.
Calif Med 1962 Sep
PMID:Appendicitis and pregnancy. 1445 25


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