MyMedR

Counter response to Response from Dr Wadhwani and Dr Rajesh to Gangrenous giant Meckel's diverticulitis masquerading acute appendicitis: a surgical conundrum

Hayati F, Azizan N, Yeap BT, Zainal Abidin ZA, Zakaria AD

ANZ J Surg, 2020 01;90(1-2):188-189.

PMID: 32067312 DOI: 10.1111/ans.15577

Matched MeSH terms: Appendicitis*

Fulltext Spontaneous bladder perforation: a rare complication of tuberculosis

Kong CH, Ali SA, Singam P, Hong GE, Cheok LB, Zainuddin ZM

Int J Infect Dis, 2010 Sep;14 Suppl 3:e250-2.

PMID: 20117032 DOI: 10.1016/j.ijid.2009.10.006

Spontaneous bladder perforation secondary to tuberculosis (TB) is very rare. Only three cases have been reported so far in the literature. Due to its rarity, the diagnosis of spontaneous bladder perforation is often missed. Confirmation of TB via culture takes a long time and starting empirical treatment for TB is necessary. We relate our experience with a young woman who presented with clinical features of a perforated appendix and was only diagnosed with bladder perforation during laparotomy. She also had distal right ureteral stricture and left infundibular stenosis. The provisional diagnosis of TB was attained via typical histopathological features and a positive Mantoux test. She was started empirically on anti-TB treatment and recovered without any complications. Urine culture after 6 weeks confirmed the diagnosis of TB.

Matched MeSH terms: Appendicitis/diagnosis

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*

Acute isolated amoebic appendicitis

Malik AK, Hanum N, Yip CH

Histopathology, 1994 Jan;24(1):87-8.

PMID: 8144148

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

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 The comparative effects of listening to prayer recitation and music therapy intraoperatively on postoperative pain

Farah Syaza Rahman, Nurlia Yahya, Nor Mohammad Md Din, Azarinah Izaham, Wan Rahiza Wan Mat

International Medical Journal Malaysia, 2018;17(2):107-116.

MyJurnal

Introduction: Non-pharmacological interventions are considered as successful adjuncts to manage pain. We are studying the comparative effects of listening to prayer recitation and music therapy intraoperatively as non-pharmacological interventions on postoperative pain and intraoperative haemodynamics. Materials and Methods: Seventy two muslim patients with acute appendicitis requiring open, emergency appendicectomies under general anaesthesia were recruited and randomised into three groups: Group A: patients who listened to prayer recitation, Group B: patients who listened to music, Group C: control group - patients who did not listen to any prayer or music. Intraoperative blood pressure, heart rate and postoperative pain scores were monitored. Results: The demographic data, pre- and post-headphones application haemodynamics were compared. There were significantly lower heart rates at 10, 20, 30, 40, 50, 60 minutes for Group A and at 50 and 60 minutes for Group B patients when compared to Group C. Significant reduction in postoperative pain scores were seen in Group A patients at 30 minutes and 8 hours as compared to Group C patients. No significant differences in pain scores were seen between Group B and C patients. No significant differences in additional analgesic requirements postoperatively were seen in all three groups. Conclusion: Listening to prayer recitation or music intraoperatively significantly lowered intraoperative heart rates, however only prayer recitation significantly reduced postoperative pain scores as compared to the control group.

Matched MeSH terms: Appendicitis

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

Fulltext Endometriosis of the appendix presenting as acute appendicitis

Khoo JJ, Ismail MS, Tiu CC

Singapore Med J, 2004 Sep;45(9):435-6.

PMID: 15334288

While endometriosis is fairly common, endometriosis of the appendix is a very rare occurrence. Correct pre-operative diagnosis is uncommon and definitive diagnosis is established by histology of the appendix. We present a case of endometriosis of the appendix that manifested as acute appendicitis in a 40-year-old woman.

Matched MeSH terms: Appendicitis/diagnosis*

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*

Perforated appendicitis--the Malaysian experience

Lee CM, Teoh MK

J R Coll Surg Edinb, 1990 Apr;35(2):83-7.

PMID: 2355382

Perforated appendicitis, with its increased complication rate, today still poses a formidable problem in the Kuala Lumpur General Hospital. Out of 1694 emergency operations performed by our unit in 1987, there were 927 appendicectomies. A retrospective study of these cases showed 126 cases of perforated appendicitis, which were then subjected to detailed analysis. We have a diagnostic accuracy of 81% and perforation rate of 18%. In addition, it is interesting to note the racial differences in the relationship of diagnostic accuracy to perforation rate. Perforation is associated with an increased wound infection rate. Transperitoneal drainage in perforated appendicitis did not lead to a lower incidence of wound infection or improve postoperative performance. Distinguishing between perforated and non-perforated appendicitis may be difficult. Perforation could occur while awaiting operation. We recommend the early administration of systemic antibiotics should appendicectomy be delayed and the cautious use of drains in cases of perforated appendicitis.

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

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

Fulltext A rare cause of acute appendicitis: Burkitt's lymphoma of the appendix

Abdul Ghani S, Noori S, Tan PE

Med J Malaysia, 1984 Dec;39(4):311-3.

PMID: 6544940

This paper presents a case report of a primary lymphoma of the appendix as the underlying cause of acute appendicitis. As in previous reported cases, diagnosis can only be made intraoperatively followed by a proven histopathological picture as they present with an acute surgical abdomen.

Matched MeSH terms: Appendicitis/etiology*

Malrotated Subhepatic Caecum with Subhepatic Appendicitis: Diagnosis and Management

Chong HC, Chai FY, Balakrishnan D, Asilah SM, Adila IN, Syibrah KZ

Case Rep Surg, 2016;2016:6067374.

PMID: 27648337

Subhepatically located caecum and appendix is a very rare entity. It occurs due to the anomaly in fetal gut rotation that results in an incomplete rotation and fixation of the intestine. Appendicitis, which is a common surgical emergency, in combination with the abnormal subhepatic location, presents a great challenge in its diagnosis and management. Here, we describe a 42-year-old male with chronic dyspepsia who presented with sepsis and severe pain at his right hypochondriac and epigastric region. The final diagnosis was acute appendicitis of the subhepatic appendix. Our discussion focuses on the diagnostic approach and clinical and surgical management. We hope that our report will increase the awareness among the clinicians and hasten the management of such rare condition to avoid complications.

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

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*

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

Ceftazidime/metronidazole versus netilmicin/metronidazole in the treatment of perforated appendicitis in children

Kooi GH, Pit S

Clin Ther, 1990 Jan-Feb;12(1):54-60.

PMID: 2183940

One hundred children with peritonitis resulting from a perforated appendix were treated with ceftazidime or netilmicin. Metronidazole was added to both groups to treat the anaerobic organisms commonly associated with the infecting aerobic organisms in peritonitis. Escherichia coli was the most common aerobe found in peritoneal pus. Wound infection occurred in nine patients of the netilmicin group and in none treated with ceftazidime (P less than 0.01). No bacterial resistance was evident in the ceftazidime group, but gram-positive streptococci found in eight patients were resistant to netilmicin. Thus it is recommended that an antibiotic of the penicillin group be added if netilmicin is used to treat peritonitis. The results indicate that ceftazidime was more effective than netilmicin in the treatment of children with peritonitis resulting from a perforated appendix.

Matched MeSH terms: Appendicitis/complications*

Disseminated histoplasmosis mimicking an acute appendicitis

Marsilla MM, Khairunisa AA, Azyani Y, Petrick P

Malays J Pathol, 2019 Aug;41(2):223-227.

PMID: 31427560

INTRODUCTION: Histoplasmosis can present in a myriad of clinical manifestations, which often makes its diagnosis difficult and occasionally, deceptive.

CASE REPORT: We describe a case of a 33 years old gentleman who was clinically diagnosed as acute appendicitis at initial presentation in view of a one-week history of fever, right lower quadrant abdominal pain- and guarding at right iliac fossa. He had thrombocytopenia and lymphopenia on presentation. Mesenteric lymphadenitis and small bowel lesion were found intraoperatively, which was respectively biopsied and resected. Histopathological result confirms disseminated histoplasmosis. Retroviral screen was positive. He was treated with amphotericin B for one week, subsequently switched to oral itraconazole, followed by initiation of highly active antiretroviral therapy (HAART).

DISCUSSION: This case illustrates the various nature of histoplasmosis presentation. A high index of suspicion is needed to clinch the diagnosis and subsequently institute prompt treatment as disseminated disease can be fatal if left untreated in an immunosuppressed host.

Matched MeSH terms: Appendicitis

Fulltext Acute appendicitis--the University Hospital experience

Lee HY, Jayalakshmi P, Noori SH

Med J Malaysia, 1993 Mar;48(1):17-27.

PMID: 8341168

A 1 year review of 529 cases of acute appendicitis, treated at the University Hospital in 1990, was performed. Perforation rate was 23.7% and delay in diagnosis was found to be significant. Patients above 50 years of age were particularly at risk. Diagnostic error was 19.3% and it was a problem not only in young women but also in children. Temperature and rectal examinations were not found to be helpful in the diagnosis in contrast to leukocytosis. Waiting time for operation was long (median 7 hours), be it for a perforated or a nonperforated appendicitis.

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

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