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.

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.

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.

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.

The incidence and clinical manifestations of human brucellosis in a referral hospital in Southern Saudi Arabia between 2015 and 2019

2021 ◽  
Author(s):  
Mutasim E. Ibrahim ◽  
Mohammad S. Al-Shahrani
Keyword(s):  
Saudi Arabia ◽  
Joint Pain ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Referral Hospital ◽  
Human Brucellosis ◽  
Local Health Authority ◽  
Local Health ◽  
Laboratory Findings ◽  
Body Ache

AbstractWe determined the incidence and clinical manifestations of human brucellosis from patients who attended a referral hospital in South of Saudi Arabia. A record-based retrospective study was conducted from January 2015 to December 2019 at King Abdulla Hospital, Bisha, Saudi Arabia. Information on patients’ demographic characteristics, detailed records of signs and symptoms, and the laboratory findings were reviewed. Of 6,586 patients included, 15.8% (n = 1,041) were infected with brucellosis. The age of infected individuals ranged from five to 95 years, with an average of 35.1 ± 21.2 years. Most infected patients were male (72.3%). Young adults (26–44 years) were the most common age group with the disease (34.1%). The annual rate of infection significantly decreased (P < 0.0001) from 33.2% in 2015 to 12.5% in 2019. An escalating number of brucellosis cases was seen in the spring and peaked during the summer. Fever (35.3%), joint pain (25.5%), generalized body ache (10.7%), and neurological symptoms (10.0%) were the most frequent clinical manifestation associated with brucellosis. Joint pain was commonly found among children (44.4%). Neurological findings were more frequent among adult patients. The study concluded that brucellosis is endemic in Southern Saudi Arabia and needs local health authority to implement preventive and educational program measures. Infected patients may present with diverse, nonspecific clinical manifestations that require intuition from clinicians to detect the disease.

scholarly journals A Case of Valentino's Syndrome Presenting as Possible Appendicitis

2019 ◽  
Vol 104 (11-12) ◽  
pp. 540-541
Author(s):  
Brandon H. Cherry ◽  
Denish Patel ◽  
Joseph E. Ronaghan
Keyword(s):  
Acute Appendicitis ◽  
Signs And Symptoms ◽  
Perforated Peptic Ulcer ◽  
Exploratory Laparotomy ◽  
Good Health ◽  
Lower Quadrant Pain ◽  
Lower Quadrant ◽  
Right Lower Quadrant Pain ◽  
The Right ◽  
Purulent Fluid

Introduction We present a case of a 24-year-old female who presented with the signs and symptoms of acute appendicitis. Case report When computed tomography and ultrasound were not definitive for the diagnosis, the decision was made to perform a laparoscopic appendectomy. The appendix showed no gross signs of inflammation, so intraoperative esophagogastroduodenoscopy was used to examine for a perforated peptic ulcer. When no perforations were found, exploratory laparotomy was performed and revealed purulent fluid in the right colic gutter and a pinhole perforation in the first part of the duodenum. The defect was repaired and the abdominal space was washed thoroughly and closed. The patient recovered well and was discharged from the hospital in good health. Conclusion Valentino's syndrome is an uncommon cause of right lower quadrant pain and symptoms mimicking 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 A systematic review and meta-analysis of pregnancy and COVID-19: Signs and symptoms, laboratory tests, and perinatal outcomes

2020 ◽  
Author(s):  
Soheil Hassanipour ◽  
Saeed Bagheri Faradonbeh ◽  
Khalil Momeni ◽  
Zahra Heidarifard ◽  
Mohammad-Javad Khosousi ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Laboratory Tests ◽  
Post Partum ◽  
Meta Analysis ◽  
Clinical Manifestations ◽  
Perinatal Outcomes ◽  
Signs And Symptoms ◽  
Lymphocyte Ratio ◽  
Laboratory Test Results ◽  
Common Sign

Background: Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 appeared in December 2019 in Wuhan, China. Objective: To investigate the clinical manifestations including signs and symptoms, laboratory results, and perinatal outcomes in pregnant women with COVID-19. Materials and Methods: Scholarly databases such as PubMed via LitCovid hub, Embase, Scopus, Web of sciences, and Google scholar were searched on April 7, 2020. Meta-analysis was performed via comprehensive meta-analysis software using the Mantel-Haenszel method. The event rate with 95% CI was calculated for each variable. Results: Ten studies were selected. The pooled prevalence for fever, post-partum fever, cough, myalgia, fatigue, dyspnea, sore throat, and diarrhea were 66.8%, 37.1%, 35%, 24.6 %, 14.9%, 14.6%, 11.5%, and 7.6%, respectively. Laboratory test results were 49.8% for lymphopenia, 47.7% for leukocytosis, 83.7% for elevated neutrophil ratio, 57% for elevated C-reactive protein, and 71.4% for decreased lymphocyte ratio. The rate of cesarean section for delivery in all cases was 84%. Of the newborns of the corona positive mothers, only one had a positive test result. Also, there was only one death due to a decreased lymphocyte ratio. Conclusion: Fever was the most common sign and symptom in pregnant women with COVID-19. Among the laboratory tests, the highest amount was related to elevated neutrophil ratio. It seems that due to the differences between pregnant women and the general population, special measures should be considered to treat these patients. Key words: COVID-19, Pregnancy, Diagnosis, Signs and symptoms, Meta-analysis.

The Role of Hyperleukocytosis in Predicting the Severity of Pertussis

2020 ◽  
Author(s):  
Xiao-Ying Wu ◽  
chuan gan
Keyword(s):  
Heart Rate ◽  
Respiratory Rate ◽  
Bacterial Infections ◽  
Clinical Manifestations ◽  
Organ Damage ◽  
Clinical Analysis ◽  
Laboratory Findings ◽  
Wbc Count ◽  
The Relationship

Abstract Background: Few reports have described the relationship between WBC count and the severity of pertussis or the timing of ET in patients with hyperleukocytosis.Methods: A retrospective clinical analysis of infants with pertussis and a WBC exceeding 30*10^9/L was performed.Results: A total of 158 patients were enrolled in the study. There were significant differences in the clinical manifestations of cyanosis, fever, highest respiratory rate, and highest heart rate. There were significant differences in all complications except for pulmonary hypertension. In laboratory findings, there were significant differences in organ damage (myocardial markers, ALT), increased inflammation indicators (CRP, PCT), and the incidence of combined bacterial infections. There were significant differences in ICU stay length, mechanical ventilation use, days hospitalized, days until cough relief and days until the WBC fell below 25*10^9/L. A WBC count >55.38 *10^9/L was calculated as the cutoff value with 88.2% sensitivity and 23.4% specificity in predicting ET. A respiratory rate of 59 breaths/min had 94.1% sensitivity and 36.7% specificity in predicting ET. A heart rate of 159 beats/min had 100% sensitivity and 38.1% specificity in predicting ET.Conclusion: WBC count is related to the severity of pertussis. We recommend that ET is considered when the patient’s WBC count exceeds 55*10^9/L, breathing exceeds 60 breaths/min, and/or heart rate exceeds 160 beats/min.

scholarly journals Case Report. Appendiceal Recurrent Colic Due to Enterobius Vermicularis Infection in a 14-Year-Old Female Patient

2016 ◽  
Vol 9 (2) ◽  
pp. 159-162
Author(s):  
Toni I. Stoyanov ◽  
Emilio Corral-Fernadez ◽  
Antonio Melero-Abellan ◽  
Pablo Sarduy-Fernandez ◽  
Paloma Casado-Santamaria ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Young Female ◽  
Lower Abdomen ◽  
Enterobius Vermicularis ◽  
Laboratory Findings ◽  
Rebound Tenderness ◽  
Radiologic Findings ◽  
The Right ◽  
Oral Doses

Summary Acute appendicitis due to Enterobius vermicularis, usually known as pinworm, is very rare and affects mostly children.According to different authors, it is controversial whether pinworms cause inflammation of the appendix or appendiceal colic only.We presentacase ofa14-year-old female with three subsequent hospitalizations in 1 month due to abdominal pain in the right lower abdomen, with rebound tenderness, normal CTscan and laboratory findings. During the last hospitalization, laparoscopic appendectomy was performed. Intraoperatively multiple pinworms were found in the appendix. These were trapped byastercolith in the appendicular base inanoninflamed and histologically normal appendix. Two oral doses of mebendazole were administered postoperatively. Uneventful postoperative period and postoperative follow-up showed lack of symptoms six months after the operation. Despite the widespread idea that acute appendicitis due to Enterobius vermicularis is very rare, it should always be considered in young female patients with repeated abdominal pain in the right lower abdomen with normal laboratory and radiologic findings.

scholarly journals Nail Biting as a Cause of Appendicitis

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Michael Pagacz ◽  
Philip Bao ◽  
Juan Carlos Alvarez Moreno ◽  
Lydia Howard
Keyword(s):  
Abdominal Pain ◽  
Foreign Body ◽  
Acute Appendicitis ◽  
Treatment Options ◽  
Signs And Symptoms ◽  
Primary Treatment ◽  
Lower Quadrant ◽  
Nail Biting ◽  
Periappendiceal Abscess ◽  
The Right

Ingestion of a foreign body is commonly encountered in clinical practice, but most cause no complications, passing spontaneously through the gastrointestinal tract. However, they can cause obstructive signs and symptoms, and surgical intervention for extraction of the foreign body may be required after identifying its location. We present here the case of a 49-year-old woman who presented to our emergency room with abdominal pain localizing to the right lower quadrant. Evaluation was most consistent with acute appendicitis, and she underwent uncomplicated appendectomy. A keratin nail with Actinomyces was identified in her appendix. Foreign bodies in the appendix can cause simple appendicitis, perforation, periappendiceal abscess, and peritonitis. Regardless of etiology, an appendectomy often ends up the primary treatment, but unusual and rare causes are worth noting if only for the clinician to be aware of when evaluating the next patient with abdominal pain and considering treatment options or future prevention. Our case is an example of a rare scenario in which an Actinomyces-contaminated human nail lodged in the appendix of a woman eventually resulting in acute appendicitis.

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