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At least 19 recordsLinked to original sources
PubMed2026

Repeated scoring with the adult appendicitis score improves the sensitivity and the specificity of appendicitis diagnosis in patients with early equivocal signs of appendicitis: a secondary analysis.

PURPOSE: The utilization of computed tomography in the early stage of acute appendicitis may result in overdiagnosis and unnecessarily expose patients to ionising radiation. The Adult Appendicitis Score (AAS) can be used to select patients for imaging. Observation and re-scoring in the DIAMOND trial reduced the need for imaging. Now, we wanted to determine if the change in AAS (∆AAS) can serve as a diagnostic tool to select patients for imaging even more precisely. METHODS: Eighty-eight patients with early equivocal appendicitis participated in the observation arm of the DIAMOND trial. The data for these patients were reanalysed, and ∆AAS during the observation was calculated. The baseline AAS, final AAS, and the change in C-reactive protein (∆CRP) were selected as reference standards. RESULTS: Eighty-three patients with complete data were included in the analysis. The AUROC (Area Under the Receiver Operating Characteristic) values are as follows: ∆AAS, 0.932 (95% CI 0.868-0.996); baseline AAS, 0.629 (95% CI 0.498-0.760); final AAS, 0.936 (95% CI 0.886-0.987); and ∆CRP, 0.796 (95% CI 0.696-0.897). Using receiver operating characteristic curves, we established the thresholds for low (AAS ≤ -2), intermediate (AAS -1 to 0), and high (AAS ≥ 1) probability of appendicitis. The negative predictive value for the low-probability group and the positive predictive value for the high-probability group concerning acute appendicitis were 97% and 94%, respectively. CONCLUSION: Patients with equivocal signs of appendicitis may benefit from short observation and the calculation of ∆AAS to reduce overdiagnosis and exposure to excessive imaging. REGISTRATION: The DIAMOND trial was officially registered on ClinicalTrials.gov (NCT02742402) on April 13, 2016.

Adult↗
PubMed1979

Appendicitis associated with recent barium study.

There have been several reports of "barium-induced" appendicitis in the literature. When confronted with a possible case of this phenomenon, a review of the literature on the subject was carried out. The suggestion is made that there is no evidence to support a cause-effect relationship between barium retained in the appendix and appendicitis. Diseased appendices can be marked by retained barium and a higher likelihood may then exist for the subsequent development of appendicitis. Following the finding of prolonged retention of barium after contrast study, it is recommended that the patient be instructed as to the possibility of developing symptoms of acute appendicitis. Patients who present with symptoms of appendicitis should be questioned as to history of recent barium study, and x-rays should be reviewed with the possibility of finding appendoliths.

Adult↗
PubMed1979

The significance of a "positive" rectal examination in acute appendicitis.

The results of rectal examinations of 495 patients with suspected acute appendicitis were correlated with six other variables from the patients' histories and results of physical examinations. Positive rectal examination results were recorded for 46 per cent of all patients with acute appendicitis and for 53 per cent of those with normal appendices. The diagnosis of acute appendicitis should not be based solely or primarily on the results of the rectal examination. The examination should, however, be performed in all suspected cases of appendicitis to rule out gynecologic and urologic disease.

Acute Disease↗
PubMed1977

Computer-aided prediction of gangrenous and perforating appendicitis.

The clinical details of 100 patients with proved acute appendicitis were compared with those of 100 patients with perforating or gangrenous appendicitis. Twenty features were found to be significantly different between the two groups. This information was incorporated into a computer data base and used in the differential diagnosis of abdominal pain. A program written to predict the probability that gangrene or perforation was present in patients with appendicitis gave a diagnostic accuracy over 91%. A clinical scoring index, which accurately predicted the state of the appendix in 88% of patients, was constructed from the significant differences between the two groups. When clinical scoring or computer analysis predicts a high probability of perforation or gangrene in patients with appendicitis, surgery should be performed without delay.

Acute Disease↗
PubMed1976

[Clinical aspects and morphology of acute catarrhal appendicitis in children].

The authors compared the clinical and pathoanatomical diagnoses in 1399 patients, operated upon for catarrhal appendicitis. In 123 children the clinical diagnosis was revised as a result of further observations following surgery. In 1276 patients the clinical diagnosis of catarrhal appendicitis was remained. An exploration of the appendicular process in these patients supported the diagnosis in 748 cases (58.6%). In 16 cases chronic appendicitis was recognized, in 111 -- phlegmonous and gangrenous appendicitis (8.7%).

Acute Disease↗
PubMed1975

[Phosphatase activity of the neutrophils in acute appendicitis in children].

Phosphatase activity of neutrophils was studied in 342 patients directed to the hospital with the diagnosis of acute appendicitis, and in 56 healthy children. The index of phosphatase activity of neutrophils (IPAN) was found to be considerably increased in all forms of appendicitis in childhood. An intensity of the reaction depends on the form and terms, elapsed since the disease onset. The determination of IPAN in the complex with clinical findings could be utilized for the differential diagnosis purposes in investigation of patients suspected of acute appendicitis, while in the postoperative period - for estimating a gravity of the course and prognosis of the disease.

Acute Disease↗
PubMed1976

Acute appendicitis and postoperative fecal fistula: symptoms of an unrecognized carcinoma of the colon.

This report is a retrospective evaluation of 12 case histories. All patients had been subjected to laparotomy on suspicion of acute appendicitis. The operative situations seemed to corroborate clinical expectations: an inflamed ileocecal process was assumed to be a result of performation of a gangrenous appendicitis. In three patients a primary adenocarcinoma arising from the appendiceal base was the incidental histologic finding postoperatively. In three other patients this inflammatory-looking process was related to a cecal carcinoma. In six patients a carcinoma existed unrecognized as the basic disease, these patients being subjected to intra-abdominal drainage only or in connection with appendectomy. In five instances a fecal fistula was the main persisting symptom of postoperative morbidity, in one patient even as long as two years after laparotomy. The problem in diagnostic verification of the initially unidentified carcinoma is illustrated. Attention is directed towards avoiding a false feeling of security in the presence of inflammatory manifestations in the right lower abdominal quadrant, which may misleadingly suggest a ruptured appendix.

Abscess↗
PubMed1979

Acute appendicitis during pregnancy.

Case reports (1970--1977) of thirty-five pregnant women with acute appendicitis were reviewed. Eighty-eight per cent had symptoms less than 24 hours and were operated on within 12 hours. No maternal or fetal loss occurred. Morbidity and mortality should be minimal if, when appendicitis is suspected in a pregnant woman, immediate operation is performed.

Acute Disease↗
PubMed2026

Long-term outcomes of non-operative compared to operative management of acute uncomplicated appendicitis - a systematic review and meta-analysis.

BACKGROUND: We evaluated long-term outcomes of non-operative management (NOM) versus surgical management of acute uncomplicated appendicitis. METHODS: Systematic review of studies comparing NOM versus surgery with ≥2 years follow-up. Primary outcome was long-term failure rate. RESULTS: 9/1635 studies were included (3 RCTs; 6 non-RCT studies), involving 3883 patients; 5 were in pediatric populations. Median follow-up was 33.6 (range 24-312) months. NOM pooled long-term failure rate was 38.9% (95% CI: 31.1%-46.7%), increasing to 44.4% (95% CI: 41.4%-47.4%) in RCTs. Pooled appendectomy rate after NOM was 36.3% (95% CI: 28.9%-43.7%). Incidence of appendiceal neoplasms was approximately 0.3%. Non-operative management had cost savings of €1535 (95% CI: -€1892 to -€1178) versus surgery. CONCLUSIONS: NOM of acute uncomplicated appendicitis was associated with high long-term failure rates and significant risk of subsequent appendectomy.

Humans↗
PubMed1976

Retrocecal appendicitis presenting with air in the subhepatic space.

Two cases of perforated retrocecal appendicitis presenting with the roentgen finding of an air containing subhepatic abscess are discussed. Although it is an unusual cause for air in the right subhepatic space, retrocecal appendicitis should be considered in the radiologist's differential diagnosis.

Adolescent↗
PubMed1977

Acute appendicitis with abscess stimulating carcinoma of the sigmoid.

Acute appendicitis with abscess often produced a distinctive extrinsic pressure deformity of the cecum. If the abscess is large or disseminated, other parts of the gastrointestinal tract may be secondarily involved. Abscesses usually produce extrinsic compression defects with benign radiologic characteristics, but occasionally the lesions may simulate malignant disease. Even careful evaluation of the clinical symptoms and signs may not be helpful in the differentiation of benign from malignant disease. Three examples of atypical acute appendicitis are described in patients with clinical and radiologic findings strongly suggestive of malignant disease.

Abscess↗
PubMed1979

Acute appendicitis and Bacteroides fragilis.

Bacteria belonging to the Bacteroides fragilis group (B. fragilis, B. ovatus, B. vulgatus, B. distasonis, B. thetaiotaomicron and B. uniformis) were cultured in quantities of less than or equal to 10(5) c.f.u./ml from the excised appendix from 30 patients. Twenty-two patients (group I) had an acute purulent appendicitis (three with perforation), four were classified as slightly inflamed cases (group 2) and four had a normal appendix (group 3). The B. fragilis group of bacteria dominated among the anaerobic isolates, but Bifidobacteria, Fusobacteri, Clostridium perfringens, Lactobacilli, Leptotrichia and Veillonella, in decreasing order, were isolated as well. Among isolates of aerobic bacteria, E. coli was most frequently isolated (26/30 patients). No other genus was isolated from more than four of the appendices. Serological investigations of the humoral antibody response to polysaccharide antigens from four of the Bacteroides species showed that a doubling of the titer, or more, in paired serum samples could be observed as follows: against B. fragilis 6/22 patients (group 1), 3/8 patients (groups 2 and 3). The corresponding figures for B. ovatus were 11/22 and 2/8, B. vulgatus 3/22 and 0/8 and B. distasonis 4/22 and 0/8. Sera from two patients with ruptured appendix, and B. fragilis cultivated, showed the highest titer increases against the B. fragilis antigen. The data from the bacteriological and immunological investigations make us conclude that (i) the B. fragilis group of bacteria is the most common anaerobic group of bacteria isolated from normal and diseased appendices, (ii) the mere isolation of B. fragilis, encapsulated or not, does not imply an etiological role in appendicitis since there was no obvious difference in titer increases against B. fragilis in sera from patients with or without an inflamed appendix, and (iii) high, and significant, titer increases against B. fragilis are seen in sera from patients with ruptured appendix.

Acute Disease↗
PubMed1979

[Acute granulomatous appendicitis. (Contribution to preventive appendectomy in acute ileitis)].

Starting with one case of acute granulomatous appendicitis of their own observation, the authors review the scant literature on the subject (only 23 published cases to date) and advocate systematic appendicectomy in all isolated appendicular localizations of Crohn's disease. On the grounds that no post-appendicectomy fistulization has ever been reported in such patients, the authors recommend prophylactic appendicectomy also in the far more frequent cases of acute ileitis, to forestall the possibility of evolution into chronic Crohn's disease and the risk of missing a nongranulomatous acute appendicitis appearing with the same clinical symptoms.

Adult↗
PubMed1979

The plain abdominal radiograph in acute appendicitis.

Although the radiological features of acute appendicitis have been well documented, the value of the plain abdominal radiograph has not been fully appreciated. This article summarises the role of radiology in acute appendicitis, especially in atypical cases and extremes of age, where there is often delay in diagnosis.

Abdomen, Acute↗
PubMed1979

Ectopic pregnancy as an etiologic agent in appendicitis.

The association of ectopic pregnancy and acute appendicitis has seldom been discussed in literature. This report presents 2 patients who had simultaneous right tubal pregnancies and acute periappendicitis. The cases reported here suggest the possibility that an ectopic pregnancy can produce an inflammatory reaction of the appendix. Ectopic pregnancy as an etiological stimulus for acute appendicitis is discussed. The advisability of examining the appendix at the time of surgery for pelvic disease, and performing an appendectomy at the same time, if pathology of the appendix is suspected, is emphasized. The use of elective appendectomy in surgery for ectopic pregnancy is reviewed.

Acute Disease↗
PubMed1979

Pediatric appendicitis. A 20-year study of 1,640 children at Cook County (Illinois) Hospital.

Of 1,640 children with acute appendicitis treated at Cook County (Illinois) Hospital between Jan 1, 1957, and Dec 31, 1976, 35% had appendiceal perforation. Overall morbidity was 12.8% and mortality was 0.24%. Antibiotics, transperitoneal drainage, and delayed wound closure were used routinely in children with appendiceal perforation. Antibiotics and transperitoneal drains did not appreciably alter the incidence of intraabdominal abscess formation. Delayed wound closure in patients with appendiceal perforation reduced the incidence of wound infection by 75%.

Abscess↗
PubMed1975

Appendicitis and mimicking conditions. A prospective study.

A prospective study of 444 consecutive patients diagnosed as having acute appendicitis was carried out in a district general hospital. The appendix was acutely inflamed, gangrenous, or perforated in 346 patients. Diagnostic error, 22% overall, was twice as common in females as in males. Organisms were isolated from the outer appendix wall in 117 patients, isolation increasing with the severity of inflammation. 12% of children under 11 had mesentric adenitis, 10% of all females had gynaecological lesions, and 14% of patients over 50 had acute diverticulitis. In only 6% of patients was no abnormality found at operation, and in every case the disorder was dealt with through the gridiron incision.

Abdomen, Acute↗