scholarly journals EP.WE.641Spectrum of Right Iliac Fossa Pain Presentation and Management During the First COVID-19 Lockdown: A Single Institution Experience

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Ahmed Salman Bodla ◽  
Chinedu Ndegbu
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Imaging ◽  
Imaging Modality ◽  
Iliac Fossa ◽  
Management Approach ◽  
Conservative Approach ◽  
Diagnosis Rate ◽  
Right Iliac Fossa Pain ◽  
Management Approaches ◽  
Surgical Unit

Abstract Aims Acute surgical presentations and management approaches have witnessed a changing pattern occasioned by COVID-19 pandemic and attendant lockdown. We report the spectrum of right iliac fossa (RIF) pain referrals and management trend within an acute surgical unit before and during the National lockdown. Methods A retrospective review of all patients referred to the acute surgical unit with RIF pain before and during first National lockdown was undertaken. Patients managed during these periods were segregated into Pre-Lockdown (January-2020) and Lockdown (April/May-2020) cohorts. Relevant data were obtained from patients’ electronic medical records and main outcome measures compared between both arms were definitive diagnosis, rate of acute appendicitis, diagnostic imaging modality utilised, management approach and post-operative 30-day complications. Results RIF pain referrals were fewer (17% vs. 23%, P = 0.045) but more likely to be related to acute appendicitis during the lockdown (52% vs. 28%, P = 0.002). However, the risk of presenting with complicated appendicitis did not alter significantly (26% vs. 19%, RR = 1.34, P = 0.56). Diagnostic imaging was increasingly deployed (for RIF pain: 91% vs. 74%, P = 0.07; for appendicitis: 77% vs. 42%, P = 0.007) especially computerised tomography scan (45% vs. 31%). Increased adoption of conservative approach in the management of acute appendicitis was significant (61% vs 23%, RR 2.65, P = 0.01) although other outcomes such as length of stay, post-operative complication and 30-day re-presentation rates were comparable to pre-lockdown phase. Conclusion Fewer RIF pain but more likelihood of acute appendicitis, increased use of radiological imaging and conservative approach to management reflect an evolving pattern during the lockdown phase.

scholarly journals Comparison of clinical examination and ultrasonography in the diagnosis of acute appendicitis

2012 ◽  
Vol 7 (2) ◽  
pp. 34-40
Author(s):  
PK Chhetri ◽  
A Tayal ◽  
PK Deka
Keyword(s):  
Acute Appendicitis ◽  
Clinical Examination ◽  
Histopathological Examination ◽  
Imaging Modality ◽  
Iliac Fossa ◽  
Clinical Impression ◽  
Medical Sciences ◽  
Right Iliac Fossa Pain ◽  
Diagnostic Work ◽  
Work Up

This study was undertaken to compare clinical examination and ultrasonography (USG) in the diagnosis of acute appendicitis and to establish their accuracy in the diagnosis of acute appendicitis. 100 patients who presented to the emergency department with a clinical diagnosis of acute appendicitis were subjected to USG. After USG a specific diagnosis was made. Patients underwent appendicectomy on the basis of the surgeon‘s final clinical impression after correlating with USG findings. Histopathological examination of the appendicectomy specimen was taken as the gold standard for the diagnosis of acute appendicitis. Appendicectomy was performed in 74 patients. Out of these 74 cases, only 66 had appendicitis on histopathological examination. Eight normal appendixes were removed. Twenty-six patients were prevented from surgery after USG had shown an alternative diagnosis for the cause of pain in right iliac fossa. Clinical examination thus had a sensitivity and Positive Predictive Value (PPV) of 66%. USG examination made a preoperative diagnosis of acute appendicitis in 62 of the 66 patients. However the remaining 4 cases with appendicitis were missed by USG. USG had a sensitivity of 93.93%, specificity of 100%, PPV of 100%, NPV of 89.47% and an overall accuracy of 96% in the diagnosis of acute appendicitis. USG is thus a sensitive and specific imaging modality in the diagnostic work up of patients with right iliac fossa pain. USG may improve the diagnostic accuracy in patients with suspected acute appendicitis.Journal of College of Medical Sciences-Nepal, 2011, Vol-7, No-2, 34-40DOI: http://dx.doi.org/10.3126/jcmsn.v7i2.6678

scholarly journals Role of C-Reactive Protein, White Blood Cell Counts, Bilirubin Levels, and Imaging in the Diagnosis of Acute Appendicitis as a Cause of Right Iliac Fossa Pain

Cureus ◽  
2018 ◽  
Author(s):  
Shetty Sushruth ◽  
Chellappa Vijayakumar ◽  
Krishnamachari Srinivasan ◽  
Nagarajan Raj Kumar ◽  
Gopal Balasubramaniyan ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Blood Cell ◽  
Iliac Fossa ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Cell Counts ◽  
Blood Cell Counts ◽  
Right Iliac Fossa Pain ◽  
White Blood Cell Counts

Appendicoliths: the neglected stones

2017 ◽  
Vol 4 (1) ◽  
pp. 3-6
Author(s):  
Saroj Dhital ◽  
Udaya Koirala ◽  
Birendra Dhoj Joshi ◽  
Amit Mani Upadhyaya ◽  
Arbin Joshi
Keyword(s):  
Acute Appendicitis ◽  
Iliac Fossa ◽  
Vermiform Appendix ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Recurrent Appendicitis ◽  
Right Iliac Fossa Pain

Introductions: Cases of colic of the vermiform appendix have been rarely described or diagnosed. Appendicoliths cause acute appendicitis and appendicular perforation. It is still not clear whether appendicoliths cause appendicular colic in the absence of acute appendicitis. Methods: A cross sectional study that included appendectomy done for recurrent appendicitis or chronic right iliac fossa pain. Histology reports were reviewed. The presence of an appendicolith in the report was noted. Results: Thirty-two cases of recurrent appendicitis and chronic right iliac fossa pain were included. Twenty-four patients (75%) had fecoliths in the histology specimens. Eight patients (25%) who presented with appendicular colic without signs of appendicitis were further evaluated. Conclusions: Majority of patients with chronic or colicky right iliac fossa pain had appendicoliths.

scholarly journals Diagnostic Role of Ultrasonography in Right Iliac Fossa Pathologies

2019 ◽  
Vol 7 (3) ◽  
pp. 382-386
Author(s):  
Mishal Javaid ◽  
Ayesha Tariq ◽  
Hiba Noreen Javaid
Keyword(s):  
Imaging Modality ◽  
Iliac Fossa ◽  
Sampling Technique ◽  
High Volume ◽  
Symptom Duration ◽  
Cross Sectional ◽  
Use Of Resources ◽  
Diagnostic Role ◽  
Right Iliac Fossa Pain

Ultrasound is often the imaging modality of choice in patients with acute right iliac fossa pain.  Right iliac fossa pain remains the commonest clinical dilemma encountered by general surgeons. The management of acute right iliac fossa pain is audited, examining the relationship between symptom duration, use of pre-operative radiological imaging and patient outcome. Objective: To determine the diagnostic role of ultrasonography in Right Iliac Fossa pathologies. Methods: A cross sectional descriptive study was carried out at the Department of Radiology in Sir Ganga Ram Hospital Lahore, Pakistan. Duration of study was from March 2018 to November 2018. 85 patients with Right Iliac Fossa pain selected through convenient sampling technique. Statistical software for social sciences (SPSS version 22.0) is used for the analysis of data. Conclusion: The results in the study reflect findings from high volume emergency surgical departments and patients of pain in right iliac fossa demonstrating that unfocussed abdominal and pelvic ultrasounds are not an appropriate use of resources in patients with Right iliac fossa pain. Int. J. Appl. Sci. Biotechnol. Vol 7(3): 382-386  

scholarly journals ACUTE APPENDICITIS

2016 ◽  
Vol 23 (03) ◽  
pp. 241-245
Author(s):  
Javeria Farid ◽  
Rizwanullah Junaid Bhambhro ◽  
Sohail Soomro
Keyword(s):  
Abdominal Pain ◽  
Postoperative Complications ◽  
Acute Appendicitis ◽  
Epigastric Pain ◽  
Iliac Fossa ◽  
University Hospital ◽  
Cross Sectional ◽  
Clinical Pattern ◽  
Rebound Tenderness ◽  
Right Iliac Fossa Pain

Objectives: To determine the clinical presenting pattern and postoperativecomplications of acute appendicitis. Study design: Observational and cross-sectional study.Setting: Isra university hospital Hyderabad. Period: 7 months. Methodology: All the patientsabove 12 years of age and both genders male/female after diagnosis of acute appendicitishad integrated in the study. Complete clinical pattern and postoperative complications hadrecorded. Results: Symptoms/sign nausea, vomiting, anorexia, rebound tenderness, fever,constipation, diarrhea and leukocytosis were noted with the percentage 98.0%, 65.0%, 95.0%,90.0%, 85.0%, 58.0%, 30.0% and 89.0% respectively. Paraumblical pain was noted in 50.0%of the cases, right iliac fossa pain was in the 99.0%, epigastric pain was seen in 61.0% and theother abdominal pain was noted in the 39.0%. Postoperative complications found in 33.0% ofthe cases and majority was seen wound infection. Conclusion: In the conclusion of this studyclinical features nausea, vomiting, anorexia, rebound tenderness, fever, and leukocytosis wereseen as most common and the most important postoperative complication is infection whichprobably created with the uncompleted sterilization.

scholarly journals A comparative study of RIPASA and Alvarado score for the diagnosis of acute appendicitis

2020 ◽  
Vol 7 (12) ◽  
pp. 4006
Author(s):  
Praveena Suresh ◽  
Rajan Janardhanan ◽  
Deepak Paul
Keyword(s):  
Acute Appendicitis ◽  
Scoring System ◽  
Prospective Observational Study ◽  
Iliac Fossa ◽  
Scoring Systems ◽  
Alvarado Score ◽  
Medical College ◽  
Right Iliac Fossa Pain ◽  
Sensitivity Specificity ◽  
Ripasa Score

Background: Acute appendicitis is a common problem and can be difficult to diagnose at time. There are many scoring systems to predict the diagnosis of acute appendicitis. The most commonly used scoring system is Alvarado scoring system but, it is far from perfect. In this study we compare Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system to Alvarado scoring system in correctly diagnosing acute appendicitis.Methods: This prospective observational study was conducted in the department of general surgery, Sree Gokulam Medical College and Research Foundation. It comprised of 60 consecutive patients who were admitted with suspicion of appendicitis who had right iliac fossa pain. RIPASA and Alvarado scoring was done and compared to histopathology after surgery. Sensitivity, specificity and accuracy was calculated.Results: Majority of the patients were below 30 years of age majority were males 36 (60%). When Alvarado score predicted appendicitis in 31 (51.77%) and RIPASA in 54 (90%). When the RIPASA score was >7.5 the sensitivity was 100%, specificity 67% and accuracy was 95%.Conclusions: RIPASA scoring system is more accurate to diagnose acute appendicitis especially when RIPASA score is >7.5. literatures.

scholarly journals A rare case of Valentino’s syndrome

2018 ◽  
Vol 5 (8) ◽  
pp. 2933
Author(s):  
Mohan C. P. ◽  
Kabalimurthy J. ◽  
Balamurugan E. ◽  
Jayavarmaa R.
Keyword(s):  
Acute Appendicitis ◽  
Rare Case ◽  
Iliac Fossa ◽  
Duodenal Perforation ◽  
Peptic Ulcer Perforation ◽  
Gastric Contents ◽  
Right Iliac Fossa Pain ◽  
The Right ◽  
Clinical Conditions

The pain in the right iliac fossa corresponds with many clinical conditions, most commonly Acute appendicitis. Rarely peptic ulcer perforation presents as pain in the right iliac fossa. This condition is called as Valentino’s syndrome. This is due to the leakage of the gastric contents from the stomach or duodenum during the perforation. This induces peritonitis and sometimes the fluids get collected in the right iliac fossa causing pain, hence mimicking appendicitis. This is the case study of a 17yr old boy with right iliac fossa pain and tenderness, vomiting, fever, all corresponding to acute appendicitis. But on surgical exploration, it was found to be duodenal perforation. Valentino’s syndrome is a very misleading condition which will lead to death if proper evaluation and timely management is not done. This study emphasis the fact that Valentino’s syndrome has to be considered as the differential diagnosis in symptoms suggestive of acute appendicitis.

scholarly journals Role of Graded Compression Ultrasonography in Evaluation of Acute Appendicitis.

2015 ◽  
Vol 12 (2) ◽  
pp. 49-53
Author(s):  
Mukunda Singh Shrestha ◽  
Hom Prasad Pant ◽  
Shiv Bahadur Basnet ◽  
Govinda Bhahadur Khadka ◽  
Rajive Raj Shahi ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
Iliac Fossa ◽  
Clinical Impression ◽  
High Morbidity ◽  
Emergency Setting ◽  
Compression Technique ◽  
Suspected Appendicitis ◽  
Right Iliac Fossa Pain ◽  
Compression Ultrasonography

Introduction: Acute appendicitis is common surgical emergency which can lead to high morbidity and mortalityin absence of timely treatment. Ultrasonography (USG) is commonly used to diagnose appendicitis and excludeother intraabdominal pathology leading to right iliac fossa pain in emergency setting. We aimed to Þ nd out thediagnostic value of graded compression USG in suspected appendicitis cases.Methods: Altogether 107 patients with clinical impression of acute appendicitis were followed. Four caseswere excluded because of other diagnosis established in USG. Appendicitis was diagnosed by standard criteriasof inß ammed appendix by graded compression technique. Informations of 103 cases were recorded in proformawhich was later entered in SPSS and statistical calculations done.Results: Out of 103 cases followed, 93 had appendicitis. Of those, 46 cases only showed inß ammed anddistended appendix, others showed ancillary features only. Males were more affected 61(65.6%) than females.Sensitivity, speciÞ city, positive predictive value, negative predictive value and accuracy of ultrasound indetecting appendicitis were 98.9%,90%,98.9%,90% and 97.1% respectively.Conclusions: Graded compression ultrasonography is good investigation modality in assessement of suspectedacute appendicitis.doi: http://dx.doi.org/10.3126/mjsbh.v12i2.12929

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