Analysis of intraoperative findings with clinico-pathological features in appendicitis-an observational study

Background: Appendectomy is the most common abdominal surgery performed today. Appendicitis consists of vast spectrum ranging from acute to chronic to recurrent forms however existence of recurrent and chronic appendicitis is still doubted by many. In spite of various scoring systems and appendectomy being the ultimate treatment, its timing remains still controversial especially in chronic and recurrent variants of appendicitis.Methods: A total of 100 consecutive cases of suspected appendicitis who were admitted investigated and treated at our centre were taken up for this observational study. Data pertaining to clinical, operative and histopathological findings were collected and tabulated. Mean and SD were used for continuous data and for categorical data, frequency and percentages were calculated. A chi-square test was used for categorical data to find statistical significance.Results: Per operatively the appendix appeared non-inflamed in 57% of patients suggestive of chronic (recurrent) form and inflamed in 43% of patients suggestive of an acute form of appendicitis. The histopathological studies revealed chronic inflammatory cells in 63% of the resected specimens, suggestive of chronic appendicitis and acute inflammatory cells in 37% of the specimens, suggestive of acute appendicitis.Conclusions: We conclude that the correlation of clinical findings, operative findings and the histopathological findings correlate with one another (p<0.001). The surgeon’s clinical and operative findings have specificity of around 87.30% and 90.47% respectively. Hence the diagnostic accuracy of the surgeon is directly dependent on the surgeons’ expertise and there is no substitution for an experienced surgeon’s judgement.

Acquired Diverticulosis of the Vermiform Appendix: A Rare Case Report

Diverticulosis of the appendix, as a rare and incident disorder, mimics acute or chronic appendicitis and is characterized by herniation of the appendiceal mucosa through the muscular wall. Symptom and laboratory data of diverticular disease usually represent chronic inflammation. In this study, a 43-year-old female with a history of right lower quadrant pain and anorexia represented abdominal tenderness and rebound tenderness in the physical examination and normal laboratory tests. Abdominal sonography did not show any evidence of acute appendicitis. The removed appendix was 12 cm in length and had multiple diverticular protrusions along with it. The histologic examination showed diverticulosis without evidence of inflammation. The patient was discharged two days later in optimal clinical condition. Diverticulosis of the appendix often is confused with acute or chronic appendicitis based on similar presenting symptoms and imaging studies. Although surgery is the definitive treatment of both conditions, an appropriate diagnosis of diverticular disease before surgery is very important because of the association of appendiceal diverticular disease with neoplasm and other complications.

Dupuis de Fresnel. Appendicitis, perivisceritis and colitis. Translated. from the French Dr. P. M. Alperin, edited by prof. H. N. Burdenko. Library "Medical Practice", State Medical Publishing House. 1929, the price is 90 kopecks

The translation from French of this small book is to be welcomed, as it is devoted to the sore point of the present moment the diagnosis of chronic appendicitis and the analysis of the reasons why some patients continue to complain of pain in the right iliac cavity. Various para-appendicular diseases and their differential diagnosis are analyzed in detail. The position (inclined, head down), in which palpation and fluoroscopy are performed, are the basic methods of researching patients. Only that pain that reaches its maximum in the region of the appendix and does not spread high along the ascending intestine is of diagnostic value, and especially the presence of a painful cord rolling under the fingers.

Abdominal migraine in children-An underdiagnosed entity

Abdominal migraine is one of the causes for chronic and recurrent abdominal pains, characterised by recurrent episodes and paroxysms of moderate to severe abdominal pain. Here, we share a case of recurrent severe abdominal pain in a 9-year-old girl who was treated over a period of three months for giardiasis, chronic appendicitis and H. pylori infection, in that order. However, after she was correctly diagnosed with abdominal migraine and accordingly treated with drugs used for the treatment of migraine headaches such as propranolol, flunarizine, cyproheptadine and ergotamine tartrate, she responded well to this regimen.

Diagnostic value of milk injections for gastric ulcers and duodeni and chronic appendicitis

According to Ya. T. Bleikhman (B. D., 1926, .V "14), such injections are a good diagnostic tool, due to the focal reaction they cause in the indicated diseases. In this way, it is possible, for example, to distinguish the so-called. pseudo-appendicitis.

To the diagnosis of chronic appendicitis. Bukhman (Tr. I Congress of Surgeons of the North Caucasian region)

Bukhman (Tr. I Congress of Surgeons of the North Caucasus. Territory) on the material of about 2000 cases checked Moschkowsk'oro's indication that in chronic appendicitis there is an expansion of the right pupil, and received the following results

Histopathological Evaluation of Lesions of Appendix - A Cross Sectional Study

BACKGROUND Appendix is considered as a vestigial organ in medical history. But recent studies reveal its importance in immunological function. Appendicectomy is one of the most common surgeries performed and acute appendicitis being the most frequent pathology noted. Various less common pathologies like parasitic infestation, granuloma, diverticulum, neoplasms are also described. In our institute, we have seen an increased rate of acute appendicitis and a relative increase in neoplastic conditions. The purpose of this study was histopathological evaluation of lesions of appendix over a period of five years and its association with demographic data. METHODS This cross-sectional study included all specimens received in the department of pathology with primary pathology in appendix. Appendix removed as a part of other surgical procedures were excluded. Relevant clinical data, gross findings and histopathological diagnoses were retrieved from pathology records and computer databases and statistical analysis was done using Statistical Package for Social Sciences (SPSS 16.0). RESULTS Out of the 576 cases, 485 (84 %) patients showed findings consistent with acute appendicitis on histopathological examination. Perforation rate was 4.86 % and was higher in male patients. Other pathologies include chronic appendicitis in 58 cases (10.06 %), eosinophilic appendicitis in one case (0.17 %), appendix with lymphoid hyperplasia in 14 cases (2.43 %), periappendicitis in 4 cases (0.69 %), fibrous obliteration of appendix in 2 cases (0.34 %), granulomatous appendicitis in 4 cases (0.69 %), appendix with lymphoid hyperplasia in 14 cases (2.43 %), diverticulitis in one case (0.17 %), tubular adenoma with low grade dysplasia in one case (0.17 %), neuroendocrine tumour in one case (0.17 %) and mucinous neoplasms in 5 cases (0.86 %). CONCLUSIONS The study supports routine histological examination of all the appendicectomy specimens to avoid missing of any clinically important condition which has significant impact on treatment and prognosis. Also noted an increased number of mucinous neoplasms suggesting the importance of future studies in this field. KEYWORDS Appendix, Acute Appendicitis, Chronic Appendicitis, Mucinous Neoplasms of Appendix, Diverticulitis

Torsion of the uterine appendages in a 12-year-old girl

Introduction. The uterine appendage torsion (UAT) is an urgent pathology accompanied by a painful abdominal syndrome and requiring urgent diagnostic and therapeutic measures. In childhood, UAT develops mainly due to organic causes and due to the specific location of internal organs in children. The literature data on organ-preserving surgeries in the long-lasting UAT is very controversial and dubious. There are no objective criteria for assessing ovarian viability after detorsion what impacts the selection of surgical intervention tactics - unjustified adnexectomy may be performed.Clinical case. Girl P., 12 years old, was admitted to the hospital with a clinical picture of long-lasting torsion of the uterus appendages. Right uterine appendages were detorsed. The child was under observation. In two years, laparoscopic appendectomy was performed for chronic appendicitis. When examining pelvic organs, the right ovary was found reduced in size compared to the left one; there were no macroscopically visible changes; single follicles were visualized in it; the fallopian tube was not changed.Conclusion. A painful sensation before surgery indicates that the uterus appendages are viable; if there is no abdominal pain, necrosis of the ovary and fallopian tube may be suspected. A surgical tactics is chosen on making a comprehensive analysis of clinical and instrumental findings.