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Harding JA, Glick SN, Teplick SK, Kowal L. Appendiceal filling by double-contrast barium enema. GASTROINTESTINAL RADIOLOGY 1986; 11:105-7. [PMID: 3943669 DOI: 10.1007/bf02035044] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The barium enema is a safe and useful diagnostic modality in the evaluation of patients with suspected acute appendicitis. Complete appendiceal filling with barium virtually excludes this diagnosis. Frequently positive diagnostic information is obtained. Only 1 study in the literature documents the frequency of normal appendiceal filling by barium enema. The authors utilized the single-contrast technique. We recorded the frequency of normal appendiceal filling with the double-contrast technique and then compared our data with the previously published study to determine if there is a significant clinical disadvantage to the double-contrast technique when acute appendicitis is a diagnostic consideration.
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Abstract
Evaluation of abdominal pain in children poses a major challenge for the pediatrician and pediatric surgeon alike. Simple appendicitis remains one of the most difficult diagnoses in children. There has been an alarming increase in the incidence of perforated appendicitis, and professional delay has been found to be a factor in this increased rate. Therefore, this discussion focuses on appendicitis and its differential diagnosis.
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Abstract
A prospective study was conducted on 107 patients with negative findings at appendectomy. The operation was unnecessary in 94 of the patients. A cause for the symptoms could be found in 43 patients, 32 during operation and 11 later by investigation or by a second operation. Diagnosis remained unclear in 64 patients. There are many diseases that mimic acute appendicitis, and based on the disease entities encountered in this series, the surgeon must examine the abdominal organs carefully if the appendix is normal. The financial loss of negative appendectomy was substantial in our study, and the total early and late complication rate was 14 percent. Patients with negative appendectomy should be regularly followed up to 1 year, since 9.3 percent of patients had a diagnosis made later by investigation, and 12.1 percent had moderate to severe pain on follow-up. Possible means to cut down the negative appendectomy rate without increasing the perforation rate have been suggested herein for further evaluation.
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Neinstein LS, Braud BJ. Coincident acute appendicitis and hemorrhagic corpus luteal cyst. JOURNAL OF ADOLESCENT HEALTH CARE : OFFICIAL PUBLICATION OF THE SOCIETY FOR ADOLESCENT MEDICINE 1984; 5:137-8. [PMID: 6706790 DOI: 10.1016/s0197-0070(84)80013-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A case of coincident acute appendicitis and hemorrhagic corpus luteal cyst is presented. The difficulty of differentiating acute appendicits from gynecological problems is discussed. In addition, prior simultaneous occurrences of other abdominal emergencies with acute appendicitis are reviewed.
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Gough IR, Morris MI, Pertnikovs EI, Murray MR, Smith MB, Bestmann MS. Consequences of removal of a "normal" appendix. Med J Aust 1983; 1:370-2. [PMID: 6835144 DOI: 10.5694/j.1326-5377.1983.tb99414.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Five hundred consecutive cases of appendicectomy were reviewed. The incidence of non-inflamed appendices removed at operation was 29.6% and was nearly twice as high in females than in males (P less than 0.001). The incidence of perforated appendices in patients with acute appendicitis was low (6.5%), and there were no deaths. Postoperative complications, mostly infections occurred in 6.7% of patients with a non-inflamed appendix and in 19.3% of patients with appendicitis (P less than 0.001). No features of the history or examination were sufficiently discriminatory to enable a definite diagnosis to be reliably established before operation. Appendicectomy remains the safest management option in patients with suspected appendicitis in whom diagnostic doubt remains after thorough clinical evaluation and observation.
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Jess P, Bjerregaard B, Brynitz S, Holst-Christensen J, Kalaja E, Lund-Kristensen J. Acute appendicitis. Prospective trial concerning diagnostic accuracy and complications. Am J Surg 1981; 141:232-4. [PMID: 7457743 DOI: 10.1016/0002-9610(81)90164-1] [Citation(s) in RCA: 127] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In a prospective trial comprising 202 patients operated on because of suspicion of acute appendicitis, the diagnostic accuracy was 70 percent based on histologic examination of all removed appendices. The diagnostic accuracy was lowest in women less than 50 years old and in young patients (aged 20 years or less), being about 60 percent in both of these groups. The reasons were gynecologic disorders and uncharacteristic abdominal pains, respectively. Twenty-three of the 142 patients with acute appendicitis had perforation (16 percent). The frequency of perforation was significantly higher in patients more than 50 years old. Postoperative complications were seen in 11 percent of the patients. There was no significant difference in the frequency of complications in patients with a normal appendix and no other surgical abdominal disorder and patients with nonperforated appendicitis. However, there was a statistically significant difference between these two groups and the group with perforated appendicitis. In the latter group, postoperative complications occurred in 39 percent of the patients as opposed to 4 percent and 8 percent, respectively, in the former groups.
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Leape LL, Ramenofsky ML. Laparoscopy for questionable appendicitis: can it reduce the negative appendectomy rate? Ann Surg 1980; 191:410-3. [PMID: 6445178 PMCID: PMC1344560 DOI: 10.1097/00000658-198004000-00004] [Citation(s) in RCA: 94] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Laparoscopy has been performed in 32 patients in whom the diagnosis of appendicitis was suspected, but in whom clinical findings were equivocal and insufficient to establish the diagnosis. These patients represented 13.6% of the total group of patients admitted with questionable appendicitis during this period. Fifty per cent of these 32 patients had unusual clinical features, such as a prolonged history of symptoms, significant intercurrent disease, prior treatment with antibiotics or steroids, etc. At laparoscopy, the diagnosis of acute appendicitis was made in 17 patients. Another disease was diagnosed in 8 patients, and 7 were judged to have no pathologic abnormalities. There were two false negative examinations and one false positive, but no ruptured appendices resulted. Twelve patients (37.5%) were spared operation by laparoscopy. The negative appendectomy rate was decreased from 10 to 1%.
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Doraiswamy NV. Leucocyte counts in the diagnosis and prognosis of acute appendicitis in children. Br J Surg 1979; 66:782-4. [PMID: 519164 DOI: 10.1002/bjs.1800661109] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Preoperative total and differential leucocyte counts were made in 225 children with acute appendicitis, 50 children with a normal appendix and 100 children with acute abdominal pain which resolved without any therapy. When adjusted to age, neutrophilia in 96 per cent, 30 per cent and 32 per cent and leucocytosis in 41.8 per cent, 4 per cent and 3 per cent was noted in the respective groups, the levels being significantly higher in the acute appendicitis group than in the other two groups. Among children with appendicitis, infections were observed in 62.8 per cent of the group with leucocytosis and in 13.7 per cent of the group with a normal leucocyte count; the difference is statistically significant. It is suggested that in acute appendicitis neutrophilia supports the diagnosis and leucocytosis indicates the prognosis. The rate of infection increases as the total leucocyte count rises above the upper normal limit. The difference of opinions on the significance of leucocyte counts in acute appendicitis is discussed.
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SIMONOWITZ DAVIDA, WHITE THOMAST. Part III: Postoperative Complications of Appendectomy (including Adhesions). ACTA ACUST UNITED AC 1979. [DOI: 10.1016/s0300-5089(21)00433-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
This paper has given a general discussion of the spectrum of pain complaints presented to the gynecologist. Specific information about pain sensation and localization has been reviewed together with the gynecologic causes of acute abdominal pain. Chronic pain has been classified as episodic or continuous, and the causes, mechanisms, diagnosis and treatment of episodic and chronic pelvic pain have been presented. The concluding remarks have outlined some diagnostic considerations for the patient with chronic pain. (The interested reader will find more extensive information on these subjects in the articles listed in the bibliography.).
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Affiliation(s)
- M Renaer
- Academisch Ziekenhuis Sint Rafaël, Gynaecologie-Verloskunde, 3000 Louvain, Belgium University of Washington School of Medicine, Seattle, Wash. 98195, U.S.A
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Lewin GA, Mikity V, Wingert WA. Barium enema: an outpatient procedure in the early diagnosis of acute appendicitis. J Pediatr 1978; 92:451-3. [PMID: 632990 DOI: 10.1016/s0022-3476(78)80447-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Fine M, Busuttil RW. Acute appendicitis: efficacy of prophylactic preoperative antibiotics in the reduction of septic morbidity. Am J Surg 1978; 135:210-2. [PMID: 564612 DOI: 10.1016/0002-9610(78)90100-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The course of 200 patients who recently underwent appendectomy at UCLA for acute appendicitis has been reviewed to determine the efficacy of preoperative systemic antibiotic prophylaxis in reducing septic morbidity after surgery. Among those with nonperforated appendicitis who were given gentamycin and clindamycin preoperatively, a reduction of infection rate from 10.2 to 5.3 per cent was found when compared with patients who received no antibiotics.
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Librach IM. Medical manpower and hospital staffing. BRITISH MEDICAL JOURNAL 1976; 2:646. [PMID: 963490 PMCID: PMC1688136 DOI: 10.1136/bmj.2.6036.646-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Jones PF. Active observation in management of acute abdominal pain in childhood. BRITISH MEDICAL JOURNAL 1976; 2:551-3. [PMID: 963429 PMCID: PMC1688119 DOI: 10.1136/bmj.2.6035.551] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Out of 363 children admitted to a surgical unit with acute abdominal pain only 126 (35%) had an operation. Of these, 20 first underwent a period of "active observation." This procedure, used to help reach a diagnosis or decision in doubtful cases, is safe and useful and may be applied at home or in hospital.
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Jones RA, MacFarlane A. Carcinomas and carcinoid tumours of the appendix in a district general hospital. J Clin Pathol 1976; 29:687-92. [PMID: 956450 PMCID: PMC476147 DOI: 10.1136/jcp.29.8.687] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In a retrospective series of 40 appendiceal tumours occurring over a 10-year period, 30 were carcinoid tumours of classical histological pattern, five were adenocarcinomas, and two were tumours intermediate in pattern between carcinoid and carcinoma. The remaining three tumours were secondaries from primary colonic tumours. The implications of the findings are discussed.
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71
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Durward WF. Letter: Testing pain sensation. Lancet 1976; 2:46. [PMID: 59111 DOI: 10.1016/s0140-6736(76)93006-3] [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] [Indexed: 12/12/2022]
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Murtadha M, Bakir F. Letter: Appendicitis and mimicking conditions. Lancet 1976; 2:46. [PMID: 59109 DOI: 10.1016/s0140-6736(76)93005-1] [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] [Indexed: 12/12/2022]
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