José Roberto Alves; Gustavo Busch Justino; Leonardo Busch Justino; Caique Martins Pereira Ternes; João Vítor Ternes Rech; Fabrissio Portelinha Graffunder
Volume 9, Issue 2 , April 2021, , Pages 101-104
Abstract
Meckel’s diverticulum is the most common gastrointestinal congenital defect, which, although asymptomatic in adults, may present symptoms in obstruction, inflammation, bleeding and foreign body perforation. There are only 8 cases reported of Meckel’s diverticulum perforation by ...
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Meckel’s diverticulum is the most common gastrointestinal congenital defect, which, although asymptomatic in adults, may present symptoms in obstruction, inflammation, bleeding and foreign body perforation. There are only 8 cases reported of Meckel’s diverticulum perforation by chicken bone. We report a case of a 24-yearold man presenting a 2-day-history of periumbilical pain that shifted to the right lower quadrant in 24 hours. Clinical and laboratory findings led to an appendicitis diagnosis, followed by laparotomy. Normal appendix was found intraoperatively along with an incidental finding of an inflamed and perforated Meckel’s diverticulum by chicken bone. Diverticulectomy and enteroanastomosis were performed and the patient had a successful recovery, being discharged 5 days after. Although rare, its clinical presentation might be similar to acuteappendicitis, which restate the importance of collecting a detailed clinical history and examining the small bowel towards to investigate a possible Meckel’s diverticulum complication in the differential diagnosis.
Somaye Bazdar; Maryam Dehghankhalili; Shekoofeh Yaghmaei; Maryam Azadegan; Amirhossein Pourdavood; Mohammad Hadi Niakan; Ali Mohammad Bananzadeh
Volume 6, Issue 2 , April 2018, , Pages 122-127
Abstract
Objective: To determine the effects of pregnancy on the presentation, management, surgical and obstetrics outcome of patients with acute appendicitis.Methods: This prospective cohort study was conducted during a 2-year period from 2014 to 2016 in Shahid Faghihi hospital of Shiraz University of Medical ...
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Objective: To determine the effects of pregnancy on the presentation, management, surgical and obstetrics outcome of patients with acute appendicitis.Methods: This prospective cohort study was conducted during a 2-year period from 2014 to 2016 in Shahid Faghihi hospital of Shiraz University of Medical Sciences. We enrolled all the pregnant individuals with acute appendicitis who required surgical appendectomy. We also enrolled age-matched controls of non-pregnant women undergoing open appendectomy during the study period. The presentation, clinical and laboratory characteristics, surgical and obstetrics outcomes were determined in both study groups and were further compared between them. In order to determine the determinants of outcome, we also ran a multivariate logistic regression model.Results: Overall we included a total number of 584 patients with presumed appendicitis among whom there were 58 (9.94%) and 526 (90.06%) non-pregnant individuals. The pregnant patients had significantly longer duration of symptoms (p=0.038), lower temperature (p=0.026), longer duration of hospital stay (p=0.026) and higher rate of hospital admission longer than 2 days (p=0.031). The complications of the surgical procedure were comparable between the two study groups except for the pneumonia which was significantly higher in pregnant patient (p=0.041). After adjusting for confounders such as age and ethnicity, pregnancy remained significantly associated with lower temperature (p=0.018), longer symptom duration (p=0.042) and higher rate of pneumonia (p=0.049).Conclusion: Acute appendicitis during the pregnancy was associated with longer duration of symptoms, lower body temperature and higher rate of pneumonia. The pregnancy and neonatal outcomes were comparable to the previously reported data.
Sadettin Er; Bülent Çomçalı; Ahmet Soykurt; Bülent Cavit Yüksel; Mesut Tez
Volume 6, Issue 2 , April 2018, , Pages 128-132
Abstract
Objective: To investigate the clinical, imaging and laboratory findings for diagnosis of acute appendicitis (AA) in patients with a normal white blood cell count (WBCC).Methods: This retrospective cross-sectional study was conducted in Ankara Numune Training and Research Hospital, Ankara, Turkey, during ...
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Objective: To investigate the clinical, imaging and laboratory findings for diagnosis of acute appendicitis (AA) in patients with a normal white blood cell count (WBCC).Methods: This retrospective cross-sectional study was conducted in Ankara Numune Training and Research Hospital, Ankara, Turkey, during a 1-year period. To determine diagnostic factors in AA in patients with normal WBCC, medical records of eligible patients were reviewed for demographic and clinical variables, as well as patient outcome.Results: A total of 105 patients that had undergone appendectomy and were found to have a normal WBCC were included in the study. Of these patients, 53 (50.5%) were men and 52 (49.5%) were women. The mean age of the patients was 34.2±12.3 (min 14, max 78). The negative exploration rate was identified as 19%. In the multivariate analysis, only the diameter of appendix was statistically significant (p=0.002). ROC analysis revealed the cut off appendiceal diameter as 8 mm. Conclusion: In patients suspected of AA due to ≥8 mm appendiceal diameter determined by imaging, we recommend surgical treatment even if WBCC and neutrophil count are normal.
Naser Mohammad Gholi Mezerji; Mohammad Rafeie; Zahra Shayan; Ghasem Mosayebi
Volume 3, Issue 2 , April 2015, , Pages 65-69
Abstract
Objective: To determine the diagnostic value of blood cells surface markers in patients with acute appendicitis. Methods: In this cross-sectional study, 71 patients who underwent appendectomy following a diagnosis of appendicitis were recruited during a one-year period. The patients were divided into ...
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Objective: To determine the diagnostic value of blood cells surface markers in patients with acute appendicitis. Methods: In this cross-sectional study, 71 patients who underwent appendectomy following a diagnosis of appendicitis were recruited during a one-year period. The patients were divided into two groups: patients with histopathologically confirmed acute appendicitis and subjects with normal appendix. Blood cell surface markers of all patients were measured. Univariate and multivariate analytical methods were applied to identify the most useful markers. Receiver operating characteristics (ROC) curves were also used to find the best cut-off point, sensitivity, and specificity.Results: Overall we included 71 patients with mean age of 22.6±10.7 years. Of the 71 cases, 45 (63.4%) had acute appendicitis while 26 (36.6%) were normal. There was no significant difference between two study groups regarding the age ( p=0.151) and sex ( p=0.142). The initial WBC count was significantly higher in those with acute appendicitis ( p=0.033). Maximum and minimum area under the ROC curve in univariate analysis was reported for CD3/RA (0.71) and CD38 (0.533), respectively. Multivariate regression models revealed the percentage of accurate diagnoses based on the combination of g/d TCR, CD3/RO, and CD3/RA markers to be 74.65%. Maximum area under the ROC curve (0.79) was also obtained for the same combination.Conclusion: the best blood cell surface markers in the prediction of acute appendicitis were HLA-DR+CD19, α/b TCR, and CD3/RA. The simultaneous use of g/d TCR, CD3/RA, and CD3/RO showed the highest diagnostic value in acute appendicitis.
Abbas Heydari; Amir Emami Zeydi
Volume 2, Issue 2 , April 2014, , Pages 99-100
Seyed Mohsen Mousavi; Shahram Paydar; Sedigheh Tahmasebi; Leila Ghahramani
Volume 2, Issue 1 , January 2014, , Pages 22-26
Abstract
Objective: To determine the effects of intravenous Acetaminophen (Apotel®) on pain severity and clinical findings of peritonitis in patients with acute appendicitis.Methods: This randomized cross-over clinical trial was carried out duringa 6-month period from August 2012 to February 2013 and comprised ...
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Objective: To determine the effects of intravenous Acetaminophen (Apotel®) on pain severity and clinical findings of peritonitis in patients with acute appendicitis.Methods: This randomized cross-over clinical trial was carried out duringa 6-month period from August 2012 to February 2013 and comprised 107 patients diagnosed with acute appendicitis. Patients were randomly assigned to received placebo (n=) or Apotel® (n=). Patients were evaluated before, 30 minutes, 1 hour and 4 hours after administration of Apotel® or placebo,and were told to fill in two forms. The first form required patientsto measure their painintensityaccording to visual analogue scale (VAS). The second form was filled by a surgeon who examined the patients and recorded his or her findings using Alvarado score criteria for diagnosis of acute appendicitis at foregoing time points.Results: Of 72 patients, 37 (51.4%) were men and 35 (48.6%) were women. The mean age of the patients was 34.1±13.5 years. The mean pain score in 107 patients included in this study was 7.96±2.3. Those who received Apotel® had significantly lower pain scores when compared to placebo at 30 minutes (p<0.001), 1 hour (p<0.001) and 4 hours of administration. There was no significant difference between two study groups regarding the frequency of Alvarado score; however the frequency of fever was significantly lower in those who received Apotel® (p<0.001). We found that Apotel® was not associated with resolved physical findings of acute appendicitis in different time intervals.Conclusion: Apotel® does not affect the clinical findings of acute appendicitis and dos not interfere with the accurate diagnosis. Therefore, it could safely be used as a reliable pain relieving agent, in patients with acute appendicitis.
Parisa Javidi Parsijani; Nima Pourhabibi Zarandi; Shahram Paydar; Hamidreza Abbasi; Shahram Bolandparvaz
Volume 1, Issue 4 , October 2013, , Pages 158-163
Abstract
Objectives: To evaluate the accuracy of sonography in diagnosing acute appendicitis in patients with Alvarado score 4–7.Methods: This is a retrospective cross-sectional study being performed in Namazee hospital affiliated with Shiraz University of Medical sciences during a one year period from 9/2007 ...
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Objectives: To evaluate the accuracy of sonography in diagnosing acute appendicitis in patients with Alvarado score 4–7.Methods: This is a retrospective cross-sectional study being performed in Namazee hospital affiliated with Shiraz University of Medical sciences during a one year period from 9/2007 to 9/2008. We evaluated all patients with Alvarado score 4-7 and divided them in two groups: those with Ultrasound study prior to surgery and those without any imaging modalities for diagnosis of AA. The demographic information, histopathology, physical examination, laboratory data, sonography report and histopathological reports of patients were gathered. Results: A total of 238 patients had Alvarado scores 4-7 including 160 males and 78 females. 110 patients did not have any imaging and 128 had undergone sonography before operation. Ultrasound had overall sensitivity of 75 %, specificity 69.2 %, PPV 88 %, NPV 46.1% and accuracy of 73.6 %. Negative appendectomy rate was20.9 % and 23.4 % in those without sonography and inpatients with sonography respectively, with a higher rate in females.Conclusion: Ultrasound is more useful when the patient is female and the result of sonography is positive; however, it is not reliable when the result is negative and maybe other diagnostic modalities such as CT scan can help us in better diagnosis of Acute Appendicitis.
Shahram Paydar; Parisa Javidi Parsijani; Armin Akbarzadeh; Alireza Manafi; Fariborz Ghaffarpasand; Hamid Reza Abbasi; Shahram Bolandparvaz
Volume 1, Issue 3 , July 2013, , Pages 123-126
Abstract
Objectives: To evaluate the short-term outcome of open appendectomy, the rate of negative appendectomy as well as pathology reports after surgery in patients with suspected acute appendicitis.Methods: This was a retrospective cross-sectional study being performed in Nemazee hospital affiliated with Shiraz ...
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Objectives: To evaluate the short-term outcome of open appendectomy, the rate of negative appendectomy as well as pathology reports after surgery in patients with suspected acute appendicitis.Methods: This was a retrospective cross-sectional study being performed in Nemazee hospital affiliated with Shiraz University of Medical Science during a 2-year period between 2008 and 2010. The medical records of all consecutive patients who underwent open appendectomy in our center due to acute appendicitis were included in the study. The elective and laparoscopic appendectomies were excluded. The demographic information, clinical findings, laboratory investigations and the histopathological examination of the appendix were recorded and reported.Results: A total of 337 patient including 137 (36.4%) females, and 240 (63.6%) males with the mean age of 16.26 ± 9.81 (range 3 to 76) years were stduied. Anorexia (64.7%) and fever (20.7%) were more prevalent symptoms. The mean duration between pain initiation and operation ranged from 0 to 14 days with mean 1.88 ± 1.63 days. Right lower quadrant (RLQ), periumbilical, epigastria, left lower quadrant (LLQ), and Right upper quadrant (RUQ), pain were manifest in 78.8%, 41.6%, 12.2%, 3.2%, and 1.3% of patients, respectively. Pathological evaluation of the appendix showed appendicitis in 70.4% of patients.Conclusion: The higher rate of negative appendectomy accounts for wasteful tapping of medical resources and causing further complication in patients. Therefore it is essential to conduct more accurate studies to detect the root cause of the disease. This would help improve the management of appendicitis which is an emergency condition with high incidence.
