Acute Appendicitis - Diagnostic Value of Direct and Indirect Ultrasonographic Signs - A Retrospective Study in Bangalore Rural

2021 ◽  
Vol 8 (02) ◽  
pp. 64-68
Author(s):  
Prashanth Venkateswaran ◽  
Vinjamuri Anuradha ◽  
Puneet Shirbur
Keyword(s):  
Retrospective Study ◽  
Acute Appendicitis ◽  
Iliac Fossa ◽  
Diagnostic Value ◽  
Good Prognosis ◽  
Free Fluid ◽  
Age Group ◽  
Delay In Diagnosis ◽  
Adult Age ◽  
Mesenteric Fat

BACKGROUND Acute appendicitis is one of the commonest causes of pain abdomen. Appendicitis has a good prognosis but a delay in diagnosis may result in risk of perforation, peritonitis, abscess formation, sepsis, and even death. METHODS A retrospective study was conducted from December 2019 to April 2020 in MVJ Medical College and the pre-operative ultrasonographic images of all the patients who underwent surgery for suspected acute appendicitis were reviewed. A total of 50 such cases were found and included in the study. The direct signs were enlarged appendix, hyperaemia of wall of appendix, non-compressibility and appendicolith. The indirect signs were increased echogenicity and thickening of mesenteric fat in right iliac fossa (RIF), increased vascularity in RIF, thickening of caecal wall, RIF probe tenderness, free fluid in the RIF and mesenteric lymphadenopathy. RESULTS 32 (64 %) were in the adult age group and 18 (36 %) patients were in the paediatric age group (below 18 years); the mean age was 38 years. 68 % (34) of the study population were males and 32 % (16) were females. At least one direct sign was present in 86 % of the cases, 2 and 3 direct signs were seen in 80 % and 56 % of the cases respectively. At least 1 indirect sign was noted in 97 % of the cases, 2 and 3 indirect signs were seen in 90 % and 70 % of the cases respectively. 2 cases had no indirect signs and all indirect signs were present in none of the cases studied. In the absence of direct signs, RIF probe tenderness (98 %) and increased echogenicity & thickness of mesenteric fat in RIF (86 %) were the most noted indirect signs in acute appendicitis. CONCLUSIONS There was a high incidence of indirect ultrasonography (USG) signs, of which the sign with maximum incidence was probe tenderness in 98 % of the cases, and increased mesenteric fat echogenicity in the RIF in 86 %. Among direct signs of acute appendicitis enlarged appendix (95 %) had the highest incidence followed by non-compressibility of appendix (90 %). KEYWORDS Acute Appendicitis, Ultrasound

scholarly journals Appendiceal Neuroendocrine Tumours - Experience of One Service

2021 ◽  
Author(s):  
Vítor Devezas ◽  
Laura Elisabete Barbosa
Keyword(s):  
Retrospective Study ◽  
Acute Appendicitis ◽  
Neuroendocrine Tumours ◽  
Adult Population ◽  
Right Hemicolectomy ◽  
Good Prognosis ◽  
Alive Today

AbstractTumours of the appendix are rare and tend to be diagnosed incidentally, in cases of acute appendicitis. For some authors, appendiceal neuroendocrine tumours (ANETs) are the most frequent neoplasm of the appendix, observed in 0.3% to 0.9% of cases acute appendicitis. The present is a unicentric retrospective study conducted between January 2005 and March 2017. Out of a total of 3,007 surgeries for appendiceal pathologies performed in the adult population at the hospital where the present study was conducted, there were 70 (2.33%) malignant cases, 20 (28.6%) of which were ANETs. The patients had a median age of 44 years (range: 18 to 85 years), and were predominantly women (there were 1.9 times more women than men). In 16 cases (80%), a simple appendicectomy was performed (1 patient was submitted to a right hemicolectomy later). The cases of ANETs had a good prognosis in our series: 85% of the patients are either alive today or were alive after 5 years of follow-up. Despite the fact that ANETs are described as the most frequent tumor of the appendix, this was not confirmed in our series, in which they only represented 28.6% of the cases; adenocarcinoma was the most frequent tumor (65.7%) among our sample.

Incidence of Appendicitis in Adults

2021 ◽  
Vol 15 (11) ◽  
pp. 3172-3173
Author(s):  
Maaz-ul-, Hassan ◽  
Syed Muhammad Shah ◽  
Ali Akbar Shah
Keyword(s):  
Abdominal Pain ◽  
Retrospective Study ◽  
Iliac Fossa ◽  
Perforated Appendicitis ◽  
Clinical Information ◽  
Age Group ◽  
Serious Illness ◽  
Imaging Result ◽  
Diagnostic Symptoms ◽  
Common Infection

Background: Appendicitis is a common infection which can lead to serious illness in children as well as adults. Objective: To assess the incidence of appendicitis in adults. Study Design: Retrospective study. Place and Duration of Study: Department of General Surgery, Shalamar Medical & Dental College, Lahore from 1st January 2020 to 30th June 2021. Methodology: One hundred and eighty cases registered for abdominal pain in right iliac fossa. The appendectomy cases of adults (>45 years) were scrutinized from these cases. Demographic and clinical information was gathered from each appendicitis patient with diagnostic symptoms as well as histopathology and radiology imaging. Result: Eighty seven were confirmed acute appendicitis with 48 males and 39 females within the age group of 45-75 years. Gangrenous appendicitis was presented in 11.5% and perforated appendicitis was noticed in 31.03% of the total patients. Conclusion: The incidence of appendicitis was 48.33% in adults. Keywords: Appendectomy, Perforated, Misdiagnosis

Acute Appendicitis in Pregnancy

1980 ◽  
Vol 25 (1) ◽  
pp. 36-38 ◽  
Author(s):  
R. G. Farquharson
Keyword(s):  
Retrospective Study ◽  
Acute Appendicitis ◽  
Neonatal Mortality ◽  
Maternal Morbidity ◽  
Causal Factor ◽  
Delay In Diagnosis ◽  
In Pregnancy

A retrospective study of appendicitis in pregnancy in Aberdeen has been performed. The incidence, symptoms, findings at laparotomy and outcome are described. Delay in diagnosis is stressed as the causal factor in increased maternal morbidity and high neonatal mortality.

scholarly journals Clinicopathological correlation of acute appendicitis undergoing emergency appendicectomy in a tertiary care hospital of Gujarat: a retrospective study

2019 ◽  
Vol 6 (9) ◽  
pp. 3201
Author(s):  
Mrugesh Chudasama ◽  
Pallav Patel
Keyword(s):  
Retrospective Study ◽  
Acute Appendicitis ◽  
Iliac Fossa ◽  
Tertiary Care ◽  
Clinical Signs ◽  
Vermiform Appendix ◽  
Study Patient ◽  
Care Hospital ◽  
Delayed Presentation ◽  
Operative Findings

Background: Acute appendicitis is acute inflammation and infection of the vermiform appendix, which is most commonly referred to simply as the appendix. The aim of this study was to determine the presenting pattern of acute appendicitis and to review the pathological diagnosis.Methods: This retrospective study was conducted in the general surgery department at tertiary care institute of Gujarat for the period of one year. One hundred patients who were attending department of surgery diagnosed as acute appendicitis were selected for the study. Patient demographics, clinical features, operative findings and histology results were recorded on a special patient proforma.Results: The most common presenting complaints were abdominal pain (n=100), nausea (n=54), vomiting (n=80) and diarrhoea (n=7). As for clinical signs 100% of the patients in this study had some degree of right iliac fossa tenderness. Open appendicectomy was performed in 62% of the patients and laparoscopic appendicectomy in 38% of the patients. 66% of the patients presented within 24 hours of the onset of symptoms whereas 28% presented 24-48 hours after the onset of symptoms.Conclusions: Diagnosis of acute appendicitis obvious based on strongly positive clinical presentation. Present study shows that acute appendicitis in India is a disease of young males. On further sub-classification of acute appendicitis, uncomplicated acute appendicitis seems to be the most common. Delayed presentation is associated with greater morbidity. 

scholarly journals Torsion of caecal appendices epiploicae: mimicking acute appendicitis

2020 ◽  
Vol 7 (7) ◽  
pp. 2407
Author(s):  
A. P. Roshini ◽  
Dattaprasad Samant ◽  
F. P. Noronha
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Iliac Fossa ◽  
Lower Abdominal Pain ◽  
Free Fluid ◽  
Normal Appendix ◽  
Menstrual Cycles ◽  
Rebound Tenderness ◽  
Appendices Epiploicae ◽  
The Right

Acute appendicitis is a common cause for pain in the right iliac fossa, which requires urgent surgical intervention. However, at the time of surgery, if the appendix is normal, the surgeon has to search for other causes of acute abdominal pain including rare etiologies, such as torsion of appendices epiploicae and subsequently its gangrene. We report the case of a 45 years old female who presented with right lower abdominal pain, rebound tenderness and guarding in right iliac fosse, with regular menstrual cycles and no urinary complaints. Investigation revealed leucocytosis and ultra-sonography abdomen was suggestive of an inflamed appendix in the right iliac fossa with free fluid. Intra-operatively, we found a normal appendix with gangrene of the appendices epiploicae which had undergone torsion. She underwent excision off appendices epiploicae with appendicectomy with uneventful post-operative period. Histopathology of the appendices was suggestive of congestion.  Preoperative diagnosis of this condition is rarely made.

scholarly journals Diagnostic value of pleural fluid adenosine deaminase level in patients of tubercular pleural effusion

2020 ◽  
Vol 8 (1) ◽  
pp. 93
Author(s):  
Amit Goyal ◽  
Amanpreet Kaur ◽  
N. C. Kajal
Keyword(s):  
Pleural Effusion ◽  
Adenosine Deaminase ◽  
Pleural Fluid ◽  
Diagnostic Value ◽  
Diagnostic Methods ◽  
Common Symptom ◽  
Age Group ◽  
Laboratory Findings ◽  
Adult Age ◽  
Invasive Test

Background: The diagnosis of tuberculosis (TB) continues to be a challenge in clinical practice. Traditional diagnostic methods are very useful but don't provide enough sensitivity and specificity. Adenosine deaminase (ADA) has been developed and widely used for the diagnosis of TB. This article reviews the characteristics, metabolism and clinical uses of ADA for the diagnosis of TB in clinical practices.Methods: This study was carried out in the department of chest and TB, GMC, Amritsar, Punjab, India. In this study total 50 who attended outpatient department (OPD) and indoor patients of adult age and either sex were taken. Patients with pleural effusion as determined by clinical and or radiological means, thoracocentesis on who yield a minimum amount of fluid enough to carry out routine test were included in the study.Results: Most of the patients were between the age group of 15-34 years, of those 72% were males and 28% female. Most of the patients of tuberculous effusion were from younger age group between 25-34 years. Most common symptom was breathlessness (90%) followed by fever (75%), cough (75%) then chest pain (72%). The diagnosis of TB was made in 40 patients (80%), while in 10 patients (20%) TB were excluded (malignancy and miscellaneous disease) based on history, clinical and laboratory findings. Sensitivity of ADA in diagnosing TB pleural effusion was 95% and specificity 80%.Conclusions: ADA level of the pleural fluid is a non-invasive test. Pleural fluid ADA is useful in early diagnosing of tuberculosis pleural effusion. So the analysis of ADA levels can be done simply, quickly and cheaply.

scholarly journals Hyperbilirubinemia as a diagnostic marker for acute appendicitis

2018 ◽  
Vol 5 (6) ◽  
pp. 2091
Author(s):  
Sagar Ramesh Ambre ◽  
Shahaji Chavan
Keyword(s):  
Acute Appendicitis ◽  
Clinical Diagnosis ◽  
Diagnostic Marker ◽  
Iliac Fossa ◽  
Clinical Signs ◽  
Research Centre ◽  
College Hospital ◽  
Alvarado Score ◽  
Delay In Diagnosis ◽  
Significant Difference

Background: Appendicitis is one of the commonest cause of abdominal pain requiring emergency surgery. Different clinical signs and symptoms always mimic the diagnosis of acute appendicitis with number of causes leading to pain in right iliac fossa, especially in females. Accurate diagnosis can be aided by additional tests. A delay in diagnosis can lead to appendiceal perforation with increased morbidity, and an appendectomy as soon as the condition is suspected, may increase the number of unnecessary appendicectomies. Objective of present study was to evaluate the role of hyperbilirubinemia as a diagnostic marker for Acute Appendicitis.Methods: This is a prospective study of 100 patients carried out at Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune from May 2015 to September 2017. Patients presenting to surgical OPD with pain in Right iliac fossa will be evaluated. Those with a clinical diagnosis of acute appendicitis will be included in the study.Results: Acute appendicitis is one of the most common emergencies and appendicectomy is one of the most frequently done abdominal operations. Clinical diagnosis using time tested clinical signs is effective in diagnosing appendicitis. However, bilirubin supports diagnosis and hence avoids chances of error in diagnosis. The investigation Bilirubin alone is not sufficient to accurately diagnose acute appendicitis, however the clinical findings, ALVARADO SCORE when combined can predict appendicitis. There is significant difference in total bilirubin in acute and probable cases of appendicitis but it can be used to differentiate both of them. In present study Mean bilirubin for acute appendicitis was 1.23mg/dl and probable cases of appendicitis was 0.84mg/dl, with SD for acute appendicitis was 0.598 and probable cases of appendicitis was 0.486. In our study bilirubin provide the highest diagnostic accuracy for acute appendicitis case. Normal inflammatory markers cannot exclude appendicitis, which remains a clinical diagnosis. The presence of history of pain and or signs of peritoneal inflammation which help you in diagnosing acute appendicitis.Conclusions: Hyperbilirubinemia can be a diagnostic marker for acute appendicitis.

Diagnostic Value of Interleukin-6 and C-Reactive Protein in Acute Appendicitis

Swiss Surgery ◽  
2000 ◽  
Vol 6 (4) ◽  
pp. 169-172 ◽  
Author(s):  
Erkasap ◽  
Ates ◽  
Ustuner ◽  
Sahin ◽  
Yilmaz ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Interleukin 6 ◽  
Iliac Fossa ◽  
Diagnostic Value ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Perforated Appendix ◽  
Right Iliac Fossa Pain ◽  
The Mean ◽  
Serum Crp

The aim of this study is prospectively to evaluate the serum C-reactive protein (CRP) and interleukin-6 (IL-6) levels in detection of acute appendicitis in patients with right iliac fossa pain. Data were collected in prospective manner on 102 consecutive patients with right iliac fossa pain. Laparotomy was performed for suspected acute appendicitis for 55 of the 102 patients, of whom 49 patients had appendicitis, 6 patients non-appendicitis (NA), and the other 47 patients had nonspecific abdominal pain (NSAP) and they did not undergo operation. Among those with appendicitis 31 had acute appendix (AA), 8 had gangrenous appendix (GA), and 10 had perforated appendix (PA). The WBC and CRP the mean (SEM) values were significantly different in AA, GA, and PA groups compared with NSAP and NA groups (P < 0.05). Although the mean IL-6 levels were significantly different only in PA group than the others groups (P < 0.05). The sensitivity and specificity of serum CRP measurements were calculated as 96% and 87%, respectively whereas these were 33% and 83% for IL-6 levels for the diagnosis of the acute appendicitis. As a result, measurement of the CRP levels and WBC have an additional diagnostic value on the diagnosis of the acute appendicitis but determination of IL-6 levels which added to the test combination of WBC and CRP, the sensitivity for the diagnosis of the acute appendicitis was not changed whereas the specificity was decreased to 66%.

An Imaging Diagnostic Protocol in Children with Clinically Suspected Acute Appendicitis

2016 ◽  
Vol 82 (5) ◽  
pp. 390-396 ◽  
Author(s):  
Matias Epifanio ◽  
Marco Antonio De Medeiros Lima ◽  
Patricia Corrêa ◽  
Matteo Baldisserotto
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
Iliac Fossa ◽  
Correct Diagnosis ◽  
Signs And Symptoms ◽  
Clinical Findings ◽  
The Other ◽  
Free Fluid ◽  
Diagnostic Strategy ◽  
The Right

The objective of the present study is to evaluate a new diagnostic strategy using clinical findings followed by ultrasound (US) and, in selected cases, MRI. This study included 166 children presenting signs and symptoms suggesting acute appendicitis. Cases classified as suggesting appendicitis according to clinical exams had to be referred to surgery, whereas the other cases were discharged. Unclear cases were evaluated using US. If the US results were considered inconclusive, patients underwent MRI. Of the 166 patients, 78 (47%) had acute appendicitis and 88 (53%) had other diseases. The strategy under study had a sensitivity of 96 per cent, specificity of 100 per cent, positive predictive value of 100 per cent, negative predictive value of 97 per cent, and accuracy of 98 per cent. Eight patients remained undiagnosed and underwent MRI. After MRI two girls presented normal appendixes and were discharged. One girl had an enlarged appendix on MRI and appendicitis could have been confirmed by surgery. In the other five patients, no other sign of the disease was detected by MRI such as an inflammatory mass, free fluid or an abscess in the right iliac fossa. All of them were discharged after clinical observation. In the vast majority of cases the correct diagnosis was reached by clinical and US examinations. When clinical assessment and US findings were inconclusive, MRI was useful to detect normal and abnormal appendixes and valuable to rule out other abdominal pathologies that mimic appendicitis.

scholarly journals A Prospective Audit of 300 Consecutive Young Women with an Acute Presentation of Right Iliac Fossa Pain

2006 ◽  
Vol 88 (2) ◽  
pp. 140-143 ◽  
Author(s):  
Adam TM Rennie ◽  
Matthew G Tytherleigh ◽  
Katerina Theodoroupolou ◽  
Ridzuan Farouk
Keyword(s):  
Acute Appendicitis ◽  
Wound Infection ◽  
Carcinoid Tumour ◽  
Iliac Fossa ◽  
District General Hospital ◽  
Childbearing Age ◽  
Delay In Diagnosis ◽  
Child Bearing ◽  
Active Observation ◽  
Right Iliac Fossa Pain

INTRODUCTION A prospective study of 300 women of child-bearing age presenting with right iliac fossa pain was carried out to determine what proportion had appendicitis and whether active observation resulted in a delay in diagnosis to the detriment of the patient. PATIENTS AND METHODS Data were prospectively collected for 300 consecutive women of childbearing age referred with right iliac fossa pain to general surgeons at a district general hospital. RESULTS After clinical assessment, 71 were discharged home immediately. Two others were found to be pregnant and 4 admitted to gynaecology. The remaining 223 women were admitted to the general surgical unit, 112 of whom underwent immediate appendicectomy. Of these, 97 had acute appendicitis. Two suffered deep infection and two had a superficial wound infection. A further decision to operate was made in 42 of 111 patients admitted for active observation, with 36 having acute appendicitis and 2 having a carcinoid tumour. Four had a wound infection. The average in-patient stay of those admitted for active observation and not operated on was 2 days (range, 1–4 days) compared with a length of stay of 2 days (range, 1–7 days) for those who underwent ‘immediate’ appendicectomy. CONCLUSIONS Most women of child-bearing age who present with right iliac fossa pain do not have appendicitis. Those who do not have the classical features of appendicitis or peritonism can be safely managed by active observation.

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