scholarly journals Acute appendicitis in pregnancy: literature review

2015 ◽  
Vol 61 (2) ◽  
pp. 170-177 ◽  
Author(s):  
Antônio Henriques de Franca Neto ◽  
Melania Maria Ramos do Amorim ◽  
Bianca Maria Souza Virgolino Nóbrega
Keyword(s):  
Literature Review ◽  
Acute Appendicitis ◽  
Pregnant Women ◽  
Clinical Manifestations ◽  
Imaging Study ◽  
Cochrane Library ◽  
Negative Appendectomy ◽  
Lower Quadrant ◽  
Diagnostic Uncertainty ◽  
Suspected Appendicitis

Introduction: suspected appendicitis is the most common indication for surgery in non-obstetric conditions during pregnancy and occurs in about one in 500 to one in 635 pregnancies per year. This occurs more often in the second trimester of pregnancy. Acute appendicitis is the most common general surgical problem encountered during pregnancy. Methods: a literature review on research of scientific articles, under the terms “acute appendicitis” and “pregnancy”, in PubMed, Lilacs/SciELO, Scopus, Cochrane Library and Uptodate databases. Results: the clinical manifestations of appendicitis are similar to non-pregnant women, however, without a classic presentation, which often occurs, diagnosis is difficult and must be supported by imaging. Discussion: clinical diagnosis should be strongly suspected in pregnant women with classic findings such as abdominal pain that migrates to the right lower quadrant. The main purpose of imaging is to reduce delays in surgical intervention due to diagnostic uncertainty. A secondary objective is to reduce, but not eliminate, the negative appendectomy rate. Differential diagnosis of suspected acute appendicitis usually includes pathologies considered in non-pregnant people. Conclusion: the imaging study of choice is ultrasound, MRI may be used when the former is not conclusive and, as a last resort, a CT scan can be performed. The treatment remains appendectomy by laparotomy, since the feasibility of video- assisted surgery in these cases remains controversial.

Utility of Magnetic Resonance Imaging for the Diagnosis of Appendicitis during Pregnancy: A Canadian Experience

2017 ◽  
Vol 68 (4) ◽  
pp. 392-400 ◽  
Author(s):  
Michael Burns ◽  
Cameron J. Hague ◽  
Patrick Vos ◽  
Pari Tiwari ◽  
Sam M. Wiseman
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Pregnant Women ◽  
Imaging Study ◽  
Retrospective Chart Review ◽  
Resonance Imaging ◽  
Lower Quadrant ◽  
Suspected Appendicitis ◽  
Mri Scans ◽  
Line Imaging

Purpose The objective of the study was to evaluate the performance of magnetic resonance imaging (MRI) for the diagnosis of appendicitis during pregnancy. Methods We conducted a retrospective review of all MRI scans performed at our institution, between 2006 and 2012, for the evaluation of suspected appendicitis in pregnant women. Details of the MRI scans performed were obtained from the radiology information system as well as details of any ultrasounds carried out for the same indication. Clinical and pathological data were obtained by retrospective chart review. Results The study population comprised 63 patients, and 8 patients underwent a second MRI scan during the same pregnancy. A total of 71 MRI scans were reviewed. The appendix was identified on 40 scans (56.3%). Sensitivity of MRI was 75% and specificity was 100% for the diagnosis of appendicitis in pregnant women. When cases with right lower quadrant inflammatory fat stranding or focal fluid, without appendix visualization, were classified as positive for appendicitis, MRI sensitivity increased to 81.3% but specificity decreased to 96.4%. Conclusions MRI is sensitive and highly specific for the diagnosis of appendicitis during pregnancy and should be considered as a first line imaging study for this clinical presentation.

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.

Diagnostic Performance and Reliability of the Standardized Computed Tomography Reporting System for Acute Appendicitis: Experience in a Tertiary Care Academic Center

2021 ◽  
Vol 104 (7) ◽  
pp. 1102-1108
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Diagnostic Performance ◽  
Interobserver Agreement ◽  
Reporting System ◽  
Lower Quadrant ◽  
Suspected Appendicitis ◽  
Diagnostic Certainty

Background: Computed tomography (CT) is generally accepted as a modality of choice for imaging workup in patients with suspected appendicitis. A standardized CT reporting system, CT certainty score, has been proposed to improve diagnostic accuracy and to reduce ambiguous CT reports. Objective: To assess the diagnostic performance and the reliability of the standardized CT reporting system for acute appendicitis in Thai adults. Materials and Methods: The present study was a retrospective data review of 421 adult patients who had CT scans of the appendix between January 2016 and December 2017. The clinical and imaging data were extracted and analyzed. The pathological result was used as a standard of reference. The diagnostic performance and interobserver agreement of the standardized CT reporting system were estimated. Results: One hundred sixty-three patients, with a mean age of 41.7 years, had clinical diagnoses of acute appendicitis. Using standardized CT report, radiologists were highly accurate at diagnosing appendicitis [area under curve (AUC) 0.988 (95% CI 0.98 to 1.00); p<0.001]. The estimated sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 95.1% (95% CI 90.6 to 97.9), 95.7% (95% CI 92.5 to 97.9), 93.4% (95% CI 88.7 to 96.2), 96.9% (95% CI 93.0 to 97.2), 95.5% (95% CI 93.0 to 97.3), respectively. The interobserver agreement was greater than 80% for all binary objective findings and more than 90% agreement on the presence or absence of greater-than-3-mm wall thickness, appendicolith, periappendiceal air, and right lower quadrant fluid collection. The use of CT certainty score had interobserver agreement of 78% (κ=0.69; 95% CI 0.62 to 0.77). Conclusion: Using a standardized CT reporting system yielded a high diagnostic accuracy and high reproducibility of supportive CT findings for appendicitis in at-risk patients. The standardized CT reporting system can improve diagnostic certainty, accuracy, and guide patient management. Keywords: Appendicitis; Certainty score; Computed tomography; Standardized reporting system

scholarly journals Outcome of diagnosed cases of appendicitis and diagnostic accuracy of ultrasound of the appendix

2020 ◽  
Vol 13 (1) ◽  
pp. 56-59
Author(s):  
Bhoj Raj Sharma ◽  
Nawaraj Paudel ◽  
Santwana Parajuli ◽  
Sushma Singh ◽  
Madhu Maya Timilsina
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Surgical Outcome ◽  
Perforated Appendicitis ◽  
College Teaching ◽  
Free Fluid ◽  
Pelvic Cavity ◽  
Negative Appendectomy ◽  
Ultrasound Scan ◽  
Suspected Appendicitis

Background: Acute appendicitis is the most common condition requiring an emergency ultrasound scan as well as surgery. Several scoring systems for acute appendicitis has been suggested to improve diagnostic accuracy and decrease the negative appendectomy rate. In this study, we have evaluated the diagnostic performance of ultrasound on the diagnosis of acute appendicitis, other appendicular pathology, and correlate with surgical outcome. Material and methods: This retrospective study included 776 cases of ultrasound scan reports in which the appendix was visualized and not visualized or equivocal. Data were collected from October 2014 to April 2019 from different department and wards of Gandaki Medical College Teaching Hospital and Research Center (GMCTHRC). All the cases with diagnosed acute appendicitis, appendicular lump, and appendicular abscess were included and were followed for its surgical outcome. The surgical note or post-operative findings served as the reference standard for determining whether perforation was present or not. Result: There were 776 ultrasound scans for suspected appendicitis out of which 423 (54.5%) were diagnosed as appendicular pathology. Out of 423 diagnosed cases, 192 (45.4%) were males and 231 (54.6%) were females, with age ranging from 24 months to 87 years. Sonographic findings, in these positive subjects, suggested acute appendicitis, appendicular lump, abscess, and amount of free fluid in right iliac fossa (RIF) and pelvic cavity. Frank acute appendicitis was present in 378 (89.3%) cases, eight (1.9%) cases had an appendicular abscess, 23 (5.4%) had an appendicular lump and 14 (3.3%) had perforated appendicitis. Conclusion: We conclude that ultrasound is a good modality for visualization of appendicitis with other appendicular pathology. We could follow a structured report and identify pathology more specifically. Ultrasound is an easy and non-invasive test to investigate.  

Can Computed Tomography Scan be Performed Effectively in the Diagnosis of Acute Appendicitis without the Added Morbidity of Rectal Contrast?

2008 ◽  
Vol 74 (10) ◽  
pp. 917-920 ◽  
Author(s):  
Daniel D. Dearing ◽  
Jamesa Recabaren ◽  
Magdi Alexander
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
Ct Scanning ◽  
Ct Scans ◽  
Negative Appendectomy ◽  
Suspected Appendicitis ◽  
Ct Examination ◽  
Preoperative Ct ◽  
Negative Appendectomy Rate ◽  
Pathology Reports

The highest degrees of accuracy have been demonstrated for CT scans using rectal contrast in diagnosing appendicitis. However, the administration of rectal contrast is associated with patient discomfort and rarely, rectosigmoid perforation (0.04%). Additionally, the commonly accepted negative appendectomy rate is around 16 per cent. We performed a retrospective review of radiology, operative, and pathology reports of consecutive patients undergoing appendectomy or CT examination for appendicitis during 2006. CT scans were performed without rectal contrast. The accuracy of each type of inpatient CT examination and negative appendectomy rates were determined. Two hundred and thirty-eight patients underwent appendectomy. One hundred and thirty-four appendectomy patients (56%) received a preoperative CT scan. The negative appendectomy rates were 6.3 per cent overall, 8.7 per cent without CT examination and 4.5 per cent with CT (P = 0.3). Two hundred and forty-five inpatient CT scans were performed for suspected appendicitis with a sensitivity of 90 per cent, specificity of 98 per cent, accuracy of 94 per cent, positive predictive value of 98 per cent, and negative predictive value of 91 per cent. CT scanning without rectal contrast is effective for the diagnosis of acute appendicitis making rectal contrast, with its attendant morbidity, unnecessary. The previously acceptable published negative appendectomy rate is higher than that found in current surgical practice likely due to preoperative CT scanning.

scholarly journals Advantage of ultrasonography in the diagnosis of acute appendicitis at Al-Karama Teaching Hospital

2019 ◽  
Vol 6 (3) ◽  
pp. 702
Author(s):  
Mohammed Hillu Surriah ◽  
Amine Mohammed Bakkour ◽  
Nidaa Ali Abdul Hussain
Keyword(s):  
Acute Appendicitis ◽  
Teaching Hospital ◽  
Predictive Value ◽  
Diagnostic Technique ◽  
Cost Effective ◽  
Cross Sectional Study ◽  
Negative Appendectomy ◽  
Cross Sectional ◽  
Suspected Appendicitis ◽  
Presenting Symptoms

Background: The clinical diagnosis of acute appendicitis remains a challenge to surgeons. Different aids were introduced to improve the diagnostic accuracy. Among these modalities, ultrasonography is simple, easily available, non-invasive, convenient and cost effective. The aim of the study was to determine the validity of ultrasound in diagnosis of the acute appendicitis in those with clinically diagnosed patients.Methods: A cross sectional study was carried out in Al-Karama teaching hospital for thirty months from the period of 1st June 2016 to 1st December 2018. All patients with suspected appendicitis underwent clinical evaluation then sent for US. Results of surgeries, where relevant, were compared against US results. Positive and negative appendices on histopathology were regarded in accordance to the criteria which was negative appendectomy was defined as normal looking appendix and absence of acute inflammation on histopathology while positive cases included appendices showing acute inflammatory changes. Sensitivity, specificity and overall accuracy was calculated.Results: A total of 435 patients with suspected appendicitis, males 224 (51.49%) and females 211 (48.50%) were included in present study. There were no significant differences between patients with positive and negative histopathology findings regarding presenting symptoms. There was a significant association between (cough sign, localized tenderness sign and pointing sign) and patients with positive histopathology findings. Regarding to the validity results of ultrasound in comparison to histopathology findings were  accuracy 87.6%, sensitivity 87.8%, specificity 85.3%, positive predictive value 98.6% and negative predictive value 62.8%.Conclusions: The ultrasonography had a good accuracy, sensitivity and specificity in diagnosing acute appendicitis cases. Negative with ultrasonography results should be re-examined with different diagnostic technique like CT-scan.

scholarly journals Negative Appendectomy Rate in Urban Referral Hospitals in Tanzania: A Cross-sectional Analysis of Associated Factors

2021 ◽  
Vol 18 (2) ◽  
pp. 109-114
Author(s):  
Masawa Klint Nyamuryekung’E ◽  
Ali Athar ◽  
Miten Ramesh Patel ◽  
Aidan Njau ◽  
Omar Sherman ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Associated Factors ◽  
Lifetime Risk ◽  
Histological Evaluation ◽  
Negative Appendectomy ◽  
Perforation Rate ◽  
Alvarado Score ◽  
Suspected Appendicitis ◽  
Referral Hospitals ◽  
Negative Appendectomy Rate

Background: Acute appendicitis (AA) has a lifetime risk of 8.3% with a consequent 23% lifetime risk of emergency appendectomy. In atypical presentation, making a clinical diagnosis is difficult, leading to a high perforation rate (PR) or misdiagnoses and high negativeappendectomy rates (NAR). This study aimed to establish NAR and explore the associated factors and possible attainable solutions to reduce it in urban referral hospitals in Tanzania. Methods: This was a crosssectional study with 91 consecutive patients, aged 10 years and older undergoing appendectomy for  suspected AA with histological evaluation of specimens. The study was powered to detect the NAR at 95% confidence level and 80% power. Results: The histological NAR was 38.5% and the perforation rate was 25.3%. The Alvarado score (AS) was rarely applied (6%), despite ademonstrated ability in this study to decrease the NAR by half. Females were four times more likely to undergo negative appendectomy than males. Conclusion: The NAR is clinically significant as about two out of every five patients undergoing emergency appendectomy for suspected AA do not require the procedure. The AS is underutilized despite a demonstrated ability to decrease the NAR. We recommend that the AS be incorporated in the management of patients with suspected appendicitis. Keywords: Negative appendectomy rate, SubSaharan Africa, Alvarado score, Appendectomy, Suspected acute appendicitis

scholarly journals Acute Appendicitis in Pregnant Women: Our Clinical Experience

2016 ◽  
Vol 39 (6) ◽  
pp. 159 ◽  
Author(s):  
Ahmet Türkan ◽  
Metin Yalaza ◽  
Mehmet Tolga Kafadar ◽  
Gürka Değirmencioğlu
Keyword(s):  
Abdominal Pain ◽  
Surgical Treatment ◽  
Acute Appendicitis ◽  
Pregnant Women ◽  
Laparoscopic Appendectomy ◽  
Open Appendectomy ◽  
Fetal Loss ◽  
University Research ◽  
Lower Quadrant ◽  
Right Lower Quadrant

Purpose: The purpose of this study was to analyse 13 patients who were treated in our clinic due to acute appendicitis during pregnancy. Methods: Records of the patients who received appendectomy with appendicitis diagnosis in our Turgut Özal University Research and Application Hospital between January 2007 and December 2015 have been analyzed retrospectively. Results: Appendectomies were performed on 13 pregnant patients with an acute appendicitis diagnosis. Average age of the patients was 27.69 years (between 22-37 years). Most frequent complaint of the patients was abdominal pain and most frequent examination finding was tenderness at right lower quadrant. Ultrasonography was used in all cases for diagnosis. Surgery was decided with clinical diagnosis for five cases (38.5%) where appendix had not been identified with ultrasonography. While laparoscopic appendectomy was applied in one case (7.7%) and open appendectomy was applied using a McBurney incision in 12 cases (92.3%). Average hospitalization duration was 1.69 days. All patients were tracked together through the Gynaecology Department for two weeks after they had been discharged from the hospital. Preterm delivery, maternal and fetal loss did not occur. Conclusion: It is considered appropriate to apply ultrasonography routinely to all pregnant patients in whom acute appendicitis is suspected. Concern for maternal or fetal complication that may occur in consequence of an unnecessary surgery should not be at a level that will delay surgical treatment needed by the patient.

scholarly journals Community-based distribution of iron–folic acid supplementation in low- and middle-income countries: a review of evidence and programme implications

2017 ◽  
Vol 21 (2) ◽  
pp. 346-354 ◽  
Author(s):  
Justine A Kavle ◽  
Megan Landry
Keyword(s):  
Folic Acid ◽  
Side Effects ◽  
Literature Review ◽  
Pregnant Women ◽  
Cochrane Library ◽  
Community Based ◽  
Middle Income ◽  
Middle Income Countries ◽  
Iron Folic Acid ◽  
Low And Middle Income

AbstractObjectiveThe present literature review aimed to review the evidence for community-based distribution (CBD) of iron–folic acid (IFA) supplementation as a feasible approach to improve anaemia rates in low- and middle-income countries.DesignThe literature review included peer-reviewed studies and grey literature from PubMed, Cochrane Library, LILAC and Scopus databases.SettingLow- and middle-income countries.SubjectsNon-pregnant women, pregnant women, and girls.ResultsCBD programmes had moderate success with midwives and community health workers (CHW) who counselled on health benefits and compliance with IFA supplementation. CHW were more likely to identify and reach a greater number of women earlier in pregnancy, as women tended to present late to antenatal care. CBD channels had greater consistency in terms of adequate supplies of IFA in comparison to clinics and vendors, who faced stock outages. Targeting women of reproductive age through school and community settings showed high compliance and demonstrated reductions in anaemia.ConclusionsCBD of IFA supplementation can be a valuable platform for improving knowledge about anaemia, addressing compliance and temporary side-effects of IFA supplements, and increasing access and coverage of IFA supplementation. Programmatic efforts focusing on community-based platforms should complement services and information provided at the health facility level. Provision of training and supportive supervision for CHW on how to counsel women on benefits, side-effects, and when, why, and how to take IFA supplements, as part of behaviour change communication, can be strengthened, alongside logistics and supply systems to ensure consistent supplies of IFA tablets at both the facility and community levels.

scholarly journals THE POTENTIAL OF CURRENT TECHNOLOGIES IN DIAGNOSTICS OF TEMPOROMANDIBULAR JOINT DYSFUNCTION (LITERATURE REVIEW)

2018 ◽  
Vol 14 (4) ◽  
pp. 6-13
Author(s):  
Ирина Найданова ◽  
Irina Naidanova ◽  
Юрий Писаревский ◽  
Yurii Pisarevskii ◽  
Алексей Шаповалов ◽  
...  
Keyword(s):  
Literature Review ◽  
Temporomandibular Joint ◽  
Clinical Manifestations ◽  
Diagnostic Value ◽  
Diagnostic Methods ◽  
Cochrane Library ◽  
Russian State ◽  
State Library ◽  
The Cochrane Library ◽  
Diagnostic Technologies

Introduction. A variety of concepts and approaches to the analysis of the etiology and pathogenesis of temporomandibular joint dysfunctions, results in increased interest in the search for highly informative diagnostic methods, especially at the stage of pre-clinical manifestations. Objectives. The aim of the study was to analyze the possibilities of modern technologies in diagnostics of temporomandibular joint dysfunctions. Materials and methods. We studied original papers on the diagnostics of temporomandibular joint dysfunctions from several databases: Russian State Library, eLibrary, PubMed, The Cochrane Library, Google Scholar. Results. The review presents both generally accepted and alternative approaches to the diagnostics of different clinical manifestations in temporomandibular joint dysfunctions. We described the diagnostic value of occlusal disorders analysis in universal articulators, virtual articulators, T-scan system. Capabilities of teleroentgenography, axiography, electromyography, computed and magnetic resonance imaging were estimated as well. Conclusions. The literature review on the problem of diagnosing the temporomandibular joint dysfunctions showed a scientifically based spectrum of diagnostic capabilities of modern dentistry, a trend in the development of highly informative digital diagnostic technologies. Due to the diversity of the etiology and pathogenesis of the temporomandibular joint dysfunctions further in-depth studies of this issue are required.

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