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Comparison of childhood appendicitis management in the regional paediatric surgery unit and the district general hospital.

BACKGROUND/PURPOSE: Ongoing debate surrounds the future provision of general paediatric surgery. The aim of this study was to compare outcomes for childhood appendicitis managed in a district general hospital (DGH) and a regional paediatric surgical unit (RU). METHODS: Data collected retrospectively for a 2-year period in a DGH were compared with data collected prospectively for 1 year in an RU, where appendicitis management is guided by a care pathway. Children aged 6 to 15 years were included. RESULTS: Four hundred and two patients were included (DGH ,196; RU, 206). There were more cases o

Primary aortoappendicular fistula arising from an infected, chronic, contained, ruptured abdominal aortic aneurysm.

Gastrointestinal bleeding can be caused by a variety of pathologies. Primary aortoappendicular fistula is rare and, in our case, arose in addition to a chronic contained rupture sac of an abdominal aortic aneurysm. Clinical diagnosis is difficult. Aortic aneurysmorrhaphy along with extensive debridement and emphasis on antibiotic therapy is curative.

Leucocyte scintigraphy or computed tomography for the febrile post-operative patient?

OBJECTIVE: The optimal initial investigation for the post-operative patient with suspected occult intra-abdominal sepsis is controversial, although the diagnostic accuracy of a variety of techniques is known. Our objective is to determine which investigation has the greatest positive effect on patient management. METHODS AND PATIENTS: We reviewed 67 consecutive post-operative patients investigated for suspected occult sepsis retrospectively and analysed the sequence of investigations required to achieve the diagnosis depending on the choice of initial investigation, and the interval between b

The present status of biliary tract surgery.

The techniques now routinely available for modern biliary tract diagnosis and treatment have allowed today's biliary surgeon to make a diagnosis more rapidly and with greater delineation of the pathology than a decade ago. As well, the extension of these diagnostic techniques has allowed interventional procedures to be carried out by both the radiologist and the endoscopist such that certain palliative procedures may now be done without laparotomy, and reoperations may be avoided by percutaneous or endoscopic approaches. Operative surgery in this area has not had the same spectacular advances.

Total Leukocyte Count Depicting the Degree of Inflammation in Acute Appendicitis.

Introduction Acute appendicitis (AA) is the most common cause of acute abdomen in young adults. The diagnosis is usually made on various clinical findings. However, a missed case of acute appendicitis is a catastrophe as it later presents with life-threatening complications and results in medicolegal issues. Raised total leukocyte count (TLC) is a frequent finding in patients with acute appendicitis. As a convention, a normal leukocyte count usually rules out the differential diagnosis of acute appendicitis. Recent studies claimed that a substantial proportion of patients with normal TLC also

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… According to a study, negative appendectomy rate was 19% in patients while 80.9% of patients had acute appendicitis who presented with normal TLC with suspicion of Acute Appendicitis [ 7 ]. … Open appendectomies were done by consultant/ senior registrar or by trainees under direct supervision. Per-operative findings were noted and recorded. The specimen was sent to KRL hospital Laboratory for histopathology. …

Our treatment approaches in recurrent chronic intussusceptions.

BACKGROUND: Intussusception is the most common cause of intestinal obstruction between 6 months and 36 months of age. There is no defined et … olding and fixation to the cecal wall was performed on one patient with recurrent intussusceptions. Appendectomy was performed first, and then, ileal folding with cecal fixation was performed using 4/0 polyglactin sutures. The sutures were placed between the serosal layers of the adjacent terminal ileal loops and the cecal wall. CONCLUSION: Surgeons should tr …

Swine influenza (H1N1) and acute appendicitis.

BACKGROUND: During the swine influenza (H1N1) pandemic that began in 2009, many hospitalized adults had gastrointestinal symptoms. The most … Acute appendicitis was diagnosed by a computed tomography scan and the patient underwent emergency appendectomy. Subsequently, it was noted that she did not have leukocytosis and, in fact, had borderline leukopenia. Her differential white blood cell count also revealed relative lymphopenia. Neither leukopenia nor relative lymphopenia are features of acute bac …

Interobserver variation in the assessment of appendiceal perforation.

BACKGROUND: Following an appendectomy, surgeons define appendicitis, for treatment and billing purposes, into one of four categories: normal appendix, acute appendicitis, gangrenous appendicitis, and perforated appendicitis. Treatment of appendicitis is predicated upon classification at the time of visual inspection. Further, this classification often plays a role in the assessment of hospital outcomes. The currently accepted classification system is based solely upon intraoperative surgeon opinion and not objective data. Inconsistent surgeon grading of the severity of appendicitis may have im…

Impact of the COVID-19 pandemic on the pediatric population with acute appendicitis: Experience at a general, tertiary care hospital.

INTRODUCTION: Appendicitis is the leading cause of surgical acute abdomen in pediatrics. During the COVID-19 pandemic, management strategies were reassessed and the number of visits to the emergency department dropped down, which may be associated with delayed diagnoses and complications. The objective of this study was to analyze the impact of the pandemic on children with acute appendicitis. METHODS: Analytical, retrospective, comparative study of pediatric patients with acute appendicitis in the 5 months of COVID-19 lockdown versus the same period in the previous year. Incidence, clinical

Withholding Urinary Catheters in Children Receiving Patient-Controlled Analgesia for Appendicitis.

BACKGROUND: In some institutions, urinary catheters (UCs) have been placed in all patients receiving opioid patient-controlled analgesia (PCA) because of the increased incidence of urinary retention. Our institutional data demonstrated no UC replacements in 48 children who had PCA for perforated appendicitis who had their catheters removed before discontinuation of the PCA. As part of a quality improvement initiative, we discontinued the practice of requiring UC with PCA for perforated appendicitis. MATERIALS AND METHODS: A prospective list of patients with perforated appendicitis was maintai

Statewide assessment of surgical outcomes and the acute care surgery model.

BACKGROUND: The acute care surgery (ACS) model has been widely implemented with single institution studies demonstrating improved outcomes. Recent multicenter studies have raised questions about the economics and efficacy of ACS. This study compares traditional and ACS outcomes across an entire state. METHODS: A retrospective review of Virginia's Health Information administrative database was completed. Adults admitted with appendicitis or cholecystitis between 2008 and 2014 were included. Hospital administration was contacted to determine surgical model. To compare patient characteristics, t

Cost-Effectiveness of Integrating a Clinical Decision Rule and Staged Imaging Protocol for Diagnosis of Appendicitis.

OBJECTIVE: To evaluate the cost-effectiveness of a diagnostic protocol for appendicitis in children, the use of a validated clinical decision rule (CDR) and a staged imaging protocol, compared with usual care. METHODS: We estimated the cost-effectiveness of the three competing strategies using parameters from existing literature as well as a Markov model developed to simulate the effects of exposure to ionizing radiation from a single computed tomography (CT) study in the course of diagnosis. The simulation model was applied to a hypothetical cohort of 100,000 boys and girls, age 10 years, pr

Trocar and Veress needle injuries during laparoscopy.

BACKGROUND: Inadvertent lesions of the intraabdominal organs and vessels caused by trocars and Veress needles are rare but serious complications of laparoscopic surgery. Establishing the pneumoperitoneum is believed to be the most dangerous step. METHODS: The Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTS) prospectively collected the data on 14,243 patients undergoing various standard laparoscopic procedures between 1995 and 1997. This database was investigated with special regard to intraabdominal complications caused by trocars and Veress needles. RESULTS: There were 2

Abdominal gynaecological emergencies in the surgical unit.

We have studied two types of emergency cases that occurred in the surgical unit who were found to have gynaecological aetiology: 1) patients with the so-called "morbus acutum dexter", i.e. appendicitis, or a gynaecological disease and 2) late complications in patients who had earlier benign gynaecological disease, usually such as tumour and surgery for it. The material with seven years follow-up consisted of 97 patients, who were treated during the periods 1959--60 and 1969--70. The relative numbers in both groups increased during the latter period. Of the patients in the reproductive age with

The place of surgery in Crohn's disease.

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Optimizing the Use of Computed Tomography for Appendicitis Diagnosis in the Pediatric Emergency Department Through the Quality Improvement Methodology.

BACKGROUND: Acute appendicitis is one of the most common causes of an acute abdomen among pediatric patients. The diagnosis of appendicitis is challenging due to the nonspecific presentation. Diagnosis is based on historical, physical, and serologic information as well as right lower quadrant ultrasound (RLQ US). In equivocal patients, or those with a high degree of suspicion, computed tomography (CT) of the abdomen and pelvis with intravenous (IV) contrast can be utilized to rule in appendicitis. However, optimizing diagnostic protocols to minimize ionizing radiation exposure while maintainin

Utility and Accuracy of Primary and Secondary Ultrasonographic Signs for Diagnosing Acute Appendicitis in Pediatric Patients.

Introduction Making an accurate diagnosis of acute appendicitis (AA) is vital to prevent the morbid complications associated with untreated … dred and fifteen patients met the inclusion criteria of which 29% had confirmatory AA. The positive appendectomy rate was 89% (337/380). Using a 3-category classification of US results, the sensitivity was 79%, specificity 97%, positive predictive value was 93%, negative predictive value was 91% and the overall accuracy was 91%. The presence of two or more sec …

[Sporadic case of desmoid tumor in outcomes of lombotomic nephrectomy].

UNLABELLED: The desmoid tumor is a rare tumor with an incidence of 2-4 cases per million people each year, and represents 0.03% of all cance … , endocrine factors. Other causes may arise from trauma or abdominal injury in surgical outcomes of appendectomy, laparotomy and other surgical scars (scar fibromatosis) or genetic predisposing factors. The surgical resection of dermoid tumors should be the therapy of choice, complete and radical, to cover the possible excision of a wide margin of surrounding …

Five common cancers in Iran.

THE AIM OF THE STUDY: was to analyze clinical material concerning postoperative atrophy of abdominal integument. MATERIAL AND METHODS: The evaluated group consisted of 29 patients with sonographically revealed atrophy of the abdominal wall. Those changes were observed after various surgical procedures: mainly after long, anterolateral laparotomies or several classical operations. Ultrasound examinations up to the year 2000 were performed with analog apparatus, in the latter years only with digital apparatus with linear transducers (7-12 MHz) and sometimes convex type conducers (3-5 MHz). The

Laparoscopic lysis of adhesions.

BACKGROUND: Intra-abdominal adhesions constitute between 49% and 74% of the causes of small bowel obstruction. Traditionally, laparotomy and … omentum. Most intestinal obstructions follow open lower abdominopelvic surgeries such as colectomy, appendectomy, and hysterectomy. The most common complications associated with adhesions are small bowel obstruction (SBO) and chronic pain syndrome. The treatment of uncomplicated SBO is generally conservative, especially with incomplete obstruction and the abse …