Showing 6 results for Appendicitis
Khorasani B, Gholizadeyeh Pasha A,
Volume 64, Issue 8 (8-2006)
Abstract
Background: The early diagnosis of acute appendicitis before progression to gangrene or abscess formation is recognized as important to minimize morbidity from this common disease process. The aim of this study was to assess the value of different risk factors in the diagnosis of perforation.
Methods: This descriptive-analytic and retrospective study was conducted to investigate epidemiological characteristics in patients with perforated and non-perforated appendicitis. A series of 1311 patients who were operated on for acute appendicitis between years 1380-1382 in Shahid Beheshti and Yahya-nejad hospitals were reviewed.. Data gathered included age at operation, gender, care sought prior to admission for appendectomy including antibiotic and analgesic therapy, time of presentation in the year, duration of symptoms, signs and symptoms at the time of admission, and the patient’s living area.
Results: One hundred twenty one of 1311 patients (9%) had perforated appendicitis and 1190 patients (91%) had unperforated appendicitis. Presentation and referral in the first 6-month was associated with higher perforation rate. Patients from rural area showed a higher rate of perforations. The perforation rate was significantly higher in elderly patients (>65 year). When the duration of symptoms was more than 12 hours at presentation, the risk of perforation showed a five-fold increase. 30.7% of perforated cases had used antibiotic or sedative before referring to the hospital.
Conclusion: Appendiceal perforation continues to be a complication in patients with acute appendicitis and increased in the frequency as the age of the patients increase and the duration of symptoms lengthen. We also found that the perforation rate is higher in patients from rural area and in whom present in the first 6-month of the year, a finding that was not reported so far.
Dorostan N, Askarpour Sh, Askaree M, Paziar F, Hoseinikhah H,
Volume 66, Issue 2 (5-2008)
Abstract
Background: Acute appendicitis is one of the most common abdominal emergencies. Many studies comparing the two routes of open and laparoscopic appendectomy have been performed comparing the duration of each operation, duration of hospitalization, amount of post-operative pain medication required and infectious complications were the most commonly evaluated factors.
Methods: This clinical trial study, performed between March 2005 and March 2006 at Golestan and Imam Khomayni hospitals in Ahvaz, Iran, included 100 patients. Open appendectomy and laparoscopic appendectomy were carried out on 50 patients each. Duration of surgery and hospitalization, amount of pain medication and infectious complications were compared, with chi-square, ANOVA and t-test used for statistical analysis.
Results: The average length of hospital stay for laparoscopic appendectomy was 44.48 hours and for open appendectomy was 54.80 hours (p<0.01). The average of amount of pain medication for laparoscopic appendectomy was 2.40 doses and for open appendectomy was 30.46 doses (p<0.01). The laparoscopic and open procedures averaged 31.8 and 35.2 minutes, respectively (p=0.5). Only one (2%) laparoscopic case had infection, while four (8%) open appendectomy subjects suffered from this complication. Patients who underwent laparoscopic appendectomy had no intra-abdominal abscesses.
Conclusions: Duration of hospitalization was statistically much shorter using the laparoscopic appendectomy than that of the open procedure (P<1%). The amount of pain medication administered was also statistically less in the laparoscopic procedure (P<1%). However, the amount of time to complete each procedure was not statistically different. Most importantly, complications such as wound infection and intra-abdominal abscess were remarkably less using laparoscopy. We recommend laparoscopic appendectomy over open appendectomy.
Laal M, Granpaye L, Khodadi F, Salavatipour A, Sadeghi Ar,
Volume 66, Issue 6 (9-2008)
Abstract
Background: Various imaging tests as well as different scoring systems based on symptoms, signs and laboratory findings are commonly used to improve diagnostic accuracy in acute appendicitis. The aim of this study was to compare the diagnostic accuracy of MANTRELS scoring system (designed by Alfredo Alvarado), which is based on symptoms, signs and laboratory results, with sonographic findings.
Methods: In this prospective observational study, 106 patients with acute abdomen suspicious of acute appendicitis at Sina Hospital, Isfahan, Iran, were studied from March 2004 to February 2006.
Results: The disease was most common in patients aged 20-29 years, with male predominance. All patients had appendectomies. One hundred patients had acute appendicitis and six had negative appendectomy. Among the patients with acute appendicitis, 88% had an Alvarado score of ≥6 and 12% had a score of ≤5. Among the six patients with negative appendectomy, 66.7% had Alvarado scores of ≤5 and 33.3% had scores of ≥6, which was significantly different (p=0.005). The sonographic results were abnormal in 71.9% of patients with acute appendicitis and in 25% of patients with negative appendectomy, which was not significantly different (p=0.08). In our study, the diagnostic accuracy of an Alvarado score ≥6 was 88% and that of the sonographic results was 71.9% for acute appendicitis. If the Alvarado score ≥6 and abnormal sonographic findings are considered together, the diagnostic accuracy improves to 97.2%.
Abbas Alibakhshi , Saeid Safari , Hamid Ghaderi , Ali Aminian , Yasra Jahangiri , Seyedeh Adeleh Mirjafari Daryasari ,
Volume 67, Issue 10 (1-2010)
Abstract
Background: Management of acute abdomen usually does not necessitate accurate pre-operative diagnosis but the surgeon should make a decision about the need for emergent laparotomy. This fact is somehow different for localized peritonitis (e.g. acute appendicitis) in which the clinical presentation directs straightly to the diagnosis. However, acute appendicitis has lots of differential diagnoses, finding the normal appendix during laparotomy is just a start point to look for other diagnoses. Omental torsion is a rare cause for acute abdomen that is usually missed. Knowing about this rare condition and its frequently encountered presentation at the operating room (sero-sanguinous fluid coming out of peritoneal cavity) may prevent missing the diagnosis and doing a malpractice.
Case report: Report a 9 year- old boy presented with acute abdomen which turned out to be an omental torsion after the operation.
Conclusion: Knowledge about this rare condition "omental torsion" and its clinical and intra operative presentations may prevent missing the diagnosis and a malpractice.
Hamid Ghaderi, Kourosh Shamimi, Fereydoon Moazzami, Seyed Hasan Emami Razavi, Ali Aminian, Seyed Mehdi Jalali, Reza Afghani, Morteza Noaparast, Seyyed Habibollah Dashti, Saeed Safari, Alireza Ahmadvand, Seyede Adeleh Mirjafari Daryasari, Fatemeh Sadat Naeemie,
Volume 68, Issue 1 (4-2010)
Abstract
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Background: Appendicitis is more common during the second
and third decade of life and appendectomy scar is important in terms of
cosmetic issues. The scar is an important factor in the patient's satisfaction.
Conventional teaching has an emphasis on the closure of skin incision with
"separate" sutures. The aim of this study was to reconsider this dogma.
Methods: Among 321 patients with acute
appendicitis who came to the emergency unit of Imam Khomeini Hospital in
Tehran, Iran since april 2007
till april 2008, 278 (86.6%) patients had
uncomplicated appendicitis and were enrolled in our clinical trial. The
patients were randomly assigned to two groups of interrupted suture closure (n=139) and subcuticular
suture closure (n=139). Anesthesia method and
surgical technique were similar between the two groups. All patients were
followed up post-operatively (four weeks) for the presence of infectious
drainage, pain, erythema, swelling and warmness at the surgical site.
Results: The patients' sex and
their mean age were not statistically different between the groups. There was
no significant difference in the frequency of surgical site complications between
the two groups (five cases in the "interrupted" group and eight cases in the
"subcuticular" group p=0.415).
Conclusion: This study showed that
appendectomy incision closure with subcuticular sutures did not increase the
risk of wound complications. From the point of better cosmetic outcome of
subcuticular sutures, this method may be the method of choice for the closure
of appendectomy incisions in uncomplicated appendicitis.
Aazam Khorassani , Farzad Vaghef Davari ,
Volume 71, Issue 3 (6-2013)
Abstract
Background: Peptic ulcer disease is one of the most common GI disorders. Perforation has the highest mortality rate of any complication of ulcer disease, while early diagno-sis and emergency treatment save patient life.
Case presentation: This paper reports an adolescent boy admitted to the Ziaeian University Hospital. He suffered from severe abdominal pain with dyspnea had been started since past three hours. Periumbilical pain started from past 2-3 days, gradually localized to the right lower quadrant. He had anorexia without nausea and vomiting. He was tachycardic and tachypneic, but he did not have fever. On physical examination, bowel sound was hypoactive, there was generalize tenderness, guarding and rebound tender-ness focused in the right lower quadrant and suprapubic region. Laboratory finding indicated leukocytosis. Chest X-ray showed free air under diaphragm. Once the diagno-sis has been made, the patient was given analgesia and antibiotics, resuscitated with isotonic fluid, and taken to the operating room. Laparotomy was implemented through a midline incision. There was bile secretion in the peritoneal cavity. Appendix was inflamated. Cecum and ileum were normal. A small perforation, 4mm in size was detected in first portion of duodenum. Appendectomy and omental patch repair were done. Ten days later, the patient was discharged in a good state. Serologic test for helicobacter pylori was negative.
Conclusion: Stomach and duodenal perforation should be considered in patients with-out peptic ulcer disease, especially in children and adolescents with sudden and severe abdominal pain who are admitted to the hospital for other diseases. Because some patients present with peptic ulcer complications that are seemingly exacerbated by stressful life events.
