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1.
Surg Clin North Am ; 101(6): 1023-1031, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34774265

RESUMO

Nonoperative management (NOM) of acute appendicitis is becoming more popular, especially in resource-strapped locations, to minimize hospital system costs. In uncomplicated cases of appendicitis, NOM can effectively treat the patient. It does carry a 39.1% risk of recurrence in 5 years, and operative management (OM) does not increase morbidity or risk of complication, so the authors recommend laparoscopic OM for uncomplicated appendicitis. For complicated cases of appendicitis, the authors recommend initial NOM with interval appendectomy in all patients. All appendicitis patients should undergo surveillance endoscopy if older than 40 years to rule out a contributing neoplasm.


Assuntos
Neoplasias do Apêndice/diagnóstico , Apendicite/terapia , Fatores Etários , Algoritmos , Antibacterianos/uso terapêutico , Apendicectomia/métodos , Apendicite/complicações , Apendicite/cirurgia , Apêndice/diagnóstico por imagem , Apêndice/cirurgia , Tomada de Decisão Clínica , Colonoscopia , Impacção Fecal/cirurgia , Humanos , Laparoscopia , Fatores de Tempo
2.
Surg Clin North Am ; 101(6): 1081-1096, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34774270

RESUMO

Incidental findings are common in the evaluation of surgical patients. Understanding the appropriate assessment and management of these frequent occurrences is important for the provision of comprehensive quality care. This review details the epidemiology, considerations, and recommendations for management of common incidental manifestations in surgical patients, including Meckel diverticulum, adrenal incidentaloma, thyroid nodule, solitary pulmonary nodule, small bowel intussusception, gallstones, and incidental appendectomy.


Assuntos
Neoplasias das Glândulas Suprarrenais , Apendicectomia , Cálculos Biliares , Divertículo Ileal , Nódulo Pulmonar Solitário , Nódulo da Glândula Tireoide , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/terapia , Cálculos Biliares/diagnóstico , Cálculos Biliares/terapia , Humanos , Achados Incidentais , Intestino Delgado , Intussuscepção/diagnóstico , Intussuscepção/terapia , Divertículo Ileal/diagnóstico , Divertículo Ileal/terapia , Nódulo Pulmonar Solitário/diagnóstico , Nódulo Pulmonar Solitário/terapia , Nódulo da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/terapia
3.
BMJ Case Rep ; 14(11)2021 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-34764095

RESUMO

The optimal management of patients with appendiceal endometriosis has not been determined because of the difficulty of establishing a preoperative diagnosis. There are no reports of preoperative hormone therapy for a patient with appendiceal endometriosis. We report a patient who underwent resection of appendiceal endometriosis after hormone therapy. A 40-year-old woman with history of recurrent pelvic abscesses presented to the emergency department with lower abdominal pain. The recurrent pelvic abscesses were synchronised with her menstrual cycle. CT scan demonstrated a 25 mm contrast-enhanced luminal structure adjacent to the cecum, which was thought to be a mucocele of the appendix. Considering the recurrent symptoms during menstruation, endometriosis was suspected. Treatment with a gonadotropin-releasing hormone agonist was started for appendiceal endometriosis, which alleviated the symptoms. After 3 months, elective laparoscopic appendectomy was performed. Preoperative hormonal therapy is an option for patients with appendiceal endometriosis, especially when there is concern for dense adhesions.


Assuntos
Apêndice , Endometriose , Mucocele , Dor Abdominal , Adulto , Apendicectomia , Apêndice/diagnóstico por imagem , Apêndice/cirurgia , Endometriose/complicações , Endometriose/diagnóstico por imagem , Endometriose/tratamento farmacológico , Feminino , Humanos
4.
J Med Invest ; 68(3.4): 334-341, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34759155

RESUMO

Background : Appendectomy can be challenging and occasionally converted to extensive resection for complicated appendicitis. However, optimal treatment strategies can be developed using preoperative risk assessment. Thus, we aimed to investigate the preoperative predictors of extensive resection in complicated appendicitis patients undergoing surgery. Materials and methods : In total, 173 complicated appendicitis patients undergoing surgery between 2014 and 2019 were classified into the appendectomy (n = 153) or extensive resection (n = 20) groups. Clinicopathological factors and surgical outcomes were compared between groups. Results : Extensive resection was performed in 20 of 173 complicated appendicitis patients (11.5%). The rates of having defects in the wall structure at the appendix root on computed tomography images were significantly higher, and the duration from onset to surgery was significantly longer in the extensive resection group. Significant differences were found in operative duration, blood loss and postoperative hospitalization, but none in the incidence of postoperative complications between groups. Multivariate analyses showed that defects in the wall structure at the appendix root and five days or longer from onset were identified as independent predictors of extensive resection. Conclusions : Defects in the wall structure at the appendix root and five days or longer from onset predict extensive resection performance in complicated appendicitis patients. J. Med. Invest. 68 : 334-341, August, 2021.


Assuntos
Apendicite , Laparoscopia , Apendicectomia/efeitos adversos , Apendicite/complicações , Apendicite/diagnóstico por imagem , Apendicite/cirurgia , Humanos , Incidência , Complicações Pós-Operatórias , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
5.
Emerg Med Clin North Am ; 39(4): 781-794, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34600637

RESUMO

Postprocedural complications encompass a wide array of conditions that vary in acuity, symptoms, index procedure, and treatment. Continued advancements in diagnostic and therapeutic procedures have led to a significant shift of procedures to the ambulatory setting. This trend is of particular interest to the emergency physician, as patients who develop complications often present to an emergency department for evaluation and treatment. Here the authors examine a high-yield collection of procedures, both ambulatory and inpatient, notable for their frequent utilization and unique complication profiles including common laparoscopic surgical procedures, bariatric surgery, endoscopic procedures, interventional radiology procedures, and hernia repairs with implantable mesh.


Assuntos
Complicações Pós-Operatórias , Apendicectomia/efeitos adversos , Cirurgia Bariátrica/efeitos adversos , Endoscopia/efeitos adversos , Herniorrafia/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Nutrição Parenteral/efeitos adversos
6.
Ann Ital Chir ; 102021 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-34636340

RESUMO

Goblet cell carcinoid or carcinoma (GCC) refers to an extremely rare appendiceal tumor usually diagnosed on post-operative histology as an incidental finding. Primary cancers of the vermiform appendix are quite rare, representing less than 1% of all gastrointestinal malignancies. GCCs are considered as a distinct entity of appendiceal tumors, consisting of both epithelial (glandular) and neuroendocrine elements containing goblet cells. This entity tends to be more aggressive than typical carcinoid tumors as it often presents with metastatic disease. Therefore, an early recognition and an appropriate grading is essential. The 5-year overall survival is 14-22% in stage III-IV disease. As a matter of fact, GCC warrants more aggressive surgical and medical (chemotherapy) treatments than typical carcinoid tumors. We, hereby, report a case of a 67-year old male presenting with an acute abdominal obstruction and a severe tenderness predominant in his right lower quadrant, together with an endoscopic and radiological suspect of left colonic malignancy and acute appendicitis. Left hemicolectomy and appendicectomy were performed and pathological specimens revealed a lowgrade adenocarcinoma of the descending colon and a high-grade appendiceal goblet cell carcinoid. Subsequent right hemicolectomy was performed according to the current guidelines. GCCs are more aggressive compared with conventional appendiceal tumors but less aggressive compared with adenocarcinomas and they often present with serosal and mesoappendiceal involvement. The lack of a standardized classification system for GCC and the discrepancies in specific reliable markers are responsible for an insufficient prognostic and predictive value at diagnosis. KEY WORDS: Appendiceal neoplasms, Carcinoid tumor, Colectomy, Goblet cells, Immunochemistry.


Assuntos
Neoplasias do Apêndice , Apendicite , Apêndice , Tumor Carcinoide , Idoso , Apendicectomia , Neoplasias do Apêndice/diagnóstico , Neoplasias do Apêndice/cirurgia , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/cirurgia , Humanos , Masculino
7.
Rozhl Chir ; 100(9): 429-434, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34649451

RESUMO

INTRODUCTION: Acute appendicitis (AA) is the most common abdominal emergency. This article aims to document the impact of the ongoing COVID-19 pandemic on timely diagnosis of AA, duration of symptoms before examination in a medical institution, levels of laboratory inflammatory markers, and the length of hospital stay. Collected data were compared with current world literature. METHOD: Two datasets were created, comprising patients with the histological diagnosis of AA determined from March 1 to June 30, 2019 (before of the onset of the COVID-19 pandemic) and in the same period of the spring pandemic of COVID-19 in 2020. The following information was obtained from patient medical records: Demographic data, information on symptom duration before AA diagnosis, information on laboratory inflammatory marker levels, the used surgical method, antibiotic treatment, histopathological findings, and the length of hospital stay. These data were processed using descriptive statistics methods and the two created datasets were compared with the use of statistical methods (an unpaired t-test and Welchs t-test). RESULTS: Thirty seven patients (26 men and 11 women) with the median age of 41 years were operated on for acute appendicitis at the Department of Surgery, Military University Hospital in Prague from March 1 to June 30, 2019. Thirty four patients (19 men and 15 women) with the median age of 42 years were operated on in the same period of 2020. No significant differences were found between these two compared datasets in terms of symptom duration, laboratory inflammatory marker levels or the length of hospital stay. The distributions of histopathological findings and used antibiotic treatments were also similar. CONCLUSION: In our study, we were unable to demonstrate any statistically significant differences between the datasets of patients operated on before and after the onset of the COVID-19 pandemic.


Assuntos
Apendicite , COVID-19 , Doença Aguda , Adulto , Apendicectomia/efeitos adversos , Apendicite/epidemiologia , Apendicite/cirurgia , Feminino , Humanos , Tempo de Internação , Masculino , Pandemias , Estudos Retrospectivos , SARS-CoV-2
8.
Cir Cir ; 89(5): 651-656, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34665171

RESUMO

BACKGROUND: Patients with compromised appendix base constitute a subgroup of patients with complicated appendicitis, and there is few available information. OBJECTIVE: To study the frequency of stump leaks and fistulae in patients with complicated appendicitis with compromised stump. METHOD: This is an observational, retrospective study of patients that underwent laparoscopic appendectomy with compromised appendix stump. RESULTS: From 2015 to 2019, 158 patients with complicated appendicitis were operated, of them 54 had compromised base or stump. There were 66.7% men, with a mean age of 38.7 years. For stump closure, a simple knot was employed in 57.4%, and in 42.6% an invaginated suture was employed. Regarding complications, 16.7% developed intraabdominal abscess, 7.4% ileus and 7.4% had wound infection. We found one stump leak and one stump fistula. The mean length of stay was 5.4 days (range: 1-20). There were 5 reoperations, 4 for abscess drainage and 1 for stump leak. CONCLUSIONS: Patients with acute complicated appendicitis with compromised appendicular base, laparoscopic surgery either with simple knot or with invaginated suture resulted in low frequency of stump leaks and fistula.


Assuntos
Apendicite , Apêndice , Laparoscopia , Adulto , Apendicectomia , Apendicite/complicações , Apendicite/cirurgia , Apêndice/cirurgia , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
9.
Rev Col Bras Cir ; 48: e20202717, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34644740

RESUMO

Acute appendicitis (AA) is a frequent cause of abdominal pain requiring surgical treatment. During the COVID-19 pandemic, surgical societies considered other therapeutic options due to uncertainties in the evolution of the disease. The purpose of this study is to assess the treatment of AA by members of two Brazilian surgical societies in this period. A common questionnaire was sent in 2020. There were 382 responses. Most surgeons had more than 15 years of profession (68.3%) and treated more than five cases per month (44.8%). About 72.5% would indicate chest CT to investigate COVID-19 in patients with AA. For those patients sustaining uncomplicated AA, without COVID-19, 60.2% would indicate laparoscopic appendectomy (VLA), followed by open appendectomy (OA) (31.7%) and non-operative management (NOM) (1.3%). For those with mild COVID-19, OA was suggested by 51.0%, followed by VLA (29.6%) and NOM (6.0%). For those with severe COVID-19, OA was proposed by 35.3%, followed by NOM (19.9%) and VLA (18.6%). For patients with periappendiceal abscesses, without COVID-19, VLA was suggested by 54.2%, followed by OA (33.2%) and NOM (4.4%). For those with mild COVID-19, OA was proposed in 49.5%, followed by VLA (29.3%) and NOM (8.9%). In those with severe COVID-19, OA was proposed in 36.6%, followed by NOM (25.1%) and VLA (17.3%). This information, based on two recognized Brazilian surgical societies, can help the surgeon to select the best approach individually.


Assuntos
Apendicite , COVID-19 , Laparoscopia , Doença Aguda , Apendicectomia , Apendicite/epidemiologia , Apendicite/cirurgia , Humanos , Tempo de Internação , Pandemias , Estudos Retrospectivos , SARS-CoV-2
10.
Rev Col Bras Cir ; 48: e20213010, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34644742

RESUMO

Acute appendicitis is the leading cause of abdominal emergency surgery worldwide and appendectomy continues to be the definitive treatment of choice. This cost-effectiveness analysis evaluates laparoscopic versus open appendectomies performed in public health services in the state of Bahia (Brazil). We conducted a retrospective observational study using the database from the Department of Informatics of the Unified Health System (DATASUS). Available data on appendectomies between 2008 and 2019 were included, and we evaluated the temporal trend of hospital admissions, procedure-related mortality rates, length of stay, and costs. Statistical analysis was performed using the R-software (R Foundation, v.4.0.3) and the BioEstat software (IMDS, v. 5.3), considering p<0.05 as significant. During 2008-2019, 53,024 appendectomies were performed in the public health services in Bahia, of which 94.9% were open surgeries. The open technique was associated with a higher mortality rate (4.9/1,000 procedures; p<0.05) and a higher risk of death (RR=4.5; p<0.05) compared to laparoscopy (1.1/1,000 procedures). Laparoscopic appendectomy (median of 2.7 days) had a shorter length of stay compared to laparotomy (median of 4.15 days) (p<0.05). There was no difference in the medians of costs nor hospital services, per procedure (p=0.08 and p=0.08, respectively). Laparoscopic professional median costs were higher by US$ 1.39 (p<0.05). Minimally invasive surgery for appendicitis is a safe and efficacious procedure in Brazilian public health care services, as it provides advantages over the open method (including lower procedure-related mortality rate and earlier discharges), and it did not imply higher expenses for public service budgets in the state of Bahia.


Assuntos
Apendicite , Laparoscopia , Apendicectomia , Apendicite/cirurgia , Análise Custo-Benefício , Humanos , Laparotomia , Tempo de Internação , Estudos Retrospectivos , Resultado do Tratamento
11.
Int J Surg ; 95: 106148, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34700020

RESUMO

BACKGROUND: During the COVID-19 pandemic in 2020 a decrease of emergency consultations and modification in treatment of numerous medical conditions were observed. Aim of this paper was to evaluate the effect of the COVID-19 pandemic on incidence, treatment strategies, severity, length of hospital stay and time of presentation in adults and children with acute appendicitis. METHODS: A systematic literature search of Pubmed, Embase and Cochrane databases was performed, and eligible studies used to perform a meta-analysis. RESULTS: 46 suitable studies were identified with an overall reduction of appendicitis cases by 20.9% in adults and an increase of 13.4% in children. The rate of open appendectomies increased without statistical significance in both groups (adults: 8.5% vs. 7.1%, P = 0.32; children: 7.1% vs. 5.3%, P = 0.13), whereas the rate of antibiotic treatment increased significantly (P = 0.007; P = 0.03). Higher rates of complicated appendicitis were observed in adults (adults: OR 2.00, P < 0.0001; children: OR 1.64, P = 0.12). Time to first consultation did not change significantly (adults: 52.3 vs. 38.5 h - P = 0.057; children: 51.5 vs. 32.0 h - P = 0.062) and length of stay was also not lengthened during the pandemic (adults: 2.9 vs. 2.7 days, P = 0.057; children: 4.2 vs. 3.7 days, P = 0.062). CONCLUSION: The COVID-19 pandemic of 2020 had major impact on incidence and treatment strategies of acute appendicitis. Results of this meta-analysis might be another hint to support the theory that appendicitis is not a progressive disease and surgeons can safely consider antibiotic therapy for acute uncomplicated appendicitis.


Assuntos
Apendicite , COVID-19 , Adulto , Apendicectomia , Apendicite/tratamento farmacológico , Apendicite/epidemiologia , Apendicite/cirurgia , Criança , Humanos , Tempo de Internação , Pandemias , Estudos Retrospectivos , SARS-CoV-2
12.
World J Emerg Surg ; 16(1): 44, 2021 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-34488825

RESUMO

BACKGROUND: Acute appendicitis is one of the most frequent abdominal surgical emergencies. Intra-abdominal abscess is a frequent post-operative complication. The aim of this meta-analysis was to compare peritoneal irrigation and suction versus suction only when performing appendectomy for complicated appendicitis. METHODS: According to PRISMA guidelines, a systematic review was conducted and registered into the Prospero register (CRD42020186848). The risk of bias was defined to be from low to moderate. RESULTS: Seventeen studies (9 RCTs and 8 CCTs) were selected, including 5315 patients. There was no statistical significance in post-operative intra-abdominal abscess in open (RR 1.27, 95% CI 0.75-2.15; I2 = 74%) and laparoscopic group (RR 1.51, 95% CI 0.73-3.13; I2 = 83%). No statistical significance in reoperation rate in open (RR 1.27, 95% CI 0.04-2.49; I2 = 18%) and laparoscopic group (RR 1.42, 95% CI 0.64-2.49; I2 = 18%). In both open and laparoscopic groups, operative time was lower in the suction group (RR 7.13, 95% CI 3.14-11.12); no statistical significance was found for hospital stay (MD - 0.39, 95% CI - 1.07 to 0.30; I2 = 91%) and the rate of wound infection (MD 1.16, 95% CI 0.56-2.38; I2 = 71%). CONCLUSIONS: This systematic review has failed to demonstrate the statistical superiority of employing intra-operative peritoneal irrigation and suction over suction-only to reduce the rate of post-operative complications after appendectomy, but all the articles report clinical superiority in terms of post-operative abscess, wound infection and operative times in suction-only group.


Assuntos
Apendicectomia , Apendicite/cirurgia , Lavagem Peritoneal/métodos , Sucção/métodos , Humanos , Complicações Pós-Operatórias
15.
J Am Coll Surg ; 233(5): 593-605.e4, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34509613

RESUMO

BACKGROUND: Virtual visits (VVs) are being used increasingly to provide patient-centered care and have undergone rapid uptake during the COVID-19 pandemic. Our aim was to compare satisfaction and convenience of virtual post-discharge follow-up for surgical patients and qualitatively analyze free-text survey responses in a randomized controlled noninferiority trial. Patient satisfaction with VVs has not been evaluated previously in a randomized controlled trial and few mixed-methods analyses have been done to understand barriers and facilitators to post-discharge visits. STUDY DESIGN: Patients undergoing laparoscopic appendectomy or cholecystectomy were randomized to VV or in-person visit (2:1). Surveys with 11 multiple-choice and 2 open-ended questions evaluated patient satisfaction and convenience. Univariate analysis compared responses to the multiple-choice questions and qualitative content analysis evaluated open-ended responses. RESULTS: Of 442 enrolled patients, 289 completed their postoperative visit and were sent surveys (55% response rate). Patients were categorized as VV (n = 135), crossover (randomized to virtual but completed in-person; n = 53), and in-person visits (n = 101). Patient-reported satisfaction was similar, but convenience was higher for VV patients. Open-ended responses (72 VVs, 14 crossovers, and 41 in-person visits) were qualitatively analyzed. In all groups, patient experience was influenced by quality of care, efficiency, and convenience. Barriers were different for virtual and in-person appointments. CONCLUSIONS: We found that quality of, and access to, care-whether in person or virtual-remained critical components of patient satisfaction. VVs address many barriers associated with in-person visits and were more convenient, but can present additional technological barriers.


Assuntos
Assistência ao Convalescente/métodos , COVID-19/prevenção & controle , Satisfação do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/diagnóstico , Telemedicina/normas , Adulto , Assistência ao Convalescente/psicologia , Assistência ao Convalescente/normas , Assistência ao Convalescente/estatística & dados numéricos , Apendicectomia/efeitos adversos , Agendamento de Consultas , COVID-19/epidemiologia , COVID-19/transmissão , Colecistectomia Laparoscópica/efeitos adversos , Controle de Doenças Transmissíveis/normas , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Alta do Paciente , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Inquéritos e Questionários/estatística & dados numéricos
16.
JNMA J Nepal Med Assoc ; 59(235): 252-255, 2021 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-34506434

RESUMO

INTRODUCTION: Acute appendicitis is the most common reason for abdominal surgery in children. Though appendectomy considered the gold standard there are a lot of complications related to it. Conservative management of acute appendicitis is not new to medical science. In pandemic like COVID-19 when all the health systems were about to shut-down because of lack of manpower and resources, we started a trial of non-operative management. The main aim of this study is to find out the management of acute appendicitis during COVID-19. METHODS: This was a descriptive cross-sectional study conducted in a tertiary care centre. Data collection was done from the record section which included the patients diagnosed with acute appendicitis from February 2020 to July 2020 after obtaining ethical clearance from Institutional Review Committee. Cases of appendicular lump, appendicular abscess, appendicular perforations have been excluded. Data was collected and entry was done in Statistical Package for the Social Science software version 20, point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: The conservative management of acute appendicitis was done in 44 cases (55.7%) while 35 cases (44.3%) had to undergo appendectomy. CONCLUSIONS: COVID-19 can complicate the perioperative course as a result of direct lung injury and multiple organ dysfunctions and can also bring serious threats to the safety of medical staffs involved in managing the acute appendicitis case operatively, so conservative management can be considered as an alternative way of management of acute appendicitis in the pandemic outbreak.


Assuntos
Apendicite , COVID-19 , Apendicectomia , Apendicite/epidemiologia , Apendicite/cirurgia , Criança , Estudos Transversais , Humanos , Pandemias , SARS-CoV-2 , Centros de Atenção Terciária
17.
Acta Biomed ; 92(4): e2021231, 2021 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-34487066

RESUMO

Background and aim of the work In April 2020, the World Society of Emergency Surgery (WSES) published the first update to the Jerusalem Guidelines on the diagnosis and treatment of acute appendicitis. In this review we have reported a summary of the contemporary evidence from the literature that led to the guidelines statements on the diagnostic strategies for appendicitis. Methods A systematic literature search was performed for studies published on the use of the most common clinical scores and imaging for the diagnosis of appendicitis. Results Alvarado, AIR and AAS scores are sufficiently sensitive (up to 99%) to exclude appendicitis, accurately identifying low-risk patients and decreasing the need for imaging and the negative appendectomy rates in such patients. Conversely, for young patients deemed to be at high-risk of appendicitis according to the scores, because of the high prevalence of the disease in this group of patients (~90%), a negative imaging scan cannot rule out appendicitis. The sensitivity and specificity of CT is reported at 0.91-0.94 and 0.90-0.95. The corresponding results for US are 0.78-0.88 and 0.81-0.94, respectively. Conclusions In young patients, a high-probability score for appendicitis may be used to select patients in which imaging is not needed. When the surgeon deems diagnostic imaging is still needed to confirm appendicitis despite the patient has been scored at high-risk, a conditional CT scan strategy is advised, with CT scan performed only after a negative or equivocal ultrasound scan.


Assuntos
Apendicite , Doença Aguda , Apendicectomia , Apendicite/diagnóstico por imagem , Apendicite/cirurgia , Humanos , Sensibilidade e Especificidade , Ultrassonografia
18.
Rev Assoc Med Bras (1992) ; 67(3): 355-359, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34468597

RESUMO

OBJECTIVE: The sudden COVID-19 outbreak has changed our health system. Physicians had to face the challenge of treating a large number of critically ill patients with a new disease and also maintain the essential healthcare services functioning properly. To prevent disease dissemination, authorities instructed people to stay at home and seek medical care only if they experienced respiratory distress. However, there are concerns those patients did not seek necessary health care because of these orientations. This study aims to see how the pandemic has influenced the severity of the disease, complication, and mortality of patients undergoing emergency cholecystectomy and appendectomy. METHODS: Retrospective review of medical records of patients admitted to the emergency department and undergoing to cholecystectomy and appendicectomy in the periods from March to May 2019 and 2020. RESULTS: We observed that COVID-19 did not change the severity of presentation or the outcome of patients with gallbladder disease, but caused a 24.2% increase in the prevalence of complicated appendicitis (p<0.05). However, disagreeing with what was expected, we did not identify a greater number of perioperative complications in patients undergoing an appendectomy. CONCLUSION: Therefore, it seems that in a university tertiary referral center COVID-19 did not influence the management and outcome of inflammatory diseases treated in the surgical emergency department.


Assuntos
Apendicite , COVID-19 , Apendicectomia/efeitos adversos , Apendicite/cirurgia , Serviço Hospitalar de Emergência , Humanos , Estudos Retrospectivos , SARS-CoV-2
19.
J Coll Physicians Surg Pak ; 31(1): S50-S54, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34530528

RESUMO

OBJECTIVE: To measure the outcomes of conservative treatment of acute appendicitis. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Fauji Foundation Hospital, Rawalpindi from April to July 2020. METHODOLOGY: All 58 patients (n=58) presenting with acute appendicitis (AA) were included. Assessment was done with Alvarado score (AS) and ultrasound. Treatment was initiated according to the algorithm corresponding with AS. Those with AS score of 4 or less were started on outpatient oral antibiotics. Patients with AS score of 5 or more were admitted for IV antibiotics. If the symptoms and signs resolved, they were sent home on oral antibiotics to complete a course of 5 days. If their condition did not improve in 72 hours or deteriorated at any time, appendectomy was done. Outcomes were recorded and analysed on SPSS. RESULTS: Out of 58 patients, 16 were treated with oral, while 42 with IV antibiotics. This yielded a statistically significant difference on the course of disease (p=0.028). Resolution of symptoms was seen in 27.6% (n=16) with conservative management; whereas, 72.4% (n=42) patients needed a subsequent appendectomy. The difference in operative findings between patients, who had been given oral or IV antibiotics was statistically insignificant (p=0.536). Diagnostic value of leukocyte count (TLC), ultrasound and AS was not found to be significant. CONCLUSION: Non-operative management is successful in about a quarter of the patients of AA. There is very limited value of sonography, laboratory parameters, or AS in confirming the diagnosis of AA. Key Words: Appendicitis, Conservative treatmen, COVID-19.


Assuntos
Apendicite , COVID-19 , Doença Aguda , Apendicectomia , Apendicite/tratamento farmacológico , Apendicite/epidemiologia , Apendicite/cirurgia , Tratamento Conservador , Humanos , Pandemias , SARS-CoV-2
20.
ANZ J Surg ; 91(10): 2067-2073, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34476891

RESUMO

BACKGROUNDS: In cancer patients, the optimal appendicitis treatment has not been established. Therefore, we aimed to determine the ideal treatment option for appendicitis in cancer patients. METHODS: This retrospective study included 185 cancer patients with acute appendicitis who were divided into the early surgical group (n = 152) involving surgery performed within 48 h following the appendicitis diagnosis or the conservative group (n = 33) involving intravenous antibiotics. We compared the appendicitis treatment efficacy between the groups. RESULTS: In the early surgical group, the antibiotic duration [5.5 days (4.0-8.0) vs. 17.0 days (12.5-25.0), p < 0.001] and hospital stay length [7.0 days (5.0-11.75) vs. 10.0 days (8.0-32.0), p < 0.001] were significantly shorter. Regarding pathology, 16/171 (9.4%) patients who underwent surgery exhibited appendiceal tumours. During the 1-year follow-up period, one recurrence occurred in each group [1/152 (0.7%) vs. 1/33 (3.0%), p = 0.326]. The 1-year treatment success rate was higher in the early surgical group [99.3% (151/152) vs. 42.4% (14/33), p < 0.001]. CONCLUSION: Early surgical treatment yielded a significantly higher success rate than conservative treatment for appendicitis in cancer patients. Surgery for appendicitis in cancer patients should be considered not only for treatment but also for pathologic confirmation.


Assuntos
Apendicite , Doença Aguda , Antibacterianos/uso terapêutico , Apendicectomia , Apendicite/complicações , Apendicite/tratamento farmacológico , Apendicite/cirurgia , Tratamento Conservador , Humanos , Tempo de Internação , Recidiva Local de Neoplasia , Estudos Retrospectivos , Resultado do Tratamento
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