MyMedR

Fulltext Acute appendicitis in pregnancy: a diagnostic and management challenge

Zainur Rashid, Z., Sulaiha, S.A., Azmi, M.N.

International Medical Journal Malaysia, 2014;13(1):77-80.

MyJurnal

Acute appendicitis is the most common extra-uterine surgical emergency encountered during pregnancy, but an accurate diagnosis is still an enigma. Anatomical shifting of the appendix by the enlarging uterus makes the clinical and sonographic diagnosis difficult. Prompt diagnosis and treatment are essential to prevent perforation, which increases the risk of fetal and maternal death. Surgical intervention, either by an open laparotomy or laparoscopy is the most appropriate treatment for appendicitis. This article reviews the epidemiology, clinical diagnosis, investigation, complications and treatment of acute appendicitis in pregnancy.

Matched MeSH terms: Appendicitis

Fulltext Imaging as an aid to the diagnosis of acute appendicitis

Wijesuriya LI

Malays Fam Physician, 2007;2(3):106-9.

PMID: 25606095 MyJurnal

Acute appendicitis has been known as a disease entity for well over a century but a confident diagnosis before surgery in all patients suspected of the condition is still not possible. Timely diagnosis is essential to minimise morbidity due to possible perforation of the inflamed organ in the event treatment is delayed; so much so that surgeons often preferred to operate at the slightest suspicion of the diagnosis in the past. This resulted in the removal of many normal appendixes. When the diagnosis of appendicitis is clear from the history and clinical examination, then no further investigation is necessary and prompt surgical treatment is appropriate. Where there is doubt about the diagnosis however it is advisable to resort to imaging studies such as abdominal ultrasound or computed tomography to clear such suspicions before subjecting the patient to an appendicectomy. These studies would also help avoid delays in surgery in deserving patients.

Matched MeSH terms: Appendicitis

Fulltext Amyand’s Hernia: A Diagnostic Dilemma

Vairavan, N., Rohaizak, M., Hairol, O.

International Medical Journal Malaysia, 2006;5(1):1-4.

MyJurnal

Appendicitis within an Amyand's hernia is rare; when it occurs it is often misdiagnosed as a strangulated inguinal hernia. Management of these cases needs to be individualized according to the presentation. In uncomplicated cases, we recommend concurrent appendectomy and darning repair of the hernia. We present such a case and review the related literature.

Matched MeSH terms: Appendicitis

Pre-emptive intraperitoneal local anaesthesia: an effective method in immediate post-operative pain management and metabolic stress response in laparoscopic appendicectomy, a randomized, double-blinded, placebo-controlled study

Thanapal MR, Tata MD, Tan AJ, Subramaniam T, Tong JM, Palayan K, et al.

ANZ J Surg, 2014 Jan-Feb;84(1-2):47-51.

PMID: 23057502 DOI: 10.1111/j.1445-2197.2012.06210.x

Although laparoscopic surgeries are associated with reduced surgical stress response and shortened post-operative recovery, intense pain and high analgesia requirements in the immediate post-operative period are often the chief complaints.

Matched MeSH terms: Appendicitis/surgery*

Fulltext Acute appendicitis: pathology of 1,000 cases

Thanaletchimy N

Med J Malaysia, 1986 Dec;41(4):336-42.

PMID: 3670157

A retrospective study of the pathology seen in 1,000 consecutive appendicectomy specimens with a pre-operative diagnosis of acute appendicitis, was made in an attempt to find common factors which might throw light on the aetiology of the disease. Acute inflammation was seen in 775 cases. In 225 cases where no inflammation was seen, 168 appendices were associated with other pathology, i.e., lymphoid hyperplasia, fibrosis and tumour. In 57 cases the appendix was not inflamed. Acute inflammation was seen more in males and in patients aged below 30 years, while normal appendices were more commonly seen in females of reproductive age.

Matched MeSH terms: Appendicitis/etiology; Appendicitis/pathology*

Fulltext Laparoscopic appendicectomy for complicated appendicitis in children

Thambidorai CR, Aman Fuad Y

Singapore Med J, 2008 Dec;49(12):994-7.

PMID: 19122949

The place of laparoscopic appendicectomy in the management of complicated appendicitis remains unsettled with reports of a higher incidence of postoperative intraperitoneal abscess. Most studies on laparoscopic appendicectomy in children have been done in the Western population. This retrospective review was done to compare laparoscopic appendicectomy with open appendicectomy in children with complicated appendicitis in a hospital in Malaysia.

Matched MeSH terms: Appendicitis/complications; Appendicitis/surgery*

Fulltext Acute appendicitis presenting as melaena

Tham KC, Kok CL, Hein T

Med J Malaysia, 1992 Jun;47(2):154.

PMID: 1494337

Matched MeSH terms: Appendicitis/complications*; Appendicitis/diagnosis

Gangrenous giant Meckel's diverticulitis masquerading acute appendicitis: a surgical conundrum

Teng WW, Yeap BT, Azizan N, Hayati F, Chuah JA

ANZ J Surg, 2019 09;89(9):E379-E380.

PMID: 29695030 DOI: 10.1111/ans.14503

Matched MeSH terms: Appendicitis

Fulltext A Study on the Clinical Factors Associated with Acute Appendicitis and Perforated Appendicitis among Children in a Secondary Medical Centre in Malaysia

Tan PH, Teng XX, Gan ZY, Tan SQ

Malays J Med Sci, 2020 Jul;27(4):139-146.

PMID: 32863753 MyJurnal DOI: 10.21315/mjms2020.27.4.13

Background: Appendicitis complicated with appendiceal perforation is common among children. The delay in diagnosis of appendicitis is due to children's varied presentations and their difficulty in communicating symptoms. We aimed to identify clinical factors that aid in predicting acute appendicitis (AA) and perforated appendicitis (PA) among children.

Methods: This retrospective study involved 215 children aged 12 years and below with the initial diagnosis of AA and PA. Clinical factors studied were demographics, presenting symptoms, body temperature on admission (BTOA), white cell count (WCC), absolute neutrophil count (ANC), platelet count and urinalysis. Simple and multiple logistic regressions were used to determine the odds ratio of the statistically significant clinical factors. Results: The mean age of the included children was 7.98 ± 2.37 years. The odds of AA increased by 2.177 times when the age was ≥ 8 years (P = 0.022), 2.380 times when duration of symptoms ≥ 2 days (P = 0.011), 2.447 times with right iliac fossa (RIF) pain (P = 0.007), 2.268 times when BTOA ≥ 38 °C (P = 0.020) and 2.382 times when neutrophil percentage was ≥ 76% (P = 0.045). It decreased by 0.409 times with non-RIF pain (P = 0.007). The odds of PA was increased by 4.672 times when duration of symptoms ≥ 2 days (P = 0.005), 3.611 times when BTOA ≥ 38 °C (P = 0.015) and 3.678 times when neutrophil percentage ≥ 76% (P = 0.016). There was no significant correlation between WCC and ANC with AA and PA.

Conclusion: Older children with longer duration of symptoms, RIF pain and higher BTOA are more likely to have appendicitis. The risk of appendiceal perforation increases with longer duration of symptoms and higher BTOA.

Matched MeSH terms: Appendicitis

The acute abdomen and the obstetrician

Sivanesaratnam V

Baillieres Best Pract Res Clin Obstet Gynaecol, 2000 Feb;14(1):89-102.

PMID: 10789262

An acute abdomen in pregnancy can be caused by pregnancy itself, be predisposed to by pregnancy or be the result of a purely incidental cause. These various conditions are discussed. The obstetrician often has a difficult task in diagnosing and managing the acute abdomen in pregnancy. The clinical evaluation is generally confounded by the various anatomical and physiological changes occurring in pregnancy itself. Clinical examination is further hampered by the gravid uterus. The general reluctance to use conventional X-rays because of the pregnancy should be set aside when faced with the seriously ill mother. A reluctance to operate during pregnancy adds unnecessary delay, which increases morbidity for both mother and fetus. Such mistakes should be avoided as prompt diagnosis and appropriate therapy are crucial. A general approach to acute abdominal conditions in pregnancy is to manage these problems regardless of the pregnancy.

Matched MeSH terms: Appendicitis/diagnosis; Appendicitis/surgery

Intraperitoneal haemorrhage from a ruptured corpus luteum. A cause of "acute abdomen" in women

Sivanesaratnam V, Singh A, Rachagan SP, Raman S

Med J Aust, 1986 Apr 14;144(8):411, 413-4.

PMID: 3959969

During the 10-year period 1974-1983, 68 patients with intraperitoneal haemorrhage as a result of the rupture of a corpus luteum were managed at the University Hospital, Kuala Lumpur, Malaysia. Most of the patients were aged between 18 and 35 years. In 63% of the patients the rupture occurred between the 14th and the 35th day of the menstrual cycle, and 10 patients had intraperitoneal bleeding severe enough (450-1500 mL) to require blood transfusion. The condition is often confused with other surgical emergencies such as appendicitis and ectopic pregnancy. An increased awareness of the problem in women of reproductive age and the use of laparoscopy, when indicated, will allow a more conservative approach to be adopted for those patients with minimal bleeding. The performance of an appendicectomy in the presence of blood in the peritoneal cavity did not appear to increase morbidity in those patients with a preoperative diagnosis of "appendicitis".

Matched MeSH terms: Appendicitis/diagnosis

Fulltext Acute appendicitis and the leucocyte count

Singh KJ

Med J Malaysia, 1980 Mar;34(3):314-6.

PMID: 7412672

The total and differential leucocyte counts were estimated in 100 consecutive cases operated for acute appendicitis. Leucocytosis was seen in 52% of cases. 480/0 of patients had a leucocyte count below 10000 per c. mm. A study of the differential count was also made to see if this parameter could be used as a specific diagnostic aid. Though the neutrophil count was high in 74% of the cases, the comparative count among the below 10000 per c.mm. group was not significant. It is concluded that the total and differential counts are of limited value in the assessment of these patients. It is suggested that such estimation be used as a supportive aid only. In those doubtful cases with normal or low counts, frequent clinical reviews should be done and reliance placed on clinical assessment rather than laboratory information.

Matched MeSH terms: Appendicitis/diagnosis*

Fulltext Scrotal abscess: an unusual complication of perforated appendix

Shahrudin MD

Med J Malaysia, 1994 Jun;49(2):172-3.

PMID: 8090098

Acute scrotal pain and swelling in children is commonly attributed to torsion of the testis or of the testicular appendage. However, following suppurative appendicitis, scrotal abscess secondary to a patent processus vaginalis must be considered.

Matched MeSH terms: Appendicitis/complications*

Fulltext Atypical Pelvic Inflammatory Disease (PID) with Empyema and Ascites in A Single Unmarried Lady

Roszaman Ramli, Mokhtar Awang, Ghazali Ismail

International Medical Journal Malaysia, 2006;5(2):1-7.

MyJurnal

Pelvic inflammatory disease (PID) is a common cause of morbidity and accounts for 1 in 60 GP consultations by women under the age of 45 in the UK. Pelvic inflammatory disease encompases a broad category of disease including endometritis, salphingitis, salphingo-oopheritis, tuboovarian abscess and pelvic peritonitis. It most commonly occurs as a result of Chlamydia trachomatis or Nesseria gonorrhea 1,2 infection of the endocervix that eventually spread into the upper genital tract. Direct spread from a nearby infection such as appendicitis and diverticulitis is not that common. Hematogenous spread is rare except in cases of tuberculous pelvic inflammatory disease. This case illustrates atypical presentation of pelvic inflammatory disease in a previously healthy single unmarried lady. The presence of ascites, bilateral ovarian mass and constitutional symptoms closely mimics that of malignant ovarian tumour. This was preceded by empyema which grew E coli.

Matched MeSH terms: Appendicitis

Fulltext Appendicitis following blunt abdominal trauma

Ramesh G, Ho PW, Ng KL, Jegan T

Med J Malaysia, 2002 Mar;57(1):123-4.

PMID: 14569731

A young boy presented with history of abdominal trauma. History and initial clinical findings suggested a soft tissue injury. Due to increasing abdominal pain and fever, we proceeded with an exploratory laparotomy with a diagnosis of intra-abdominal injury, at which we found a perforated appendix. Appendicitis following blunt abdominal trauma needs high index of suspicion.

Matched MeSH terms: Appendicitis/diagnosis*; Appendicitis/etiology*; Appendicitis/surgery

Incidence of Retrocaecal Acute Appendicitis at the Hospital Sultanah Nora Ismail (HSNI) Batu Pahat

Nur Bazlaah B, Khairuzi S, Nabiha F, Mohd Nadzri M, Nur Bazilah B, Hirdayu AB, et al.

Med J Malaysia, 2021 03;76(2):223-228.

PMID: 33742632

BACKGROUND: A surgical audit study among Batu Pahat population was conducted in determining the commonest position of appendix in post appendectomy.

METHODOLOGY: This is a retrospective study. A total of 204 cases of patients underwent an appendectomy admitted to the surgical ward from January 2017 until January 2018 at Hospital Sultanah Nora Ismail (HSNI) were audited retrospectively.

RESULTS: This findings showed different figures of ascendancy in gender among patients who underwent an appendectomy with females 58.8% and males 41.2%. The perforation rate was 40.7% and delay in diagnosis was found to be 19.1%. The perforated appendix had a significantly higher incidence in males with a correlation of p-value 0.04. Retrocaecal appendix (RA) remained the commonest position for patients who underwent an appendectomy with 26.9%. RA is associated with an increased incidence of perforation (p-value 0.01).

CONCLUSION: The position of appendix in our patients who underwent an appendectomy is parallel to the reports available globally in that it is retrocaecal followed by retroileal as the commonest position among residence of Batu Pahat.

Matched MeSH terms: Appendicitis

Pediatric appendicitis in a developing country: what are the clinical predictors and outcome of perforation?

Ngim CF, Quek KF, Dhanoa A, Khoo JJ, Vellusamy M, Ng CS

J Trop Pediatr, 2014 Dec;60(6):409-14.

PMID: 25063462 DOI: 10.1093/tropej/fmu037

This study explored the risk factors and outcomes associated with perforation in children who underwent emergency appendicectomies.

Matched MeSH terms: Appendicitis/complications; Appendicitis/epidemiology; Appendicitis/surgery*

Fulltext Issues in management of acute appendicitis in pregnancy

Nalliah, Sivalingam, Wijesuriya, Lionel, Venugopal, Subramani

International e-Journal of Science, Medicine & Education, 2011;5(1):2-9.

MyJurnal

Acute appendicitis is an infrequent yet the commonest surgical emergency in pregnancy occurring in about 1:1500 pregnancies. The classical abdominal pain in the right lower quadrant of the abdomen is the only reliable clinical sign. Delay in diagnosis is attributed to presence of symptoms commonly seen in pregnancy like nausea and vomiting and difficulty in localizing abdominal pain due to displacement of the appendix with advancing gestation. Perforated appendix and generalized peritonitis impacts adversely on pregnancy contributing to increases in miscarriage, pre-term delivery, fetal loss and even maternal mortality. Imaging studies like abdominal ultrasonogram, helical computerized tomography and magnetic imaging have been utilized to complement clinical suspicion and decrease ‘negative appendectomies’ but robust data on their routine use is awaited. Although the laparoscopic approach is a useful diagnostic and therapeutic tool in early pregnancy, its use as the primary approach for appendicectomy in pregnancy requires further evaluation as increases in the incidence of fetal loss of 5.6% has been reported compared to 3.1% in open access surgery

Matched MeSH terms: Appendicitis

Appendicitis despite previous appendicectomy

Moissinac K, To BC, Gul YA, Liew NC

Trop Doct, 2001 Oct;31(4):217.

PMID: 11676058

Matched MeSH terms: Appendicitis/pathology*; Appendicitis/surgery*

Rare complication of appendix: small bowel gangrene caused by the appendicular knot

Mohana RT, Zainal AA

Med J Malaysia, 2017 12;72(6):370-371.

PMID: 29308777 MyJurnal

Intestinal knot formation was first described by Riverius in 16th century and later by Rokitansky in 1836. We report a very rare cause of small bowel gangrene caused by appendiceal knotting on to the ileum in a previously healthy mid aged lady. Patient underwent laparatomy and right hemicolectomy and primary anastomosis. The intra operative findings were the appendix was twisting (knotting) the small bowel about 40cm from the terminal ileum and causing gangrene to the segment of small bowel. Appendicitis is a common condition and management is usually straightforward. However we must be aware of rare complications which may arise that require a change from the standard treatment of acute appendicitis.

Matched MeSH terms: Appendicitis/complications*

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