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Introducción. La hernia de Amyand es una condición en la que el apéndice cecal está contenido dentro del saco herniario inguinal. Su diagnóstico y su manejo continúan siendo un reto al tratarse de una patología poco frecuente. Caso clínico. Lactante varón de 10 meses con antecedente de prematuridad extrema, quien presentó hernia de Amyand derecha con apéndice normal. Se retornó el apéndice a la cavidad y se procedió a la reparación de la hernia. Resultado. Después de un año de seguimiento, el paciente no presentó complicaciones. Conclusiones. Se ha reportado que el riesgo de incarceración en niños nacidos a término es del 12 % y en prematuros del 39 %, por tanto, la reparación quirúrgica de una hernia inguinal siempre es necesaria. No existe un tratamiento estándar para la hernia de Amyand en niños, por tanto, la clasificación CiX podría considerarse para el manejo. Se presenta una propuesta de tratamiento en la población pediátrica, donde se incluyeron 3 tipos, considerando el estadio evolutivo del apéndice cecal y que casi la totalidad de hernias inguinales en niños son debidas a persistencia del proceso vaginal, por tanto, el tratamiento quirúrgico solo incluye herniotomía. Al no utilizar material protésico, se facilita el manejo y se reduce el riesgo de infección.
Introduction. Amyand's hernia is a condition in which the cecal appendix is contained within the inguinal hernia sac, its diagnosis and management continue to be a challenge as it is a rare pathology. Case report. A 10-month-old male infant with a history of extreme prematurity presented a right Amyand's hernia and a normal appendix. The appendix was returned to the cavity and the hernia was repaired. Result. After one year of follow-up, the patient had no complications. Conclusions. Has been reported that the risk of incarceration in full-term children is 12% and in premature babies it is 39%, therefore, surgical repair of an inguinal hernia is always necessary. There is no standard treatment for Amyand hernia in children, therefore the CiX classification could be considered for management. A treatment proposal is presented in the pediatric population, where three types were included, considering the evolutionary stage of the cecal appendix and that almost all inguinal hernias in children are due to persistence of the vaginal process; therefore, surgical treatment only includes herniotomy. By not using prosthetic material, handling is facilitated and the risk of infection is reduced.
Sujet(s)
Humains , Appendicite , Prématuré , Hernie inguinale , Appendice vermiforme , Hernie , NourrissonRÉSUMÉ
Acute appendicitis represents the most common surgical emergency in the world. Clinically, it presents with pain in the right iliac fossa. One third of patients presents with pain in another location, secondary to the variability of the anatomical position of the appendix. Acute left appendix is a very rare pathology, and it is commonly associated with congenital anomalies such as intestinal malrotation or situs inversus. The patient in this case, a 30-year-old male, presented with abdominal pain in the epigastrium which later radiated to the hypogastrium. Initially with a diagnosis of suspected gastroenteritis, with no improvement with treatment, it was decided to perform an abdominal tomography, where the left cecal appendix was observed, with increased diameter, associated with signs of midgut malrotation. Diagnostic laparoscopy was performed, and no appendix was identified. It converted to open surgery, revealing small intestine on the right side, colon on the left side and perforated left cecal appendix. Acute left appendicitis it should be suspected early to avoid delay in diagnosis and treatment, and to avoid future complications. Abdominal tomography is a highly sensitive diagnostic tool in the case of acute appendicitis associated with intestinal malrotation. Laparoscopy is the first choice in suspected left appendicitis, but the surgeon must take into account the difficulties that may arise during the procedure, the time of evolution and not delay definitive treatment; it must also decide when open surgery is necessary.
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Introducción. La transposición de los órganos debido al situs inversus (SI) es una rara afección que dificulta el diagnóstico de la apendicitis aguda. Esta condición hace que la sintomatología del paciente y los hallazgos al examen físico puedan ser atípicos, lo que demanda el uso de imágenes para la confirmación diagnóstica en la mayoría de los casos. Métodos. Se describieron tres casos de apendicitis en pacientes con diagnóstico de situs inversus. Dos de ellos tenían el antecedente conocido, mientras el tercer caso fue diagnosticado de forma intraoperatoria. Resultados. En dos pacientes se decidió llevar a cirugía vía laparoscópica sin imágenes diagnósticas adicionales. Los pacientes evolucionaron de manera satisfactoria. Conclusión. Siempre se debe considerar la apendicitis dentro de los diagnósticos diferenciales en los pacientes con dolor en fosa ilíaca izquierda. Es fundamental diagnosticar y tratar la apendicitis de manera efectiva para minimizar las complicaciones asociadas. La importancia de la anamnesis y la sospecha clínica del examinador son vitales en estos casos, que se pueden confirmar con las imágenes diagnósticas. Pueden existir casos en donde la condición clínica del paciente no permita la realización de estudios diagnósticos por imágenes; esto apoya cada vez más el uso del abordaje laparoscópico. Se recomienda considerar el abordaje laparoscópico en primera instancia, ya que nos permite la confirmación diagnóstica de situs inversus totalis en caso de que el antecedente sea desconocido y facilita el manejo oportuno de la urgencia.
Introduction. Organ transposition due to situs inversus (SI) is a rare condition that makes the diagnosis of acute appendicitis difficult. This condition entails that the patient' symptoms and physical examination findings may be atypical, which requires the use of images for diagnostic confirmation in most cases. Clinical cases. Three cases of appendicitis in patients diagnosed with situs inversus are described. Two of them had a known medical history, while the third case was diagnosed intraoperatively. Results. In two patients it was decided to undergo laparoscopic surgery without additional diagnostic images. The patients progressed satisfactorily. Conclusion. Appendicitis should always be considered in the differential diagnoses in patients with pain in the left iliac fossa. It is essential to diagnose and treat appendicitis effectively to minimize associated complications. The importance of the anamnesis and the examiner's clinical suspicion are vital in these cases, which can be confirmed with diagnostic images. There may be cases where the patient's clinical condition does not allow diagnostic imaging studies to be performed, increasingly supports the use of the laparoscopic approach. It is recommended to consider the laparoscopic approach in the first instance, since it allows us to confirm the diagnosis of situs inversus totalisin case the history is unknown and facilitates timely management of the emergency.
Sujet(s)
Humains , Appendicectomie , Situs inversus , Appendicite , Syndrome de Kartagener , Laparoscopie , Diagnostic différentielRÉSUMÉ
A 60-year-old male case whose condition began 6 months prior to admission to the emergency department, presenting an increase in volume in the right inguinal region, with intermittent pain, colic type, with an intensity rating of 8-10/10. On physical examination we found increased volume in the right inguinal region when standing, tumor measuring approximately 5x5 cm, hernia defect approximately 4 cm in diameter, non-painful and reducible. Patient was diagnosed clinically as direct right inguinal hernia and ultrasound confirmed the diagnosis with the presence of the appendix in the sac. A pre-operative diagnosis of right inguinal hernia was made and was planned for hernia mesh repair, during surgery under spinal blockage, the hernia sac was found to contain an appendix without signs of inflammation, so we decided to close the defect and repair with a Lichtenstein mesh hernioplasty without doing an appendectomy. In this case we treated a rare clinical entity called Amyand's hernia. This case highlights the importance of considering Amyand's hernia in the differential diagnosis of inguinal pathologies and the role of imaging modalities in pre-operative diagnosis. Various classification systems have been proposed, including those by Losanoff and Bason, later modified by Rikki et al offering insights into surgical management strategies based on the condition of the appendix and concomitant pathologies. Despite efforts to standardize treatment approaches, consensus on the optimal management strategy remains elusive, necessitating further research to refine diagnostic and therapeutic guidelines.
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Introducción: La apendicitis aguda, definida como la inflamación del apéndice vermiforme, es la causa más frecuente de abdomen agudo quirúrgico y es la patología aguda quirúrgica más común en la infancia y en el niño mayor. Objetivo: Determinar las características clínicas de niños con apendicitis aguda que acuden al Servicio de Urgencias del Hospital Regional de Pilar durante el periodo 2020 al 2023. Materiales y métodos: Estudio observacional descriptivo, retrospectivo, de corte transversal en pacientes pediátricos que acuden al servicio de urgencias del Hospital Regional de Pilar. Incluyó pacientes de 4 a 15 años que acudieron al servicio de urgencias por cuadro de dolor abdominal agudo durante el periodo enero 2020 a julio 2023. Resultados: Se realizaron 80 apendicetomías en niños de 4 a 15 años, la media de edad fue 11±3años; predominó el sexo femenino en el 34,4%; el principal motivo de consulta fue dolor abdominal más vómitos con un tiempo promedio de evolución de 29,6±22horas; se presentó signo de defensa muscular en el 77,5%; la característica apendicular predominante fue flegmonosa en el 51,3%; el tiempo promedio de estancia hospitalaria fue de 3±1,2días y el 71,3% de los niños no presentó complicación aguda. Conclusión : El conocimiento de las características clínicas de la apendicitis aguda resultan de suma importancia para el médico en el Servicio de Urgencias para un diagnóstico precoz y; por ende, una apendicetomía temprana minimizando tanto las tazas de complicaciones intraoperatorias como posoperatorias.
Introduction: Acute appendicitis, defined as inflammation of the vermiform appendix, is the most common cause of acute surgical abdomen and is the most common acute surgical pathology in childhood and older children. Objective: Determine the clinical characteristics of children with acute appendicitis who attend the Emergency Service of the Pilar Regional Hospital during the period 2020 to 2023. Materials and methods: Descriptive, retrospective, cross-sectional observational study in pediatric patients attending the emergency service of the Pilar Regional Hospital. It included patients aged 4 to 15 years who attended the emergency department due to acute abdominal pain during the period January 2020 to July 2023. Results: 80 appendectomies were performed in children from 4 to 15 years old, the average age was 11±3 years; The female sex predominated in 34.4%; The main reason for consultation was abdominal pain plus vomiting with an average duration of 29.6±22 hours; sign of muscular defense was present in 77.5%; the predominant appendiceal characteristic was phlegmonous in 51.3%; The average length of hospital stay was 3±1.2 days and 71.3% of the children did not present acute complications. Conclusion: Knowledge of the clinical characteristics of acute appendicitis is of utmost importance for the doctor in the Emergency Department for early diagnosis and therefore, an early appendectomy minimizes both intraoperative and postoperative complication rates.
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La pileflebitis es definida como la trombosis supurativa de la vena porta como complicación de infecciones abdominales. En pediatría, la etiología más frecuente es la apendicitis, generalmente de diagnóstico tardío, que se presenta como sepsis, con una elevada mortalidad. Para el diagnóstico son necesarios métodos de diagnóstico por imágenes; los más utilizados son la ecografía Doppler y la angiotomografía. El tratamiento se basa en la intervención quirúrgica, la antibioticoterapia y la anticoagulación. Esta última tiene indicación controvertida, pero podría mejorar el pronóstico y disminuir la morbimortalidad. Se presenta un caso clínico de pileflebitis secundaria a sepsis por Escherichia coli con punto de partida en una apendicitis aguda, en un paciente pediátrico que evoluciona a la transformación cavernomatosa de la vena porta. Es de importancia conocer el manejo de esta entidad, ya que, una vez superado el cuadro inicial, requerirá un minucioso seguimiento por la posibilidad de evolucionar a la insuficiencia hepática.
Pylephlebitis is defined as suppurative thrombosis of the portal vein as a complication of abdominal infections. In pediatrics, the most frequent etiology is appendicitis, generally of late diagnosis, presenting as sepsis, with a high mortality rate. Imaging methods are necessary for diagnosis; the most common are the Doppler ultrasound and computed tomography angiography. Treatment is based on surgery, antibiotic therapy, and anticoagulation. The indication for the latter is controversial, but it may improve prognosis and decrease morbidity and mortality. Here we describe a clinical case of pylephlebitis secondary to Escherichia coli sepsis, which started as acute appendicitis in a pediatric patient who progressed to cavernomatous transformation of the portal vein. It is important to know the management of this disease because, once the initial symptoms are overcome, it will require close follow-up due to a potential progression to liver failure.
Sujet(s)
Humains , Enfant , Appendicite/diagnostic , Thrombophlébite/diagnostic , Thrombophlébite/étiologie , Thrombophlébite/traitement médicamenteux , Sepsie/étiologie , Maladies du foie , Veine porte , Antibactériens/usage thérapeutiqueRÉSUMÉ
Introducción. La apendicitis aguda es una afección común, con un pico de incidencia entre los 10 y 20 años. La cirugía es el tratamiento preferido y la apendicectomía por laparotomía sigue siendo el estándar, aunque el abordaje laparoscópico ha mostrado menos complicaciones. El objetivo de este artículo fue caracterizar tanto la enfermedad como el tratamiento quirúrgico en Colombia, usando datos de bases oficiales. Métodos. Se accedió a la base de datos del Sistema Integrado de Información para la Protección Social (SISPRO) del Ministerio de Salud de Colombia en febrero de 2023. Se recogieron datos de los pacientes con diagnóstico de apendicitis y con procedimiento de apendicectomía entre 2017 y 2021, y se analizaron por edad, sexo y ubicación geográfica. Resultados. Entre 2017 y 2021 se diagnosticaron 345.618 casos de apendicitis (51,8 % mujeres), con pico de incidencia a los 15-20 años. Se realizaron 248.133 apendicectomías, el 16,7 % por laparoscopia. Los hospitales con más procedimientos reportados estaban en Bogotá, Yopal, Popayán y Florencia. La mortalidad fue de 0,56 % en hombres y 0,51 % en mujeres. Conclusión. La apendicitis es común, con pico a los 10-19 años. Las mujeres tienen mayor probabilidad de apendicectomía, debido a otras afecciones ginecológicas. El acceso a la apendicectomía disminuye la mortalidad; en estos pacientes, el 16 % fue laparoscópica, lo que sugiere que se necesita más entrenamiento y acceso a esta técnica. Este estudio aporta a la comprensión de la epidemiología de la apendicitis y apendicectomías en Colombia.
Introduction. Acute appendicitis is a common condition, with a peak incidence between 10 and 20 years of age. Surgery is the preferred treatment and laparotomy appendectomy remains the standard, although the laparoscopic approach has shown fewer complications. The objective of this article was to characterize both the disease and the surgical treatment in Colombia, using data from official databases. Methods. The Integrated Information System for Social Protection (SISPRO) database of the Ministry of Health was accessed in February 2023. Data with diagnosis of apendicitis and with appendectomy between 2017 and 2021 were collected. Analysis was done by age, gender, and geographic location. Results. Between 2017 and 2021, 345,618 cases of appendicitis were diagnosed (51.8% females), with peak incidence at 15-20 years of age. A total of 248,133 appendectomies were performed, 16.7% by laparoscopy. The hospitals with most reported procedures were located in Bogotá, Yopal, Popayán, and Florencia. Mortality was 0.56% in men and 0.51% in women. Conclusion. Appendicitis is common, peaking at ages 10-19. Women are more likely undergo appendectomy due to other gynecological conditions. Access to appendectomy improves mortality. In these patients, 16% were laparoscopic, suggesting that more training and access to this technique is needed. This study contributes to the understanding of the epidemiology of appendicitis and appendectomies in Colombia.
Sujet(s)
Humains , Appendicite , Épidémiologie , Appendicectomie , Enregistrements , Prévalence , LaparoscopieRÉSUMÉ
Chilaiditi's condition refers to the presence of a loop of small intestine or colon between the diaphragm and the hepatic rim, usually due to alterations in the attachment of the liver to the diaphragm. Chilaiditi syndrome is associated with abdominal pain as the most common clinical manifestation. Pneumoperitoneum should always be ruled out in the context of these patients. We presented the case of a male in his eighth decade of life who presented with data suggestive of drug-modified acute appendicitis, for which computed tomography of the abdomen identified acute appendicitis and Chilaiditi's condition. An open appendectomy was performed without complications and the condition resolved.
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Amyand's hernia is described as the presence of the caecal appendix within the hernial sac of an incarcerated inguinal hernia. It was reported as an incidental finding in 1% of cases and with evidence of appendicitis in 0.1% of cases. The approach involves performing appendectomy and inguinal repair in the same surgical time, depending on the clinical scenario and the surgeon's decisions. We presented the case of a 76-year-old male patient with a diagnosis of Amyand's right inguinal hernia diagnosed during trans-operative right inguinal plasty.
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Background: Among the plethora of causes for patients presenting with an acute abdomen, appendicitis is the most common conclusive diagnosis. Known being controversial for its etiology and pathogenesis, diagnosis of acute appendicitis has been challenging despite the development of various clinical and laboratory studies. Inflammatory markers of hematological origin-total leucocyte count (TLC), platelet indices viz. mean platelet count (MPV), plateletcrit (PCT), and platelet distribution width (PDW), have long been preferred as rudimentary diagnostic parameters for acute appendicitis despite being contentious. Methods: An analytical and cross-sectional study among 100 individuals. Statistical evaluation of TLC, MPV, PCT and PDW of 21 appendicitis cases and 70 healthy individuals were complied. Results: Compared to the control group, cases showed significantly higher values of TLC and MPV while the PCT and PDW were normally distributed and showed no significant statistics. The sensitivity of TLC and MPV was determined to be 95.2%, 71.4%, and specificity 100%, 73.8% respectively. Conclusions: With equitable results, the routine and cost-effective TLC and MPV play a novel role in the early diagnosis of acute appendicitis.
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Objective To explore the characteristics and diagnostic significance of ultrasound signs in the diagnosis of acute appendicitis in children.Methods This study focused on 81 children with acute appendicitis and divided them into two groups based on pathological examination results:34 children with severe progressive appendicitis(41.98%)and 47 children with simple appendicitis(58.02%).By analyzing the indirect and direct signs of ultrasound detection,as well as pathological examination data,and using ROC curve analysis to analyze the area under the curve(area under curve,AUC)of ultrasound signs combined,a comprehensive analysis is conducted to score the ultrasound examination results of children.Results The detection rates of wall continuity interruption/low-level clarity,intraluminal fluid accumulation,periappendiceal or abdominal fluid accumulation,periappendiceal hyperechogenicity,cecal and ileal wall thickening in the advanced group were higher than those in the simple group(P<0.05);The scores of indirect,direct,and combined ultrasound signs in the progressive group were higher than those in the simple group(P<0.05);Under the ROC curve,the sensitivity,specificity,positive predictive value,and negative predictive value of combined signs were 98.77%,97.53%,98.77%,and 96.30%,respectively,higher than those of indirect signs and direct signs.The AUC was 0.835,higher than those of indirect signs and direct signs(P<0.05).Conclusion The combined diagnosis of ultrasound examination signs can provide objective evidence for the early diagnosis of acute appendicitis in children,and can also achieve dynamic monitoring of the disease,which is conducive to the formulation of clinical treatment plans.
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Objective To compare the clinical efficacy of abdominal ultrasound-guided endoscopic retrograde appendicitis therapy(ERAT)with laparoscopic appendectomy(LA)for acute uncomplicated appendicitis using propensity score matching.Methods The clinical data of 441 patients with acute uncomplicated appendicitis admitted to the Third People's Hospital of Yunnan Province from March 2020 to April 2023 were collected.The cases were classified based on the differences in surgical method and divided into the ERAT group(n = 30)and LA group(n = 411).The clinical efficacy of patients was compared between the two groups after reducing confounding bias by propensity score matching(PSM).Results After PSM,a total of 30 pairs of patients in the two groups were successfully matched,and the baseline data of the two groups met the requirements for comparability.At 24 hours after the operation,the ERAT group exhibited lower white blood cells,neutrophil counts,and C-reactive protein levels compared to the LA group,and these differences were statistically significant(P<0.05).There was no significant difference in the operation time and total effective rate between the ERAT group and the LA group(P>0.05).However,the ERAT group had lower intraoperative blood loss and shorter pain relief time compared to the LA group,and these differences were statistically significant(P<0.05).Conclusion Abdominal ultrasound-guided endoscopic retrograde appendicitis treatment is an effective,safe,and feasible technique with good prospects for the treatment of acute uncomplicated appendicitis.
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Objective To compare the diagnostic value of ultrasonography and CT in acute appendicitis.Methods A retrospective analysis was conducted on 279 patients who were diagnosed with acute appendicitis and followed emergency surgery.Patients were divided into different subgroups based on postoperative pathological results and body mass index(BMI),and the pathological results were used as the gold standard to analyze whether there were differences in the diagnostic accuracy of ultrasonography and CT examination for acute appendicitis.Results A total of 279 patients with confirmed acute appendicitis,with 64 cases of simple appendicitis,127 cases of suppurative appendicitis,and 88 cases of gangrenous appendicitis according to pathological classification.The diagnostic accuracy of ultrasonography was 68.75%(44/64),73.22%(93/127),and 81.81%(72/88),respectively.The diagnostic accuracy of CT was 71.87%(46/64),82.67%(105/127),and 90.90%(80/88),respectively.There was no statistically significant difference in diagnostic accuracy between the two examinations(P>0.05).Subgroup analysis based on patient BMI showed that there was no difference in diagnostic accuracy of the two examinations for patients with normal BMI(P>0.05),while for overweight and obese patients,the diagnostic accuracy of CT was better than that of ultrasonography,with a statistical difference(P<0.05).Conclusion There is no difference in the diagnostic accuracy of ultrasonography and CT examinations for acute appendicitis of different pathological types.But for overweight and obese acute appendicitis patients,the diagnostic accuracy of CT examination is superior to ultrasonography.
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Objective:To study the clinical features and risk factors of prognosis of neonatal appendicitis.Methods:From January 2014 to December 2022, all infants with neonatal appendicitis and received surgery in our hospital were retrospectively analyzed.Results:A total of 6 cases were enrolled, including 1 boy and 5 girls, with gestational age 36-40 weeks, birth weight 1 990~3 300 g, age of admission 5-11 d and time from illness onset to admission 0.5-4 d. All infants had abdominal distension, combined with vomiting in 4 cases, fever in 3 cases and blood in stool in 1 case. Gastrointestinal perforation was found on preoperative abdominal X-ray in 5 cases. All 6 cases received surgery and confirmed the diagnosis of appendicitis with perforation during the surgery. Appendectomy was performed without mortality. 1 case had Amyand hernia and received high ligation of the hernia sac during operation. 1 case had meningitis and was cured after 3 weeks of antibiotic treatment. 1 case developed adhesive intestinal obstruction 3 months after surgery and underwent intestinal adhesiolysis. One case developed colonic stenosis one month after surgery. The stenotic segment of the colon was resected and primary intestinal anastomosis was performed.Conclusions:Neonatal appendicitis progresses rapidly and is difficult to diagnose. The possibility of appendicitis with perforation should be considered when preoperative abdominal X-ray suggesting pneumoperitoneum. Intraoperatively, it is necessary to pay attention to the relationship between appendiceal perforation and other lesions for comprehensive treatment, and change the surgical approach accordingly.
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Objective To study the effect of spectrum irradiation combined with operative laparoscopy on inflammatory reaction and immune function in children with appendicitis.Methods 120 children with appendicitis from January 2022 to January 2023 were selected as the study subjects,randomly divided them into two groups using a random number table method:the control group(n = 60)and the study group(n = 60).The control group underwent laparoscopic minimally invasive appendectomy,and the study group underwent spectrum irradiation combined with laparoscopic minimally invasive appendectomy.The two groups compared perioperative recovery,procalcitonin(PCT),C-reactive protein(CRP)level,cellular immune function(CD4+,CD8+,and CD4+/CD8+),humoral immune function[immunoglobulin M(IgM),immunoglobulin G(IgG),C3,and C4],pain visual analogue scale(VAS),Alvarado score,and treatment effect and postoperative complication rate.Results Compared with the control group,the study group showed a significant reduction in the time to first anal exhaust and hospital stay after surgery,the differences were statistically significant(P<0.05).Compared with preoperative levels,the levels of PCT and CRP in both groups of patients increased at 12 and 24 h postoperatively,with the highest levels occurring at 12 h postoperatively;The PCT and CRP levels in the study group were lower than those in the control group at 12 and 24 h after surgery,the differences were statistically significant(P<0.05).Compared with preoperative data,the CD4+,CD8+,and CD4+/CD8+ levels decreased in both groups at 12 and 24 h postoperatively,with the lowest levels observed at 12 h postoperatively;The CD4+,CD8+,and CD4+/CD8+ levels in the study group were higher than those in the control group at 12 and 24 h after surgery,the differences were statistically significant(P<0.05).Compared with preoperative levels,the levels of IgM,IgG,C3,and C4 in both groups of patients decreased after surgery,with the lowest levels occurring 12 h after surgery;The levels of IgM,IgG,C3,and C4 in the study group were higher than those in the control group at 12 and 24 h after surgery,the differences were statistically significant(P<0.05).Compared with preoperative conditions,the VAS and Alvarado scores in both groups of patients decreased at 12 and 24 h after surgery.The VAS and Alvarado scores of the study group were lower than those of the control group at 12 and 24 h after surgery,the differences were statistically significant(P<0.05).Compared with the control group,the study group had a higher overall effective rate and a lower total incidence of complications,the differences were statistically significant(P<0.05).Conclusion Spectrum irradiation combined with operative laparoscopy can reduce postoperative inflammatory reaction,and improve immune function in children with appendicitis,shorten inflammatory reaction and immunosuppression time,reduce pain,and have a low incidence of postoperative complications,with ideal effect.
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La apendicitis aguda se manifiesta, en ocasiones, con una variada e inespecífica presentación clínica, lo que dificulta su diagnóstico oportuno y favorece el riesgo de complicaciones. El objetivo es actualizar la información relacionada con las características clínicas de la apendicitis aguda, para lo que se realizó una revisión no sistemática de la literatura hasta abril del año 2022. Se revisaron artículos, libros especializados y citas bibliográficas de estudios elegidos, 20 de los cuales fueron seleccionados para la revisión. Mediante esta investigación se concluye que la primera y principal manifestación clínica es el dolor abdominal. El paciente debe someterse a una cuidadosa exploración física, incluyendo un examen rectal si lo precisa, y en las mujeres a un examen ginecológico si existiera duda diagnóstica.
Acute appendicitis is manifested, sometimes, with a varied and unspecific clinical presentation, which makes difficult its timely diagnosis and favors the complication risk. The objective is to update the information related to the clinical characteristics of acute appendicitis, for which a non-systematic review of the literature was carried out until April 2022. Articles, specialized books and bibliographic citations of selected studies were reviewed, 20 of which were chosen for the review. Through this research it is concluded that the first and main manifestation is abdominal pain. The patient should undergo a rigorous physical examination, including a rectal examination if necessary, and in the case of women, a gynecological examination if there is diagnostic doubt.
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Las hernias gigantes de Amyand son hernias inguinales excepcionales por extenderse por debajo de la mitad del muslo en posición de pie y contener al apéndice cecal. Presentamos un paciente portador de una hernia gigante de Amyand irreductible, al cual se le realiza una reparación quirúrgicas, mediante una combinada de técnicas para su resolución. El tratamiento de las hernias inguinales gigantes es todo un desafío, debido a la distorsión anatomía existente, y por la pérdida de derecho a domicilio de los órganos que puede llegar a ocasionar. Consideramos que la combinación de las técnicas de Bassini y Lichtennstein asociado a las maniobras de Ombrédanne y de Camay es una estrategia adecuada para reparar exitosamente las hernias inguinales gigantes grado I. La apendicectomía en la hernia de Amyand tipo I es una alternativa de tratamiento cuando existe riesgo de apendicitis aguda.
Giant Amyand hernias are exceptional inguinal hernias because they extend below the middle of the thigh in the standing position and contain the cecal appendix. We present a patient with an irreducible giant Amyand hernia, who underwent surgical repair, using a combination of techniques for its resolution. The treatment of giant inguinal hernias is quite a challenge, due to the existing anatomical distortion, and the loss of the right to domicile of the organs that it can cause. We consider that the combination of the Bassini and Lichtenstein techniques associated with the Ombrédanne and Camay maneuvers is an appropriate strategy to successfully repair grade I giant inguinal hernias. Appendectomy in Amyand type I hernia is a treatment alternative when a risk of acute appendicitis exists.
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La Hernia de Garengeot es la presencia del apéndice cecal dentro de una hernia crural atascada/estrangulada. Es una entidad rara de baja incidencia, poco conocida en el mundo, la mayoría son diagnosticadas durante el acto quirúrgico. El objetivo del presente artículo es exponer un caso de Hernia de Garengeot, diagnosticada y tratada en el Hospital Municipal Los Pinos, en una paciente de 67 años; que tras la revisión sintomatológica y semiológica, se dio el diagnostico de Hernia Crural Derecha Estrangulada, fue programada para cirugía de urgencia y en el acto quirúrgico tras la apertura del saco herniario se identificó el apéndice cecal dentro del mismo. Por la atipia del cuadro se enfocara aspectos históricos, etiológicos y fisiopatológicos; que implica tomar en cuenta para dirigir el tratamiento más adecuado según hallazgos y estado del paciente, en esta variedad poco frecuente de hernias.
Garengeot hernia is the presence of the cecal appendix within a stuck/strangulated crural hernia. It is a rare entity of low incidence, little known in the world, most are diagnosed during the surgical act. The objective of this article is to present a case of Garengeot Hernia, diagnosed and treated at the Los Pinos Municipal Hospital, in a 67-year-old patient; that after the symptomatological and semiological review, the diagnosis of Right Crural Hernia Strangulated was given, it was scheduled for emergency surgery and in the surgical act after the opening of the hernial sac the cecal appendix was identified within it. Due to the atypia of the picture, historical, etiological and physiopathological aspects will be focused; which implies taking into account to direct the most appropriate treatment according to findings and condition of the patient, in this rare variety of hernias.
RÉSUMÉ
Introduction: Appendicitis is the surgical disease with the highest prevalence in emergency rooms. Its clinical and/or surgical complications are associated with the time course of symptoms, age, comorbidities, and stages of the disease. Objectives: To analyze the demographic and clinical data of patients who underwent appendectomy for acute appendicitis in a tertiary referral hospital in the city of São Paulo and compare these data between services provided by the Public and Supplementary Health System. Methodology: Retrospective analysis of data from electronic medical records of patients over 14 years old who underwent appendectomy for acute appendicitis at Hospital Santa Marcelina, both in the Public and Supplementary Health Systems from January 2015 to December 2017. Results: A total of 536 patients were analyzed, 354 (66%) of whom were male with a general mean age of 29.85 years (14-81 years). The mean time from symptoms to seeking medical care was 53.84 hours. Regarding the phases of acute appendicitis, a greater number of cases of complicated disease was observed in patients operated on in the Public Health System (p < 0.0001), as well as the time course of symptoms (p = 0.0005) and Conclusion: There was a predominance of male patients undergoing appendectomy for acute appendicitis, with longer time course of symptoms in those operated on in the Public Health System and a predominance of appendicitis in advanced stages (3 and 4) in this group. However, in this group there was no significant increase in the rate of postoperative infection, and the length of stay was shorter than that of patients operated on in the Supplementary Health System. (AU)
Sujet(s)
Humains , Adolescent , Adulte , Adulte d'âge moyen , Sujet âgé , Sujet âgé de 80 ans ou plus , Appendicectomie/statistiques et données numériques , Hôpitaux privés , Hôpitaux publics , Études rétrospectivesRÉSUMÉ
Introducción: Las infecciones de sitio quirúrgico (ISQ), se encuentran entre las infecciones asociadas al cuidado de la salud (IACS) más frecuentes, la profilaxis antibiótica administrada en el período preoperatorio contribuye a prevenir las ISQ. Objetivo: determinar si los esquemas antimicrobianos utilizados para profilaxis en cirugía corresponden a recomendados por Guías Internacionales de Tratamiento de Enfermedades Infecciosas; así como conocer los esquemas antimicrobianos utilizados, estimar el costo de la quimioprofilaxis y comparar con los resultados obtenidos en un estudio similar realizado en el mismo servicio en el año 2005. Materiales y métodos: Estudio descriptivo, observacional, retrospectivo donde se seleccionaron todas las historias clínicas de pacientes de ≤15 años de edad sometidos a apendicectomía, con diagnóstico posquirúrgico de apendicitis congestiva o flegmonosa, desde enero a diciembre del 2022. Se elaboró una planilla electrónica donde se cargaron los siguientes datos: antibiótico utilizado, dosis, número de dosis y momento de la administración. Resultados: 53 pacientes ≤ de 15 años fueron sometidos a apendicectomía, de los cuales 21 llenaban los criterios de inclusión. Fue utilizado Amoxicilina/Sulbactam en 19/21. El número total de dosis administradas fue de 68 dosis y la media de 3,3±1,9 dosis; solo en 8 de los pacientes se administró el antimicrobiano profiláctico en el tiempo correcto; solo 1 paciente recibió el esquema correcto, 1 sola dosis, 1 hora antes del inicio de la cirugía. El costo de la profilaxis antimicrobiana por paciente fue de 15,7 USD. Conclusión: Este trabajo nos permitió verificar la falta de aplicación de guías en el uso de antimicrobianos en la profilaxis quirúrgica, lo cual demuestra: i) la necesidad de revisar y estandarizar la conducta de prescripción relacionada en profilaxis quirúrgica, ii) la importancia de elaborar y socializar una guía de manejo de antimicrobianos y iii) el monitoreo de su implementación.
Introduction: Surgical site infections (SSIs) are among the most frequent healthcare-associated infections (HCIs). Antibiotic prophylaxis administered during the preoperative period contributes to preventing SSIs. Objective: to determine if the antimicrobial regimens used for prophylaxis in surgery correspond to those recommended by International Guidelines for the Treatment of Infectious Diseases; as well as knowing the antimicrobial regimens used, estimating the cost of chemoprophylaxis and comparing the current results with those obtained in a similar study carried out in the same service in 2005. Materials and methods: This was a descriptive, observational and retrospective study where we reviewed all medical records of patients ≤15 years of age undergoing appendectomy, with a post-surgical diagnosis of congestive or phlegmonous appendicitis, from January to December 2022. An electronic spreadsheet was prepared where the following data were uploaded: antibiotic used, dose, number of doses and time of administration. Results: 53 patients ≤ 15 years of age underwent appendectomy, of which 21 met the inclusion criteria. Amoxicillin/Sulbactam was used in 19/21. The total number of doses administered was 68 doses and the average was 3.3±1.9 doses; only in 8 of the patients was the prophylactic antimicrobial administered at the correct time; only 1 patient received the correct regimen, 1 single dose, 1 hour before the start of surgery. The cost of antimicrobial prophylaxis per patient was 15.7 USD. Conclusions: This study allowed us to verify the lack of application of existing guidelines in the use of antimicrobials in surgical prophylaxis, which demonstrates: i) the need to review and standardize prescription behavior related to surgical prophylaxis, ii) the importance of developing and disseminating an antimicrobial management guide and iii) the need to monitor its implementation.