Clinical and laboratory findings in the diagnosis of right lower quadrant abdominal pain: outcome analysis of the APPAC trial

2016 ◽  
Vol 54 (10) ◽  
Author(s):  
Elina Lietzén ◽  
Imre Ilves ◽  
Paulina Salminen ◽  
Hannu Paajanen ◽  
Tero Rautio ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Antibiotic Treatment ◽  
Roc Curves ◽  
Multicenter Trial ◽  
Clinical Findings ◽  
Outcome Analysis ◽  
Laboratory Findings ◽  
Duration Of Symptoms ◽  
Lower Quadrant ◽  
Wbc Count

AbstractBackground:The current research on acute appendicitis aims to improve the diagnostics and to clarify to whom antibiotic treatment might be the treatment of choice.Methods:The present study is a retrospective analysis of a prospectively collected data in our randomized multicenter trial comparing surgery and antibiotic treatment for acute uncomplicated appendicitis (APPAC trial, NCTO1022567). We evaluated 1321 patients with a clinical suspicion of acute appendicitis, who underwent computed tomography (CT). Age, gender, body temperature, pain scores, the duration of symptoms, white blood cell count (WBC) and C-reactive protein (CRP) were recorded on admission.Results:CT confirmed the diagnosis of acute appendicitis in 73% (n=970) and in 27% (n=351) it revealed no or other diagnosis. Acute appendicitis patients had significantly higher WBC levels than patients without appendicitis (median 12.2 and 10.0, respectively, p<0.0001), whereas CRP levels did not differ between the two groups. Ideal cut-off points were assessed with receiver operating characteristic (ROC) curves, but neither these markers or neither their combination nor any clinical characteristic could accurately differentiate between patients with acute appendicitis and those without. The proportion of patients with normal WBC count and CRP was significantly (p=0.0007) lower in patients with acute appendicitis than in patients without appendicitis.Conclusions:Both clinical findings and laboratory tests are unable to reliably distinguish between patients with acute appendicitis and those without. If both WBC count and CRP are normal, acute appendicitis is very unlikely. The current results emphasize the role of CT imaging in patients with suspected acute appendicitis.

Follow-up of Osteomyelitis of Infants with Systemic Serum Parameters and Bone Scintigraphy

1996 ◽  
Vol 35 (04) ◽  
pp. 116-121 ◽  
Author(s):  
G. E Fueger ◽  
M. Vejda ◽  
R. M. Aigner
Keyword(s):  
Bone Scintigraphy ◽  
Antibiotic Treatment ◽  
Diagnostic Value ◽  
Clinical Findings ◽  
Laboratory Findings ◽  
Radiographic Findings ◽  
Serum Parameters ◽  
Wbc Count ◽  
Differential White Blood Cell

Summary Aim: To prevent orthopedic sequelae in acute hematogenous pyogenic osteomyelitis (AHPO) of infants early diagnosis, recognition of recurrence and effective therapy is needed. This retrospective study of 47 infants with bacteriologically confirmed AHPO concerned with an analysis of the diagnostic value of systemic serum parameters compared to bone scintigraphy (BSC). Methods: AHPO was characterized initially and during the course of disease by clinical findings, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), total and differential white blood cell (WBC) count, BSC, and plain radiography. Results: CRP was the most effective serum parameter for follow- up of disease. The first sign of BSC to signal adequate response to antibiotic treatment was the decrease or normalization of hyperperfusion. Escape from therapy or poor prognosis, even when the serum parameters were normalized, was signaled by the recurrence of focal hyperperfusion and the persistent or increasing local uptake ratios on the 3-h-image over 6 weeks during a course of antibiotic treatment. Conclusion: Antibiotic treatment masks the clinical presentation, and the radiographic findings, causes non-characteristic laboratory findings, but do not prevent the scintigraphic visualization; BSC and serum parameters used in the right completion are the most successful and efficient modalities for follow-up of AHPO. Maintenance of antibiotic therapy should be done until BSC findings have reverted to normal.

Risk factors Associated in Acute Appendicitis in Pregnancy

2020 ◽  
Vol 16 ◽  
Author(s):  
Mojtaba Ahmadinejad ◽  
Seyed Mozaffar Hashemi ◽  
Mahnaz Jamee
Keyword(s):  
Acute Appendicitis ◽  
Pregnant Women ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Laboratory Findings ◽  
Lower Quadrant ◽  
Rebound Tenderness ◽  
Abnormal Increase ◽  
Clinical Indices ◽  
Wbc Count

Backgrounds:: Acute appendicitis has been considered as the most common non-obstetric indication, that requires surgical intervention in pregnant women. Objective: The aim of this study is to compare clinical manifestations and para-clinical indices between pregnant and non-pregnant patients whom underwent appendectomy. Methods:: In this prospective cohort study, 57 pregnant and non-pregnant women, presenting appendicitis, were compared in terms of diagnostic indicators, histopathological characteristics and laboratory findings. Results:: Periumbilical region was the point of initiation of the pain, however, was more prominent in non-pregnant women. Similarly, tenderness in RLQ (right lower quadrant) of abdomen was more detectable in non-pregnant group and some of the cases has no rebound tenderness. Pregnant women with appendicitis were presented abnormal increase in WBC count. Conclusion:: Pregnancy and appendicitis-related signs and symptoms have similarity among them. Due to pregnancy, physical examination might not present exact diagnosis, therefore, pregnant women, susceptible have appendicitis must undergo complete and careful on-time examination that includes; ultrasound and labs.

Improving diagnosis of acute appendicitis with atypical findings by Tc-99m HMPAO leukocyte scan

2002 ◽  
Vol 41 (01) ◽  
pp. 37-41 ◽  
Author(s):  
S. Shung-Shung ◽  
S. Yu-Chien ◽  
Y. Mei-Due ◽  
W. Hwei-Chung ◽  
A. Kao
Keyword(s):  
Acute Appendicitis ◽  
False Positive ◽  
False Positive Rate ◽  
Accurate Method ◽  
Clinical Findings ◽  
Pathological Findings ◽  
Lower Quadrant ◽  
Predictive Values ◽  
Positive Rate

Summary Aim: Even with careful observation, the overall false-positive rate of laparotomy remains 10-15% when acute appendicitis was suspected. Therefore, the clinical efficacy of Tc-99m HMPAO labeled leukocyte (TC-WBC) scan for the diagnosis of acute appendicitis in patients presenting with atypical clinical findings is assessed. Patients and Methods: Eighty patients presenting with acute abdominal pain and possible acute appendicitis but atypical findings were included in this study. After intravenous injection of TC-WBC, serial anterior abdominal/pelvic images at 30, 60, 120 and 240 min with 800k counts were obtained with a gamma camera. Any abnormal localization of radioactivity in the right lower quadrant of the abdomen, equal to or greater than bone marrow activity, was considered as a positive scan. Results: 36 out of 49 patients showing positive TC-WBC scans received appendectomy. They all proved to have positive pathological findings. Five positive TC-WBC were not related to acute appendicitis, because of other pathological lesions. Eight patients were not operated and clinical follow-up after one month revealed no acute abdominal condition. Three of 31 patients with negative TC-WBC scans received appendectomy. They also presented positive pathological findings. The remaining 28 patients did not receive operations and revealed no evidence of appendicitis after at least one month of follow-up. The overall sensitivity, specificity, accuracy, positive and negative predictive values for TC-WBC scan to diagnose acute appendicitis were 92, 78, 86, 82, and 90%, respectively. Conclusion: TC-WBC scan provides a rapid and highly accurate method for the diagnosis of acute appendicitis in patients with equivocal clinical examination. It proved useful in reducing the false-positive rate of laparotomy and shortens the time necessary for clinical observation.

Acute Appendicitis: The Reliability of Diagnosis by Clinical Assessment Alone

2005 ◽  
Vol 94 (3) ◽  
pp. 201-206 ◽  
Author(s):  
V. Kalliakmanis ◽  
E. Pikoulis ◽  
I. G. Karavokyros ◽  
E. Felekouras ◽  
P. Morfaki ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Clinical Assessment ◽  
Aged Patients ◽  
Duration Of Symptoms ◽  
Lower Quadrant ◽  
Rebound Tenderness ◽  
Local Rigidity ◽  
Long Duration ◽  
Appendiceal Inflammation ◽  
Loss Of Appetite

Background and Aims: This prospective study aimed to review the trustworthiness of the initial clinical assessment in acute appendicitis without employment of imaging modalities, laparoscopy or any other adjunct diagnostic test. Patients and Methods: 717 patients were operated on for appendicitis by six different surgeons. Initial clinical and laboratory examination were evaluated in relation to the intraoperative and the pathological appreciation of the appendiceal inflammation. Results: 598 patients were found to have appendicitis, 34 a different condition, 41 had both appendicitis and an additional condition and 44 no pathology. 6% of the laparotomies and 11 % of the appendectomies were unnecessary. The severity of the inflammation correlated significantly with periumbilical pain, pain migrating to right lower quadrant, loss of appetite, fever, rebound tenderness, local rigidity, polymorphonuclear predominance on deferential, polymorhonucleosis and leukocytosis. Leukocytosis was less frequent in aged patients. All the six surgeons were found to be equally reliable, although they all underestimated the setting compared to the pathologists. Patients with a long duration of symptoms had milder forms of inflammation and increased percentage of unanticipated abdominal conditions. Conclusions: Appendicitis can be reliably diagnosed clinically without employment of adjunct tests. These can be reserved for equivocal cases.

Prognostic significance of sex in childhood B-precursor acute lymphoblastic leukemia: a Pediatric Oncology Group Study.

1998 ◽  
Vol 16 (8) ◽  
pp. 2854-2863 ◽  
Author(s):  
J J Shuster ◽  
P Wacker ◽  
J Pullen ◽  
J Humbert ◽  
V J Land ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Pediatric Oncology ◽  
Lymphoblastic Leukemia ◽  
Prognostic Significance ◽  
Outcome Analysis ◽  
Oncology Group ◽  
Dna Index ◽  
Duration Of Symptoms ◽  
Pediatric Oncology Group ◽  
Wbc Count

PURPOSE In childhood B-precursor acute lymphoblastic leukemia (ALL), possible interactions among sex, time, and widely used prognostic factors (age, WBC count, and DNA index) were investigated for the first 5 years after diagnosis. PATIENTS AND METHODS All eligible patients aged 1 to less than 22 years, registered between February 1986 and September 1994 in two B-precursor ALL studies from the Pediatric Oncology Group (POG), were included in the analysis. Cutpoints for age (3.0, 5.0, and 10.0 years), WBC count (10, 50, and 100 x 10(9)/L), and DNA index (DI; 1.16) were defined. Four time periods after diagnosis (years 1, 2, 3, and 4 and 5 combined) were selected for the study of prognostic significance over time. The cut-off date for analysis was April 1996. RESULTS A total of 3,717 children (2,010 boys and 1,707 girls) were included in the outcome analysis. No major differences between the sexes were observed in age, duration of symptoms before registration, WBC count, hemoglobin level, platelet count, ploidy, presence of CNS disease at diagnosis, or induction failure rate. Event-free survival (EFS) differences between sexes became significantly different from 2 years following diagnosis. At 5 years, in all subsets analyzed, boys fared worse than girls, although not all differences were statistically significant. Major sex differences in EFS were observed in older children (10 to 22 years), in patients with intermediate WBC counts (10 to 50 x 10(9)/ L), and in children who fit both of these subgroups, in whom the 2-year EFS was almost 20% higher in girls than in boys, reaching a 38% difference at 5 years. CONCLUSION This study shows an outcome interaction among sex, time, and commonly used prognostic variables. The important sex difference observed at 2 and 5 years suggests that more intensive consolidation and/or maintenance therapy in some boys with B-precursor ALL should be investigated.

scholarly journals Echoskopijos ir kompiuterinės tomografijos reikšmė diagnozuojant ūminį apendicitą

2003 ◽  
Vol 1 (3) ◽  
pp. 0-0
Author(s):  
Raminta Šydeikienė ◽  
Jūratė Dementavičienė ◽  
Aurelijus Grigaliūnas
Keyword(s):  
Computed Tomography ◽  
Differential Diagnosis ◽  
Acute Appendicitis ◽  
Correct Diagnosis ◽  
Contrast Material ◽  
Clinical Findings ◽  
Lower Quadrant ◽  
Additional Information ◽  
Emergent Surgery ◽  
Suspected Acute Appendicitis

Raminta Šydeikienė1, Jūratė Dementavičienė2, Aurelijus Grigaliūnas11 Vilniaus greitosios pagalbos universitetinė ligoninė,Šiltnamių g. 29, LT-2043 Vilnius,2 Vilniaus universiteto ligoninė "Santariškių klinikos",Santariškių g. 2, LT-2021 VilniusEl paštas: [email protected] Įvadas / tikslas Ūminio apendicito diagnozę dažniausiai galima tiksliai nustatyti pagal klinikinius požymius ir sėkmingai taikyti chirurginį gydymą. Tačiau apie 20–30% operacinių radinių nepatvirtina ūminio apendicito diagnozės – kirmėlinė atauga būna nepakitusi. Todėl neaiškiais klinikiniais atvejais turėtų būti taikomas nuodugnesnis ligonio ištyrimas prieš operaciją, kad galėtume nustatyti skausmo dešiniajame apatiniame pilvo kvadrante priežastį. Mūsų tyrimo tikslas – nustatyti ultragarso (UG) ir kompiuterinės tomografijos (KT) reikšmę diagnozuojant ūminį apendicitą. Ligoniai ir metodai Kiekvienais metais Vilniaus greitosios pagalbos universitetinės ligoninės Bendrosios chirurgijos centre operuojama apie 750 ligonių, kuriems diagnozuojamas ūminis apendicitas. Nuo 2000 m. iki 2003 m. pirmojo pusmečio pabaigos 225 ligoniams, tirtiems ultragarsu, buvo nustatyta ūminio apendicito diagnozė. Mūsų ligoninėje operuoti 193 ligoniai (85,78%), iš jų 101 moteris ir 92 vyrai (amžius nuo 16 iki 80 metų). Rezultatai Iš 225 ligonių, kuriems ultragarsu buvo nustatyta ūminio apendicito diagnozė, mūsų ligoninėje operuoti 193 (85,78%). 32 ligoniams (14,22%) chirurginis gydymas nebuvo taikytas. Operacijos radiniai su UG nesutapo 44 atvejais (22,8%), iš kurių 20 atvejų (10,4%) buvo diagnozuotas katarinis apendicitas, 24 atvejais (12,4%) – kita patologija: divertikulitas, Krono liga, pūlinis adneksitas, aklosios ir storosios žarnų navikai ir kt. 149 ligoniams (77,20%) nustatyta ūminio apendicito diagnozė, iš jų 82 (42,49%) – flegmoninis apendicitas, 25 (12,95%) – gangreninis apendicitas, 42 (21,76%) – gangreninis perforacinis apendicitas ir apendikulinis abscesas. Kompiuterinė tomografija buvo atlikta 43 ligoniams, kuriems ūminio apendicito klinika, subjektyvūs skundai, objektyvių tyrimų duomenys ir ligos eiga buvo ne visai tipiški, o UG tyrimu diagnozė nenustatyta. Šešiolikai ligonių buvo patvirtinta ūminio ar ūminio komplikuoto apendicito diagnozė, 10 ligonių pokyčių nerasta, o 17 ligonių diagnozuotos kitos ligos. Išvados Pilvo dešiniojo apatinio kvadranto skausmą gali sukelti daugelis ūminių ligų. Kai klinikiniai radiniai yra abejotini, turėtų būti atliekamas ultragarsinis tyrimas. Tais atvejais, kai diagnozė lieka neaiški, būtina atlikti pilvo ir dubens kompiuterinę tomografiją. Prasminiai žodžiai: ūminis apendicitas, ultragarsinis tyrimas (UG), sonoskopija, kompiuterinė tomografija (KT). The value of ultrasonography and computed tomography in diagnosing acute appendicitis Raminta Šydeikienė1, Jūratė Dementavičienė2, Aurelijus Grigaliūnas1 Background / objective The purpose of our study was to determine the role of US and CT in differential diagnosis of suspected acute appendicitis. In most cases the clinical findings are reliable for correct diagnosis and emergent surgery due to acute appendictitis. Nevertheless, 20–30% of operation findings do not confirm the diagnosis of acute appendicitis (normal appendix is found). In some cases additional examinations should be done prior to surgery. Patients and methods Every year almost 750 patients with acute appendicitis are operated on at Vilnius University Emergency Hospital. 225 patiens were examined with US for suspected acute appendicitis in the period 2000–half 2003. In 193 cases (85.78%) patients were operated on. Sex: 101 F, 92 M. The age varied from 16 to 80 years. By CT, 43 patients were examined. In all cases helical unenhanced CT was performed, with collimation 8 mm and table feed 12 mm. In the cases when differential diagnosis was necessary, 50 ml of 300 g/ml J nonionic contrast material was injected i/v (by hand). Results For suspected acute appendicitis 225 patients were examined with US. In 193 cases (85.78%) patients were operated on. In 32 cases (14.22%) no emergent surgery was performed in our hospital. The disagreement of findings was in 44 cases (22.8%), where in 20 cases (10.4%) appendicitis catarrhalis and in 24 cases (12.4%) other pathology (coecum, colon tumor, Crohn’s disease, diverticulitis, adnexitis) were found. In 149 cases (77.20%) the diagnosis of acute appendicitis was confirmed, including phlegmonous in 82 cases (42.49%), gangrenous in 25 cases (12.95%), gangrenous perforated and appendiculas abscesses in 42 cases (21.76%). CT revealed acute or acute complicated appendicitis in 16 cases, no changes were found in 10 cases, other diseases were found in 17 cases. Conclusions Acute clinical presentation of the diseases in the right lower quadrant could be caused by a broad spectrum of pathologies.When clinical findings are doubtful, US should be performed. In the case when all data do not confirm the diagnosis, CT is necessary for additional information and correct diagnosis. Keywords: acute appendicitis, ultrasound (US), computed tomography (CT).

scholarly journals Acute appendiceal diverticulitis diagnosed in the postoperative context of appendectomy

2021 ◽  
Vol 8 (3) ◽  
pp. 1004
Author(s):  
Sofia M. Frade ◽  
Ana K. Andrade ◽  
João S. Pimentel ◽  
Luis M. Moniz ◽  
Helder J. Viegas
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Age Groups ◽  
Lower Abdominal Pain ◽  
Vermiform Appendix ◽  
Duration Of Symptoms ◽  
Lower Quadrant ◽  
Appendiceal Diverticulitis ◽  
And Gender ◽  
Histological Result

Acute appendiceal diverticulitis is a rare cause of acute abdomen that is commonly interpreted as acute appendicitis until definitive histological result. We herein present two cases of patients of distinct age groups and gender who presented to the emergency department with right lower quadrant abdominal pain. Laboratory and imaging studies led to the diagnosis of acute appendicitis. In both cases, intraoperative findings were compatible with the initial diagnosis and therefore appendectomy was performed. Later pathological exam showed diverticulitis of the vermiform appendix. Although appendiceal diverticulitis is associated with a higher risk of perforation and neoplasms, both patients had linear postoperative period, without complications or dysplastic findings. Despite its similarities to the acute appendicitis, appendiceal diverticulitis presents itself as a distinct entity and should be suspected in patients with right lower abdominal pain in older age and with longer duration of symptoms.

scholarly journals Solitary Cecal Diverticulitis During Surgery for Acute Appendicitis.

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Rovena Bode ◽  
Eriol Braholli ◽  
Asfloral Haxhiu ◽  
Xheladin Draçini ◽  
Etmont Çeliku
Keyword(s):  
Acute Appendicitis ◽  
Acute Abdomen ◽  
Preoperative Diagnosis ◽  
Acute Diverticulitis ◽  
Right Hemicolectomy ◽  
University Hospital ◽  
Duration Of Symptoms ◽  
Lower Quadrant ◽  
Cecal Diverticulitis ◽  
The Right

Background: Caecal diverticulitis is an unusual condition that presents clinically similar to appendicitis. The diagnosis is not always easy and in the majority of cases, it is usually made at laparotomy. The aim of the present study is to retrospectively report our personal experience with solitary caecal diverticulitis, to determine its incidence in patients presenting as an acute abdomen, as well as identify the symptoms and clinical features that may aid in making a pre-operative diagnosis. And to compare this with a review of the literature, focusing on the surgical treatment and also on the indication of appendectomy in the presence of caecal diverticulitis not requiring surgery. Materials and methods: Data was collected in patients hospitalized for acute appendicitis or acute abdomen, in the surgical emergency unit of University Hospital Center "Mother Teresa" of Tirana, in a period of 3 years (2015-2017). Sex, age, duration of symptoms, preoperative diagnosis, management, intraoperative findings, histologic examination, length of hospital stay and complications of allpatients affected by solitary caecal diverticulitis were reviewed. Results: In the study period, 15 patients presented with a solitary caecal diverticulitis. Most of patients had pain in the right iliac fossa, with a duration of 2–6 days. All patients presented with abdominal pain, additional symptoms were nausea, vomiting and fever. The mean white blood cell count was from 8500-19.200/mm3, while the remaining laboratory results were normal. There were no specific findings on abdominal X-ray or ultrasonography. Intraoperative findings ranged from localized /circumscript peritonitis to generalised peritonitis due to acute diverticulitis and a normal appendix. Surgery ranged from diverticulum resection accompanied to appendectomy, to ileocaecal resection, and right hemicolectomy. Conclusions: Cecal diverticulitis should be included in the differen­tial diagnosis of the cases with pain in the right lower quadrant. Preoperative diagnosis of caecal diverticulitis cannot always be made, since the signs and symptoms are similar to acute appendicitis, but is impor­tant in order to decide how to manage this condition.Diverticulectomy and incidental appendectomy are the preferred method of treatment in uncomplicated cases. Right hemicolectomy is a recommended treatment option in complicated patients or those suspicious for tumor during surgery.

scholarly journals A Patient with an Unusual Cause Right Lower Quadrant Pain and Vomiting: Pyelonephritis of an Ectopic Right Kidney Masquerading as Acute Appendicitis

2009 ◽  
Vol 2009 ◽  
pp. 1-3 ◽  
Author(s):  
Michele N. Lossius ◽  
Carlos E. Araya ◽  
Dwayne D. Henry ◽  
Richard E. Neiberger
Keyword(s):  
Acute Appendicitis ◽  
Surgical Intervention ◽  
Clinical Findings ◽  
Adolescent Female ◽  
Quadrant Pain ◽  
Lower Quadrant Pain ◽  
Lower Quadrant ◽  
Right Lower Quadrant Pain ◽  
The Right ◽  
Right Lower Quadrant

An adolescent female presented with one day of abdominal pain and clinical findings of acute appendicitis. CT scan revealed an ectopic right kidney with changes of acute pyelonephritis. This paper underscores the importance of imaging the right pelvis prior to surgical intervention in suspected cases of acute appendicitis in children.

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