MyMedR

Fulltext A Cross-Sectional Study of Neutrophil-to-Lymphocyte Ratio in Diagnosing Acute Appendicitis in Hospital Melaka

Ahmad KA, Ideris N, Aziz SHSA

Malays J Med Sci, 2019 Nov;26(6):55-66.

PMID: 31908587 DOI: 10.21315/mjms2019.26.6.6

Background: Acute appendicitis is one of the most common surgical emergencies. However, its proper diagnosis is complicated. This study aims to evaluate the ability of the neutrophil-to-lymphocyte ratio (NLR) to diagnose acute appendicitis in pre-operative state.

Methods: Histopathological examination of appendicectomies conducted between 2016 and 2017 in Melaka Hospital, Malaysia were traced and categorised into three groups: i) G1 (normal appendix), ii) G2 (acute appendicitis) and iii) G3 (perforated appendicitis). The reports were randomised and a total of 338 samples were collected. NLR values were compared between the three different groups and analysed.

Results: The median values of NLR for G1, G2 and G3 were 2.37, 5.25 and 9.27, respectively. We found a statistically significant difference in NLR between G1 and G2 (P < 0.001), and G2 and G3 (P < 0.001). The diagnostic values of NLR for acute appendicitis and perforated appendicitis were 3.11 (sensitivity: 75.23%, specificity: 68.70%) and 6.17 (sensitivity: 76.32%, specificity: 58.72%), respectively. There was a substantial correlation between NLR and disease severity, and a moderate correlation between NLR and duration of admission.

Conclusion: NLR, with a sensitivity of 75.23% and specificity of 68.70%, is a useful and reliable adjunct in diagnosing acute appendicitis. Hence, it will help in reducing the rate of negative appendicectomies.

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

Fulltext A rare case of an appendiceal mass masquerading as a pelvic tumour and causing bilateral hydronephrosis

Abdul Rashid S, Ab Hamid S, Mohamad Saini S, Muridan R

Biomed Imaging Interv J, 2012 Apr;8(2):e11.

PMID: 22970067 MyJurnal DOI: 10.2349/biij.8.2.e11

Diagnosing acute appendicitis in children can be difficult due to atypical presenting symptoms. While there are reported cases of acute appendicitis or appendiceal masses causing unilateral hydronephrosis, bilateral hydronephrosis as a complication of appendiceal mass is very rare. We report a case of a child who presented with cardinal symptomatology associated with the urogenital tract. Ultrasound (US) investigation showed a pelvic mass causing bilateral hydronephrosis. An initial diagnosis of a pelvic teratoma was made based on the US and computed tomography (CT) scan findings. The final diagnosis of an appendiceal mass causing bilateral hydronephrosis was established intraoperatively.

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*

Fulltext A review of acute appendicitis seen in the Taiping District Hospital from July to December, 1990

Chua MW, Fazidah Y, Khalijah MY, Sofiah ZA, Hashami B, Lim KG

Med J Malaysia, 1993 Mar;48(1):28-32.

PMID: 8341169

In a retrospective study, 455 people were found to have been admitted to the Surgical Unit of the Taiping District Hospital, suspected of acute appendicitis in the study period from 1 July to 31 December 1990. However, only 147 (32.3%) were clinically confirmed to have appendicitis and underwent appendicectomy. Out of these, 120 (81.6%) cases were subjected to detailed analysis. The study showed that the commonest age group affected was the 10 to 20 year old. Males were slightly more often affected but there seemed to be an equal distribution among the major races. The diagnostic accuracy, that is the operated cases that were actually acute appendicitis, was 92.5%. The perforation rate was 31.5%. Fifty-five percent of patients developed some post-operative complications, of which the commonest was fever.

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

Acute appendicitis in West Malaysia

Hussein Bin Dato Sall, Balasegaram M

Med J Malaya, 1972 Sep;27(1):43-7.

PMID: 4264824

Matched MeSH terms: Appendicitis/epidemiology*

Fulltext Acute appendicitis in infants: a case report

Goon HK

Med J Malaysia, 1986 Sep;41(3):236-8.

PMID: 3670141

A case of acute appendicitis occurring in a 10- month-old infant is reported. The difficulties of an early preoperative diagnosis are highlighted. Perforation has usually occurred on presentation. However, prognosis may not necessarily be poor if active measures are instituted soon after perforation. The importance of active and aggressive preoperative resuscitation with fluids and electrolyte and intravenous antibiotics is stressed.

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

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 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

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

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*

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 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

An unexpected gangrenous duplication of ileum

Chiar CI, Elango T, Sivaneswaran L, Umasangar R, Mohan N

Med J Malaysia, 2017 02;72(1):83-84.

PMID: 28255153 MyJurnal

Alimentary tract duplication is a rare congenital anomaly which may involve any part of the alimentary tract extending from stomach to rectum. Clinical presentation may mimic an inflamed appendix as described in this case. A 9-year-old boy with a clinical diagnosis of perforated appendix was noted to have a normal appendix intra-operatively. On further search for an underlying pathology, a gangrenous ileal duplication was discovered. En-bloc resection with primary bowel anastomosis was done. Histopathology report revealed a gangrenous small bowel duplication. We discuss the preoperative diagnostic dilemma and management options in approaching this rare entity.

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*

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

Fulltext Appendicular mass complicating acute appendicitis in a patient with dengue fever

Low YN, Cheong BM

Med J Malaysia, 2016 04;71(2):83-4.

PMID: 27326951 MyJurnal

Abdominal pain with dengue fever can be a diagnostic challenge. Typically, pain is localised to the epigastric region or associated with hepatomegaly. Patients can also present with acute abdomen. We report a case of a girl with dengue fever and right iliac fossa pain. The diagnosis of acute appendicitis was made only after four days of admission. An appendicular mass and a perforated appendix was noted during appendectomy. The patient recovered subsequently. Features suggestive of acute appendicitis are persistent right iliac fossa pain, localised peritonism, persistent fever and leucocytosis. Repeated clinical assessment is important to avoid missing a concurrent diagnosis like acute appendicitis.

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

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

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*

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