EP.FRI.103 Acute Appendicitis in an Amyand Hernia – a case report and literature review

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Manal Ahmad ◽  
Noureen Fazili ◽  
Tou-Pin Chang ◽  
Hashim Abdalla ◽  
Josef Watfah ◽  
...  
Keyword(s):  
Literature Review ◽  
Acute Appendicitis ◽  
Neuroendocrine Tumour ◽  
Imaging Techniques ◽  
White Cell Count ◽  
Reactive Protein ◽  
Inguinoscrotal Hernia ◽  
Mesh Terms ◽  
History Of ◽  
Amyand Hernia

Abstract Introduction An Amyand Hernia (AH) is the presence of an Appendix within an Inguinal Hernia. We present here our clinical management of acute appendicitis in an AH and subsequent literature review. A 73 year old male patient presented with a two day history of right sided irreducible inguinoscrotal hernia with tender swelling on standing and walking. This was not associated with symptoms of bowel obstruction or fevers. Blood investigations revealed a raised C-Reactive Protein of 129m/l and White Cell Count of 15x 10^9/L. A Computed Tomography scan of the Abdomen and Pelvis revealed a right sided inguinoscrotal hernia arising lateral to the inferior epigastric vessels, containing an inflamed appendix and omental fat. The patient underwent an emergency open hernia repair with mesh and, considering that the appendix base was intra-abdominal, also underwent a laparoscopic appendicectomy.  Method We conducted a literature review on Pubmed and Medline using the MeSH terms ‘Amyand Hernia’ AND ‘Appendicitis’ from 1970-2020.   Results We longlisted 179 articles. Of these, 117 were excluded, as they were either paediatric cases, not relevant or mentioned in discussions. Finally, 62 relevant articles were included in the review.  Conclusion Acute Appendicitis in Amyand Hernias has an incidence of 0.07-0.13%. Most cases remain as incidental findings however, increased use of imaging techniques has allowed accurate diagnoses and attempts at classifications. There is also weak association with Situs Inversus and atypical appendiceal tumours including adenocarcinoma, carcinoid and neuroendocrine tumour. Their management varies according to the extent of inflammation, radiological and intraoperative findings.

scholarly journals 827 Acute Appendicitis in An Amyand Hernia – A Case Report and Literature Review

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Ahmad ◽  
N Fazili ◽  
T P Chang ◽  
H Abdalla ◽  
J Watfah ◽  
...  
Keyword(s):  
Literature Review ◽  
Acute Appendicitis ◽  
Neuroendocrine Tumour ◽  
Imaging Techniques ◽  
White Cell Count ◽  
Reactive Protein ◽  
Inguinoscrotal Hernia ◽  
Mesh Terms ◽  
Amyand Hernia ◽  
Operative Findings

Abstract Introduction An Amyand Hernia (AH) is the presence of an Appendix within an Inguinal Hernia. We present here our clinical management of acute appendicitis in an AH and subsequent literature review. A 73-year-old male patient presented with a two-day history of right sided irreducible inguinoscrotal hernia with tender swelling on standing and walking. This was not associated with symptoms of bowel obstruction or fevers. Blood investigations revealed a raised C-Reactive Protein of 129m/l and White Cell Count of 15x10^9/L. A Computed Tomography scan of the Abdomen and Pelvis revealed a right sided inguinoscrotal hernia arising lateral to the inferior epigastric vessels, containing an inflamed appendix and omental fat. The patient underwent an emergency open hernia repair with mesh and, considering that the appendix base was intra-abdominal, also underwent a laparoscopic appendicectomy. Method We conducted a literature review on Pubmed and Medline using the MeSH terms ‘Amyand Hernia’ AND ‘Appendicitis’ from 1970 to 2020. Results We longlisted 179 articles. Of these, 117 were excluded, as they were either paediatric cases, not relevant or mentioned in discussions. Finally, 62 relevant articles were included in the review. Conclusions Acute Appendicitis in Amyand Hernias has an incidence of 0.07-0.13%. Most cases remain as incidental findings however, increased use of imaging techniques has allowed accurate diagnoses and attempts at classifications. There is also weak association with Situs Inversus and atypical appendiceal tumours including adenocarcinoma, carcinoid and neuroendocrine tumour. Their management varies according to the extent of inflammation, radiological and intra-operative findings.

929 Not Another Abscess - A Case of Streptococcal Myositis Misdiagnosed as a Right Axillary Abscess

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
O Oyende ◽  
J Jackman
Keyword(s):  
White Cell Count ◽  
General Surgeon ◽  
High Dose ◽  
General Anaesthetic ◽  
Microbiological Analysis ◽  
Reactive Protein ◽  
Affected Tissue ◽  
Life Threatening ◽  
History Of ◽  
High Degree

Abstract Introduction Streptococcal myositis is a rare form of infectious myositis caused by Lansfield A beta-haemolytic streptococci. It is characterised by rapidly spreading inflammation that can result in severe systemic toxicity and necrosis of the affected tissue if not diagnosed and aggressively treated. Presentation We report a case of a 42-year-old male who presented with a one-week history of worsening right axillary swelling that progressed to painful swelling of his arm. Inflammatory markers were significantly elevated with a white cell count of 17 ×109/L and C-reactive protein of 212 mg/L. On examination, a fluctuant axillary swelling was appreciated, and a decision was made for incision and drainage under general anaesthetic. Intraoperative aspiration of his arm revealed copious purulent fluid prompting intraoperative orthopaedic consult and exploration of the anterior compartment in which there was extensive involvement of the biceps muscle. The microbiological analysis revealed gram-positive cocci in chains, and microbiology advice sought for tailoring of antibiotic regimen. He has recovered well. Discussion Though uncommon, the emergency general surgeon should have a high degree of suspicion when evaluating soft tissue infections to avert potentially disastrous outcomes. Conclusion Early diagnosis, aggressive management with high-dose intravenous antibiotics, and surgical debridement are principles to treat this rare, life-threatening infection.

scholarly journals Predictors of hospital discharge and mortality in patients with diabetes and COVID-19: updated results from the nationwide CORONADO study

Diabetologia ◽  
2021 ◽  
Vol 64 (4) ◽  
pp. 778-794 ◽  
Author(s):  
Matthieu Wargny ◽  
◽  
Louis Potier ◽  
Pierre Gourdy ◽  
Matthieu Pichelin ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Hospital Discharge ◽  
Microvascular Complications ◽  
White Cell Count ◽  
Symptom Duration ◽  
Protein Levels ◽  
Reactive Protein ◽  
Patients With Diabetes ◽  
History Of ◽  
Routine Therapy

Abstract Aims/hypothesis This is an update of the results from the previous report of the CORONADO (Coronavirus SARS-CoV-2 and Diabetes Outcomes) study, which aims to describe the outcomes and prognostic factors in patients with diabetes hospitalised for coronavirus disease-2019 (COVID-19). Methods The CORONADO initiative is a French nationwide multicentre study of patients with diabetes hospitalised for COVID-19 with a 28-day follow-up. The patients were screened after hospital admission from 10 March to 10 April 2020. We mainly focused on hospital discharge and death within 28 days. Results We included 2796 participants: 63.7% men, mean age 69.7 ± 13.2 years, median BMI (25th–75th percentile) 28.4 (25.0–32.4) kg/m2. Microvascular and macrovascular diabetic complications were found in 44.2% and 38.6% of participants, respectively. Within 28 days, 1404 (50.2%; 95% CI 48.3%, 52.1%) were discharged from hospital with a median duration of hospital stay of 9 (5–14) days, while 577 participants died (20.6%; 95% CI 19.2%, 22.2%). In multivariable models, younger age, routine metformin therapy and longer symptom duration on admission were positively associated with discharge. History of microvascular complications, anticoagulant routine therapy, dyspnoea on admission, and higher aspartate aminotransferase, white cell count and C-reactive protein levels were associated with a reduced chance of discharge. Factors associated with death within 28 days mirrored those associated with discharge, and also included routine treatment by insulin and statin as deleterious factors. Conclusions/interpretation In patients with diabetes hospitalised for COVID-19, we established prognostic factors for hospital discharge and death that could help clinicians in this pandemic period. Trial registration Clinicaltrials.gov identifier: NCT04324736 Graphical abstract

scholarly journals The diagnostic value of white cell count, C-reactive protein and bilirubin in acute appendicitis and its complications

2013 ◽  
Vol 95 (3) ◽  
pp. 215-221 ◽  
Author(s):  
I G Panagiotopoulou ◽  
D Parashar ◽  
R Lin ◽  
S Antonowicz ◽  
AD Wells ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Cell Count ◽  
Inflammatory Markers ◽  
White Cell Count ◽  
Perforated Appendicitis ◽  
Diagnostic Value ◽  
White Cell ◽  
C Reactive Protein ◽  
Reactive Protein

Introduction Inflammatory markers such as white cell count (WCC) and C-reactive protein (CRP) and, more recently, bilirubin have been used as adjuncts in the diagnosis of appendicitis. The aim of this study was to determine the diagnostic accuracy of the above markers in acute and perforated appendicitis as well as their value in excluding the condition. Methods A retrospective analysis of 1,169 appendicectomies was performed. Patients were grouped according to histological examination of appendicectomy specimens (normal appendix = NA, acute appendicitis = AA, perforated appendicitis = PA) and preoperative laboratory test results were correlated. Receiver operating characteristic (ROC) curve area analysis (area under the curve [AUC]) was performed to examine diagnostic accuracy. Results ROC analysis of all laboratory variables showed that no independent variable was diagnostic for AA. Good diagnostic accuracy was seen for AA when all variables were combined (WCC/CRP/bilirubin combined AUC: 0.8173). In PA, the median CRP level was significantly higher than that of AA (158mg/l vs 30mg, p<0.0001). CRP also showed the highest sensitivity (100%) and negative predictive value (100%) for PA. CRP had the highest diagnostic accuracy in PA (AUC: 0.9322) and this was increased when it was combined with WCC (AUC: 0.9388). Bilirubin added no diagnostic value in PA. Normal levels of WCC, CRP and bilirubin could not rule out appendicitis. Conclusions CRP provides the highest diagnostic accuracy for PA. Bilirubin did not provide any discriminatory value for AA and its complications. Normal inflammatory markers cannot exclude appendicitis, which remains a clinical diagnosis.

sTREM-1 assessment as a diagnostic biomarker for suspected acute appendicitis in children

2019 ◽  
Author(s):  
Tal Taraboulos Klein ◽  
Elkana Kohn ◽  
Baruch Klin ◽  
Tomer Ziv-Baran ◽  
Eran Kozer ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Complete Blood Count ◽  
Surrogate Marker ◽  
Serum Levels ◽  
Alvarado Score ◽  
Suspected Appendicitis ◽  
Reactive Protein ◽  
Significant Difference ◽  
History Of ◽  
Suspected Acute Appendicitis

Abstract Background The typical history of acute appendicitis is observed in less than 60% of cases. Therefore, searching for a surrogate marker is mandatory. Our goal was to determine whether the soluble triggering receptor expressed on myeloid cells (sTREM-1) is an efficient biomarker for acute appendicitis. Methods sTREM-1 serum levels were measured in addition to carrying out routine diagnostic tests (urine dipstick, complete blood count and C- reactive protein) in children admitted to the Emergency Department with suspected appendicitis. Statistical analysis was performed in order to examine whether sTREM-1 was a significant predictor of appendicitis. Results Fifty three of 134 children enrolled in the study were diagnosed with appendicitis. There was no significant difference in serum sTREM-1 levels (p=0.111) between children with or without appendicitis. Leukocytes, neutrophils and CRP were significantly elevated in the appendicitis group (p<0.001). The appendix diameter was significantly larger and the Alvarado score significantly higher in the appendicitis group (p<0.001). Conclusion serum sTREM-1 is not a good marker for acute appendicitis. Customary tests in addition to a proper patient history and physical examination are still the most effective methods to diagnose acute appendicitis.

Adolescent with abdominal pain poorly responsive to analgesia

2020 ◽  
pp. edpract-2020-320772
Author(s):  
Neil Chanchlani ◽  
Philip Jarvis ◽  
James W Hart ◽  
Christine H McMillan ◽  
Christopher R Moudiotis
Keyword(s):  
Abdominal Pain ◽  
Ct Scan ◽  
White Cell Count ◽  
Autism Spectrum ◽  
Free Fluid ◽  
List Type ◽  
Reactive Protein ◽  
Normal Limits ◽  
History Of ◽  
Normal Gallbladder

Case presentationA 14-year-old boy, with autism spectrum disorder, presented with a 1-day history of colicky abdominal pain, non-bilious vomiting, anorexia and loose normal-coloured stool. Two days previously, he had a poorly reheated takeaway chicken.On examination, body mass index (BMI) was >99th centile. He had inconsistent epigastric, periumbilical and umbilical tenderness, and guarding, with normal bowel sounds. Observations were within normal limits, but his pain was poorly responsive to paracetamol, ibuprofen, hyoscine butylbromide, codeine and morphine.Investigations are in table 1. On day 3, his temperature increased to 38.5° and a CT scan was performed, which showed concerning features (figure 1).Table 1Serology and further investigations throughout admissionDay 1Day 2Day 3Day 4Serology White cell count (3.8–10.6×109/L)7.514.615.713.6 Neutrophils (1.8–8.0×109/L)5.312.312.85.3 C reactive protein (<5 mg/L)12010398 Bilirubin (0–21 μmol/L)812Further investigations Urine dipstickNegative UltrasoundSmall volume of free fluid, normal gallbladder, pancreas and appendix not visualisedFigure 1CT scan of the abdomen (A) and pelvis (B).QuestionsWhat is the diagnosis?Appendicitis.Pancreatitis.Cholecystitis.Gastroenteritis.Which serology would have been most helpful at presentation?Renal function.Coagulation.Amylase and lipase.Gamma glutamyltransferase.What are the acute treatment principles?What is the the most common cause?Idiopathic.Gallstones.Medications.Genetic.Answers can be found on page 2.

A toddler with a persisting limp after a minor trauma

2019 ◽  
pp. edpract-2019-317506
Author(s):  
Andrea Trombetta ◽  
Ester Conversano ◽  
Giorgio Cozzi ◽  
Andrea Taddio ◽  
Flora Maria Murru ◽  
...  
Keyword(s):  
White Cell Count ◽  
Surgical Excision ◽  
List Type ◽  
Minor Trauma ◽  
Normal Value ◽  
Reactive Protein ◽  
Oral Ibuprofen ◽  
History Of ◽  
Wait And See ◽  
A Minor

A 3-year-old toddler was admitted for a 5-day history of worsening painful limping on his left leg. History was remarkable only for a minor trauma 2 days before the onset of symptoms; the boy fell on his buttocks but was walking normally in the following days. No fever was reported. Pain was also present at night, with no response to oral ibuprofen.On physical examination, the patient refused to stand on his left leg, palpation of the left buttock evoked pain, and exorotation and abduction of the left hip were only moderately limited, without local signs of inflammation such as redness, swelling or skin warming. Blood tests showed elevated erythrocyte sedimentation rate (ESR) (98 mm/hour, normal value <20 mm/hour) with normal C reactive protein (CRP) level (0.5 mg/dL, normal value <0.5 mg/dL). His white cell count was 12 110 x 109/L, haemoglobin was 127 g/L and PLT was 430 x 109/L. Creatine kinase values were within the normal range.An X-ray of the pelvis was unremarkable. An ultrasound of the left hip showed a 2 mm articular effusion.QuestionsBased on the clinical picture and laboratory tests, what is the most likely diagnosis?Perthes disease.Pyomyositis.Septic arthritis.Bone fracture.Leukaemia.What test could confirm the diagnosis?Bone scintigraphy.CT.Bone marrow aspirate.MRI.Intra-articular puncture.What is the mainstay of management of this condition?Wait and see.Surgical excision.Antibiotic course.Antineoplastic treatment.Answers can be found on page 2.

scholarly journals AMYAND HERNIA: A RARE SURGICAL VARIATION

2021 ◽  
Vol 71 (1) ◽  
pp. 367-69
Author(s):  
Ghufran Ahmed ◽  
Imran Ashraf ◽  
Muhammad Ali Muazzam ◽  
Muhammad Shoaib ◽  
Muhammad Farooq Shahid ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Acute Appendicitis ◽  
Clinical Presentation ◽  
Inguinal Canal ◽  
Amyand’S Hernia ◽  
Inguinoscrotal Hernia ◽  
Amyand Hernia

Amyand’s hernia is an inguinal hernia with trapped appendix; its frequency is approximately 1%. Acute appendicitis is a rare clinical presentation (0.1%) of Amyand’s hernia. It was first described by Claudius Amyand in 1735. We report a patient of Amyand’s hernia, three years of age, presented with right inguinoscrotal hernia. Right side groin discomfort was present. Herniotomy was performed revealing anon-inflamed appendix within the inguinal canal for which a classic appendectomy was done.

scholarly journals Air in the urine: a mystified patient and a concerned surgeon

2019 ◽  
Vol 12 (1) ◽  
pp. bcr-2018-227334
Author(s):  
Samarth Agarwal ◽  
Ashish Sharma ◽  
Ajay Aggarwal ◽  
Satyanarayan Sankhwar
Keyword(s):  
Acute Appendicitis ◽  
Imaging Techniques ◽  
Rare Complication ◽  
Prior History ◽  
Radiological Imaging ◽  
Rare Type ◽  
Detailed History ◽  
History Of

Appendicovesical fistula is a rare type of enterovesical and a very rare complication of acute appendicitis. Herein, we report a case of a 22-year-old man who presented with cloudy urine and pneumaturia with a prior history of acute appendicitis. Imaging techniques including ultrasonography, CT and cystoscopy were performed to diagnose the abnormality. Diagnosis of this fistula is challenging and relies on detailed history and radiological imaging.

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