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1.
Clin Lab ; 67(11)2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34758216

RESUMO

BACKGROUND: An increasing number of studies have indicated that uncomplicated acute appendicitis can be cured with antibiotics alone. Reducing the hazards of appendicitis in infants and young children is a priority problem. It is necessary to search for potential biomarkers for early diagnosis of appendicitis in infants and young children. METHODS: A retrospective cohort study, including 366 infants and young children treated in the pediatric surgery department, was conducted. Complete blood count, C-reactive protein, and procalcitonin were measured at admission and 24 hours after operation. RESULTS: The median of PCT, CRP, and WBC in the acute appendicitis group and other diseases group were 1.20, 0.11 - 4.06; 16.50, 0.81 - 76.21; 13.51, 7.53 - 26.30 and 0.03, 0.01 - 0.13; 3.35, 0.92 - 6.33; 14.34, 8.84 - 17.23 at the admission, respectively. PCT and CRP were found higher in the acute appendicitis group than that in other abdominal pain diseases group (p < 0.05). WBC is not a specific indicator for identifying acute appendicitis and other abdominal pain diseases (p > 0.05). In different acute appendicitis cases, PCT and CRP significantly increased in complicated appendicitis (p < 0.05). Data showed that WBC mildly increased in complicated appendicitis compared to acute simple appendicitis (p < 0.05). ROC curves showed that PCT was a specific indicator for identifying acute appendicitis and other abdominal pain diseases, AUCPCT = 1.000 (95% CI, 0.999 - 1.000). The median of antibiotic treatment is 4.0 d (95% CI 3.0 - 5.0) in acute appendicitis with PCT results versus 7.0 d (95% CI 5.0 - 9.0) in acute appendicitis without PCT result. CONCLUSIONS: PCT shows a high diagnostic ability for appendicitis in infants and young children at admission and assists pediatricians in management of pediatric appendicitis. The combination of these biomarkers is highly recommended. Further studies are needed to confirm our findings.


Assuntos
Apendicite , Pró-Calcitonina , Apendicite/diagnóstico , Apendicite/cirurgia , Biomarcadores , Proteína C-Reativa/análise , Criança , Pré-Escolar , Humanos , Lactente , Contagem de Leucócitos , Curva ROC , Estudos Retrospectivos
3.
Surg Infect (Larchmt) ; 22(9): 973-982, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34723648

RESUMO

Background: The aim of this study was to describe and analyze the current status of the diagnosis and management of acute appendicitis in China. Patients and Methods: An online record system was used to collect data retrospectively from 52 medical centers in mainland China. All patients with acute appendicitis who were first treated at the hospital in 2017 were included and followed up for one year. Propensity score matching (PSM) was used to exclude the potential confounders and analyze the difference in outcomes between the non-operative management (NOM) and surgical groups. Results: A total of 10,187 patients were enrolled, of whom 5,517 (54.2%) were males. A total of 2,056 (20.2%) cases received NOM. The one-year recurrence rate of appendicitis in the NOM group was 19.3%. On PSM analysis, we found that the NOM group had a lower complication rate (2% vs. 4.2%; p = 0.001) and an acceptable success rate (96.8% vs. 100%; p < 0.001) compared with the operative group in patients with non-complicated acute appendicitis. However, in the complicated acute appendicitis population, the in-hospital complication rate in the NOM group was higher (10.8% vs. 5.8%; p = 0.048) and the success rate was lower (95.4% vs. 100%; p < 0.001) than the operative group. The recurrence rate was lower in patients with non-complicated acute appendicitis than in those with complicated acute appendicitis (17.3% vs. 30.8%; p = 0.010). In the operative group, pre-operative antimicrobial prophylaxis-covered anaerobes could reduce the surgical site infection (SSI) rate compared with that in the non-covered anaerobes group in non-complicated patients (0.9% vs. 1.9%; p = 0.020). Conclusions: Appendectomy is currently the most effective treatment for acute appendicitis. However, NOM is an alternative treatment for non-complicated acute appendicitis but not for complicated acute appendicitis because of the lower complication rate, considerable success rate, and recurrence rate.


Assuntos
Apendicite , Antibacterianos/uso terapêutico , Apendicectomia , Apendicite/diagnóstico , Apendicite/epidemiologia , Apendicite/cirurgia , China/epidemiologia , Estudos Transversais , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
4.
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
5.
Ann Ital Chir ; 92: 592-594, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34795116

RESUMO

AIM: We describe treatments of acute appendicitis at "Bambino Gesù" Children's Hospital during the peak of the Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) pandemic in Italy. MATERIAL AND METHODS: From March 1st to May 31st, all suspected appendicitis admitted to hospital entered this study. Following Institutional COVID19-protocol, between March 1st-21st, only patients with respiratory symptoms and/or history of recent travel to risk areas received nasopharyngeal swab. From March 22nd to May 31st, protocol was adapted to worsening epidemic conditions and a pre-triage area has been arranged to accommodate all patients undergoing the swab. RESULTS: 14 out of 53 patients were hospitalized between march 1st-21st, 39 from march 22nd to may 31st. swab was performed in 2 patient of first group and in all of second. DISCUSSION: During the study period, no covid19-contagion occurred in hospital staff by covid19-patients. CONCLUSION: Our covid19-protocol protected staff and patients allowing the maintenance of our standard of treatment. KEY WORDS: Appendicitis, Children, Covid19, Sars-cov-2.


Assuntos
Apendicite , COVID-19 , Apendicite/epidemiologia , Apendicite/cirurgia , Criança , Humanos , Pandemias , Encaminhamento e Consulta , SARS-CoV-2
6.
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
7.
Medicina (Kaunas) ; 57(11)2021 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-34833452

RESUMO

Background and Objectives: Our aim was to see if the COVID-19 pandemic led to an increase of time until diagnosis, operation, and time spent in Emergency room (ER), and if it resulted in more cases of complicated appendicitis and complication rates in children. Materials and Methods: We conducted a retrospective analysis of patients admitted to the Pediatric Surgery Department with acute appendicitis during a 4-month period of the first COVID-19 pandemic and compared it to the previous year data-the same 4-month period in 2019. Results: During the pandemic, the time spent in the ER until arriving at the department increased significantly 2.85 vs. 0.98 h p < 0.001, and the time spent in the department until the operation 5.31 vs. 2.66 h, p = 0.03. However, the time from the beginning of symptoms till ER, operation time and the length of stay at the hospital, as well as the overall time until operation did not differ and did not result in an increase of complicated appendicitis cases or postoperative complications. Conclusions: The COVID-19-implemented quarantine led to an increase of the time from the emergency room to the operating room by 4 h. This delay did not result in a higher rate of complicated appendicitis and complication rates, allowing for surgery to be postponed to daytime hours if needed.


Assuntos
Apendicite , COVID-19 , Apendicectomia , Apendicite/diagnóstico , Apendicite/epidemiologia , Apendicite/cirurgia , Criança , Humanos , Pandemias , Estudos Retrospectivos , SARS-CoV-2
8.
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
9.
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
10.
Sci Rep ; 11(1): 19645, 2021 10 04.
Artigo em Inglês | MEDLINE | ID: mdl-34608197

RESUMO

Anecdotal evidence suggests that community infection control measures during the COVID-19 outbreak have modified the number and natural history of acute surgical inflammatory processes (ASIP-appendicitis, cholecystitis, diverticulitis and perianal abscesses) admissions. This study aims to evaluate the impact of the COVID-19 pandemic on the presentation and treatment ASIP and quantify the effect of COVID-19 infection on the outcomes of ASIP patients. This was a multicentre, comparative study, whereby ASIP cases from 2019, 2020 and 2021 (March 14th to May 2nd) were analyzed. Data regarding patient and disease characteristics as well as outcomes, were collected from sixteen centres in Madrid, and one in Seville (Spain). The number of patients treated for ASIP in 2019 was 822 compared to 521 in 2020 and 835 in 2021. This 1/3rd reduction occurs mainly in patients with mild cases, while the number of severe cases was similar. Surgical standards suffered a step back during the first wave: Lower laparoscopic approach and longer length of stay. We also found a more conservative approach to the patients this year, non-justified by clinical circumstances. Luckily these standards improved again in 2021. The positive COVID-19 status itself did not have a direct impact on mortality. Strikingly, none of the 33 surgically treated COVID positive patients during both years died postoperatively. This is an interesting finding which, if confirmed through future research with a larger sample size of COVID-19 positive patients, can expedite the recovery phase of acute surgical services.


Assuntos
Apendicite/patologia , COVID-19/patologia , Colecistite/patologia , Diverticulite/patologia , Adulto , Idoso , Apendicite/complicações , Apendicite/epidemiologia , Apendicite/cirurgia , COVID-19/complicações , COVID-19/epidemiologia , COVID-19/virologia , Colecistite/complicações , Colecistite/epidemiologia , Colecistite/cirurgia , Diverticulite/complicações , Diverticulite/epidemiologia , Diverticulite/cirurgia , Feminino , Humanos , Laparoscopia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2/isolamento & purificação , Índice de Gravidade de Doença , Espanha/epidemiologia
12.
Am J Case Rep ; 22: e933341, 2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34623978

RESUMO

BACKGROUND Intussusception is a rare pathological entity in adults and remains a diagnostic challenge for clinicians, as it shares many clinical signs and symptoms with other morbid conditions (including appendicitis, abdominal hernias, colic, volvulus, and Meckel diverticulum). High clinical suspicion and use of appropriate imaging techniques are essential for early diagnosis and treatment of intussusception. Surgical intervention is the treatment of choice in cases of sustained and persistent invagination. CASE REPORT We present the case of a 65-year-old woman with a medical history of Crohn's disease, diabetes mellitus type II, hypertension, and rheumatoid arthritis. She was hospitalized for diarrhea, fatigue, and anemia. Computerized tomography of the abdomen and a colonoscopy revealed telescoping of the ileum, ileocecal valve, and part of the ascending colon inside the terminal segment of the ascending colon. The antegrade ileocolic intussusception was treated by performing a right hemicolectomy. The pathologic examination of the excised intestine showed mucosal lesions compatible with Crohn's disease, an inflammatory fibroid polyp at the terminal section of the ileum, and a low-grade appendiceal mucinous neoplasm. CONCLUSIONS Regardless of the etiology, when the normal motility of the intestine is altered, it can lead to invagination. Although intussusception is rare, it must always be part of the differential diagnosis for a patient presenting with constant abdominal pain.


Assuntos
Apendicite , Doenças do Íleo , Valva Ileocecal , Intussuscepção , Adulto , Idoso , Detecção Precoce de Câncer , Feminino , Humanos , Doenças do Íleo/diagnóstico , Doenças do Íleo/etiologia , Doenças do Íleo/cirurgia , Intussuscepção/diagnóstico , Intussuscepção/etiologia , Intussuscepção/cirurgia
13.
Pediatr Ann ; 50(10): e419-e423, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34617844

RESUMO

Point-of-care ultrasound (POCUS) for pediatric abdominal symptoms has expanded in both the inpatient and outpatient settings. POCUS may be used to aid in the diagnosis of appendicitis, hypertrophic pyloric stenosis, and intussusception in the pediatric population. This article reviews the benefits of POCUS for the diagnosis of these pediatric pathologies. This article also provides instruction on how to perform these important examinations. [Pediatr Ann. 2021;50(10):e419-e423.].


Assuntos
Apendicite , Intussuscepção , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia , Apendicite/diagnóstico por imagem , Criança , Humanos , Intussuscepção/diagnóstico por imagem
14.
J Med Case Rep ; 15(1): 521, 2021 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-34689824

RESUMO

BACKGROUND: Postpartum ovarian thrombosis is an uncommon condition. It appears with the nonspecific, predominantly right-sided abdominal symptoms and must be differentiated from other acute visceral conditions. If left untreated, postpartum ovarian thrombosis can have severe consequences, including sepsis, pulmonary embolism, and even death. Momentarily, there are no specific guidelines for postpartum ovarian thrombosis management. We present a case of postpartum ovarian thrombosis admitted to our hospital with symptoms of acute appendicitis. CASE PRESENTATION : A 39-year-old Omani obese multiparous woman of Afro-Arab origin was admitted with acute symptoms, mainly abdominal pain, fever, and vomiting 1 week postpartum. Clinical picture and biochemical profile did not exhibit a recognizable pattern. Ultrasonography excluded retained products of conception. Computerized scan for abdomen and pelvis with oral and intravenous contrast reported a dilated tubular structure in the right adnexa extending up to the right renal hilum level with surrounding inflammation. Those findings were consistent with the thrombophlebitis of the right ovarian vein. Blood cultures and sensitivity showed group A ß-hemolytic streptococci sensitive to penicillin G and clindamycin. The patient was treated successfully with antibiotics and therapeutic anticoagulants and discharged home 3 days later; follow-up was arranged. CONCLUSION: This pathology is an exceptional entity in Oman. Therefore, awareness of this unique condition is required so that clinicians will be vigilant, exploring similar cases with imaging and avoiding unnecessary surgical interventions.


Assuntos
Apendicite , Trombose , Trombose Venosa , Adulto , Apendicite/diagnóstico por imagem , Feminino , Humanos , Período Pós-Parto , Tomografia Computadorizada por Raios X , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/tratamento farmacológico
15.
Emerg Med Clin North Am ; 39(4): 703-717, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34600632

RESUMO

Abdominal pain is the most common chief complaint in the Emergency Department. Abdominal pain is caused by a variety of gastrointestinal and nongastrointestinal disorders. Some frequently missed conditions include biliary pathology, appendicitis, diverticulitis, and urogenital pathology. The Emergency Medicine clinician must consider all aspects of the patient's presentation including history, physical examination, laboratory testing, and imaging. If no diagnosis is identified, close reassessment of pain, vital signs, and physical examination are necessary to ensure safe discharge. Strict verbal and written return precautions should be provided to the patient.


Assuntos
Dor Abdominal/etiologia , Diagnóstico Ausente , Aneurisma da Aorta Abdominal/diagnóstico , Apendicite/diagnóstico , Colecistite/diagnóstico , Cetoacidose Diabética/diagnóstico , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Isquemia Mesentérica/diagnóstico , Neoplasias/diagnóstico , Nefrolitíase/diagnóstico , Torção Ovariana/diagnóstico , Alta do Paciente , Doenças Respiratórias/diagnóstico , Doenças Sexualmente Transmissíveis/diagnóstico , Torção do Cordão Espermático/diagnóstico , Infecções Urinárias/diagnóstico
16.
Emerg Med Clin North Am ; 39(4): 719-732, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34600633

RESUMO

Although abdominal pain is a common chief complaint in the emergency department, only 1 in 6 patients with abdominal pain are diagnosed with a gastrointestinal (GI) emergency. These patients often undergo extensive testing as well as hospitalizations to rule out an acute GI emergency and there is evidence that not all patients benefit from such management. Several clinical decision rules (CDRs) have been developed for the diagnosis and management of patients with suspected acute appendicitis and upper GI bleeding to identify those patients who may safely forgo further testing or hospital admission. Further validation studies demonstrating the superiority of these CDRs over contemporary practice are needed.


Assuntos
Apendicite/diagnóstico , Regras de Decisão Clínica , Técnicas de Apoio para a Decisão , Hemorragia Gastrointestinal/diagnóstico , Dor Abdominal/etiologia , Serviço Hospitalar de Emergência , Humanos
17.
Rev Fac Cien Med Univ Nac Cordoba ; 78(3): 330-332, 2021 09 29.
Artigo em Inglês | MEDLINE | ID: mdl-34617710

RESUMO

Introduction: The finding of a vermiform appendix within the peritoneal sac of an indirect inguinal hernia occurs in approximately 1% of cases. However, the presence of appendicitis within an inguinal hernial sac is found only in 0.08% of the general population. Case Report: We present the case of a 58-year-old male patient that was admitted with abdominal pain associated with a small non-reducible right groin mass. Discussion: To establish the correct diagnosis preoperatively, an abdominal and pelvic CT scan is mandatory. Conclusion: Acute appendicitis in an Amyand's hernia is a very rare entity that can be easily misdiagnosed preoperatively. CT is extremely useful in reaching the correct preoperative diagnosis.


Assuntos
Apendicite , Apêndice , Hérnia Inguinal , Doença Aguda , Apendicite/diagnóstico , Apendicite/diagnóstico por imagem , Apêndice/diagnóstico por imagem , Apêndice/cirurgia , Hérnia Inguinal/complicações , Hérnia Inguinal/diagnóstico por imagem , Hérnia Inguinal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
18.
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
19.
Rozhl Chir ; 100(9): 459-462, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34649456

RESUMO

Primary torsion of large omentum is a rare cause of abdominal pain. The knowledge of this disease is essential for surgeons. It plays an important role in differential diagnosis of acute abdomen. The authors present two cases of primary omental torsion. They describe the diagnostic and therapeutic process. Diagnosis of omental torsion is difficult. Frequently, it presents with abdominal pain and imitates other acute abdominal diseases such as acute appendicitis in most cases. It is difficult to diagnose before surgical revision is approached. Laboratory and paraclinical examinations may not provide any clear findings. Laparoscopic revision is the method of choice, with confirmation of the diagnosis and laparoscopic resection of the ischemic part of omentum.


Assuntos
Abdome Agudo , Apendicite , Doenças Peritoneais , Abdome Agudo/etiologia , Abdome Agudo/cirurgia , Apendicite/diagnóstico , Diagnóstico Diferencial , Humanos , Omento/cirurgia , Doenças Peritoneais/diagnóstico , Doenças Peritoneais/diagnóstico por imagem , Anormalidade Torcional/diagnóstico , Anormalidade Torcional/diagnóstico por imagem
20.
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
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