Retrospective Analysis of the Clinical Features and Pregnancy Outcomes in 124 Pregnant Patients with Non-Obstetric Acute Abdomen.

Objective: To retrospectively analyze the clinical characteristics and pregnancy outcomes of patients with the non-obstetric acute abdomen (AAD) during pregnancy. Methods: A total of 124 patients with non-obstetric AAD during pregnancy were selected, including acute gastroenteritis (n = 42), acute appendicitis (n = 24), pedicle torsion of ovarian tumor (n = 21), acute pancreatitis (n = 10), urinary stones (n = 8), acute cholecystitis (n = 5), ruptured ovarian cyst (n = 6), red degeneration of hysteromyoma (n = 4), pedicle torsion of subserosal hysteromyoma (n = 3) and intestinal obstruction (n = 1). The clinical data of included patients were collected, and their clinical manifestations, clinical diagnosis, treatment modalities, and pregnancy outcomes were analyzed. Results: Common clinical manifestations included abdominal pain, nausea, vomiting, fever, elevated leukocytes, and neutrophil count. Clinical diagnosis analysis revealed acute gastroenteritis (n = 42), acute appendicitis (n = 24), pedicle torsion of ovarian tumor (n = 21), acute pancreatitis (n = 10), urinary stones (n = 8), acute cholecystitis (n = 5), ruptured ovarian cyst (n = 6), red degeneration of hysteromyoma (n = 4), pedicle torsion of subserosal hysteromyoma (n = 3) and intestinal obstruction (n = 1) in patients. Surgery was performed for conditions such as acute appendicitis and ovarian tumor torsion, while conservative treatment was preferred for cases of acute gastroenteritis. 65 patients received surgery and 59 patients received conservative treatment. The pregnancy outcomes indicated 113 patients with full-term delivery, 5 with premature delivery, 6 with miscarriage and 1 with fetal death. Pregnancy outcomes varied, with 113 patients achieving full-term delivery, 5 experiencing premature delivery, 6 undergoing miscarriage, and 1 case of fetal death. Conclusion: Non-obstetric AAD during pregnancy manifests clinically as nausea and vomiting, abdominal pain, elevated body temperature, and leukocytes, all of which have pregnancy outcomes. Pregnant patients with non-obstetric AAD should be diagnosed according to their clinical manifestations, physical examinations, and relevant imaging examinations, and appropriate treatment modalities should be selected to achieve a better pregnancy outcome and ensure the safety of the mother and baby during the clinical diagnosis and treatment process. This study underscores the need for prompt and accurate diagnosis in pregnant patients with non-obstetric AAD, to optimize pregnancy outcomes and ensure maternal-fetal safety.

Common Conditions II: Acute Appendicitis, Intussusception, and Gastrointestinal Bleeding.

Perforated appendicitis continues to be a significant cause of morbidity for children. In most centers, ultrasound has replaced computed tomography as the initial imaging modality for this condition. Controversies surrounding optimal medical and surgical management of appendicitis are discussed. Management of intussusception begins with clinical assessment and ultrasound, followed by image-guided air or saline reduction enema. When surgery is required, laparoscopy is typically utilized unless bowel resection is required. The differential diagnosis for pediatric gastrointestinal bleeding is broad but often made with age, history, and physical examination. Endoscopy or laparoscopy is sometimes needed to confirm a diagnosis or for treatment.

Hyperbilirubinemia and Hyponatremia as Predictors of Complicated Appendicitis.

Several studies have reported elevated serum bilirubin or reduced serum sodium levels in patients with complicated appendicitis (CA). This study examined the efficacy of hyperbilirubinemia, hyponatremia, and both combined in the preoperative diagnosis of CA. Patients who underwent surgery for acute appendicitis were included in this retrospective review. In total, 247 patients were included in the final analysis. Of these, 36 (14.2%) had early appendicitis, 177 (72.0%) had acute suppurative appendicitis, 32 (13.0%) had necrotizing/gangrenous acute appendicitis, and 2 (0.8%) had other types of appendicitis. The mean total bilirubin (TBIL) level was significantly higher in patients with CA than in those with uncomplicated appendicitis. Conversely, the mean serum sodium level was significantly lower in patients with CA than in those with uncomplicated appendicitis. The levels of TBIL (odds ratio: 1.098, 95% CI: 1.052-1.147) and serum sodium (odds ratio: 0.743, 95% CI: 0.646-0.855) were associated with CA. Hyponatremia combined with hyperbilirubinemia yielded significant discriminatory value for the diagnosis of CA. TBIL and serum sodium levels can be considered as adjuvant parameters in the diagnosis of perforated/necrotizing appendicitis. Although hyperbilirubinemia and hyponatremia together were better able to determine the risk of CA than either marker alone, other markers are required to definitively predict CA. Furthermore, large-scale studies are needed to confirm these findings.

Double Appendix: Implications for the Emergency Department.

BACKGROUND: A double appendix, also known as vermiform appendix duplex, is a rare anomaly in humans, with a reported incidence of 1 in 25,000. The rarity of vermiform appendix duplication makes it a noteworthy medical occurrence. Approximately 100 reported cases have been documented since the first observed case in 1892. There are multiple types of appendiceal duplications, some of which include duplications of other organs. CASE REPORT: A 10-year-old boy was diagnosed with acute appendicitis by clinical examination and ultrasound. He underwent a laparoscopic appendectomy and had an unremarkable recovery. His pathology revealed acute suppurative appendicitis. Two months later, he presented to the emergency department due to bilateral lower abdominal pain with guarding and distension on examination. He underwent a computed tomography of the abdomen and pelvis secondary to concern for a postoperative abscess, which instead showed a normal-appearing retrocecal appendix containing oral contrast. The patient was diagnosed with constipation, and his symptoms resolved with an enema. Our patient had two completely separate appendices, one arising from the cecal tinea coli, and one retrocecal. Why Should an Emergency Physician Be Aware of This? Clinicians should be aware of this rare anomaly as a potential diagnosis in a patient with a history of prior appendectomy and clinical signs consistent with recurrent appendicitis. This also underscores the need for communication between doctors and patients, along with their families, to avoid delays in diagnosis in the future.

Correlación diagnóstica de la escala RIPASA en pacientes intervenidos quirúrgicamente por apendicitis aguda / Diagnostic correlation of the RIPASA score in patients operated on for acute appendicitis

Antecedentes: La apendicitis aguda (AA) es la urgencia quirúrgica más frecuente alrededor del mundo. Su diagnóstico precoz y certero es fundamental para evitar cirugías innecesarias y complicaciones asociadas a su evolución natural. Objetivo: Determinar la sensibilidad y especificidad diagnóstica de la escala RIPASA en pacientes con sospecha clínica de apendicitis aguda. Material y métodos: Estudio analítico, transversal, observacional y retrospectivo; se incluyeron todas las piezas de apendicectomías de pacientes de ambos sexos mayores de 18 años operados con diagnóstico clínico de apendicitis aguda que consultaron entre el 1º de enero y el 31 de diciembre de 2017. Como procedimiento de referencia (gold standard) diagnóstico se analizaron los hallazgos histopatológicos del apéndice extirpado. Se aplicó la escala RIPASA a cada uno de los pacientes (punto de corte de 7,5). Se realizó estadística descriptiva y pruebas diagnósticas (sensibilidad, especificidad, valor predictivo positivo [VPP], valor predictivo negativo [VPN]). Resultados: Se incluyeron 68 apendicectomías. Cincuenta y siete muestras (83,82%) fueron positivas para apendicitis aguda. El promedio de edad fue 43,32 años. De los 38 hombres, 32 (84,21%) tuvieron diagnóstico histopatológico de AA. De las 30 mujeres, 25 (83,33%) tuvieron AA. Para la escala RIPASA, 54 pacientes tuvieron un resultado verdadero positivo (punto de corte ≥7,5 e histología positiva para AA) resultando con una sensibilidad del 93%, especificidad del 40%, VPP del 90%, VPN del 50%, razón de verosimilitud positiva de 1,55 y razón de verosimilitud negativa de 0,175. Conclusión: El puntaje (score) RIPASA ha demostrado una excelente sensibilidad y especificidad para el diagnóstico clínico de AA de manera rápida, simple y no invasiva.

Background: Acute appendicitis (AA) is the most common surgical emergency worldwide. Its correct and early diagnosis is essential to avoid unnecessary surgeries and complications associated with its natural history. Objective: The aim of this study was to determine the diagnostic sensitivity and specificity of the RIPASA score in patients with suspected AA. Material and methods: This analytical, cross-sectional, observational and retrospective study included appendectomy specimens of patients of both sexes > 18 years operated on with clinical diagnosis of AA between January 1 and December 31, 2017. The histopathological examination of the appendectomy specimens was considered the gold standard diagnostic test. A score of 7.5 for the RIPASA score was chosen as cut-off value. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Results: A total of 68 appendectomies were included; 57 (83.82%) specimens were positive for acute appendicitis. Mean age was 43.32 years. The histological diagnosis of AA was present in 32 (84.21%) men and in 25 (83.33%) women. For the RIPASA score, 54 patients had a true positive result (cut-off point ≥ 7.5 and positive histology for AA) with a sensitivity of 93%, specificity of 40%, PPV of 90%, NPV of 50%, positive likelihood ratio of 1.55 and negative likelihood ratio of 0.175. Conclusion: The RIPASA score has demonstrated excellent sensitivity and specificity for the clinical diagnosis of AA in a fast, simple and non-invasive fashion.

Multi-institutional trial of non-operative management and surgery for uncomplicated appendicitis in children: Design and rationale.

Traditionally, children presenting with appendicitis are referred for urgent appendectomy. Recent improvements in the quality and availability of diagnostic imaging allow for better pre-operative characterization of appendicitis, including severity of inflammation; size of the appendix; and presence of extra-luminal inflammation, phlegmon, or abscess. These imaging advances, in conjunction with the availability of broad spectrum oral antibiotics, allow for the identification of a subset of patients with uncomplicated appendicitis that can be successfully treated with antibiotics alone. Recent studies demonstrated that antibiotics alone are a safe and efficacious treatment alternative for patents with uncomplicated appendicitis. The objective of this study is to perform a multi-institutional trial to examine the effectiveness of non-operative management of uncomplicated pediatric appendicitis across a group of large children's hospitals. A prospective patient choice design was chosen to compare non-operative management to surgery in order to assess effectiveness in a broad population representative of clinical practice in which non-operative management is offered as an alternative to surgery. The risks and benefits of each treatment are very different and a "successful" treatment depends on which risks and benefits are most important to each patient and his/her family. The patient-choice design allows for alignment of preferences with treatment. Patients meeting eligibility criteria are offered a choice of non-operative management or appendectomy. Primary outcomes include determining the success rate of non-operative management and comparing differences in disability days, and secondarily, complication rates, quality of life, and healthcare satisfaction, between patients choosing non-operative management and those choosing appendectomy.

[Status of diagnosis and management of acute appendicitis in 2017: a national multi-center retrospective study].

OBJECTIVE: To analyze the current status of diagnosis and management of acute appendicitis (AA) in China. METHODS: Questionnaire survey was used to retrospectively collect data of hospitalized patients with AA from 43 medical centers nationwide in 2017 (Sort by number of cases provided: Jinling Hospital of Medical School of Nanjing University, The First Affiliated Hospital of Xinjiang Medical University, Lu'an People's Hospital, Tengzhou Central People's Hospital, Dalian Central Hospital, The Affiliated Hospital of Xuzhou Medical University, Dongying People's Hospital, Jinjiang Hospital of Traditional Chinese Medicine, Huangshan Shoukang Hospital, Xuyi People's Hospital, Nanjing Jiangbei People's Hospital, Lanzhou 940th Hospital of PLA, Heze Municipal Hospital, The First College of Clinical Medical Science of China Three Gorges University, Affiliated Jiujiang Hospital of Nanchang University, The Second People's Hospital of Hefei, Affiliated Central Hospital of Shandong Zaozhuang Mining Group, The Third People's Hospital of Kunshan City, Xuzhou First People's Hospital, The 81st Group Army Hospital of PLA, Linyi Central Hospital, The General Hospital of Huainan Eastern Hospital Group, The 908th Hospital of PLA, Liyang People's Hospital, The 901th Hospital of Joint Logistic Support Force, The Third Affiliated Hospital of Chongqing Medical University, The Fourth Hospital of Jilin University, Harbin Acheng District People's Hospital, The First Affiliated Hospital of Zhengzhou University, Nanjing Luhe People's Hospital, Taixing Municipal People's Hospital, Baotou Central Hospital, The Affiliated Hospital of Nantong University, Linyi People's Hospital, The 72st Group Army Hospital of PLA, Zaozhuang Municipal Hospital, People's Hospital of Dayu County, Taixing City Hospital of Traditional Chinese Medicine, Suzhou Municipal Hospital, Beijing Guang'anmen Hospital, Langxi County Hospital of Traditional Chinese Medicine, Nanyang Central Hospital, The Affiliated People's Hospital of Inner Mongolia Medical University).The diagnosis and management of AA were analyzed through unified summary. Different centers collected and summarized their data in 2017 and sent back the questionnaires for summary. RESULTS: A total of 8 766 AA patients were enrolled from 43 medical centers, including 4 711 males (53.7%) with median age of 39 years and 958 (10.9%) patients over 65 years old. Of 8 776 patients, 5 677 cases (64.6%) received one or more imaging examinations, and the other 3 099 (35.4%) did not receive any imaging examination. A total of 1 858 (21.2%) cases received medical treatment, mainly a combination of nitroimidazoles (1 107 cases, 59.8%) doublet regimen, followed by a single-agent regimen of non-nitroimidazoles (451 cases, 24.4%), a nitroimidazole-free doublet regimen (134 cases, 7.2%), a triple regimen of combined nitroimidazoles (116 cases, 6.3%), nitroimidazole alone (39 cases, 2.1%) and nitroimidazole-free triple regimen (3 cases, 0.2%). Of the 6 908 patients (78.8%) who underwent surgery, 4 319 (62.5%) underwent laparoscopic appendectomy and 2589 (37.5%) underwent open surgery. Ratio of laparotomy was higher in those patients under 16 years old (392 cases) or over 65 years old (258 cases) [15.1%(392/2 589) and 10.0%(258/2 589), respectively, compared with 8.5%(367/4 316) and 8.0%(347/4 316) in the same age group for laparoscopic surgery, χ²=91.415, P<0.001; χ²=15.915,P<0.001]. Patients with complicated appendicitis had higher ratio of undergoing open surgery as compared to those undergoing laparoscopic surgery [26.7%(692/2 589) vs. 15.6%(672/4 316), χ²=125.726, P<0.001].The cure rates of laparoscopic and open surgery were 100.0% and 99.8%(2 585/2 589) respectively without significant difference (P=0.206). Postoperative complication rates were 4.5%(121/2 589) and 4.7%(196/4 316) respectively, and the difference was not statistically significant (χ²=0.065, P=0.799). The incidence of surgical site infection was lower (0.6% vs. 1.7%, χ²=17.315, P<0.001), and hospital stay was shorter [6(4-7) days vs. 6(5-8) days, U=4 384 348.0, P<0.001] in the laparoscopic surgery group, while hospitalization cost was higher (median 12 527 yuan vs. 9 342 yuan, U=2 586 809.0, P<0.001). CONCLUSIONS: The diagnosis of acute appendicitis is still clinically based, supplemented by imaging examination. Appendectomy is still the most effective treatment at present. Laparoscopic appendectomy has become the main treatment strategy, but anti-infective drugs are also very effective.

Consideraciones vigentes en torno al diagnóstico de la apendicitis aguda / Current considerations on the diagnosis of acute appendicitis

La apendicitis aguda es la causa más común de abdomen agudo y de intervención quirúrgica efectuada en los servicios de urgencias y a pesar de ser conocida desde tiempos remotos, su diagnóstico todavía adolece de imprecisiones que preocupan a la comunidad científica. Objetivo: Realizar una revisión sobre los criterios vigentes en torno al diagnóstico de la apendicitis aguda a fin de profundizar en sus aspectos cognoscitivos. Métodos: Búsqueda digital en bases de datos Web of Science, Lilacs, Scielo, Latindex, Elsevier, PubMed, Medline y Google de publicaciones actualizadas en inglés y español. Resultados: En los últimos años ha descendido la mortalidad asociada a la apendicitis aguda, lo cual se atribuye a los avances tecnológicos de la cirugía y de la anestesiología y reanimación, la existencia de salas de cuidados intensivos para la atención de pacientes graves y de la utilización de antibióticos cada vez más potentes. No obstante, la morbilidad todavía refleja alta incidencia de perforaciones a pesar de la utilización de marcadores inflamatorios, los diagnósticos realizados mediante imágenes, y del desarrollo de técnicas videolaparoscópicas. Aun así, continúan realizándose apendicectomías en apéndices normales. Conclusiones: La clínica sigue siendo el método de elección para efectuar el diagnóstico, dado que los exámenes de laboratorio e imágenes no han logrado superarlo. Si bien constituyen una importante ayuda, toda vez que las escalas diagnósticas contribuyen a su precocidad en aras de disminuir la morbilidad y mortalidad, así como las apendicectomías innecesarias o en estadios avanzados de la enfermedad(AU)

Acute appendicitis is the most common cause of acute abdomen and surgical treatment in the emergency services, and although this disease has been known since ancient times, its diagnosis still has inaccuracies that concern the scientific community. Objective: To make a review of the current criteria about the diagnosis of acute appendicitis in order to delve into its cognitive aspects. Methods: Search of updated publications in Spanish and English in Science, Lilacs, Latindex, Elsevier, PubMed, Medline and Google databases. Results: In the last few years, the acute appendicitis-associated mortality has decreased due to the technological advances in surgery, anesthesiology and resuscitation, the existence of intensive care units for critically-ill patients and the use of increasingly powerful antibiotics. However, morbidity rates still show high incidence of perforations despite the use of inflammatory markers, imaging-based diagnoses and the development of videolaparoscopic techniques. Despite all this, appendicectomies continue to be performed to treat normal appendices. Conclusions: The clinical method remains the method of choice to make a diagnosis, since the lab and imaging tests have not been better so far. Nevertheless, they are important support because the diagnostic scales contribute to their earliness with a view to reducing morbidity and mortality as well as unnecessary appendicectomies or appendicectomy in advanced disease stagings(AU)

Consideraciones vigentes en torno al diagnóstico de la apendicitis aguda / Current considerations on the diagnosis of acute appendicitis

Introducción: La apendicitis aguda es la causa más común de abdomen agudo y de intervención quirúrgica efectuada en los servicios de urgencias y a pesar de ser conocida desde tiempos remotos, su diagnóstico todavía adolece de imprecisiones que preocupan a la comunidad científica. Objetivo: Realizar una revisión sobre los criterios vigentes en torno al diagnóstico de la apendicitis aguda a fin de profundizar en sus aspectos cognoscitivos. Métodos: Búsqueda digital en bases de datos Web of Science, Lilacs, Scielo, Latindex, Elsevier, PubMed, Medline y Google de publicaciones actualizadas en inglés y español. Resultados: En los últimos años ha descendido la mortalidad asociada a la apendicitis aguda, lo cual se atribuye a los avances tecnológicos de la cirugía y de la anestesiología y reanimación, la existencia de salas de cuidados intensivos para la atención de pacientes graves y de la utilización de antibióticos cada vez más potentes. No obstante, la morbilidad todavía refleja alta incidencia de perforaciones a pesar de la utilización de marcadores inflamatorios, los diagnósticos realizados mediante imágenes, y del desarrollo de técnicas videolaparoscópicas. Aun así, continúan realizándose apendicectomías en apéndices normales. Conclusiones: La clínica sigue siendo el método de elección para efectuar el diagnóstico, dado que los exámenes de laboratorio e imágenes no han logrado superarlo. Si bien constituyen una importante ayuda, toda vez que las escalas diagnósticas contribuyen a su precocidad en aras de disminuir la morbilidad y mortalidad, así como las apendicectomías innecesarias o en estadios avanzados de la enfermedad(AU)

Introduction: Acute appendicitis is the most common cause of acute abdomen and surgical treatment in the emergency services, and although this disease has been known since ancient times, its diagnosis still has inaccuracies that concern the scientific community. Objective: To make a review of the current criteria about the diagnosis of acute appendicitis in order to delve into its cognitive aspects. Methods: Search of updated publications in Spanish and English in Science, Lilacs, Latindex, Elsevier, PubMed, Medline and Google databases. Results: In the last few years, the acute appendicitis-associated mortality has decreased due to the technological advances in surgery, anesthesiology and resuscitation, the existence of intensive care units for critically-ill patients and the use of increasingly powerful antibiotics. However, morbidity rates still show high incidence of perforations despite the use of inflammatory markers, imaging-based diagnoses and the development of videolaparoscopic techniques. Despite all this, appendicectomies continue to be performed to treat normal appendices. Conclusions: The clinical method remains the method of choice to make a diagnosis, since the lab and imaging tests have not been better so far. Nevertheless, they are important support because the diagnostic scales contribute to their earliness with a view to reducing morbidity and mortality as well as unnecessary appendicectomies or appendicectomy in advanced disease stagings(AU)

Adenocarcinoma mimicking appendicular lump: a diagnostic dilemma-a case report.

BACKGROUND: Primary appendiceal adenocarcinoma is a rare tumor, mucinous variety being common. This case is reported to highlight the unusual presentation and diagnostic difficulty of appendiceal adenocarcinoma. CASE PRESENTATION: Patient presented with acute appendicitis with ill-defined tender lump which responded to conservative management. CONCLUSIONS: High index of suspicion should be kept in mind for elderly patients presenting with appendicular lump. Every effort should be made during elective appendectomy to remove stump in case of sloughed out appendix.

[Appendiceal carcinoid tumors. Evaluation of long-term outcomes in a tertiary level]. / Tumores carcinoides apendiculares. Evaluación de los resultados a largo plazo en un hospital de tercer nive.

BACKGROUND: Appendiceal tumors are found in about 1% of appendectomies performed and 0.5% of intestinal neoplasias. Appendiceal carcinoids are the predominant histology in this group and are usually casual after appendectomy for other reasons. The prognosis is excellent and survival is 95% at 5 years after surgery. METHODS: Retrospective analysis of all patients with appendiceal carcinoid surgery in our hospital for 20 years (1990-2010) and survival at 5 years. We also discuss the need for additional treatment and testing for follow-up visits. RESULTS: 42 patients underwent surgery for appendiceal carcinoid tumor. 38 of them were operated on urgently, mostly for suspected acute appendicitis, without having reached the carcinoid tumor diagnosed preoperatively in any of them. The predominant symptomatology at admission was abdominal pain. Surgical treatment was appendectomy in 34 patients (12 laparoscopic), 7 patients required colon resections over intraoperatively by colonic involvement; only one patient required reoperation to complete right hemicolectomy. 2 patients had disseminated disease at diagnosis (liver metastases). The 5-year survival is over 95%, with no recurrence. CONCLUSIONS: The appendiceal carcinoid tumor is difficult to diagnose preoperatively. Appendectomy surgical treatment is usually sufficient, although colonic resections may be needed for dissemination. The 5-year survival is over 95%.

Antecedentes: los tumores apendiculares se encuentran en cerca de 1% de las apendicectomías y representan 0.5% de las neoplasias intestinales. El tipo de tumor más frecuente es el carcinoide apendicular, que casi siempre es un hallazgo durante la apendicectomía por otro motivo. Su pronóstico es excelente y la supervivencia es mayor de 95% a cinco años de la intervención. Objetivo: reportar una serie de casos y analizar la supervivencia media a cinco años posteriores a la identificación el tumor. Material y métodos: análisis retrospectivo (1990-2010) de pacientes con tumor carcinoide apendicular intervenidos en el servicio de Cirugía General y del Aparato Digestivo del Hospital Universitario Virgen del Rocío, Sevilla, España. Se analizaron: la supervivencia a cinco años, la necesidad de tratamiento complementario y las pruebas para seguimiento en la consulta. Resultados: se encontraron 42 pacientes intervenidos por tener un tumor carcinoide apendicular. En 38 pacientes la operación fue de urgencia, la mayoría por sospecha de apendicitis aguda, sin que en ninguno se hubiera establecido el diagnóstico de tumor carcinoide antes de la operación. El síntoma predominante al ingreso fue el dolor abdominal. El tratamiento quirúrgico fue: apendicectomía en 34 pacientes (12 por laparoscopia), en el intraoperatorio siete pacientes requirieron resecciones colónicas mayores debido a la afectación del colon; sólo uno requirió la reintervención para completar la hemicolectomía derecha. Al momento del diagnóstico dos pacientes tenían enfermedad diseminada (metástasis hepáticas). La supervivencia a cinco años fue superior a 95%, sin recidivas o tratamiento posterior de la enfermedad. Conclusiones: el tumor carcinoide apendicular difícilmente se diagnostica antes del procedimiento quirúrgico. La apendicectomía suele ser suficiente aunque en algunos pacientes las resecciones colónicas son necesarias por diseminación. La supervivencia a 5 años es superior a 95%.

Intermesenteric appendicular abscess, a diagnostic challenge; case report and review.

The appendicular origin of an intermesenteric abscess is rarely suspected prior to surgery, due to atypical clinical presentation and poor sensitivity of exploratory methods. A 43-year-old male was admitted for recent pain and mild tenderness in the epigastrium, slight emesis, leucocytosis (C-reactive protein was not determined), with no pathological findings on simple abdominal radiological examination (Rx). Abdominal ultrasound(US) and endoscopy were irrelevant. The abdomen became moderately tender, distended; diffuse enteric gas,slightly impaired bowel movement could be demonstrated by anew Rx. CT (oral contrast) was performed in the 3rd day:edematous infiltration of the mesentery and of a left-flank digestive loop (jejunal, sigmoidian?), small-size fluid collection(with extraluminal air-level) and paretic loops in the proximity, but normal wall-appearance of the caecum and its surrounding fat; the CT result was inconclusive (perforated diverticulosis or malignancy?). Barium enema: normal,including the caecum. Installation of vesperal fever, progressive mid-abdominal pain, tenderness and formation of a mass were the rationale for open mid-line laparotomy, discovering a large intermesenteric abscess, secondary to perforated gangrenous intermesenteric appendicitis. Surgical outcome of appendectomy was normal. A high index of suspicion may be suggested by: atypical clinical presentation (fever; ileus;presence or formation of a tender, periumbilical, mass) and CT findings (abscess; extraluminal air; ileus).

Hyperbilirubinemia as a predictor for appendiceal perforation: a systematic review.

BACKGROUND AND AIMS: Delayed or wrong diagnosis in patients with appendicitis can result in perforation and consequently increased morbidity and mortality. Serum bilirubin may be a useful marker for appendiceal perforation. The purpose of this systematic review was to evaluate studies investigating elevated serum bilirubin as a predictor for appendiceal perforation. MATERIAL AND METHODS: Medline, Embase, and Cochrane databases were searched for studies evaluating elevated bilirubin in the diagnosis of perforated appendicitis. Study selection criteria included English language papers evaluating serum bilirubin as a marker of appendiceal perforation in humans. A total of 189 abstracts were screened for eligibility, of which five clinical studies were included in this study. RESULTS: Bilirubin was significantly higher in patients with appendiceal perforation compared with patients with appendicitis without perforation. Elevated serum bilirubin had a sensitivity ranging from 0.38 to 0.77 and a specificity ranging from 0.70 to 0.87 in predicting appendiceal perforation. CONCLUSIONS: Elevated serum bilirubin for determining the risk of perforation in appendicitis has low sensitivity but higher specificity. This measure can therefore be used as a supplement in the diagnostic process.

Barolith as a rare cause of acute appendicitis: a case report.

A barolith consists of inspissated barium associated with feces and is seen, rarely, after barium studies for imaging the gastrointestinal system. The barium used in such studies can enter the appendiceal lumen and, rarely, cause appendicitis by obliterating or narrowing the lumen of the appendix. The appendix fills with barium and the entire appendix is visualized in 80-90% of barium swallow or enema studies, and this is accepted as a reliable sign of a non-diseased appendix Post-examination retention of barium in the appendix is very common (90~95%), and 10% of the patients retain barium in the appendix beyond 72 hours. If the barium is retained for more than two months, complicated appendicitis can result. We present a 46-year-old male who was diagnosed with acute appendicitis due to a barolith and required an appendectomy three months after a double-contrast barium enema study. After barium studies, patients should be informed regarding retention of barium in the appendix and the possibility that it can cause acute appendicitis. Thus, if abdominal pain develops, the patient can be referred quickly to a medical center for the appropriate treatment and the complications of acute appendicitis can be prevented with early intervention.

Concerted spatial-frequency and polarization-phase filtering of laser images of polycrystalline networks of blood plasma smears.

The complex technique of concerted polarization-phase and spatial-frequency filtering of blood plasma laser images is suggested. The possibility of obtaining the coordinate distributions of phases of linearly and circularly birefringent protein networks of blood plasma separately is presented. The statistical (moments of the first to fourth orders) and scale self-similar (logarithmic dependences of power spectra) structure of phase maps of different types of birefringence of blood plasma of two groups of patients--healthy people (donors) and those suffering from rectal cancer--is investigated. The diagnostically sensitive parameters of a pathological change of the birefringence of blood plasma polycrystalline networks are determined. The effectiveness of this technique for detecting change in birefringence in the smears of other biological fluids in diagnosing the appearance of cholelithiasis (bile), operative differentiation of the acute and gangrenous appendicitis (exudate), and differentiation of inflammatory diseases of joints (synovial fluid) is shown.

Supporting diagnostic decisions using hybrid and complementary data mining applications: a pilot study in the pediatric emergency department.

INTRODUCTION: This article demonstrates the capacity of a combination of different data mining (DM) methods to support diagnosis in pediatric emergency patients. By using a novel combination of these DM procedures, a computer-based diagnosis was created. METHODS: A support vector machine (SVM), artificial neural networks (ANNs), fuzzy logics, and a voting algorithm were simultaneously used to allocate a patient to one of 18 diagnoses (e.g., pneumonia, appendicitis). Anonymized data sets of patients who presented in the emergency department (ED) of a pediatric care clinic were chosen. For each patient, 26 identical clinical and laboratory parameters were used (e.g., blood count, C-reactive protein) to finally develop the program. RESULTS: The combination of four DM operations arrived at a correct diagnosis in 98% of the cases, retrospectively. A subgroup analysis showed that the highest diagnostic accuracy was for appendicitis (97% correct diagnoses) and idiopathic thrombocytopenic purpura or erythroblastopenia (100% correct diagnoses). During the prospective testing, 81% of the patients were correctly diagnosed by the system. DISCUSSION: The combination of these DM methods was suitable for proposing a diagnosis using both laboratory and clinical parameters. We conclude that an optimized combination of different but complementary DM methods might serve to assist medical decisions in the ED.

The process of treating pediatric appendicitis.

BACKGROUND: A large service and distant geographical area can make the process of diagnosing and treating appendicitis a challenge. METHODS: Hospital records of children treated for appendicitis between 2007 and 2009 were retrospectively analyzed, including time from emergency (ER) to operating room (OR), diagnostic imaging (DI) utilization, preoperative antibiotic usage, operating time, length of stay (LOS), and perforation rate. RESULTS: The perforation rate was 34%, with longer LOS. Transfer time to the children's hospital between ER inside and outside the city was not different. ER to OR time was significantly shorter for patients assessed at the children's hospital directly. Ultrasound remained the most used DI modality (55%). Preoperative antibiotics were only fully administered in 42% of the cases. CONCLUSION: A clinical pathway for pediatric appendicitis may address the challenges of the process of pre-ER, ER to OR, and OR care to maintain an acceptable perforation rate.

Perforated appendicitis and appendicolith in a child presenting as intussusception: a case report.

Simultaneous diagnoses of intussusception and appendicitis in the same patient have rarely been described in the pediatric literature. A case of a 30-month-old boy is presented with an initial diagnosis of intussusception that was successfully reduced by air contrast enema. When the patient's condition deteriorated, a diagnostic search surprisingly revealed a missed perforated appendicitis with an appendicolith that had been part of the intussusception. The patient's hospitalization and surgical course is described along with a discussion of the intermingling of intussusception and appendicitis in a young child. This case illustrates the need to consider alternative diagnoses when a patient's course takes an unexpected and confusing turn.

[Diagnosis of acute appendicitis over two decades - effects of increasing number of imaging procedures on costs, preoperative reliability and patient outcome]. / Diagnostik der akuten Appendizitis im Verlauf von 2 Jahrzehnten - Auswirkungen der bildgebenden Verfahren auf präoperative Diagnosesicherung, Kosten und Patientenoutcome.

BACKGROUND: An increasing number of modern imaging procedures are being applied for the diagnosis of appendicitis. We compared one hundred consecutive appendectomies of the years 1988, 1998 and 2008 concerning reliability of preoperative diagnosis and resulting costs. METHODS: We analysed the first one hundred consecutive patients undergoing appendectomy during the years 1988, 1998 and 2008, 59 % were female and 41 % male. The average age was 26 years, the average BMI 21.09. The costs and results of radiological investigations (US, CT, MRI, X-ray) have been compared in all patients. The sensitivity of ultrasound and CT scan in preoperative diagnosis has been analysed. RESULTS: The number of preoperative imaging procedures for the diagnosis of appendicitis has increased over the last two decades. Simultaneously increased the costs (total costs and costs per partient) for imaging procedures. 2008 the costs were 10 times higher than 1988. CT had a higher sensitivity (77 %) in the diagnosis of appendicitis than ultrasound (33 %). The number of operations because of subacute and chronic appendicitis was lower in 2008 (34 of 100) compared with 1988 (80 of 100) and 1998 (60 of 100). In 2008 (14) we found a higher number of gangrenous and perforated appendicitis compared to 1988 (2) and 1998 (5). The majority (50 of 100) of patients in the group with acute and phlegmonous appendicitis was found in 2008. CONCLUSION: There has been an increase in the use of preoperative imaging procedures in the diagnosis of appendicitis during the last 20 years. This causes more costs in the public health system. Ultrasound as the standard imaging method for diagnosing appendicitis showed poor sensitivity. CT scans had good results concerning sensitivity, but are expensive and involve exposure to radiation for the patient.

[Mesenteric cyst: case report and review of the literature]. / Cisti mesenteriale: case report e revisione della letteratura.

Mesenteric and retroperitoneal cysts are rare intra-abdominal tumours with an incidence of 1/140.000 in surgery departments and 1/20.000 in paediatric departments. There are no pathognomonic signs or symptoms for the cysts. In the differential diagnosis lymphangiomas, sarcomas, adenocarcinomas and intestinal duplications should be considered. Diagnostic includes abdominal computed tomography, ultrasound and MRI. Barium enema examination or intravenous pyelogram may be used in special cases. Surgical treatment is indicated also in asymptomatic patients; laparoscopic approach is the "gold standard". Laparotomic approach should be used in the cases of impossibility of total enucleation or in the cases of malignant degeneration. Complete enucleation is the treatment of choice for retroperitoneal and mesenteric cysts. If this cannot be accomplished, the alternative should be the excision of the cyst or the marsupialization. In this paper we present a case of young man with a mesenteric cyst mimicking acute appendicitis.