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Echevarria S, Rauf F, Hussain N, Zaka H, Farwa UE, Ahsan N, Broomfield A, Akbar A, Khawaja UA. Typical and Atypical Presentations of Appendicitis and Their Implications for Diagnosis and Treatment: A Literature Review. Cureus 2023; 15:e37024. [PMID: 37143626 PMCID: PMC10152406 DOI: 10.7759/cureus.37024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2023] [Indexed: 05/06/2023] Open
Abstract
Appendicitis, an acute inflammation of the appendix, affects all demographic groups and exhibits various incidences and clinical manifestations. While acute appendicitis typically presents with colicky periumbilical abdominal pain that localizes to the right lower quadrant, atypical presentations are more common in children, geriatric, and pregnant patient populations, leading to delays in diagnosis. Clinical evaluation, clinical scoring systems, and inflammatory markers are commonly used, but their limitations have led to the increased use of diagnostic imaging in patients suspected of appendicitis. Acute appendicitis is managed by non-operative and operative management, depending on whether it is uncomplicated or complicated. Developing diagnostic pathways to improve outcomes and reduce complications is crucial. Although medical advancements have been made, diagnosing and managing appendicitis can be challenging, mainly when patients are present atypically. This literature review aims to comprehensively review typical and atypical presentations of appendicitis and their current implications for diagnosis and treatment modalities in pediatric, adult, pregnant, and geriatric patient populations.
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Affiliation(s)
| | - Fatima Rauf
- Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | - Nabeel Hussain
- Internal Medicine, Saba University School-Medicine, Devens, USA
| | - Hira Zaka
- Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Umm-E- Farwa
- Surgery, Jinnah Sindh Medical University, Karachi, PAK
| | - Nayab Ahsan
- Internal Medicine, Quaid-e-Azam Medical College, Bahawalpur, PAK
| | - Alison Broomfield
- Family Medicine, Spartan Health Sciences University, Vieux Fort, LCA
| | - Anum Akbar
- Pediatrics, University of Nebraska Medical Center, Omaha, USA
| | - Uzzam Ahmed Khawaja
- Pulmonary and Critical Care Medicine, Jinnah Medical and Dental College, Karachi, PAK
- Clinical and Translational Research, Dr Ferrer BioPharma, South Miami, USA
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García IC, Villalba JS, Iovino D, Franchi C, Iori V, Pettinato G, Inversini D, Amico F, Ietto G. Liver Trauma: Until When We Have to Delay Surgery? A Review. Life (Basel) 2022; 12:life12050694. [PMID: 35629360 PMCID: PMC9143295 DOI: 10.3390/life12050694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/06/2022] [Accepted: 04/29/2022] [Indexed: 01/09/2023] Open
Abstract
Liver involvement after abdominal blunt trauma must be expected, and in up to 30% of cases, spleen, kidney, and pancreas injuries may coexist. Whenever hemodynamics conditions do not contraindicate the overcoming of the ancient dogma according to which exploratory laparotomy should be performed after every major abdominal trauma, a CT scan has to clarify the liver lesions so as to determine the optimal management strategy. Except for complete vascular avulsion, no liver trauma grade precludes nonoperative management. Every attempt to treat the injured liver by avoiding a strong surgical approach may be considered. Each time, a nonoperative management (NOM) consisting of a basic “wait and see” attitude combined with systemic support and blood replacement are inadequate. Embolization should be considered to stop the bleeding. Percutaneous drainage of collections, endoscopic retrograde cholangiopancreatography (ERCP) with papilla sphincterotomy or stent placement and percutaneous transhepatic biliary drainage (PTBD) may avoid, or at least delay, surgical reconstruction or resection until systemic and hepatic inflammatory remodeling are resolved. The pathophysiological principle sustaining these leanings is based on the opportunity to limit the further release of cell debris fragments acting as damage-associated molecular patterns (DAMPs) and the following stress response associated with the consequent immune suppression after trauma. The main goal will be a faster recovery combined with limited cell death of the liver through the ischemic events that may directly follow the trauma, exacerbated by hemostatic procedures and surgery, in order to reduce the gross distortion of a regenerated liver.
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Affiliation(s)
- Inés Cañas García
- General and Digestive Surgery, Hospital Clínico San Cecilio of Granada, 18002 Granada, Spain;
| | - Julio Santoyo Villalba
- General and Digestive Surgery, Hospital Virgen de Las Nieves of Granada, 18002 Granada, Spain;
| | - Domenico Iovino
- General, Emergency and Transplant Surgery Department, ASST-Settelaghi and University of Insubria, 21100 Varese, Italy; (D.I.); (C.F.); (V.I.); (D.I.)
| | - Caterina Franchi
- General, Emergency and Transplant Surgery Department, ASST-Settelaghi and University of Insubria, 21100 Varese, Italy; (D.I.); (C.F.); (V.I.); (D.I.)
| | - Valentina Iori
- General, Emergency and Transplant Surgery Department, ASST-Settelaghi and University of Insubria, 21100 Varese, Italy; (D.I.); (C.F.); (V.I.); (D.I.)
| | - Giuseppe Pettinato
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA;
| | - Davide Inversini
- General, Emergency and Transplant Surgery Department, ASST-Settelaghi and University of Insubria, 21100 Varese, Italy; (D.I.); (C.F.); (V.I.); (D.I.)
| | - Francesco Amico
- Trauma Service, Department of Surgery, University of Newcastle, Newcastle 2308, Australia;
| | - Giuseppe Ietto
- General, Emergency and Transplant Surgery Department, ASST-Settelaghi and University of Insubria, 21100 Varese, Italy; (D.I.); (C.F.); (V.I.); (D.I.)
- Correspondence: ; Tel.: +39-339-8758024
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Vega-Peña NV, Domínguez-Torres LC. ¿Se deben confiar actividades profesionales en cirugía mínimamente invasiva al médico general? Una propuesta basada en el aprendizaje experiencial. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.1445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. El entrenamiento en cirugía mínimamente invasiva y la definición de las actividades profesionales específicas, socialmente responsables y seguras para el paciente, son un desafío y un deber en la educación médica. Nuestro objetivo es argumentar a favor de esta intervención y describir las especificaciones, alcances y limitaciones de las actividades profesionales confiables a este nivel, así como su lugar en un modelo de aprendizaje experiencial en cirugía mínimamente invasiva para toda la vida.
Métodos. Se evalúa el contexto de la actividad quirúrgica asistencial de los médicos generales, con relación a su participación en el equipo quirúrgico y la necesidad de incorporación en su perfil profesional de unas competencias propias de la cirugía mínimamente invasiva, acorde con su nivel y funciones. Mediante una postura académica y reflexiva, se identifican vacíos y oportunidades de avanzar en el tema.
Resultados. El perfil profesional de un médico general debe contemplar la cirugía mínimamente invasiva como una competencia dentro de su formación, de manera análoga a las propias de la cirugía tradicional abierta. Para ello, se requiere afrontar coherentemente el cambio de teoría y educación quirúrgica, el cambio en la demanda de servicios quirúrgicos y procedimientos, así como fortalecer el rol activo del médico general en el equipo quirúrgico.
Conclusiones. Es necesario modificar el paradigma educativo en cirugía, desde la formación médica en el pregrado. Se plantea un modelo de aprendizaje experiencial de cirugía mínimamente invasiva, y se establecen las competencias fundamentadas en actividades profesionales confiables, necesarias para el perfil profesional de un médico general del siglo XXI.
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Afzal B, Changazi SH, Hyidar Z, Siddique S, Rehman A, Bhatti S, Ahmad QA, Farooka MW. Role of Laparoscopy in Diagnosing and Treating Acute Nonspecific Abdominal Pain. Cureus 2021; 13:e18741. [PMID: 34796051 PMCID: PMC8589343 DOI: 10.7759/cureus.18741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 12/02/2022] Open
Abstract
Background Nonspecific abdominal pain (NSAP) is a pain for which no immediate cause is evident on acute admission and does not necessitate emergency surgical intervention. NSAP is a frequent reason for presentation in the emergency department (ED). Laparoscopy is a well-established technique that allows a surgeon to visualize the abdominal cavity after insufflation through a few small incision ports. Despite the increasing availability of laparoscopic investigation, the availability of a laparoscope in the ED settings in Pakistan is low due to the expense and maintenance needs of the system. Objective This study aimed to evaluate the role of laparoscopy in diagnosing the cause of acute NSAP and its role in treating the pathology of disease in patients presenting to the emergency department (ED) of Services Hospital, which is a government sector hospital in Lahore, Pakistan. Materials and methods This study was conducted in Services Hospital Lahore, Pakistan, from January 1, 2016 to December 31, 2019. The study included patients aged 12 to 70 years of either sex who presented to the ED with abdominal pain for whom no diagnosis could be achieved on clinical assessment, laboratory findings, and radiological findings (x-ray abdomen, ultrasonography, and computed tomography scan). All study participants underwent diagnostic laparoscopy under general anesthesia. Patients were monitored weekly via follow-up postoperatively for the first month and then monthly for 12 months. All study data were recorded on a predesigned proforma. The data were analyzed using IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp. Results A total of 122 patients diagnosed with acute NSAP were enrolled in our study (mean age, 46.4 ± 20.3 years). The study population consisted of 52 male patients (42.6%) and 70 female patients (57.4%). Our study participants had a mean body mass index of 24.2 ± 3.3 kg/m2. The most common ED presentation was lower abdominal pain. One hundred sixteen patients (95.1%) had positive findings on laparoscopy, while six patients (4.9%) had no identified pathology on laparoscopy. The most frequent pathology was appendicular in origin, followed by pelvic inflammatory disease. Surgical management of patients through laparoscopy was performed in 97 patients (79.5%). Conversion to laparotomy was done in 12 patients (9.8%). Definite diagnosis was established in 118 patients (96.7%). Port site infection occurred in four patients (3.3%), chest infection in five patients (4.1%), deep venous thrombosis in one patient (0.8%), and anastomotic leakage in one (0.8%) patient. Four patients (3.3%) developed recurrence of symptoms. Conclusions This study explored the role of laparoscopy in diagnosing and treating patients presenting to the ED with acute NSAP. According to our results, laparoscopy is a safe and effective method for diagnosing and treating acute NSAP with low postoperative morbidity and potentially decreased risk of postoperative complications. Physicians should consider laparoscopy as a first-line invasive investigation for patients presenting with undiagnosed acute abdominal pain.
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Affiliation(s)
- Barza Afzal
- General Surgery, Services Hospital Lahore, Lahore, PAK
| | | | | | | | - Aveena Rehman
- General Surgery, Services Hospital Lahore, Lahore, PAK
| | | | - Qamar Ashfaq Ahmad
- Department of Surgery, Services Institute of Medical Services, Lahore, PAK
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Laparoscopy in Emergency: Why Not? Advantages of Laparoscopy in Major Emergency: A Review. Life (Basel) 2021; 11:life11090917. [PMID: 34575066 PMCID: PMC8470929 DOI: 10.3390/life11090917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 01/09/2023] Open
Abstract
A laparoscopic approach is suggested with the highest grade of recommendation for acute cholecystitis, perforated gastroduodenal ulcers, acute appendicitis, gynaecological disorders, and non-specific abdominal pain (NSAP). To date, the main qualities of laparoscopy for these acute surgical scenarios are clearly stated: quicker surgery, faster recovery and shorter hospital stay. For the remaining surgical emergencies, as well as for abdominal trauma, the role of laparoscopy is still a matter of debate. Patients might benefit from a laparoscopic approach only if performed by experienced teams and surgeons which guarantee a high standard of care. More precisely, laparoscopy can limit damage to the tissue and could be effective for the reduction of the overall amount of cell debris, which is a result of the intensity with which the immune system reacts to the injury and the following symptomatology. In fact, these fragments act as damage-associated molecular patterns (DAMPs). DAMPs, as well as pathogen associated molecular patterns (PAMPs), are recognised by both surface and intracellular receptors of the immune cells and activate the cascade which, in critically ill surgical patients, is responsible for a deranged response. This may result in the development of progressive and multiple organ dysfunctions, manifesting with acute respiratory distress syndrome (ARDS), coagulopathy, liver dysfunction and renal failure. In conclusion, none of the emergency surgical scenarios preclude laparoscopy, provided that the surgical tactic could ensure sufficient cleaning of the abdomen in addition to resolving the initial tissue damage caused by the “trauma”.
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Guthrie GJ, Johnston T, Ewing A, Mullen R, Suttie SA, Patil PV. A prospective observational study of the utility of early diagnostic laparoscopy for right lower abdominal pain: a safe and effective diagnostic and therapeutic tool. Scott Med J 2019; 64:49-55. [PMID: 30630393 DOI: 10.1177/0036933016649869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Diagnostic laparoscopy is commonly performed for diagnosis of right lower abdominal pain and its use is increasing in the emergency setting. Some studies have reported that diagnostic laparoscopy and laparoscopic appendicectomy have advantages over conventional surgery. Many emergency surgeons now perform diagnostic laparoscopy for both clinically diagnosed appendicitis and when the diagnosis is in doubt. The aim of the present study was to assess whether the use of diagnostic laparoscopy is justified and safe for those admitted with right lower abdominal pain. METHODS AND RESULTS Data were collected prospectively on consecutive patients attending the acute surgical receiving unit with right iliac fossa pain or a suspected diagnosis of acute appendicitis. A total of 284 patients underwent diagnostic laparoscopy. Of them 233 (82%) had a positive finding at laparoscopy, 207 (88%) underwent appendicectomy, the majority of which were carried out laparoscopically. Surgical trainees performed the majority of operations and this did not have a negative impact on operative findings (p 0.856), operation performed (0.642), or operative duration (0.831). No intra-operative complications were sustained. Ultrasound examination was carried out in 49 patients, while CT was carried out in 24. CONCLUSION The results of the present study highlight the utility of early diagnostic laparoscopy as both a diagnostic and therapeutic tool in the acute setting.
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Affiliation(s)
- Graeme Jk Guthrie
- 1 Specialty Registrar General Surgery, Department of General Surgery, Ninewells Hospital, UK
| | - Thomas Johnston
- 2 Foundation Doctor General Surgery, Department of General Surgery, Ninewells Hospital, UK
| | - Anne Ewing
- 3 Foundation Doctor General Surgery, Department of General Surgery, Ninewells Hospital, UK
| | - Russell Mullen
- 4 Specialty Registrar General Surgery, Department of General Surgery, Ninewells Hospital, UK
| | - Stuart A Suttie
- 5 Specialty Registrar General Surgery, Department of General Surgery, Ninewells Hospital, UK
| | - Pradeep V Patil
- 6 Consultant General Surgeon, Department of General Surgery, Ninewells Hospital, UK
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Chatzipapas I, Kathopoulis N, Protopapas A, Loutradis D. Using a Mobile Smartphone to Perform Laparoscopy. J Minim Invasive Gynecol 2018; 25:912-915. [DOI: 10.1016/j.jmig.2017.12.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 11/28/2017] [Accepted: 12/27/2017] [Indexed: 10/18/2022]
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Yoshimaru K, Kinoshita Y, Matsuura T, Esumi G, Wada M, Takahashi Y, Yanagi Y, Hayashida M, Ieiri S, Taguchi T. Bowel obstruction without history of laparotomy: Clinical analysis of 70 patients. Pediatr Int 2016; 58:1205-1210. [PMID: 27061976 DOI: 10.1111/ped.13003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 03/04/2016] [Accepted: 04/01/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Determining the cause of bowel obstruction without a history of laparotomy (BO without HL) is difficult and can result in delay of treatment and development of a potentially life-threatening situation. We herein investigated the clinical characteristics of pediatric patients who underwent laparotomy due to BO without HL. METHODS All surgical pediatric patients aged <16 age who were diagnosed with BO without HL between January 2004 and September 2014 were included. Etiology of BO, intraoperative findings and postoperative outcome were investigated retrospectively. RESULTS Seventy patients were diagnosed with BO without HL in this period. In these 70 patients, malrotation (n = 34), intussusception (n = 19), internal hernia (n = 6) and Meckel's diverticulum (n = 5) were predominantly identified. Regarding preoperative definitive diagnosis, prevalence of internal hernia, Meckel's diverticulum or idiopathic volvulus was significantly lower than that of malrotation or intussusception (P < 0.05). Intraoperatively, the rates of strangulation and bowel resection were 55.7% and 30.0%, respectively. The optimal time for emergency operation in order to avoid strangulated bowel resection was <19 h from onset of symptoms. CONCLUSIONS Malrotation and intussusception are major causes of BO without HL in children, but internal hernia, Meckel's diverticulum and idiopathic volvulus should always be taken into account, particularly because of the preoperative diagnostic difficulty and resulting high rate of intestinal resection. In order to avoid resection of the bowel, surgery should be done within 19 h before bowel ischemic change occurs.
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Affiliation(s)
- Koichiro Yoshimaru
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshiaki Kinoshita
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiharu Matsuura
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Genshiro Esumi
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Momoko Wada
- Department of Pediatric Surgery, Japan Community Health care Organization Kyushu Hospital, Kitakyushu, Japan
| | - Yoshiaki Takahashi
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yusuke Yanagi
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Makoto Hayashida
- Department of Pediatric Surgery, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Tomoaki Taguchi
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
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Cikot M, Peker KD, Bozkurt MA, Kocatas A, Kones O, Binboga S, Gedikbasi A, Alis H. Plasma calprotectin level: usage in distinction of uncomplicated from complicated acute appendicitis. World J Emerg Surg 2016; 11:7. [PMID: 26819626 PMCID: PMC4729141 DOI: 10.1186/s13017-016-0062-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 01/20/2016] [Indexed: 02/07/2023] Open
Abstract
Background The aim of this study was to identify the diagnostic role of plasma calprotectin value for a distinction of presence acute appendicitis and the indifference of uncomplicated from complicated acute appendicitis. Methods Plasma calprotectin, white blood cell and C-reactive protein values of 89 patients, who have undergone laparoscopic appendectomy between January 2013 and May 2013 were evaluated. Results Calprotectin was 91 ng/mL (range 45–538) for acute appendicitis and 47 ng/ml (range 28–205) for the control group. There was a positive, statistically significant relation between calprotectin and C-reactive protein values (r = 0. 292 p = 0. 001, respectively). There was no statistically significant difference was determined between calprotectin and white blood cell values (r = 0. 142 p = 0. 187, respectively). CRP and Cal values were significantly higher in patients with a complicated AA group than in those with uncomplicated AA (p = 0. 014, p = 0. 0001, respectively) whereas white blood cell counts did not differ significantly between two groups (p = 0. 164). Conclusion Plasma calprotectin levels were increased in patients with acute appendicitis and should use in a distinction of uncomplicated from complicated acute appendicitis patients.
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Affiliation(s)
- Murat Cikot
- Department of General Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No: 11, 34147 Bakirkoy/Istanbul, Turkey
| | - Kivanc Derya Peker
- Department of General Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No: 11, 34147 Bakirkoy/Istanbul, Turkey
| | - Mehmet Abdussamet Bozkurt
- Department of General Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No: 11, 34147 Bakirkoy/Istanbul, Turkey
| | - Ali Kocatas
- Department of General Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No: 11, 34147 Bakirkoy/Istanbul, Turkey
| | - Osman Kones
- Department of General Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No: 11, 34147 Bakirkoy/Istanbul, Turkey
| | - Sinan Binboga
- Department of General Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No: 11, 34147 Bakirkoy/Istanbul, Turkey
| | - Asuman Gedikbasi
- Department of Biochemistry, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Bakirkoy/Istanbul, Turkey
| | - Halil Alis
- Department of General Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No: 11, 34147 Bakirkoy/Istanbul, Turkey
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Blom MC, Landin-Olsson M, Lindsten M, Jonsson F, Ivarsson K. Patients presenting at the emergency department with acute abdominal pain are less likely to be admitted to inpatient wards at times of access block: a registry study. Scand J Trauma Resusc Emerg Med 2015; 23:78. [PMID: 26446825 PMCID: PMC4596503 DOI: 10.1186/s13049-015-0158-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 09/23/2015] [Indexed: 11/10/2022] Open
Abstract
Background Also known as access block, shortage of inpatient beds is a common cause of emergency department (ED) boarding and overcrowding, which are both associated with impaired quality of care. Recent studies have suggested that access block not simply causes boarding in EDs, but may also result in that patients are less likely to be admitted to the hospital from the ED. The present study’s aim was to investigate whether this effect remained for patients with acute abdominal pain, for which different management strategies have emerged. Access block was defined in terms of hospital occupancy and the appropriateness of ED discharges addressed as 72 h revisits to the ED. Methods As a registry study of ED administrative data, the study examined a population of patients who presented with acute abdominal pain at the ED of a 420-bed hospital in southern Sweden during 2011–2013. Associations between exposure and outcomes were addressed in contingency tables and by logistic regression models. Results Crude analysis revealed a negative association between access block and the probability of inpatient admission (38.6 % admitted at 0–95 % occupancy, 37.8 % at 95–100 % occupancy, and 35.0 % at ≥100 % occupancy) (p < .001). No significant associations between exposure and 72 h revisits emerged. Multivariable models indicated an odds ratio of inpatient admission of 0.992 (95 % CI: 0.986–0.997) per percentage increase in hospital occupancy. Conclusions Study findings indicate that patients with acute abdominal pain are less likely to be admitted to the hospital from the ED at times of access block and that other management strategies are employed instead. No association with 72 h revisits was seen, but future studies need to address more granular outcomes in order to clarify the safety aspects of the effect. Electronic supplementary material The online version of this article (doi:10.1186/s13049-015-0158-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M C Blom
- Department of Clinical Sciences Lund, Lund University, HS 32, EA-blocket, 2nd floor, SE-22185, Lund, Sweden.
| | - M Landin-Olsson
- Department of Clinical Sciences Lund, Lund University, HS 32, EA-blocket, 2nd floor, SE-22185, Lund, Sweden.
| | - M Lindsten
- Department of Surgery, Ystad General Hospital, Kristianstadsvägen 3A, SE-27182, Ystad, Sweden.
| | - F Jonsson
- Department of Pre- and Intrahospital Emergency Medicine, Helsingborg General Hospital, S Vallgatan 5, SE-25187, Helsingborg, Sweden.
| | - K Ivarsson
- Department of Clinical Sciences Lund, Lund University, HS 32, EA-blocket, 2nd floor, SE-22185, Lund, Sweden.
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Andersson RE. Short-term complications and long-term morbidity of laparoscopic and open appendicectomy in a national cohort. Br J Surg 2014; 101:1135-42. [PMID: 24979720 DOI: 10.1002/bjs.9552] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 04/14/2014] [Indexed: 12/22/2022]
Abstract
Abstract
Background
Laparoscopic appendicectomy has been proposed as the standard for surgical treatment of acute appendicitis, based on controversial evidence. This study compared outcomes after open and laparoscopic appendicectomy in a national, population-based cohort.
Methods
All patients who underwent open or intended laparoscopic appendicectomy in Sweden between 1992 and 2008 were identified from the Swedish National Patient Register. The outcomes were analysed according to intention to treat with multivariable adjustment for confounding factors and survival analytical techniques where appropriate.
Results
A total of 169 896 patients underwent open (136 754) or intended laparoscopic (33 142) appendicectomy. The rate of intended laparoscopic appendicectomy increased from 3·8 per cent (425 of 11 175) in 1992 to 32·9 per cent (3066 of 9329) in 2008. Laparoscopy was used most frequently in middle-aged patients, women and patients with no co-morbidity. The rate of conversion from laparoscopy to open appendicectomy decreased from 75·3 per cent (320 of 425) in 1992 to 19·7 per cent (603 of 3066) in 2008. Conversion was more frequent in women and those with perforated appendicitis, and the rate increased with age and increasing co-morbidity. After adjustment for co-variables, compared with open appendicectomy, laparoscopy was associated with a shorter length of hospital stay (by 0·06 days), a lower frequency of negative appendicectomy (adjusted odds ratio (OR) 0·59; P < 0·001), wound infection (adjusted OR 0·54; P = 0·004) and wound rupture (adjusted OR 0·44; P = 0·010), but higher rates of intestinal injury (adjusted OR 1·32; P = 0·042), readmission (adjusted OR 1·10; P < 0·001), postoperative abdominal abscess (adjusted OR 1·58; P < 0·001) and urinary infection (adjusted OR 1·39; P = 0·020). Laparoscopy had a lower risk of postoperative small bowel obstruction during the first 2 years after surgery, but not thereafter.
Conclusion
The outcomes of laparoscopic and open appendicectomy showed a complex and contrasting pattern and small differences of limited clinical importance. The choice of surgical method therefore depends on the local situation, the surgeon's experience and the patient's preference.
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Affiliation(s)
- R E Andersson
- Department of Surgery, County Hospital Ryhov, Jönköping, and Department of Clinical and Experimental Medicine, Surgery, Faculty of Health Sciences, Linköping University, Linköping, Sweden
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Acute chylous peritonitis: Report of a case. Int J Surg Case Rep 2013; 4:419-21. [PMID: 23500748 DOI: 10.1016/j.ijscr.2013.01.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 12/17/2012] [Accepted: 01/02/2013] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Acute chylous peritonitis, a rare condition, is defined as an abrupt chylous fluid accumulation in the peritoneal space in the absence of a significant underlying pathology. Diagnosis is difficult due to abrupt onset and accompanying acute abdomen signs. PRESENTATION OF CASE Here we presented the case of a 32-year-old female patient who underwent laparoscopy due to acute abdomen findings and was diagnosed with acute chylous peritonitis. No underlying pathologies were detected, and only irrigation and drainage were applied. She was discharged unproblematically with a low-fat diet and somatostatin administration. No recurrence occurred, and no other pathologies were encountered during her 9-month visit. DISCUSSION Chylous fluid accumulation is reported to arise from various etiological factors such as trauma, chronic liver diseases, tuberculosis, filariasis, radiation, abdominal aorta surgery, different peritoneal infection and extended lymph node dissections. We have presented an acute chylous peritonitis case that was admitted with acute abdomen findings and followed up and treated with laparoscopy. CONCLUSION In conclusion, this case demonstrates the effectiveness of laparoscopy in acute abdomen cases in which a specific preoperative diagnosis cannot be made. Aspiration of the fluid and drainage comprise a sufficient therapy if a focus cannot be found. Postoperative somatostatin use may be beneficial.
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Lozano Bretón CE. Dolor abdominal agudo: Enfoque para el médico de atención primaria. MEDUNAB 2012. [DOI: 10.29375/01237047.1652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
El dolor abdominal es una causa frecuente de consulta en cualquier servicio de urgencias, y por esto, los médicos de atención primaria deben conocer las patologías que puedan poner en peligro la vida de sus pacientes. Se hace una revisión de las patologías mas frecuentemente asociadas a dolor abdominal en el ámbito de urgencias, y se hace énfasis en los medios por los que se puede llegar al diagnóstico adecuado y los conceptos generales del tratamiento de cada una de estas condiciones.
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Morino M, Famiglietti F. Nonspecific Abdominal Pain. THE ROLE OF LAPAROSCOPY IN EMERGENCY ABDOMINAL SURGERY 2012:153-161. [DOI: 10.1007/978-88-470-2327-7_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Gohil R, Agha R, Tang TY, Walsh SR. Early cross-sectional imaging for patients with acute abdominal pain: systematic review of randomised clinical trials. INTERNATIONAL JOURNAL OF CLINICAL PRACTICE. SUPPLEMENT 2011; 65:23. [PMID: 22008195 DOI: 10.1111/j.1742-1241.2011.02783.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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