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1.
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
2.
Am Surg ; 85(11): 1209-1212, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31775960

RESUMO

Prompt appendectomy has long been the standard of care for acute appendicitis because of the risk of progression to perforation. Recently, studies have suggested nonemergent management of acute appendicitis. Our study aimed to determine changes in risk of rupture and complications in patients with appendicitis, with increasing time from symptom onset to treatment. Retrospective study of patients aged ≥18 years presenting to the University of North Carolina Hospitals with signs and symptoms of acute appendicitis who subsequently underwent appendectomy from 2011 to 2015 was performed. Demographic, clinical, laboratory, and pathologic data were reviewed. Bivariate analysis was performed to assess variables associated with increased risk of perforation. Poisson regression modeling was completed to evaluate the risk of perforation and postoperative abscess based on time from symptoms to treatment. Within our database of 1007 patients, the mean time from onset of symptoms to operative intervention was 3.24 ± 2.2 days. Modified Poisson regression modeling demonstrated the relative risk for perforation increases by 9% (RR 1.09, P < 0.001) for each day delay. Age (RR 1.03), male gender (RR 1.50), temperature on admission (RR 1.32), and the presence of fecalith (RR 1.89) statistically significantly increased the risk of perforation. Furthermore, for each day delay, there is an 8% increased risk of postoperative abscess (RR 1.08, P = 0.027). The relative risk for appendiceal perforation is 9 per cent per day delay with a resultant 8 per cent increased risk of postoperative abscess. Thus, appendectomy for acute appendicitis should remain an emergent procedure, given that delays in operative management lead to complications and increases in cost of care.


Assuntos
Abscesso/etiologia , Apendicite/complicações , Apendicite/cirurgia , Perfuração Intestinal/etiologia , Doença Aguda , Adulto , Fatores Etários , Temperatura Corporal , Estudos de Casos e Controles , Emergências , Impacção Fecal/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição de Poisson , Estudos Retrospectivos , Fatores de Risco , Ruptura Espontânea/etiologia , Fatores Sexuais , Tempo para o Tratamento
3.
Khirurgiia (Mosk) ; (11): 109-110, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31714539

RESUMO

Femoral hernia strangulation is usually observed in middle-aged women. There are few case reports of appendix strangulation in the femoral hernia. Acute appendicitis in a strangulated femoral hernia is relatively rare (0.4% of cases). Clinical case of acute destructive appendicitis within a strangulated femoral hernia in an elderly woman is reported in the article. If there is doubt about the urgency of surgical intervention, surgeon needs to take a proactive stance and lean toward emergency surgery. Surgeon should be aware of possible strangulation-associated destructive appendicitis due to injury of the appendix.


Assuntos
Apendicite/cirurgia , Hérnia Femoral/cirurgia , Doença Aguda , Idoso , Apendicite/complicações , Feminino , Hérnia Femoral/complicações , Humanos
4.
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
6.
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
7.
Am Surg ; 85(10): 1179-1183, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657320

RESUMO

Delayed presentation of acute appendicitis is associated with increased complications. We hypothesized that the outcomes of appendectomy in delayed presentations of acute appendicitis (>72 hours of pain) were dependent on radiologic findings rather than late presentation. We reviewed records from 2009 to 2015 and analyzed delayed presentations of acute appendicitis. We divided patients into three groups based on specific CT findings: uncomplicated appendicitis (UA), phlegmon or abscess (PA), and other perforated appendicitis (PERF, signs of perforation without abscess or phlegmon). One hundred thirty-eight patients were included in this study (58 in the UA, 67 in the PA, and 13 in the PERF groups). Overall, 78 (57%) patients underwent early appendectomy (EA) and 60 (43%) underwent initial conservative management. The incidence of adverse events was lower in EA than that in initial conservative management (17% vs 42%, P = 0.005). EA in the UA group was associated with shorter hospitalization (3.2 vs 5.6 days, P < 0.001) and less adverse events (6% vs 29%, P < 0.05). Severe adverse events (two colectomies and one fecal fistula) were observed in the PA group. In conclusion, in these late presentations of appendicitis, complicated appendicitis was common. EA was safe in selected patients, however, and associated with decreased adverse events.


Assuntos
Apendicectomia , Apendicite/diagnóstico por imagem , Apendicite/cirurgia , Diagnóstico Tardio/efeitos adversos , Perfuração Espontânea/diagnóstico por imagem , Abscesso/diagnóstico por imagem , Abscesso/etiologia , Doença Aguda , Adulto , Apendicectomia/estatística & dados numéricos , Apendicite/complicações , Tratamento Conservador/efeitos adversos , Tratamento Conservador/estatística & dados numéricos , Diagnóstico Tardio/estatística & dados numéricos , Diagnóstico Precoce , Feminino , Humanos , Tempo de Internação , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Análise de Regressão , Perfuração Espontânea/complicações , Perfuração Espontânea/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
9.
Chirurgia (Bucur) ; 114(4): 461-466, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31511132

RESUMO

Background: Appendicular neuroendocrine neoplasms (ANEN) are rare tumours diagnosed incidentally on histology after an appendicectomy carried out for acute appendicitis. Five years survival rate of node-negative an early ANEN is over 90%. However, the growing interest, among clinicians, to treat appendicitis by antibiotics only, could potentially miss these indolent tumours. The aim of our study was to look at the incidence and management of ANEN discovered in appendicectomy specimens carried out for acute appendicitis. Methods: A retrospective review was performed for all patients undergone appendicectomy, at Barnsley hospital from 2009 to 2015, as suspected acute appendicitis, with particular focus on incidence, investigations and outcome of ANEN. Results: During 2009-2015, 1562 appendicectomies were carried out for acute appendicitis, with 11 specimens showed neuroendocrine tumours (0.70%). Mean age of patients was 31.73 years, with 81.8% female. 8 patients had laparoscopic appendicectomy (72.7%), 2 had open appendicectomy (18.2%), while one had laparoscopic converted to open appendicectomy. Tumour size was less 10 mm in 6 patients (54.5%), between 10-20 mm in 4 (36.4%). Majority were located at the body/base of appendix (54.5%). All tumours were grade 1 well differentiated tumours. 9 patients had clear resection margins, while two patients needed further surgery as an open right hemicolectomy as a curative procedure. In our series, 3 patients (27.27%) had follow up scans 2 years after surgery and showed no tumour recurrence. Conclusion: Appendicectomy is the curative procedure for the majority of ANEN. As shown in our study, if acute appendicitis is managed with conservative treatment only, there is less than 1% risk of missing the diagnosis of ANEN. Also, two of our patients had locally advanced diseases. These could definitely have a poor prognosis without ap-pendectomy.


Assuntos
Neoplasias do Apêndice/complicações , Neoplasias do Apêndice/diagnóstico , Apendicite/complicações , Apendicite/diagnóstico , Tumores Neuroendócrinos/complicações , Tumores Neuroendócrinos/diagnóstico , Doença Aguda , Adulto , Apendicectomia , Neoplasias do Apêndice/cirurgia , Apendicite/cirurgia , Apêndice/cirurgia , Erros de Diagnóstico , Feminino , Humanos , Laparoscopia , Masculino , Recidiva Local de Neoplasia , Tumores Neuroendócrinos/cirurgia , Estudos Retrospectivos
10.
Chirurgia (Bucur) ; 114(4): 467-474, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31511133

RESUMO

Background: The high prevalence of Human Immunodeficiency Virus (HIV) has added a new dimension to the management and outcomes of many general surgical conditions in South Africa. However, there is a paucity of data describing the impact of HIV status on surgical outcomes in our setting. Appendicitis is a most common gastrointestinal emergency, and its surgical outcomes in areas of high HIV prevalence are poorly described in the literature. Thus, the aim of this study is to describe and compare the outcomes of appendectomy between HIV-infected (HIV+) and HIV-negative (HIV-) patients. Methods: This is a retrospective cohort study of patients undergoing appendectomy at a large regional hospital over a 12-month period. Demographic data, duration of pre-hospital symptoms, HIV status, surgical approach, operative findings, histopathology reports, hospital stay and complications were recorded. Data for the HIV+ and HIV- patient cohorts were then described, analysed and compared. Results: The study group comprised 134 patients; 18 (13.4 %) tested positive for HIV. HIV+ patients were significantly older (mean age of 29.3 vs. 20.3 years, P= 0.002) and had longer duration of pre-hospital symptoms (mean of 3.94 vs. 2.57 days, P= 0.03). Postoperative complications (44.4 % vs. 17.2 %, P= 0.03) and lengthier hospital stays (7.28 days vs. 5.95 days, P= 0.004) were also more frequently seen in the HIV+ patients. There were no differences in appendiceal rupture rates, histopathological findings and mortality. Conclusions: Presentation in HIV+ patients was delayed and surgery was associated with significant postoperative morbidity and longer hospital stay.


Assuntos
Apendicectomia , Apendicite/cirurgia , Infecções por HIV/complicações , Adulto , Apendicectomia/efeitos adversos , Apendicite/complicações , Humanos , Tempo de Internação , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
11.
Khirurgiia (Mosk) ; (9): 66-72, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31532169

RESUMO

OBJECTIVE: The purpose of the study is to determine the correlation of changes in the humoral and tissue components of the hemostasis system with lipid metabolism in case of various urgent surgical diseases, on the basis of which the systemic coagulopathic distress syndrome can be used as the scientific basis for the definition of a new syndrome. MATERIAL AND METHODS: The work includes the results of experimental and clinical laboratory tests. Experiments on dogs: in the first group (n=18) destructive pancreatitis; in the second (n=18) - fecal peritonitis; in the third (n=15), acute obstructive intestinal obstruction; in the fourth (n=16) fecal peritonitis, in the postoperative period, Remaxol (15 ml/kg) was included in the therapy. The analysis of 55 patients with acute peritonitis, operated on for acute appendicitis, perforated gastric or duodenal ulcer, acute intestinal obstruction, acute destructive cholecystitis. In the study group (n=28), Remaxol is included in the postoperative therapy. The state of the humoral and tissue (in the experiment, the tissues of the liver, intestines, kidneys, heart, lungs, pancreas, in the clinic - tissues of the resected organs) components of the hemostasis system was evaluated, a number of lipid metabolism indicators were determined, etc. RESULTS: In the early periods of all investigated urgent diseases of the abdomen, pronounced changes in the system of both humoral and tissue components of the hemostasis system were revealed. The modification of the coagulation system is registered not only in the tissues of the lesion organs, but also in the target organs (system tissue hemocoagulation modifications). The research established one of the most important processes - the trigger of the hemostatic cascade reaction - is membrane-destabilizing (the source of tissue thromboplastin), which is determined by changes in the phospholipid composition of various organs tissues (involved in the pathological process or not in it). Changes in lipid metabolism are due to the activation of phospholipases and membrane lipid peroxidation in tissues. The factual material was the scientific basis for the establishment of a new syndrome. Systemic coagulopathic distress syndrome is a set of pathological processes of the body, the most important component of which is a violation of the phospholipid bilayer of blood cell membranes and organ cells due to oxidative and phospholipase induced phenomena, leading to a coagulopathic condition. It changes understanding of the prevention of thrombohemorrhagic complications, proving the effectiveness of complex therapy, including not only anticoagulants, but also drugs with membrane-stabilizing activity, in particular, Remaxol.


Assuntos
Transtornos da Coagulação Sanguínea/prevenção & controle , Doenças do Sistema Digestório/complicações , Infecções Intra-Abdominais/complicações , Substâncias Protetoras/administração & dosagem , Succinatos/administração & dosagem , Doença Aguda , Animais , Apendicite/complicações , Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/fisiopatologia , Colecistite Aguda/complicações , Doenças do Sistema Digestório/fisiopatologia , Cães , Doenças Hematológicas/etiologia , Doenças Hematológicas/fisiopatologia , Doenças Hematológicas/prevenção & controle , Hemostasia/fisiologia , Humanos , Obstrução Intestinal/complicações , Infecções Intra-Abdominais/fisiopatologia , Metabolismo dos Lipídeos/fisiologia , Pancreatite/complicações , Úlcera Péptica Perfurada/complicações , Peritonite/complicações , Síndrome
13.
Prensa méd. argent ; 105(8): 427-430, sept 2019. fig
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1023136

RESUMO

The aim of this study was to analyse a patient dignosed in our hospital as having pylephlebitis. The patient is a 29 years old male, and we must consider that pylophlebitis refers to the septic thrombosis of the portal venous system, associated to some kind of infectious process. Can occur related to acute appendicitis, colonic diverticulitis and cholangitis, among others. Is a rare but close to a significant morbidity and mortality, since it can develop to an abdominal sepsis. The management review of the case reported, is presented (AU)


Assuntos
Humanos , Masculino , Adulto , Apendicite/complicações , Sistema Porta , Veia Porta/patologia , Tomografia Computadorizada por Raios X , Sepse , Tromboembolia Venosa/complicações
14.
BMJ Case Rep ; 12(8)2019 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-31401566

RESUMO

A 30-year-old woman known to have a paraumbilical hernia presented with central abdominal pain and vomiting. On examination, she was tender around the umbilical area, and a lump was felt on the umbilicus with associated skin changes. A CT scan was performed which showed an inflamed appendix within an incarcerated paraumblical hernia.


Assuntos
Apendicite/complicações , Hérnia Umbilical/complicações , Adulto , Apendicectomia/métodos , Apendicite/diagnóstico por imagem , Apendicite/cirurgia , Feminino , Hérnia Umbilical/diagnóstico por imagem , Hérnia Umbilical/cirurgia , Humanos , Tomografia Computadorizada por Raios X
15.
Rozhl Chir ; 98(7): 291-296, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31398990

RESUMO

INTRODUCTION: Fourniers gangrene is a rare but fast deteriorating and serious condition with high mortality. In most cases, it is characterized as necrotizing fasciitis of the perineum and external genitals. Amyands hernia is a rare condition where the appendix is contained in the sac of an inguinal hernia. Inflammatory alterations in the appendix account only for 0.1 % of the cases when Amyands hernia is verified. Fourniers gangrene as a complication of a late diagnosis of appendicitis located in the inguinal canal is described in the literature as rare case reports.   Case report: The case report of a 70-year-old patient with Fourniers gangrene resulting from gangrenous appendicitis of Amyands hernia.  Conclusion: Fourniers gangrene as a complication of Amyands hernia is a rare condition. Only sporadic case reports thereof can be found in the literature. Because of the rarity of this pathology and the lack of randomized controlled studies, it is difficult to determine the optimal treatment according to the principles of evidence-based medicine. An appropriate approach for this condition appears to be the combination of guidelines developed in Amyands therapy according to Losanoff and Basson, along with the recommended “gold standard” therapy for Fourniers gangrene. This means early and highly radical surgical debridement, adequate antibiotic therapy and intensive care.


Assuntos
Apendicite , Apêndice , Gangrena de Fournier , Hérnia Inguinal , Idoso , Apendicite/complicações , Gangrena de Fournier/etiologia , Hérnia Inguinal/complicações , Humanos
16.
Rev Fac Cien Med Univ Nac Cordoba ; 76(3): 180-184, 2019 08 29.
Artigo em Espanhol | MEDLINE | ID: mdl-31465187

RESUMO

Introducction: Acute appendicitis is a pathology caused by inflammation of the cecal appendix , due tocthe obstruction of the appendicular lumen,witch leads to a venous congestion and then eventually to an arterial compromise of the appendicular wall with the consequent perforation of it.The main problem of this pathology in children under 4 years is the high index of appendicecal preforations presented by patients at the time of diagnosis,mainly driven by an unspecific clinical presentation,which leads to a low index of suspicion and a high percentage of complications in that age group. Objetive: perform a literature review on the subject and investigate what is known of appendicitis in children under four years old to date. The data were obtained through a systematic bibliographic search in the pubmed data base from 1980 to 2017 Conclussion: Conclussion the increase in morbidity of acute apendicitis in children under 4 years has a mixed origin since organic factors are mixed age,together with a temporary diagnostic delay and with it the appearance of complicated forms of the disease, there is no sign,symptom or group of them that allows early detection of appendicitis in children under 4 years of age.


Assuntos
Apendicite/diagnóstico , Doença Aguda , Apendicite/complicações , Apendicite/cirurgia , Pré-Escolar , Diagnóstico Diferencial , Humanos , Medição de Risco
18.
J Med Case Rep ; 13(1): 208, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31391122

RESUMO

BACKGROUND: Acute appendicitis is known to cause intestinal obstruction. The presentation is commonly due to functional obstruction, but on very rare occasions it presents as mechanical obstruction, especially closed loop. CASE PRESENTATION: We report a case of a 59-year-old Egyptian man who presented with symptoms suggestive of intestinal obstruction. On examination, he was afebrile with distended tender abdomen with no obvious hernias. There was no history of previous abdominal surgery. Laboratory investigations were within normal range except for elevated serum creatinine levels. Plain erect X-ray and computed tomography scan of his abdomen indicated mechanical small bowel obstruction. Preoperative preparations with administration of intravenously administered fluids and antibiotics were done for exploratory laparotomy. The operation was approached through a midline incision, revealing dilated small bowel loops with a terminal ileal loop occluded by a ring of his appendix. The appendicular tip was adherent to small bowel mesentery by adhesive band (appendiceal tourniquet). Release of the band with simple appendectomy was done; a segment of ileal bowel loop was congested but regained its viability after 5 minutes' application of gauze soaked in warm saline. His abdomen was closed in layers and one drainage tube left in situ. Paralytic ileus was the only postoperative complication which was relieved after 2 days. He was started on orally administered fluids on the third postoperative day, and discharged on the fifth postoperative day. CONCLUSION: Acute appendicitis should be suspected as a cause of mechanical intestinal obstruction in an elderly patient with no obvious diagnostic cause, and can be managed with simple appendectomy when an early intervention is made.


Assuntos
Apendicite/complicações , Doenças do Íleo/etiologia , Obstrução Intestinal/etiologia , Apendicectomia/métodos , Apendicite/cirurgia , Humanos , Doenças do Íleo/diagnóstico por imagem , Obstrução Intestinal/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
19.
BMJ Case Rep ; 12(7)2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31296635

RESUMO

Amyand's hernia is a rare entity where the appendix is trapped within inguinal canal. For even rarer are the cases where the appendix has perforated and caused an abscess into inguinal canal. Here we report a case where a male patient had Amyand's hernia, acute appendicitis and abscess which were treated by laparotomy. We present the diagnostic process and intraoperative finding leading to diagnosis of Amyand's hernia.


Assuntos
Abscesso/complicações , Abscesso/diagnóstico por imagem , Apendicite/complicações , Apendicite/diagnóstico por imagem , Hérnia Inguinal/complicações , Hérnia Inguinal/diagnóstico por imagem , Abscesso/cirurgia , Doença Aguda , Adulto , Apendicectomia , Apendicite/cirurgia , Apêndice/diagnóstico por imagem , Apêndice/cirurgia , Hérnia Inguinal/cirurgia , Herniorrafia , Humanos , Canal Inguinal/diagnóstico por imagem , Canal Inguinal/cirurgia , Masculino , Tomografia Computadorizada por Raios X/métodos
20.
World J Surg ; 43(9): 2131-2136, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31187245

RESUMO

BACKGROUND: To compare the presentation, management, and outcome of HIV-positive patients with appendicitis to those of HIV-negative patients with appendicitis. SUMMARY BACKGROUND DATA: The literature is limited regarding the impact of HIV infection on patients with appendicitis. METHODS: A retrospective review of patients with appendicitis and known HIV status admitted to Princess Marina Hospital, Gaborone, Botswana, aged 13 years and greater was performed from January 2013 to December 2015. Data on patient demographics, presentation, laboratory findings, management, and outcomes were analyzed. RESULTS: A total of 295 patients with appendicitis and known HIV status were identified, of which 119 (40.3%) were HIV positive. The median [IQR] ages for HIV-positive and HIV-negative patients were 34 [29-42] and 26 [20-33] years, respectively. The male-to-female ratio for the same two groups was 0.8:1 and 1.4:1, respectively. Presenting symptoms, signs, and white blood cell count were similar in both groups. HIV-positive patients had significantly higher overall (4.2 vs. 0.0%, p = 0.010) and postoperative (4.4 vs. 0.0%, p = 0.024) mortality rates. There was no significant difference in the total complication rate between HIV-positive and HIV-negative patients (13.2 vs. 7.9%, p = 0.192). Compared to HIV-positive patients with a CD4 count ≥200, patients with a CD4 count <200 have a significantly higher postoperative mortality rate (17.6 vs. 1.4%, p = 0.023) and a trend toward a higher total postoperative complication rate (31.3 vs. 10.8%, p = 0.054). CONCLUSION: Within our setting, HIV infection, particularly with a CD4 <200, was correlated with significantly higher mortality in patients with acute appendicitis.


Assuntos
Apendicite/complicações , Infecções por HIV/complicações , Doença Aguda , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Apendicite/diagnóstico , Apendicite/mortalidade , Apendicite/cirurgia , Botsuana/epidemiologia , Contagem de Linfócito CD4 , Feminino , Infecções por HIV/imunologia , Infecções por HIV/mortalidade , Hospitalização , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Adulto Jovem
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