scholarly journals 353 AIR Score Based Management of Appendicitis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Carlile
Keyword(s):  
Acute Appendicitis ◽  
Ct Scan ◽  
Acute Abdomen ◽  
General Surgery ◽  
Diagnostic Laparoscopy ◽  
Open Appendicectomy ◽  
Common Cause ◽  
Retrospective Audit ◽  
Negative Appendicectomy ◽  
Score Risk

Abstract Introduction Appendicitis is the most common cause of an acute abdomen. Approximately 7% of the population will be affected at some point. The development of AIR has been developed to aid diagnosis and decreasing the number of negative appendectomies while also safely identifying those who have developed appendicitis. Aim This retrospective audit, which aims to assess the effects of the introduction of AIR score risk on the negative appendicectomy rate of patients admitted to Taranaki Base Hospital. Method All patients under General Surgery receiving open appendicectomy, laparoscopic appendicectomy or diagnostic laparoscopy for evaluation or treatment of appendicitis from January 1st 2017 – December 31st 2018. Results The negative appendicectomy rate dropped 11.1% after introduction of the AIR score, we also noted a decrease in CT scan use. Discussion Our results suggest that the Air score could be used as an adjunct to the clinical diagnosis of acute appendicitis.

scholarly journals A comparison of intra-operative diagnosis to histopathological diagnosis of acute appendicitis in paediatric and adult cohorts: an analysis of over 1000 patients

2021 ◽  
Author(s):  
Johnathon Harris ◽  
Christina A. Fleming ◽  
Paul N. Stassen ◽  
Daniel Mullen ◽  
Helen Mohan ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Histopathological Diagnosis ◽  
Open Appendicectomy ◽  
Normal Appendix ◽  
Macroscopic Appearance ◽  
Surgical Department ◽  
Suspected Appendicitis ◽  
Final Histological Diagnosis ◽  
Negative Appendicectomy ◽  
Operating Surgeon

Abstract Background Appendicitis is a common general surgical emergency. The role of removing a normal appendix is debated. However, this relies on accurate intra-operative diagnosis of a normal appendix by the operating surgeon. This study aimed to compare surgeon’s intra-operative assessment to final histological result acute appendicitis in paediatric and adult patients. Methods All patients who underwent appendicectomy over a 14-year period in a general surgical department were identified using the prospective Lothian Surgical Audit system and pathology reports retrieved to identify final histological diagnosis. Open appendicectomy was selected to examine, as the routine practise at our institution is to remove a normal appendix at open appendicectomy. Results A total of 1035 open appendicectomies were performed for clinically suspected appendicitis. Sensitivity of intra-operative diagnosis of appendicitis with operating surgeon was high at 95.13% with no difference between trainee and consultant surgeon or between adult and paediatric cases. Specificity of intra-operative diagnosis was lower in the paediatric group (32.58%) than in the adult group (40.58%). Women had a higher rate of negative appendicectomy than men. Conclusion The results of this study highlight some discordance between histological evidence of acute appendicitis and intra-operative impression. Therefore other clinical variables and not just macroscopic appearance alone should be used when deciding to perform appendicectomy.

scholarly journals External validation of Tzanakis scoring system in acute appendicitis in a rural hospital

2019 ◽  
Vol 7 (5) ◽  
pp. 1536
Author(s):  
Mohd Riyaz Lattoo ◽  
Shabir Ahmad Mir ◽  
Nayeemul Hassan Ganie ◽  
Shabir Hussain Rather
Keyword(s):  
Retrospective Study ◽  
Acute Appendicitis ◽  
Predictive Value ◽  
Scoring System ◽  
Histopathological Examination ◽  
External Validation ◽  
Scoring Systems ◽  
Common Cause ◽  
Negative Laparotomy ◽  
Negative Appendicectomy

Background: Acute appendicitis is one of the most common cause of acute abdomen surgery. Several scoring systems have been adopted by physicians to aid in the diagnosis and decrease the negative appendicectomy rate. Tzanakis scoring system is one such score. Objective of present study was the validation of this scoring system in our population and compare its accuracy with histopathological examination (HPE).Methods: A retrospective study was carried out at the Department of Surgery at Mohammad Afzal Beigh Memorial Hospital Anantnag India. Tzanakis score was calculated in 288 patients who underwent appendicectomy from September 2016-2018 and HPE results were analysed.Results: 276 patients were eligible for the study. The sensitivity and specificity of Tzanakis score in diagnosing appendicitis was 90.66% and 73.68% respectively. The overall diagnostic accuracy was 86.23% with positive predictive value of 97.89% and negative predictive value of 36.84%.Conclusions: Tzanakis scoring system is an accurate modality in establishing the diagnosis of acute appendicitis and preventing a negative laparotomy.

scholarly journals ACUTE APPENDICITIS;

2014 ◽  
Vol 21 (06) ◽  
pp. 1139-1143
Author(s):  
Zahid Saeed
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Acute Abdomen ◽  
Carcinoid Tumour ◽  
Diagnostic Tools ◽  
Associated Conditions ◽  
Proper Diagnosis ◽  
Negative Appendicectomy ◽  
Appendiceal Inflammation ◽  
Time Of Presentation

Background: Acute appendicitis is the commonest cause of acute abdomen presenting in emergency room, which is mainly diagnosed on clinical grounds. Objective: To determine the diagnostic accuracy in patient of acute appendicitis and to review the pathological diagnosis. Material and Method: A retrospective study was conducted at PNS SHIFA hospital at Karachi; from May 2012 to April 2013. A total of 120 patients were included in the study who presented with acute abdomen and clinically diagnosed as acute appendicitis. Emergency appendectomy was done in all consecutive subjects and intra operative finding along with histo-pathological reports were compared with clinical diagnosis. Results: A total of 120 patients were included in the study who underwent appendicectomy during this period. The majority of our patients were in the age group between 15-30 years (66.5%) and presented within 24 h of onset of symptoms. The most common symptoms were abdominal pain (100%), vomiting (57.4%) and anorexia (49.0%). Pyrexia was noted in 41.0%.Localized abdominal tenderness with positive release sign was mainly present. The most common incision was gridiron (57.2%) followed by Lanz (37.3%) and in remaining Rutherford Morrison incision was made. Acute appendiceal inflammation and gangrenous appendicitis was present in 67% and 13%, respectively. The perforation rate was 5.0% and there was a direct correlation with time of presentation. There were no patients with carcinoid tumour or adenocarcinoma. Parasites and other associated conditions were seen in 3 % of cases. On the basis of histo-pathological report, 84% were found to have acute appendicitis with negative appendicectomy rate of 16.0%. Conclusions: Clinical surgical skill is good enough to diagnose acute appendicitis but auxiliary diagnostic tools can help to elevate the diagnostic accuracy,but these are not 100% accurate and at times may not be available.So clinial good judgement is essential for proper diagnosis and that can be confirmed by histopathology report.

scholarly journals 1185 Acute Paediatric Appendicitis(AA)-Decreasing The Negative Rate Of Appendicectomy

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
G Karagiannidis ◽  
O Toma ◽  
E Mallidis ◽  
F Youssef
Keyword(s):  
Data Collection ◽  
Conservative Treatment ◽  
Observational Study ◽  
Acute Appendicitis ◽  
First Trimester ◽  
Operative Management ◽  
Open Appendicectomy ◽  
Number Of Children ◽  
Negative Rate ◽  
Negative Appendicectomy

Abstract Aim The COVID -19 pandemic has forced changes in the management of Acute Appendicitis (AA), such as prioritising conservative management and avoiding laparoscopic procedures. This observational study aims to monitor and reduce the negative rate of paediatric appendicectomy and optimise the acute paediatric management following the newly introduced workflow. Method Retrospective patient data collection via electronic sources for all paediatric patients(0-16 years old) admitted with AA between March 23rd and October 31st 2020. Results During this period 74 patients were admitted with suspected AA. Conservative treatment was performed in 16 (22%) patients and operative management in 58 (78%), of which 15 (26%) had an open appendicectomy, while 43 (74%) underwent laparoscopic appendicectomy. The first trimester the negative appendicectomy rate was 25%, which dropped to 11% because of the newly introduced paediatric AA workflow and the more extensive use of US in the context of diagnosis of appendicitis.In the beginning of the study, the percentage of US scanning was 72% and was increased to 90% after the end of the 3rd period. Conclusions The introduction of the paediatric AA workflow and the more extensive use of US helped to decrease the percentage of negative rate of paediatric appendicecomy the number of children who underwent unnecessary operation.

scholarly journals The morbidity of negative appendicectomy

2014 ◽  
Vol 96 (7) ◽  
pp. 517-520 ◽  
Author(s):  
M Lee ◽  
T Paavana ◽  
F Mazari ◽  
TR Wilson
Keyword(s):  
Diagnostic Laparoscopy ◽  
District Hospital ◽  
Iliac Fossa ◽  
Complication Rates ◽  
Electronic Patient Records ◽  
Retrospective Audit ◽  
Significant Difference ◽  
Right Iliac Fossa Pain ◽  
Negative Appendicectomy ◽  
Invasive Intervention

Introduction The increased use of diagnostic laparoscopy for management of right iliac fossa pain may have lowered the threshold for removing normal appendices, particularly as there is a perception that this practice carries little additional morbidity. The aim of this retrospective audit was to determine the negative appendicectomy rate after laparoscopic appendicectomy (LA) in our busy district hospital, and to compare the relative incidence and severity of complications after removal of an inflamed or non-inflamed appendix. Methods Adult patients who underwent LA in 2011–2012 were identified from theatre registers. Histology results were reviewed to differentiate between inflamed and normal appendices. Postoperative complications and events following discharge were identified via electronic patient records. Complication severity was stratified using the Clavien–Dindo classification. Results Over 2 years, 467 LAs were performed, of which 143 (30.6%) were for normal appendices. Significantly more negative appendicectomies were performed in women (43%) than in men (17%) (p<0.0001). Complications were seen in 62 patients (13.3%). There was no significant difference between the complication rates for those who had an inflamed (16.6%) or non-inflamed (11.9%) appendix (p=0.141). Similarly, there was no difference in the severity of complications between these groups. Reoperation or invasive intervention was required after four negative appendicectomies (2.8%). Conclusions LA carries a similar morbidity regardless of whether the appendix is inflamed. Negative appendicectomy should not be undertaken routinely during laparoscopy for right iliac fossa pain.

scholarly journals 575 Management of Acute Appendicitis During the COVID-19 Pandemic. Our Experience at The General Surgery Department in Queen Elizabeth Hospital, London

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Chatzikonstantinou ◽  
A Pouncey ◽  
M l David ◽  
F Aljarad ◽  
P Sorelli
Keyword(s):  
Acute Appendicitis ◽  
General Surgery ◽  
Emergency Services ◽  
Surgical Patients ◽  
Queen Elizabeth Hospital ◽  
Single Centre ◽  
Open Procedure ◽  
Negative Appendicectomy ◽  
Surgery Department ◽  
The Impact

Abstract Introduction The pandemic of CoViD-19 had a major impact on provision of emergency services. National (CoViD-19) Guidelines (NG) were issued by the Colleges of Surgeons for the management of surgical patients. Aim To assess the impact of CoViD-19 in the management of patients with acute appendicitis (AA) and review patients’ characteristics and compliance with NG. Method A single-centre retrospective analysis of prospectively collected data on surgical admissions with suspected AA between March and May 2020. Main outcomes of interest were the pre-operative investigation, the type of operation and the negative appendicectomy rate (NAR) comparing to 2019. Results A total of 109 patients were referred for suspected AA. Out of 39 patients who had surgery 21 (53.8%) were investigated with a CT and 13 (33%) with an ultrasound. There was a 31.6% reduction in appendicectomies compared to 2019. 30 patients (76.9%) had an open procedure vs 9 laparoscopic (23.1%) in alignment with the NG2. Histology showed AA in 37 out of 39 of the cases. The NAR was 5.12 vs 12.2 for 2019. Conclusions There was a 31.6% reduction in appendicectomies during CoViD-19. Most patients were investigated with a CT and underwent an open procedure. Pre-operative investigation with a CT led in reduction of NAR.

Another Look at Acute Appendicitis in Tropical Africa: And the Value of Laparoscopy in Diagnosis

1993 ◽  
Vol 23 (2) ◽  
pp. 82-84 ◽  
Author(s):  
B C Ogbonna ◽  
P O Obekpa ◽  
J T Momoh ◽  
J T Ige ◽  
C H Ihezue
Keyword(s):  
Decision Making ◽  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Acute Abdomen ◽  
Clinical Decision Making ◽  
Acute Abdominal Pain ◽  
Clinical Decision ◽  
Tropical Africa ◽  
Increased Risk ◽  
Negative Appendicectomy

Acute appendicitis is believed to be one of the commonest causes of the acute abdomen in tropical Africa. Negative appendicectomy rates are usually above 20%, which is now considered unacceptably high because of increased risk to patients and the availability of diagnostic facilities to aid clinical decision-making. Our negative appendicectomy rate over a 4-year retrospective period was 29.7% in males, and 47% in females. These reduced to 11 % and 10%, respectively, after the introduction of laparoscopy for doubtful cases of acute abdominal pain.

scholarly journals Torsion of the omentum: A rare cause of acute abdomen.

2021 ◽  
Vol 28 (12) ◽  
pp. 1869-1873
Author(s):  
Sajid Malik ◽  
Gul e Lala ◽  
Abdullah Khan
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Ct Scan ◽  
Acute Abdomen ◽  
Preoperative Diagnosis ◽  
Clinical Signs ◽  
Lower Abdominal Pain ◽  
X Rays ◽  
Omental Torsion ◽  
Operative Recovery

Omental torsion is a rare cause of acute abdominal pain. Diagnosis of omental torsion is usually difficult because clinical signs and symptoms are similar to other common causes of abdominal pain. The most common preoperative diagnosis is acute appendicitis and the proper preoperative diagnosis is important for the appropriate treatment option. Diagnosis of omental torsion is difficult and mainly based on ultrasound and computed tomography (CT) scan analysis. Case Presentation: A 26 years old male patient presented to emergency department with acute abdomen mimicking acute appendicitis. The chest and abdominal X-rays were normal. Due to intense clinical signs and worsening of the symptoms the patient underwent an operation with the probable diagnosis of acute appendicitis. In this case patient explored via gridiron incision, the omentum was found to be gangrenous that had encased the appendix so midline incision given. Post-operative recovery was uneventful. Conclusion: Omental torsion is highly uncommon cause of right lower abdominal pain and difficult to diagnose preoperatively. It presents with non-specific symptoms, mimicking other abdominal conditions presenting a similar clinical settings. CT scan is very helpful in diagnosis. Surgical treatment is the procedure of choice with laparoscopy being the preferable approach. 

Ultrasound of Appendicitis

Ultrasound ◽  
2005 ◽  
Vol 13 (2) ◽  
pp. 78-85 ◽  
Author(s):  
R.P. Guillerman ◽  
C. S. Ng
Keyword(s):  
Acute Appendicitis ◽  
Acute Abdomen ◽  
Ultrasound Imaging ◽  
Surgical Intervention ◽  
Imaging Technique ◽  
Common Cause ◽  
Perforation Peritonitis ◽  
Diagnostic Approaches ◽  
Emergency Surgical Intervention ◽  
Appendiceal Perforation

Acute appendicitis is a common cause for an 'acute abdomen' and is the most common abdominal condition requiring emergency surgical intervention. Misdiagnosis is fraught with morbid complications, ranging from unnecessary surgery to appendiceal perforation, peritonitis or sepsis. In this article, we discuss the application of ultrasound to the diagnosis of appendicitis. We detail the ultrasound imaging technique, including practical tips and pitfalls, describe the sonographic criteria for the diagnosis of appendicitis, discuss the relative strengths and weaknesses of ultrasound compared with other diagnostic approaches, and review the reported performance of ultrasound in the diagnosis of appendicitis.

scholarly journals Omental Infarction with Acute Appendicitis in an Overweight Young Female: A Rare Presentation

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Vishnu R. Mani ◽  
Shantanu Razdan ◽  
Tonny Orach ◽  
Aleksandr Kalabin ◽  
Rinil Patel ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Ct Scan ◽  
Acute Abdomen ◽  
Treatment Options ◽  
Young Female ◽  
Uneventful Recovery ◽  
Rare Presentation ◽  
Omental Infarction ◽  
Obese Female ◽  
Limiting Condition

Omental infarction is an uncommon cause of acute abdomen but one that clinically mimics more serious and common causes of acute abdomen like appendicitis and cholecystitis. Historically, it was diagnosed only intraoperatively during surgery for presumed appendicitis or other causes of acute abdomen. But with the increase in the use of imaging, especially abdominal computed tomography (CT) scan in the work-up for acute abdomen, more cases of omental infarction are being diagnosed preoperatively. This has also led to the observation that omental infarction is a self-limiting condition which can be managed conservatively. Currently, conservative management and surgery are the only treatment options for omental infarction with no consensus as to the best treatment modality. Having a patient with both acute appendicitis and omental infarction simultaneously is extremely rare with only two reported cases in the literature thus far. Here, we present a 10-year-old obese female who presented to our hospital with acute abdomen and was found to have acute appendicitis and omental infarction. The patient underwent laparoscopic appendectomy and resection of the infarcted omentum and had uneventful recovery and was discharged on the second postoperative day. In this report, we present a review of current literature on omental infarction and highlight the importance of imaging especially abdominal CT scan in the nonoperative diagnosis and treatment of omental infarction.

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