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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
Non-operative treatment is currently reserved for patients with uncomplicated acute appendicitis, with intravenous antibiotics being used for 1 to 3 days, followed by oral antibiotics until 10 days after treatment. The patient should be advised that the rate of treatment failure and recurrence is typically between 15–25%. Regarding morbidity, the most common complication after appendectomy is surgical site infection, from simple wound infections to the appearance of intra-abdominal abscesses.
Introduction to the clinical stations
Published in Sukhpreet Singh Dubb, Core Surgical Training Interviews, 2020
Important terms: Chronic/recurrent appendicitis: This can occur in up to 5% of patients with appendicitis and most often results from antibiotic therapy in subclinical/early appendicitis whereby the inflammatory process does not fully resolve;Mesenteric adenitis: More common in children, where a painful lymphadenopathy of the small bowel mesentery occurs following a viral infection. This can mimic an appendicitis but can be treated with supportive therapy alone; andInterval appendicectomy: Treatment option for appendicitis complication with abscess formation. Antibiotic therapy is initiated to reduce sepsis with drainage of the abscess under CT guidance. If symptoms do not resolve an appendicectomy is performed after an interval of usually 6 weeks.
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
In pregnant women with AM, it is important to distinguish two situations (Figures 2 and 3). First, the management of AM discovered intraoperatively in a pregnant woman does not differ from that in the general population. The abdominal cavity is explored, and peritoneal nodules and/or mucin are systematically removed. The PCI should then be calculated as this will guide further treatment. The principles of surgery include resection of the appendix, wide resection of the mesoappendix and complete evacuation of the intraperitoneal mucoid material [6]. Mucin deposits in AM may be acellular or contain a neoplastic epithelium [9]. A challenge in pregnant women is the exploration of the ovaries as well as the rectouterine pouch or right para-colic gutter, which are preferential areas of mucus accumulation. In our patient, the surgeon carefully performed an appendectomy that included the meso-appendix. A laparoscopic approach is possible only if the surgeon uses the ‘no touch tumour’ technique, to avoid perforation of the tumour. Otherwise, a conversion to laparotomy is necessary and the appendectomy is performed according to the same principle. Macroscopic involvement of the appendiceal base requires ileocecal resection or right hemi-colectomy (more to obtain a macroscopically complete resection and adequate lymph node dissection. The main risk of AM is progression to PMP.
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.
Comparison of surgical gloves: perforation, satisfaction and manual dexterity
Published in International Journal of Occupational Safety and Ergonomics, 2022
Tulay Basak, Gul Sahin, Ayla Demirtas
An observational, prospective study was performed during April–May 2018. Scrub nurses used specified gloves during nine selected surgeries: (a) total hip prosthesis or total knee prosthesis; (b) lumbar laminectomy; (c) vitrectomy; (d) transurethral resection of the prostate or ureterorenoscopy; (e) ileus surgery; (f) caesarean section; (g) graft-flap surgeries; (h) video-assisted thoracoscopic surgery (VATS); (i) appendectomy surgery. We determined the cases by taking the frequencies of procedures into consideration in our hospital. A homogeneous number for the surgeries is aimed at mostly operative clinics in our hospital. scrub nurses wore antiallergenic surgical (powder and latex free). Also use powder and latex free gloves during three operations, double latex and powdered gloves during three operations and single latex and powdered gloves during three operations. Within the scope of the study, each type of glove was used in each of nine operations. All gloves were worn 105 times by 35 nurses. Thus, the effectiveness of all types of gloves was examined 315 times in total (Figure 1). If the gloves were visibly perforated during surgery, they were immediately replaced with new gloves of the same type and size. The number of punctured gloves was recorded. Among the scrub nurses, 60% were women and 40% were men.