OBJECTIVEPrevention of the misdiagnosis of acute appendicitis when it first manifested as acute intestinal obstruction, and to search proper way of diagnosis and treatment for such event to provide the reference.

METHODSClinical data of 33 acute appendicitis cases presented with acute intestinal obstruction in Beijing Tong Ren Hospital during January 2000 and December 2015 were analyzed retrospectively.

RESULTSAll 33 patients were admitted to the Emergency Department with symptoms of various degrees abdominal pain and abdominal distension. There was no passage of gas and feces. The mean time of onset was (62.2±25.0) hours. The imaging examination showedthat all patients had complete bowel obstruction. Twenty one patients(63.6%) had peritonitis, three of whom developed with septic shock. Abdominal CT was performed in 17 patients preoperatively, which showed retention of gas and fluid in the small intestine in all the patients and 13 were suggestive of acute appendicitis. All of these patients received surgical treatment, 12 patients underwent laparoscopic exploration, and the remaining 21 patients received exploratory laparotomy during which acute appendicitis was confirmed to be the cause of intestinal obstruction, of whom 14(42.4%) was identified as mechanical intestinal obstruction. Nine patients underwent appendectomy and lysis of adhesion, five appendectomy and partial excision of the greateromentum. Nineteenpatients(57.6%) were identified as paralytic ileus and underwent appendectomy only. Twelve patients required respiratory and circulatory support and were admitted to ICU postoperatively. The mean duration time in ICU was(8.8±5.2) days. Postoperative pathology showedgangrene accompanied with perforation in the appendix. All patients were discharged without any complication. The length of hospital stay was (15.4±4.6) days. All patients were followed up for 3 ~ 12 months. One patient with chronic obstructive pulmonary disease developed repeated pulmonary infection and died of respiratory failure at 185 days postoperatively. The remaining patients were followed up and there were no patients developed intra-abdominalsepsis, intestinal obstruction, surgery-related complications, or death.

CONCLUSIONPatients with acute appendicitis presenting with acute intestinal obstruction are mostly in severe condition. Clinical diagnosis for this patients is difficult and surgery should be performed as soon as possible.

Abdominal Pain ; Acute Disease ; Appendectomy ; Appendicitis ; diagnosis ; pathology ; surgery ; Diagnostic Errors ; Humans ; Intestinal Obstruction ; diagnosis ; Intestine, Small ; Laparoscopy ; Laparotomy ; Length of Stay ; Physical Examination ; Postoperative Period ; Retrospective Studies

OBJECTIVETo find out the clinical and pathological characteristics in acute complicated appendicitis.

METHODSA retrospective clinical analysis was made on 742 cases of acute appendicitis from January 2003 to December 2012. All cases underwent appendectomy. Patients were allocated to the acute complicated appendicitis (ACA) group and the acute uncomplicated appendicitis group based on pathological reports. The χ² test was used to check for differences between proportions. Multivariate analysis was made through the Logistic regression.

RESULTSOf 742 patients, 533 were allocated to the ACA group, including acute suppurative appendicitis 306 patients, acute gangrenous appendicitis 100 patients, appendicitis with perforation 59 patients, appendicitis with abscess formation 6 patients and appendicitis with tumor 5 patients. Statistical result shows that the patients of ACA group usually had higher total WBC count, local or diffuse muscle guarding, intraluminal stercolith or periappendiceal fluid. Logistic regression also indicated that ACA were mathematically related to high level white blood cell count (>20 × 10⁹/L, OR = 2.717, 95%CI: 1.834-4.027, P < 0.05), local or diffuse muscle guarding (OR = 1.649, 95%CI: 1.047-2.597, P < 0.05), intraluminal stercolith (OR = 2.939, 95%CI: 1.607-5.377, P < 0.05) and periappendiceal fluid (OR = 3.273, 95%CI: 1.424-7.525, P < 0.05).

CONCLUSIONSPatients with high level WBC count, local or diffuse muscle guarding, intraluminal stercolith or periappendiceal fluid are likely suffering from acute complicated appendicitis. Appendectomy must be considered as first-line therapy other than conservative antibiotic therapy under these situations.

Acute Disease ; Adult ; Appendectomy ; Appendicitis ; diagnosis ; pathology ; surgery ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

To evaluate the ultrasound imaging characteristics and diagnostic criteria for acute abdominal Meckel's di- verticulum disease (MD), we retrospectively analyzed the ultrasonic characteristics, clinical data of 58 cases of pathologically proved MD from January 2009 to May 2012. We found that among all the 58 patients, 21 patients were diagnosed with the preoperative clinical diagnosis of MD. Fourteen cases of MD inflammation with acute appendicitis were evaluated by pathological examinations after the surgery. We also found 4 cases of MD with perforation, 15 cases of MD with intussusceptions, 14 cases MD with intestinal obstruction, 5 cases of MD secondary to intestinal obstructionor intestinal necrosis, and 5 cases of MD without any obvious complications. Emergency ultrasound examinations revealed 8 cases of simple MD, 1 case of MD with intussusceptions, 9 cases of MD with acute appendicitis, 12 cases of MD with intestinal obstruction, 2 cases of MD with intussusceptions and intestinal obstruction, 1 case of MD with omphalocele and 1 case of MD with abdominal abscess. The emergency sonographic findings suggested that MD was relatively fixed bowel or thick-walled cystic mass, with one end connected to small intestine, and the other end connected to the blind side, at the periumbilicus region or at the lower right abdomen. A conclusion could be drawn that MD is difficult to be detected by ultrasound (detection rate was about 15. 5%), and MD with complications such as intussusceptions, intestinal obstruction, acute appendicitis can usually be more easily detected (detection rates were 24.1%, 24.1% and 15.5%, respectively). Sonography is a simple, effective way to make diagnosis and differential diagnosis of MD with different acute abdomen symptoms from other disease.
Acute Disease ; Appendicitis ; pathology ; Diagnosis, Differential ; Humans ; Inflammation ; Intestine, Small ; pathology ; surgery ; Meckel Diverticulum ; diagnostic imaging ; surgery ; Retrospective Studies ; Ultrasonography

Appendicitis ; Appendix ; pathology ; surgery ; Hernia, Inguinal ; diagnosis ; surgery ; Humans ; Male ; Middle Aged

Adult ; Antigens, CD ; metabolism ; Antigens, Differentiation, Myelomonocytic ; metabolism ; Appendectomy ; Appendiceal Neoplasms ; complications ; metabolism ; pathology ; surgery ; Appendicitis ; etiology ; surgery ; Diagnosis, Differential ; Female ; Granular Cell Tumor ; complications ; metabolism ; pathology ; surgery ; Humans ; Paraganglioma ; metabolism ; pathology ; Phosphopyruvate Hydratase ; metabolism ; S100 Proteins ; metabolism

Appendectomy ; adverse effects ; Appendicitis ; surgery ; Diagnosis, Differential ; Hernia, Abdominal ; diagnosis ; etiology ; surgery ; Herniorrhaphy ; methods ; Humans ; Male ; Radiography, Abdominal ; Tomography, X-Ray Computed ; Young Adult

PURPOSE: Acute appendicitis has been reported to be relatively rare in pediatric leukemia patients but there is no official data for this in Korea. And there is no consensus for its treatment in this population. MATERIALS AND METHODS: We conducted a retrospective study of 7 patients diagnosed with appendicitis among 1209 pediatric patients who were diagnosed with leukemia from 1996 to 2008 at a single institution in Korea. RESULTS: The median age at the time of the diagnosis of appendicitis was 12 years (range: 3-15 years), and 3 of the patients were male. The median absolute neutrophil count (ANC) at the time of diagnosis was 0.99x10(9)/L (range: 0-3x10(9)/L). The mean time from the onset of symptoms to the diagnosis was 4 days. All 7 leukemia patients with appendicitis underwent surgery and they demonstrated a survival of 100% without significant complications. CONCLUSION: The incidence of appendicitis in pediatric leukemia patients was 0.57% in our study. Early diagnosis with abdominal ultrasound or computed tomography and early surgical resection in leukemic patient with acute appendicitis may be a safer and more effective treatment option. Even when perforation has already occurred and when the patient has an ANC of 0x10(9)/L, surgical treatment may improve overall survival without incurring significant complications.
Acute Disease ; Adolescent ; Appendectomy/adverse effects ; Appendicitis/*diagnosis/surgery ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Korea ; Leukemia/*physiopathology ; Male ; Retrospective Studies

BACKGROUNDAppendicitis is the most common surgical problem in pregnancy, however the particular dangers of appendicitis in pregnancy lie in the varied presentation of symptoms and the higher chance of delayed diagnosis. The aim of this study was to determine the risk factors associated with prenatal outcome in acute appendicitis during second and third trimester pregnancies.

METHODSThis was a retrospective single-center study that presented a descriptive analysis of the results. A total of 102 pregnant women who were diagnosed with acute appendicitis and operated upon in Peking University Third Hospital, China between January 1993 and December 2007 were presented. SPSS 12.0 for Windows was used for data analysis.

RESULTSSeventy-eight pregnant women who were diagnosed with acute appendicitis (sixteen patients had a perforated appendix, 62 patients had a non-perforated appendix) were operated upon during late pregnancy. The interval between symptom onset and surgery was the only predictive variable. A longer interval between symptom onset and surgery was associated with appendix perforation ((109.5 +/- 52.7) hours) than with no appendix perforation ((35.1 +/- 19.62) hours; P = 0.007). There was a significant difference in the rate of preterm labor (5.1% vs 1.3%) and the rate of fetal mortality (25% vs 1.7%) between patients with and without a perforated appendix.

CONCLUSIONSDelaying surgery correlates to more advanced disease with an increased risk of perforation. This contributes to an increased risk of further complications, including premature labor or abortion, and to higher maternal complication rates. Prompt diagnosis may improve the prenatal outcome.

Adult ; Appendicitis ; complications ; diagnosis ; surgery ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Pregnancy ; Pregnancy Complications ; etiology ; Pregnancy Outcome ; Retrospective Studies ; Young Adult

Stump appendicitis is an acute inflammation of the residual appendix and a rare complication after an appendectomy. Although the signs and symptoms do not differ from acute appendicitis, the diagnosis is often not considered because of the past surgical history. Only a small number of stump appendicitis cases have been reported, but there has been no report of stump appendicitis in Korea. Herein, we report a case of stump appendicitis. A 28-year-old female was admitted to our hospital due to right lower quadrant abdominal pain. Fifteen months ago, the patient had a laparoscopic appendectomy under the diagnosis of an acute appendicitis, but she subsequently suffered from intermittent abdominal pain and fever. Abdominal ultrasonography and CT scan showed an inflamed appendiceal stump. Laparoscopic stump appendectomy was done and the biopsy revealed stump appendicitis.
Acute Disease ; Adult ; *Appendectomy ; Appendicitis/*diagnosis/surgery/ultrasonography ; Appendix/surgery ; Diagnosis, Differential ; Female ; Humans ; Postoperative Complications/*diagnosis/ultrasonography ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Though acute appendicitis is one of the most common surgical conditions, the diagnosis in patients with equivocal signs can be difficult. Many patients with suspected appendicitis are admitted for observation. We designed this study to investigate whether the Alvarado score can be used as an admission criterion. METHODS: This is a prospective study comprising consecutive patients who attended the emergency room with right lower abdominal pain from January 2007 to March 2007. Patients were scored with the Alvarado score and if they were admitted, had a second scoring in the ward. Patients who were not admitted were told to attend the clinic the next day and patients who did not attend the clinic were interviewed by telephone. RESULTS: Total of 132 patients (M=83, F=49) were included and 105 patients were admitted for observation. Eighty-seven patients had surgery with the intention to treat appendicitis and 10 patients did not have appendicitis. The diagnosis of acute appendicitis was highly accurate for an Alvarado score above 6 (90.9%). Patients with a score 4 or less in the ward as well as in the emergency room did not have appendicitis. Of the patients with appendicitis, 49% (38/77) had higher scores in the ward than initial score at the emergency room. CONCLUSIONS: None of the patients with a score of 4 or less had appendicitis. They did not need admission. The Alvarado score can be used as an admission criterion in patients with suspected appendicitis.
Acute Disease ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Appendectomy ; Appendicitis/*diagnosis/surgery ; Child ; Child, Preschool ; Diagnosis, Differential ; Emergency Service, Hospital ; Female ; Humans ; Male ; Middle Aged ; Patient Admission/standards ; Sensitivity and Specificity ; Severity of Illness Index