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1.
Ann R Coll Surg Engl ; 103(10): e317-e318, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34414784

RESUMO

Transabdominal preperitoneal (TAPP) repair is a common laparoscopic inguinal hernia repair technique performed worldwide. A rare long-term complication of TAPP is mesh-induced appendicitis, of which only four cases have been described in the literature to date. We report a case of appendicitis due to appendix entrapped in the TAPP mesh.


Assuntos
Apendicite/etiologia , Hérnia Inguinal/cirurgia , Laparoscopia/efeitos adversos , Telas Cirúrgicas/efeitos adversos , Humanos , Masculino , Adulto Jovem
2.
N Engl J Med ; 385(12): 1078-1090, 2021 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-34432976

RESUMO

BACKGROUND: Preapproval trials showed that messenger RNA (mRNA)-based vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had a good safety profile, yet these trials were subject to size and patient-mix limitations. An evaluation of the safety of the BNT162b2 mRNA vaccine with respect to a broad range of potential adverse events is needed. METHODS: We used data from the largest health care organization in Israel to evaluate the safety of the BNT162b2 mRNA vaccine. For each potential adverse event, in a population of persons with no previous diagnosis of that event, we individually matched vaccinated persons to unvaccinated persons according to sociodemographic and clinical variables. Risk ratios and risk differences at 42 days after vaccination were derived with the use of the Kaplan-Meier estimator. To place these results in context, we performed a similar analysis involving SARS-CoV-2-infected persons matched to uninfected persons. The same adverse events were studied in the vaccination and SARS-CoV-2 infection analyses. RESULTS: In the vaccination analysis, the vaccinated and control groups each included a mean of 884,828 persons. Vaccination was most strongly associated with an elevated risk of myocarditis (risk ratio, 3.24; 95% confidence interval [CI], 1.55 to 12.44; risk difference, 2.7 events per 100,000 persons; 95% CI, 1.0 to 4.6), lymphadenopathy (risk ratio, 2.43; 95% CI, 2.05 to 2.78; risk difference, 78.4 events per 100,000 persons; 95% CI, 64.1 to 89.3), appendicitis (risk ratio, 1.40; 95% CI, 1.02 to 2.01; risk difference, 5.0 events per 100,000 persons; 95% CI, 0.3 to 9.9), and herpes zoster infection (risk ratio, 1.43; 95% CI, 1.20 to 1.73; risk difference, 15.8 events per 100,000 persons; 95% CI, 8.2 to 24.2). SARS-CoV-2 infection was associated with a substantially increased risk of myocarditis (risk ratio, 18.28; 95% CI, 3.95 to 25.12; risk difference, 11.0 events per 100,000 persons; 95% CI, 5.6 to 15.8) and of additional serious adverse events, including pericarditis, arrhythmia, deep-vein thrombosis, pulmonary embolism, myocardial infarction, intracranial hemorrhage, and thrombocytopenia. CONCLUSIONS: In this study in a nationwide mass vaccination setting, the BNT162b2 vaccine was not associated with an elevated risk of most of the adverse events examined. The vaccine was associated with an excess risk of myocarditis (1 to 5 events per 100,000 persons). The risk of this potentially serious adverse event and of many other serious adverse events was substantially increased after SARS-CoV-2 infection. (Funded by the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute.).


Assuntos
Vacinas contra COVID-19/efeitos adversos , COVID-19/complicações , Doenças Cardiovasculares/etiologia , Miocardite/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicite/etiologia , Doenças Cardiovasculares/epidemiologia , Feminino , Herpes Zoster/etiologia , Humanos , Israel , Estimativa de Kaplan-Meier , Linfadenopatia/etiologia , Masculino , Pessoa de Meia-Idade , Miocardite/epidemiologia , Risco , Fatores de Risco , Adulto Jovem
3.
Medicina (B Aires) ; 81(4): 649-651, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-34453810

RESUMO

Stump appendicitis is a rare complication of appendectomy. It may develop from a few weeks to several years after the surgical procedure. To achieve its diagnosis a high index of suspicion is necessary. The objective of this publication is to make a review of two cases of this entity that occurred in our institution and to mention its most frequent imaging findings. Computed tomography is an excellent method to assess this entity, not only for its diagnosis but also to rule out other pathologies that present similar clinical features.


Assuntos
Apendicite , Apendicectomia , Apendicite/diagnóstico por imagem , Apendicite/etiologia , Apendicite/cirurgia , Diagnóstico Diferencial , Humanos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Tomografia Computadorizada por Raios X
4.
Medicina (B.Aires) ; 81(4): 649-651, ago. 2021. graf
Artigo em Espanhol | LILACS | ID: biblio-1346520

RESUMO

Resumen La apendicitis del muñón es una complicación poco frecuente de la apendicectomía. Puede aparecer desde unas semanas a varios años luego del procedimiento quirúrgico. Para arribar a su diagnóstico es necesario un alto índice de sospecha. El objetivo de esta publicación es hacer una reseña de dos casos de esta entidad ocurridos en nuestra institución y mencionar sus hallazgos imagenológicos más frecuentes. La tomografía computarizada es un excelente método para valorar esta entidad, no solo para su diagnóstico sino también para descartar otras patologías que presentan un cuadro clínico similar.


Abstract Stump appendicitis is a rare complication of appendectomy. It may develop from a few weeks to several years after the surgical procedure. To achieve its diagnosis a high index of suspicion is necessary. The objective of this publication is to make a re view of two cases of this entity that occurred in our institution and to mention its most frequent imaging findings. Computed tomography is an excellent method to assess this entity, not only for its diagnosis but also to rule out other pathologies that present similar clinical features.


Assuntos
Humanos , Apendicite/cirurgia , Apendicite/etiologia , Apendicite/diagnóstico por imagem , Apendicectomia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Diagnóstico Diferencial
5.
Pediatr Infect Dis J ; 40(10): e364-e369, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34260501

RESUMO

BACKGROUND: To date, there are only sporadic reports of acute abdomen and appendicitis in children with coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C). METHODS: Children 17 years of age or younger assessed in 5 Latin American countries with a diagnosis of microbiologically confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and children fulfilling MIS-C definition were included. For children with acute abdomen, we investigate main radiologic patterns, surgical treatment and intraoperative findings, outcomes. FINDINGS: One-thousand ten children were enrolled. Forty-two children (4.2%) had a clinical diagnosis of acute abdomen. Four (9.5%) were diagnosed with MIS-C and did not undergo surgery. The remaining 38 children (3.8%) underwent abdominal surgery due to suspected appendicitis, 34 of them (89.7%) had an intraoperative diagnosis of acute appendicitis (AA), while 4 of them had nonsurgical findings. Eight children died (0.8%), none of them being diagnosed with appendicitis. Children with AA were significantly older than those without (P < 0.0001). Children with complicated appendicitis had more frequently fever (85.7% vs. 60%), intestinal distension on the abdominal radiograph (7.1% vs. none), leukocytosis (85.7% vs. 40%) and high levels of C-reactive protein (35.7% vs. 5%), although differences were not statistically significant. CONCLUSIONS: Our study showed that children may present with acute abdomen during COVID-19 or MIS-C, which is not always associated with intraoperative findings of appendicitis, particularly in case of MIS-C. Further studies are needed to better characterize children with acute abdomen during COVID-19 or MIS-C, to avoid delay in diagnosis of surgical conditions and at the same time, minimize unnecessary surgical approaches.


Assuntos
Abdome Agudo/etiologia , Abdome Agudo/virologia , Apendicite/etiologia , Apendicite/virologia , COVID-19/complicações , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Síndrome de Resposta Inflamatória Sistêmica/virologia , Adolescente , COVID-19/etiologia , COVID-19/virologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , América Latina , Masculino , SARS-CoV-2/patogenicidade
6.
Am J Trop Med Hyg ; 105(3): 801-806, 2021 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-34228635

RESUMO

Hantaviruses are Bunyaviridae viruses that cause hemorrhagic fever with renal syndrome. Appendicitis caused by Hantaan virus has not been reported previously. An 81-year-old man who underwent laparoscopic appendectomy for suspected appendicitis based on abdominal pain, fever, hypotension, and computed tomography findings. Based on a suspicion of hemorrhagic fever with renal syndrome, the patient's plasma was simultaneously analyzed using an indirect immunofluorescent antibody assay and nested reverse transcription-polymerase chain reaction (RT-PCR). The appendix tissue was also analyzed using nested RT-PCR and immunohistochemical (IHC) staining to identify the presence of Hantaan virus. Nested RT-PCR detected the presence of Hantaan virus, and indirect immunofluorescent antibody assay results revealed the presence of elevated antibody levels. Furthermore, IHC staining of the appendix tissue confirmed Hantaan virus antigens in the peripheral nerve bundle. Based on these findings, we confirmed the nerve tropism of the Hantaan virus. Hantaan virus in plasma and appendix tissue samples was confirmed using PCR and phylogenetic tree analysis. Moreover, we detected hypertrophy of the submucosa and periappendiceal adipose tissue nerve bundle along with Hantaan virus antigens in peripheral nerve bundles using IHC staining. Hence, we report that Hantaan virus infection may be accompanied by appendicitis.


Assuntos
Apendicite/virologia , Febre Hemorrágica com Síndrome Renal/diagnóstico , Idoso de 80 Anos ou mais , Apendicectomia , Apendicite/etiologia , Apendicite/patologia , Apendicite/cirurgia , Apêndice/patologia , Apêndice/virologia , Vírus Hantaan/genética , Febre Hemorrágica com Síndrome Renal/complicações , Humanos , Masculino , Filogenia , Reação em Cadeia da Polimerase
7.
Rev Esp Enferm Dig ; 113(11): 799-800, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34154370

RESUMO

We present the case of a 70-year-old male who consulted for abdominal pain, vomiting, fever, and signs of peritoneal irritation. Histopathology showed goblet-like cells organized in nests, without tubules, with transmural infiltration. Immunohistochemistry was positive for synaptophysin and chromogranin, and a grade-3 goblet-cell adenocarcinoma (GCA) was diagnosed.


Assuntos
Adenocarcinoma , Neoplasias do Apêndice , Apendicite , Tumor Carcinoide , Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico por imagem , Idoso , Neoplasias do Apêndice/complicações , Neoplasias do Apêndice/diagnóstico por imagem , Neoplasias do Apêndice/cirurgia , Apendicite/etiologia , Apendicite/cirurgia , Humanos , Imuno-Histoquímica , Masculino
8.
PLoS Negl Trop Dis ; 15(6): e0009478, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34166369

RESUMO

BACKGROUND: Globally, schistosomiasis affects at least 240 million people each year with a high proportion of cases in sub-Saharan Africa. The infection presents a wide range of symptoms mainly at the gastrointestinal and urogenital level. Cases of schistosomiasis-related appendicitis are seldom reported. The aim of the present study is to identify the prevalence of schistosomiasis-related appendicitis in Beira, Mozambique and compare to global prevalence. METHODS: We retrospectively reviewed all cases of appendicitis recorded from January 2017 to March 2020 at a single pathology department located in Beira in order to assess the prevalence of schistosomiasis. Moreover, we performed a systematic review on the prevalence of schistosomiasis-related appendicitis in all countries. FINDINGS: A total of 145 appendicitis cases in Beira showed a 13.1% prevalence of schistosomal-related appendicitis. The mean age of patients was 29.1 years, and 14 (73.7%) were male. The systematic review identified 20 studies with 34,790 inpatients with schistosomiasis-related appendicitis with a global prevalence of 1.31% (95% confidence interval (CI): 0.72 to 2.06); a high heterogeneity (I2 = 96.0%) was observed. Studies carried out in Africa reported a significantly higher prevalence of schistosomiasis-related appendicitis (2.75%; 95% CI: 1.28 to 4.68) than those in Middle East (0.49%; 95% CI: 0.18 to 0.95) (p for interaction < 0.0001). CONCLUSIONS: Schistosomiasis infection should be considered as possible cause of appendicitis not only in endemic areas but also in developed countries. Considering that prevention is the best way to control the infection, more efforts should be put in place in order to increase the prevention coverage and avoid the cascading implications for health. This is even more so important in this Coronavirus Disease 2019 (COVID-19) era where the majority of attention and funds are used to fight the pandemic.


Assuntos
Apendicite/etiologia , Esquistossomose/complicações , Adulto , Apendicite/epidemiologia , Feminino , Humanos , Masculino , Prevalência , Estudos Retrospectivos
9.
Sci Rep ; 11(1): 12170, 2021 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-34108513

RESUMO

Acute appendicitis is a rare gastrointestinal complication of anti-cancer chemotherapy and hematopoietic stem cell transplantation. Among a cohort of 2341 hemato-oncologic patients at a pediatric tertiary care cancer center, we identified 21 patients (0.9%) with 23 episodes of acute appendicitis, based on pathological imaging of the appendix and clinical findings. Median age at diagnosis was 10.21 years. Types of underlying disease included acute leukemias (n = 15), solid tumors (n = 4), and aplastic anemia (n = 2). Clinical symptoms seen in > 1 case were recorded for all 23 episodes as follows: abdominal pain, n = 22; abdominal tenderness, n = 4; fever, n = 7; nausea, n = 2; emesis; n = 2; diarrhea, n = 5; and constipation, n = 2. Median leukocyte count at diagnosis was 0.5 × 109/L, with a median of 0.1 × 109/L for the absolute neutrophil count (ANC). All patients received broad-spectrum antibiotics and 18/23 (78%) patients underwent uneventful appendectomy after a median of 5 days and with a median ANC of 0.7 × 109/L. Median duration until continuation of chemotherapy was 17 days for the 20 cases of appendicitis occurring during the patients' disease course. Overall, 5/21 (19%) patients died including one related to the appendicitis itself which progressed to a typhlitis and was due to a fungal infection. The other fatalities were transplant- (n = 2) and leukemia-related (n = 2). Acute appendicitis is a rare and usually not life-threatening event in pediatric hemato-oncologic patients, which, if managed by prompt administration of broad-spectrum antibiotics (and antimycotics), can be safely followed by an elective (delayed) appendectomy, even before complete recovery of the neutrophils is achieved.


Assuntos
Antibacterianos/uso terapêutico , Apendicectomia/métodos , Apendicite/diagnóstico , Apendicite/terapia , Neoplasias Hematológicas/complicações , Atenção Terciária à Saúde/estatística & dados numéricos , Adolescente , Apendicite/etiologia , Criança , Pré-Escolar , Terapia Combinada , Gerenciamento Clínico , Feminino , Seguimentos , Humanos , Lactente , Masculino , Prognóstico , Estudos Retrospectivos
10.
Am J Surg Pathol ; 45(12): 1703-1706, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33999557

RESUMO

Data from previous studies suggest Crohn disease of the appendix accounts for ∼25% of granulomatous appendicitis cases. However, we have found that granulomatous inflammation in appendectomy specimens rarely heralds Crohn disease. We suspect that appendiceal involvement by Crohn disease is uncommon, even when patients have severe ileocolonic inflammation. We performed this study to determine the prevalence and nature of appendiceal inflammation among patients with Crohn disease. We reviewed 100 ileocolic specimens with strictures and fistulizing Crohn disease for the nature and distribution of inflammatory changes in the appendix and compared them with 100 appendices on colectomy specimens from age-matched and sex-matched patients with ulcerative colitis. We also evaluated 27 additional cases of granulomatous appendicitis in appendectomy specimens to determine the frequency with which this finding represented Crohn disease. The appendix was usually normal (26%) or showed fibrous obliteration (50%) in ileocolic resection specimens from patients with Crohn disease. Mucosal inflammation was much less common in appendices from patients with Crohn disease than ulcerative colitis (6% vs. 28%, P<0.0001); only 4 cases contained epithelioid granulomata, 3 showed mural fibrosis and lymphoid aggregates, and 10 displayed only periappendiceal inflammation. None of the patients with granulomatous appendicitis in appendectomy specimens had, or developed, evidence of Crohn disease. We conclude that Crohn disease infrequently affects the appendix. Interval appendectomy and infection are more important considerations when appendectomy specimens feature granulomatous inflammation and/or mural lymphoid aggregates, especially if there is no history of idiopathic inflammatory bowel disease.


Assuntos
Apendicite/etiologia , Apêndice/patologia , Doença de Crohn/complicações , Granuloma/etiologia , Adulto , Apendicectomia , Apendicite/patologia , Apendicite/cirurgia , Apêndice/cirurgia , Doença de Crohn/patologia , Doença de Crohn/cirurgia , Feminino , Granuloma/patologia , Granuloma/cirurgia , Humanos , Masculino , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
12.
J UOEH ; 43(1): 103-115, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-33678780

RESUMO

We report two cases of synchronous double primary cancers, which were composed of prostate cancer accompanied by bone metastasis and colon cancer, within only five months of each other. The first was a 77-year-old man whose ECOG PS was 0. He was referred to our hospital in March 2020 because abdominal CT scan, which was performed at a clinic for the purpose of close examination of poor control of diabetes, showed wall thickening of the sigmoid colon. A further examination revealed prostate cancer accompanied by metastatic bone cancer and sigmoid colon cancer. Laparoscopic sigmoid colectomy was performed in April. Currently, six months after the surgery, both the prostate cancer and its accompanying metastatic bone cancer are well controlled by hormonal therapy. The second case was an 86-year-old man with an ECOG PS of 3 who was brought to our hospital by ambulance in August, 2020 because of fever and abdominal pain. A close examination revealed cecal cancer accompanying acute appendicitis. Prostate cancer accompanied by metastatic bone cancer was also diagnosed. Laparoscopic ileocecal resection was performed in the same month, but, unfortunately, the patient had repeated aspiration pneumonia and he finally passed away 43 days after surgery. We discuss the treatment strategy for colorectal cancer with synchronous or metachronous prostate cancer, which has been increasing in recent years, and include epidemiological considerations.


Assuntos
Neoplasias do Apêndice/cirurgia , Neoplasias Ósseas/secundário , Neoplasias Primárias Múltiplas , Neoplasias da Próstata/patologia , Neoplasias do Colo Sigmoide/cirurgia , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Apêndice/complicações , Apendicite/etiologia , Apendicite/cirurgia , Endoscopia Gastrointestinal , Evolução Fatal , Humanos , Laparoscopia , Masculino , Resultado do Tratamento
13.
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
14.
Langenbecks Arch Surg ; 406(2): 367-375, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33550453

RESUMO

PURPOSE: The COVID-19 pandemic has transformed medical care worldwide. General surgery has been affected in elective procedures, yet the implications for emergency surgery are unclear. The current study analyzes the effect of the COVID-19 lockdown in spring 2020 on appendicitis treatment in Germany. METHODS: Hospitals that provided emergency surgical care during the COVID-19 lockdown were invited to participate. All patients diagnosed with appendicitis during the lockdown period (10 weeks) and, as a comparison group, patients from the same period in 2019 were analyzed. Clinical and laboratory parameters, intraoperative and pathological findings, and postoperative outcomes were analyzed. RESULTS: A total of 1915 appendectomies from 41 surgical departments in Germany were included. Compared to 2019 the number of appendectomies decreased by 13.5% (1.027 to 888, p=0.003) during the first 2020 COVID-19 lockdown. The delay between the onset of symptoms and medical consultation was substantially longer in the COVID-19 risk group and for the elderly. The rate of complicated appendicitis increased (58.2 to 64.4%), while the absolute number of complicated appendicitis decreased from 597 to 569, (p=0.012). The rate of negative appendectomies decreased significantly (6.7 to 4.6%; p=0.012). Overall postoperative morbidity and mortality, however, did not change. CONCLUSION: The COVID-19 lockdown had significant effects on abdominal emergency surgery in Germany. These seem to result from a stricter selection and a longer waiting time between the onset of symptoms and medical consultation for risk patients. However, the standard of emergency surgical care in Germany was maintained.


Assuntos
Apendicectomia/estatística & dados numéricos , Apendicite/cirurgia , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Apendicectomia/efeitos adversos , Apendicite/diagnóstico , Apendicite/etiologia , COVID-19/diagnóstico , COVID-19/epidemiologia , Feminino , Alemanha , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Utilização de Procedimentos e Técnicas , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
15.
AJR Am J Roentgenol ; 216(3): 677-682, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33474985

RESUMO

OBJECTIVE. With heightened interest in nonoperative antibiotic management of uncomplicated appendicitis, appendicoliths become a more relevant issue, and because of higher failure rates their presence may be considered a contraindication. The purpose of this study was to investigate the prevalence of appendicoliths at CT in adults with suspected appendicitis. MATERIALS AND METHODS. Among adults undergoing MDCT for suspected appendicitis, 248 patients (134 women, 114 men; mean age, 35.2 years) consecutively registered over a 3-year period constituted a cohort with surgically proven appendicitis. A cohort of 248 patients (175 women, 73 men; mean age, 37.7 years) without appendicitis consecutively registered over a 1-year period served as control subjects. CT examinations were reviewed for the presence, size, and attenuation of appendicoliths and whether the appendicoliths were obstructing. In the cohort with appendicitis, degree of inflammation (3-point scale) and likelihood for perforation (5-point scale) were scored. RESULTS. The prevalence of appendicoliths at CT was 38.7% (96/248) among patients with appendicitis and 4.4% (11/248) among control subjects (p < .001). Among the 96 patients with appendicitis who had visible appendicoliths, mean width, length, and maximum attenuation of the dominant appendicolith were 6.0 mm, 8.2 mm, and 313 HU, respectively. In 70.8% (68/96) of patients appendicoliths were obstructing, and 32.3% (31/96) of patients had more than one appendicolith. Inflammation (1.75 vs 1.43) and likelihood of perforation (2.07 vs 1.51) (p < .05) scores were higher among patients with appendicitis who had appendicoliths. Extraluminal appendicoliths were seen in five cases of perforated appendicitis. CONCLUSION. Appendicoliths were identified at CT in nearly 40% of adults with proven appendicitis, compared with slightly more than 4% of those without appendicitis, and were associated with increased inflammation and risk of perforation.


Assuntos
Apendicite/diagnóstico por imagem , Cálculos/diagnóstico por imagem , Doenças do Ceco/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Doença Aguda , Adulto , Idoso , Apendicite/etiologia , Cálculos/complicações , Cálculos/epidemiologia , Estudos de Casos e Controles , Doenças do Ceco/complicações , Doenças do Ceco/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
17.
J Pediatr Hematol Oncol ; 43(1): 28-30, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32134840

RESUMO

A 9-year-old child with sickle cell disease (sickle beta zero thalassemia) was diagnosed to have acute appendicitis during a hospitalization for pain, acute chest syndrome, and exacerbation of asthma. Because of his high surgical risk, his appendicitis was treated nonsurgically, successfully deferring his appendectomy. He remains well after 1 year. This approach should be considered at least in other sickle cell patients with appendicitis, and perhaps other high-risk populations, if not all children with appendicitis.


Assuntos
Anemia Falciforme/complicações , Antibacterianos/uso terapêutico , Apendicite/tratamento farmacológico , Doença Aguda , Apendicite/etiologia , Apendicite/patologia , Criança , Humanos , Masculino , Prognóstico
18.
Endoscopy ; 53(4): 424-428, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32894866

RESUMO

BACKGROUND: Conventional endoscopic resection of lesions affecting the appendiceal orifice is difficult. Endoscopic full-thickness resection (EFTR) is a novel technique in interventional endoscopy. As EFTR near the appendiceal orifice is associated with a subtotal appendectomy, it remains unclear whether the risk of developing appendicitis is increased. We conducted a retrospective analysis of lesions involving the appendiceal orifice treated by EFTR. METHODS: This was a multicenter retrospective analysis of patients (n = 50) treated with EFTR for lesions involving the appendiceal orifice between 2014 and 2019. The objective was to evaluate the occurrence of appendicitis. RESULTS: Acute appendicitis occurred in seven patients (14 %) during follow-up. Conservative treatment was sufficient in four cases, and three patients underwent appendectomy. CONCLUSIONS: EFTR of lesions involving the appendiceal orifice may be associated with an imminent risk of developing appendicitis and a consecutive need for appendectomy. Patients should be informed about this specific risk prior to resection. It is unclear why some patients develop appendicitis while the majority remains asymptomatic.


Assuntos
Apendicite , Apêndice , Ressecção Endoscópica de Mucosa , Apendicite/etiologia , Apendicite/cirurgia , Apêndice/diagnóstico por imagem , Apêndice/cirurgia , Endoscopia , Humanos , Estudos Retrospectivos
19.
Langenbecks Arch Surg ; 406(2): 357-365, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33169297

RESUMO

PURPOSE: The COVID-19 pandemic has reformed global healthcare delivery. On 25 March 2020, Intercollegiate guidelines were published in the UK to promote safe surgical provision during the COVID-19 outbreak advocating non-operative management or avoidance of laparoscopy when surgery is essential. The effects of this on the investigation and management of appendicitis remain unknown. METHODS: We performed a multicentre, prospective, observational study from the start of the new guidelines to the 6th of May 2020. We included all patients referred to surgical teams with suspected appendicitis. A recent historical cohort was identified for comparison. The primary outcome was the impact of the COVID-19 pandemic on the use of non-operative management in appendicitis. Secondary outcomes included imaging, negative appendicectomy rate (NAR), length of stay (LOS) and 30-day complications. RESULTS: A total of 63/164 (38%) patients compared to 79/191 (41%) were diagnosed with appendicitis before and after the guidelines were introduced (p = 0.589). CT scanning increased (71/164 vs 105/191; p = 0.033) while ultrasound scanning decreased (71/164 vs 62/191; p = 0.037). Appendicitis was more likely to be managed non-operatively (11/63 vs 51/79; p < 0.001) and, of those managed surgically, with an open approach (3/52 vs 26/28 p < 0.001). The NAR also reduced (5/52 vs 0/28; p = 0.157). LOS was shorter in non-operatively managed patients (1 day vs 3 days; p < 0.001) without a difference in complications (10/51 vs 4/28; p = 0.760). CONCLUSION: Introduction of the guidelines was associated with changes in practice. Despite these changes, short-term complications did not increase and LOS decreased. Questions remain on the longer-term complication rates in non-operatively managed patients.


Assuntos
Apendicite/diagnóstico , Apendicite/terapia , COVID-19/prevenção & controle , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicectomia , Apendicite/etiologia , COVID-19/diagnóstico , COVID-19/epidemiologia , Estudos de Coortes , Feminino , Humanos , Laparoscopia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Reino Unido , Adulto Jovem
20.
Expert Rev Gastroenterol Hepatol ; 15(6): 657-664, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33350352

RESUMO

INTRODUCTION: Appendectomy remains the gold standard for treating uncomplicated and complicated appendicitis. However, the vermiform appendix may play a significant role in the immune system (secondary immune function) and maintain a reservoir of the normal microbiome for the human body. The aim of this study was to summarize the long-term effects after appendectomy and discuss whether appendectomy is suitable for all appendicitis patients. AREAS COVERED: A comprehensive and unbiased literature search was performed in PubMed. The terms 'appendix,' 'appendicitis,' 'appendectomy,' and 'endoscopic retrograde appendicitis therapy' were searched in the title and/or abstract. This review summarizes the long-term effects of appendectomy on some diseases in humans and describes three methods including appendectomy, medical treatment, and an 'organ-sparing' technique, named endoscopic retrograde appendicitis therapy (ERAT) to treat appendicitis. EXPERT OPINION: Appendectomy remains the first-line therapy for appendicitis. The patient's problem is appendix, not appendicitis. If we treat appendicitis, the problem should be resolved. During COVID-19, an initial antibiotic treatment of mild appendicitis represents a promising strategy. For patients who are worried about the long-term adverse effect after appendectomy and have a strong desire to preserve the appendix and are aware of the risk of appendicitis recurrence, medical treatment, or ERAT could be proposed.


Assuntos
Apendicectomia/efeitos adversos , Apendicite/cirurgia , COVID-19/prevenção & controle , Complicações Pós-Operatórias/epidemiologia , Antibacterianos/uso terapêutico , Apendicite/tratamento farmacológico , Apendicite/etiologia , COVID-19/epidemiologia , COVID-19/transmissão , Endoscopia , Humanos , Seleção de Pacientes
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