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Journal of Pain Research 2024Postoperative pain relief after laparoscopic appendicectomy is a key determinant of early rehabilitation in children. Recent guidelines recommend performing either a...
Clinical Effectiveness of Transversus Abdominis Plane (TAP) Block versus Local Anesthesia Wound Infiltration for Postoperative Pain Relief After Laparoscopic Appendicectomy in Children: A Study Protocol for a Multicenter Double-Blind Randomized Controlled Phase III Trial.
PURPOSE
Postoperative pain relief after laparoscopic appendicectomy is a key determinant of early rehabilitation in children. Recent guidelines recommend performing either a transversus abdominis plane (TAP) block or local anesthesia (LA) wound infiltration as part of multimodal postoperative analgesia after appendectomy. To date, the clinical effectiveness of TAP block versus LA wound infiltration has never been compared. The hypothesis of this study is that the TAP block may provide a greater opioid-sparing effect after laparoscopic appendicectomy in children than LA wound infiltration.
STUDY DESIGN AND METHODS
We designed a multicenter double-blind randomized controlled phase III trial and aim to include 110 children who undergo laparoscopic appendicectomy. Children are randomized to receive either TAP block (TAP group) or LA wound infiltration (infiltration group). Multimodal analgesia is standardized in the two groups using the same protocol, which includes the stepwise prescription of paracetamol, phloroglucinol, ketoprofene, and nalbuphine according to the hetero-evaluation of pain performed by the nurses who were blinded to the treatment allocated using the validated FLACC scale. The primary outcome is the total dose of nalbuphine administered within 24 hours after surgery.
DISCUSSION
No study has specifically compared the clinical effectiveness of TAP block versus LA wound infiltration for postoperative pain relief after laparoscopic appendectomy in children. This paper describes the protocol for a randomized trial that addresses this issue. The results of this trial will be useful for editing guidelines with a higher level of evidence on this topic.
PubMed: 38699069
DOI: 10.2147/JPR.S453661 -
Movement Disorders Clinical Practice Jun 2024The vermiform appendix is considered a potential reservoir for the abnormal α-synuclein aggregate in Parkinson's disease (PD). Previous epidemiologic evidence on the...
BACKGROUND
The vermiform appendix is considered a potential reservoir for the abnormal α-synuclein aggregate in Parkinson's disease (PD). Previous epidemiologic evidence on the association between appendectomy and PD risk remains inconclusive, especially outside the Western world.
OBJECTIVES
To investigate the association between appendectomy and PD risk in Korea.
METHODS
Among 703,831 eligible adult subjects in the National Health Insurance Service sample cohort, we identified 16,122 patients who underwent appendectomy. The rest formed the control group. PD risk was assessed using time-dependent Cox regression analyses.
RESULTS
The appendectomy group did not have altered risk of PD compared with the control group in either unadjusted [hazard ratio (HR) 1.32, 95% confidence interval (CI) 0.97-1.80, P = 0.08] or adjusted model (HR 1.42, CI 0.88-2.30, P = 0.15). No further statistical difference appeared when stratified by sex.
CONCLUSIONS
Appendectomy is not associated with altered risk of PD in the Korean population.
Topics: Humans; Parkinson Disease; Male; Appendectomy; Female; Republic of Korea; Middle Aged; Aged; Adult; Risk Factors; Cohort Studies; Proportional Hazards Models
PubMed: 38696328
DOI: 10.1002/mdc3.14031 -
Annals of Medicine and Surgery (2012) May 2024Appendiceal signet-ring cell adenocarcinoma (ASCA) is rare and more aggressive in malignant appendiceal neoplasms. The presentation can be appendicitis, which is lack of...
INTRODUCTION
Appendiceal signet-ring cell adenocarcinoma (ASCA) is rare and more aggressive in malignant appendiceal neoplasms. The presentation can be appendicitis, which is lack of specific symptom and makes early diagnosis difficult. There is no effective surveillance. Prognosis largely relies on timely detection. We report a case of ASCA incidentally diagnosed through pathological examination after appendectomy for appendicitis.
CASE PRESENTATION
The patient presented to our department with a progressive right lower quadrant abdominal pain lasting for 3 days. Physical examination revealed rigidity, tenderness, and rebound tenderness on the right lower quadrant. A computed tomography scan showed a thickened, inflamed appendix with peri-appendiceal fat stranding without noticeable appendiceal mass at initial evaluation. The diagnosis was considered acute appendicitis, and an appendectomy was performed. The appendix was inflamed, gangrenous and perforated, and no mass was found during the surgery. Surgical specimen was sent for physiological examination, which incidentally detected signet-ring cell in H&E staining. And immunohistochemistry confirmed the diagnosis of ASCA with small amount of neuroendocrine neoplasms.
CONCLUSION
Early diagnosis of ASCA can incidentally be made on pathological specimen following appendectomy for appendicitis. A routine pathological examination should be emphasized, and appendectomy may not be the endpoint of the treatment. Hemicolectomy and adjuvant therapy might ensue upon the diagnosis of appendiceal neoplasm. The poor prognosis of ASCA makes a timely diagnosis significant. Basic research is promising to unravel the molecular mechanisms of pathogenesis, finding typical tumor markers for screening and novel effective therapies for advanced cases.
PubMed: 38694365
DOI: 10.1097/MS9.0000000000001973 -
Annals of Medicine and Surgery (2012) May 2024Appendicitis is the most common surgical emergency encountered in the emergency department, and diagnosis is difficult at times. Imaging and various clinical scoring are...
BACKGROUND
Appendicitis is the most common surgical emergency encountered in the emergency department, and diagnosis is difficult at times. Imaging and various clinical scoring are present to aid in the diagnosis. Ultrasound is an easily accessible modality and can accomplish more than a computed tomography (CT) scan at times. Modified Alvarado score (MAS) includes parameters that do not pose an extra financial burden to the patient. Combining both the imaging and clinical scoring systems, the authors decided to evaluate the combined MAS for the diagnosis of acute appendicitis.
METHODS
This is a prospective analytical study conducted in a tertiary hospital for one and a half years. Fifty-five patients with right lower quadrant pain were enroled, and evaluated along with an ultrasound. MAS and combined MAS were obtained, and the results of the histopathological examination were compared.
RESULTS
Out of 55 clinically diagnosed cases who underwent an emergency appendectomy, 27 were males and 28 were females. Of these, 50 cases had acute appendicitis as per histopathological examination. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the MAS was 42%, 100%, 100%, 20.8%, 47.27%, respectively. The sensitivity, specificity, PPV, NPV and accuracy of the USG were 84%, 40%, 93.3%, 20%, and 80%, respectively. Combining both the scores, the Combined MAS had the sensitivity, specificity, PPV, NPV, and accuracy of 98.18%, 0%, 90.7%, 0%, and 89.09%, respectively.
CONCLUSION
As the combination of USG has raised the sensitivity and diagnostic accuracy of the MAS, it can be an alternative to CT/MRI imaging for the diagnosis of acute appendicitis in resource-limited settings. This score requires further studies to validate with a larger sample size.
PubMed: 38694336
DOI: 10.1097/MS9.0000000000001932 -
Archives of Iranian Medicine May 2024Acute appendicitis is known as the most common diagnosis of acute abdomen leading to surgery. Therefore, timely diagnosis is of special importance. This study was...
BACKGROUND
Acute appendicitis is known as the most common diagnosis of acute abdomen leading to surgery. Therefore, timely diagnosis is of special importance. This study was conducted with the aim of pathological assessment of the appendix in appendectomies performed in children to determine the rate of negative appendectomies and the predictors of negative appendectomy and to evaluate the paraclinical tools used in the diagnosis of acute appendicitis.
METHODS
This is a cross-sectional descriptive study. All children who underwent appendectomy at Shahid Motahari Hospital in Urmia from March 2021 to March 2022 were examined. The required data including demographic, paraclinical, and final pathology characteristics were collected and recorded. The investigated cases were classified into positive and negative appendectomy categories for comparison.
RESULTS
Among 234 pathology samples of the appendix, 22 cases were related to accidental appendectomy. In addition, 11.3% of cases were negative appendectomy and 88.7% were positive appendectomy. The age range of 8 to 14 years and male gender were associated with a lower negative appendectomy rate (both <0.001). Inflammatory (49.5%) and gangrenous appendicitis (30.2%) were the most commonly reported histopathologies. Sonography had a sensitivity of 84%, a specificity of 79%, and an overall diagnostic accuracy of 83%.
CONCLUSION
A relatively significant number of accidental and negative appendectomies are performed. More careful investigation and the use of expectant and medical treatment instead of surgery, especially in females and young children, can be effective in improving diagnostic accuracy and preventing negative appendectomies.
Topics: Humans; Appendectomy; Child; Female; Appendicitis; Male; Cross-Sectional Studies; Adolescent; Appendix; Child, Preschool; Ultrasonography; Iran; Sensitivity and Specificity
PubMed: 38690793
DOI: 10.34172/aim.2024.38 -
International Journal of Surgery Case... Jun 2024Appendiceal tumors are rare neoplasms detected in about 2 % of appendicectomies. The clinical presentation is often unspecific, varying from unspecific abdominal pain...
INTRODUCTION
Appendiceal tumors are rare neoplasms detected in about 2 % of appendicectomies. The clinical presentation is often unspecific, varying from unspecific abdominal pain or presenting as an acute appendicitis or being asymptomatic.
CASE PRESENTATION
We present a case of a patient presenting as an acute appendicitis with a mucocele, and then classified as HAMN. The patient was treated with initial laparoscopic approach and then conversion in laparotomy with appendectomy. Histology demonstrated a high grade appendiceal mucinous neoplasm limited to submucosa (pT3), with concomitant acute phlegmonous appendicitis. The patient was subsequently sent to a referral center where a right hemicolectomy with HIPEC was performed.
DISCUSSION
HAMN is a rare entity, only recently classified as a new kind of appendiceal mucinous neoplasm. Due to the supposed higher aggressivity, HAMN must be treated as an appendiceal adenocarcinoma. The treatment of this rare entity is not yet well standardized, because of the rarity of this disease.
CONCLUSION
HAMN is a very rare tumor. In the emergency setting, it is mandatory to avoid rupture of the appendix, to minimize the risk of developing pseudomyxoma peritonei. Pathology is essential for further decisions in these patients and plays a very important role in treatment and prognosis.
PubMed: 38688155
DOI: 10.1016/j.ijscr.2024.109716 -
Revista Espanola de Enfermedades... Apr 2024Endoscopic transcecal appendectomy has become an alternative treatment for laparoscopic appendectomy due to its less invasive nature. Here we report a rare complication...
Endoscopic transcecal appendectomy has become an alternative treatment for laparoscopic appendectomy due to its less invasive nature. Here we report a rare complication of small intestinal obstruction after endoscopic transcecal appendectomy.
PubMed: 38685903
DOI: 10.17235/reed.2024.10474/2024 -
Langenbeck's Archives of Surgery Apr 2024Endometriosis is a common condition affecting 5 to 10% of women of childbearing age. The true incidence of endometriosis of the appendix is currently unknown. Since...
INTRODUCTION
Endometriosis is a common condition affecting 5 to 10% of women of childbearing age. The true incidence of endometriosis of the appendix is currently unknown. Since symptoms often overlap with those of acute appendicitis, endometriosis of the appendix presents a diagnostic challenge in the emergency department. This large retrospective study investigates the incidence and perioperative clinical, radiologic, and laboratory findings, as well as possible differences between patients with and without endometriosis.
METHODS
Data from consecutive patients who underwent appendectomy for suspected appendicitis without a history of endometriosis were analyzed. Perioperative clinical, laboratory, perioperative, and histopathologic findings were compared between women with and without endometriosis.
RESULTS
Between January 2008 and June 2023, 2484 consecutive patients without a history of endometriosis underwent urgent appendectomy for suspected appendicitis. Endometriosis was detected on histopathologic examination in 17 (0.7%) patients. Signs of appendicitis were found less frequently on ultrasound in the endometriosis group compared to the non-endometriosis group (23.4% vs. 61.5%; p = 0.002; OR = 0.193; 95% CI 0.063-0.593). There were no differences in physical examination findings, duration of symptoms, degree of inflammation, surgical outcomes, or complication rates.
CONCLUSION
The incidence of endometriosis of the appendix in patients undergoing appendectomy for suspected appendicitis was higher than suggested by data from autopsy series and populations with biopsy-proven endometriosis. Patients with endometriosis of the appendix were less likely to have a positive ultrasound finding, but perioperative and histopathologic findings and severity of inflammation did not differ from patients without endometriosis, presenting diagnostic challenges for clinicians.
Topics: Humans; Female; Endometriosis; Appendicitis; Appendectomy; Retrospective Studies; Adult; Incidence; Middle Aged; Young Adult; Adolescent
PubMed: 38684518
DOI: 10.1007/s00423-024-03328-6 -
Cureus Mar 2024Acute appendicitis (AA) is one of the most frequent surgical emergencies, especially in pediatric populations, with its misdiagnosis in emergency settings presenting... (Review)
Review
Acute appendicitis (AA) is one of the most frequent surgical emergencies, especially in pediatric populations, with its misdiagnosis in emergency settings presenting significant health risks. This misdiagnosis leads to various complications, such as delayed treatment or unnecessary surgeries. Factors such as age, gender, and comorbidities contribute to diagnostic errors, leading to complications such as peritonitis and increased negative appendectomy rates. This underscores the importance of accurate clinical assessment and awareness of common pitfalls, such as cognitive biases and over-reliance on laboratory tests. This review delves into the prevalence of AA misdiagnosis, its health burden, and the challenges inherent in the diagnostic process. It scrutinizes the effectiveness of different diagnostic approaches, including clinical assessment and imaging techniques. The treatment paradigms for AA are also explored, focusing on surgical interventions and the potential of conservative treatments using antibiotics. The review underscores the criticality of precise diagnosis in preventing adverse outcomes and ensuring effective treatment.
PubMed: 38681367
DOI: 10.7759/cureus.57141 -
Cureus Mar 2024A 52-year-old male presented to the emergency room with acute abdominal pain. Imaging determined acute appendicitis, with an incidental finding of a renal mass. The...
A 52-year-old male presented to the emergency room with acute abdominal pain. Imaging determined acute appendicitis, with an incidental finding of a renal mass. The biopsy was positive for renal cell carcinoma, and the patient underwent simultaneous appendectomy and nephrectomy. Postoperatively, the patient developed hypoxia at night with exertion, requiring oxygen supplementation. The remainder of his vital signs were stable. Due to renal function, a ventilation/perfusion (V/Q) scan was conducted, which showed a high probability of pulmonary embolism (PE). Follow-up computed tomography angiography of the chest showed a massive saddle embolism. Interventional radiology performed an uncomplicated thrombectomy, oxygen saturations improved, and the patient was discharged on apixaban.
PubMed: 38681266
DOI: 10.7759/cureus.57215