scholarly journals Outcomes of early surgical management of complicated appendicitis in children

2018 ◽  
Vol 5 (3) ◽  
pp. 1063
Author(s):  
Pramod S. ◽  
B. Revanth Kumar
Keyword(s):  
Surgical Management ◽  
Laparoscopic Appendectomy ◽  
Leucocyte Count ◽  
Complicated Appendicitis ◽  
Early Surgery ◽  
High Morbidity ◽  
Paediatric Surgery ◽  
Delayed Presentation ◽  
Duration Of Stay ◽  
Pain Abdomen

Background: Appendicitis is the most common surgical emergency in children. Nearly 30% of children present with complicated appendicitis. Controversy exists between early or delayed surgery in complicated appendicitis. Present study was done to evaluate the outcome of early surgical management of complicated appendicitis in children and also to analyze risk factors for complicated appendicitis.Methods: A retrospective observational study conducted by the department of Paediatric Surgery, KIMS, hospital Bangalore. All children with complicated appendicitis (perforated, gangrenous and mass) from October 2014 to October 2017 were included in the study. Clinical, biochemical and imaging findings of these children were tabulated. Children underwent either open or laparoscopic appendectomy. Intra operative data regarding the type of complication, presence or absence of Fecolith, position of appendix was documented. Post operatively duration of stay and complications were analyzed.Results: 47 children were included in the study. Mean age of presentation was 10.38±2.84 years. Most common presentation was pain abdomen. 65% of the patient had pain abdomen for duration of three days or more. Total leucocyte count of more than 15000 was seen in about 50% of the children. 68% of children underwent laparotomy, 23.5% underwent laparoscopic appendectomy. Intra operatively, perforation of the appendix with generalized peritonitis was the commonest finding. Fecolith was present in 32% of the cases. Mean duration of stay was 7.46 days. Wound infection was seen in 15% of the children. Late complication in the form of adhesive obstruction was seen in 5 patients.Conclusions: Complicated appendicitis is associated with high morbidity. High leucocyte count, delayed presentation and Fecolith are possible indicators of complicated appendicitis. Early surgery in complicated appendicitis is safe, feasible. The complication rate is acceptable and most of them can be managed conservatively. Hence early surgery in complicated appendicitis is an option to be considered.

scholarly journals Laparoscopic interventions in children with complicated appendicitis

2018 ◽  
pp. 232-236
Author(s):  
S. A. Korovin ◽  
A. V. Dzyadchik ◽  
E. V. Dvorovenko ◽  
Yu. Yu. Sokolov
Keyword(s):  
Vocational Education ◽  
Operative Treatment ◽  
Laparoscopic Appendectomy ◽  
High Efficiency ◽  
Complicated Appendicitis ◽  
Paediatric Surgery ◽  
Medical Academy ◽  
Russian State ◽  
State Medical Academy ◽  
Laparoscopic Techniques

The article presents an overview of laparoscopic appendectomy experience in 3,766 children with complicated appendicitis in the clinic of the Department of Paediatric Surgery of the Russian State Medical Academy of Continuous Vocational Education (Moscow). The authors showed the high efficiency of laparoscopic techniques in the operative treatment. The features of tactics in destructive appendicitis and peritonitis are highlighted.

scholarly journals Enteric Fever Complicated by Intestinal Perforation in Children: A Persistent Health Problem Requiring Surgical Management

2020 ◽  
Vol 36 (5) ◽  
Author(s):  
Muhammad Azhar ◽  
Naima Zamir ◽  
Mishraz Shaikh ◽  
Inayat Ullah
Keyword(s):  
Surgical Management ◽  
Health Problem ◽  
Intestinal Perforation ◽  
Surgical Procedure ◽  
Enteric Fever ◽  
Primary Repair ◽  
High Morbidity ◽  
Paediatric Surgery ◽  
Duration Of Symptoms ◽  
Enteric Perforation

Objective: To evaluate clinical presentation and surgical outcome in children with enteric perforation. Methods: A descriptive retrospective study was conducted in Department of Paediatric Surgery at National Institute of Child Health, Karachi from August 2016 and September 2019, in children 12 years of age and under with diagnosis of enteric perforation. Data about age, gender, duration of illness, hemodynamic status and baseline investigation on admission was reviewed. Details about patients operated early and those who required prolong resuscitation and were operated after 24 hours of admission, need for tube laparostomy, operative findings, type of surgical procedure performed and post-operative outcome were reviewed. Data was analyzed using SPSS version 22. Results: Ninety-seven patients, 60(61.85%) males and 37(38.14%) females were managed during the study period with age ranged from 3-12 years (mean 7.82, ± 2.94 years).and duration of symptoms ranged from 7-30 days (mean 15.56, ± 9.39days). High grade fever and abdominal pain were seen in all patients (100%). Pneumoperitoneum was noted in 71(73.19%) cases on X-ray abdomen. Fifty-one (52.57%) children were anemic and required blood transfusion before surgery. Seventy-one (73.19) patients were optimized and operated within 24 hours while 28(28.86%) cases required more resuscitation so tube laparostomy was done initially and operated after 24 hours. Seventy nine (81.44%) cases had single perforation, 14(14.43%) cases had multiple and four had sealed perforation. Primary repair of perforation was done in 37(38.14%) cases, while ileostomy in 65(76.01%) cases. Postoperatively wound infection was seen in 71(73.19%) cases, intra-abdominal collections in 31(31.95%) and burst abdomen in nine (9.27%) cases. Overall mortality was 12.37%. Till date in 47 patients (72.30%) reversal of stoma has been done. Conclusions: Enteric perforation in children presents usually with hemodynamic instability and sepsis due to prolong period of illness. Therefore, regardless of surgical procedure performed it is associated with high morbidity and mortality. doi: https://doi.org/10.12669/pjms.36.5.2270 How to cite this:Azhar M, Zamir N, Shaikh M, Inayat ullah4. Enteric Fever Complicated by Intestinal Perforation in Children: A Persistent Health Problem Requiring Surgical Management. Pak J Med Sci. 2020;36(5):---------. doi: https://doi.org/10.12669/pjms.36.5.2270 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Antibiotic Duration After Laparoscopic Appendectomy for Acute Complicated Appendicitis

JAMA Surgery ◽  
2016 ◽  
Vol 151 (4) ◽  
pp. 323 ◽  
Author(s):  
Charles C. van Rossem ◽  
Marc H. F. Schreinemacher ◽  
Anna A. W. van Geloven ◽  
Willem A. Bemelman ◽  
Keyword(s):  
Laparoscopic Appendectomy ◽  
Complicated Appendicitis ◽  
Antibiotic Duration

Study of factors affecting mortality and morbidity in patients presenting with peritonitis due to duodenal ulcer perforation

2021 ◽  
Vol 19 (2) ◽  
pp. 35-39
Author(s):  
Pradeep Chandra Sharma ◽  
Keyword(s):  
Duodenal Ulcer ◽  
Previous History ◽  
Common Factors ◽  
Duodenal Perforation ◽  
High Morbidity ◽  
Delayed Presentation ◽  
Mortality And Morbidity ◽  
Factors Affecting ◽  
Ulcer Perforation ◽  
Duodenal Ulcer Perforation

Background: Peptic ulcer disease in the general population had lifetime prevalence of 5-10% with incidence of 0.1–0.3% per year. Despite the tremendous improvement in preventive therapies, the rate of complication of this disease is still high and is burdened by high morbidity and mortality. In present study, we aimed to study factors affecting mortality and morbidity in patients presenting with peritonitis due to duodenal ulcer perforation at our tertiary hospital. Material and Methods: Present study was single-center, prospective, observational study conducted in patients admitted, diagnosed with duodenal ulcer perforation and surgically treated at our hospital. Results: In present study period total 56 patients were studied. All were male, most common age group was 51-60 years (37.5%) followed by 41-50 years (23.21%). Duration from onset of symptoms to admission was >24 hours (30.36%) in most of patients followed by 12-24 hours (28.57%). Most commons symptoms were pain in abdomen (100%), vomiting (100%). Anaemia (37.5%), LRTI and Pulmonary complications (19.64%), Diabetes mellitus (12.5%) and Hypertension (10.71%) were common comorbidities noted. Associated risk factors were previous history of PUD (41.07%), Alcohol use (64.29%), Cigarette smoking (51.79%) and Use of NSAIDs (12.5%). Presence of free gas under diaphragm was noted in 83.93% patients. Intraoperatively duodenal perforation diameter was 1–5 mm (60.71%) in most of patients followed by 6–10 mm (23.21%). Only 1 patient had duodenal perforation diameter was > 20mm. Common postoperative complications were wound infection (37.5%) and pulmonary infection (21.43%). In present study mortality within 1 month was noted in 13 patients (23.21%). Most common factors related to mortality were delayed presentation > 24 hours (61.54%), age > 60 years (46.15%), diabetes mellites (38.46%), Size of perforation > 1 cm (38.46%) and septicaemic shock (23.08%). Conclusion: Delayed presentation > 24 hours, age > 60 years size of perforation > 1 cm were common factors related to mortality in duodenal ulcer perforation patients.

scholarly journals Blister like aneurysm: a review about its surgical management / Aneurismas blister-like: uma revisão sobre seu manejo cirúrgico

2019 ◽  
Vol 64 (2) ◽  
pp. 131
Author(s):  
Rodrigo Salmeron de Toledo Aguiar ◽  
Guilherme Brasileiro de Aguiar ◽  
Rafael Gomes dos Santos ◽  
André Freitas Nunes ◽  
Renan Maximilian Lovato ◽  
...  
Keyword(s):  
Surgical Management ◽  
Intracranial Aneurysms ◽  
Surgical Techniques ◽  
Vascular Lesion ◽  
High Morbidity ◽  
Good Efficiency ◽  
Treatment Techniques ◽  
Pubmed Database ◽  
Surgical Methods ◽  
Ruptured Intracranial Aneurysms

ABSTRACT Introduction: Blister aneurysms are of uncertain pathogenesis and are a vascular lesion located in the brain. Overall, they represent 0.3% - 1.0% of all intracranial aneurysms and 0.9% - 6.5% of ruptured intracranial aneurysms. They are associated with high morbidity and mortality. Even with the first description being from 1969, there is still debate in the literature about which type of treatment is the best: surgical or endovascular. In this review, we focus on the surgical management. Method: The authors performed a review of available surgical techniques used for blood blister-like aneurysms treatment. Pubmed database was used as search source introducing blister-like aneurysm and blister aneurysms as keywords. The most relevant articles and those that focused on surgical treatment techniques were selected. Discussion: The most used surgical methods are clipping, trapping, wrapping and bypass. As main features of each technique, we can highlight clipping with good efficiency, when there is good neck exposure; trapping being employed in ruptured aneurysm; wrapping for avulsion and bypass that promotes vascularization to the distal territory of the aneurysm. Conclusion: The endovascular method has shown to be promising and efficient. However, different surgical techniques are still being employed based on their efficiency when facing certain surgical scenarios.Keywords: Neurosurgery, Subarachnoid hemorrhage, Intracranial aneurysm, Endovascular proceduresRESUMOIntrodução: Aneurismas cerebrais blister-like são lesões vasculares de patogenia incerta. De modo geral, representam 0.3%-1.0% de todos aneurismas intracranianos e 0.9% - 6.5% dos aneurismas intracranianos que rompem. Estão associados a alta morbimortalidade. Mesmo com a primeira descrição sendo de 1969, ainda há debate na literatura sobre qual tipo de tratamento é o melhor: cirúrgico ou endovascular. Nessa revisão, focamos no tratamento cirúrgico. Métodos: Os autores realizaram uma revisão das técnicas cirúrgicas utilizadas para tratamento de aneurismas blister-like. A plataforma Pubmed foi utilizada para a pesquisa das palavras chaves “blister-like aneurysm” e “blister aneurysm”. Os artigos de maior relevância e aqueles que enfatizam as técnicas cirúrgicas foram selecionados. Discussão: Os métodos cirúrgicos empregados são clipagem, trapping, wrapping e bypass. Quanto às características de cada método, podemos salientar a eficácia da clipagem, quanto melhor for a exposição do aneurisma; o uso do trapping em situações de rompimento do aneurisma; wrapping para casos em que houve avulsão do aneurisma e by-pass que promove a vascularização distal ao aneurisma. Conclusão: O método endovascular tem se mostrado promissor e efetivo. No entanto, as diferentes técnicas cirúrgicas ainda são empregadas e defendidas devido a sua eficiência frente certos cenários cirúrgicos.Descritores: Neurocirurgia, Hemorragia subaracnóidea, Aneurisma intracraniano, Procedimentos endovasculares

scholarly journals Inappropriate manipulation and drainage exacerbate post-operative pain and prolong the hospital stay after laparoscopic appendectomy for pediatric complicated appendicitis

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yi-Wen Tsai ◽  
Shin-Yi Lee ◽  
Jyun-Hong Jiang ◽  
Jiin-Haur Chuang
Keyword(s):  
Hospital Stay ◽  
Laparoscopic Appendectomy ◽  
Pediatric Patients ◽  
Complicated Appendicitis ◽  
Postoperative Hospital Stay ◽  
Postoperative Outcomes ◽  
Chang Gung Memorial Hospital ◽  
Abdominal Abscess ◽  
Penrose Drain ◽  
Drain Group

Abstract Background This study examined whether drain placement or not is associated with the postoperative outcomes of pediatric patients following trans-umbilical single-port laparoscopic appendectomy (TUSPLA) for complicated appendicitis. Methods The medical records of pediatric patients undergoing TUSPLA for acute complicated appendicitis from January 2012 to September 2018 in Kaohsiung Chang Gung Memorial Hospital were reviewed retrospectively. They were classified according to whether they received passive drainage with a Penrose drain (Penrose group) (19), active drainage with a Jackson-Pratt drain with a vacuum bulb (JP group) (16), or no drain (non-drain group) (86). The postoperative outcomes of the three groups were compared. Results Postoperative visual analog scale pain score was significantly higher in the non-drain group than in either the JP group or Penrose group. Patients in the Penrose group had a significantly longer postoperative hospital stay than those in the non-drain group and a higher rate of intra-abdominal abscess, while patients in the JP group had a significantly shorter postoperative hospital stay; moreover, no patient in JP group developed a postoperative intra-abdominal abscess. Conclusions Compared to passive drainage with a Penrose drain or no drain, active drainage with a JP drain shorter the postoperative hospital stay and decreased the risk of postoperative intra-abdominal abscess.

Laparoscopic appendectomy is a favorable alternative for complicated appendicitis in children

2006 ◽  
Vol 23 (3) ◽  
pp. 257-259 ◽  
Author(s):  
Mohammad Saquib Mallick ◽  
Aayed Al-Qahtani ◽  
Abdulrahman Al-Bassam
Keyword(s):  
Laparoscopic Appendectomy ◽  
Complicated Appendicitis

Reduced Opioid Prescription Practices and Duration of Stay after TAP Block for Laparoscopic Appendectomy

2019 ◽  
Vol 24 (2) ◽  
pp. 418-425 ◽  
Author(s):  
Matthew C. Hernandez ◽  
Eric J. Finnesgard ◽  
Johnathon M. Aho ◽  
Martin D. Zielinski ◽  
Henry J. Schiller
Keyword(s):  
Laparoscopic Appendectomy ◽  
Tap Block ◽  
Opioid Prescription ◽  
Duration Of Stay ◽  
Prescription Practices

scholarly journals Acute Upper Limb Ischemia Due to Delayed Presentation of a Brachial Artery Pseudoaneurysm Post-Venipuncture

2019 ◽  
Vol 54 (1) ◽  
pp. 80-84 ◽  
Author(s):  
Adele H. H. Lee ◽  
Sara D. Qi ◽  
Nathaniel Chiang
Keyword(s):  
Median Nerve ◽  
Upper Limb ◽  
Brachial Artery ◽  
Limb Ischemia ◽  
High Morbidity ◽  
Delayed Presentation ◽  
Artery Pseudoaneurysm ◽  
Hand Ischemia ◽  
Iatrogenic Trauma ◽  
Median Nerve Neuropathy

Brachial artery pseudoaneurysms (BAPs) are rare but could lead to complications of high morbidity. We report a case of a BAP presenting with hand ischemia and median nerve neuropathy nearly a decade after the inciting iatrogenic trauma, successfully treated with excision and direct repair. This report highlights that untreated pseudoaneurysms can be indolent and present late with both symptoms of embolization and local compression.

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