99MTECHNETIUM LABELLED LEUCOCYTE SCANNING IN ACUTE LOWER ABDOMINAL PAIN: CAN IT REDUCE THE NEGATIVE APPENDECTOMY RATE?

Background. Several pathologies, including pharyngitis, are associated with abdominal pain that can mimic appendicitis. We sought to further understand the link between appendicitis-like symptoms and streptococcal (strep) pharyngitis. Methods. All patients undergoing ultrasound imaging for appendicitis in our emergency department during 2013 were reviewed (n = 1572). A total of 207 patients were identified who underwent both ultrasound for appendicitis and testing for strep pharyngitis. Demographic and outcomes data between rule out appendicitis patients who underwent strep testing and those who did not were compared. Results. Strep testing was more common in younger patients (mean age = 8.26 vs 10.26 years P < .001) and evenly matched by gender (104 male, 103 female). Of the 207 patients tested for strep pharyngitis, 8 (3.9%) patients had appendicitis and 35 (16.9%) patients tested positive for strep pharyngitis. No cases of concurrent strep pharyngitis and appendicitis were identified. The negative appendectomy rate in the strep pharyngitis tested group was 38.5% (5/13), compared with 7.7% (23/296) ( P = .003) in the nontested group. The appendicitis rate among the strep tested group was 3.8% (8/207) compared with 20% (273/1365) in the nontested group ( P < .001). Conclusions. Patients undergoing testing for strep pharyngitis were younger, had lower rates of appendicitis, and had a higher rate of negative appendectomy. A diagnosis of concurrent appendicitis and strep pharyngitis is rare. In cases of patients with sufficient symptoms to warrant testing for strep pharyngitis a diagnosis of appendicitis is less likely and surgical intervention leads to higher negative appendectomy rates.

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ACUTE APPENDICITIS DURING PREGNANCY: NO PLACE FOR MAYBE

Journal of Surgical Sciences ◽

10.33695/jss.v2i4.129 ◽

2015 ◽

Vol 2 (4) ◽

pp. 159-162

Author(s):

I. Negoiu ◽

S. Păun ◽

S. Hostiuc ◽

A. Moldoveanu ◽

M. Beuran

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Pregnant Women ◽

Operating Time ◽

Lower Abdominal Pain ◽

Negative Appendectomy ◽

Level Of Evidence ◽

Hospital Database ◽

History Of ◽

Obstetrical Emergency

Acute appendicitis is the most common abdominal non-obstetrical emergency in pregnant women;its management however is supported by a low level of evidence. The main objective of this studywas to evaluate the clinical management of pregnant women with acute appendicitis.We havereviewed the hospital database selecting the pregnant women with acute appendicitis managed inthe last 24 months. 8 appendectomies were performed in pregnant women. Mean age was 27.2±6.1years. All patients had a history of right lower abdominal pain of 36 hours or less. Generalanesthesia was used in 12.5% of cases and spinal anesthesia in the remaining of cases. In all casesappendectomy was performed through a McBurney’s incision with a mean operating time of 36.25minutes. There was no maternal or fetal mortality.The diagnosis of acute appendicitis ischallenging in pregnant women. A prompt, but a non-negative appendectomy should always beaimed, and no unecessary risks should be taken.

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APPENDICITIS IN CHILDREN: SYMPTOMS AND SIGNS, LABORATORY AND HISTOPATHOLOGY FINDINGS IN 67 PATIENTS

Facta Universitatis Series Medicine and Biology ◽

10.22190/fumb170509014z ◽

2018 ◽

pp. 66

Author(s):

Dragoljub Živanović ◽

Ivona Đorđević ◽

Milan Petrović

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Acute Abdominal Pain ◽

Clinical Signs ◽

Negative Appendectomy ◽

Chronic Appendicitis ◽

Markers Of Inflammation ◽

Laboratory Markers ◽

Negative Appendectomy Rate ◽

Symptoms And Signs

Acute abdominal pain is a reason for hospital admission of about 20% of children. Typical clinical presentation of appendicitis may be significantly different in children. Diagnosis is based on the combination of symptoms, clinical signs, and results of laboratory and radiology examinations. The objective of the present study was to analyze symptoms, signs, laboratory and histopathology findings in children who underwent surgery for acute appendicitis. Sixty-seven patients (37 males and 30 females) with mean age of 9.77 years, operated on for clinical diagnosis of acute appendicitis were enrolled in the study. Abdominal pain was present in all patients, followed by vomitus and fever. Laboratory markers of inflammation varied significantly with severity of inflammation, but were normal in chronic appendicitis. Clinical and histopathology assessments of inflammation were concordant in 22 – 43% depending of the degree of appendicitis. Perforation occurred in 26.86% and negative appendectomy rate was 6%.

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Chronic lower abdominal pain is commonly associated with pelvic congestion syndrome

Geburtshilfe und Frauenheilkunde ◽

10.1055/s-0036-1593045 ◽

2016 ◽

Vol 76 (10) ◽

Author(s):

A Jurga-Karwacka ◽

GM Karwacki ◽

FD Schwab ◽

A Schötzau ◽

C Zech ◽

...

Keyword(s):

Abdominal Pain ◽

Lower Abdominal Pain ◽

Pelvic Congestion Syndrome ◽

Pelvic Congestion

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Surgical Case

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v9ispl1.1278 ◽

2018 ◽

Vol 9 (SPL1) ◽

Author(s):

Ali Hameed Al-Badri

Keyword(s):

Diagnostic Delay ◽

Small Population ◽

Negative Appendectomy ◽

Time Cost ◽

Voluntary Cough ◽

Suspected Appendicitis ◽

Sharp Pain ◽

Clinical Syndromes ◽

Negative Appendectomy Rate ◽

Classical Symptom

Appendicitis is a common and urgentsurgical illness with protean manifestations,generous overlap with other clinical syndromes,and significant morbidity,whichincreases with diagnostic delay. No single sign,symptom,or diagnostic test accurately confirms the diagnosis ofappendiceal inflammation in all cases. The surgeon's goals are to evaluate a relatively small population of patients referred for suspected appendicitis and to minimize the negative appendectomy rate without increasing the incidence of perforation. The emergency department clinician must evaluate the larger group of patients who present to the ED with abdominal pain of all etiologies with the goal of approaching 100% sensitivity for the diagnosis in a time-,cost-,and consultation-efficient manner.IN 1886Reginald fitz, pathologist 1st described the clinical condition of A.A.Fewyears laterCharles mcBurney describe the clinical finding ofA.A.55% of patients presented with classical symptom of A.A so complication occurbecauseof atypical presentation which due to variation in app. Position, age of patient & degree of inflammation.Migrating pain 80% sensitive and specific Vomiting 50% Nausea60 -90 %Anorexia 75 % Diarrhea18 % 32 % has similar attach 90 % RLQ tenderness Marklesign 74 %Dunphy's sign (sharp pain in the RLQ elicited by a voluntary cough) may be helpful in making the clinical diagnosis of localized peritonitis. Similarly,RLQ pain in response to percussion of a remote quadrant of the abdomen,or to firm percussion of the patient's heel,suggests peritoneal Inflammation

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Conditional CT Strategy—An Effective Tool to Reduce Negative Appendectomy Rate and the Overuse of the CT

Journal of Clinical Medicine ◽

10.3390/jcm10112456 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2456

Author(s):

Raminta Luksaite-Lukste ◽

Ruta Kliokyte ◽

Arturas Samuilis ◽

Eugenijus Jasiunas ◽

Martynas Luksta ◽

...

Keyword(s):

Computed Tomography ◽

Acute Appendicitis ◽

Sensitivity And Specificity ◽

Surgical Outcomes ◽

Imaging Modality ◽

Ct Scans ◽

Negative Appendectomy ◽

Transabdominal Ultrasound ◽

First Choice ◽

Negative Appendectomy Rate

(1) Background: Diagnosis of acute appendicitis (AA) remains challenging; either computed tomography (CT) is universally used or negative appendectomy rates of up to 30% are reported. Transabdominal ultrasound (TUS) as the first-choice imaging modality might be useful in adult patients to reduce the need for CT scans while maintaining low negative appendectomy (NA) rates. The aim of this study was to report the results of the conditional CT strategy for the diagnosis of acute appendicitis. (2) Methods: All patients suspected of acute appendicitis were prospectively registered from 1 January 2016 to 31 December 2018. Data on their clinical, radiological and surgical outcomes are presented. (3) Results: A total of 1855 patients were enrolled in our study: 1206 (65.0%) were women, 649 (35.0%) were men, and the median age was 34 years (IQR, 24.5–51). TUS was performed in 1851 (99.8%) patients, and CT in 463 (25.0%) patients. Appendices were not visualized on TUS in 1320 patients (71.3%). Furthermore, 172 (37.1%) of 463 CTs were diagnosed with AA, 42 (9.1%) CTs revealed alternative emergency diagnosis and 249 (53.8%) CTs were normal. Overall, 519 (28.0%) patients were diagnosed with AA: 464 appendectomies and 27 diagnostic laparoscopies were performed. The NA rate was 4.2%. The sensitivity and specificity for TUS and CT are as follows: 71.4% and 96.2%; 93.8% and 93.6%. (4) Conclusion: A conditional CT strategy is effective in reducing NA rates and avoids unnecessary CT in a large proportion of patients. Observation and repeated TUS might be useful in unclear cases.

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Pyometra: An Atypical Cause of Abdominal Pain

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/23247096211022481 ◽

2021 ◽

Vol 9 ◽

pp. 232470962110224

Author(s):

Leonidas Walthall ◽

Marc Heincelman

Keyword(s):

Abdominal Pain ◽

Vaginal Discharge ◽

Elderly Women ◽

Lower Abdominal Pain ◽

Endometrial Biopsy ◽

Laboratory Evaluation ◽

Inpatient Service ◽

Gynecologic Malignancy ◽

Intravenous Contrast ◽

Lower Quadrant

Pyometra, a purulent infection of the uterus, is a rare cause of a very common complaint—abdominal pain. Risk factors include gynecologic malignancy and postmenopausal status. The classically described presentation includes abdominal pain, fever, and vaginal discharge. In this article, we present an atypical presentation of nonperforated pyometra in an 80-year-old female who was admitted to the internal medicine inpatient service. She initially presented with nonspecific subacute right lower quadrant abdominal pain. Physical examination did not demonstrate vaginal discharge. Laboratory evaluation failed to identify an underlying etiology. Computed tomography scan of the abdomen and pelvis with oral and intravenous contrast demonstrated a 6.5 × 6.1 cm cystic containing structure within the uterine fundus, concerning for a gynecologic malignancy. Pelvis ultrasound confirmed the mass. Endometrial biopsy did not reveal underlying malignancy, but instead showed frank pus, leading to the diagnosis of pyometra. This report illustrates that pyometra should be considered in the differential diagnosis of lower abdominal pain in elderly women.

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Successful treatment of recurrent volvulus in the afferent limb of the pouch following proctocolectomy for ulcerative colitis: a case report

Surgical Case Reports ◽

10.1186/s40792-020-01007-4 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Michio Itabashi ◽

Yoshiko Bamba ◽

Hisako Aihara ◽

Kimitaka Tani ◽

Ryousuke Nakagawa ◽

...

Keyword(s):

Ulcerative Colitis ◽

Abdominal Pain ◽

Lower Abdominal Pain ◽

Anterior Wall ◽

Middle Part ◽

Presacral Space ◽

Previous Surgery ◽

Afferent Limb ◽

Radiographic Findings ◽

Oral Side

Abstract Background Pouch volvulus after proctocolectomy for ulcerative colitis is a very rare postoperative complication. The common site of pouch volvulus has been reported to be the ileal pouch–anal anastomosis and the middle part of the pouch, but no reports on pouch volvulus in the afferent limb of the pouch have been observed. Here, we report the case of a patient with afferent limb volvulus who underwent afferent limbpexy, but required reoperation 7 months later. Case presentation A 38-year-old man with refractory ulcerative colitis had undergone open proctocolectomy 10 years ago at another hospital. He had been aware of lower abdominal pain and bowel movement difficulty for 2 years. After repeated bowel obstruction, he was referred to our hospital for surgery. Based on the radiographic findings, we diagnosed a pouch volvulus and performed an operation. Laparoscopically, counterclockwise rotation of the afferent limb of the pouch was recognized. Moreover, the ileal mesentery was adhered and fixed to the presacral space 20 cm from the oral side of the pouch. The antimesenteric side of the afferent limb was fixed using interrupted stiches on the left peritoneal wall of the pelvis. He was discharged uneventfully 18 days after surgery, and defecation improved immediately. However, he was readmitted 7 months after surgery with the same abdominal pain and defecation difficulty. A similar finding was found and diagnosed as recurrent volvulus. Therefore, we performed a laparoscopic surgery. The same volvulus as in the previous surgery was confirmed. The site fixed during the previous surgery showed scars, but the afferent limb was free. The dilated ileum that contained the volvulus was excised only on the oral side of the pouch and an intraluminal anastomosis was performed on the anterior wall of the pouch. He had a good postoperative course and was discharged. Conclusion Proper diagnosis of volvulus based on the characteristic imaging findings is important. In principle, bilateral row fixation of the rotated ileum is the basic procedure for volvulus. However, fixation with this technique is sometimes difficult. Therefore, this procedure is one of the useful options for the fixation of difficult or recurrent cases.

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Spontaneous Perinephric Urinoma Secondary to Drug Induced Acute Interstitial Nephritis: A Case Report

Journal of Gastrointestinal and Abdominal Radiology ◽

10.1055/s-0041-1723924 ◽

2021 ◽

Author(s):

Rajesh Kumar Varatharajaperumal ◽

Rupa Renganathan ◽

V Mangalakumar ◽

Sriman Rajasekaran ◽

Venkatesh Kasi Arunachalam

Keyword(s):

Abdominal Pain ◽

Interstitial Nephritis ◽

Lower Abdominal Pain ◽

Acute Interstitial Nephritis ◽

Computed Tomography Scan ◽

Drug Induced ◽

Significant Deterioration ◽

Loin Pain ◽

Tomography Scan ◽

Collecting System

AbstractUrinoma is defined as the extravasation of urine from any part of the urinary collecting system, which causes lipolysis of the surrounding fat, resulting in an encapsulated collection. The most common cause of urinoma is the direct obstruction of the urinary system. The other etiologies include trauma and postinstrumentation/surgery. Parenchymal cause for spontaneous urinoma is exceedingly rare. We present a case of a 30-year-old gentleman who presented with lower abdominal pain and was treated with a Diclofenac injection. The pain got better temporarily, but he presented again with right loin pain after 3 days. His computed tomography scan images revealed bilateral perinephric urinoma. As there was significant deterioration of renal function, he underwent a renal biopsy. The histopathology was reported as acute interstitial nephritis (AIN). Drug-induced AIN is very rarely presented with acute loin or abdominal pain due to spontaneous perinephric urinoma, as it was seen in our case.

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Roberts uterus: a rare congenital anomaly

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20175304 ◽

2017 ◽

Vol 6 (12) ◽

pp. 5657

Author(s):

Nagendra Sardeshpande ◽

Pratima Chipalkatti ◽

Jainesh Doctor

Keyword(s):

Congenital Anomaly ◽

Abdominal Pain ◽

Adnexal Mass ◽

Lower Abdominal Pain ◽

Uterine Horn ◽

Transabdominal Ultrasound ◽

Septate Uterus ◽

Bicornuate Uterus ◽

Rare Congenital Anomaly ◽

Hysteroscopic Resection

A 23-year-old girl presented with severe cyclical lower abdominal pain during menstruation since menarche, which had increased since the last 4 years. Transabdominal ultrasound showed adnexal mass with no internal vascularity; MRI reported it as bicornuate uterus with one non-communicating right uterine horn with haematometra. On hysteroscopy there was evidence of septate uterus communicating only to the left ostia. Ultrasonography-guided hysteroscopic resection of septa with drainage of haematometra was done. Patient is presently asymptomatic.

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