Computed Tomography for Acute Appendicitis Diagnosis and Confirmation in Men : Trends and Cost Implications.

Computed Tomography for Acute Appendicitis Diagnosis and Confirmation in Men : Trends and Cost Implications. Am Surg. 2020 Sep 28;:3134820951483 Authors: Westfall KM, Purcell LN, Charles AG Abstract INTRODUCTION: The classic findings of acute appendicitis-right lower quadrant pain, anorexia, and leukocytosis-have been well known. However, emergency medicine and surgical providers continue to rely on imaging to confirm the diagnosis. We aimed to evaluate the increase in reliance on computed tomography (CT) scans for acute appendicitis diagnosis over time. METHODS: We conducted a retrospective study of patients ≥18 years presenting to UNC Hospitals with signs and symptoms of acute appendicitis who subsequently underwent appendectomy from 2011 to 2015. Demographic, clinical, laboratory, and pathologic data were reviewed. We evaluated the incidence of CT scans stratified by year, age, and sex. RESULTS: Within our male population, 55.2% (278/504) had classic appendicitis symptoms. Of the 278 male patients with classic appendicitis symptoms, 248 underwent CT imaging. Male patients 65 (10/39, 25.6%). Of the male patients
Source: The American Surgeon - Category: Surgery Authors: Tags: Am Surg Source Type: research

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The classic findings of acute appendicitis –right lower quadrant (RLQ) pain, anorexia, and leukocytosis–have been well known to physicians since the mid twentieth century. However, emergency medicine and surgical providers continue to rely on imaging to confirm the diagnosis. We aimed to evaluate the increase in reliance on computed tomo graphy (CT) scans for diagnosis of acute appendicitis over time.
Source: Journal of the American College of Surgeons - Category: Surgery Authors: Tags: General Surgery Source Type: research
We report a 42-year-old male who appeared in the morning in the emergency department with abdominal pain localized in the right lower abdomen and associated with anorexia and nausea. Clinical examination, laboratory tests, and abdominal ultrasound revealed deep tenderness at Mc Burney point and a mild elevation of CRP (0.7 mg/dL). In the evening, the symptoms were exacerbated, and a diagnostic laparoscopy was performed. Intra-operatively, the appendix was normal and a twisted, necrotic epiploic appendage originating from the antimesenteric border of the mid ascending colon was found. Laparoscopic resection of the necrotic ...
Source: Korean J Gastroenter... - Category: Gastroenterology Authors: Tags: Korean J Gastroenterol Source Type: research
We report on a 13-year-old boy who presented with right iliac fossa pain associated with anorexia, tenderness, guarding and rebound tenderness. Abdominal ultrasound showed findings of acute appendicitis. However, laparoscopy revealed a wooden toothpick perforating MD and a hyperemic appendix. The FB was removed and laparoscopic diverticulectomy and appendectomy performed. Perforation of MD by a FB is a diagnostic challenge and it should be included in the differential diagnosis of acute abdomen in children.
Source: Journal of Pediatric Surgery Case Reports - Category: Surgery Source Type: research
​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
A 20-year-old man presented to the Emergency Department (ED) with 3  days of constant abdominal pain that waxed and waned in intensity. He was seen in the ED 2 days prior, at which time his appendix was not well visualized on computed tomography (CT) of the abdomen and pelvis with i.v. contrast only. Symptoms included anorexia, loose stool, subjective fevers, and cramp-like periumbilical and right lower quadrant pain. The patient denied blood in his stool or vomiting. Vital signs were normal. Physical examination demonstrated tenderness in the right lower abdomen and periumbilical region.
Source: The Journal of Emergency Medicine - Category: Emergency Medicine Authors: Tags: Visual Diagnosis in Emergency Medicine Source Type: research
Conclusion Although infection with R. planticola is typically benign when treated appropriately, this pathogen has homology with Klebsiella species, and has the potential to acquire antimicrobial resistance. The case presented here suggests that R. planticola should be considered as a potential source of bacteremia in inflammatory/infectious gastrointestinal tract diseases even in the absence of typical risk factors.
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
This article discusses tips and pitfalls in diagnosis and addresses many of the controversies that surround the management of this condition.
Source: Journal of Paediatrics and Child Health - Category: Pediatrics Authors: Tags: Review Article Source Type: research
ConclusionA new CPR for predicting appendicitis, in patients presenting with RIF pain, has been derived and validated for use in our population. A prospective study to further evaluate its performance is required.
Source: ANZ Journal of Surgery - Category: Surgery Authors: Tags: Original Article Source Type: research
Case report An 11-year-old boy presented with a 1-day history of a generalised lower abdominal pain extending from the right to the left iliac fossa. His symptoms were associated with nausea, anorexia and a mild fever. On physical examination, deep tenderness and guarding were elicited at McBurney's point, as well as the hypogastrium and the left iliac fossa. Haematological investigations revealed normal ranges of both white cell count and C reactive protein. Urinalysis and abdominal ultrasound were also both normal. Due to the unclear nature of the initial clinical picture, the patient was monitored overnight; unfortunate...
Source: Postgraduate Medical Journal - Category: Journals (General) Authors: Tags: Journalology, Pain (neurology), Child and adolescent psychiatry, Eating disorders, Radiology, Clinical diagnostic tests, Gastrointestinal surgery, Radiology (diagnostics), Ethics Images in medicine Source Type: research
A 33-year-old female presented at the emergency department with a 36-hour history of peri-umbilical pain associated with anorexia and nausea. On physical examination, she was tender to palpation in the right lower quadrant. Psoas sign was absent, and there was no rebound tenderness. Laboratory examination revealed slightly elevated neutrophil count and elevated C-reactive protein. Her past medical history was unremarkable.Appendicitis was suspected and abdominal ultrasound was performed, which demonstrated an oval hyperechogenic mass with a hypo-echogenic rim in the right para-umbilical region (Figure A). There was maximal...
Source: Journal of the Belgian Society of Radiology - Category: Radiology Source Type: research
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