scholarly journals EP.FRI.229 The Role of Ultrasound in the Diagnosis of Paediatric Appendicitis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Lará Armstrong ◽  
Conor McGuigan ◽  
Muhammad Yousaf
Keyword(s):  
Low Cost ◽  
Iliac Fossa ◽  
District General Hospital ◽  
Highly Sensitive ◽  
Right Iliac Fossa Pain ◽  
Operative Ultrasound ◽  
Negative Appendicectomy ◽  
Surgical Unit ◽  
Do So

Abstract Background Acute appendicitis remains the most common acute surgical presentation among children and adults. Ultrasonography is a commonly used investigation for patients with right iliac fossa pain were the diagnosis is unclear, however in a district general hospital (DGH), appropriate radiologists are not often readily available. The aim of this study was to determine the value of ultrasonography in the diagnosis of appendicitis in children. Methods A retrospective review was carried out of all paediatric patients (aged 5-16), who underwent an appendicectomy in a single acute surgical unit, over a 6 month period.  An institutional database and up to date electronic care records were used to record preoperative ultrasound results, intraoperative findings and histopathology results. Results A total of 59 patients were admitted with possible appendicitis within the audit window, 31 of which underwent an appendicectomy, 58% performed laparoscopically.  38.7% underwent pre- operative ultrasound, 33.3% of which identified an acutely inflamed appendix. The remaining patients who did not proceed to theatre were successfully discharged with no re-attendance following a period of observation. Following histopathological confirmation, ultrasonography was found to have a sensitivity and specificity of 100%. Negative appendicectomy rate returned at 6.7%. Conclusion Ultrasonography is a low cost, highly sensitive diagnostic tool in appendicitis, where provisions are in place to do so. Visualising the appendix on ultrasound can reduce negative pathology rates. This is a small study within a DGH and access to ultrasound is limited. Better utilisation or the development of a protected ultrasound slot should be sought.

scholarly journals Giant sigmoid diverticulitis mimicking acute appendicitis

2011 ◽  
Vol 93 (6) ◽  
pp. e89-e90 ◽  
Author(s):  
M Anderton ◽  
B Griffiths ◽  
G Ferguson
Keyword(s):  
Computed Tomography ◽  
Iliac Fossa ◽  
Treatment Options ◽  
Sigmoid Diverticulitis ◽  
Acute Presentation ◽  
Rare Manifestation ◽  
Giant Sigmoid Diverticulum ◽  
Right Iliac Fossa Pain ◽  
Colonic Diverticula

Giant colonic diverticula are a rare manifestation of diverticular disease and there are fewer than 150 cases described in the literature. They may have an acute or chronic presentation or may remain asymptomatic and be found incidentally. As the majority (over 80%) of giant diverticula are located in the sigmoid colon, they usually present with left-sided symptoms but due to the variable location of the sigmoid loop, right-sided symptoms are possible. We describe the acute presentation of an inflamed giant sigmoid diverticulum with right iliac fossa pain. We discuss both the treatment options for this interesting condition and also the important role of computed tomography in the diagnosis and management of abdominal pain in elderly patients.

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

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 The role of mycorrhizal symbioses in phytotechnology

Botany ◽  
2017 ◽  
Vol 95 (10) ◽  
pp. 971-982 ◽  
Author(s):  
P.L. Chagnon ◽  
J. Brisson
Keyword(s):  
Ecosystem Services ◽  
Stress Tolerance ◽  
Mycorrhizal Fungi ◽  
Low Cost ◽  
Fundamental Understanding ◽  
The Future ◽  
Fungal Associates ◽  
Mechanistic Understanding ◽  
Do So

There is a growing interest in using plants to provide low-cost ecosystem services in a diversity of environments (e.g., polluted, degraded, urban). These utilizations of plants are collectively referred to as phytotechnologies. Many plants used in phytotechnological applications are naturally found to associate with mycorrhizal fungi. These fungal associates can provide numerous ecosystem services, or help plants to do so. There is thus an obvious incentive to better understand how mycorrhizal symbioses can assist phytotechnologies. For some phytotechnological applications, the benefits of using mycorrhizal fungi seem well-established, while for others, these benefits are either uncertain or simply unexplored. In all cases, a trait-based, mechanistic understanding of what allows mycorrhizal fungi to provide any benefit/service is urgently needed. This will help to develop reliable, mycorrhiza-assisted phytotechnologies in the future, while also improving our fundamental understanding of the evolution of stress tolerance in these important plant-associated symbionts.

scholarly journals Towards an evidence-based management of right iliac fossa pain in the over 50-year-old patient

2016 ◽  
Vol 98 (7) ◽  
pp. 496-499 ◽  
Author(s):  
E Gammeri ◽  
A Catton ◽  
BH van Duren ◽  
SG Appleton ◽  
GI van Boxel
Keyword(s):  
Iliac Fossa ◽  
Ct Scanning ◽  
District General Hospital ◽  
The Elderly ◽  
Colonic Diverticulitis ◽  
Published Evidence ◽  
Right Iliac Fossa Pain ◽  
Unexpected Findings ◽  
Operative Findings ◽  
Acute Colonic Diverticulitis

Introduction Right iliac fossa pain is a common presenting complaint to general surgery. The differential diagnosis is wide, particularly in the elderly. Computed tomography (CT) is often used in the ‘older’ population, as they have a higher prevalence of acute colonic diverticulitis and colonic neoplasia, both of which should be identified prior to surgery. There is, however, no published evidence to support this practice. Methods We retrospectively reviewed the records of all patients aged over 50 years who presented with right iliac fossa (RIF) pain to a district general hospital. We determined whether tenderness was predominantly right- or left-sided and whether systemic inflammatory response syndrome (SIRS) was present on admission. The use of imaging modalities, their results and, if performed, operative findings were recorded. Results Of 3160 patients identified, 89 met the inclusion criteria. Diagnoses included appendicitis (27%), neoplasia (15%), non-specific abdominal pain (15%) and acute colonic diverticulitis (10%). CT was performed in 82% of patients, with a sensitivity of 97% based on operative findings. Six patients underwent surgery without a scan, two of whom required a change in the planned procedure due to unexpected findings. Conclusions Unless contraindicated, CT scanning should be mandatory in patients aged over 50 years presenting with signs of peritonism in the RIF or lower abdomen.

scholarly journals P118 The 134-year-old problem meets the 1-year-old problem: lessons learned in managing acute appendicitis during the COVID era

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Sherwin Fernando ◽  
Diwakar Ryali Sarma ◽  
Sherwin Fernando
Keyword(s):  
Pain Treatment ◽  
Iliac Fossa ◽  
Lessons Learned ◽  
Open Approach ◽  
Patient Demographics ◽  
Right Iliac Fossa Pain ◽  
American Society ◽  
The Uk ◽  
The Right

Abstract Introduction The Right Iliac Fossa Pain Treatment (RIFT) study highlighted the rate of negative appendicectomies in the UK as one third of all procedures. However, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2/COVID) pandemic has changed surgical practice. New practices in the COVID era have changed the rate of negative appendicectomies. Methods A retrospective analysis was conducted of patients admitted with appendicitis from March 2020 to June 2020. Patient Demographics 58 patients were identified, 43 (74%) were adults and 15 (26%) were children. The median age of the adults was 33 (range 18-80) and the median American Society of Anaesthetists (ASA) grading was 1. The median age of children was 11 (range 4-17) and all were ASA grade 1. Results 73.8% (31) of adult patients had a Computerised Tomography (CT) scan as part of their workup. 40% of paediatric patients underwent an ultrasound scan of the abdomen whilst the remaining 60% were diagnosed clinically. The open approach was favoured in both cohorts (39.5% and 46.7% respectively). No negative appendicectomies were performed. Conclusion COVID19 has changed practice resulting in better outcomes for colorectal units. Further studies (COVID SURG and COVID HAREM) are needed to fully assess the role of imaging in reducing the number of negative appendicectomies.

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.

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