Postoperative Outcomes Following Surgical Management of Secondary Peritonitis in a Referral Hospital in Eastern Venezuela.

Background Secondary peritonitis (SP) arises from direct contamination of the peritoneum by spillage from the gastrointestinal or urogenital tracts. Objective This research aimed to evaluate the clinical and epidemiological characteristics of patients with SP undergoing surgical management and to study potential factors associated with morbidity and mortality in a reference hospital in Eastern Venezuela. Methodology A retrospective cross-sectional study was conducted on patients aged 18 to 80 undergoing surgical treatment for SP at "Dr. Luis Razetti" University Hospital in Barcelona, Anzoátegui state, Venezuela, between January and December 2022. We calculated odds ratios to assess mortality risks based on the presence of postoperative complications. Results Analysis of 168 adult patients revealed a predominantly male population (n=110, 65.5%) with a mean age of 35.63 years (SD=14.34). Generalized peritonitis was observed in 126 cases (75%), primarily originating from the appendix (n=117, 69.6%). Postoperative complications occurred in 18 patients (10.7%); sepsis represented the most common associated complication (n=10, 43.5%). Patients with secondary peritonitis associated with acute appendicitis had a lower mortality rate (p=0.042). Additionally, laparotomy was associated with higher frequencies of complications (p=0.001) and mortality (p=0.025), while open appendectomy showed lower frequencies of complications (p=0.002) and mortality (p=0.035). Notably, patients experiencing postoperative complications had a significantly elevated risk of mortality (OR=98, 95% confidence interval = 21.74 - 441.69). Conclusion The most common source of SP was appendicular. Patients undergoing exploratory laparotomy for the management of SP had a higher frequency of complications and mortality, whereas those undergoing open appendectomy had lower rates of complications and mortality.

Conversion Rates, Causes, and Preoperative Associated Factors in 3,411 Laparoscopic Appendectomies: Insights after Nearly Three Decades of Laparoscopy and an Analysis of the Learning Curve.

INTRODUCTION: Laparoscopic appendectomy is the current gold standard in treating acute appendicitis. Despite the low frequency of conversion to open surgery, it remains necessary in certain cases. Our primary outcome was to identify the conversion rate of laparoscopic appendectomy to open surgery and how this rate has changed over the learning curve. Second, we aim to determine the causes of conversion, their changes in frequency over time and to identify preoperative factors associated with conversion. METHODS: A retrospective comparative study with prospective case registry was conducted. All patients who underwent laparoscopic appendectomy from January 2000 to December 2023 at a high-volume center were analyzed. The series was divided into six periods, each spanning 4 years. All patients who underwent totally laparoscopic appendectomy and those requiring conversion to open appendectomy were included. RESULTS: A total of 3,411 appendectomies were performed during the study period, with an overall conversion rate of 0.96% (33/3,411). Our analysis showed that after the first three periods (12 years), the conversion rate decreased and reached a plateau of approximately 0.4%. The most common causes of conversion were perforation of the appendix base (9/33), abdominal cavity adhesions (8/33), and pneumoperitoneum intolerance (3/33). Age over 65, American Society of Anesthesiologists (ASA) score III/IV and symptom duration exceeding 24 h were preoperative factors significantly associated with conversion at univariate analysis. However, only age (p 0.0001) and symptoms exceeding 24 h (p 0.01) remained independently associated with conversion after multivariate analysis. CONCLUSION: In experienced centers, conversion from laparoscopic appendectomy to open appendectomy is uncommon, but remains necessary in certain cases. Despite identifying a population with higher association with conversion which should be advised preoperatively, due to the low incidence of conversions once the learning curve is overcome, an initial laparoscopic approach is the preferred choice.

Appendectomy: Cross-sectional study of the effects of COVID-19 in a hospital in South Brazil.

Background: COVID-19 has further burdened the Brazilian healthcare system, especially emergencies. Patients may have delayed seeking care for surgical abdominal pain. Delays in the approach may have impacted clinical evolution and outcomes. This study evaluated appendectomies and their complications performed by the public system during one-year follow-up of COVID-19 in a hospital in southern Brazil. Materials and methods: In this hospital-based cross-sectional study, we included adult patients who underwent appendectomy from March 2019 to April 2021 (n = 162). Patients were divided into pre-pandemic (n = 78) and pandemic (n = 84) groups based on the surgery date. The analyzed variables included hospitalization duration, intensive care unit (ICU) admission, surgical approach, histopathological findings, COVID-19 testing, patient outcomes, and 30-day survival rate. Results: The cohorts exhibited similar epidemiology, with the sex ratio and average age being maintained. No statistical difference was found in the 30-day survival rate and clinical outcomes. Of the four patients admitted to the ICU, three belonged to the pandemic cohort and tested negative for COVID-19. Only 47.6 % of the patients in the pandemic cohort underwent COVID-19 polymerase chain reaction examination; one tested positive (2.5 %). Conclusion: This study demonstrated that there was no increased risk for appendectomies during the first wave of the pandemic. Surgeries were safe during this period. Patients continued to access the emergency service despite surgical abdominal pain and restrictive measures imposed by health authorities. The similar results observed across cohorts are attributed to the readiness of the teams and the availability of medical surgical equipment in safe quantities.

Hallazgo incidental de hernia de Amyand en un lactante de 10 meses de edad con antecedente de prematuridad extrema: Presentación de caso y propuesta de manejo / Incidental finding of Amyand's hernia in a 10-month-old infant with a history of extreme prematurity: Case report and proposed management

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.

[Factors associated with normal leukocyte count and C-reactive protein in adults with acute appendicitis: a retrospective cohort study]. / Faktory, svyazannye s normal'nym kolichestvom leikotsitov i urovnem S-reaktivnogo belka u vzroslykh bol'nykh s ostrym appenditsitom: retrospektivnoe kogortnoe issledovanie.

OBJECTIVE: To identify the factors associated with normal leukocyte count and C-reactive protein (CRP) in adults with acute appendicitis. MATERIAL AND METHODS: A retrospective cohort study included patients aged 18-60 years after surgeries for acute appendicitis. Convenience sampling was used to select medical records, and variables such as age, sex, weight, height, origin, self-medication, diabetes (DM2), high blood pressure (HBP), type of appendicitis, duration of illness, preoperative time, type of appendectomy, operative time, and hospital stay were analyzed. Patients were categorized into those with normal and abnormal inflammatory parameters. The SPSS version 28 software was used for analysis. RESULTS: We included 333 patients; 11.11% ones had normal inflammatory parameters. Both groups had mean age of approximately 33 years. Men comprised 56.76% and 57.43%in both groups, respectively. The abnormal group had shorter mean preoperative time, and catarrhal appendicitis was more common in the normal group. Multivariate analysis revealed that rural origin and self-medication were significantly associated with normal inflammatory parameters. CONCLUSION: The prevalence of normal inflammatory parameters in acute appendicitis patients was 11.11%. Rural origin, self-medication, shorter preoperative time, and catarrhal appendicitis were significantly associated with normal inflammatory parameters in this context.

[Right-sided acute appendicitis in situs inversus totalis. Case report]. / Apendicitis aguda del lado derecho en situs inversus totalis. Reporte de caso.

Background: Acute appendicitis is widely recognized as the prevailing abdominal surgical emergency globally, exhibiting an annual incidence ranging from 96.5 to 100 cases per 100,000 adults. Conversely, situs inversus totalis is a rare anatomical anomaly characterized by the complete reversal of the chest and abdominal organs, occurring in approximately 1 out of every 10,000 to 50,000 individuals. Clinical case: 53-year-old female patient who presented to the emergency department with a complaint of diffuse abdominal pain of colic nature that had persisted for 5 days. The patient referred systemic hypertension, pre-diabetes mellitus type 2, and situs inversus as relevant medical history. A laparotomy procedure was conducted, revealing a perforated appendix located in the right hypochondrium. Additionally, the patient exhibited situs inversus totalis, with the colon positioned in its normal anatomical location. Conclusions: Due to the low incidence of situs inversus totalis, in cases similar to the one presented, the utilization of image studies and laboratory studies is imperative for accurate diagnosis. In the face of diagnostic suspicions and inconclusive paraclinical studies, the most effective approach is to pursue surgical examination and intervention, preferably utilizing laparoscopic techniques.

Introducción: la apendicitis aguda es la urgencia quirúrgica abdominal más frecuente en el mundo, con una incidencia anual de 96.5 a 100 casos por 100,000 adultos. Por otra parte, el situs inversus totalis es un trastorno posicional inverso de los órganos torácicos y abdominales con una incidencia de 1 en 10,000 a 50,000 personas. Caso clínico: paciente del sexo femenino de 53 años que se presentó en sala de urgencias refiriendo dolor abdominal difuso tipo cólico de 5 días de evolución. La paciente refirió hipertensión arterial sistémica esencial, prediabetes mellitus tipo 2 y situs inversus. Se realizó intervención quirúrgica (laparotomía) en la que se encontró el apéndice perforado en hipocondrio derecho y situs inversus totalis con colon en posición anatómica normal. Conclusiones: debido a la baja incidencia del situs inversus totalis, el diagnóstico en casos como el presentado representa un reto en el que el uso de estudios de imagen y laboratorio resulta indispensable. Ante la sospecha diagnóstica y estudios paraclínicos con resultados no concluyentes, la mejor estrategia consiste en la exploración y el manejo quirúrgicos, preferentemente laparoscópicos.

Apendicectomía en pacientes con situs inversus: Serie de tres casos con manejo laparoscópico / Appendectomy in patients with situs inversus: Three cases series with laparoscopic approach

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.

Diagnostic utility of the Alvarado scale in older adults with suspected acute appendicitis.

BACKGROUND: Acute appendicitis remains as a differential diagnosis in older patients with abdominal pain. The Alvarado scale may assist to guide the diagnosis and treatment of this entity. The operative characteristics of the scale are little known in this population. METHOD: We conducted a systematic review of original studies published between 1986 and 2022 evaluating the diagnostic performance of the Alvarado scale in older adults with suspected acute appendicitis. The review was conducted according to the PRISMA statement. The evaluation of the methodological quality of the studies was performed according to the ROBINS-I criteria. RESULTS: Four original studies of retrospective design including 480 patients were identified. The heterogeneity and poor methodological quality limited an aggregate statistical analysis (meta-analysis). The value of the ROC curve of the scale varies between 0.799 and 0.969. From the available studies, the value of the ROC curve is lower in comparison to the RIPASA scale and comparable to the Lintula scale. CONCLUSIONS: The evidence on the diagnostic performance of the Alvarado scale in older adults is limited. The poor methodological quality of the available studies calls for a prudent use of this tool in this population. Our findings offer opportunities for future research.

ANTECEDENTES: La apendicitis aguda es un diagnóstico diferencial en el adulto mayor con dolor abdominal. La escala de Alvarado se utiliza para orientar el diagnóstico y el tratamiento. Las características operativas de la escala son poco conocidas en este grupo de pacientes. MÉTODO: Revisión sistemática de estudios originales publicados entre 1986 y 2022 que evaluaron el rendimiento diagnóstico de la escala de Alvarado en adultos mayores con sospecha de apendicitis aguda, con base en la declaración PRISMA. La evaluación de la calidad metodológica de los estudios se realizó con los criterios ROBINS-I. RESULTADOS: Se identificaron cuatro estudios originales de diseño retrospectivo que incluyen 480 pacientes. La heterogeneidad y la baja calidad metodológica limitaron un análisis estadístico agregado (metaanálisis). El valor de la curva ROC de la escala varía entre 0.799 y 0.969. En los estudios disponibles, el valor de la curva ROC es inferior al de la escala RIPASA y similar al de la escala de Lintula. CONCLUSIONES: La evidencia que sustenta el rendimiento diagnóstico de la escala de Alvarado en los adultos mayores es limitada. La pobre calidad de los estudios disponibles advierte sobre el uso prudente de esta herramienta en este grupo poblacional. Los hallazgos identificados ofrecen oportunidades de investigación futura.

Case Report: A rare instance of acute appendicitis induced by Balantidium Coli parasitic infection.

Introduction: Acute appendicitis secondary to parasitic infections is uncommon, being detected in less than 1% of cases. Balantidium coli is a parasite found in pigs and primates with zoonotic potential. To date, only three cases of acute appendicitis induced by this parasite have been documented globally. Case: A 7-year-old female patient, who consumed pork daily, presented to the emergency department with a one-day history of abdominal pain in the lower quadrants, described as colic-like, alongside abdominal distension. Initial abdominal radiography led to a diagnosis of intestinal obstruction. Conservative management without therapeutic response necessitated referral to a higher complexity center. Upon admission, an abdominal computed tomography scan diagnosed acute appendicitis and secondary ileus. During surgical intervention, an appendiceal phlegmon formed by loops of the small intestine was mechanically released, revealing a perforated appendix with extensive fecal peritoneal contamination. Pathological analysis identified an inflammatory infiltrate and the presence of Balantidium coli trophozoites. Medical treatment included Piperacillin-Tazobactam and Metronidazole. The patient was discharged after 10 days of medical treatment. Discussion: Acute appendicitis caused by Balantidium coli is a rare occurrence. It is crucial to identify parasites in pathological samples due to their impact on postoperative management. The close contact between humans and pigs, especially in developing countries, suggests that the prevalence of parasitic infection and colonization by Balantidium coli may be higher than currently recognized. Regarding the identification of this patient's specific exposure, the regular consumption of pork suggests the hypothesis that improper processing is linked to the acquisition of the parasitic infection.

Características clínicas de niños con apendicitis aguda que acuden al Servicio de Urgencias del Hospital Regional de Pilar en el periodo 2020 al 2023

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.

[Predictive appendicitis scale for children under 4 years of age: Is it possible to apply artificial intelligence?] / Escala predictiva de apendicitis para menores de 4 años: ¿Es posible aplicar la inteligencia artificial?

Acute appendicitis in the pediatric population is a pathology of heterogeneous presentation that is currently diagnosed using various criteria or predictive scales, which have proven not to be sufficiently accurate to be standardized, however, methods have been created to establish a more accurate diagnosis, an aspect that has been provided by artificial intelligence, which through different algorithms has the ability to show the patient's condition and the most appropriate intervention for this, thus reducing the rate of unnecessary interventions and therefore possible related complications.

La apendicitis aguda en la población pediátrica es una patología de presentación heterogénea que es diagnósticada actualmente mediante diversos criterios o escalas predictivas, que han demostrado no ser lo suficientemente precisas para ser estandarizadas, sin embargo, se han creado métodos que permitan establecer un diagnóstico más preciso, aspecto que ha sido proporcionado por la inteligencia artificial, la cual mediante diferentes algoritmos cuenta con la capacidad de arrojar cuál es el estado del paciente y la intervención más adecuada para este, disminuyendo así la tasa de intervenciones inecesarias y por ende posibles complicaciones relacionadas.

Pileflebitis en pediatría: un desafío diagnóstico / Pylephlebitis in pediatrics: A diagnostic challenge

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.

Epidemiología de la apendicitis aguda en Colombia: Un análisis de las bases de datos administrativas del Ministerio de Salud / Epidemiology of acute appendicitis in Colombia: An Analysis of the Ministry of Health administrative databases

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.

Pylephlebitis in pediatrics: A diagnostic challenge. / Pileflebitis en pediatría: un desafío diagnóstico.

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.

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.

Elementos clínicos para el diagnóstico de apendicitis aguda en la atención primaria de salud

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.

Retrospective study of patients submitted to appendectomy in a tertiary hospital: is there a difference between the public and supplementary health system?

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)

Combinación de técnicas quirúrgicas en la hernia gigante de Amyand irreductible

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.

Hernia de garengeot, de la teoria a la practica: a propósito de un caso / Garengeot's hernia, from theory to practice: a case report

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.