Should All Complicated Appendicitis Be Treated the Same? The Answer Is No.

Should All Complicated Appendicitis Be Treated the Same? The Answer Is No. Am Surg. 2019 Oct 01;85(10):1179-1183 Authors: Wang V, Kriger D, Fanous E, Lee A, Zakhary B, Coimbra R, Depew AJ Abstract Delayed presentation of acute appendicitis is associated with increased complications. We hypothesized that the outcomes of appendectomy in delayed presentations of acute appendicitis (>72 hours of pain) were dependent on radiologic findings rather than late presentation. We reviewed records from 2009 to 2015 and analyzed delayed presentations of acute appendicitis. We divided patients into three groups based on specific CT findings: uncomplicated appendicitis (UA), phlegmon or abscess (PA), and other perforated appendicitis (PERF, signs of perforation without abscess or phlegmon). One hundred thirty-eight patients were included in this study (58 in the UA, 67 in the PA, and 13 in the PERF groups). Overall, 78 (57%) patients underwent early appendectomy (EA) and 60 (43%) underwent initial conservative management. The incidence of adverse events was lower in EA than that in initial conservative management (17% vs 42%, P = 0.005). EA in the UA group was associated with shorter hospitalization (3.2 vs 5.6 days, P
Source: The American Surgeon - Category: Surgery Authors: Tags: Am Surg Source Type: research

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Publication date: Available online 23 January 2020Source: Journal of Minimally Invasive GynecologyAuthor(s): Whitney Trotter Ross, Jordan M. Newell, Richard Zaino, Allen R. Kunselman, Gerald J. Harkins, Andrea S. BentonAbstractStudy ObjectiveTo evaluate the diagnosis of appendiceal endometriosis in coincidental appendectomy specimens using a standard versus modified histopathologic analysis.DesignProspective analysis of 300 consecutive patients undergoing coincidental appendectomy at time of a primary gynecologic procedure.SettingAcademic tertiary referral hospital in the Northeastern United States.PatientsWomen ages 22 to...
Source: Journal of Minimally Invasive Gynecology - Category: OBGYN Source Type: research
ConclusionThe importance of POCUS in scanning right iliac fossa for patients present with signs and symptoms that are mimicking acute appendicitis for diagnosing a rare pathology and avoiding the risk of ionizing radiation hazards and unnecessary surgical intervention.
Source: Critical Ultrasound Journal - Category: Radiology Source Type: research
We report a case of appendiceal intussusception induced by a mucinous cystadenoma presenting as acute appendicitis. A 37-year-old woman was admitted with a one-day history of acute onset, right lower abdominal pain. Computed tomography showed swelling of the appendix, a pathological mass in the ileocolic region and oedematous pericolonic fat stranding. Emergency laparotomy via a McBurney incision revealed that the base of the appendix was swollen and intussuscepting into the caecum. Palpation of the caecum demonstrated an intraluminal mass, 6cm in size, at the appendicocaecal junction. After extension of the McBurney incis...
Source: Annals of the Royal College of Surgeons of England - Category: Surgery Authors: Tags: Ann R Coll Surg Engl Source Type: research
A 19-year-old woman was referred to our tertiary gynecology unit from a regional center with prolonged menstrual bleeding, brown intermenstrual discharge, dysmenorrhea, and a recent diagnosis of uterine didelphys. She had initially presented with pelvic pain and fever and undergone a laparoscopy for suspected appendicitis. She was found to have a normal appendix, infected right endometrioma, and 2 uterine horns. After treatment with antibiotics, magnetic resonance imaging (Fig. 1) showed uterine didelphys with a single vaginal lumen, right renal agenesis, and a 3-cm right endometrioma.
Source: The Journal of Minimally Invasive Gynecology - Category: OBGYN Authors: Tags: Images in Gynecologic Surgery Source Type: research
Acute appendicitis is a common condition emergency physician encounter during pediatric emergency visits. With a reported incidence of 1 in 50,000 appendectomies, stump appendicitis, an acute inflammation of the residual appendicular tissue, is a rare post-operative complication. The diagnosis of stump appendicitis is time-critical to prevent associated morbidities of abscess formation, perforation and sepsis. Another atypical presentation of appendicitis includes recurrent appendicitis, which is recognized as one or more previous episodes of similar clinical presentation as acute appendicitis, but symptoms subside within 24 to 48  h.
Source: The American Journal of Emergency Medicine - Category: Emergency Medicine Authors: Source Type: research
CONCLUSION: The strategy of repeating limited focused US followed by CT scan in cases that remain inconclusive has good diagnostic accuracy and reasonable NAR and decreases the number of CT scans. PMID: 31913249 [PubMed - as supplied by publisher]
Source: Pain Physician - Category: Anesthesiology Authors: Tags: Pediatr Emerg Care Source Type: research
A 19-year-old woman was referred to our tertiary gynaecology unit from a regional centre with prolonged menstrual bleeding, brown intermenstrual discharge, dysmenorrhoea and a recent diagnosis of uterine didelphys. She had initially presented with pelvic pain and fever and underwent a laparoscopy for suspected appendicitis. She was found to have a normal appendix, infected right endometrioma and two uterine horns. After treatment with antibiotics, magnetic resonance imaging (Figure 1) showed uterine didelphys with a single vaginal lumen, right renal agenesis and a 3cm right endometrioma.
Source: The Journal of Minimally Invasive Gynecology - Category: OBGYN Authors: Tags: Original Article Source Type: research
​Before you break out the bottles for a paracentesis, you may want to consider doing a test for ascites. Many procedures require executing an old-school test before even looking at a result or grabbing an ultrasound machine. Knowing what to look for on a physical exam may guide your practice and intervention dramatically. Using noninvasive tools first could help your patient avoid other tedious or unnecessary testing, which may also result in lost time. Incorporating ultrasound into your practice may also help you nail a diagnosis or allow you to perform a procedure better than you expected.A markedly distended abdomen d...
Source: The Procedural Pause - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
ConclusionThis case highlights difficulties in diagnosis of a tumor that has potential to cause significant morbidity. There is need for further research to discover the best management after surgical resection of these tumors.
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
ConclusionWith two primary, non-synchronous lesions, a thorough literature review suggests that during the patient's initial TAH-BSO, she could have additionally undergone an appendectomy. In doing so, this would provide accurate, complete staging and determine if the two neoplasms were truly primary in origin or metastatic. In addition, new genetic markers are being discovered, such as the Special AT-rich sequence-binding protein 2 (SATB2) marker, which has been found to be positive in those with a LAMN and negative in those with a primary mucinous ovarian carcinoma. By acquiring appropriate and complete staging we can be...
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
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