26
|
Kambadakone AR, Santillan CS, Kim DH, Fowler KJ, Birkholz JH, Camacho MA, Cash BD, Dane B, Felker RA, Grossman EJ, Korngold EK, Liu PS, Marin D, McCrary M, Pietryga JA, Weinstein S, Zukotynski K, Carucci LR. ACR Appropriateness Criteria® Right Lower Quadrant Pain: 2022 Update. J Am Coll Radiol 2022; 19:S445-S461. [PMID: 36436969 DOI: 10.1016/j.jacr.2022.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
This document focuses on imaging in the adult and pregnant populations with right lower quadrant (RLQ) abdominal pain, including patients with fever and leukocytosis. Appendicitis remains the most common surgical pathology responsible for RLQ abdominal pain in the United States. Other causes of RLQ pain include right colonic diverticulitis, ureteral stone, and infectious enterocolitis. Appropriate imaging in the diagnosis of appendicitis has resulted in decreased negative appendectomy rate from as high as 25% to approximately 1% to 3%. Contrast-enhanced CT remains the primary and most appropriate imaging modality to evaluate this patient population. MRI is approaching CT in sensitivity and specificity as this technology becomes more widely available and utilization increases. Unenhanced MRI and ultrasound remain the diagnostic procedures of choice in the pregnant patient. MRI and ultrasound continue to perform best in the hands of the experts. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
Collapse
|
27
|
McMullan BJ, Valentine JC, Hall L, Thursky K. Disease and economic burden of infections in hospitalised children in New South Wales, Australia. AUST HEALTH REV 2022; 46:471-477. [PMID: 35667892 DOI: 10.1071/ah21360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/10/2022] [Indexed: 11/23/2022]
Abstract
ObjectivesTo describe the burden of disease and hospitalisation costs in children with common infections using statewide administrative data.MethodsWe analysed hospitalisation prevalence and costs for 10 infections: appendicitis, cellulitis, cervical lymphadenitis, meningitis, osteomyelitis, pneumonia, pyelonephritis, sepsis, septic arthritis, and urinary tract infections in children aged <18 years admitted to hospital within New South Wales, Australia, using an activity-based management administrative dataset over three financial years (1 July 2016-30 June 2019).ResultsAmong 339 077 admissions, 28 748 (8.48%) were coded with one of the 10 infections, associated with a total hospitalisation cost of AUD230 905 190 and a per episode median length-of-stay of 3 bed-days. Pneumonia was the most prevalent coded infection (3.1% [n = 10 524] of all admissions), followed by appendicitis (1.61%; n = 5460), cellulitis (1.22%; n = 4126) and urinary tract infections (0.94%; n = 3193). Eighty per cent of children (n = 22 529) were admitted to a non-paediatric hospital. Mean costs were increased 1.18-fold per additional bed-day, 2.14-fold with paediatric hospital admissions, and 5.49-fold with intensive care unit admissions, which were both also associated with greater total bed-day occupancy. Indigenous children comprised 9.7% of children admitted with these infections, and mean per episode costs, and median bed-days were reduced compared with non-Indigenous children (0.84 [95% CI 0.78, 0.89] and 3 (IQR: 2,5) vs 2 (IQR: 2,4), respectively.ConclusionsInfections in children requiring hospitalisation contributea substantial burden of disease and cost to the community. This varies by infection, facility type, and patient demographics, and this information should be used to inform and prioritise programs to improve care for children.
Collapse
|
28
|
Adumah CC, Mosanya AO, Salami OF, Apata OK, Ogundele IO, Onuoha EC. Early Experience of Laparoscopic Surgery in a Teaching Hospital in Rural Nigeria. West Afr J Med 2022; 39:516-520. [PMID: 35633634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION/BACKGROUND Laparoscopic surgery is still at its budding phase in low resource countries. The reasons for this include poor financing of the health sector and lack of trained personnel. The aim of this article is to highlight our initial experiences, our challenges in setting up laparoscopic surgery in a private tertiary hospital in rural southwestern Nigeria, and to share our efforts towards alleviating these challenges. METHODOLOGY A retrospective analysis of all patient who had laparoscopic surgery between January 2019 and December 2020 at the Surgery Department of Babcock University Teaching Hospital, Ilisan, Ogun State was carried out. Their sociodemographic, preoperative and intraoperative data along with postoperative records were subjected to descriptive analysis. RESULTS During the period, 19 patients had laparoscopic procedures: 12(63.2%) males and 7 (36.8%) females with age ranging from 4 to 63years. The most common indication for laparoscopic surgery was appendicitis, representing 84.2% of the procedures. Most of the procedures were done on emergency basis (63.1%) while 36.9% were elective procedures. All the procedures were therapeutic though in 21.1% we started with diagnostic intent but intra-operatively we proceed to therapeutic procedure following confirmation of the diagnosis. The duration of the procedures ranged from 40 minutes to 107 minutes with a mean duration of 74.8±19 minutes. No intra or post operative complications were recorded in this cohort of patients. The mean duration of hospital stay was 2 days. CONCLUSION Laparoscopic surgery is safe and feasible in low resource setting. We recommend that centers embarking on laparoscopic surgeries should start with diagnostic procedures and gradually incorporate therapeutic procedures as they improve in proficiency.
Collapse
|
29
|
Sluijter TE, Yakar D, Kwee TC. On-call abdominal ultrasonography: the rate of negative examinations and incidentalomas in a European tertiary care center. Abdom Radiol (NY) 2022; 47:2520-2526. [PMID: 35486165 PMCID: PMC9226090 DOI: 10.1007/s00261-022-03525-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 11/24/2022]
Abstract
Objectives To determine the proportions of abdominal US examinations during on-call hours that are negative and that contain an incidentaloma, and to explore temporal changes and determinants. Methods This study included 1615 US examinations that were done during on-call hours at a tertiary care center between 2005 and 2017. Results The total proportion of negative US examinations was 49.2% (795/1615). The total proportion of US examinations with an incidentaloma was 8.0% (130/1615). There were no significant temporal changes in either one of these proportions. The likelihood of a negative US examination was significantly higher when requested by anesthesiology [odds ratio (OR) 2.609, P = 0.011], or when the indication for US was focused on gallbladder and biliary ducts (OR 1.556, P = 0.007), transplant (OR 2.371, P = 0.005), trauma (OR 3.274, P < 0.001), or urolithiasis/postrenal obstruction (OR 3.366, P < 0.001). In contrast, US examinations were significantly less likely to be negative when requested by urology (OR 0.423, P = 0.014), or when the indication for US was acute oncology (OR 0.207, P = 0.045) or appendicitis (OR 0.260, P < 0.001). The likelihood of an incidentaloma on US was significantly higher in older patients (OR 1.020 per year of age increase, P < 0.001) or when the liver was evaluated with US (OR 3.522, P < 0.001). Discussion Nearly 50% of abdominal US examinations during on-call hours are negative, and 8% reveal an incidentaloma. Requesting specialty and indication for US affect the likelihood of a negative examination, and higher patient age and liver evaluations increase the chance of detecting an incidentaloma in this setting. These data may potentially be used to improve clinical reasoning and restrain overutilization of imaging. Supplementary Information The online version contains supplementary material available at 10.1007/s00261-022-03525-1.
Collapse
|
30
|
Montali F, Costi R, Virgilio E, Presicci C, Sartorio C, Pedrazzini M. Omental torsion at the time of COVID-19 in Northern Italy: a case report of conservative management with a review of the pertinent literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022123. [PMID: 35421073 PMCID: PMC10510973 DOI: 10.23750/abm.v93is1.11903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND AIM In middle-aged men, omental torsion (OT) can be a cause of acute abdomen.The right side of the omentum is longer, heavier and more mobile than the left one and, as a consequence, it can twist more easily on its vascular axis. Consequently, OT localization in the lower right quadrant is more frequent, and therefore it can mimic acute appendicitis clinical onset.In most cases, OT is defined as "primary" in the absence of any other underlying pathologies, or, rarely, "secondary", when caused by other intra-abdominal diseases such as inguinal hernia, tumors, cysts or post-surgical scarring. To date, clinical diagnosis of OT still remains a challenging one in a preoperative setting and most cases are diagnosed intraoperatively. If diagnosis is correctly achieved preoperatively by adequate imaging examinations, most patients presenting with OT do not undergo surgery anymore. Such considerations gain importance at the time of COVID 19 pandemic, where a conservative management and an early discharge may be preferred owing to in-hospital morbidity after abdominal surgery whenever surgery may be avoided. METHODS AND RESULTS We present a case of an OT successfully treated in a non-operative manner during COVID-19 outbreak in Norhern Italy and offer a review of the literature that supports such a clinical attitude. Conclusions: OT preoperative diagnosis is challenging and is usually achieved by abdominal CT-scan. The suggested OT initial management is conservative, leaving a surgical approach, preferably by laparoscopy, for the 15% of cases not improving with a non-surgical approach.
Collapse
|
31
|
Kartal İ. Childhood neuroendocrine tumors of the digestive system: A single center experience. Medicine (Baltimore) 2022; 101:e28795. [PMID: 35147110 PMCID: PMC8830841 DOI: 10.1097/md.0000000000028795] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 01/18/2022] [Indexed: 01/04/2023] Open
Abstract
The prevalence and incidence of neuroendocrine tumors (NETs) are increasing in the pediatric population. This increase can be associated with improved diagnostics and increased detection rates of the disease. We aimed to discuss the clinical and pathological characteristics of patients with this rare disease who were followed and treated at our center.The medical records of children (aged 0-18 years) with NETs of the digestive system, followed up and treated between 2007 and 2020 at Ondokuz Mayis University Faculty of Medicine, were reviewed.Overall, 16 patients (8 girls and 8 boys) were analyzed. Fifteen patients had NETs in the appendix; 14 of these had grade I NETs, and 1 had grade II NETs. No additional surgery was performed except for appendectomy. All patients were in complete remission at the last follow-up (median 38 months). The other patient, a 12-year-old girl, had a primary hepatic neuroendocrine carcinoma (grade III NET). Three cycles of neoadjuvant and adjuvant platinum-based chemotherapy were administered, and right hepatectomy was performed to remove the mass. The patient is being followed-up for approximately 3 years without disease recurrence.Most NETs are observed in adults, and most studies have focused on this population. Unlike adults, increasing awareness of the disease in the pediatric population (especially in cases of acute appendicitis), discovering therapeutic treatments, and sharing experiences are crucial for developing an optimal therapeutic approach for pediatric NETs.
Collapse
|
32
|
Rossi E, Imdahl A. [ Appendicitis in the elderly - a challenge]. MMW Fortschr Med 2022; 164:44-45. [PMID: 35088332 DOI: 10.1007/s15006-021-0572-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
|
33
|
White MG, Morgan RB, Drazer MW, Eng OS. Gastrointestinal Surgical Emergencies in the Neutropenic Immunocompromised Patient. J Gastrointest Surg 2021; 25:3258-3264. [PMID: 34506017 PMCID: PMC8665083 DOI: 10.1007/s11605-021-05116-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/03/2021] [Indexed: 01/31/2023]
Abstract
Surgeons encounter neutropenic patients through elective or emergency consultation with increasing regularity. As medical management continues to extend the lives of patients with benign hematologic diseases, hematologic malignancies, solid malignancies, or iatrogenic neutropenia, more patients are presenting with infectious complications caused and/or complicated by their neutropenia. This leaves surgeons in the difficult position of managing medically fragile patients with unusual presentations of common disease processes. These patients often fall outside of classical guidelines and treatment pathways. Many studies addressing these issues are retrospective and non-randomized. Here, we review common emergency gastrointestinal surgery scenarios and their management in the setting of a neutropenic patient. While biliary disease, appendicitis, anorectal disease, and perforations will be covered in detail, an extensive appreciation of a patient's medical or oncologic disease course and appropriate utilization of consultants such as interventional radiology, gastroenterology, and hematology is often necessary.
Collapse
|
34
|
Amato L, Valeri M, Petrina A, Boncompagni M, Pietropaoli N, Ciaccarini R. An extremely rare finding of goblet cell carcinoid of the appendix. A case report. Ann Ital Chir 2021; 10:S2239253X21035672. [PMID: 34636340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Goblet cell carcinoid or carcinoma (GCC) refers to an extremely rare appendiceal tumor usually diagnosed on post-operative histology as an incidental finding. Primary cancers of the vermiform appendix are quite rare, representing less than 1% of all gastrointestinal malignancies. GCCs are considered as a distinct entity of appendiceal tumors, consisting of both epithelial (glandular) and neuroendocrine elements containing goblet cells. This entity tends to be more aggressive than typical carcinoid tumors as it often presents with metastatic disease. Therefore, an early recognition and an appropriate grading is essential. The 5-year overall survival is 14-22% in stage III-IV disease. As a matter of fact, GCC warrants more aggressive surgical and medical (chemotherapy) treatments than typical carcinoid tumors. We, hereby, report a case of a 67-year old male presenting with an acute abdominal obstruction and a severe tenderness predominant in his right lower quadrant, together with an endoscopic and radiological suspect of left colonic malignancy and acute appendicitis. Left hemicolectomy and appendicectomy were performed and pathological specimens revealed a lowgrade adenocarcinoma of the descending colon and a high-grade appendiceal goblet cell carcinoid. Subsequent right hemicolectomy was performed according to the current guidelines. GCCs are more aggressive compared with conventional appendiceal tumors but less aggressive compared with adenocarcinomas and they often present with serosal and mesoappendiceal involvement. The lack of a standardized classification system for GCC and the discrepancies in specific reliable markers are responsible for an insufficient prognostic and predictive value at diagnosis. KEY WORDS: Appendiceal neoplasms, Carcinoid tumor, Colectomy, Goblet cells, Immunochemistry.
Collapse
|
35
|
Gulati S, Rathi V, Jain S, Bhatt S. Incidentalomas of the female genital tract on 64-slice MDCT: a clinico-radiological pictorial review. Abdom Radiol (NY) 2021; 46:4420-4431. [PMID: 33890122 DOI: 10.1007/s00261-021-03086-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/01/2021] [Accepted: 04/09/2021] [Indexed: 11/27/2022]
Abstract
Sonography is the imaging modality of choice for diagnosing diseases of the female genital tract due to its high resolution, easy availability, low cost and lack of radiation. CT is not advocated for the primary evaluation of the female pelvis. However, with the advent of Multidetector CT (MDCT), females of all ages undergo CT scan of the abdomen and pelvis for myriad non-gynaecological diseases, e.g. subacute intestinal obstruction, abdominal lump, abdominal tuberculosis, appendicitis, ureteric colic, pancreatitis, oncological staging, follow-up, etc. Incidental female genital tract disorders were seen on these scans that are a dilemma for both, the radiologists and the clinicians. The objective of this pictorial review is to characterise the incidentally detected lesions of the female genital tract observed on 64-slice MDCT by correlating with sonography, if necessary, and establishing a clinico-radiological diagnosis. Our aim is to emphasise that the radiologist may be the first person to recognise a gynaecologic disorder and hence can play a significant role in patient management.
Collapse
|
36
|
Nasher O, Alizai N. Enterocolic lymphocytic phlebitis: a rare pathology in children. BMJ Case Rep 2021; 14:e243826. [PMID: 34426428 PMCID: PMC8383883 DOI: 10.1136/bcr-2021-243826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 11/04/2022] Open
Abstract
Enterocolic lymphocytic phlebitis (ELP) is a rare pathology, usually seen in the adult population. The condition affects the venous vasculature of the intestine sparing the arteries and lymphatics. It is commonly identified histologically after surgical resection making the preoperative diagnosis a clinical challenge. As the condition can lead to intestinal ischaemia and necrosis, surgical resection of the affected segment is the treatment of choice. We report the case of a 9-year-old girl who presented with a 2-day history of lower abdominal pain and anorexia. The initial diagnosis of appendicitis was made clinically and the patient underwent a diagnostic laparoscopy . The appendix was macroscopically normal and there were no other obvious intra-abdominal pathologies to account for her presenting complaints . The appendix was removed, as per the preoperative discussion and consent from parents. She recovered well and was discharged home the following day. The histological examination of the appendix demonstrated ELP. We describe this rare clinical entity in a child especially in view of the scarce published literature in the paediatric population.
Collapse
|
37
|
Michelson KA, Dart AH, Finkelstein JA, Bachur RG. Validation of an Automated System for Identifying Complications of Serious Pediatric Emergencies. Hosp Pediatr 2021; 11:864-878. [PMID: 34290041 PMCID: PMC8651277 DOI: 10.1542/hpeds.2020-005792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Illness complications are condition-specific adverse outcomes. Detecting complications of pediatric illness in administrative data would facilitate widespread quality measurement, however the accuracy of such detection is unclear. METHODS We conducted a cross-sectional study of patients visiting a large pediatric emergency department. We analyzed those <22 years old from 2012 to 2019 with 1 of 14 serious conditions: appendicitis, bacterial meningitis, diabetic ketoacidosis (DKA), empyema, encephalitis, intussusception, mastoiditis, myocarditis, orbital cellulitis, ovarian torsion, sepsis, septic arthritis, stroke, and testicular torsion. We applied a method using disposition, diagnosis codes, and procedure codes to identify complications. The automated determination was compared with the criterion standard of manual health record review by using positive predictive values (PPVs) and negative predictive values (NPVs). Interrater reliability of manual reviews used a κ. RESULTS We analyzed 1534 encounters. PPVs and NPVs for complications were >80% for 8 of 14 conditions: appendicitis, bacterial meningitis, intussusception, mastoiditis, myocarditis, orbital cellulitis, sepsis, and testicular torsion. Lower PPVs for complications were observed for DKA (57%), empyema (53%), encephalitis (78%), ovarian torsion (21%), and septic arthritis (64%). A lower NPV was observed in stroke (68%). The κ between reviewers was 0.88. CONCLUSIONS An automated method to measure complications by using administrative data can detect complications in appendicitis, bacterial meningitis, intussusception, mastoiditis, myocarditis, orbital cellulitis, sepsis, and testicular torsion. For DKA, empyema, encephalitis, ovarian torsion, septic arthritis, and stroke, the tool may be used to screen for complicated cases that may subsequently undergo manual review.
Collapse
|
38
|
Pizzol D, Trott M, Grabovac I, Antunes M, Colangelo AC, Ippoliti S, Ilie CP, Carrie A, Veronese N, Smith L. Laparoscopy in Low-Income Countries: 10-Year Experience and Systematic Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115796. [PMID: 34071312 PMCID: PMC8198316 DOI: 10.3390/ijerph18115796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 11/16/2022]
Abstract
Laparoscopy is a procedure that ultimately reduces hospital stay time and speeds up post-operative recovery. It is mainly performed in high-income countries but its implementation in many low- and middle-income countries (LMICs) is increasing. However, no aggregate data exist regarding the outcomes of this procedure in resource-limited settings. We retrospectively reviewed all cases of laparoscopy recorded from January 2007 to March 2017 at the Department of Surgery of Beira to assess the related outcomes. Moreover, we performed a systematic review of the laparoscopic practices and outcomes in low-income countries. Data from the Department of Surgery of Beira identified 363 laparoscopic procedures, mainly relating to gynecological diseases, cholelithiasis, and appendicectomy with only a 1.6% complication rate (6 cases) and a 1.9% conversion rate (7 cases) to open surgery. The systematic review showed a pooled risk of overall complications significantly lower in laparoscopic vs. open appendicectomy (OR = 0.43; 95% CI 0.19-0.97; I2 = 85.7%) and a significantly lower risk of infection (OR = 0.53; 95% CI 0.43-0.65; I2 = 0.00%). The pooled SMD in operation duration in laparoscopic vs. open appendectomy was 0.58 (95% CI -0.00; 1.15; I2 = 96.52), while the pooled SMD in hospitalization days was -1.35 (95% CI -1.87; -0.82; I2 = 96.41). Laparoscopy is an expensive procedure to adopt as it requires new equipment and specialized trained health workers. However, it could reduce post-operative costs and complications, especially in terms of infections. It is crucial to increase its accessibility, acceptability, and quality particularly in LMICs, especially during this COVID-19 era when the reduction of patient hospitalization is essential.
Collapse
|
39
|
Seifert J, Böthig R, Wolter S, Izbicki JR, Thietje R, Tachezy M. [The paraplegic patient-Characteristics of diagnostics and treatment in visceral surgery]. Chirurg 2021; 92:551-558. [PMID: 33630122 PMCID: PMC8159781 DOI: 10.1007/s00104-021-01364-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients with paraplegia develop syndrome-specific complications relevant to visceral surgery, which occur in the context of the acute spinal shock or as a consequence of the progressive neurogenic bowel dysfunction (NBD) with the formation of an elongated colon and/or megacolon. Moreover, acute abdominal emergencies, such as acute appendicitis, cholecystitis, diverticulitis and ileus images, pose particular challenges for the clinician when the clinical signs are atypical or even absent. The expansion of indications for obesity surgery to include patients with a paraplegic syndrome, whose independence and quality of life can be impaired due to the restricted mobility, especially by obesity, is becoming increasingly more important. OBJECTIVE This article provides an overview of the special requirements and aspects in the treatment of this special patient collective and to show the evidence of paraplegia-specific visceral surgery treatment. MATERIAL AND METHODS Targeted literature search in Medline and Cochrane library (German and English, 1985-2020). RESULTS AND CONCLUSION The clinical treatment of paraplegic patients requires in-depth knowledge of the pathophysiological changes at the different height of the paraplegia (upper versus lower motor neuron) and the phase of the disease (spinal shock versus long-term course). Missing or atypical clinical symptoms of acute diseases delay a quick diagnosis and make early diagnosis essential. The evidence for surgical treatment of the acute and chronic consequences of NBD is based on small retrospective series and case reports, as is that for special indications such as obesity surgery.
Collapse
|
40
|
Auer S. [Not Available]. REVUE MEDICALE SUISSE 2021; 17:106. [PMID: 33443840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
|
41
|
Bernardes Filho F, Andrade Prestes L, Mendes Queiroz R. Amyand's Hernia: A Fortuitous Diagnosis. ACTA MEDICA PORT 2020; 33:843. [PMID: 33496253 DOI: 10.20344/amp.11651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 07/26/2019] [Accepted: 07/26/2019] [Indexed: 11/20/2022]
|
42
|
Takiguchi N, Ota H, Takeoka T, Ito K, Miyazaki H, Ueda H, Nakai S, Matsuno H, Konishi K, Okada K, Yokoyama S, Fukunaga M. [A Case of Appendix Torsion with Low-Grade Appendiceal Mucinous Neoplasm]. Gan To Kagaku Ryoho 2020; 47:2314-2316. [PMID: 33468945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
An 84-year-old woman with a chief complaint of right lower abdominal pain was admitted to our hospital in November 20XX. Abdominal CT scan revealed a 9.6×4.1 cm diameter low density area proximal to the 13 mm diameter appendix, which led to perforated appendicitis with a huge abscess. The patient underwent an open appendectomy with partial cecum resection. The appendix was found to be twisted by 540°. The pathological diagnosis was low-grade appendiceal mucinous neoplasm(LAMN). Recent research has found that the use of laparoscopic surgery for the treatment of LAMN has been increasing. Appropriate surgical intervention should be considered for LAMN because it is a borderline malignancy. Careful treatment with laparoscopic surgery might be considered as one of the treatment options for LAMN. We hope to accumulate more cases of LAMN to confirm our results.
Collapse
|
43
|
Costamagna G. Response. Gastrointest Endosc 2020; 92:1279-1280. [PMID: 33237005 DOI: 10.1016/j.gie.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/04/2020] [Indexed: 12/11/2022]
|
44
|
Nakamoto H, Yokota R, Namba H, Ishikawa T, Yamada K, Hosoda M, Taguchi K. A Benign Appendiceal-Colonic Fistula, Diagnosed and Managed Laparoscopically: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e925946. [PMID: 33162549 PMCID: PMC7666437 DOI: 10.12659/ajcr.925946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/28/2020] [Accepted: 09/16/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Treatment methods for appendiceal-colonic fistulas differ greatly depending on whether lesions are benign or malignant. If the tumor is malignant, appendectomy with lymph node resection (ileocecal resection or right hemicolectomy) should be performed. There is no consensus on the method of surgery for organs infiltrated by appendiceal cancer. Furthermore, there are no reported laparoscopic cases that could be prevented from over-surgery by laparoscopy examination or rapid intraoperative pathological examination. CASE REPORT A 76-year-old man presented with positive fecal occult blood. Lower endoscopy revealed a 10-mm tumor in the rectosigmoid colon accompanied by white moss. A biopsy showed inflammatory granulation and no malignancy. Fluorodeoxyglucose-positron emission tomography showed highly increased accumulation at the tip of the appendix, and the standardized uptake value max was 7.3. We suspected a benign lesion rather than appendiceal cancer with infiltration into the rectosigmoid colon; therefore, we performed laparoscopic appendectomy and wedge-shaped resection of the rectum of the sigmoid colon. An intraoperative rapid pathological examination showed no appearance of malignancy; therefore, additional resection was omitted, and an ileostomy was created in the right lower quadrant. A permanent pathological examination showed complicated appendicitis, with no appearance of malignancy. The ileostomy was closed on postoperative day 25, and the patient was discharged on postoperative day 32. CONCLUSIONS In cases where there is difficulty in identifying whether the appendiceal-colonic fistula lesion is benign or malignant, laparoscopy and intraoperative rapid pathological examination may be useful in avoiding excessive treatment.
Collapse
|
45
|
Qu C, Gao K, Li W. Viral infection and pediatric pancreatitis. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 112:815-816. [PMID: 32954771 DOI: 10.17235/reed.2020.6933/2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We have read the article entitled "A rare association: acute pancreatitis caused by the influenza virus A with secondary appendicitis in a six-year-old girl" by Láinez Ramos-Bossini AJ et al. with great interest. This case report is successful and informative. We are specifically interested in viruses and pediatric pancreatitis and would like to mention a few crucial points about pediatric pancreatitis caused by a viral infection.
Collapse
|
46
|
Kazaryan AM, Warberg EA, Mala T. Surgery for Appendicitis: Where Do We Go? Rational Imaging and Surgical Approach. World J Surg 2020; 44:2974-2975. [PMID: 32440954 DOI: 10.1007/s00268-020-05594-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
47
|
Tsang JS, Chung Foo C, Yip J, Kwok Choi H, Lun Law W, Siu Hung Lo O. Emergency surgery comparison of right versus left acute colonic diverticulitis: A 10-year outcome analysis. Surgeon 2020; 19:150-155. [PMID: 32690462 DOI: 10.1016/j.surge.2020.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/14/2020] [Accepted: 04/20/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The difference in outcome between right (RCD) and left colonic diverticulitis (LCD) is not well established. The aim of this study was to analyse the presentation and surgical outcome of RCD versus left-sided disease following emergency surgery. METHOD We conducted a retrospective review of patients presenting with acute diverticulitis over a 10-year period from 2004 to 2014 to a tertiary unit. Patient demographics, Hinchey classification, need for emergency surgery, perioperative outcome and recurrence were evaluated. RESULTS In total 360 patients presented with acute diverticulitis, 218 (61%) were right-sided and 142 (39%) were left-sided. The mean age (57 yrs vs 68 yrs) and median length of stay (4 days vs 5 days) were significantly less in RCD (p < 0.001). The need for emergency surgery was similar between RCD and LCD (30.7% vs 23.2%, p = 0.12). Sixty-seven (31%) patients with RCD required emergency surgery, 42 (62.7%) of these were based on a presumptive diagnosis of appendicitis and underwent laparoscopic appendicectomy only. Operative morbidity (10.4% vs 51.5%, p < 0.001) and mortality were significantly higher in LCD (1.5% v 15.2%, p = 0.007). Subgroup analysis of non-appendicectomy, RCD patients, showed LCD were more likely to require surgery (11.5% vs 23.2%, p = 0.003). There was no difference in recurrence (p = 0.6). CONCLUSION Right colonic diverticulitis patients are younger and disease course is more benign compared to LCD. Presentation can be confused with appendicitis without proper imaging. In the rare cases where emergency surgery is required, RCD is associated with a lower operative morbidity and mortality compared to left-sided disease.
Collapse
|
48
|
Toh PY, Parys S, Watanabe Y. Appendiceal Diverticular Disease: A 10-year Retrospective Study of Cases from Tertiary Hospitals in Western Australia. Chirurgia (Bucur) 2020; 115:348-356. [PMID: 32614290 DOI: 10.21614/chirurgia.115.3.348] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2020] [Indexed: 11/23/2022]
Abstract
Background: Appendiceal diverticular disease (ADD) is typically a histological diagnosis. Our paper aims to investigate the implications of ADD compared to acute appendicitis (AA). Methods: We conducted a retrospective data collection of patients who had undergone an appen dicectomy in three tertiary hospitals across Western Australia between 2009-2019 and included patients with histopathological diagnoses of ADD and AA. Results: Thirty-seven patients with ADD and forty with AA were included. The mean age in the ADD group was significantly older (p 0.001) at 50.1 compared to the AA group (37.3). The mean white cell count (WCC) in the ADD group was lower than the AA group (11x109/L vs. 13.3x109/L, p 0.001), whereas the C-Reactive Protein (CRP) level was greater, although not statistically significant. The ADD group had a greater risk of major surgery (p 0.05) and complications such as appendiceal perforation and appendiceal mass (p 0.05). Post-operative colonoscopy also demon strated a higher incidence of polyps in patients with ADD (19% vs. 2.5%, p 0.001). Conclusion: ADD frequently presents with clinical features indiscernible from AA. Our study demonstrates that ADD is associated with higher rates of appendiceal perforation, polyps and malignancy. We recommend that patients with ADD be advised to have a colonoscopy post-opera tively to rule out underlying malignancy.
Collapse
|
49
|
Yang H, Shu Q, Guo XD. Letter to the Editor concerning: "Nonoperative treatment for nonperforated appendicitis in children: a systematic review and meta-analysis". Pediatr Surg Int 2020; 36:861-862. [PMID: 32394060 DOI: 10.1007/s00383-020-04668-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2020] [Indexed: 11/26/2022]
|
50
|
Michela Chiarello M, Brisinda G. An invited commentary on "Reducing the negative appendectomy rate with the laparoscopic appendicitis score; a multicenter prospective cohort and validation study" (Int J Surg 2020; Epub ahead of print). Int J Surg 2020; 79:292-293. [PMID: 32526268 DOI: 10.1016/j.ijsu.2020.05.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 02/08/2023]
|