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Abdominal surgery
Published in Roy Palmer, Diana Wetherill, Medicine for Lawyers, 2020
Appendicitis is perhaps the most common surgical emergency. The appendix is situated on the end of the caecum and consists of a collection of lymphoid tissue. One of its functions is to control local infection and swelling of the appendix is probably quite common and will usually resolve. If the lumen of the appendix becomes obstructed, the appendix can swell and burst, giving rise to abdominal pain which then localizes towards the right lower side of the abdomen as the inflammation affects the outer part of the appendix. If the appendix is left in situ it may rupture giving rise to generalized peritonitis.
Feculent Empyema after Laparoscopic Appendectomy
Published in Wickii T. Vigneswaran, Thoracic Surgery, 2019
Raed Abdulkareem, Francis J. Podbielski
Acute appendicitis is a common surgical emergency. Successful surgical appendectomy requires removal of the appendix and its contents. An ectopic appendicolith can migrate to a variety of locations and act as a nidus for infection and abscess formation. In this case, the appendicolith/fecal matter was found in the thoracic cavity along with subsequent formation of a thoracic empyema.
Non-Gynecological Causes of Pelvic Pain
Published in Juan Luis Alcázar, María Ángela Pascual, Stefano Guerriero, Ultrasound of Pelvic Pain in the Non-Pregnant Female, 2019
Computed tomography scan (CT scan) and magnetic resonance imaging (MRI) are considered as second-line imaging techniques for assessing female patients presenting with suspected appendicitis.1 CT scan and MRI findings for acute appendicitis are similar to those described for ultrasound: inflamed appendix, inflamed peri-appendiceal fat, appendicoliths, and appendix diameter >6 mm.1,11 A recent meta-analysis has shown that diagnostic performance of CT scan and MRI after inconclusive ultrasound evaluation are similar in children and adult patients (Table 9.1).12
Management of mucocele of the appendix with peritoneal dissemination in pregnant women: a case report and literature review
Published in Acta Chirurgica Belgica, 2023
Sophiane Derbal, Clemence Klapczynski, Aurélie Charissoux, Sylvaine Durand Fontanier, Abdelkader Taibi
Second, AM is often diagnosed on routine abdominal ultrasound. However, in pregnant women it should also be characterised by abdominal diffusion-weighted MRI according to the RENARAD protocol [10]. A further advantage of this imaging exam is its ability to detect pools of mucin, especially in areas that are difficult to access in pregnant patients, and its good sensitivity in analyses of the cellularity, including in determination of the PCI and the detection of mucin pools [11,12]. According to literature reports, in patients with AM discovered fortuitously during pregnancy, appendectomy was performed after childbirth, given the risk of miscarriage and the slow progression of the pathology [13]. In our opinion, in a pregnant patient, if the progression of AM is slow (AM without perforation) or moderate (AM with acellular mucin), the pregnancy should be allowed to proceed to a vaginal delivery. In this case, acellular mucin is re-absorbed and does not lead to PMP. Nevertheless, the absence of epithelial cells outside the appendix is key.
Safety and efficacy of short-course intravenous antibiotics after complicated appendicitis in selected patients
Published in Acta Chirurgica Belgica, 2023
Hidde M. Kroon, Tim Kenyon-Smith, Gavin Nair, James Virgin, Bev Thomas, Karolina Juszczyk, Paul Hollington
The FMC appendicitis protocol (Appendix A) states that patients who present to the Emergency Department (ED) with a suspected appendicitis undergo clinical examination, blood work-up and imaging if required. If AA is confirmed, patients are given analgesia, intravenous fluids and IVAB (amoxicillin 2,000mg, metronidasole 500 mg and gentamicin 5 mg/kg), and are booked for an emergency appendicectomy. A laparoscopic appendicectomy is a preferred approach. Intraoperatively, the operating surgeon diagnoses CA, defined as a gangrenous or perforated appendix, determining postoperative antibiotic treatment for a minimum duration of five days. Postoperative IVAB can be changed to oral antibiotics (amoxicillin/clavulanic acid 875/125 mg) when after 48 h patients are responding well to therapy, which is determined by being afebrile and have a decreasing white cell count. Patients can then be discharged home. Antibiotics are ceased all together when patients are afebrile for 24 h with normalising white cell counts.
Genes vs environment in inflammatory bowel disease: an update
Published in Expert Review of Clinical Immunology, 2022
Valeria Dipasquale, Claudio Romano
Appendectomy may disrupt the immune system since the appendix has a complex immunological role. The research on the link between appendectomy and future IBD has been inconclusive. Appendectomy has been linked to subsequent CD. However, the risk decreases if CD is diagnosed more than 5 years after appendectomy, suggesting that the appendicectomy could have been unneeded in newly emerging CD patients with complaints similar to those of appendicitis [53,66]. Furthermore, it was found that appendicitis has a considerable protective effect against UC [67]. Individuals who have a first-degree relative who has had appendicitis are at a lower risk of developing UC, especially if there is a family history of UC [68]. A very recent nationwide cohort analysis of 246,562 individuals over the age of 20 who underwent appendectomy between 2000 and 2012 found that they had a 2.23- and 3.48-fold increased incidence of UC and CD than the comparison group [69]. Interestingly, regardless of whether appendicitis was present, the incidence of UC and CD rose considerably in the appendectomy group [69]. Tonsillectomy has been linked to late CD [53]. On the other hand, antibiotic exposure may be an unmeasured confounder because people who have tonsillectomy have frequently been exposed to antibiotics previously.