Macroamylasemia is a condition of persistent, elevated serum amylase activity with no apparent clinical symptoms of a pancreatic disorder. In Korea, however, no such case has been reported to date. We report a case of a 17-year-old female diagnosed with macroamylasemia and acute appendicitis. One day earlier, she developed epigastric and right lower quadrant abdominal pain. She was characterized by high level of serum amylase, but normal lipase. Amylase isoenzyme analysis demonstrated increased fraction of salivary type and follow-up amylase level was persistently increased. Immunofixation disclosed the macroamylase binding with an immunoglobulin, consisting of IgA and kappa chain. The patient was treated by appendectomy, and the abdominal pain subsided.
Adolescence ; Amylases/blood* ; Appendectomy ; Appendicitis/enzymology ; Appendicitis/blood* ; Case Report ; Female ; Human ; IgA/blood ; Immunoglobulins, kappa-Chain/blood ; Isoenzymes/blood ; Protein Binding

OBJECTIVETo evaluate the value of high mobility group box 1(HMGB1) in the diagnosis of pediatric acute appendicitis.

METHODSThe children with acute abdomen who had a diagnosis of suspected acute appendicitis between January and July 2013 and 25 healthy children were enrolled in this study. Serum HMGB1 levels were measured using ELISA on admission. The patients were classified into 2 groups according to surgery confirmation or pathological results: appendicitis (n=28) and non-appendicitis (n=35).

RESULTSSerum HMGB1 levels and WBC in the appendicitis and non-appendicitis groups were significantly higher than in the healthy children group (P<0.01). The appendicitis group showed more increased serum HMGB1 levels compared with the non-appendicitis group (median: 32.9 ng/mL vs 22.0 ng/mL; P<0.01). For a diagnosis of acute appendicitis, the sensitivity and specificity of serum HMGB1 was 71.4% and 82.9% respectively at the best cutoff of 28.0 ng/mL, with the accuracy of 77.8% and the area under the curve of 0.765 (95%CI 0.638-0.893).

CONCLUSIONSHMGB1 may play a role in the diagnosis of pediatric acute appendicitis.

Acute Disease ; Appendicitis ; blood ; diagnosis ; Child, Preschool ; Female ; HMGB1 Protein ; blood ; Humans ; Infant ; Male

Actinomycosis is a chronic suppurative and granulomatous-disease caused by Actinomycosis israelli. Clinical presentation of the abdominal form of actinomycosis is nonspecific-pain, fever, leukocytosis, increased erythrocyte sedimentation rate, a sensation of abdominal mass and a formation of fistula. In addition, abdominal actinomycosis may mimic a carcinoma, diverticular abscess, inflammatory bowel disease, and tuberculosis. Most of abdominal actinomycosis develops after trauma, appendicitis, diverticulitis or gastrointestinal perforation. We report a case of abdominal actinomycosis preoperatively mimicking as colon carcinoma, which had no predisposing factors.
Abscess ; Actinomycosis* ; Appendicitis ; Blood Sedimentation ; Causality ; Colon* ; Diverticulitis ; Fever ; Fistula ; Inflammatory Bowel Diseases ; Leukocytosis ; Sensation ; Tuberculosis

PURPOSE: The delta neutrophil index corresponds to calculated immature granulocyte counts and severity of sepsis. This study was conducted in order to investigate the diagnostic value of the delta neutrophil index as a preoperative laboratory marker for appendiceal perforation in patients with acute appendicitis. METHODS: This study was conducted as a retrospective analysis of patients confirmed pathologically as appendicitis at two hospitals from November 2009 to September 2010. Delta neutrophil index was automatically calculated as a subset of routine complete blood count testing. The diagnostic performance of the delta neutrophil index for perforated appendicitis was evaluated. RESULTS: During the study period, 308 patients were enrolled. Among them, 32 patients (10.4%) were confirmed as perforated appendicitis. The delta neutrophil index was significantly higher in the perforated group, compared with the non-perforated group (4.8+/-7.1% vs 2.0+/-2.0%, p<0.05). Sensitivity and specificity of the delta neutrophil index for prediction of perforated appendicitis was 25.0% and 96.7%, respectively, at a cutoff level of 5% with an area under the curve of 0.78 on the ROC (receiver operating characteristics) curve. CONCLUSION: Results of this study suggested an association of the delta neutrophil index with perforated appendicitis. However, the sensitivity was not high enough for use as clinical guidance.
Appendicitis ; Biomarkers ; Blood Cell Count ; Granulocytes ; Humans ; Neutrophils ; Retrospective Studies ; Sensitivity and Specificity ; Sepsis

OBJECTIVETo investigate the value of serum inflammatory markers in the diagnosis of acute appendicitis (AA) in children.

METHODSBlood samples were collected from 51 children with AA and 16 children with nonsurgical abdominal pain (NSAP) to examine white blood cell count (WBC), serum C-reactive protein (CRP), interleukin-6, and tumor necrosis factor-α (TNF-α).

RESULTSWBC count, CRP, IL-6 and TNF-α increased significantly in children with severe AA (phlegmonous or gangrenous, and perforated appendicitis). ROC curves showed that IL-6 or TNF-α had a greater contribution than WBC count to the diagnosis of severe appendicitis.

CONCLUSIONIL-6 and TNF-α can provide complementary information to assist the clinical decision of emergency operation for children with AA.

Appendicitis ; blood ; diagnosis ; Biomarkers ; blood ; C-Reactive Protein ; metabolism ; Child ; Child, Preschool ; Female ; Humans ; Inflammation ; blood ; diagnosis ; Interleukin-6 ; blood ; Lymphocyte Count ; Male ; Tumor Necrosis Factor-alpha ; blood

PURPOSE: Acute appendicitis has atypical clinical findings that make accurate preoperative diagnosis difficult. The aim of this study was to investigate the usefulness of laboratory analyses, especially total leukocyte count (WBC) and neutrophil count, C-reactive protein (CRP) in the diagnosis of acute appendicitis. METHODS: Sixty-nine patients who visited to the Department of Surgery, Sangju St. Mary's hospital with the diagnosis suspected acute appendicitis were studied. WBC, neutrophil count, CRP, and erythrocyte sedimentation rate (ESR) were analysed. Surgery for acute appendicitis was performed in fifty-four patients. According to histopathological findings of the appendix, the patients were divided into four groups: complicated (20 patients with perforated & gangrenous type), suppurative (9 patients), phlegmonous (25 patients), and normal (15 patients). The sensitivity and specificity of the laboratory tests in the diagnosis of acute appendicitis were calculated. RESULTS: The sensitivity of WBC>10, 000/mm3, neutrophil count>70% or >7, 000/mm3, and CRP>12 mg/L in acute appendicitis was 68.5%, 85.1%, and 74.0%, and the specificity was 86.0%, 73.3%, and 80.0% respectively. The combination of neutrophil count or CRP was 94.4% sensitivity. The severity of appendicitis had positive relationship with WBC, neutrophil count, and CRP (P=0.0001, P<0.0001, and P= 0.0014, respectively). The appendicitis and normal groups were significantly different in WBC, neutrophil count, and CRP (P<0.05). CONCLUSION: WBC, neutrophil count, and CRP have diagnostic value among the myriad causes of right lower quadrant abdominal pain and show a positive relationship with the severity of appendicitis.
Abdominal Pain ; Appendicitis* ; Appendix ; Blood Sedimentation ; C-Reactive Protein ; Cellulitis ; Diagnosis ; Gyeongsangbuk-do ; Humans ; Leukocyte Count ; Neutrophils ; Sensitivity and Specificity

PURPOSE: Most patients diagnosed with right-sided colonic diverticulitis complain of right lower quadrant pain, which is frequently confused for appendicitis and therefore may result in unnecessary emergency surgery. In this paper we intend to differentiate between right-sided colonic diverticulitis and appendicitis by initial presentation in the emergency department. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 450 patients between January 1997 and July 2003. Among these patients, 92 with right-sided colonic diverticulitis were classified as group I; 268 patients with simple appendicitis were classified as group II; and 90 patients with perforated appendicitis were classified as group III. RESULTS: Prodromal symptoms were less common in group I (p < 0.05) than in the other groups. In comparing the location of maximal tenderness among groups, 19.6% of group I patients complained of maximal tenderness at a point lateral to McBurney's point, a greater percentage than those in groups II and III (p=0.002). Group I experienced less leukocytosis (10,913.8/mm(3)) than did groups II (13,238.3/mm(3)) and III (15,589.3/mm(3)). The percentage of segmented forms in the differential counts was also smaller in group I (73.6%) than in groups II (79.1%) and III (81.8%). In addition, the proportion of lymphocytes was larger in group I (17.7%) than in groups II (13.9%) and III (9.3%). CONCLUSION: Among patients complaining of right lower quadrant pain in an emergency setting, right-sided colonic diverticulitis must be considered in the following conditions to avoid unnecessary emergency operations: lack of prodromal symptoms, tenderness at a point lateral to McBurney's point, and absent or mild leukocytosis with a low fraction of segmented forms and a high fraction of lymphocytes in the CBC.
Adolescent ; Adult ; Appendicitis/blood/*pathology ; Child ; Child, Preschool ; Diagnosis, Differential ; Diverticulitis, Colonic/blood/*pathology ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Middle Aged ; Retrospective Studies

Omental torsion is a rare cause of acute abdominal pain. It presents with nonspecific symptoms and signs of an acute abdomen, making it difficult to diagnose preoperatively, because symptoms mimic those caused by other conditions such as appendicitis, cholecystitis, diverticulitis, and other gynecologic diseases. Computed tomography is an effective and useful method to diagnose and exclude other acute abdominal conditions. Our case presented with sudden right upper abdominal pain with tenderness, rebound tenderness, mild fever (37.2degrees C), increased erythrocyte sedimentation rate (37 mm/hr), increased high-sensitivity C-reactive protein level (5.97 mg/dL). Computed tomography showed a large, well-circumscribed heterogeneous fatty mass and a 7.3 cm subserosal myoma. We could not exclude the myoma as the cause of acute abdominal pain, so we performed an emergency operation with suspicion of omental torsion or necrotic degeneration of the myoma. During the operation, we diagnosed primary omental torsion with infarction and subserosal myoma without secondary degeneration.
Abdomen, Acute ; Abdominal Pain ; Appendicitis ; Blood Sedimentation ; C-Reactive Protein ; Cholecystitis ; Diverticulitis ; Emergencies ; Female ; Fever ; Genital Diseases, Female ; Hysterectomy* ; Infarction ; Myoma

Femoral hernias account for up to 4% of all hernias that occur in the inguinal region. The hernial sac usually contains the greater omentum, small intestine, large intestine and preperitoneal fat, but rarely, in only 0.8% of the all cases, it also contains the appendix. Femoral, inguinal and incisional hernias, combined with appendicitis, occur in only 0.13% of cases. Thus, the incidence of appendicitis associated with a femoral hernia would be expected to be very rare. Herein, a case of an incarcerated femoral hernia, including a gangrenous appendix, is reported. An 81-year-old female was admitted with a protruding mass in the right inguinal area of 2 days duration. On inspection, a 4x3 cm sized erythematous bulging mass was noted. On palpation, the mass was tender and fixed in nature. There were no signs of peritoneal irritation or other palpable masses in the whole abdomen. Under the impression of a femoral hernia, a manual reduction was attempted, but to no avail. An immotile edematous intestine was noted on ultrasonography, and fluid retention with decreased blood circulation was noted in the intestine, suggestive of incarceration. An emergency operation was performed, with an incision made through the right groin region, where an incarcerated femoral hernia, including a gangrenous appendix, was found. An appendectomy and McVay repair were performed. The patient was discharged after 5 days, without any complications.
Abdomen ; Aged, 80 and over ; Appendectomy ; Appendicitis ; Appendix* ; Blood Circulation ; Emergencies ; Female ; Groin ; Hernia ; Hernia, Femoral* ; Humans ; Incidence ; Intestine, Large ; Intestine, Small ; Intestines ; Omentum ; Palpation ; Ultrasonography

PURPOSE: To investigate the predictors of perforated appendicitis (PA) in pediatric patients with appendicitis seen in the emergency department. METHODS: We retrospectively reviewed 564 pediatric patients (< 16 years) who visited the emergency department and subsequently had pathologically confirmed appendicitis from 2005 through 2014. Clinical features, inflammatory markers, including the white blood cell (WBC), neutrophil, and lymphocyte counts, neutrophil-to-lymphocyte ratio, C-reactive protein (CRP) concentration, erythrocyte sedimentation rate (ESR), and the Alvarado score were compared between the patients with and without PA regarding their predictability of PA. RESULTS: Of 564 pediatric patients with appendicitis, 204 (36.2%) had PAs. The patients with PA had longer duration of symptoms and median length of hospital stay, more frequent nausea and vomiting, and higher median WBC and neutrophil counts, neutrophil-to-lymphocyte ratio, ESR, and CRP concentration. Overall, WBC count showed the highest sensitivity of 79.9% and negative predictive value of 82.6%, and CRP concentration had the highest area under the receiver operating characteristic curve of 0.72. Multivariable logistic analysis showed that WBC count > 13.5 × 109/L (odds ratio [OR], 3.27; confidence interval [CI], 1.49–7.18; P = 0.003) and ESR > 15 mm/h (OR, 3.18; 95% CI, 2.13–4.74; P < 0.001) are independent predictors of PA. CONCLUSION: WBC count and ESR might be better predictors of PA in pediatric patients with appendicitis in the emergency department than the Alvarado score and CRP concentration.
Appendicitis* ; Blood Sedimentation ; C-Reactive Protein ; Child* ; Emergencies ; Emergency Service, Hospital ; Humans ; Length of Stay ; Leukocyte Count* ; Leukocytes* ; Lymphocyte Count ; Nausea ; Neutrophils ; Pediatrics ; Prognosis ; Retrospective Studies ; ROC Curve ; Vomiting