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1.
Georgian Med News ; (311): 21-27, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33814384

RESUMO

The timely diagnosis of necrotic fasciitis (NF) - an extremely rare fatal complication of acute appendicitis is difficult due to the variability of the clinical picture and depends on the degree of inflammatory changes in the appendix wall, localization, age, reactivity, and the presence or absence of comorbidities. It is characterized by high mortality rate, associated with the rapid progression of the disease with the development of septic shock and multiple organ failure. A clinical case of necrotic fasciitis of the right lower limb without damage of the anterior abdominal wall, secondary to the perforated process, as an extremely rare complication of appendicitis is presented. A 78-year-old patient was urgently operated on laparoscopically for acute gangrenous appendicitis. Necrotic fasciitis has not been diagnosed. Ten hours after the operation, the diagnosis of NF was established and the patient underwent phlegmon autopsy of the right thigh and lower leg, revision of the retroperitoneal space on the right. Subsequently, sanitation and surgical treatment of purulent foci were performed. Despite the ongoing comprehensive treatment in the intensive care unit using broad-spectrum antibiotics the disease progressed, and wet gangrene of the right lower limb developed. The patient underwent amputation at the level of the upper third of the right thigh. The course of the disease was complicated by sepsis, septic shock, bilateral pneumonia, multiple organ failure syndrome, cerebral edema. The patient died on the 8th day from the moment of hospitalization. The rarity of this formidable and fatal disease determines the difficulties of early diagnosis and timely treatment, since most doctors can see one case of NSTIs throughout their medical career. Our case shows how important the early diagnosis of this fatal complication is, as it is crucial for achieving optimal treatment results.


Assuntos
Apendicite , Fasciite Necrosante , Fasciite , Choque Séptico , Doença Aguda , Idoso , Apendicite/complicações , Apendicite/cirurgia , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/etiologia , Fasciite Necrosante/cirurgia , Humanos
2.
Orv Hetil ; 162(16): 608-610, 2021 04 07.
Artigo em Húngaro | MEDLINE | ID: mdl-33830938

RESUMO

Összefoglaló. Bevezetés: A COVID-19-pandémia miatt a gyermekkori appendicitisek kezelésében számos változás történt (laparoszkópia helyett nyílt mutét, antibiotikumkezelés). Világszerte emelkedett a szövodményes appendicitisek aránya. Célkituzés: Munkánk során a COVID-19-járványnak a gyermekkori akut appendicitisekre kifejtett hatását szerettük volna vizsgálni: lett-e több perforált eset? Módszerek: A 2012 és 2020 között akut vakbélgyulladás miatt operált gyermekeket vizsgáltuk, külön, havi bontásban a 2020-as eseteket. A szövettani diagnózis alapján perforált és nem perforált appendicitis csoportokat alkottunk. A 2020-ban operált betegek COVID-19-statusát is rögzítettük. Statisztikai analízisre a khi2-próbát ('chi2 test for trend') és a Fisher-féle egzakt tesztet alkalmaztuk. Eredmények: A vizsgált idoszakban 1343 appendectomia történt, többségében nem perforált akut appendicitis miatt (1166/1343). 2015-tol kezdodoen a perforált esetek aránya szignifikáns emelkedést mutat (p = 0,0002). Az igazoltan COVID-19-pozitív betegek között magasabb volt a perforáltak aránya (5/8), mint az igazoltan negatív betegek között (15/92) (p = 0,0075). Megbeszélés: A nemzetközi trendeknek megfeleloen 2020-ban osztályunkon is magasabb volt a perforált appendicitisek aránya, mint a korábbi években. Ez az emelkedés 2015-tol tart, a pandémiával nem mutat szoros összefüggést. A perforált appendicitisek COVID-19-pozitív betegek között észlelt magas arányának okát nem ismerjük. Következtetés: További vizsgálat indokolt annak feltárására, hogy mi okozza a perforált appendicitisek COVID-19-pozitív betegek között észlelt magas, illetve 2015 óta emelkedo rátáját. Orv Hetil. 2021; 162(16): 608-610. INTRODUCTION: As a result of the COVID-19 pandemic, the management of paediatric appendicitis has changed (open instead of laparoscopic appendectomy, antibiotic treatment). The number of complicated appendicitis cases increased worldwide. OBJECTIVE: Our aim was to study the effect of the COVID-19 pandemic on paediatric acute appendicitis: has there been more perforated cases? METHODS: Children operated because of acute appendicitis between 2012 and 2020 were studied. Cases from the year 2020 were analysed monthly. Patients were divided into perforated and non-perforated appendicitis groups according to their histological findings. COVID-19 status of patients in 2020 was studied. Chi2 test for trend and Fisher's exact test were used for statistical analysis. RESULTS: In the study period, 1343 appendectomies were performed. The majority of our cases were non-perforated (1166/1343). The rate of perforated appendicitis cases has been increasing from 2015 (p = 0.0002). The number of perforated cases was higher in COVID-19 positive patients (5/8) then in negative ones (15/92) (p = 0.0075). DISCUSSION: In line with the international trend, more perforated appendicitis cases were treated in our departement in 2020. However, this increase started in 2015, and there is no correlation with the COVID-19 pandemic. The cause of the increased number of perforated cases in COVID-19 positive appendicitis patients is unknown. CONCLUSION: The causes of the high proportion of perforated cases in COVID-19 positive patients and the rising rate of perforated appendicitis cases since 2015 need further studies. Orv Hetil. 2021; 162(16): 608-610.


Assuntos
Apendicectomia/estatística & dados numéricos , Apendicite/cirurgia , Doença Aguda , Apendicite/epidemiologia , Criança , Feminino , Humanos , Masculino , Pandemias , Pediatria
3.
N Z Med J ; 134(1531): 55-62, 2021 03 12.
Artigo em Inglês | MEDLINE | ID: mdl-33767487

RESUMO

AIMS: The management of a macroscopically normal appendix during diagnostic laparoscopy depends on the accuracy of surgeons' intra-operative assessments. This study aims to determine the accuracy of this assessment and identify factors affecting it. METHODS: We reviewed appendicectomies on adult patients at Waikato District Health Board in 2017. The primary outcome was the agreement between the operative assessment and the gold standard histopathologic assessment. Secondary outcomes were predictors of this agreement. RESULTS: 420 patients were included. Among 74 appendixes assessed as normal by surgeons, 16 (21.6%) had appendicitis on histology. Surgeons assessed 346 appendixes as inflamed; however, 22 (6.3%) were revealed to be histologically normal. Only 2 of the 14 appendiceal neoplasms on histology were identified at the time of laparoscopy. Overall, there was disagreement in 9.1% of cases. This yielded a kappa of 0.69, indicating moderate inter-rater reliability. An inflamed appendix was significantly more likely to be falsely assessed as normal by non-trainee registrars, in female patients and in patients with a pre-operative ultrasound. A pre-operative computerised tomography scan (CT) decreased the odds of false negative operative diagnoses, but it increased the odds of false positives. CONCLUSIONS: Macroscopic assessment of the appendix lacks accuracy and may be challenging in certain groups of operators and patients.


Assuntos
Apendicite/diagnóstico , Erros de Diagnóstico/estatística & dados numéricos , Período Intraoperatório , Adolescente , Adulto , Apendicectomia , Apendicite/cirurgia , Auditoria Clínica , Competência Clínica , Feminino , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Estudos Retrospectivos , Adulto Jovem
4.
Ann R Coll Surg Engl ; 103(4): 250-254, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33682449

RESUMO

INTRODUCTION: The COVID-19 pandemic stimulated a national lockdown in the UK. The public were advised to avoid unnecessary hospital attendances and health professionals were advised to avoid aerosol-generating procedures wherever possible. The authors hypothesised that these measures would result in a reduction in the number of patients presenting to hospital with acute appendicitis and alter treatment choices. METHODS: A multicentred, prospective observational study was undertaken during April 2020 to identify adults treated for acute appendicitis. Searches of operative and radiological records were performed to identify patients treated during April 2018 and April 2019 for comparison. RESULTS: A total of 190 patients were treated for acute appendicitis pre-lockdown compared with 64 patients treated during lockdown. Patients treated during the pandemic were more likely to have a higher American Society of Anesthesiology (ASA) score (p = 0.049) and to have delayed their presentation to hospital (2 versus 3 days, p = 0.03). During the lockdown, the use of computed tomography (CT) increased from 36.3% to 85.9% (p < 0.001), the use of an antibiotic-only approach increased from 6.2% to 40.6% (p < 0.001) and the rate of laparoscopic appendicectomy reduced from 85.3% to 17.2% (p < 0.001). The negative appendicectomy rate decreased from 21.7% to 7.1% during lockdown (p < 0.001). CONCLUSIONS: The COVID-19 lockdown was associated with a decreased incidence of acute appendicitis and a significant shift in the management approach. The increased use of CT allows the identification of simple appendicitis for conservative treatment and decreases the negative appendicectomy rate.


Assuntos
Apendicectomia/tendências , Apendicite/diagnóstico , Apendicite/cirurgia , Acesso aos Serviços de Saúde/tendências , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Padrões de Prática Médica/tendências , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Apendicectomia/métodos , Apendicite/tratamento farmacológico , Apendicite/epidemiologia , Tratamento Conservador/métodos , Tratamento Conservador/tendências , Diagnóstico Tardio/tendências , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Prospectivos , Índice de Gravidade de Doença , Reino Unido/epidemiologia
5.
Ann R Coll Surg Engl ; 103(3): 203-207, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33645277

RESUMO

INTRODUCTION: Patients with suspected appendicitis remain a diagnostic challenge. The aim of this study was to validate risk prediction models, and to investigate diagnostic accuracy of ultrasonography and computed tomography (CT) in adults undergoing appendicectomy. METHODS: A retrospective case review was performed of patients aged 16-45 years having an appendicectomy between January 2019 and January 2020 at a tertiary referral centre. Primary outcomes were the accuracy of a high risk appendicitis risk score and ultrasonography and CT imaging modalities compared with histological reports following appendicectomy. RESULTS: A total of 206 patients (52% female) were included in the study. Removal of a histologically normal appendix was equally likely in men and women (13.1% vs 11.2% respectively, relative risk: 1.17, 95% confidence interval: 0.56-2.44, p=0.674). A high risk appendicitis score correctly identified 84.0% (79/94) of cases in men and 85.9% (67/78) of cases in women. Ultrasonography was reported as equivocal in 85.7% (18/21) of low risk women and 59.0% (23/39) of high risk women. CT correctly detected or excluded appendicitis in 75.0% (6/8) of low risk women and 88.5% (23/26) of high risk women. CONCLUSIONS: This study suggests that risk prediction models may be useful in both women and men to identify appendicitis. Ultrasonography gave high rates of equivocal results and should not be relied on for the diagnosis of appendicitis. CT is a highly accurate diagnostic tool and could be considered in those at low risk where clinical suspicion remains to reduce negative appendicectomy rates.


Assuntos
Apendicite/diagnóstico por imagem , Apêndice/patologia , Regras de Decisão Clínica , Adolescente , Adulto , Apendicectomia , Neoplasias do Apêndice/patologia , Apendicite/patologia , Apendicite/cirurgia , Erros de Diagnóstico , Reações Falso-Positivas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/patologia , Readmissão do Paciente , Estudos Retrospectivos , Fatores Sexuais , Tomografia Computadorizada por Raios X , Ultrassonografia , Adulto Jovem
6.
Pediatr Emerg Care ; 37(3): 185-190, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33651763

RESUMO

AIM: The aim of this study was to describe the incidence of complicated appendicitis during the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic lockdown. METHODS: This was a retrospective study of pediatric patients diagnosed with acute appendicitis in a single pediatric institution that assumed care responsibility for most of the pediatric emergencies during the lockdown period in Madrid (Spain). A control group was made up of the same number of patients diagnosed the previous year. RESULTS: One hundred fifty-one patients diagnosed with acute appendicitis were included (77 during self-quarantine and 74 during the previous year). The incidence of complicated appendicitis was 38.9% versus 28.3%, showing no significant differences. The 2 groups were homogeneous, with no differences in time elapsed between symptom onset and first emergency department visit, laboratory test results, median length of stay, intensive care admissions, or patients correctly diagnosed on their first visit. CONCLUSIONS: COVID-19 (coronavirus disease 2019) self-quarantine has not increased the incidence of complicated appendicitis, and children who developed complicated appendicitis did not have worse clinical outcomes. Parents did not delay presenting for medical attention, and emergency department pediatricians did not fail to diagnose this condition. Reorganization of hospital resources, fast-track treatment protocols for noncomplicated appendicitis, and extended use of home-stay hospitalization for complicated appendicitis could have contributed to these favorable outcomes.


Assuntos
Apendicectomia/métodos , Apendicite/diagnóstico , Diagnóstico Tardio , Emergências , Doença Aguda , Apendicite/epidemiologia , Apendicite/cirurgia , Criança , Feminino , Humanos , Incidência , Masculino , Pandemias , Estudos Retrospectivos , Espanha/epidemiologia
7.
J Med Life ; 14(1): 75-80, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33767789

RESUMO

Our objective was to compare the diagnostic accuracy of Alvarado and appendicitis inflammatory response (AIR) scoring systems among children suspected of acute appendicitis concerning their postoperative outcomes. During a two-year period, a prospective multicentric study was carried in the selected hospitals of Iran. All children who were admitted with the diagnosis of acute appendicitis were enrolled in the study. However, patients suffering from generalized peritonitis or those who had a history of abdominal surgery were excluded. Before decision-making, each patient's score according to two appendicitis scoring systems was calculated. The clinical outcomes and diagnosis of patients were then compared to the results of each scoring system. For those patients who were a candidate for surgery, the final diagnosis of acute appendicitis was made by histopathology. Patients were divided into a high- and low-risk group according to scoring systems outcomes. Among the patients with a low score for appendicitis, the AIR scoring system had a sensitivity and specificity of 95% and 74%, respectively, which was more promising in comparison to that of the Alvarado system (90% and 70%, respectively). Regarding the patients at higher risk of acute appendicitis, none of the scoring systems provided reliable results since both systems showed sensitivity and specificity of less than 50%, which was not sufficient to distinguish patients who are a candidate for surgery. AIR and Alvarado scoring systems are not accurate models to predict the risk of acute appendicitis among children; however, the AIR system could be used as a reliable material to rule out the acute appendicitis diagnosis.


Assuntos
Apendicite/diagnóstico , Projetos de Pesquisa , Doença Aguda , Adolescente , Apendicite/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Irã (Geográfico) , Masculino , Estudos Prospectivos , Fatores de Risco
13.
Int J Surg Oncol ; 2021: 8816643, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33628502

RESUMO

Mucocele of the appendix is the accumulation of mucoid material in the appendiceal lumen. Although the terminology is imprecise, as it does not differentiate between the benign and malignant nature of the condition, preoperative recognition is imperative as spillage of the mucus during surgical handling can result in grave complications like pseudomyxoma peritonei. Mucocele developing in a stump of the appendix, i.e., a remnant of appendiceal tissue after surgical removal of an inflamed organ, is an extremely uncommon phenomenon, as not many cases are reported in the literature. In this review, all cases reported in English literature are discussed.


Assuntos
Mucocele/diagnóstico , Mucocele/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Apendicectomia , Apendicite/cirurgia , Apêndice/patologia , Apêndice/cirurgia , Doenças do Ceco/diagnóstico , Doenças do Ceco/patologia , Doenças do Ceco/cirurgia , Humanos , Mucocele/patologia , Complicações Pós-Operatórias/patologia
15.
JAMA Netw Open ; 4(2): e2036344, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33560426

RESUMO

Importance: Appendicitis is the most common pediatric surgical emergency. Efforts to improve efficiency and quality of care have increased reliance on computed tomography (CT) and ultrasonography (US) in children with suspected appendicitis. Objective: To evaluate the effectiveness of an electronic health record-linked clinical decision support intervention, AppyCDS, on diagnostic imaging, health care costs, and safety outcomes for patients with suspected appendicitis. Design, Setting, and Participants: In this parallel, cluster randomized trial, 17 community-based general emergency departments (EDs) in California, Minnesota, and Wisconsin were randomized to the AppyCDS intervention group or usual care (UC) group. Patients were aged 5 to 20 years, presenting for an ED visit with right-sided or diffuse abdominal pain lasting 5 days or less. We excluded pregnant patients, those with a prior appendectomy, those with selected comorbidities, and those with traumatic injuries. The trial was conducted from October 2016 to July 2019. Interventions: AppyCDS prompted data entry at the point of care to estimate appendicitis risk using the pediatric appendicitis risk calculator (pARC). Based on pARC estimates, AppyCDS recommended next steps in care. Main Outcomes and Measures: Primary outcomes were CT, US, or any imaging (CT or US) during the index ED visit. Safety outcomes were perforations, negative appendectomies, and missed appendicitis. Costs were a secondary outcome. Ratio of ratios (RORs) for primary and safety outcomes and differences by group in cost were used to evaluate effectiveness of the clinical decision support tool. Results: We enrolled 3161 patients at intervention EDs and 2779 patients at UC EDs. The mean age of patients was 11.9 (4.6) years and 2614 (44.0%) were boys or young men. RORs for CT (0.94; 95% CI, 0.75-1.19), US (0.98; 95% CI, 0.84-1.14), and any imaging (0.96; 95% CI, 0.86-1.07) did not differ by study group. In an exploratory analysis conducted in 1 health system, AppyCDS was associated with a reduction in any imaging (ROR, 0.82; 95% CI, 0.73- 0.93) for patients with pARC score of 15% or less and a reduction in CT (ROR, 0.58; 95% CI, 0.45-0.74) for patients with a pARC score of 16% to 50%. Perforations, negative appendectomies, and cases of missed appendicitis by study phase did not differ significantly by study group. Costs did not differ overall by study group. Conclusions and Relevance: In this study, AppyCDS was not associated with overall reductions in diagnostic imaging; exploratory analysis revealed more appropriate use of imaging in patients with a low pARC score. Trial Registration: ClinicalTrials.gov Identifier: NCT02633735.


Assuntos
Dor Abdominal/diagnóstico , Apendicite/diagnóstico , Sistemas de Apoio a Decisões Clínicas , Diagnóstico Ausente/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Ultrassonografia/estatística & dados numéricos , Dor Abdominal/etiologia , Adolescente , Apendicectomia , Apendicite/complicações , Apendicite/diagnóstico por imagem , Apendicite/cirurgia , Criança , Pré-Escolar , Serviço Hospitalar de Emergência , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Masculino , Medição de Risco , Adulto Jovem
17.
Ann R Coll Surg Engl ; 103(2): e50-e52, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33559554

RESUMO

Appendix-associated hernias are extremely rare. They have been described sporadically in the literature, mostly as inguinal hernias. Appendix-associated incisional hernias are even more unusual. High clinical awareness is needed as complications can arise if misdiagnosis or delay occurs. We present an 80-year-old man with acute appendicitis in an incisional hernia. After successful surgery, the patient made a full recovery.


Assuntos
Apendicectomia , Apendicite/diagnóstico , Herniorrafia/efeitos adversos , Hérnia Incisional/diagnóstico , Doenças Raras/diagnóstico , Dor Abdominal/etiologia , Parede Abdominal/cirurgia , Idoso de 80 Anos ou mais , Apendicite/etiologia , Apendicite/cirurgia , Apêndice/diagnóstico por imagem , Apêndice/cirurgia , Hérnia Inguinal/cirurgia , Humanos , Hérnia Incisional/etiologia , Hérnia Incisional/cirurgia , Masculino , Náusea/etiologia , Doenças Raras/etiologia , Doenças Raras/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Vômito/etiologia
18.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33541980

RESUMO

Eosinophilic gastroenteritis is a rare inflammatory disorder of the gastrointestinal tract. Although commonly associated with allergic diseases, it is also rarely associated with autoimmune disorders. This case report describes a 17-year-old Filipino male with eosinophilic gastroenteritis, manifesting as abdominal pain, vomiting and diarrhoea. He had no allergic diseases, but he was previously diagnosed with chronic bullous disease. His symptoms improved with the initiation of corticosteroids. To date, this is the first case report of a patient with eosinophilic gastroenteritis and chronic bullous disease.


Assuntos
Enterite/diagnóstico , Eosinofilia/diagnóstico , Gastrite/diagnóstico , Gastroenterite/diagnóstico , Dor Abdominal/etiologia , Adolescente , Anti-Infecciosos/uso terapêutico , Apendicite/diagnóstico , Apendicite/tratamento farmacológico , Apendicite/cirurgia , Diarreia/etiologia , Enterite/tratamento farmacológico , Enterite/patologia , Eosinofilia/tratamento farmacológico , Eosinofilia/patologia , Gastrite/tratamento farmacológico , Gastrite/patologia , Gastroenterite/tratamento farmacológico , Humanos , Masculino , Metronidazol/uso terapêutico , Omento/patologia , Filipinas , Prednisona/uso terapêutico , Vômito/etiologia
19.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33541988

RESUMO

An 18-year-old adolescent with intermittent colicky abdominal pain for 4 months was admitted to a Medical Emergency Assessment Unit for further investigation of possible colitis, after being reviewed by a surgeon in Accident and Emergency. Initially he was treated for a urinary tract infection, however a CT of the abdomen revealed appendicular perforation with pelvic abscess formation. The patient required an urgent laparoscopy and was discharged without complications. Typically, appendicitis is an acute surgical problem whereas chronic abdominal pain is routinely considered a medical problem. This case demonstrates the importance of maintaining acute causes as part of the differentials list in young patients with unexplained recurrent abdominal pain as well as justifying the early use of CT when there is ambiguity surrounding a diagnosis.


Assuntos
Dor Abdominal/etiologia , Apendicite/cirurgia , Diagnóstico Diferencial , Near Miss , Infecções Urinárias/diagnóstico , Adolescente , Dor Crônica/etiologia , Humanos , Masculino , Tomografia Computadorizada por Raios X
20.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33542013

RESUMO

A 21-year-old female patient presented with vague lower abdominal pain associated with nausea since 2 days. On examination, she was tender in the right iliac fossa. Based on clinical presentation and radiological test finding, she was diagnosed as appendicitis and was subjected for diagnostic laparoscopy and appendectomy. Histopathology proved it to be a tubercular appendix, which is a rarely encountered entity. However, in a country like India, tuberculosis (TB) is highly prevalent; however, TB of appendix is rare and less known.


Assuntos
Dor Abdominal/cirurgia , Apendicite/cirurgia , Apêndice/patologia , Laparoscopia , Dor Abdominal/etiologia , Adulto , Feminino , Humanos , Índia
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