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1.
Khirurgiia (Mosk) ; (10): 49-59, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33047586

RESUMO

OBJECTIVE: To analyze the role of mesoappendixectomy in the development of intra-abdominal surgical site infection (IAB SSI) after LAE. MATERIAL AND METHODS: A prospective randomized non-blind multiple-center registered (ClinicalTrials.gov NCT03754777) study has been performed for the period from 2016 to 2018. The study was devoted to effectiveness and safety of the modified enhanced recovery protocol in LAE. In the main group, this protocol (n=56) included routine mesoappendixectomy, restrictive strategy for abdominal drainage and postoperative antibiotic prevention. In the control group (n=71), mesoappendixectomy was performed only in case of necrotic changes. Both groups were comparable by demographic parameters and severity of comorbidities. RESULTS: In the main group, significant decrease in the incidence of IAB SSI was found (0% versus 9.8%). Moreover, the main group was characterized by reduced length of hospital-stay (1.43±1.34 d versus 2.94±2, 43 days). CONCLUSION: Mesoappendixectomy should be evaluated in further research as a potential factor in prevention of IAB SSI.


Assuntos
Apendicectomia/métodos , Apendicite/cirurgia , Mesocolo/cirurgia , Peritonite/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Antibacterianos/administração & dosagem , Apendicectomia/efeitos adversos , Apendicite/tratamento farmacológico , Drenagem , Recuperação Pós-Cirúrgica Melhorada , Humanos , Peritonite/etiologia , Estudos Prospectivos , Infecção da Ferida Cirúrgica/etiologia
2.
Cochrane Database Syst Rev ; 10: CD008359, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33001448

RESUMO

This Cochrane review has been withdrawn. The Cochrane review is out of date and included a retracted article in the analysis. Withdrawn by Cochrane Colorectal Group. A new update is expected. The editorial group responsible for this previously published document have withdrawn it from publication.


Assuntos
Antibacterianos/uso terapêutico , Apendicectomia/métodos , Apendicite/tratamento farmacológico , Apendicite/cirurgia , Doença Aguda , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
3.
Khirurgiia (Mosk) ; (9): 89-91, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33030008

RESUMO

Low-grade mucinous tumors (MT) of the appendix are rare malignancies. One of the most formidable complications of these tumors is mucin depositing in the peritoneum with development of peritoneal pseudomyxoma. Currently, there are no single clinical - pathomorphological classification and treatment approach to these tumors. This situation is complicated by the fact that tumor of the appendix cannot be preoperatively suspected in many cases and MT is detected after appendectomy for acute appendicitis or its complications. Thus, prognosis of patients is deteriorated.


Assuntos
Neoplasias do Apêndice , Apêndice , Apendicectomia , Apendicite , Humanos , Neoplasias Peritoneais
4.
Rozhl Chir ; 99(8): 361-363, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33032441

RESUMO

Acute appendicitis is one of the most common acute abdomen cases. Although many causes have been described in literature, it is mostly primary affection of the appendix that leads to acute appendicitis. A 57-year-old patient was admitted to our department displaying all usual signs of acute appendicitis, both clinical and laboratory. During laparoscopic appendectomy, we found the inflammation of the appendix in this case appeared secondary, originating in a structure located nearby the appendix, strongly resembling a testicle. We performed appendectomy and removed the suspected structure altogether. The patient recovered completely within a week. Subsequent histological examination confirmed that the suspected tissue was indeed a retained testicle causing se-condary inflammation of the appendix. As we found out later, this condition probably occurred in the patient secondarily in adulthood, most likely due to inguinal hernia repair undergone during childhood.


Assuntos
Apendicite , Apêndice , Hérnia Inguinal , Apendicectomia , Apendicite/diagnóstico por imagem , Apendicite/cirurgia , Apêndice/diagnóstico por imagem , Apêndice/cirurgia , Hérnia Inguinal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Testículo
6.
Mymensingh Med J ; 29(4): 887-894, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116092

RESUMO

The aim of this prospective study was to evaluate the role and application of laparoscopy in the management of acute appendicitis and its complications. The study was conducted between January 2011 to February 2019 in Bangabandhu Sheikh Mujib Medical University (BSMMU) and some private hospitals of Dhaka, Bangladesh. A total of 641 patients who presented with acute appendicitis and its complications were treated by laparoscopic method. Around 70% (449) patients had classical presentation, 20% (128) were atypical and 10% (64) were recurrent or chronic presentation. Maximum (527, 82%) came with acute appendicitis. Eighty eight (13.72%) patients had burst (perforated) appendicitis, 12(1.87%) patients had appendicular abscess, 11(1.71%) showed early appendicular lump, 2(0.4%) had stump appendicitis and 1(0.2%) had previous laparoscopic clip control of stump. Energy source was unipolar diathermy. Intracorporeal knotting, endoloop and haemoclip were used for haemostosis and ligation of appendicular stump. Mean duration of surgery was 20minutes and mean hospital stay was 36 hours. Histopathological patterns were acute appendicitis (554, 86.42%), gangrenous appendicitis (58, 9.04%), catarrhal (13, 2.02%), chronic appendicitis (10, 1.56%) lymphoid hyperplasia (6, 0.93%) and carcinoid tumor (1, 0.15%), among the complications (25) were single or multiple port infections, port TB, paralytic ileus and diarrhea. Conversion was 1(0.15%) for controlling haemorrhage of burst appendicitis. The rest of the patients recovered quickly and uneventfully. In conclusion, it can be stated that laparoscopic appendicectomy is safe, convenient and achievable and can become the gold standard of management of acute appendicitis and its complications.


Assuntos
Apendicite , Laparoscopia , Apendicectomia/efeitos adversos , Apendicite/cirurgia , Bangladesh/epidemiologia , Humanos , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos
7.
Acta Gastroenterol Belg ; 83(3): 441-448, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33094592

RESUMO

Primary appendiceal cancer is rare and most commonly found incidentally on a surgical specimen after appendectomy for acute appendicitis. This small organ gives rise to different subtypes which are histological and biological distinct. Historically the classification of these tumors has been confusing because of the different nomenclature that is used. This review has broadly classified them into four subgroups : colonic-type adenocarcinoma, mucinous neoplasm, goblet cell carcinoma and neuroendocrine neoplasm. Signet ring cells is not considered as a distinct subgroup but as a histologic feature that can be present in colonic-type adeno- carcinoma and mucinous neoplasms. As staging and management of appendiceal tumors depends on these subtypes, an adequate classification of them is important. This review aimed to give an overview of the epidemiology, grading and staging, management and prognosis of these neoplasms. Despite its rarety specific staging systems and treatment guidelines exist for some subtypes. For other subtypes staging systems and management is extrapolised from colorectal cancer because of the lack of randomised, prospective trials.


Assuntos
Neoplasias do Apêndice , Apendicite , Neoplasias Colorretais , Apendicectomia , Neoplasias do Apêndice/complicações , Neoplasias do Apêndice/diagnóstico , Neoplasias do Apêndice/terapia , Neoplasias Colorretais/diagnóstico , Humanos , Estudos Prospectivos
8.
Asian J Surg ; 43(10): 1002-1005, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32863144

RESUMO

OBJECTIVES: To assess the prevalence of complicated appendicitis (including gangrene, abscess and perforation) after the outbreak of the 2019-nCoV epidemic and to identify the risk factors associated with complicated appendicitis. METHODS: Two groups were established in the study consisting of: one group for cases of acute appendicitis before the 2019-nCoV epidemic (before January 1, 2020; pre-epidemic group) and another group for those after the epidemic outbreak (after January 1, 2020; epidemic group). These two groups were compared in terms of demographic and clinical characteristics, prevalence of complicated appendicitis, and treatment intention. A multivariate analysis model using binary logistic regression was constructed. RESULTS: A total of 163 patients were included in this study, with 105 in the pre-epidemic group and 58 in the epidemic group. In the epidemic group, the interval from the onset of symptoms to admission was 65.0 h, which is significantly longer than the 17.3 h interval noted in the pre-epidemic group (P < 0.001). The prevalence of complicated appendicitis after the epidemic outbreak was significantly higher than before the outbreak (51.7% vs. 12.4%, P < 0.001). In addition, the epidemic group had a lower score of patient's intention to seek treatment than the pre-epidemic group (9.5 ± 2.7 vs. 3.4 ± 2.6, P < 0.001). Based on the multivariate analysis, the risk factors for complicated appendicitis included the time from symptoms onset to admission (OR = 1.075) and the patients' intention to receive treatment (OR = 0.541). CONCLUSION: Complicated appendicitis was more common in patients with acute appendicitis after the outbreak of the 2019-nCoV epidemic.


Assuntos
Apendicite/complicações , Apendicite/epidemiologia , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Adulto , Apendicite/diagnóstico , China , Feminino , Hospitalização , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pandemias , Prevalência , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
9.
Medicine (Baltimore) ; 99(36): e21961, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899032

RESUMO

This retrospective study was aimed to determine the factors suggesting the need for computed tomography (CT) scanning when ultrasound (US) imaging results are negative or non-diagnostic in children suspicious for acute appendicitis in the emergency department.Patients less than 18 years old who underwent abdominal ultrasound and CT to rule out acute appendicitis were enrolled. Patients were classified into 2 groups: the false-negative group, in which patients had negative or non-diagnostic results on the initial US and a final diagnosis of acute appendicitis on the following abdominal CT, and the true-negative group, in which patients had negative or non-diagnostic US results and were negative on abdominal CT. Logistic regression and propensity score matching with the predicting factors were performed.The presence of vomiting (odds ratio (OR), 7.78; 95% confidence interval (CI), 1.92-41.04) and poor oral intake (OR, 4.67; 95% CI, 1.21-21.15) with a high white blood cell (WBC) count (OR 1.26; 95% CI, 1.09-2.37), segmented neutrophil ratio (OR, 1.09; 95% CI, 1.03-1.16), and C-reactive protein (CRP) (OR, 1.49; 95% CI, 1.09-2.37) were suggestive of the false-negative group. The propensity-matched population also showed significant associations with vomiting (OR, 7.86; 95% CI, 1.65-37.40) and poor oral intake (OR, 5.50; 95% CI, 1.28-23.69) with an elevated WBC count (OR, 1.27; 95% CI, 1.08-1.50), segmented neutrophil ratio (OR, 1.09; 95% CI, 1.03-1.16), and CRP (OR, 1.51; 95% CI, 1.03-2.22).A CT scan should be considered in children with suspected acute appendicitis if they have vomiting, high CRP, and high WBC count, despite negative or non-diagnostic US results.


Assuntos
Apendicite/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Apendicite/fisiopatologia , Proteína C-Reativa/análise , Estudos de Casos e Controles , Criança , Diagnóstico Tardio , Erros de Diagnóstico , Feminino , Humanos , Masculino , Pontuação de Propensão , Curva ROC , Estudos Retrospectivos , Ultrassonografia , Vômito/etiologia
10.
Scott Med J ; 65(4): 144-148, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32878574

RESUMO

BACKGROUND AND AIM: COVID-19 pandemic has predisposed patients undergoing surgery to post-operative infection and resultant complications. Appendicitis is frequently managed by appendicectomy. After the onset of the pandemic, selected cases of appendicitis were managed with antibiotics which is a recognised treatment option. Our objective was to compare the management of appendicitis and post-operative outcomes between pre- and post-COVID-19. METHODS: Ninety-six patients were identified from before the onset of the pandemic (November 2019) to after the onset of the pandemic (May 2020). Data were collected retrospectively from electronic records including demographics, investigations, treatment, duration of inpatient stay, complications, readmissions and compared between pre- and post-COVID-19 groups. RESULTS: One hundred percent underwent surgical treatment before the onset of pandemic, compared with 56.3% from the onset of the pandemic. A greater percentage of patients were investigated with imaging post-COVID-19 (100% versus 60.9%; p < 0.00001). There was no significant difference in the outcomes between the two groups. CONCLUSION: CT/MRI scan was preferred to laparoscopy in diagnosing appendicitis and conservative management of uncomplicated appendicitis was common practice after the onset of pandemic. Health boards can adapt their management of surgical conditions during pandemics without adverse short-term consequences. Long term follow-up of this cohort will identify patients suitable for conservative management.


Assuntos
Apendicectomia , Apendicite/diagnóstico , Apendicite/cirurgia , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Feminino , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Seleção de Pacientes , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Complicações Pós-Operatórias/epidemiologia , Padrões de Prática Médica , Estudos Retrospectivos , Adulto Jovem
12.
Medicine (Baltimore) ; 99(33): e21801, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872081

RESUMO

Acute appendicitis (AA) is the most common nonobstetric surgical emergency during pregnancy. According to the current guidelines and meta-analyses, traditional open appendectomy (OA) is still recommended for pregnant patients over laparoscopic appendectomy (LA), which might be associated with higher rates of fetal loss. Previous studies and experiences indicated that LA might be safe in the second trimester of pregnancy. The current study aimed to evaluate the safety and feasibility of LA in pregnant women during the second trimester.At our institution, a retrospective study was conducted with pregnant patients who underwent LA or OA during the second trimester between January 2016 and August 2018.A total of 48 patients were enrolled. Of them, 12 were managed with laparoscopy and 36 with the open approach. We found that the LA group had higher BMIs than the OA group (4.0 ±â€Š4.3 vs 21.5 ±â€Š2.9, P = .031). The financial results showed that the average daily medical costs for patients who underwent LA was higher than those who underwent OA (444 ±â€Š107 US$ vs 340 ±â€Š115 US$, P = .009), while the total cost of hospitalization was comparable between the 2 approaches. The perioperative and obstetric outcomes were comparable between LA and OA. In each group, only 1 patient had fetal loss. No "Yinao" was found in any of the patients in the LA group.In this study, with the proven advantages of the laparoscopic techniques, LA was found to be safe and feasible for pregnant women during the second trimester.


Assuntos
Apendicectomia/estatística & dados numéricos , Apendicite/cirurgia , Laparoscopia/estatística & dados numéricos , Complicações na Gravidez/cirurgia , Adulto , Apendicectomia/métodos , Feminino , Humanos , Gravidez , Segundo Trimestre da Gravidez , Estudos Retrospectivos , Adulto Jovem
13.
Khirurgiia (Mosk) ; (8): 5-16, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32869609

RESUMO

OBJECTIVE: To improve treatment outcomes in patients with acute appendicitis (AA). MATERIAL AND METHODS: An internet survey was performed. Questionnaire consisted of 15 questions concerning diagnosis and treatment of AA: application of prognostic scales, incidence and technical aspects of laparoscopic appendectomy (LA), antibiotic prophylaxis, postoperative management, compliance with international and national clinical guidelines. A total of 690 questionnaires were received and analyzed (3.67% of all surgeons in the Russian Federation). RESULTS: Eighteen percent of respondents use at least one prognostic scale. The vast majority of surgeons (92%) use antibiotic prophylaxis. Almost half of respondents place trocars in the triangulation position (44%), one third of surgeons ligate the mesentery of the appendix (35%), most respondents perform mesoappendectomy (60%) with monopolar and bipolar cautery. Forty-five percent of all respondents do not invert the appendix stump. Significant number of respondents use abdominal drainage routinely. Only 3.5% of surgeons use multimodal postoperative analgesia. Less than 22% of patients are operated under low-pressure pneumoperitoneum. Standardization of surgical technique and perioperative approaches including those specified in the guidelines is absent. We also found insufficient awareness of surgeons about international and national clinical guidelines. CONCLUSION: This study may be useful for standardizing treatment approaches, choosing the best practice, popularizing and improving of current clinical guidelines.


Assuntos
Apendicectomia/métodos , Apendicite/diagnóstico , Apendicite/cirurgia , Antibacterianos/administração & dosagem , Antibioticoprofilaxia , Apendicectomia/normas , Apendicite/terapia , Apêndice/cirurgia , Fidelidade a Diretrizes , Pesquisas sobre Serviços de Saúde , Humanos , Internet , Laparoscopia , Assistência Perioperatória , Guias de Prática Clínica como Assunto , Federação Russa
14.
S Afr Med J ; 110(9): 910-915, 2020 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-32880277

RESUMO

BACKGROUND: With COVID-19 having spread across the globe, it has become standard to implement infection control strategies (colloquially known as lockdown) with the intention of reducing the magnitude and delaying the peak of the epidemiological curve. Personal infection mitigation strategies coupled with lockdown have caused a change in healthcare-seeking behaviour, with individuals not attending to their ill health as they previously did. OBJECTIVES: To determine whether admissions for urgent and emergency surgical pathologies have declined during the COVID-19 lockdown period, and the magnitude of the decline. METHODS: A retrospective analysis was conducted, comparing pre-lockdown (3 February - 26 March 2020) and lockdown (27 March - 30 April 2020) admission incidences for surgical pathologies at a tertiary healthcare complex in North West Province, South Africa. Poisson regression models were created to determine admission incidence rate ratios (IRRs). RESULTS: Of 769 surgical admissions included in the analysis, 49.7% were male and 67.2% were unemployed. There was a 44% reduction in the incidence of non-trauma admissions during lockdown (IRR 0.56; 95% confidence interval (CI) 0.47 - 0.68; p<0.001) and a 53% reduction in the incidence of trauma-related admissions (IRR 0.47; 95% CI 0.34 - 0.66; p<0.001). CONCLUSIONS: Even when the prevalence of SARS-CoV-2 infection was minimal, COVID-19 lockdown in North West was associated with a significant reduction in surgical admissions. In order to ensure an overall benefit to public health, a balance between maintaining the integrity of COVID-19 control mechanisms and access to healthcare services is essential.


Assuntos
Apendicite/epidemiologia , Infecções por Coronavirus/epidemiologia , Hospitalização/estatística & dados numéricos , Neoplasias/epidemiologia , Pneumonia Viral/epidemiologia , Infecções dos Tecidos Moles/epidemiologia , Centro Cirúrgico Hospitalar , Ferimentos e Lesões/epidemiologia , Adulto , Idoso , Betacoronavirus , Emergências , Emprego/estatística & dados numéricos , Feminino , Hemorragia Gastrointestinal/epidemiologia , Humanos , Obstrução Intestinal/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , África do Sul/epidemiologia , Centros de Atenção Terciária , Adulto Jovem
15.
An. pediatr. (2003. Ed. impr.) ; 93(2): 118-122, ago. 2020.
Artigo em Espanhol | IBECS | ID: ibc-188368

RESUMO

INTRODUCCIÓN: La apendicitis aguda (AA) es la urgencia quirúrgica abdominal más frecuente. No encontramos estudios específicos que evalúen el impacto de la pandemia causada por el coronavirus 2 (SARS-Cov-2) sobre la AA y su tratamiento quirúrgico. Analizamos la influencia de esta nueva patología sobre la AA. MATERIAL Y MÉTODOS: Estudio observacional retrospectivo en pacientes intervenidos por AA desde enero hasta abril de 2020. Fueron clasificados según el momento de la apendicectomía, antes de la declaración del estado de alarma (Pre-COVID19) y después de la declaración del estado de alarma (Post-COVID19) en España. Se evaluaron variables demográficas, duración de la sintomatología, tipo de apendicitis, tiempo quirúrgico, estancia hospitalaria y complicaciones postoperatorias. RESULTADOS: Se incluyeron 66 pacientes (41 Pre-COVID19; 25 Post-COVID19 con edad media de 10.7 ± 3 y 9.3 ± 3.1; p = 0.073; respectivamente). La fiebre se encontró en un mayor número de pacientes post-COVID19 (52 vs 19.5%; p = 0.013), así como una PCR más elevada (72.7 ± 96.2 vs 31.3 ± 36.2 mg/dl; p = 0.042). Este grupo presentó una mayor proporción de apendicitis complicada al compararle con el Pre-COVID19 (32 vs 7.3%; p = 0.015). La estancia media hospitalaria fue mayor en el grupo Post-COVID19 (5.6 ± 5.9 vs 3.3 ± 4.3 días; p = 0.041). No se encontraron diferencias en el tiempo de evolución de los síntomas ni en el tiempo quirúrgico. CONCLUSIONES: La pandemia por SARS-Cov-2 influye en el momento de diagnóstico de la apendicitis, así como en su grado de evolución y estancia hospitalaria. La peritonitis fue lo más frecuentemente observado. Una sospecha y orientación clínica más temprana, es necesaria para evitar un manejo inadecuado de este trastorno quirúrgico común


INTRODUCTION: Acute appendicitis (AA) is the most common abdominal surgical emergency. No specific studies have been found that evaluate the impact of the coronavirus 2 (SARS-Cov-2) pandemic on AA and its surgical management. An analysis was made on the influence of this new pathology on the clinical course of AA. MATERIAL AND METHODS: Retrospective observational study was conducted on patients operated on for AA from January to April 2020. They were classified according to the time of the appendectomy, before the declaration of the state of alarm (Pre-COVID-19), and after its declaration (Post-COVID-19) in Spain, one the most affected countries in the world. An evaluation was made of demographic variables, duration of symptoms, type of appendicitis, surgical time, hospital stay, and postoperative complications. RESULTS: The study included 66 patients (41 Pre-COVID-19; 25 Post-COVID-19) with mean age of 10.7 ± 3 and 9.3 ± 3.1; P = .073, respectively. Fever was found in a higher number of post-COVID-19 patients (52 vs 19.5%; P = .013), as well as a higher CRP (72.7 ± 96.2 vs 31.3±36.2 mg/dL; P = .042). This group presented with a higher proportion of complicated appendicitis when compared to Pre-COVID-19 (32 vs 7.3%; P = .015). The mean hospital stay was longer in the Post- COVID-19 group (5.6 ± 5.9 vs 3.2 ± 4.3 days; P = .041). No differences were found in the time of onset of symptoms or surgical time. Conclusions. The SARS-Cov-2 pandemic influenced the time of diagnosis of appendicitis, as well as its course, and mean hospital stay. Peritonitis was more frequently seen. As a result of the significant circumstances, delaying diagnosis and treatment of AA during SARS-Cov-2 pandemic, inappropriate management of this common surgical disorder has been noticed


Assuntos
Humanos , Criança , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Betacoronavirus , Pandemias , Necessidades e Demandas de Serviços de Saúde , Acesso aos Serviços de Saúde , Apendicite/cirurgia , Apendicite/diagnóstico , Tempo de Internação , Estudos Retrospectivos , Doença Aguda
18.
Ther Umsch ; 77(4): 147-156, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-32772694

RESUMO

Acute appendicitis - recent controversies in diagnostic and therapy Abstract. Acute appendicitis is one of the most frequent surgically treated gastrointestinal diseases. For most of the patients it is supposed to be easily diagnosed and treated, but there are cases with complex diagnosis and indistinct treatment. For correct diagnosis an elaborated patients' history and clinical examination by an experienced surgeon is necessary. In many countries, patients undergo additional extensive radiological diagnostics beside of ultrasound. This fact leads to an unjustified risk of x-ray exposure and increased costs in the health care system. In contrast, delay during diagnosis and treatment and consecutive complications are often the trigger for legal dispute and the accusation of malpractice of the responsible surgeon. In addition, the treatment of acute appendicitis has undergone changes towards a non-surgical therapy, so that the routinely performed urgent appendectomy has been displaced by conservative therapy using antibiotics, percutaneous drainage, and interval surgery after a certain time in a non-inflammatory state. So far, no distinct guideline is available, as profound prospective and randomized results and subgroup analysis are still missing. In this article these problems and controversies are enlightened. Particularly, legal aspects and potential conflicts between family doctors, surgeons, relatives, and patients are discussed. Finally, nothing is easy to diagnose or treat, even potentially simple diseases as acute appendicitis is considered to be.


Assuntos
Apendicite , Doença Aguda , Antibacterianos/uso terapêutico , Apendicectomia , Drenagem , Humanos , Estudos Prospectivos
19.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(8): 786-790, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32810951

RESUMO

Objective: To analyze clinical characteristics of recurrent appendicitis. Methods: A retrospective cohort study was carried out. Clinical data of patients who underwent appendectomy due to acute appendicitis confirmed by pathology in the Affiliated Hospital of Qingdao University from January 2011 to December 2015 were analyzed retrospectively. Exclusion criteria: (1) age of less than 18 years;(2) chronic appendicitis; (3) periappendiceal abscess; (4) appendiceal mucocele or mucinous neoplasms; (5) appendiceal neuroendocrine tumors or cancers; (6) appendicitis during pregnancy; (7) concurrent AIDS, hematological disease, autoimmune disease, inflammatory bowel disease or advanced cancer; (8) other simultaneous surgery. A total of 373 patients were enrolled the study. These patients were divided into the recurrent group (133 cases) and the first episode group (240 cases) according to the previous history of antibiotic therapy for acute appendicitis. The prevalence of recurrent appendicitis was calculated, and the clinical characteristics were analyzed, including gender, age, comorbidities and preoperative CT images. Results: Of 373 patients, 209 were male and 164 were female, with a median age of 42 (18 to 88) years. Median recurrent time of the recurrent group was 4 (1 to 60) months. Compared to the first episode group, the recurrent group had higher proportion of age <50 years [71.4% (95/133) vs. 57.5% (138/240), χ(2)=7.081, P=0.008], higher proportion of concurrent diabetes [13.5% (18/133) vs. 5.4% (13/240), χ(2)=7.399, P=0.007], shorter onset time [(41.7±13.6) hours vs. (59.4±56.2) hours, t=-3.286, P=0.001], lower proportion of abdominal tension and rebound pain [57.9% (77/133) vs. 66.7% (160/240), χ(2)=5.065, P=0.024], lower score of modified Alvarado score [(5.6±1.9) point vs. (6.1±1.9) point, t=-2.417, P=0.016], lower WBC count [(10.5±4.6) ×10(9)/L vs. (11.5±4.5)×10(9)/L, t=-1.190, P=0.047], higher percentage of lymphocyte [(19.4±14.7)% vs. (16.1±13.3)%, t=2.069, P=0.039]. In the recurrent group, ratio of length of removed appendix ≥7 cm was higher as compared with the first episode group [44.4% (59/133) vs. 32.9% (79/240), χ(2)=4.808, P=0.028], while the ratio of complicated appendicitis was significantly lower [8.3% (11/133) vs. 22.9% (55/240), χ(2)=10.823, P=0.001]. CT images were available in 129 patients, intraluminal appendicoliths was found in 19 of 50 patients (38%) in the recurrent group, while in 16 of 79 patients (20.3%) in the first episode group, and there was statistically significant difference between the two groups (χ(2)=4.880, P=0.027). Conclusions: Clinical characteristics of recurrent acute appendicitis include age less than 50 years, concurrent diabetes, short onset time, less abdominal tension or rebound pain, low modified Alvarado score, low WBC count, high percentage of lymphocyte, appendix length longer than 7 cm, non-complicated appendicitis and intraluminal appendicoliths.


Assuntos
Apendicite , Apêndice , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicectomia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Recidiva , Estudos Retrospectivos , Adulto Jovem
20.
Chirurg ; 91(9): 700-711, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32747976

RESUMO

The paradigm shift in the treatment concept for acute appendicitis is currently the subject of intensive discussions. The diagnosis and differentiation of an uncomplicated from a complicated appendicitis as well as the selection of an adequate treatment is very challenging, especially since nonoperative treatment models have been published. The laparoscopic appendectomy is still the standard for most cases. Guidelines for the treatment of acute appendicitis do not exist in Germany. Therefore, a group of experts elaborated 21 recommendations on the treatment of acute appendicitis after 3 meetings. After initial definition of population, intervention, comparison and outcome (PICO) questions, recommendations have been finalized through the Delphi voting system. The results were evaluated according to the current literature. The aim of this initiative was to define a basic support for decision making in the clinical routine for treatment of acute appendicitis.


Assuntos
Apendicite , Laparoscopia , Doença Aguda , Apendicectomia , Alemanha , Humanos , Resultado do Tratamento
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