scholarly journals Appendiceal Malignancy: The Hidden Risks of Nonoperative Management for Acute Appendicitis

2019 ◽  
Vol 85 (2) ◽  
pp. 223-225
Author(s):  
Kristen M. Westfall ◽  
Rebecca Brown ◽  
Anthony G. Charles
Keyword(s):  
Acute Appendicitis ◽  
Nonoperative Management ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Standard Of Care ◽  
Operative Management ◽  
Adult Patients ◽  
Appendiceal Cancer ◽  
Retrospective Case ◽  
Appendiceal Neoplasm

One potential harm of nonoperative management for acute appendicitis is missed appendiceal cancer, a rare and often aggressive malignancy due to the frequency of late stage of diagnosis. Previous studies have reported an increasing incidence of appendiceal neoplasms in the population. This is a retrospective case–control study of 1007 adult patients, who presented to the University of North Carolina-Memorial Hospital (UNC-MH) between 2011 and 2015 with clinical signs and symptoms of appendicitis. We evaluated the incidence of primary appendiceal cancer in this population and determined factors that predict appendiceal cancer diagnosis using multi-variate logistic regression analysis. The overall incidence of appendiceal neoplasm for adult patients presenting to UNC-MH with appendicitis from 2011 to 2015 was 2.3 per cent (23/1007). The incidence in patients without appendiceal perforation on pathology was 1.9 per cent (16/832). Age (odds ratio (OR) 1.03), number of days of abdominal pain (OR 1.16), self-reported fever (OR 2.08), appendiceal width (OR 1.95), and appendiceal wall thickness (OR 1.30) were predictors of appendiceal neoplasm diagnosis in patients that present with acute appendicitis. We recommend that an operative approach to acute appendicitis should remain the standard of care because operative management may not only be diagnostic but potentially therapeutic.

scholarly journals Appendicitis in puerpeium: Case report

2011 ◽  
Vol 58 (4) ◽  
pp. 111-112 ◽  
Author(s):  
Milica Berisavac ◽  
Biljana Kastratovic-Kotlica ◽  
V. Tosic ◽  
N. Markovic ◽  
S. Ljustina ◽  
...  
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Early Detection ◽  
Acute Appendicitis ◽  
Abdominal Wall ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Laboratory Infection ◽  
Infection Parameters ◽  
Clinical Signs And Symptoms

Acute appendicitis in puerperium is often diagnosed too late, because clinical signs can be unrelaible. Abdominal wall rigidity is rarely noticed in puerpeium because of weak abdominal wall muscles, laboratory parameters are not enough relaible and atipycal appendix presentation makes difficulties in diagnosis3,4. Knowing clinical signs and symptoms of appendicitis, possible complications and their early detection, make a chance for a good surgical outcome. Measuring of axillar and rectal temperature can take confusion in, and prolong time until surgical treatment. Leucocytosis in puerperium is not valid for diagnosis. We report a case of patient in puerperium with high laboratory infection parameters. Diagnosis of appendicitis is made based on clinical signs and symptoms, that is proved intraoperatively and histologicaly. Appendectomy without perforation carries less risks for mother and fetus.

Abdominal Pain

2018 ◽  
pp. 327-331
Author(s):  
Elizabeth DeVos
Keyword(s):  
United States ◽  
Signs And Symptoms ◽  
Standard Of Care ◽  
Clinical Decision ◽  
Operative Management ◽  
The United States ◽  
Potential Utility ◽  
Treatment Protocols ◽  
Common Presentation ◽  
Treatment Risks

This case demonstrates a common presentation of appendicitis including frequent signs and symptoms and classic examination findings. Options for diagnostic imaging are reviewed. Clinical decision scores may assist in risk stratification, which may be particularly useful in austere or low-resource settings. The discussion introduces the concept of “antibiotics first” treatment for appendicitis including a discussion of patients who are poor candidates for such treatment, risks for need of future operative management, and proposed treatment protocols. While surgical management remains the standard of care in the United States, this case discusses potential utility for an “antibiotics first” protocol when definitive surgical treatment is not readily available.

scholarly journals Hyperbilirubinemia as a predictor of the severity of acute appendicitis - an observational study

2017 ◽  
Vol 4 (4) ◽  
pp. 1341 ◽  
Author(s):  
Sadhan Kumar Cheekuri ◽  
Alok Mohanty ◽  
T. Ganesh ◽  
R. Kannan ◽  
Robinson Smile
Keyword(s):  
Observational Study ◽  
Acute Appendicitis ◽  
Serum Bilirubin ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Complicated Appendicitis ◽  
Total Serum ◽  
P Value ◽  
Predictive Capacity ◽  
Computed Tomography Scanning

Background: Appendicitis is the most common acute abdominal condition requiring emergency surgery, with a lifetime risk of 6%. Appendectomy continues to be one of the commonest procedures in general surgery, accounts for approximately 1% of all surgical operation. Despite the increased use of ultrasonography, computed tomography scanning and laparoscopy, the rate of misdiagnosis of appendicitis has remained constant (15.3%). The aim of this study was to whether Serum Bilirubin can be considered as a new laboratory marker to aid in the diagnosis of acute appendicitis and if so, does it have the predictive capacity to warn us about complicated appendicitis.Methods: This was prospective observational study done in Mahatma Gandhi Medical College and Research Institute, Pondicherry between November 2014 and August 2016. About 110 patients of acute appendicitis who had undergone appendicectomy were studied. Data was collected and analyzed critically.Results: Males 66 (60%) outnumbered females 44 (40%) and overall mean age was 26.61±12.37 years. Of the 110 patients, 9% were normal appendix, 59.09% were confirmed as acute appendicitis while 31.81% were diagnosed with complicated appendicitis on biopsy. The Sensitivity and Specificity of serum bilirubin as a marker in predicting Acute appendicitis and complicated appendicitis was 47.6% and 90.9% respectively. Similarly, the Positive predicative value and Negative predicative value for the same was 88.5% and 61.5% respectively with odds ratio 12.4 with significant p value <0.0001.Conclusions: Serum bilirubin is easily available test and cheap and can be estimated from the sample of blood drawn for routine blood investigations. Patients with clinical signs and symptoms of appendicitis and with hyperbilirubinemia should be identified as having a higher probability of complicated appendicitis. Hence, serum bilirubin levels have a predictive potential for the diagnosis of severity of acute appendicitis and need for early appendicectomy. If total serum bilirubin is added to already existing laboratory tests, then the diagnosis of complicated appendicitis in clinically suspected cases can be made with fair degree of accuracy, the need for CECT and MRI can be reduced and unnecessary delay in appendicectomy can be avoided.

scholarly journals Clinical symptoms, paraclinical tests and histopathological results in children with acute appendicitis in Zabol southeast of Iran: a cross-sectional study

2017 ◽  
Vol 5 (7) ◽  
pp. 2836
Author(s):  
Mehran Hesaraki
Keyword(s):  
Acute Appendicitis ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Cross Sectional Study ◽  
Intestinal Loop ◽  
Negative Appendectomy ◽  
Sectional Study ◽  
Cross Sectional ◽  
Clinical Signs And Symptoms ◽  
Histopathological Results

Background: This article aimed to assessment clinical signs and symptoms, paraclinical tests and histopathological results in children with acute appendicitis.Methods: A cross-sectional study conducted on 100 children with acute appendicitis in an urban hospital in southeast of Iran from January to December 2016. Participants were selected by simple random sampling method. Clinical signs and symptoms, paraclinical tests and histopathological results recorded in checklists. The data were analyzed using SPSS 22.Results: Mean age of the patients was 10.26±3.25, fourthly-eight of patients (58.5%) were males and 34 patients (41.5%) were females. The most frequent clinical signs and symptoms were acute suppurative appendicitis with peri appendicitis (45.83%) and acute suppurative appendicitis (39.58%). The most frequent results in ultrasound reports were Intestinal loop thickness greater than 6 mm without peristalsis (positive report) (46.34%) and Invisible appendix (nega Hesaraki tive report) (13.41%).Conclusions: The results of this study showed that abdominal pain and RLQ tenderness were the most common signs and symptoms and WBC left-shift was the most common laboratory finding. Since the rate of negative appendectomy in this study was consistent with surgical results and other articles, it is concluded that diagnostic accuracy of preoperative appendectomy was acceptable and most children with acute appendicitis underwent appendectomy.

scholarly journals Splenic trauma in the twenty-first century: changing trends in management

2018 ◽  
Vol 100 (8) ◽  
pp. 650-656 ◽  
Author(s):  
P Roy ◽  
R Mukherjee ◽  
M Parik
Keyword(s):  
Nonoperative Management ◽  
Standard Of Care ◽  
Operative Management ◽  
Diagnostic Techniques ◽  
Splenic Trauma ◽  
Spleen Preserving ◽  
Changing Trends ◽  
Pubmed Database ◽  
Blunt Splenic Trauma ◽  
Patient Selection Criteria

Over the past three decades, management of blunt splenic trauma has changed radically. Use of improved diagnostic techniques and proper understanding of disease pathology has led to nonoperative management being chosen as the standard of care in patients who are haemodynamically stable. This review was undertaken to assess available literature regarding changing trends of management of blunt splenic trauma, and to identify the existing lacunae in nonoperative management.The PubMed database was searched for studies published between January 1987 and August 2017, using the keywords ‘blunt splenic trauma’ and ‘nonoperative management’. One hundred and fifty-three articles were reviewed, of which 82 free full texts and free abstracts were used in the current review.There is clear evidence in published literature of the greater success of nonoperative over operative management in patients who are haemodynamically stable and the increasing utility of adjunctive therapies like angiography with embolisation. However, the review revealed a lack of universal guidelines for patient selection criteria and diagnostic and grading procedures needed for nonoperative management. Indications for splenic artery embolisation, the current role of splenectomy and spleen-preserving surgeries, together with the place of minimal access surgery in blunt splenic trauma remain grey areas. Moreover, parameters affecting the outcomes of nonoperative management and its failure and management need to be defined. This shows a need for future studies focused on these shortcomings with the ultimate aim being the formulation and implementation of universally accepted guidelines for safe and efficient management of blunt splenic trauma.

scholarly journals The Dynamics of Inflammatory Markers in Patients with Suspected Acute Appendicitis

Medicina ◽  
2021 ◽  
Vol 57 (12) ◽  
pp. 1384
Author(s):  
Ąžuolas Algimantas Kaminskas ◽  
Raminta Lukšaitė-Lukštė ◽  
Eugenijus Jasiūnas ◽  
Artūras Samuilis ◽  
Vytautas Augustinavičius ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Inflammatory Mediators ◽  
Inflammatory Markers ◽  
Laboratory Tests ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Significant Difference ◽  
Wbc Count ◽  
Suspected Acute Appendicitis

Background: Laboratory tests of inflammatory mediators are routinely used in the diagnosis of acute appendicitis (AA). The aim of this study was to evaluate the differences of dynamics of inflammatory markers of the blood in patients with suspected acute appendicitis between complicated AA (CAA), non-complicated AA (NAA), and when AA was excluded (No-AA). Methods: This was a retrospective analysis of prospectively collected data of patients presented to the Emergency Department (ER) of a tertiary hospital center during a three-year period. All patients suspected of acute appendicitis were prospectively registered from 1 January 2016 to 31 December 2018. The dynamics of inflammatory markers of the blood between different types of AA (No-AA, NAA or CAA) during different periods of time are presented. Results: A total of 453 patients were included in the study, with 297 patients in the No-AA group, 99 in the NAA group, and 57 in the CAA group. White blood cell (WBC) count in the No-AA decreased with time, with a statistically significant difference between the <8 h and 25–72 h group. The neutrophils (NEU) percentage decreased in the No-AA group and was statistically significantly different between the <8 h and 25–72 h and <8 h and >72 h groups. C-reactive protein (CRP) increased significantly in the No-AA group throughout all time intervals, and from the first 24 h to the 25–72 h in the NAA and CAA groups. There was a statistically significant difference between the WBC count between No-AA, NAA, and No-AA and CAA groups during the first 24 and 24–48 h. There was a statistically significant difference between NEU percentage and LYMP percentage and in the NEU/LYMP ratio between No-AA and CAA groups through all time periods. CRP was significantly higher in the first 24 h in the CAA than in the No-AA group, and in the 24–48 h in the CAA group than in the No-AA and NAA groups. The linear logistic regression model, involving inflammatory mediators and clinical characteristics, showed mediocre diagnostic accuracy for diagnosing AA with an AUC of 0.737 (0.671–0.802). Conclusions: Increasing concentrations of inflammatory markers are more characteristic in CAA patients than in No-AA during the first 48 h after onset of the disease. A combination of laboratory tests with clinical signs and symptoms has a mediocre diagnostic accuracy in suspecting AA.

scholarly journals What Is High Enough? Elevated NT-pro-BNP in Decompensated Paroxysmal Supraventricular Tachycardia

2017 ◽  
Vol 07 (01) ◽  
pp. 049-053
Author(s):  
Clayton Womack ◽  
L. Lutherer ◽  
Christopher Todd ◽  
Kerrie Pinkney ◽  
Thivakorn Kasemsri ◽  
...  
Keyword(s):  
Heart Failure ◽  
Supraventricular Tachycardia ◽  
Natriuretic Peptide ◽  
Clinical Signs ◽  
Case Series ◽  
Signs And Symptoms ◽  
Decompensated Heart Failure ◽  
Adult Patients ◽  
Cardiac Monitoring ◽  
Paroxysmal Supraventricular Tachycardia

AbstractSince the late 1980s, elevated atrial natriuretic peptide (ANP) was considered the cause of brisk diuresis in adult patients with paroxysmal supraventricular tachycardia (PSVT). Pro-brain natriuretic peptide (pro-BNP) and related molecules, e.g., N-terminal pro b-type natriuretic peptide (NT-pro-BNP) are known biomarkers of heart failure in adult patients from many causes with probable relevance in children. Perhaps, pro-BNP or related molecules such as NT-pro-BNP are useful in the management of PSVT in infants, thus hastening treatment in children who may otherwise significantly decompensate. Case series of one infant and two neonates presenting with cardiogenic shock and evidence of heart failure are presented. Cardiac monitoring or electrocardiogram (ECG) confirmed the presence of PSVT. Adenosine was administered resulting in successful chemical cardioversion with each case. Significantly elevated NT-pro-BNP levels correlated with heart failure prior to cardioversion. In each case, patients were discharged home with lower NT-pro-BNP levels and maintenance with a β-blocker. Due to documented relationships between elevated pro-BNP level and heart failure in adults, the authors measured the related biomarker NT-pro-BNP in each case, as the relationship could be similar in pediatric PSVT. Based on our experience with children in acute heart failure from other causes, NT-pro-BNP can increase to potentially extreme levels in infants. It appears to correlate with clinical signs of insufficient cardiac output, such as tachycardia, respiratory distress, and moribund appearance. Indeed, in the case series, extremely high NT-pro-BNP values were obtained when the patients appeared moribund from decompensated PSVT. The question arising from these observations is: At what level of elevated NT-pro-BNP, would patients be identified for cardioversion prior to appearance of other signs and symptoms? For each patient within the case series, NT-pro-BNP levels of approximately 20,000 pg/mL were indicative of decompensated heart failure, which was subsequently confirmed by examination of the patient. Further investigation is needed to determine the clinical significance of NT-pro-BNP and related peptides in pediatric patients with PSVT and intermittent PSVT. However, the possibility exists that an increase in NT-pro-BNP and related peptides could be a biomarker for cardiac decompensation after prolonged or intermittent PSVT, thereby shortening the time of diagnosis and intervention, and hence, potentially preventing morbidity, mortality, and extended hospitalization. Additional evidence-based research would help provide biomarker information during PSVT allowing practitioners to more objectively analyze risks.

scholarly journals Clinical signs and symptoms of adult patients with intracranial arachnoid cysts

2015 ◽  
Vol 12 (Suppl 1) ◽  
pp. O37
Author(s):  
Katrin KM Rabiei ◽  
Roberto Medina ◽  
Mats Högfeldt ◽  
Per Hellström ◽  
Carsten Wikkelsö ◽  
...  
Keyword(s):  
Clinical Signs ◽  
Signs And Symptoms ◽  
Adult Patients ◽  
Arachnoid Cysts ◽  
Clinical Signs And Symptoms

scholarly journals Appendiceal diverticulosis: Asymptomatic positive FDG-PET uptake in the appendix should prompt operative management

2021 ◽  
pp. 256
Author(s):  
Keyword(s):  
Acute Appendicitis ◽  
Complication Rate ◽  
Fdg Pet ◽  
Operative Management ◽  
Pet Scan ◽  
Appendiceal Neoplasm ◽  
First Case

Appendiceal diverticulosis is rarely diagnosed and presentation mimics acute appendicitis. It has a documented high malignant risk and increased complication rate and excision is recommended if suspected preoperatively. We report a case of an incidental FDG avid appendiceal lesion on PET scan which was suspected to be an appendiceal neoplasm, however histologically was appendiceal diverticulosis. This is the first case of appendiceal diverticulosis detected via PET scan and we discuss the implications of this.

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