The NOTA study: non-operative treatment for acute appendicitis: prospective study on the efficacy and safety of antibiotic treatment (amoxicillin and clavulanic acid) in patients with right sided lower abdominal pain

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.

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Conservative management of early uncomplicated appendicitis in children

International Surgery Journal ◽

10.18203/2349-2902.isj20170855 ◽

2017 ◽

Vol 4 (3) ◽

pp. 1024 ◽

Cited By ~ 1

Author(s):

Sunil Kumar Maini ◽

Neeraj Kumar Jain ◽

Manjari Goel Jain ◽

Vicky Khobragade

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Conservative Management ◽

Medical Management ◽

Surgical Intervention ◽

Lower Abdominal Pain ◽

Primary Treatment ◽

Research Centre ◽

Uncomplicated Appendicitis

Background: Right lower abdominal pain management in children is a challenging task for the surgeon. Most of the time right lower abdominal pain ends up in acute appendicitis. For long time appendicetomy was the treatment of choice. However surgical intervention has its own disadvantages such as pain, scarring, adhesions, hernia development and venous thrombosis disease. Anxiety and fear of surgery were also two difficulties in obtaining consent for surgery. Parents often request and insist for medical management. Their unwillingness for surgical intervention was the most important reason for medical management of uncomplicated acute appendicitis.Methods: Our prospective observational study was conducted in the Department of General Surgery, R.K.D.F. Medical College and Research Centre, Bhopal, Madhya Pradesh, India during period of January 2014 to January 2016 and follow up was done till December 2016. Our target group was children under 16 years. A total of 92 children with complaint of right lower abdominal pain attended the hospital for treatment. Routine investigations including ultrasonography of abdomen were performed for all the patients. Out of 92 patients diagnosis of acute appendicitis was made in 74 patients, Surgery was performed in 32 patients, while remaining 42 patients were treated conservatively and the results were analyzed.Results: In this study of 92 patients of pain in right iliac fossa below 16 years, 74 (80.43%) were diagnosed as acute appendicitis. 32 (43.24%) Patients were operated earlier. 42 (56.75%) Patient were treated conservatively. Out of 42 patients, 12 (16.21%) patients were operated within 1 year, 30 (40.54%) Patients didn’t require any surgical intervention during 1 year follow up. In present study, significant role of antibiotic was found in conservative management of acute appendicitis in children. So it can be concluded that conservative management of acute appendicitis in children can be attempted under observation.Conclusions: Antibiotics are both effective and safe as primary treatment for patients with uncomplicated acute appendicitis. Initial antibiotic treatment merits consideration as a primary treatment option for early uncomplicated appendicitis. Appendicectomy should be done but conservative management of acute appendicitis in children can be attempted under observation.

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Torsion of vermiform appendix: case report and review of the literature

Surgical Case Reports ◽

10.1186/s40792-020-0771-x ◽

2020 ◽

Vol 6 (1) ◽

Cited By ~ 2

Author(s):

Kosuke Endo ◽

Masahito Sato ◽

Kenichi Saga ◽

Atsushi Higashio ◽

Yoshiaki Yuba ◽

...

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Rare Disease ◽

Treatment Plan ◽

Laboratory Data ◽

Lower Abdominal Pain ◽

Emergency Operation ◽

Abdominal Ultrasound ◽

Vermiform Appendix ◽

Ileocecal Region

Abstract Background Torsion of the vermiform appendix is a rare disease with symptoms very similar to those of acute appendicitis. We herein report a case of torsion of the vermiform appendix diagnosed by intraoperative findings. Case presentation A 4-year-old boy presented to our hospital because of abdominal pain and vomiting. Laboratory data revealed a C-reactive protein level of 0.08 mg/dL and white blood cell count of 19,300/μL (neutrophils, 88.9%). Abdominal ultrasound showed a target sign-like finding in the ileocecal region. A computed tomography scan showed swelling of the appendix. We performed an emergency operation under suspicion of acute appendicitis. Laparoscopic examination showed that the appendix had twisted 720° in the clockwise direction. Appendectomy was performed, and the postoperative course was uneventful. Conclusions Although torsion of the vermiform appendix is a very rare disease and difficult to differentiate from appendicitis, an inappropriate treatment plan could lead to necrosis and perforation of the appendix. It is important to consider this disease as a differential diagnosis in patients with right lower abdominal pain.

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White Cell Count and C-Reactive Protein Measurement in Patients with Possible Appendicitis

Annals of The Royal College of Surgeons of England ◽

10.1308/003588409x359330 ◽

2009 ◽

Vol 91 (2) ◽

pp. 113-115 ◽

Cited By ~ 47

Author(s):

Anshuman Sengupta ◽

George Bax ◽

Simon Paterson-Brown

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Cell Count ◽

White Cell Count ◽

Lower Abdominal Pain ◽

White Cell ◽

C Reactive Protein ◽

Economic Implications ◽

Suspected Appendicitis ◽

Reactive Protein

INTRODUCTION Clinical assessment outweighs the use of investigations in the diagnosis of acute appendicitis. Nevertheless, white cell count (WCC) and C-reactive protein (CRP) are regularly measured in patients with suspected appendicitis. The aim of this study was to assess the utility of these markers in patients presenting with acute lower abdominal pain. PATIENTS AND METHODS WCC and CRP were measured prospectively in 98 patients presenting with lower abdominal pain, and the results were correlated with each patient's outcome. RESULTS No patients with WCC and CRP both in the normal range had acute appendicitis. Raised WCC and CRP were poor positive predictors of appendicitis, both alone and in combination, and correlated poorly with the development of complications. CONCLUSIONS This result may have important clinical and economic implications. We suggest that patients experiencing lower abdominal pain, with normal WCC and CRP values, are unlikely to have acute appendicitis and can be safely sent home.

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Torsion of caecal appendices epiploicae: mimicking acute appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20202858 ◽

2020 ◽

Vol 7 (7) ◽

pp. 2407

Author(s):

A. P. Roshini ◽

Dattaprasad Samant ◽

F. P. Noronha

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Iliac Fossa ◽

Lower Abdominal Pain ◽

Free Fluid ◽

Normal Appendix ◽

Menstrual Cycles ◽

Rebound Tenderness ◽

Appendices Epiploicae ◽

The Right

Acute appendicitis is a common cause for pain in the right iliac fossa, which requires urgent surgical intervention. However, at the time of surgery, if the appendix is normal, the surgeon has to search for other causes of acute abdominal pain including rare etiologies, such as torsion of appendices epiploicae and subsequently its gangrene. We report the case of a 45 years old female who presented with right lower abdominal pain, rebound tenderness and guarding in right iliac fosse, with regular menstrual cycles and no urinary complaints. Investigation revealed leucocytosis and ultra-sonography abdomen was suggestive of an inflamed appendix in the right iliac fossa with free fluid. Intra-operatively, we found a normal appendix with gangrene of the appendices epiploicae which had undergone torsion. She underwent excision off appendices epiploicae with appendicectomy with uneventful post-operative period. Histopathology of the appendices was suggestive of congestion. Preoperative diagnosis of this condition is rarely made.

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A CASE OF ACUTE APPENDICITIS PRESENTING WITH LEFT LOWER ABDOMINAL PAIN ASSOCIATED WITH MALROTATION OF THE INTESTINE

The journal of the Japanese Practical Surgeon Society ◽

10.3919/ringe1963.57.2494 ◽

1996 ◽

Vol 57 (10) ◽

pp. 2494-2498 ◽

Cited By ~ 6

Author(s):

Kenji KATO ◽

Hiroyuki SAKURAI ◽

Shinsuke MATSUDA ◽

Hideaki SUZUKI

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Lower Abdominal Pain

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Manifestations of Acute Appendicitis: A Prospective Study on Acute Abdominal Pain

Digestive Surgery ◽

10.1159/000350043 ◽

2013 ◽

Vol 30 (3) ◽

pp. 198-206 ◽

Cited By ~ 7

Author(s):

H. Laurell ◽

L.-E. Hansson ◽

U. Gunnarsson

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Prospective Study ◽

Acute Abdominal Pain ◽

A Prospective Study

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Torsion of the omentum: A rare cause of acute abdomen.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.12.6701 ◽

2021 ◽

Vol 28 (12) ◽

pp. 1869-1873

Author(s):

Sajid Malik ◽

Gul e Lala ◽

Abdullah Khan

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Ct Scan ◽

Acute Abdomen ◽

Preoperative Diagnosis ◽

Clinical Signs ◽

Lower Abdominal Pain ◽

X Rays ◽

Omental Torsion ◽

Operative Recovery

Omental torsion is a rare cause of acute abdominal pain. Diagnosis of omental torsion is usually difficult because clinical signs and symptoms are similar to other common causes of abdominal pain. The most common preoperative diagnosis is acute appendicitis and the proper preoperative diagnosis is important for the appropriate treatment option. Diagnosis of omental torsion is difficult and mainly based on ultrasound and computed tomography (CT) scan analysis. Case Presentation: A 26 years old male patient presented to emergency department with acute abdomen mimicking acute appendicitis. The chest and abdominal X-rays were normal. Due to intense clinical signs and worsening of the symptoms the patient underwent an operation with the probable diagnosis of acute appendicitis. In this case patient explored via gridiron incision, the omentum was found to be gangrenous that had encased the appendix so midline incision given. Post-operative recovery was uneventful. Conclusion: Omental torsion is highly uncommon cause of right lower abdominal pain and difficult to diagnose preoperatively. It presents with non-specific symptoms, mimicking other abdominal conditions presenting a similar clinical settings. CT scan is very helpful in diagnosis. Surgical treatment is the procedure of choice with laparoscopy being the preferable approach.

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Blind Dates - Potential Killers: Jujube Kernel Caused Enterobrosis Need to be Differentiated with Acute Appendicitis – A Chinese Single Center Case Series Study

10.21203/rs.3.rs-51705/v1 ◽

2020 ◽

Author(s):

Zhi ye Bao ◽

Chun hu Zhang ◽

Bo qian Liu ◽

Jia yi Zhu ◽

Zhan sheng Wang ◽

...

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Clinical Manifestations ◽

Case Series ◽

Lower Abdominal Pain ◽

Diffuse Peritonitis ◽

Elderly Age ◽

Ct Examination ◽

Case Series Study ◽

Enhanced Ct

Abstract Background: Accidentally swallowed date kernels are high risk factors for enterobrosis. Most patients showed no obvious symptoms at the beginning but later developed lower abdominal pain, which should be differentiated with acute appendicitis, especially in elder patients without a clear medical history. This study investigated the clinical features, diagnosis and treatment of enterobrosis caused by accidentally swallowed kernel of Chinese date in adults. Methods: A retrospective analysis was performed on 14 cases of adult patients suffered from date kernel - induced enterobrosis during June 2016 to June 2019. All these patients received treatment in the first hospital of China medical university. Results: Eleven female and three male patients were diagnosed, and they were mainly in the middle to elderly age, with 12/14 patients (86%) above 50 years old. The main clinical manifestations were abdominal pain, with onset times from seven hours to four days, and all patients visited the emergency department. Physical signs of local or diffuse peritonitis were presented as guarding tenderness, rebounding, and increased rigidity. Through full-abdominal enhanced CT examination, high density linear objects were identified at the terminal or distal ileum segments in 11/14 (78%) patients. During emergent laparotomy, enterobrosis were found in all patients. Secondary perforations were also detected in 6/14 (42%) patients on the opposing side of the first puncturing sites. The fusiform kernels with two sharp tips were extracted by minimal enterotomies in 13 patients. In one patient with colonic perforation, sigmoid colostomy was performed. All patients were cured and 93% of them were discharged within two weeks. Conclusions: Full-abdominal enhanced CT examination is of great diagnostic value for the intestinal perforation caused by date kernels, and patients can benefit from early surgical treatment after definite diagnosis. Thorough exploration should be performed to detect whether a second perforation was formed on the contrary site of first piercing site. Caution should be taken to void “blind dates” ingestion, and special tools such as seeders and slicers are recommended to removal kernels in advance, thus prevent the potential killing threats of enterobrosis.

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Clinicopathological evaluation of acute appendicitis and the role of ultrasound in diagnosis: a prospective study

International Surgery Journal ◽

10.18203/2349-2902.isj20191560 ◽

2019 ◽

Vol 6 (5) ◽

pp. 1471

Author(s):

Tony Mathew ◽

Amit Shivshankar Ammanagi

Keyword(s):

Acute Appendicitis ◽

Positive Predictive Value ◽

Prospective Study ◽

Negative Predictive Value ◽

Predictive Value ◽

Scoring System ◽

Lower Abdominal Pain ◽

Negative Appendicectomy ◽

A Prospective Study

Background: Acute appendicitis is the most common acute surgical condition of the abdomen. Delay in treatment of acute appendicitis causes lot of complication. Study was done with the objective to study the clinical and pathological presentations of acute appendicitis, to evaluate the role of ultrasound in early diagnosis of acute appendicitis and to reduce negative appendicectomy in patients.Methods: This is a prospective study done on 100 patients with acute right lower abdominal pain clinically presumed to be of appendicular origin. A thorough history, clinical examination and ultrasound scan, was done for all cases. All ultrasound positive cases were subjected to surgery and some negative cases were also taken for surgery based on clinical suspicion. The ultrasound diagnosis was compared with clinical findings, operative findings and histopathological examination reports.Results: The overall accuracy of clinical diagnosis (Alvarado scoring system) with histopathology findings was 72%. The overall sensitivity and specificity was 70.3% and 81.3% respectively and positive predictive value of was 95.2% whereas the negative predictive value was 34.2%. The overall accuracy of ultrasound with histopathology report was 93%, with a sensitivity of 96.4%, specificity of 75%, and a positive predictive value of 95% and a negative predictive value of 80%. Negative appendicectomy rate was 8.82% in females and 3.63% in males.Conclusions: The Alvarado scoring system combined with ultrasound can therefore be used as a cheap and inexpensive way of confirming acute appendicitis thus reducing negative appendicectomy rate.

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