Low-Dose CT Doesn't Impair Clinical Outcomes in Younger Patients with Suspected Appendicitis (FREE)

By Kelly Young Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM Using low-dose — instead of standard-dose — computed tomography doesn't lead to unnecessary appendectomies in young adults with suspected appendicitis, according to …
Source: Physician's First Watch current issue - Category: Primary Care Source Type: news

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​BY JEFFREY LOMBARDO, MD, &MARK SUPINO, MDThe progressive suprapubic pain was a cunning symptom.The 38-year-old man had had five days of that pain and dysuria. By the time he presented to our ED, his pain had spread to the right lower quadrant as well. He had a history of diverticulitis after a laparoscopic left hemicolectomy four years earlier.He reported no fevers, but complained of nausea and diarrhea. He was afebrile at 36.8°C with a pulse of 76 bpm. All other vital signs were normal. Physical exam was significant for suprapubic pain and right lower quadrant tenderness to palpation without rebound, guarding, ...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
Publication date: Available online 20 February 2019Source: The American Journal of SurgeryAuthor(s): Timothy Bax, Matthew Macha, John MayberryAbstractAbdCT for the evaluation of AAP in the ED in the US may be excessive and is potentially (although rarely) misleading and harmful. A selective policy of ‘AbdUS first’ combined with an observation unit and/or surgeon evaluation prior to AbdCT is preferred to a ‘routine AbdCT’ policy. Repeated AbdCTs for abdominal pain are not recommended because of cumulative radiation exposure. Standardized and complete history and physical examination, such as that ori...
Source: The American Journal of Surgery - Category: Surgery Source Type: research
Rationale: The horseshoe anomaly of the vermiform appendix is extremely rare. Preoperative confirmation of this anomaly is difficult; therefore, routine procedures, such as appendectomy, may become unexpectedly challenging when such anomalies are encountered during the surgical process. Patient concerns: A 33-year-old man presented with abdominal pain in the right lower abdomen owing to acute appendicitis confirmed via computed tomography. Immediate laparoscopic appendectomy was decided as the method for treatment. Diagnosis: Horseshoe anomaly was diagnosed as a gross finding during surgery. Intervention: First,...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
ConclusionsThe incidence of conservative treatment preceding an antibiotics-first strategy for acute appendicitis is increasing. However, it is thought that appendectomy should be performed when acute appendicitis is complicated with septic DIC, even if it is a non-perforating appendicitis in which improvement with conservative treatment is anticipated.
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
Abstract A 49-year-old man visited the emergency room of Korea University Ansan Hospital with hematochezia starting the day before the visit. Recently, he was on anti-platelet medication due to hypertension. The patient had no definite symptoms other than hematochezia. Digital rectal exam was positive and laboratory tests showed severe anemia. Sigmoidoscopy was initiated and almost no fecal material was observed in the intestinal tract, allowing insertion into the cecum. Active bleeding from the appendiceal opening was noted. On abdominal CT, contrast enhancement was observed at the tip of the appendix. Under susp...
Source: Korean J Gastroenter... - Category: Gastroenterology Authors: Tags: Korean J Gastroenterol Source Type: research
CONCLUSION: Overall, the care providers preferred SR to FTR. Further investigation into the sustained use of the SR is needed. PMID: 30672164 [PubMed - in process]
Source: Korean J Radiol - Category: Radiology Authors: Tags: Korean J Radiol Source Type: research
Abstract Background and objective: In patients with acute appendicitis (AA), preoperative computed tomography (CT) findings suggesting development of intraabdominal abscess (IAA) had not been widely used. The aim of this study was to investigate the preoperative clinical and radiological factors that predict the development of a postoperative IAA in patients with AA who were treated by laparoscopic appendectomy (LA). Methods: Two hundred and sixteen patients with pathologically proven AA underwent LA between January 2013 and March 2018 in our department. Medical records and preoperative CT images of these 216 pati...
Source: Medicina (Kaunas) - Category: Universities & Medical Training Authors: Tags: Medicina (Kaunas) Source Type: research
Objective The aim of this study was to assess whether increased time from emergency department (ED) triage to appendectomy is associated with a greater risk of children developing appendiceal perforation. Methods We performed a multicenter retrospective cohort study of children younger than 18 years hospitalized with appendicitis. To avoid enrolling patients who had perforated prior to ED arrival, we included only children who had a computed tomography (CT) scan demonstrating nonperforated appendicitis. Time to appendectomy was measured as time from ED triage to incision. The main outcome was appendiceal perforation a...
Source: Pediatric Emergency Care - Category: Emergency Medicine Tags: Original Articles Source Type: research
ConclusionsIn the diagnosis of acute appendicitis in children, ultrasound is useful and accurate mode, which results in a significant decrease in negative appendectomies with no increase in the number of CT scans. This has important implications in the reduction of childhood radiation exposure.Study designcross sectional validation.
Source: Annals of Medicine and Surgery - Category: General Medicine Source Type: research
A 42-year-old man was admitted because of abdominal pain and constipation, which had persisted for 1 year. Total colonoscopy showed a 2.5-cm subepithelial lesion in the cecum involving the appendicular orifice. After bite-on-bite biopsy, drainage of mucinous and viscous fluid was observed (Figure A), which was aspirated with complete disappearance of the lesion (Figure B). Abdominal computed tomography only revealed a slight thickening of the appendix without lymph node and distant metastasis. The patient underwent appendectomy, and surgical pathology identified an enlarged appendix filled with mucus extending until the mu...
Source: Clinical Gastroenterology and Hepatology - Category: Gastroenterology Authors: Tags: Electronic Image of the Month Source Type: research
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