-
Sisli Etfal Hastanesi Tip Bulteni 2024Granulomatous appendicitis (GA) is granulomatous inflammation of the appendix wall. It is generally idiopathic; however, it may also be associated with many diseases...
Granulomatous appendicitis (GA) is granulomatous inflammation of the appendix wall. It is generally idiopathic; however, it may also be associated with many diseases such as Crohn's disease, parasitic infections, tuberculosis, or foreign bodies. An 11-year-old male patient, with a 3-month history of abdominal pain and bilious vomiting, had right lower quadrant abdominal tenderness. His white blood cell count was 8.6 x10/µL. An abdomen ultrasound was considered to show plastron appendicitis and an appendectomy was performed. Microscopically, thickening of the appendix wall with edema, fibrosis and lymphoid infiltration was observed. The patient was evaluated as idiopathic GA since no disease was detected that caused GA. When the appendix has a firm consistency and is difficult to separate from the surrounding tissues, GA should be considered before malignancy, particularly in the pediatric age group. An appendectomy should be performed before deciding on radical surgery.
PubMed: 38808059
DOI: 10.14744/SEMB.2023.03780 -
BMC Surgery May 2024The emergence of the COVID-19 pandemic in December 2019 initiated a global transformation in healthcare practices, particularly with respect to hospital management. PCR...
BACKGROUND
The emergence of the COVID-19 pandemic in December 2019 initiated a global transformation in healthcare practices, particularly with respect to hospital management. PCR testing mandates for medical treatment seekers were introduced to mitigate virus transmission.
AIMS
This study examines the impact of these changes on the management of patients with appendicitis.
METHODS
We conducted a retrospective analysis of medical records for 748 patients diagnosed with appendicitis who underwent surgery at a tertiary care hospital during two distinct periods, the pre-pandemic year 2019 and the post-pandemic year 2021. Patient demographics, clinical characteristics, laboratory data, surgical outcomes, and hospital stay duration were assessed.
RESULTS
While no significant differences were observed in the general characteristics of patients between the two groups, the time from hospital visit to operation increased significantly during the pandemic. Unexpectedly, delayed surgical intervention was associated with shorter hospital stays but did not directly impact complication rates. There was no discernible variation in the type of surgery or surgical timing based on symptom onset. The pandemic also prompted an increase in appendicitis cases, potentially related to coronavirus protein expression within the appendix.
CONCLUSIONS
The COVID-19 pandemic has reshaped the landscape of appendicitis management. This study underscores the complex interplay of factors, including changes in hospital protocols, patient concerns, and surgical timing. Further research is needed to explore the potential link between COVID-19 and appendicitis. These insights are valuable for informing healthcare practices during and beyond the pandemic.
Topics: Humans; Appendicitis; COVID-19; Retrospective Studies; Male; Female; China; Adult; Appendectomy; Middle Aged; Length of Stay; Time-to-Treatment; Pandemics; SARS-CoV-2; Young Adult; Aged
PubMed: 38807152
DOI: 10.1186/s12893-024-02466-4 -
Asian Journal of Surgery May 2024
PubMed: 38806357
DOI: 10.1016/j.asjsur.2024.05.060 -
Heliyon May 2024Common complications following laparoscopic appendectomy include wound infection, bleeding, intra-abdominal abscess, small bowel obstruction, stump leakage, and stump...
Common complications following laparoscopic appendectomy include wound infection, bleeding, intra-abdominal abscess, small bowel obstruction, stump leakage, and stump appendicitis. Here, we presented a case reporting detailing a rare complication following laparoscopic appendectomy: the development of a metastatic neck abscess induced by . A 49-year-old male underwent emergency laparoscopic surgery with prophylactic antibiotic administration for acute appendicitis. Subsequently, he experienced persistent neck pain and fever postoperatively, prompting further investigation. Pus and blood cultures revealed , with magnetic resonance imaging confirming the presence of a neck abscess. Antibiotic therapy was adjusted, and surgical drainage of the abscess was performed after multidisciplinary consultation. The patient was discharged without complications. While rare, metastatic abscesses following appendectomy warrant consideration, particularly in infections. Comprehensive clinical assessment, imaging, and laboratory evaluation are crucial for timely diagnosis and management of such complications.
PubMed: 38803894
DOI: 10.1016/j.heliyon.2024.e31062 -
Cureus Apr 2024Appendiceal signet ring cell carcinoma is an exceedingly rare neoplasm which makes up only 4% of carcinomas of the appendix. It is a rare cause of abdominal pain which...
Appendiceal signet ring cell carcinoma is an exceedingly rare neoplasm which makes up only 4% of carcinomas of the appendix. It is a rare cause of abdominal pain which can mimic acute appendicitis. This case reports a 77-year-old female who presented to the emergency room with a complaint of right lower quadrant abdominal pain. After exploratory laparoscopy and histopathological studies, the patient was found to have peritoneal carcinomatosis and appendiceal signet ring cell carcinoma. This diagnosis unfortunately carries a relatively poor prognosis due to its aggressive nature. This study discusses the etiology, prevalence, clinical findings, and treatment of a rare cause of abdominal pain. This report sheds light on the importance of early detection and treatment of appendiceal signet ring cell carcinoma.
PubMed: 38803764
DOI: 10.7759/cureus.59137 -
Frontiers in Pediatrics 2024Acute appendicitis secondary to parasitic infections is uncommon, being detected in less than 1% of cases. Balantidium coli is a parasite found in pigs and primates with...
INTRODUCTION
Acute appendicitis secondary to parasitic infections is uncommon, being detected in less than 1% of cases. Balantidium coli is a parasite found in pigs and primates with zoonotic potential. To date, only three cases of acute appendicitis induced by this parasite have been documented globally.
CASE
A 7-year-old female patient, who consumed pork daily, presented to the emergency department with a one-day history of abdominal pain in the lower quadrants, described as colic-like, alongside abdominal distension. Initial abdominal radiography led to a diagnosis of intestinal obstruction. Conservative management without therapeutic response necessitated referral to a higher complexity center. Upon admission, an abdominal computed tomography scan diagnosed acute appendicitis and secondary ileus. During surgical intervention, an appendiceal phlegmon formed by loops of the small intestine was mechanically released, revealing a perforated appendix with extensive fecal peritoneal contamination. Pathological analysis identified an inflammatory infiltrate and the presence of Balantidium coli trophozoites. Medical treatment included Piperacillin-Tazobactam and Metronidazole. The patient was discharged after 10 days of medical treatment.
DISCUSSION
Acute appendicitis caused by Balantidium coli is a rare occurrence. It is crucial to identify parasites in pathological samples due to their impact on postoperative management. The close contact between humans and pigs, especially in developing countries, suggests that the prevalence of parasitic infection and colonization by Balantidium coli may be higher than currently recognized. Regarding the identification of this patient's specific exposure, the regular consumption of pork suggests the hypothesis that improper processing is linked to the acquisition of the parasitic infection.
PubMed: 38803639
DOI: 10.3389/fped.2024.1410850 -
Journal of Surgical Case Reports May 2024This report describes a rare instance of bacteremia secondary to acute appendicitis in a young man. Initially presenting with symptoms typical of appendicitis, he was...
This report describes a rare instance of bacteremia secondary to acute appendicitis in a young man. Initially presenting with symptoms typical of appendicitis, he was diagnosed through clinical examination, laboratory tests, and computed tomography imaging, which confirmed an inflamed appendix with sealed perforation and abscess. , a Gram-negative anaerobe commonly found in the human gut, was identified as the causative agent through blood culture. The patient underwent successful laparoscopic appendectomy and was treated with intravenous amoxicillin-clavulanate, leading to a full recovery. This case highlights the potential of to act as an opportunistic pathogen in the context of intra-abdominal inflammation. It underscores the diagnostic challenges posed by , and the efficacy of advanced diagnostic tools like matrix-assisted laser desorption/ionization-time of flight mass spectrometry in identifying such rare infections.
PubMed: 38800504
DOI: 10.1093/jscr/rjae328 -
Journal of Clinical Medicine May 2024: Many scoring systems, algorithms, and guidelines have been developed to aid in the evaluation and diagnosis of acute appendicitis (AA). Many of these algorithms...
: Many scoring systems, algorithms, and guidelines have been developed to aid in the evaluation and diagnosis of acute appendicitis (AA). Many of these algorithms advocate against the routine use of radiological investigations when there is a high clinical suspicion of AA. However, there has been a significant rise in the use of imaging techniques for diagnosing AA in the past two decades. This is a national study aimed at assessing the adherence of residents assigned to the emergency department to the clinical guidelines for diagnosing AA. : We introduced a case study of a male patient with highly suspicious clinical findings of AA to all surgical and emergency medicine residents assigned to the emergency department with the autonomy to make critical decisions to determine the preferred way of diagnosing AA. : A total of 62.4% of all relevant residents participated in this survey; 69.6% reported that the Alvarado score was eight or higher, and 82.1% estimated that the next step recommended by most clinical guidelines was appendectomy without further abdominal imaging tests. However, 83.4% chose to perform an imaging test to establish the diagnosis of AA. : Our study revealed a notable non-adherence to clinical guidelines in diagnosing AA. Given the significance of these guidelines, we assert that adopting medical recommendations should not solely depend on individual education but should also be incorporated as a departmental policy.
PubMed: 38792404
DOI: 10.3390/jcm13102862 -
International Journal of Surgery Case... Jun 2024Abdominal pregnancy is an extremely rare form of ectopic gestation, and it presents with pelvic pain, severe bleeding, or remain asymptomatic. Its Risk factors include...
INTRODUCTION
Abdominal pregnancy is an extremely rare form of ectopic gestation, and it presents with pelvic pain, severe bleeding, or remain asymptomatic. Its Risk factors include previous ectopic pregnancies, cesarean section, smoking, pelvic inflammatory disease, using intrauterine devices (IUD), and assisted reproductive techniques (ARTs). Accurate diagnosis of rectal ectopic pregnancy remains challenging due to the lack of well-established diagnostic criteria.
CASE PRESENTATION
A 25-year-old woman presented to the emergency department with a 2-day history of unresponsive lower abdominal pain and nausea. Ultrasound imaging revealed a normal-sized uterus with endometrial thickness, fluids, and clots in the abdominal cavity, but no intrauterine gestational sac was detected. Based on the clinical presentation, ectopic pregnancy was suspected. During laparotomy, the placenta and fetal tissue remnants were found on the anterior wall of the upper third of the rectum.
DISCUSSION
Abdominal ectopic pregnancy is a high-risk condition that can manifest with gastrointestinal symptoms such as nausea, vomiting, constipation, as well as abdominal and pelvic pain. These variable symptoms underscore the importance of considering rectal ectopic pregnancy as a differential diagnosis and ruling it out to prevent life-threatening complications, including severe bleeding.
CONCLUSION
Due to its rarity, diverse presentation, and similarity to other conditions, diagnosing rectal ectopic pregnancy and determining the appropriate management can be challenging. Physicians should be aware of this specific type of ectopic pregnancy to enable early-stage diagnosis and provide optimal care.
PubMed: 38788636
DOI: 10.1016/j.ijscr.2024.109798 -
Ethiopian Journal of Health Sciences Jul 2023Acute appendicitis is a common cause of hospital admission and emergency laparotomy among children and young adults. Although the diagnosis is clinical, the use of... (Observational Study)
Observational Study
BACKGROUND
Acute appendicitis is a common cause of hospital admission and emergency laparotomy among children and young adults. Although the diagnosis is clinical, the use of radiological imaging has emerged over the past decades. Its principal use is as a problem-solving tool in equivocal cases. Owing to the increased use of imaging in the last few years, the negative appendicectomy rate has dropped significantly. In this prospective observational study, we compared the diagnostic accuracy of Ultrasonography and Non-Contrast Computed Tomography.
METHOD
One hundred and eighteen patients with clinically suspected appendicitis followed a designed protocol. Patients underwent appendicectomy after a first performed positive ultrasonography or after a positive Non-Contrast Computed Tomography when Ultrasonography was equivocal or nonspecific. When any other diagnosis was apparent in either imaging modality which could explain the symptomatology in the patient, they were considered negative for acute appendicitis and treated accordingly.
RESULTS
The respective sensitivity, specificity, and accuracy for Ultrasonography, Non-Contrast Computed Tomography, and the whole diagnostic pathway for the diagnosis of acute appendicitis were 70.73%,80.83%, and 78.54; 100%,100%,100%, and 83.6%; and 100%,83.33% and 94.92%.
CONCLUSION
Using Ultrasonography as the first-line diagnostic tool and Non-Contrast Computed Tomography as a complementary second-line diagnostic tool, appendicitis can be diagnosed with high accuracy and the negative laparotomy rate can be brought down significantly without any increase in the risk of complications. Computed Tomography is superior to Ultrasonography for the diagnosis of acute appendicitis.
Topics: Humans; Appendicitis; India; Female; Tertiary Care Centers; Male; Ultrasonography; Prospective Studies; Tomography, X-Ray Computed; Adult; Adolescent; Young Adult; Appendectomy; Sensitivity and Specificity; Child; Acute Disease; Middle Aged
PubMed: 38784213
DOI: 10.4314/ejhs.v33i4.14