scholarly journals APPENDICITIS IN CHILDREN: SYMPTOMS AND SIGNS, LABORATORY AND HISTOPATHOLOGY FINDINGS IN 67 PATIENTS

2018 ◽  
pp. 66
Author(s):  
Dragoljub Živanović ◽  
Ivona Đorđević ◽  
Milan Petrović
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Acute Abdominal Pain ◽  
Clinical Signs ◽  
Negative Appendectomy ◽  
Chronic Appendicitis ◽  
Markers Of Inflammation ◽  
Laboratory Markers ◽  
Negative Appendectomy Rate ◽  
Symptoms And Signs

Acute abdominal pain is a reason for hospital admission of about 20% of children. Typical clinical presentation of appendicitis may be significantly different in children. Diagnosis is based on the combination of symptoms, clinical signs, and results of laboratory and radiology examinations. The objective of the present study was to analyze symptoms, signs, laboratory and histopathology findings in children who underwent surgery for acute appendicitis. Sixty-seven patients (37 males and 30 females) with mean age of 9.77 years, operated on for clinical diagnosis of acute appendicitis were enrolled in the study. Abdominal pain was present in all patients, followed by vomitus and fever. Laboratory markers of inflammation varied significantly with severity of inflammation, but were normal in chronic appendicitis. Clinical and histopathology assessments of inflammation were concordant in 22 – 43% depending of the degree of appendicitis. Perforation occurred in 26.86% and negative appendectomy rate was 6%.

scholarly journals A study of correlation between clinical, radiological and pathological diagnosis of appendicitis: a retrospective analytic study

2018 ◽  
Vol 5 (9) ◽  
pp. 3011
Author(s):  
Prabhu R. ◽  
Vijayakumar C. ◽  
Balagurunathan K. ◽  
Senthil Velan M. ◽  
Kalaiarasi R. ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Scoring System ◽  
Acute Abdominal Pain ◽  
Histopathological Examination ◽  
Tertiary Care ◽  
Radiological Finding ◽  
Clinical Signs ◽  
Emergency Setting ◽  
Alvarado Score

Background: Acute appendicitis is the most common cause of acute abdominal pain in young adults requiring emergency surgery. Appendicectomy is the most frequently performed surgery. The diagnosis is often challenging and the decision to operate in an emergency setting is always debatable. A combination of clinical signs and symptoms with laboratory findings in many scoring systems are suggesting the probability of appendicitis and the possible subsequent management pathway. The aim was to evaluate accuracy of the clinical Alvarado scoring system, radiological finding and histopathological examination for the diagnosis of acute appendicitis.Methods: A retrospective study was conducted in the department of general surgery in a tertiary care centre in South India. Total of 237 patients with acute abdominal pain were included and evaluated with the clinical Alvarado scoring system, radiological finding with (USG/CT abdomen) and histopathological examination for the diagnosis of acute appendicitis. The data was collected and analyzed retrospectively.Results: Of the 237 patients, 164 patients were male (69.1%) and rest is female. The correlation of the Alvaroda score with histopathological findings in groups with score > 7 and ≤7 the correlation of Alvarado score and the ultrasound findings were comparable between the study groups. The sensitivity of ultrasound in diagnosing acute appendicitis in patients with Alvarado score >7 was 72.99%. The sensitivity of ultrasound in diagnosing acute appendicitis in patients with Alvarado score ≤7 was decreased to 27%.Conclusions: The diagnostic accuracy of clinical features is far better than radiological investigations in the diagnosis of acute appendicitis. Therefore, it is concluded that it is better to use radiological investigations only to confirm the diagnosis of acute appendicitis rather to diagnose it.

scholarly journals Usefulness of Modified Alvarado Score in Diagnosis of Acute Appendicitis in Adults

2015 ◽  
Vol 14 (4) ◽  
pp. 336-338
Author(s):  
Hari Pada Mondal ◽  
Md. Hadiuzzaman ◽  
Chandranath Mukhopadhyay ◽  
Shibram Chattopadhyay ◽  
Sajal Kumar Biswas ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Scoring System ◽  
Medical Science ◽  
Clinical Signs ◽  
Negative Appendectomy ◽  
Alvarado Score ◽  
Negative Appendectomy Rate ◽  
Modified Alvarado Score

Background: Definitive diagnosis of acute appendicitis preoperatively is sometimes difficult. Failure to make a diagnosis is the main reason for persistent rate of morbidity and mortality. Various scoring systems are devised to aid diagnosis of acute appendicitis. In some studies the modified Alvarado score was helpful, reliable and practical in minimizing unnecessary appendectomy. Objective: The purpose of this study was to evaluate the usefulness of modified Alvarado score for the diagnosis of acute appendicitis. Materials and Method: A prospective study of 89 adult patients, admitted with abdominal pain suggestive of acute appendicitis, from July 2011 to June 2012, was conducted. Data including clinical signs and symptoms and laboratory findings were recorded in modified Alvarado score record form. All 89 patients underwent appendectomy. Final diagnosis was confirmed by histopathological examination. Reliability of scoring system was assessed by negative appendectomy rate and positive predictive value. Results: Out of 89 patients who underwent appendectomy, 85 had acute appendicitis on histopathology. Positive predictive value was 95.5% and negative appendectomy rate was 4.5%. 52.8% had score 7 or above and 47.2% had score less than 7. From score it is difficult to predict which patient warranted appendectomy and who may be safely observed or discharged. Conclusions: Diagnosis of acute appendicitis remains mainly clinical evaluation and it is more helpful than modified Alvarado scoring system in adults.Bangladesh Journal of Medical Science Vol.14(4) 2015 p.336-338

scholarly journals ACUTE ABDOMINAL PAIN IN CHILDREN

2015 ◽  
Vol 22 (08) ◽  
pp. 1080-1086
Author(s):  
Muhammad Ali Sheikh ◽  
Tariq Latif
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Acute Abdominal Pain ◽  
Paediatric Surgery ◽  
Discharge Diagnosis ◽  
Lower Quadrant ◽  
Rebound Tenderness ◽  
Presenting Symptoms ◽  
Symptoms And Signs ◽  
Right Lower Quadrant

Objective: To determine the clinical outcomes of acute abdominal pain andevaluation of symptoms and signs in children admitted in pediatric surgery department.Design: Cohort study. Place and Duration of study: This study was conducted in Departmentof Paediatric Surgery Shaikh Zayed Hospital, Lahore between August 2010 to August 2012.Patients and methods: Children aged 2 to 14 years who presented to emergency departmentwith complaint of acute abdominal pain of less than 5 days duration and admitted in pediatricsurgery department were included. Presenting symptoms, signs, hospital course of patientsand discharge diagnosis were recoded. Data was analyzed by SPSS. Results: Out of 73104patients who were seen in Paediatric emergency 1420 (1.94%) were referred for surgicalevaluation. Out of these 157 children were admitted. Six patients left against medical adviceso 151 patients were studied. Patients were divided into acute appendicitis, non-specificpain abdomen and miscellaneous categories on the basis of discharge diagnosis. Acuteappendicitis was diagnosed in 61(40.4%) patients. The patients who were admitted and nocause of pain abdomen could be found in them, were included in non-specific pain abdomengroup. NSPA group had 39 (25.8%) patients. Rests of the 51 (33.8%) patients were includedin miscellaneous group. Anorexia, fever, pain in right lower quadrant, tenderness in right iliacfossa, guarding, rebound tenderness and tachycardia were all significantly higher in patientswith acute appendicitis. Conclusion: Most of the children with acute abdominal pain wouldnot require surgery. Detailed history and thorough physical examination are cornerstone of thediagnosis.

scholarly journals Conditional CT Strategy—An Effective Tool to Reduce Negative Appendectomy Rate and the Overuse of the CT

2021 ◽  
Vol 10 (11) ◽  
pp. 2456
Author(s):  
Raminta Luksaite-Lukste ◽  
Ruta Kliokyte ◽  
Arturas Samuilis ◽  
Eugenijus Jasiunas ◽  
Martynas Luksta ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Sensitivity And Specificity ◽  
Surgical Outcomes ◽  
Imaging Modality ◽  
Ct Scans ◽  
Negative Appendectomy ◽  
Transabdominal Ultrasound ◽  
First Choice ◽  
Negative Appendectomy Rate

(1) Background: Diagnosis of acute appendicitis (AA) remains challenging; either computed tomography (CT) is universally used or negative appendectomy rates of up to 30% are reported. Transabdominal ultrasound (TUS) as the first-choice imaging modality might be useful in adult patients to reduce the need for CT scans while maintaining low negative appendectomy (NA) rates. The aim of this study was to report the results of the conditional CT strategy for the diagnosis of acute appendicitis. (2) Methods: All patients suspected of acute appendicitis were prospectively registered from 1 January 2016 to 31 December 2018. Data on their clinical, radiological and surgical outcomes are presented. (3) Results: A total of 1855 patients were enrolled in our study: 1206 (65.0%) were women, 649 (35.0%) were men, and the median age was 34 years (IQR, 24.5–51). TUS was performed in 1851 (99.8%) patients, and CT in 463 (25.0%) patients. Appendices were not visualized on TUS in 1320 patients (71.3%). Furthermore, 172 (37.1%) of 463 CTs were diagnosed with AA, 42 (9.1%) CTs revealed alternative emergency diagnosis and 249 (53.8%) CTs were normal. Overall, 519 (28.0%) patients were diagnosed with AA: 464 appendectomies and 27 diagnostic laparoscopies were performed. The NA rate was 4.2%. The sensitivity and specificity for TUS and CT are as follows: 71.4% and 96.2%; 93.8% and 93.6%. (4) Conclusion: A conditional CT strategy is effective in reducing NA rates and avoids unnecessary CT in a large proportion of patients. Observation and repeated TUS might be useful in unclear cases.

scholarly journals THE COMPARATIVE ANALYSIS OF ALVARADO AND PAS SCALES IN THE DIFFERENTIAL DIAGNOSTICS OF ACUTE ABDOMINAL PAIN IN CHILDREN

2020 ◽  
Vol 23 (6) ◽  
pp. 309-313
Author(s):  
Viktor G. Vakulchyk
Keyword(s):  
Clinical Trial ◽  
Abdominal Pain ◽  
Comparative Analysis ◽  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Acute Abdominal Pain ◽  
Differential Diagnostics ◽  
Current Trends

Introduction. Current trends in the diagnostics of acute appendicitis have the following main objectives: to improve the diagnostic accuracy in destructive forms; to reduce the number of negative appendectomies and diagnostic laparoscopies. Purpose. To compare the effectiveness of Alvarado and PAS scales and to find out which of them is more appropriate in the differential diagnostics of acute abdominal pain in children. Material and Methods. A prospective randomized blind clinical trial was performed. 326 children aged 5-17 years with abdominal pain were examined. Results. No significant advantages of any of the analyzed scales were found in the differential diagnostics of acute abdominal pain in children aged 5-17 years. Both scales can be used in the primary stratification of patients. With the conclusion “Acute appendicitis is likely possible,” the level of non-diagnosed cases of acute appendicitis will not exceed 3%. Conclusions. Further assessment of various scales for the diagnostics of acute appendicitis in children has to be done in order to select the optimal one. The obtained results urge to make scales’ modification so as to improve the diagnostic accuracy and to reduce the number of negative appendectomies and diagnostic laparoscopies.

scholarly journals Acute Appendicitis Secondary to Appendiceal Endometriosis

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
João Paulo Nunes Drumond ◽  
André Luis Alves de Melo ◽  
Demétrius Eduardo Germini ◽  
Alexander Charles Morrell
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Laparoscopic Appendectomy ◽  
Clinical Picture ◽  
Acute Abdominal Pain ◽  
Rare Condition ◽  
Vermiform Appendix ◽  
Histopathological Analysis ◽  
Women Of Childbearing Age ◽  
Childbearing Age

Endometriosis in the vermiform appendix is a rare condition that affects women of childbearing age. The clinical picture can simulate inflammatory acute abdominal pain, especially acute appendicitis. Laboratory and imaging tests may assist in the diagnosis but are not conclusive. This article reports a case of acute appendicitis caused by appendiceal endometriosis for which laparoscopic appendectomy and diagnostic confirmation were performed after histopathological analysis.

scholarly journals Abdominal Pain in the Female Patient: A Case of Concurrent Acute Appendicitis and Ruptured Endometrioma

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Martine A. Louis ◽  
Amanda R. Doubleday ◽  
Elizabeth Lin ◽  
Ji Yoon Baek ◽  
Alda Andoni ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Acute Abdominal Pain ◽  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Common Cause ◽  
Surgical Emergencies ◽  
Ovarian Endometrioma ◽  
General Surgeons

General surgeons are often asked to evaluate acute abdominal pain which has an expanded differential diagnosis in women of childbearing age. Acute appendicitis accounts for many surgical emergencies as a common cause of nongynecologic pelvic pain. In some rare instances, acute appendicitis has been shown to occur simultaneously with a variety of gynecologic diseases. We report a case of concurrent acute appendicitis and ruptured ovarian endometrioma.

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 Omental infarction in an obese 10-year-old boy

2011 ◽  
Vol 3 (3) ◽  
pp. 22 ◽  
Author(s):  
Katerina Kambouri ◽  
Stefanos Gardikis ◽  
Alexandra Giatromanolaki ◽  
Aggelos Tsalkidis ◽  
Efthimios Sivridis ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Preoperative Diagnosis ◽  
Acute Abdominal Pain ◽  
Accurate Diagnosis ◽  
Lower Abdomen ◽  
Omental Infarction ◽  
Appropriate Treatment ◽  
Low Incidence ◽  
The Right

Primary omental infarction (POI) has a low incidence worldwide, with most cases occurring in adults. This condition is rarely considered in the differential diagnosis of acute abdominal pain in childhood. Herein, we present a case of omental infarction in an obese 10-year-old boy who presented with acute abdominal pain in the right lower abdomen. The ultrasound (US) examination did not reveal the appendix but showed secondary signs suggesting acute appendicitis. The child was thus operated on under the preoperative diagnosis of acute appendicitis but the intraoperative finding was omental infarct. Since the omental infarct as etiology of acute abdominal pain is uncommon, we highlight some of the possible etiologies and emphasize the importance of accurate diagnosis and appropriate treatment of omental infarction.

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