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1.
Nihon Shokakibyo Gakkai Zasshi ; 117(1): 78-83, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-31941860

RESUMO

Generally, a colon lesion is evaluated by endoscopy. In many cases, total colonoscopy is often difficult to perform due to postsurgical adhesion. Here, we described a case of a colon tumor that could not be recognized by colonoscopy and palpation under laparotomy. Nonetheless, this tumor could be observed by laparoscopy from the appendix root after appendectomy. Eventually, this tumor was locally resected. The patient was a 79-year-old male who had PET-CT examination to explore distant metastasis before the rectal cancer surgery. In this examination, the ascending-colon lesion was suspected as a malignant tumor. This tumor could not be observed by colonoscopy because of the adhesion from the past history of right pneumonectomy and open cholecystectomy. Nevertheless, the contrast enema at the hepatic flexure of the colon was normal. We then suspected an early colon carcinoma and subsequently performed laparotomy. However, the tumor was not detected by palpation at the ascending colon. Thus, we observed the colon tumor by laparoscopy from the appendix root after appendectomy, followed by local excision of the colon tumor. Therefore, observation by laparoscopy from the appendix root was useful for the diagnosis and treatment of the ascending-colon lesion that could not be recognized by colonoscopy and palpation under laparotomy.


Assuntos
Apêndice , Neoplasias do Colo , Laparoscopia , Idoso , Apendicectomia , Humanos , Masculino , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons
3.
J Surg Res ; 246: 395-402, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31629495

RESUMO

BACKGROUND: Laparoscopic appendectomy is a preferred approach in children with appendicitis. Patient characteristics associated with open appendectomy are poorly characterized, although such information can help optimize the care. MATERIAL AND METHODS: To characterize the factors associated with open appendectomy, we performed a retrospective analysis using the 2014 Nationwide Readmissions Database, capturing 49.3% of US hospitalizations. We identified surgically managed appendicitis using International Classification of Diseases, Ninth Revision, Clinical Modification among patients aged 18 or younger. Factors associated with open appendectomy, 30-d readmission rate, and hospitalization length were assessed using logistic regression, Cox proportional hazards regression, and Poisson regression, respectively. RESULTS: Of 46,147 children with surgically managed appendicitis, 85.2% had laparoscopic appendectomy. Low-volume hospitals (odds ratio, OR: 3.01 [95% confidence interval, CI: 1.81-5.01]), rural hospitals (OR: 2.36 [95%CI: 1.63-3.40]), public insurance (OR: 1.19 [95%CI: 1.03-1.36]), lower-income neighborhood residence (OR: 1.40 [95%CI: 1.06-1.86]), younger age (OR: 5.00 [95%CI: 3.64-6.86] in <5 year-old), and abscess complicating appendicitis (OR: 1.91 [95%CI: 1.58-2.31]) were associated with open appendectomy. Laparoscopic appendectomy was associated with shorter hospitalization (incidence rate ratio: 0.77 [95%CI: 0.69-0.87]) and less readmission with wound infection, but not with 30-d readmission, or readmission with intraabdominal abscess. CONCLUSIONS: Along with clinical factors, non-clinical factors including appendicitis volume and rural/teaching status of the treating hospitals play a role in the choice of surgical approach. Awareness of the patient- and hospital-level factors associated with open appendectomy may allow for future resource distribution or improvement in access to care, resulting in population-level impact.


Assuntos
Abscesso Abdominal/epidemiologia , Apendicectomia/efeitos adversos , Apendicite/cirurgia , Readmissão do Paciente/estatística & dados numéricos , Infecção da Ferida Cirúrgica/epidemiologia , Abscesso Abdominal/etiologia , Abscesso Abdominal/cirurgia , Adolescente , Fatores Etários , Apendicectomia/métodos , Apendicite/complicações , Criança , Pré-Escolar , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais Rurais/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/cirurgia
5.
J Surg Res ; 245: 383-389, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31425880

RESUMO

BACKGROUND: Self-assessment is fundamental in surgical training. Accuracy of self-assessment is superior with greater age, experience, and the use of video playback. Presently, there is scarce evidence in the literature regarding predictors for a surgical trainee's aptitude for self-assessment. The objective of this study was to investigate whether emotional intelligence or visual-spatial aptitude can predict effective self-assessment among novice surgeons performing laparoscopic appendectomy (LA). MATERIALS AND METHODS: Eighteen novice trainees performed a simulated LA, and two aptitude measures were evaluated: (1) emotional intelligence questionnaire and (2) visual spatial ability test. Self-assessment of their performance was conducted using the Objective Assessment of Surgical and Technical Skills global rating scale and ranking five subtasks of the procedure in order of quality of performance after watching a playback of their LA. Two blinded experts (senior consultant surgeons, performed >100 LAs) assessed surgical quality using the same scoring system. Candidates were ranked into higher and lower aptitude groups for the two aptitude measures. Spearman's rank correlation coefficient was calculated to identify if either of the two groups demonstrated greater agreement between self and expert assessment in relation to the two aptitude measures. RESULTS: Participants with a higher degree of emotional intelligence demonstrated significant agreement with expert assessment (r = 0.73, P = 0.031). CONCLUSIONS: Emotional intelligence can predict better self-assessment of surgical quality after performing a simulated LA. This may facilitate early identification of individuals who might require mentoring or guidance with self-assessment as well as contribute to selection criteria.


Assuntos
Testes de Aptidão , Inteligência Emocional , Cirurgia Geral/educação , Autoavaliação , Processamento Espacial , Adulto , Apendicectomia , Competência Clínica , Feminino , Cirurgia Geral/normas , Humanos , Laparoscopia , Masculino , Projetos Piloto , Adulto Jovem
6.
Medicine (Baltimore) ; 98(50): e18047, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852066

RESUMO

BACKGROUND: There currently exists no substantial evidence reporting the efficacy of peritoneal irrigation in reducing the incidence of postoperative intra-abdominal abscess in pediatric patients. The purpose of our study was to perform a meta-analysis to compare rates of intra-abdominal abscess after appendectomy between irrigation and suction alone groups. METHODS: We identified studies by a systematic search in EMBASE, PubMed, Web of Science, and the Cochrane Library to recognize randomized controlled trials and case control studies from the 1950 to May 2019. We limited the English language studies. We checked the reference list of studies to recognize other potentially qualified trials. We analyzed the merged data with use of the Review Manager 5.3. RESULTS: We identified 6 eligible papers enrolling a total of 1633 participants. We found no significant difference in the incidence of postoperative intraabdominal abscess, wound infection, and the length of hospitalization between 2 group, but duration of surgery is longer in irrigation group (MD = 6.76, 95% CI = 4.64 to 8.87, P < .001; heterogeneity, I = 25%, P = .26). CONCLUSION: Our meta-analysis did not provide strong evidence allowing definite conclusions to be drawn, but suggested that peritoneal irrigation during appendectomy did not decrease the incidence of postoperative IAA. This meta-analysis also indicated the need for more high-quality trials to identify methods to decrease the incidence of postoperative IAA in pediatric perforated appendicitis patients.Trial registration number Standardization of endoscopic treatment of acute abdomen in children: 14RCGFSY00150.


Assuntos
Abscesso Abdominal/prevenção & controle , Apendicectomia/métodos , Apendicite/cirurgia , Laparoscopia/métodos , Lavagem Peritoneal/métodos , Complicações Pós-Operatórias/prevenção & controle , Abscesso Abdominal/etiologia , Apendicite/complicações , Criança , Humanos , Período Intraoperatório , Complicações Pós-Operatórias/etiologia
7.
Arch. argent. pediatr ; 117(6): 375-380, dic. 2019. tab, graf
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1046251

RESUMO

Introducción. El índice de volumen plaquetario medio/linfocitos (IVPML) es un parámetro novedoso de inflamación y trombosis. El objetivo fue evaluar si cumple una función en el diagnóstico de la apendicitis pediátrica.Población y métodos. Se revisaron retrospectivamente historias clínicas de pacientes de hasta 18 años con sospecha de apendicitis aguda (AA) sometidos a apendicectomía entre enero de 2016 y diciembre de 2017. Según la evaluación histopatológica, se clasificó a los pacientes en apéndice normal y apendicitis simple y perforante. Se midieron volumen plaquetario medio (VPM), amplitud de distribución plaquetaria (ADP), IVPML, índice de plaquetas/linfocitos (IPL), recuentos de plaquetas y leucocitos, y concentración de proteína C-reactiva (PCR).Resultados. Se revisaron los registros de 219 niños con sospecha de AA sometidos a tratamiento quirúrgico por apendicitis, y se incluyó a 100 niños sanos de la misma edad y sexo. Comparados con los controles, los valores medios de IVPML, IPL, leucocitos y PCR fueron más elevados en los niños con apendicectomía (p < 0,001). Estos valores fueron más elevados en los casos de apendicitis simple que de apéndices normales (p< 0,01). Comparados con la apendicitis simple, estos valores fueron más elevados en los niños con apendicitis perforante (p< 0,001). Las áreas bajo la curva del IVPML e IPL fueron 0,771 y 0,726 en la predicción de apendicitis y 0,693 y 0,722 en la predicción de perforación, respectivamente.Conclusiones. Una concentración elevada de IVPML podría contribuir a diagnosticar la AA pediátrica. Además, puede ayudar a diferenciar la apendicitis simple de la perforante.


Introduction. Mean platelet volume-to-lymphocyte ratio (MPVLR) has emergedas a novel parameter of inflammation andthrombosis. The aim was to evaluate whether MPVLR has a role in the diagnosis ofchildhood appendicitis. Population and methods. Retrospectively reviewed the medical records up to 18 year with suspected acute appendicitis (AA) who underwent appendectomy between January 2016 and December 2017. Based on histopathological evaluation, the patients were classified into normal appendix, and simple and perforated appendicitis. Preoperative mean platelet volume (MPV), platelet distributionwidth (PDW), MPVLR, platelet-to-lymphocyteratio (PLR), counts of platelets and white bloodcells (WBC), and C-reactive protein (CRP) levels were measured. Results. A total of 219 children with clinically suspected AA who underwent surgical treatmentfor appendicitis were reviewed, and 100 gender-age matched healthy subjects were included. Compared with the controls, the mean levels of MPVLR, PLR, WBC and CRP were significantly higher in the children underwent appendectomy (p <0.001). These values were significantly higherin simple appendicitis than in normal appendices (p<0.01). Compared with simple appendicitis,these levels were significantly higher in thechildren with perforated appendicitis (p <0.001). The area under curves for MPVLR and PLR were0.771 and 0.726 in the prediction of appendicitisand 0.693 and 0.722 in the prediction of perforation, respectively. Conclusions. Increased level of MPVLR may bevaluable for aiding the diagnosis of pediatric AA. In addition, it can help discriminate simple and perforated appendicitis in children.


Assuntos
Humanos , Pré-Escolar , Criança , Adolescente , Apendicectomia , Apendicite/diagnóstico , Contagem de Linfócitos , Volume Plaquetário Médio , Estudos Retrospectivos
8.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(4): 494-502, Oct.-Dec. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1041352

RESUMO

ABSTRACT Objective: To analyze the preoperative use of antibiotics in children and adolescents requiring appendectomy. Data source: Integrative review was performed in the MEDLINE, Latin American and Caribbean Health Sciences (LILACS) and Cochrane databases and the PubMed portal, with no time limit. The keywords used were: appendicitis, child, adolescent and antibacterial with Boolean AND. The articles included were published in Portuguese, English or Spanish and whose participants were under 18 years of age. Review articles and guidelines were excluded. The studies were classified according to their level of evidence and 24 papers were selected. Data collection and analysis: Seven randomized clinical trial studies (level of evidence II), eight cohorts (level III), seven retrospective observational studies (level V) and two historical documentary analysis (level IV) were selected. The studies addressed antibiotics used in acute appendicitis in both uncomplicated and complicated cases. Antibiotics initiated in the preoperative period showed a decrease in the rates of surgical wound infections. First-line (empiric) regimens were tested for sensitivity to microorganisms in peritoneal material cultures, however the results were controversial. Broad-spectrum antibiotics have been suggested in some studies because they have good coverage, but in others they have not been recommended because of the risk of developing bacterial resistance. Shorter administration time and earlier change to the oral route reduced hospitalization time. Conclusions: There are several clinical protocols with different antibiotics. However, there is no standardization concerning the type of antibiotic drug, time of use, or route.


RESUMO Objetivo: Analisar o uso de antibióticos em crianças e adolescentes no perioperatório de apendicectomia. Fonte de dados: Realizou-se uma revisão integrativa, nas bases de dados MEDLINE, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Cochrane e no portal PubMed, sem limite de tempo. As palavras-chave utilizadas foram: apendicite, criança, adolescente e antibacterianos com booleano AND. Os artigos incluídos foram publicados nos idiomas português, inglês ou espanhol e cujos participantes tivessem idade inferior a 18 anos. Os artigos de revisão e diretrizes foram excluídos. A qualidade da evidência foi analisada, e foram selecionados 24 artigos. Síntese dos dados: Sobre os estudos selecionados, sete foram ensaios clínicos randomizados (nível de evidência II), oito coortes (nível III), sete observacionais retrospectivos (nível V) e duas análises documentais históricas (nível IV). Os estudos abordaram antibióticos usados na apendicite aguda em suas formas não complicada e complicada. Os antibióticos iniciados no pré-operatório evidenciaram diminuição nas taxas de infecção da ferida cirúrgica. Os esquemas de primeira linha (empíricos) foram testados em relação à sensibilidade dos microrganismos nas culturas de material peritoneal, no entanto os resultados foram controversos. Sugeriram-se antibióticos de amplo espectro em alguns estudos por apresentar boa cobertura, no entanto em outros eles não foram recomendados, pelo risco de desenvolver resistência bacteriana. O menor tempo de administração e a mudança mais precoce para a via oral reduziram o tempo de internação. Conclusões: Existe um grande número de protocolos clínicos com antibióticos diversos, no entanto não existe padronização em relação ao tipo de antibiótico, tempo de uso nem via.


Assuntos
Humanos , Criança , Adolescente , Apendicectomia , Apendicite/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Cuidados Pré-Operatórios/métodos , Antibioticoprofilaxia/métodos , Antibacterianos/uso terapêutico , Esquema de Medicação , Resultado do Tratamento
9.
Surg Technol Int ; 35: 71-83, 2019 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-31710087

RESUMO

BACKGROUND: Single-incision laparoscopy (SIL) was initially reported in the mid-1900's, but remained unpopular until the arrival of Natural Orifice Transluminal Endoscopic Surgery. It was described not only for surgery involving the digestive system, but also for breast, thoracic, urologic, gynecologic and pediatric surgery. Various studies have proven its feasibility, safety and effectiveness. This report describes the 10-year experience with SIL of a single surgeon at a single institution. PATIENTS AND METHODS: From May 2009 to May 2019, 1700 abdominal SILs were performed, including: cholecystectomy (475), inguinal hernia repair (319), incisional/ventral hernia repair (293), appendectomy (226), colorectal surgery (158), fundoplication/diaphragmatic hernia repair (72), gastric surgery (54), diagnostic laparoscopy (42), liver surgery (18), small bowel resection (15), splenectomy (12), adrenalectomy (6), gynecologic surgery (6), pancreatic surgery (2), and urologic surgery (2). Three types of incision/access-site were adopted. Inclusion and exclusion criteria were considered. The following outcomes were evaluated: laparoscopic operative time, operative bleeding, supplementary scars or trocars for improved exposure of the operative field and/or control of perioperative complications, final incision length, hospital stay, postoperative pain during hospitalization and after discharge, early and late access-site complications and other early and late general complications. RESULTS: While there were no conversions to open surgery or conventional laparoscopy, a supplementary millimetric instrument or a 5-mm trocar was needed in 27.8% and 0.5% of cases, respectively. No operative or postoperative mortalities were registered. The mean final incision length was between 13.1 and 21.0 mm at the umbilicus, between 43.3 and 57.2 mm suprapubically, and between 21.4 and 36.3 mm in another abdominal quadrant. Postoperative pain decreased from the first hours until the end of hospitalization. The percentage of patients who required an analgesic drug for more than 5 days after discharge ranged between 0 and 16.6%. The early access-site complication rate was 7.5%, and the access-site incisional hernia rate was 1.3%. The other early general complication rate was 10.7%, and reoperation was required in 1.4%. The other late general complication rate was 0.7%, and reoperation was required in 0.5%. CONCLUSION: SIL is a laparoscopic technique that can safely be offered to patients presenting abdominal diseases. The main advantages include enhanced cosmetic results and reduced abdominal trauma. The main disadvantages are patient selection, a longer operative time for some procedures, and a need to expose the operative field for some other procedures.


Assuntos
Apendicectomia , Hérnia Inguinal , Herniorrafia , Laparoscopia , Criança , Feminino , Hérnia Inguinal/cirurgia , Humanos , Tempo de Internação , Duração da Cirurgia
10.
BMC Surg ; 19(1): 168, 2019 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-31711462

RESUMO

BACKGROUND: Appendiceal inversion with neoplasia in adults is an extremely rare event with a reported incidence of < 0.01%. Preoperative diagnosis is very important for surgical treatment; however, it is very difficult to be exact. CASE PRESENTATION: The patient was a 60-year-old woman with complaints of intermittent abdominal pain. Computed tomography and colonoscopy revealed a cecal mass, which was diagnosed as a tubulovillous adenoma in the preoperative colonoscopic biopsy. At surgery, the appendix was found to be completely inverted into the cecum. The cecum was partially resected, and surgical pathology examination confirmed a tubulovillous adenoma of the appendix with local high-grade intraepithelial neoplasia. CONCLUSIONS: Although preoperative diagnosis of appendiceal inversion with neoplasia may be often difficult due to its non-specific symptoms, clinicians should consider this disease entity when they encounter an intraluminal protruding cecal mass without visualization of the normal appendix on CT and colonoscopy.


Assuntos
Dor Abdominal/etiologia , Apêndice/diagnóstico por imagem , Doenças do Ceco/diagnóstico , Dor Abdominal/diagnóstico , Dor Abdominal/cirurgia , Apendicectomia/métodos , Apêndice/cirurgia , Doenças do Ceco/complicações , Doenças do Ceco/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Laparoscopia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos
11.
Clin Ter ; 170(6): e409-e417, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31696901

RESUMO

BACKGROUND: Stump appendicitis is a rare delayed complication post-appendectomy and it represents a diagnostic problem as clinicians are often not very familiar with this pathology. MATERIALS AND METHODS: One case of stump appendicitis has been reported in a 54 year old woman, whose acute phase was conservatively treated in our Department. A review of Medline literature was also carried out, from 1945 to 2015, showing 111 cases of stump appendicitis. RESULTS: Stump appendicitis has been reported after either open or laparoscopic appendectomy, in a range between days to several years from the first procedure. Nowadays, it is not considered yet as a possible differential diagnosis in patients with pain in the right iliac fossa previously undergone appendectomy. For this reason, the diagnosis can be delayed and complications such as acute abdomen, perforation, sepsis can occur. Completion appendectomy is the treatment of choice for stump appendicitis. CONCLUSIONS: The aim of this article is to underline the importance of stump appendicitis. Clinicians should be aware of the possibility of SA and they should confirm any clinical suspicion throughout radiologic images, in order to promptly recognize this entity and to avoid the related complications.


Assuntos
Apendicectomia/efeitos adversos , Apendicite/diagnóstico , Adulto , Apendicite/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico
12.
Ulus Travma Acil Cerrahi Derg ; 25(6): 616-621, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31701507

RESUMO

BACKGROUND: In this study, using single or double endoloops, with reference to the literature, we aimed to retrospectively assess the results for patients in our clinic who underwent a laparoscopic appendectomy. METHODS: This study included 251 patients who were operated on by a single surgeon; 137 of the patients were male (54.6%) and 114 were female (45.4%). Patients were divided into two groups based on the type of endoloop procedure that was used. Group 1 included 107 patients for whom a single endoloop was used. Group II included 144 patients for whom double endoloop was used. Age, sex, duration of operation, length of hospital stay, pathological findings, perioperative appendix findings, perioperative abdominal findings, post-operative complications requiring hospitalization and wound infections were assessed for each patient. Patients were also assessed statistically for complications. RESULTS: There were no significant differences in the demographic characteristics, perioperative surgery findings, pathological findings or duration of hospital stays between the two groups of the patients. However, the duration of operation was shorter in Group I (54.9±16.1 min) as compared to Group II (61.2±18.8 min). The incidence of complications requiring rehospitalization was statistically significantly lower in Group I (1.9%; n=2) as compared to Group II (9%; n=13) (p=0.018). There were no complications requiring re-operation for patients in Group I. In Group II, four patients (2.8%) required re-operation; however, this difference was not statistically significant. Concerning wound infection, there was also no significant difference between Group I (7.5% n=8) and Group II (4.9% n=7). CONCLUSION: Using a double endoloop does not decrease the risk of post-operative complications, but it does increase the cost and the duration of the operation. We have concluded that using a single endoloop in a laparoscopic appendectomy may be more appropriate.


Assuntos
Apendicectomia , Apêndice/cirurgia , Laparoscopia , Apendicectomia/efeitos adversos , Apendicectomia/métodos , Apendicectomia/estatística & dados numéricos , Apendicite/cirurgia , Feminino , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Masculino , Complicações Pós-Operatórias , Reoperação , Estudos Retrospectivos
13.
Surg Technol Int ; 35: 107-111, 2019 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-31687786

RESUMO

BACKGROUND: The laparoscopic appendectomy approach (LAA) for acute appendicitis has fewer intra- and post-operative complications, less pain, and smaller scars compared to the traditional open appendectomy approach (OAA), but a higher frequency of intra-abdominal abscess (IAA). The relationship between this higher frequency of IAA and the omission of appendicular stump invagination is difficult to explain, even though such invagination of the appendicular stump is the only difference between standard LAA and OAA.


Assuntos
Abscesso Abdominal , Apendicectomia , Apendicite , Laparoscopia , Abscesso Abdominal/cirurgia , Apendicectomia/métodos , Apendicite/cirurgia , Humanos , Complicações Pós-Operatórias
14.
Pan Afr Med J ; 34: 15, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31762884

RESUMO

Using a practical scoring system for diagnosing acute appendicitis can help reduce the rate of unnecessary surgery. This prospective study was carried out to evaluate Alvarado scoring system for diagnosing of acute appendicitis in our set up. Out of total 100 patients, appendicitis was confirmed in 80 patients, thus giving negative appendectomy rate of 20% (male 6%, female 14%). Perforation rate was 4%. Positive predictive value was 89%. The sensitivity was 54% and specificity 75%. Alvarado score is not a sensitive tool for aiding diagnosis of acute appendicitis.


Assuntos
Apendicectomia/métodos , Apendicite/diagnóstico , Adolescente , Adulto , Apendicite/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade , Adulto Jovem
15.
Medicine (Baltimore) ; 98(47): e18072, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764839

RESUMO

INTRODUCTION: Appendectomy is one of the most common emergency surgical operations. Stump appendicitis is a rare complication after appendectomy and is caused by acute inflammation of the remnant part of the appendix. Because of the low index of suspicion owing to a previous history of appendectomy, the diagnosis of stump appendicitis is often delayed. METHODS: Between January 2008 and December 2017, 6 patients were diagnosed with stump appendicitis with or without perforation at a single institution. They had undergone operative management with laparoscopic approach. The clinical data of these patients were retrospectively analyzed by reviewing the medical records and pathologic reports. RESULTS: Five patients were male, with a mean age of 42.4 years (range 11-77 years). The time interval after initial appendectomy ranged from 2 weeks to 30 years. Three patients underwent laparoscopic completion appendectomy, and the others underwent laparoscopic ileocecectomy. The mean hospital stay was 9 days (range 5-13 days). There were no cases of open conversion. CONCLUSIONS: Stump appendicitis is a rare complication after appendectomy. A laparoscopic procedure can be performed for management of stump appendicitis with or without perforation.


Assuntos
Apendicectomia/efeitos adversos , Apendicite/etiologia , Apendicite/cirurgia , Laparoscopia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
16.
Medicine (Baltimore) ; 98(48): e18002, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770213

RESUMO

RATIONALE: Mesenteric venous thrombosis is an uncommon but potentially fatal condition that can cause bowel ischemia. It results from a systemic hypercoagulable state or abdominal infection draining into the portal venous system. Several cases regarding portomesenteric venous thrombosis as a complication of appendicitis were reported in adults, but there are far fewer reports in pediatric patients. The mortality rate of the condition is high if untreated, especially in children, reaching up to 50%. PATIENT CONCERNS: A healthy 15-year-old male with no significant past medical history presented with right lower quadrant pain, lethargy, and fever. The computed tomography scan showed a focal thrombosis at the superior mesenteric vein branch and an inflamed appendix. DIAGNOSES: Mesenteric venous thrombosis complicating acute appendicitis. INTERVENTIONS: Intravenous antibiotics along with anticoagulants and laparoscopic appendectomy OUTCOMES:: After 1 month, a follow-up ultrasonography revealed full resolution of the thrombosis. LESSONS: Appendicitis is one of the most frequently encountered causes of pediatric surgical emergencies; therefore, physicians should be conscious of mesenteric venous thrombosis as a possible complication of acute appendicitis, irrespective of whether patients have thrombophilic conditions or not.


Assuntos
Apendicite/complicações , Isquemia Mesentérica/terapia , Veias Mesentéricas/cirurgia , Doença Aguda , Adolescente , Antibacterianos/uso terapêutico , Anticoagulantes/uso terapêutico , Apendicectomia/métodos , Apendicite/terapia , Humanos , Masculino , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/etiologia , Veias Mesentéricas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia
19.
Am Surg ; 85(10): 1089-1093, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657300

RESUMO

Older adults undergoing nonelective surgery are at risk for geriatric events (GEs: delirium, dehydration, falls/fractures, failure to thrive, and pressure ulcers), but the impact of GEs on postoperative outcomes is unclear. Using the 2013 to 2014 National Inpatient Sample, we analyzed nonelective hospital admissions for five common operations (laparoscopic cholecystectomy, colectomy, soft tissue debridement, small bowel resection, and laparoscopic appendectomy) in older adults (aged ≥65 years) and a younger referent group (aged 55-64 years). Nationally weighted descriptive statistics were generated for GEs. Logistic regression controlling for patient, procedure, and hospital characteristics estimated the association of 1) age with GEs and 2) GEs with outcomes. Of 471,325 overall admissions, 64.7 per cent were aged ≥65 years. The rate of any GE in older adults was 26.9 per cent; GEs varied by age and procedure (P < 0.001). After adjustment, the probability of any GE increased with age category (P < 0.001); having any GE was associated with higher probability of all outcomes (P < 0.001): mortality (4.5% vs 0.8%), postoperative complications (61.7% vs 24.9%), prolonged length of stay (24.3% vs 7.9%), and skilled nursing facility discharge (46.6% vs 10.3%). In addition, there was a dose-response relationship between GEs and negative outcomes. GEs are prevalent in the nonelective surgery setting and associated with worse clinical outcomes. Quality improvement efforts should focus on addressing GEs.


Assuntos
Apendicectomia/efeitos adversos , Colecistectomia Laparoscópica/efeitos adversos , Colectomia/efeitos adversos , Desbridamento/efeitos adversos , Intestino Delgado/cirurgia , Complicações Pós-Operatórias/epidemiologia , Acidentes por Quedas/estatística & dados numéricos , Fatores Etários , Idoso , Apendicectomia/estatística & dados numéricos , Colecistectomia Laparoscópica/estatística & dados numéricos , Colectomia/estatística & dados numéricos , Desbridamento/estatística & dados numéricos , Desidratação/epidemiologia , Desidratação/etiologia , Delírio/epidemiologia , Delírio/etiologia , Insuficiência de Crescimento/epidemiologia , Insuficiência de Crescimento/etiologia , Feminino , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Lesão por Pressão/epidemiologia , Lesão por Pressão/etiologia , Instituições de Cuidados Especializados de Enfermagem/estatística & dados numéricos , Resultado do Tratamento
20.
Am Surg ; 85(10): 1129-1133, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657308

RESUMO

Best management for acute appendicitis (AA) in adults with liver cirrhosis is controversial and needs more investigation. We aimed to examine the impact of different treatment modalities on outcomes in this complex patient population. The Nationwide Inpatient Sample database from 2012 to 2014 was queried to identify AA patients with no cirrhosis, compensated cirrhosis (CC), and decompensated cirrhosis (DC). Each cohort was further stratified according to the treatment type: nonoperative management, open appendectomy, and laparoscopic appendectomy (LA). Chi-square, ANOVA, and binary regression analyses were used to determine differences between groups and risk factors for mortality and complications, with P < 0.05 considered statistically significant. A total of 108,289 AA patients were analyzed; of those, 304 with CC and 134 with DC were identified. Compared with CC and no cirrhosis, DC patients had significantly higher mortality, higher cost, and longer hospital length of stay. LA is accompanied by higher survival, lower cost, shorter duration of hospitalization, and lower incidence of complications across all groups. We conclude that LA is the best management strategy for AA in cirrhotic patients. Even in decompensated cirrhotics, which are associated with worse clinical outcomes, LA is still a favorable option over open appendectomy and nonoperative management.


Assuntos
Apendicectomia/métodos , Apendicite/cirurgia , Laparoscopia , Cirrose Hepática/complicações , Doença Aguda , Adulto , Análise de Variância , Apendicectomia/efeitos adversos , Apendicectomia/economia , Apendicectomia/mortalidade , Apendicite/complicações , Apendicite/mortalidade , Distribuição de Qui-Quadrado , Conversão para Cirurgia Aberta/estatística & dados numéricos , Custos e Análise de Custo , Feminino , Preços Hospitalares , Mortalidade Hospitalar , Humanos , Incidência , Laparoscopia/economia , Laparoscopia/mortalidade , Tempo de Internação/economia , Cirrose Hepática/classificação , Cirrose Hepática/mortalidade , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Análise de Regressão , Fatores de Risco , Resultado do Tratamento
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