Acute Appendicitis: An Extracolonic Manifestation of Clostridium difficile Colitis

The current report is the case of a 30-year-old male patient who presented with symptomatology suggestive of appendicitis. However, careful history-taking and laboratory tests led to the diagnosis of Clostridium difficile colitis, resulting in successful nonsurgical management of this patient. Although both appendicitis and C. difficile colitis are common conditions, they are rarely diagnosed concurrently. This is reflected by paucity of literature describing this manifestation. Given this current presentation, the authors contend that the manifestation of extracolonic colitis within the appendix is possibly underdiagnosed or misdiagnosed as an acute appendicitis and thus potentially results in unnecessary surgical intervention. This report reminds physicians to consider the medical approach to managing acute appendicitis given the possibility of underlying C. difficile colitis as the causative factor.

Download Full-text

Surgical intervention in fulminant Clostridium difficile colitis

Gastroenterology ◽

10.1016/s0016-5085(01)82352-0 ◽

2001 ◽

Vol 120 (5) ◽

pp. A474-A474

Author(s):

R DALLAL ◽

K LEE ◽

R SIMMONS

Keyword(s):

Clostridium Difficile ◽

Surgical Intervention ◽

Clostridium Difficile Colitis

Download Full-text

Internationally Adopted Children and Cytomegalovirus

PEDIATRICS ◽

10.1542/peds.84.5.937 ◽

1989 ◽

Vol 84 (5) ◽

pp. 937-937

Author(s):

LESLIE L. BARTON ◽

ALLAN D. FRIEDMAN

Keyword(s):

Primary Infection ◽

Laboratory Tests ◽

Adopted Children ◽

Test Results ◽

History Taking ◽

Women Of Childbearing Age ◽

Childbearing Age ◽

Income Groups ◽

Internationally Adopted Children ◽

Careful History

We read with interest the article by Hostetter et al in Pediatrics and the companion article in American Journal of Diseases of Children. Although we agree with the need for careful history taking, physical examination, and selected screening laboratory tests for these (and all) children, we cannot agree with the recommendation for routine urine cultures for cytomegalovirus. More than one half of women of childbearing age in upper income groups have seronegative test results and, thus, are at risk for primary infection with cytomegalovirus.

Download Full-text

Parameters for a Knowledge Base for Acute Appendicitis

Methods of Information in Medicine ◽

10.1055/s-0038-1635012 ◽

1994 ◽

Vol 33 (02) ◽

pp. 220-226 ◽

Cited By ~ 4

Author(s):

J. Ikonen ◽

M. Juhola ◽

M. Eskelinen ◽

E. Pesonen

Keyword(s):

Decision Making ◽

Expert System ◽

Acute Appendicitis ◽

Surgical Intervention ◽

Acute Abdominal Pain ◽

History Taking ◽

Research Committee ◽

Common Cause ◽

The World ◽

World Organization

Abstract:Acute appendicitis is the most common cause of acute abdomen requiring surgical intervention. The clinical diagnosis of acute appendicitis is not always easy due to variable symptomatology, particularly at the onset. The contributions of history-taking and physical examination in the diagnosis of acute appendicitis was studied in connection with the Research Committee of the World Organization of Gastroenterology (OMGE) survey of acute abdominal pain. Especially the suitability of diagnostic parameters in the construction of an expert system for automatic decision making was studied. The results clearly show that it is possible to construct an expert system for automatic decision making in the diagnosis of acute appendicitis.

Download Full-text

Acute Appendicitis in the Setting of Clostridium difficile Colitis: Case Report and Review of the Literature

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2007.04.016 ◽

2007 ◽

Vol 5 (8) ◽

pp. 969-971 ◽

Cited By ~ 13

Author(s):

Thomas A. Brown ◽

Lakshmi Rajappannair ◽

Arthur B. Dalton ◽

Ram Bandi ◽

Joseph P. Myers ◽

...

Keyword(s):

Case Report ◽

Clostridium Difficile ◽

Acute Appendicitis ◽

Review Of The Literature ◽

Clostridium Difficile Colitis

Download Full-text

Patience is a Virtue: An Argument for Delayed Surgical Intervention in Fulminant Clostridium difficile Colitis

The American Surgeon ◽

10.1177/000313481408000628 ◽

2014 ◽

Vol 80 (6) ◽

pp. 614-619 ◽

Cited By ~ 3

Author(s):

Jesse Clanton ◽

Ryan Fawley ◽

Nairmeen Haller ◽

Timothy Daley ◽

Joel Porter ◽

...

Keyword(s):

Risk Factors ◽

Clostridium Difficile ◽

Surgical Intervention ◽

Therapeutic Option ◽

Laboratory Data ◽

Admission Diagnosis ◽

Traditional Teaching ◽

Factors Associated ◽

Clostridium Difficile Colitis ◽

Vasopressor Use

Recently, the incidence and severity of Clostridium difficile infection (CDI) has increased. In cases of fulminant infection, surgery is a viable therapeutic option but associated with high mortality. We sought to examine factors associated with mortality in a large sample of patients with severe CDI that underwent surgery. A retrospective study was conducted in patients with severe CDI undergoing colectomy. Demographics, risk factors, comorbidities, clinical and laboratory data, and time between admission/diagnosis of CDI and colectomy were collected. Conventional markers of severity were evaluated as predictors of mortality. Sixty-four cases were included for analysis. The overall observed mortality rate was 45.3 per cent. Few conventional markers of severity were significantly associated with mortality. Risk factors that correlated with postsurgical mortality were vasopressor use (odds ratio, 3.08; 95% confidence interval, 1.00 to 9.92) and shorter time between diagnosis and surgery (median time, 2 vs 3 days, P = 0.009). This study suggests that a delay in surgery after diagnosis of severe CDI may improve overall outcomes. The finding regarding timing of surgery is contrary to traditional teaching and may be the result of improved medical treatment and stabilization before surgery. Consideration should be given to the importance of timing of colectomy in fulminant CDI, whereas prospective studies should be conducted to elucidate causal relationships.

Download Full-text