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Journal of Surgical Case Reports Oct 2023Dolichocolon is an under-reported, under-diagnosed etiology of chronic constipation that is often overlooked as being a primary diagnosis. We present a case of an...
Dolichocolon is an under-reported, under-diagnosed etiology of chronic constipation that is often overlooked as being a primary diagnosis. We present a case of an undiagnosed dolichocolon in a young adult female whose initial presentation was concerning of appendicitis. Eventually, the patient underwent a subtotal colectomy as a definitive treatment for chronic constipation. Dolichocolon is an anatomical variant that can have severe lifelong consequences, such as chronic constipation, which greatly affects a patient's quality of life and overall health if undiagnosed. The purpose of this case report is to raise awareness among the surgical community regarding the significance of early dolichocolon diagnosis, prevent misdiagnosis, and ultimately improve patient outcomes, including reducing complications associated with chronic constipation.
PubMed: 37854520
DOI: 10.1093/jscr/rjad565 -
Annals of Medicine and Surgery (2012) Nov 2023The coronavirus disease 2019 (COVID-19) was first reported in Wuhan, Hubei Province, China. It mainly involves the respiratory system, causing fever, cough, chest...
INTRODUCTION AND IMPORTANCE
The coronavirus disease 2019 (COVID-19) was first reported in Wuhan, Hubei Province, China. It mainly involves the respiratory system, causing fever, cough, chest tightness, and other symptoms. However, when combined with other common or rare diseases, such as appendicitis and intestinal tuberculosis (TB), it can cause other systemic lesions, thus making the original disease lose its specific clinical manifestations. This case highlights the importance of early identification and clinical precision medicine diagnosis and treatment.
CASE PRESENTATION
A young woman presented with intermittent pain and discomfort in the right lower quadrant. Ultrasonography suggested appendicitis with a peripheral abscess. The nucleic acid test of COVID-19 was positive, and the chest computed tomography scan showed pulmonary involvement. She was sent for surgery. Postoperative body temperature increased regularly, and the TB T-cell test was positive.
CLINICAL DISCUSSION
Multiple infections caused by common bacteria, pandemic virus, and specific mycobacterium TB cause a series of nonspecific clinical manifestations, which brings challenges to clinical diagnosis and treatment. Therefore, when facing a complex infection case, the authors should consider the possibility of multiple infections and give targeted treatment for the pathogens.
CONCLUSIONS
During the epidemic of COVID-19, the incidence of intestinal TB is relatively low, which is easy to be overlooked and misdiagnosed, especially in the case of appendicitis. Therefore, clinicians must be highly vigilant in the diagnosis process to avoid missed diagnosis or misdiagnosis, so as to provide the best diagnosis and treatment plan.
PubMed: 37915626
DOI: 10.1097/MS9.0000000000001295 -
Journal of Medical Case Reports Jun 2024Schistosomiasis is one of the endemic parasitic diseases in many developing countries. Despite this, appendicitis secondary to schistosomiasis is an uncommon condition...
BACKGROUND
Schistosomiasis is one of the endemic parasitic diseases in many developing countries. Despite this, appendicitis secondary to schistosomiasis is an uncommon condition even in some endemic areas. Schistosomal appendicitis, an incidentally discovered appendicitis associated with schistosomiasis histological findings, affects young males predominantly. Timely diagnosis and treatment, including appendectomy and anti-helminthic therapy, are crucial.
CASE REPORT
A 24-year-old Sudanese male patient presented with abdominal pain. Diagnosed with acute appendicitis, he underwent appendectomy, revealing appendix inflammation with Schistosoma ova in histopathology. Abdominal ultrasound detected no complications. Weakly positive Schistosoma serology was noted, but stool and urine analysis showed no infection evidence. Prescribed praziquantel, patient had 3-year post-op follow-up without complications.
CONCLUSIONS
This case report underscores the significance of including schistosomiasis in the differential diagnosis of appendicitis, particularly in regions where the disease is endemic. It underscores the necessity of histopathological evaluations for accurate diagnosis, emphasizing the potential implications for clinical practice in similar settings.
Topics: Humans; Appendicitis; Male; Young Adult; Praziquantel; Appendectomy; Anthelmintics; Schistosomiasis; Diagnosis, Differential; Abdominal Pain; Ultrasonography; Animals; Treatment Outcome; Appendix
PubMed: 38890741
DOI: 10.1186/s13256-024-04610-3 -
World Journal of Clinical Cases Dec 2023Colonoscopy is widely used for examination, diagnosis, and treatment because of its low incidence of associated complications. Post-colonoscopy appendicitis (PCA) is...
BACKGROUND
Colonoscopy is widely used for examination, diagnosis, and treatment because of its low incidence of associated complications. Post-colonoscopy appendicitis (PCA) is very rare and is easily misdiagnosed as electrocoagulation syndrome or colon perforation. Therefore, clinicians should pay close attention to this complication.
CASE SUMMARY
A 47-year-old female patient underwent a colonoscopy for a systematic physical examination, and the procedure was uneventful with normal endoscopic and histologic findings. However, the bowel preparation was suboptimal (Boston 2-3-2). After the examination, the patient experienced pain in the lower abdomen, which progressively worsened. Computed tomography of the lower abdomen and pelvis revealed appendiceal calcular obstruction and appendicitis. As the patient refused surgery, she was managed with antibiotics and recovered well.
CONCLUSION
In the current literature, the definition of PCA remains unclear. However, abdominal pain after colonoscopy should be differentiated from acute appendicitis.
PubMed: 38188211
DOI: 10.12998/wjcc.v11.i36.8563 -
Cureus Aug 2023Introduction The association of acute appendicitis with caecal or colorectal cancer is known. One of the proposed theories for acute appendicitis is luminal blockage by...
Introduction The association of acute appendicitis with caecal or colorectal cancer is known. One of the proposed theories for acute appendicitis is luminal blockage by mass at the base of the appendix. There have been no national recommendations or guidelines for follow-up with patients aged 40 and older after an emergency appendicectomy. The purpose of this study was to evaluate the prevalence of caecal and colonic cancer or polyps in patients over the age of 40 who have undergone an appendicectomy. This shall enable us to develop the necessary strategies to investigate and diagnose associated caecal and colonic pathology in acute appendicitis to prevent delayed diagnosis of colon cancer. Methods All patients who underwent appendicectomy between October 2011 and October 31, 2021, and who were 40 years of age or older were included in this retrospective cohort study. Patients aged 40 to 54 years old and patients 55 years or older underwent subgroup analyses. We looked at any investigations of the colon (CT pneumocolon or colonoscopy) within three years before the appendicectomy or three years after an appendicectomy. All colorectal cancers diagnosed within five years of the index episode of appendicitis were included in the analysis. Results A total of 1076 appendicectomies were performed on patients aged 40 and older during the study period of 10 years. A total of 769 patients were confirmed to have appendicitis on histology. One hundred and fifty-seven patients had colonic investigations within three years of the diagnosis of acute appendicitis. In our study, 51 of the 769 patients (6.63%) were found to have colorectal neoplasms. Eight patients (8/769, 1.04%) were diagnosed with colorectal cancers, and the occurrence of caecal cancer was 0.26% (2/769). The mortality rate was 75% (6/8) in these patients diagnosed with colorectal cancer. Four out of six died due to advanced metastatic colonic cancer. In comparison to patients aged 40 to 54, patients over the age of 55 had a statistically significant increased risk of caecal pathology (polyp and cancer) (p = 0.07). Conclusion There seems to be an increased risk of significant colorectal neoplasm in patients over the age of 55 who are admitted with acute appendicitis, and there appears to be an increased severity with a poor prognosis of cancer in these individuals. We recommend the use of routine colonoscopy or CT pneumocolon, particularly for those over the age of 55 who present with acute appendicitis or the histology of appendicular neoplasms.
PubMed: 37692620
DOI: 10.7759/cureus.43248 -
Journal of Pediatric Surgery May 2024Data science approaches personalizing pediatric appendicitis management are hampered by small datasets and unstructured electronic medical records (EMR). Artificial...
PURPOSE
Data science approaches personalizing pediatric appendicitis management are hampered by small datasets and unstructured electronic medical records (EMR). Artificial intelligence (AI) chatbots based on large language models can structure free-text EMR data. We compare data extraction quality between ChatGPT-4 and human data collectors.
METHODS
To train AI models to grade pediatric appendicitis preoperatively, several data collectors extracted detailed preoperative and operative data from 2100 children operated for acute appendicitis. Collectors were trained for the task based on satisfactory Kappa scores. ChatGPT-4 was prompted to structure free text from 103 random anonymized ultrasound and operative records in the dataset using the set variables and coding options, and to estimate appendicitis severity grade from the operative report. A pediatric surgeon then adjudicated all data, identifying errors in each method.
RESULTS
Within the 44 ultrasound (42.7%) and 32 operative reports (31.1%) discordant in at least one field, 98% of the errors were found in the manual data extraction. The appendicitis grade was erroneously assigned manually in 29 patients (28.2%), and by ChatGPT-4 in 3 (2.9%). Across datasets, the use of the AI chatbot was able to avoid misclassification in 59.2% of the records including both reports and extracted data approximately 40 times faster.
CONCLUSION
AI chatbot significantly outperformed manual data extraction in accuracy for ultrasound and operative reports, and correctly assigned the appendicitis grade. While wider validation is required and data safety concerns must be addressed, these AI tools show significant promise in improving the accuracy and efficiency of research data collection.
LEVELS OF EVIDENCE
Level III.
Topics: Humans; Child; Artificial Intelligence; Appendicitis; Ultrasonography; Electronic Health Records; Surgeons
PubMed: 38383177
DOI: 10.1016/j.jpedsurg.2024.01.033 -
EClinicalMedicine Sep 2023Acute appendicitis is the most common digestive disease requiring emergency surgery. Colorectal cancer is the third most common cancer in France. An increased risk of...
BACKGROUND
Acute appendicitis is the most common digestive disease requiring emergency surgery. Colorectal cancer is the third most common cancer in France. An increased risk of colorectal cancer after acute appendicitis has been suggested. We aimed to assess the frequency of hospitalization for colon cancer after appendicitis in a nationwide analysis.
METHODS
Using the French Hospital Discharge Database (PMSI), we included all patients aged 18-59 years presenting with acute appendicitis between 2010 and 2015. Univariate and multivariate analyses were performed to compare colon cancer occurrence in these patients vs a control-matched population with a hospital stay for trauma in the same period. Patients presenting strong risk factors for colorectal cancer were excluded.
FINDINGS
A total of 230,349 patients with acute appendicitis (exposed group) were included. We used a propensity score to match each exposed patient with two unexposed patients (controls) to ensure the comparability of the groups, resulting in a control group of 460,698 patients. Univariate analysis found significantly more colon cancer in the appendicitis group, especially during the first year after appendicitis (5 per 10,000 vs 1 per 10,000, p < 0.000, this corresponds to 111 patients in the appendicitis group), namely within the first 6 months. Survival analysis confirmed patients treated for appendicitis present a 4 times higher risk of being diagnosed with colon cancer than control patients during the first year of follow-up (sHR = 4.67 (95% CI: 3.51-6.21), and 8 times higher during the first 6 months (sHR = 8.39; 95% CI: 5.41-12.99). The association was even more marked for right-sided colon cancer (sHR = 8.25; 95% CI: 5.03-13.54 during the 1st year). While the risk of diagnosis of colon cancer was also significant for patients over 40 years, it was even greater in patients under 40 years, who had between a 6-fold and 12-fold increase in risk.
INTERPRETATION
In this population-based study, we found that acute appendicitis seems to be a warning sign for colon cancer (reverse causality) in both middle-aged and younger adults. The risk of presenting with cancer colon was higher during the first six months after acute appendicitis. This raises the issue of routine diagnostic work-up in adults presenting with acute appendicitis.
FUNDING
Regional Council of Burgundy.
PubMed: 37680941
DOI: 10.1016/j.eclinm.2023.102196 -
Arquivos Brasileiros de Cirurgia... 2023Acute appendicitis is a common surgical emergency worldwide. Recent studies on hematological inflammatory markers concerning acute appendicitis have shown variable... (Observational Study)
Observational Study
BACKGROUND
Acute appendicitis is a common surgical emergency worldwide. Recent studies on hematological inflammatory markers concerning acute appendicitis have shown variable results.
AIMS
The aim of this study was to evaluate pre-operative values of platelet indices such as mean platelet volume (MPV) and platelet distribution width (PDW), and red cell distribution width (RDW) in relation to the diagnosis of acute appendicitis and their efficacy as predictors of appendicular perforation.
METHODS
A prospective observational study of 190 patients diagnosed with appendicitis and who underwent an appendectomy was undertaken and confirmed histopathologically. Preoperatively, blood samples of white blood cells (WBCs), platelet count, MPV, PDW, and RDW were analyzed using a Sysmex XN1000 analyzer machine.
RESULTS
Of 190 patients, 169 had acute appendicitis, and 21 had perforated appendicitis. The mean age of patients was 28.04 ± 14.2 years. The male-to-female ratio was 1.5:1. The WBC (p<0.05), MPV (p<0.05), and PDW (p<0.05) were found to have higher statistically significant values in acute appendicitis and perforated appendicitis compared to the RDW (p>0.05). However, perforated appendicitis had a higher RDW value compared to acute appendicitis, which can be a predictive factor.
CONCLUSIONS
The elevated value of MPV and PDW associated with leukocytosis can be used as supportive evidence for the clinical and radiological diagnosis of acute appendicitis and appendicular perforation. Thus, these values can be used as diagnostic cost-effective inflammatory biomarkers.
Topics: Humans; Female; Male; Adolescent; Young Adult; Adult; Appendicitis; Erythrocyte Indices; Appendectomy; Acute Disease; Biomarkers
PubMed: 37729283
DOI: 10.1590/0102-672020230039e1757 -
Cureus Sep 2023Appendicitis is a common abdominal emergency requiring swift medical intervention. Misconceptions about this condition can lead to delayed diagnosis and potentially...
BACKGROUND
Appendicitis is a common abdominal emergency requiring swift medical intervention. Misconceptions about this condition can lead to delayed diagnosis and potentially life-threatening complications. In the Aseer region of Saudi Arabia, where healthcare accessibility and awareness levels vary, addressing such misconceptions is of paramount importance. The aim of this study is to investigate and identify the prevalent misconceptions regarding appendicitis among the resident population of the Aseer region. Understanding the prevalent misconceptions and knowledge gaps is essential to develop targeted educational interventions and enhance public awareness.
METHODS
This study utilized a cross-sectional study design to investigate misconceptions about appendicitis among residents in the Aseer region. Over a period of three months, 329 Aseer region resident population were interviewed. The symptoms, causes, diagnosis, treatment, and preventive measures of appendicitis were all covered in a questionnaire that was created to gather information on people's knowledge of appendicitis. Data were collected using an online questionnaire. Descriptive analysis was performed using frequencies and percentages, while inferential analysis employed appropriate statistical tests such as chi-square.
RESULTS
The study's 329 participants were made up of 56% men and 44% women. 40% of the sample size was between the ages of 18 and 30, 26% were between the ages of 31 and 40, 15% were between the ages of 41 and 50, and 10% were above 50 years, with those under the age of 18 years accounting for the smallest proportion (9%). The majority of the respondents (37%) were college graduates, 25% were college students, 23% were in high school and 15% were in middle school. Chi-square tests were conducted to examine the associations between background knowledge and pain area, as well as between background knowledge and source of information. For the association between background knowledge and pain area, the Chi-square test yielded a significant result (X² = 9.104, p = 0.028); the Chi-square test also revealed a significant result (X² = 8.078, p = 0.044) between background knowledge and the source of information about appendicitis.
CONCLUSION
The analysis suggests a notable knowledge gap among the participants, with a significant portion displaying limited understanding or responding with "I don't know" when queried about appendicitis. It is important to note that this observation includes middle school students, who may be too young to be expected to possess knowledge about medical conditions. Additionally, there appears to be gender-related variation in opinions, misconceptions, and understanding regarding appendicitis.
PubMed: 37842387
DOI: 10.7759/cureus.45229 -
Journal of Minimal Access Surgery May 2024Gangrene/perforated appendicitis entails high rates of morbidity and mortality. The purpose of this study is to discuss the reliability, surgical management and...
INTRODUCTION
Gangrene/perforated appendicitis entails high rates of morbidity and mortality. The purpose of this study is to discuss the reliability, surgical management and post-operative complications of laparoscopic interventions in the treatment of perforated appendicitis.
PATIENTS AND METHODS
One hundred and ten patients (50 men and 60 women) diagnosed with perforated appendicitis based on history, physical examinations, laboratory and computed tomography findings between January 2016 and May 2022 were analysed retrospectively. Preoperative laboratory and radiological findings, surgical methods and post-operative complications were evaluated.
RESULTS
Abdominal pain defence and rebound were present in all patients. In terms of radiological findings, intra-abdominal free fluid was present in all patients and abscess in 42. Post-operative abdominal surgical site infection developed in six patients. No intra-abdominal abscess or incisional hernia was observed during follow-ups.
CONCLUSION
As a diagnostic tool, permitting better visualisation of the abdominal cavity, entailing fewer post-operative complications and obviating the need for large incisions, laparoscopy can represent the approach of choice in the treatment of perforated appendicitis.
PubMed: 38726968
DOI: 10.4103/jmas.jmas_241_23