scholarly journals TP9.2.19Factors Associated with Multiple Presentations Prior to Appendicectomy in Children Presenting with Suspected Appendicitis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
James Chean Khun Ng ◽  
Vi June Tay ◽  
Francesca Ligori Malcolm ◽  
Zoe Chia ◽  
Ahmed M El-Sharkawy ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Discharge Rate ◽  
White Cell Count ◽  
Iliac Fossa ◽  
Significant Proportion ◽  
Initial Presentation ◽  
Surgical Team ◽  
Emergency Operations ◽  
Suspected Appendicitis ◽  
Negative Appendicectomy

Abstract Aims Appendicectomy is amongst the most common emergency operations in children. We aim to audit the rate of re-presentation within 30-days prior to appendicectomy in children presenting to the emergency department (ED) with suspected appendicitis and identify the factors associated with re-presentations. Methods Retrospective review of the medical notes of all children that had an emergency appendicectomies between June 2016 and June 2019. Results A total of 231 appendicectomies were performed, all presented through ED, with 8.2%(n = 19) re-presenting within 30-days prior to appendicectomy. Negative appendicectomy rates were similar in those that had appendectomy at initial presentation or when they re-presented (13.2(n = 28)%vs.15.8%(n = 3), p = 0.752), respectively. Of those that re-presented, 84.2%(n = 16) were not reviewed by the surgical team at the index presentation. Female patients accounted for 62.5%(n = 10) of those that re-presented, compared with 31%(n = 57) of those that presented once(p = 0.010). Pyrexia(p = 0.029), Rovsing's sign(p = 0.032), nausea or vomiting(p = 0.012) was associated with histological appendicitis. Absence of migratory pain(p = 0.005), anorexia(p = 0.004), right iliac fossa tenderness(p < 0.001) or guarding(p < 0.001) was associated with higher successful discharge rate. Among those re-presented, there was significant CRP rise between first and second presentation (median(Q1,Q3): 6(1.25,28.5)vs.95.5(27,176.5), p = 0.016) however, white cell count was comparable (median(Q1,Q3): 14.6(11.98,16.05)vs.14.0(11.02,18.58), p = 0.815). Conclusion Clinical symptoms and signs correlated with histological appendicitis. A significant proportion of those that re-presented were not assessed by the surgical team at initial presentation. Early surgical consultation at initial presentation may reduce rates of re-presentation.

scholarly journals Cost-effectiveness of routine imaging of suspected appendicitis

2018 ◽  
Vol 100 (1) ◽  
pp. 47-51 ◽  
Author(s):  
N D’Souza ◽  
M Marsden ◽  
S Bottomley ◽  
N Nagarajah ◽  
F Scutt ◽  
...  
Keyword(s):  
Imaging Modality ◽  
Financial Burden ◽  
Iliac Fossa ◽  
Hospital Costs ◽  
Cost Savings ◽  
Cross Sectional ◽  
Suspected Appendicitis ◽  
Negative Appendicectomy ◽  
The Uk ◽  
Routine Imaging

Introduction The misdiagnosis of appendicitis and consequent removal of a normal appendix occurs in one in five patients in the UK. On the contrary, in healthcare systems with routine cross-sectional imaging of suspected appendicitis, the negative appendicectomy rate is around 5%. If we could reduce the rate in the UK to similar numbers, would this be cost effective? This study aimed to calculate the financial impact of negative appendicectomy at the Queen Alexandra Hospital and to explore whether a policy of routine imaging of such patients could reduce hospital costs. Materials and methods We performed a retrospective analysis of all appendicectomies over a 1-year period at our institution. Data were extracted on outcomes including appendix histology, operative time and length of stay to calculate the negative appendicectomy rate and to analyse costs. Results A total of 531 patients over 5 years of age had an appendicectomy. The negative appendicectomy rate was 22% (115/531). The additional financial costs of negative appendicectomy to the hospital during this period were £270,861. Universal imaging of all patients with right iliac fossa pain that could result in a 5% negative appendicectomy rate would cost between £67,200 and £165,600 per year but could save £33,896 (magnetic resonance imaging), £105,896 (computed tomography) or £132,296 (ultrasound) depending on imaging modality used. Conclusions Negative appendicectomy is still too frequent and results in additional financial burden to the health service. Routine imaging of patients with suspected appendicitis would not only reduce the negative appendicectomy rate but could lead to cost savings and a better service for our patients.

EP.FRI.615 Assessing the reliability of the Adult Appendicitis Score in managing patients with suspected acute appendicitis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Carry Zheng ◽  
Shiela Lee ◽  
Steven Brown ◽  
Venkat Kanakala
Keyword(s):  
Acute Appendicitis ◽  
Risk Group ◽  
Pathological Finding ◽  
High Risk Group ◽  
Histological Diagnosis ◽  
Suspected Appendicitis ◽  
Tertiary Centre ◽  
Negative Appendicectomy ◽  
Age Range ◽  
Suspected Acute Appendicitis

Abstract Aims To evaluate the effectiveness of using a clinical prediction tool in the management of suspected acute appendicitis Methods Retrospective data was collected on patients undergoing appendicectomy at a single tertiary centre from November 2019 to June 2020. Inclusion criteria were all patients aged 18 and above undergoing diagnostic laparoscopy for suspected appendicitis. Exclusion criteria were all patients that had a pathological finding other than appendicitis at laparoscopy. The pre operative AAS score at first presentation was calculated and patients grouped into low(0-10), intermediate(11-15), and high(16 and above) risk. These groups were then compared to the histological findings. Results A total of 74 patients were included, 44 male and 30 female. The age range was from 18 to 83, with a median age of 36. Of 10 patients in the low risk group, 4 (40%) had appendicitis on histology. 36 out of 40 (90%) patients in the intermediate risk group had appendicitis and 100% of the 24 patients in the high risk group. Pearson’s coefficient showed a significant correlation between the AAS risk (low, intermediate, and high) and the histological diagnosis of appendicitis (r = 0.48, p = 0.000016). Conclusions Our study did show a positive correlation between the AAS risk stratification and histological diagnosis. Based on our findings we would recommend the adoption of this score in assessing patients with suspected acute appendicitis and minimising the negative appendicectomy rate.

scholarly journals Does Serum Bilirubin Add Value in the Diagnosis of Appendicitis? A Multi-Institution Analysis of 2024 Patients

2021 ◽  
Author(s):  
Andrew Phillip Maurice ◽  
Benjamin David Swinson ◽  
Eduardo Miguel Apellaniz ◽  
Sarah Emily King ◽  
Thomas Grant Mackay ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Neutrophil Count ◽  
Serum Bilirubin ◽  
White Cell Count ◽  
Delayed Diagnosis ◽  
Complicated Appendicitis ◽  
Total Serum ◽  
Suspected Appendicitis ◽  
Uncomplicated Appendicitis ◽  
Operative Findings

Abstract BACKGROUNDEven with modern diagnostics, appendicitis can be difficult to diagnose accurately. Negative appendicectomies (NA) and delayed diagnosis of complicated appendicitis (CA, i.e. perforation or abscess) remain common. Serum bilirubin has been proposed as an additional biomarker to assist with the diagnosis of appendicitis. In this large series, we assessed the value of bilirubin in the diagnosis of appendicitis.METHODS A retrospective review of patients with suspected appendicitis at three hospitals over a three year period was performed. All consecutive patients with appendicectomy were included. In addition, a “discharged” sub-group of consecutive patients who were admitted with suspected appendicitis but discharged without an operation was also identified.Demographic data, presence of fever, tachycardia, total white cell count (WCC), neutrophil count, total serum bilirubin, operative findings and final histology were recorded. Multivariate logistic regression was performed to determine independent predictors of appendicitis and CA. Receiver-operator analysis was performed to compare bilirubin to WCC and neutrophil count.RESULTS There were 2024 patients: 1167 had uncomplicated appendicitis, 355 had CA and 303 underwent NA. 200 non-surgical "discharged" patients were included for comparison. Compared to those without appendicitis (NA and discharged groups), increased serum bilirubin was associated with an increased likelihood of appendicitis (OR 1.030 (1.013, 1.048), p<0.0001) and increased likelihood of CA (OR 1.035, 95% CI (1.021, 1.050), p<0.001). These results remained significant when the discharged group, NA group and uncomplicated appendicitis groups were analyzed separately.The sensitivity and specificity of bilirubin was inferior to neutrophil count for the diagnosis of appendicitis (AUC 0.657 versus 0.725, p<0.0001). Bilirubin, WCC and neutrophils each were all relatively insensitive and non-specific over a variety of cut-off values and combinations did not improve their accuracy.CONCLUSION Hyperbilirubinaemia was independently associated with an increased likelihood of both uncomplicated and complicated appendicitis, however had similar sensitivity and specificity when compared to WCC or neutrophils. Bilirubin, neutrophil count and WCC alone are not discriminatory enough to be used in isolation but may be incrementally useful adjuncts in pre-operative assessment of patients with suspected appendicitis.

scholarly journals PSEUDOMYXOMA ON APPENDICULAR MUCOCELE

2020 ◽  
Vol 8 (12) ◽  
pp. 842-846
Author(s):  
Yehouenou Tessi T. Romeo ◽  
◽  
Asaad El Bakkari ◽  
Adeyemi A. Boris ◽  
Khadija Ben El Hosni ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Iliac Fossa ◽  
Disease Onset ◽  
Vermiform Appendix ◽  
Complete Resection ◽  
Mucocele Of The Appendix ◽  
Thin Walled ◽  
Ct Density ◽  
The Right ◽  
Underlying Pathology

Mucocele of the appendix is a descriptive term for mucinous distension of the appendiceal lumen (vermiform appendix) regardless of the underlying pathology. It refers to the progressive retrograde dilatation of the vermiform appendix with concomitant intraluminal accumulation of the mucoid substance. It is an uncommon pathology that occurs in both sexes. it especially poses the problem of differential diagnosis in particular in women because of the location of clinical symptoms in the right iliac fossa. The incidence is estimated between 0.2 % and 0.4 % of the appendectomied specimens.The estimated incidence is approximately 1/1 000 000/year. The disease onset is usually after the age of 40 years and more frequently affects females.The means of medical imaging are mainly ultrasound and scanner. On CT typical mucocele appears as a cecal-based, rounded and well-defined mass, thin-walled, with fine parietal calcifications CT density is variable, from fluid to tissue. A stercolith is sometimes visible at the base of the appendix. The wall of the mucocele may be thickened, irregular, taking the contrast there may be peri-appendicular inflammation, which may be inflammatory or tumor, without specificity.The treatment of unbroken appendicular mucocele is surgical, preferably by laparotomy than laparoscopy. The appendectomy is performed, without breaking the appendix, with complete resection of the meso-appendix, and sampling for cytology of the peritoneal fluid.

scholarly journals Clinico-pathological and etiological evaluation of acute appendicitis and assessment of significance of laboratory and ultrasonography examination as an ancillary aid to clinical diagnosis

2019 ◽  
Vol 6 (6) ◽  
pp. 1954
Author(s):  
Sailendra Nath Paul ◽  
Dilip Kumar Das
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Scoring System ◽  
Clinical Symptoms ◽  
Lower Abdominal Pain ◽  
Complication Rates ◽  
Alvarado Score ◽  
Negative Appendicectomy ◽  
Operative Findings

Background: Timely diagnosis and intervention of acute appendicitis reduces morbidity and mortality associated with the disease condition. The study aimed to evaluate the etiology of acute appendicitis, to analyze the sensitivity of modified Alvarado scoring system and radiology in the diagnosis of acute appendicitis and to correlate the observations of laboratory tests, operative findings with the histopathological report of specimen of appendix.Methods: This was a prospective study done on 100 patients with clinical symptoms of acute right lower abdominal pain suggestive of appendicular origin during the period from February 2015 to January 2016 in the department of surgery thorough clinical assessment, laboratory investigations, ultrasound findings as were done for all patients. After confirming the diagnosis of AA the patients had operative intervention and specimens were sent for histopathological study.Results: Male preponderance was seen in the study. Majority of them belongs to 21 to 30 years age group (50%). Faecolith was the most common etiological factor observed (58%). Abdominal pain (100%) was the most common clinical symptom. Alvarado score had sensitivity of 95.74% and specificity of 66.67% in diagnosing AA. In correlation to histopathological findings, ultrasonography findings showed 100% positive visualization rate in all 71 cases. Elevated ESR (94%) had high diagnostic accuracy as confirmed by HPE finding (96.81%) which is statistically significant (p<0.000).Conclusions: Alvarado scoring system, elevated ESR levels and USG findings of the appendix can be considered as adjuncts to clinically diagnose the AA, to improve the diagnostic accuracy thereby consequently the rate of negative appendicectomy can be reduced and thus decreases the complication rates.

Episootological features of demodekosis in dogs in the conditions of the city of Shcholkovo, Moscow region

2020 ◽  
Vol 1 (12) ◽  
pp. 90-97
Author(s):  
M. E. Obukhova ◽  
◽  
E. G. Deryabkina ◽  
E. S. Latynina ◽  
A. M. Nikanorova ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Significant Proportion ◽  
Moscow Region ◽  
The City

The article analyzes the epizootological situation of dogs demodicosis in the city of Shchelkovo, Moscow region. It was found that among all studied animals with lesions of the skin and hair, dogs with a confirmed diagnosis of demodicosis occupy a significant proportion. Animals with the absence of any clinical symptoms of demodicosis and without pronounced signs of violation of the integrity of the skin and hair, however, can be carriers of its pathogen.

scholarly journals Analysis of the risk of ovarian torsion in 49 consecutive pediatric patients treated at a single institution

2019 ◽  
Vol 2 (2) ◽  
pp. e000009
Author(s):  
Koshiro Sugita ◽  
Takafumi Kawano ◽  
Mukai Motoi ◽  
Toshihiro Muraji ◽  
Shun Onishi ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Pediatric Patients ◽  
Clinical Symptoms ◽  
White Cell Count ◽  
Ovarian Torsion ◽  
Imaging Findings ◽  
Single Institution ◽  
Exact Test ◽  
Cystic Masses ◽  
Ovarian Masses

PurposeAn early diagnosis of ovarian torsion is sometimes difficult due to variable clinical symptoms and non-specific imaging findings. We retrospectively reviewed patients with pediatric ovarian masses manifesting torsion.MethodsFifty-eight ovarian masses (55 episodes) in 49 non-neonatal patients treated from April 1984 to March 2017 were retrospectively analyzed. The Mann-Whitney U test and Fisher’s exact test were used for the statistical analysis.ResultsThe median age of these 55 episodes was 10.5 years old (range 1.0–23.0). Thirty-three patients presented with abdominal pain. Forty-five tumors and 13 cystic masses were resected and diagnosed pathologically (50 benign and 8 malignant). Torsion was identified in 15 cases (25.9%) at operation. The torsion masses were all benign, and 8 ovaries (53.3%) were successfully preserved. Comparing the torsion cases with the non-torsion cases, only the white cell count was significantly higher in the torsion cases (p=0.0133) and in the patients presented with abdominal pain (p=0.0068). The duration of abdominal pain was significantly shorter in ovary preserved cases than in oophorectomy cases.ConclusionThe white blood cell may be a helpful indicator of the presence of torsion as well as the need for surgery.

Peritonitis in Continuous Ambulatory Peritoneal Dialysis (CAPD): Diagnostic Findings, Therapeutic Outcome and Complications

1989 ◽  
Vol 9 (3) ◽  
pp. 179-190 ◽  
Author(s):  
Anders Tranæus ◽  
Olof Heimbürger ◽  
Bengt Lindholm
Keyword(s):  
Membrane Filtration ◽  
Mononuclear Cells ◽  
Clinical Symptoms ◽  
White Cell Count ◽  
Positive Culture ◽  
Generation Cephalosporin ◽  
Drop Out ◽  
Coagulase Negative Staphylococci ◽  
In Vitro Susceptibility

The analysis of all episodes of peritonitis occurring in a uniformly treated continuous ambulatory peritoneal dial ysis (CAPD) population ( N = 128) at one centre during a six-year period showed the following major findings. The initial white cell count (WCC) of the dialysate was <100 .106/L in 10% of the episodes and showed a predominance of mononuclear cells in 15%. The Gram stain results were consistent with the findings of the culture in 28% of the episodes and influenced the initial therapy in only 7% of the cases. Between 9% and 31% of all episodes would not have been classified as peritonitis if positive culture, a WCC of >100 .106/L in the dialysate, or clinical symptoms had been required for the diagnosis. The proportion of negative dialysate cultures was 2% after the introduction of pre-culture membrane filtration. Tunnel infection as a cause of peritonitis was more frequent in episodes due to Staphylococcus aureus than in episodes due to coagulase-negative staphylococci (p = 0.009). Peritonitis caused by coagulase negative staphylococci were followed by a milder course than other organisms (p = 0.02). Of all episodes initially treated with cephradine only 62% were cured with this antibiotic (or cloxacillin) and 35% were followed by recurrency, protracted course or catheter loss, despite intermediate or full in vitro susceptibility. In only 53% of all episodes no complication was observed. Complications were more frequent in women and diabetics than in men (p = 0.01) and non-diabetics (p = 0.03), and were more common in episodes with clinical symptoms (p = 0.02). Peritonitis resulted in drop-out from CAPD in 6% of all episodes. Hospital care was needed in 68% of all episodes. We conclude that turbidity can be used as the sole criterion for the initial diagnosis of peritonitis, and that a first generation cephalosporin should not be used as a first line antibiotic in the treatment of CAPD peritonitis.

scholarly journals Sensitivity of Alvarado Score among the Suspected Appendicitis Patients at a Tertiary Level Teaching Hospital

2020 ◽  
Vol 32 (1) ◽  
pp. 45-47
Author(s):  
Md Shamsuzzaman ◽  
Md Alamgir Hossain Sikder ◽  
Quazi Sabran Uddin Ahmed ◽  
Shyamol Chandra Banik ◽  
Kartick Chanda Shaha
Keyword(s):  
Iliac Fossa ◽  
Medical College Hospital ◽  
College Hospital ◽  
Alvarado Score ◽  
Predictive Values ◽  
Suspected Appendicitis ◽  
National Medical College ◽  
Medical College ◽  
National Medical ◽  
The Right

Introduction: The aim of this study was to screening the Sensitivity of Alvarado score among the hospitalized suspected appendicitis patients at Dhaka National Medical College Hospital for determine the diagnostic accuracy. Materials and Methods: It was an observational type of descriptive study, conducted in the Dhaka National Medical College Hospital, Dhaka, during the study period of July 2015 to December 2015. The study was approved by the institutional ethical committee. Results: Most of the appendicitis patients belonged to the between 21-30 years which was 64 (32%). Male appendicitis patients (52%) are more than the female patients (48%). Majority of the patients (69%) complains pain occurs in the Right iliac fossa. The sensitivity of Alvarado scores was 81.60%, specificity 74.58%, accuracy 79.35%, positive and negative predictive values were 87.18% and 65.67% respectively. Conclusion: Alvarado score has more specificity. Medicine Today 2020 Vol.32(1): 45-47

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