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A junior SHO's experience on the surgical admission unit
Published in Tim French, Terry Wardle, The Problem-Based Learning Workbook, 2022
Acute appendicitis is a common condition and usually requires appendicectomy. The main question is could the acute problem be non-surgical? Several medical problems which cause acute abdominal pain have been referred to elsewhere in this book (see pp. 11, 42, 113, 122, 163 and 183), however these problems do not generally cause peritonitis. Many of the conditions that mimic acute appendicitis also require surgery.
Acute Care Emergency Surgery
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
Marcelo A. F. Ribeiro, Mansoor Khan
Nowadays, the gold standard in treatment continues to be the appendicectomy, preferably by lap-aroscopic approach. In certain circumstances, the treatment will be performed by an open surgical procedure and, in selected cases, treated by antibiotic therapy with or without interval appendicectomy. The treatment of non-perforated acute appendicitis remains surgical, preferably within the first 12 hours after diagnosis. However, this approach can change in a resource-limited environment. The patients can have delayed presentation and surgery in this environment should only be undertaken if absolutely necessary.
Acute appendicitis
Published in Alexander Trevatt, Richard Boulton, Daren Francis, Nishanthan Mahesan, Take Charge! General Surgery and Urology, 2020
Diagnosis of acute appendicitis is a clinical one. The investigations listed here will generally only serve to confirm the diagnosis in the presence of equivocal findings or to rule out an alternative diagnosis. Ultrasound abdomen This has a sensitivity of 86% and specificity of 81% in acute appendicitis.It is operator-dependant and should only be used in conjunction with high clinical suspicion and laboratory markers. Appendicitis is diagnosed when an aperistaltic non-compressible tubular structure is seen with a diameter >6 mm.CT AP This has a sensitivity and specificity of 95% in acute appendicitis.Appendicitis can be diagnosed when an abnormal appendix or calcified appendicolith are seen alongside localised inflammation, free fluid or appendix diameter >6 mm.
Low intra-operative diagnostic accuracy does not affect postoperative treatment of acute appendicitis
Published in Acta Chirurgica Belgica, 2020
Eric E. Vinck, Ricardo A. Villarreal, Carlos Luna-Jaspe, Luis F. Cabrera, Tim F. Peterson, Felipe Bernal, Carmen L. Roa
Acute appendicitis continues to be the most common cause of emergency abdominal surgery performed by general surgeons. The lifetime risk of appendicitis is 8.6% in men and 6.7% in women [1,2]. Surgery is the gold-standard treatment for acute appendicitis despite trials using antibiotics alone. Despite being such a common surgical pathology, preoperative and intra-operative diagnosis continue to be a challenge. Clinical signs and symptoms, lab work, and imaging studies help guide surgeons in making the decision to take a patient to surgery. Although various imaging modalities exist along with preoperative scores, many patients are taken to surgery only to find that the presurgical suspicion was different than the intra-operative findings. During surgical explorations, a subjective-macroscopic classification is given by the surgeon [3,4]. Postoperative treatment is directly influenced by this designation. Once the pathologist examines these specimens, an objective-microscopic classification is given. This being the ‘true’ classification since appendicitis is a histopathological diagnosis. A total of 11–27% of negative appendicitis have been reported and 70% of patients with right-sided diverticulitis are taken to surgery only to find a normal appendix [3–5]. True histopathological appendicitis reaches 88.8% of specimens. Strong et al. reported that 27.8% of intra-operative ‘normal-looking’ appendices had histopathological findings of appendicitis and 9.6% of specimens considered to have appendicitis by the surgeon where histologically normal [4–7].
Beyond the commonest: right lower quadrant abdominal pain is not always appendicitis
Published in Alexandria Journal of Medicine, 2020
Mahmoud Agha, Maha Sallam, Mohamed Eid
Another one 67 y male patient (0.1%) was presented with severe acute appendicitis like symptoms and signs. CT scan revealed showed a linear dense foreign body in the mesentery, in close relation to the tip of a pre-ileal inflamed appendix. There was an ileocecal mucosal hyperenhancement and submucosal edema and regional stranding of the right iliac fossa fat planes. This mesenteric foreign body was surrounded with a considerable ring-enhancing collection, which was reported as sealed appendicular perforation with periappendicular abscess Figure 11(a-b). The patient was first managed conservatively with intense broad-spectrum short antibiotic course, with repeated CT scan after 1 week. The second study revealed a significant resolution of the collection and clearly demonstrated the residual inflamed appendix. Figure 11 (C-D) Operative feedback history documented a sealed appendicular perforation with extra-appendicular fish bone foreign body.
Negative Appendectomy. It is Really Preventable?
Published in Journal of Investigative Surgery, 2019
Preventing the progression from uncomplicated to complicated appendicitis via a timely intervention remains the focus of management. The risk of perforation has been shown to increase following delayed or missed diagnosis of an uncomplicated appendicitis. Recently, antibiotics have been employed in the management of uncomplicated appendicitis.2 Thus, the risk of progression to complicated appendicitis might be reduced by early use of antibiotics. Nonetheless, complications like perforation with intra-abdominal abscess formation, peritonitis, and abdominal sepsis represent severe complication of acute appendicitis. These complications might be associated with severe morbidity or mortality. Therefore, early diagnosis remains the key to a successful management. For this reason, the indication for emergency appendectomy is lavishly made. On the other hand, the risk of negative appendectomy defined as normal, uninflamed appendix following histopathology must always be considered. Negative appendectomy might be associated with serious postoperative complications.3 Thus there is need for an accurate preoperative diagnosis in cases with suspected acute appendicitis.