Periappendicitis: is it a clinical entity?

The aim of this study was to identify clinical parameters that may help distinguish periappendicitis from the more common clinical entity of acute appendicitis. Serosal inflammation of the appendix without mucosal involvement constitutes the condition known as periappendicitis. In most situations this is a sequel of extra-appendicular sepsis and is likely to benefit from treatment targeted to the underlying pathology. But the majority of these cases are initially treated for acute appendicitis as clinical distinction between the two conditions is difficult. In this study some commonly used clinical yardsticks have been analyzed with respect to their value in this subtle diagnosis. We reviewed 231 successive cases clinically diagnosed as acute appendicitis; of these 18 had histologically demonstrated periappendicitis. Eight parameters were studied: age, gender, temperature, white blood cell count, location and duration of pain, associated symptoms, and peritoneal signs. Significant statistical differences were found between the two groups with regard to pain location, pain duration, and the presence of peritoneal signs. It may be possible to suspect periappendicitis preoperatively with meticulous clinical assessment. This may be of value in avoiding missed nonappendicular pathologies.

Appendicitis due to tongue stud ingestion: a case study and review of management plans.

Among the causes of appendicitis, foreign body obstruction of the appendiceal lumen is one of the rarest. In the majority of cases, swallowed foreign bodies pass through the alimentary system without causing any significant disease manifestation. Of those items that are swallowed, rigid and/or sharp ones, such as needles, have the greatest potential to enter the appendiceal lumen and cause an inflammatory reaction with or without perforation. In this case report, appendectomy was performed in a patient who was symptomatic after swallowing a sharp foreign body.