The Diagnostic Value of SCUBE1 in Acute Appendicitis

BACKGROUND

SCUBE1 has recently been studied as a diagnostic biomarker for acute coronary syndrome, ischemic stroke, and acute mesenteric ischemia. The aim of this study is to evaluate the value of SCUBE1 and routine parameters used in patients diagnosed with acute appendicitis.

METHODS

Of the 150 patients admitted to the emergency department whose initial diagnosis were acute appendicitis (AA), 103 patients were excluded from the study for various reasons. Forty-seven patients with a definitive diagnose of AA and 43 volunteers were enrolled in the study. SCUBE1, Alvarado scoring (ASK), C-reactive protein (CRP), and routine tests were compared between the two groups.

RESULTS

SCUBE1 was not statistically significant between the patient and the control groups (p = 0.209). SCUBE1 was significantly higher in the CRP (+) group (p = 0.048). Both the diameter of the appendix on computerized tomography (CT) and SCUBE1 levels increased proportionally (p = 0.043). CRP was significantly higher in the perforated appendicitis (PA) compared to non-perforated appendicitis (NPA) (p = 0.007). White blood cell (WBC) count was not differential for perforation (p = 0.06).

CONCLUSIONS

Although SCUBE1 was significantly higher in CRP (+) patients, it was not a diagnostic biomarker for AA. There was a positive correlation between SCUBE1 values and the diameter of appendix measured on CT.

Perforated sub-hepatic appendix; rare presentation of a common disease

An elderly gentleman presented to our emergency with a 10-day history of right upper quadrant pain and nausea with associated tenderness on examination. His white cell counts were raised with predominant neutrophils with ultrasound evidence of a heterogeneous sub-hepatic collection, not associated with fever, diarrhoea or vomiting. He had a similar episode 3 weeks ago, which resolved with antibiotics. Initially thought to be a perforated acute appendicitis or a liver abscess a CT scan was done to further substantiate our finding. This to the contrary revealed a perforated sub hepatic appendix. Patient was treated conservatively with IV fluids and antibiotics and the sub hepatic collection was aspirated under ultrasound guidance. He responded well to treatment and made an uneventful recovery.

[Application of laparoscopy in gastrointestinal abdominal emergency operation for patients over 65 years old]

OBJECTIVE

To explore the clinical application of laparoscopy in gastrointestinal abdominal emergency operation for patients over 65 years old.

METHODS

Clinical data of 138 cases (age>65 years) with acute abdomen undergoing laparoscopic surgery from January 2006 to June 2014 were analyzed retrospectively. Data of 170 cases treated by laparotomy during the same period were enrolled as controls.

RESULTS

The laparoscopy group and the laparotomy group showed statistically significant differences in blood loss [(107.1±47.7) ml vs. (163.6±106.5) ml, P=0.000], postoperative complications rate [2.9%(4/138) vs. 12.9%(22/170), P=0.022], hospital stay [(10.5±7.5) d vs. (16.5±9.9) d, P=0.044], postoperative ambulation time [(25.6±7.7) h vs. (33.2±5.6) h, P=0.020], and recovery time of postoperative gastrointestinal function [(36.9±9.1) h vs. (49.3±10.6) h, P=0.031]. Patients with acute appendicitis, upper digestive tract perforation and bowel obstruction in the laparoscopy group were superior to those in the laparotomy group in hospital stay, postoperative ambulation time, recovery time of postoperative gastrointestinal function and intraoperative blood loss(all P<0.01), while no significant differences in colon perforation and mesentery diseases were found in hospital stay, intraoperative blood loss and recovery time of postoperative gastrointestinal function between the two groups (all P>0.05).

CONCLUSIONS

Compared with laparotomy, the laparoscopy offers the advantages of less trauma, faster recovery, shorter hospital stay, and lower postoperative complications rate for patients over 65 years with acute abdomen.

Letter to the editor concerning the article: Figueiredo J, Santos A, Clemente H, Lourenço A, Costa S, Grácio MA, Belo S. Schistosomiasis and acute appendicitis. Acta Med Port. 2014;27:396-9

<strong>Keywords:</strong> Appendicitis/parasitology; Schistosomiasis; Angola; África.

Intussusception of the appendix mimicking appendicitis during pregnancy: a case report

BACKGROUND

Intussusception occurs when a segment of bowel and its associated mesentery telescopes into the lumen of the adjacent distal bowel. Appendiceal intussusception is a rare form of ileocoloc intussusception, is rarely diagnosed preoperatively, can mimic appendicitis and has not been previously reported during pregnancy.

CASE

A 31-year-old gravid woman at 27 1/7 weeks' gestation presented with symptoms suggestive of acute appendicitis and was found at laparoscopy to have complete appendiceal intussusception.

CONCLUSION

The list of causes of abdominal pain in pregnancy is very long, but the presence of right-sided abdominal tenderness with guarding and rebound are highly suggestive of acute appendicitis. Regardless of preoperative imaging, because the morbidity, and even mortality, from appendicitis is the morbidity of delay, early surgical intervention is recommended. This is a case of complete appendiceal intussusception mimicking acute appendicitis, but the treatment of both conditions is appendectomy.

Infarcted epiploic appendage of the vermiform appendix masquerading as acute appendicitis

Infrequent causes of right lower quadrant pain that mimic acute appendicitis include infarcted epiploic appendages. Although usually located in the colon, we report the very rare case of an infarcted epiploic appendage located directly on the serosal surface of the appendix itself. In a patient with right lower quadrant pain, the diagnosis of infarcted epiploic appendages is rarely made preoperatively and the incidence is rare. Definitive treatment is excision.

Omental torsion mimicking acute appendicitis: a case report

Primary omental torsion is an uncommon cause of an acute abdomen that can mimic acute appendicitis. Herein we report a case of suspected acute appendicitis that proved to be a distal segment of infarcted omentum secondary to primary torsion.