Streptococcal Pharyngitis and Appendicitis in Children

2017 ◽  
Vol 57 (1) ◽  
pp. 36-39
Author(s):  
Jason W. Nielsen ◽  
Stuart A. Abel ◽  
Brian Kenney
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Ultrasound Imaging ◽  
Surgical Intervention ◽  
Streptococcal Pharyngitis ◽  
Negative Appendectomy ◽  
Younger Patients ◽  
Negative Appendectomy Rate ◽  
Rule Out

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.

scholarly journals Endometriosis of the appendix causing small bowel obstruction in a virgin abdomen

2019 ◽  
Vol 12 (7) ◽  
pp. e230496 ◽  
Author(s):  
Joseph Do Woong Choi ◽  
Michael Yunaev
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Oestrogen Receptor ◽  
Surgical Intervention ◽  
Prior History ◽  
Good Recovery ◽  
History Of

A 29-year-old, otherwise well, nulligravid woman presented to the emergency department with 1-day history of generalised abdominal pain and vomiting. She had similar symptoms 6 months prior following recent menstruations, which resolved conservatively. She had no prior history of abdominal surgery or endometriosis. CT scan demonstrated distal small bowel obstruction. A congenital band adhesion was suspected, and she underwent prompt surgical intervention. During laparoscopy, a thickened appendix was adhered to a segment of distal ileum. There was blood in the pelvis. Laparoscopic adhesiolysis and appendicectomy were performed. Histopathology demonstrated multiple foci of endometriosis of the appendix with endometrial glands surrounded by endometrial stroma. Oestrogen receptor and CD10 immunostains highlighted the endometriotic foci. The patient made a good recovery and was referred to a gynaecologist for further management.

scholarly journals Etiologies of abdominal pain emergencies in pediatrics

2021 ◽  
Author(s):  
Hala Atta Youssef ◽  
Aishah Mohammad Alkhaldi ◽  
Manar Mohammed Alshahrani ◽  
Abdullah Tariq Almalki ◽  
Amjad Ali Alahmari ◽  
...  
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Pediatric Patients ◽  
Surgical Intervention ◽  
Acute Abdominal Pain ◽  
Clinical Importance ◽  
Healthcare Settings ◽  
Common Causes ◽  
The Common ◽  
Attending Physicians

Reports showed that children usually complained of acute abdominal pain, which indicated the presence of severe underlying conditions and can have significant clinical importance. Serious challenges have been reported in healthcare settings where an urgent evaluation of the cases was necessary to adequately manage the patient before developing serious complications that might even end up with death. Some of these conditions included intussusception, appendicitis, volvulus and adhesions. Although estimates indicated that only around 1% of pediatric patients with acute abdominal pain usually required surgical intervention, concerns regarding the overlooking and misdiagnosis of significant conditions that might have severe prognostic outcomes were aroused among the different emergency departments. This study reviewed the common causes of acute abdominal pain among children admitted to the emergency department. Our results indicated that various etiologies can develop acute abdominal pain and therefore, establishing an adequate diagnosis by differentiating between the different etiologies should be done by the attending physicians to enhance the outcomes and adequately manage the admitted patients. Gastrointestinal causes of acute abdominal pain were the commonest to cause admissions to the emergency department. However, care should also be provided to the less common conditions, which might include genitourinary and pulmonary disorders and therefore, a thorough examination of children should be provided not to conduct a misdiagnosis of the underlying condition.

scholarly journals Olmesartan Associated Sprue-Like Enteropathy and Colon Perforation

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Mahmoud Abdelghany ◽  
Luis Gonzalez ◽  
John Slater ◽  
Christopher Begley
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Abdominal Pain ◽  
Complete Resolution ◽  
Surgical Intervention ◽  
Severe Abdominal Pain ◽  
Colon Perforation ◽  
Unique Case

We are reporting a unique case of olmesartan associated severe sprue-like enteropathy in a 52-year-old woman who presented to our hospital complaining of severe abdominal pain and nausea. At the emergency department she suffered from a cardiac arrest and was found to have a colon perforation. The patient was treated conservatively without surgical intervention and olmesartan was discontinued. After one month, she had complete resolution of her symptoms.

scholarly journals Perforated Duodenal Diverticulum with Subtle Pneumoretroperitoneum on Abdominal X-Ray

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Yuzeng Shen ◽  
Mark Kwok Fai Leong
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Male Patient ◽  
Surgical Intervention ◽  
Duodenal Diverticulum ◽  
Differential Diagnoses ◽  
X Rays ◽  
Elderly Male ◽  
Hollow Viscus ◽  
X Ray

Abdominal pain is one of the most common presenting complaints at the Emergency Department (ED). Given the myriad of possible differential diagnoses for abdominal pain, it becomes more important to diagnose conditions requiring emergent surgical intervention early. We present a case of an elderly male patient with abdominal pain secondary to perforated hollow viscus, subtle evidence of pneumoretroperitoneum on the initial supine abdominal X-ray, and review the signs of pneumoperitoneum and pneumoretroperitoneum on plain abdominal X-rays.

Caution on Overdiagnosis

PEDIATRICS ◽  
1977 ◽  
Vol 60 (2) ◽  
pp. 261-261
Author(s):  
John B. Reinhart
Keyword(s):  
Abdominal Pain ◽  
Physical Examination ◽  
Surgical Intervention ◽  
X Ray ◽  
Laboratory Procedures ◽  
Careful Physical Examination ◽  
Careful History ◽  
Rule Out

I am writing to comment on the article by Bugenstein and Phibbs, which appeared in the December 1975 issue of Pediatrics (page 1073). I do not question that such herniations do occur and may need surgical intervention on occasion. Whether they cause generalized abdominal pain or cause confusion in diagnosis to the pediatrician or surgeon who takes a careful history and does a careful physical examination is my question. There is already the tendency to make a diagnosis on a "rule out" basis, and, in my opinion, there is excessive use of gastrointestinal x-ray and other laboratory procedures.

scholarly journals 699 Does Pre-Operative Imaging Improve Negative Appendicectomy Rate?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
J Dirie ◽  
N Merali ◽  
A. Maria S Macias
Keyword(s):  
Histological Analysis ◽  
Radiation Risk ◽  
Paediatric Population ◽  
Time Frame ◽  
Negative Appendectomy ◽  
Younger Patients ◽  
Emergency Operations ◽  
Negative Appendectomy Rate ◽  
Negative Appendicectomy ◽  
The Uk

Abstract Aim Appendicectomy is one of the most commonly performed emergency operations. There is no set guideline for an acceptable negative appendectomy rate (NAR) in the UK. Based on previous studies, a NAR of 15-30% is typically accepted. We sought to define our local practice NAR in our initial audit, introduced an appendicitis pathway based on this initial data, and then re-audited to assess whether there had been an improvement in the NAR. Method All emergency appendicectomies carried out over a 1-year period from April 2018 – April 2019 were initially analysed. The subsequent audit analysed data from August 2020 - November 2020, after the pathway had been introduced. Histological analysis was used to determine positive or negative appendicectomy. Results A total of 207 patients had an appendicectomy over the initial 1-year time frame. In our re-audit, 38 patients had an appendicectomy. Demographics were similar in both groups. The NAR increased from 17% to 18%. Conclusions On first glance, the NAR does not seem to have improved. On a closer look, all patients over the age of 18 in our re-audit had a pre-operative CT, and there were no negative appendicectomies in these patients. The issue arises with younger patients, in whom justifying the radiation associated with a CT scan may be difficult. Although ultrasound does not carry the same radiation risk, previous audits at our trust have shown both its sensitivity and specificity for appendicitis is below 50%. We may have to explore alternative imaging modalities in the paediatric population or accept the higher NAR.

scholarly journals Intestinal Obstruction Following Ingestion of Alginate Dental Impression Material

2020 ◽  
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Case Report ◽  
Foreign Body ◽  
Surgical Intervention ◽  
Medical Intervention ◽  
Abdominal Ct ◽  
Distended Bowel ◽  
Ct Evaluation ◽  
Dental Impression

Introduction: No medical intervention is required for emergency department applications resulting from foreign body ingestion. Patients who need intervention are generally with complications such as obstruction, perforation or fistula. Alginate is a non-toxic and non-irritant substance that is elastic in the form of a paste preserving its elasticity under heat, which is used as a printing material for measuring the teeth in dental prosthesis applications . A case of ileus developing as a result of ingestion of alginate impression has been presented. Case report: A 74-year-old male patient presented to our emergency department due to abdominal pain nausea and vomiting . He described periumbilical pain and stated that he felt mild swelling. He had vomit one time and the content of vomit was what he had eaten. On physical examination, his abdomen was slightly distended, bowel sounds had increased slightly on auscultation and there was mild periumbilical tenderness with palpation, with no defence or rebound. On the abdominal CT evaluation, a homogeneous, lobulated, hyperintense foreign body image was detected in the distal ileus and distension in the small bowel loops proximal to the foreign body was interpreted. After general surgery consultation, distal ileal resection was performed and pink, homogenous, slightly soft charactered object was extrected. Later this object was understood to be alginate impression. Conclusion: Elderly patients in particular, ileus may occur due to foreign body associated with dental interventions, and in such cases, patients may need surgical intervention.

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

1995 ◽  
Vol 65 (6) ◽  
pp. 403-405 ◽  
Author(s):  
James Moore ◽  
Dylan Bartholomeusz ◽  
Alan Wycherley ◽  
Peter Devitt ◽  
James Toouli ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Lower Abdominal Pain ◽  
Negative Appendectomy ◽  
Negative Appendectomy Rate

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

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%.

Bedside ultrasound in the emergency department and abdominal pain

2016 ◽  
Vol 37 (S 01) ◽  
Author(s):  
M Algaba Montes ◽  
AÁ Oviedo García ◽  
M Patricio Bordomás
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Bedside Ultrasound
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