The purpose of this prospective study was to elucidate the characteristics of adult patients with acute abdomen admitted to a Finnish university hospital. A total of 639 patients entered the study. The most common cause of acute abdomen was non-specific abdominal pain (NSAP) (33.0%) followed by acute appendicitis (23.3%) and acute biliary disease (8.8%). The male:female ratio was 47:53 in the whole study population, but there were differences in the age and sex distributions when studied by diagnosis. NSAP was mainly presented in young women, but also in patients over 75 years of age. Acute appendicitis was most frequently found in young men, and biliary disease was most common in elderly women. A male predominance was noted in cases of alcoholic pancreatitis and gastritis, renal stones and peptic ulcer. Young women and elderly patients were slightly over-represented in the study population when compared with the whole population residing within the study area. 43% of the patients were operated on, and surgery was most common in patients aged 55-64 years and 15-24 years. Altogether 15% of the patients were discharged without hospitalisation. Twelve patients (1.9%) died of various causes, the most common of which was malignancy (four patients). In conclusion, a considerably large proportion (one third) of cases with acute abdomen remained without any specific explanation. Further, age and gender seem to be important factors when the most probable cause of acute abdomen is to be considered. Operative treatment is necessary in almost half of cases, and mortality for acute abdomen is low.
Something over 12,000 appendectomies are performed in Sweden annually. Preoperative diagnosis and outcome were the subject of a survey carried out in 1991. Based on analysis of the results and a review of recently published reports, the article presents proposals for quality markers in appendectomy: the frequency of healthy appendixes operated, of perforated appendixes, and of postoperative infection.
Appendiceal tumors are rare, but high neoplasm rates have been reported at interval appendectomy after periappendicular abscess. Non-operative management of uncomplicated acute appendicitis has shown promising results. The data on appendiceal tumor incidence and presentation among acute appendicitis patients is limited, especially in patient cohorts differentiating between uncomplicated and complicated acute appendicitis. Objective was to assess appendiceal tumor incidence and tumor association to appendicitis in patients with uncomplicated and complicated acute appendicitis.
This nationwide population-based registry study was conducted from 2007 to 2013. The Finnish Cancer Registry and the National Institute for Health Registry were used to combine data on all appendiceal tumors and acute appendicitis diagnosis with medical reports evaluated at eight study hospitals.
Altogether, 840 appendiceal tumors were identified, and out of these, 504 patient reports were reviewed, including 472 patients in this study. Tumor was diagnosed at appendectomy for suspected acute appendicitis in 276 patients (58%). In the whole study, histologically acute appendicitis and tumor were both present in 53% (n =?250), and out of these, 41% (n =?102) were complicated and 59% (n =?148) uncomplicated acute appendicitis. The associated tumor risk was significantly higher in complicated acute appendicitis compared with uncomplicated cases (3.24% vs. 0.87%, p
Appendicectomy for acute appendicitis, but not for other causes, is inversely associated with immune-mediated diseases such as ulcerative colitis, suggesting appendicitis is a marker of immune characteristics influencing immune-mediated disease risk. This study investigated the association of appendectomy and its underlying diagnosis with multiple sclerosis (MS).
Swedish general population registers and the Swedish MS register provided information on 20,542 cases with MS diagnosed between 1964-2006 and 204,157 controls matched for age, sex, period and region. Appendicectomy prior to MS diagnosis was identified in 673 cases and 6518 controls. Conditional logistic regression, with adjustment for socio-economic index, assessed the association of diagnosis underlying appendicitis with MS risk.
A perforated appendix, the best indicator of acute appendicitis in this material, was inversely associated with MS, although not statistically significantly, with an odds ratio (and 95% confidence interval of 0.86 (0.70-1.04). The odds ratios are 1.04 (0.94-1.16) for appendicitis without perforation and 1.14 (0.98-1.33) for appendectomy without appendicitis.
Although inconclusive in terms of assessing the hypothesis, these results may help to explain why earlier studies of appendicitis and MS risk have been inconsistent, as there may be variation in association by diagnosis underlying appendicectomy.
The author traces the history of appendicitis through the successive stages of its evolution--from the early anatomic descriptions of the appendix by Leonardo da Vinci and Vesalius to Louyer-Villermay's recognition of the fatal course that appendiceal inflammation may take; through the confusion of typhlitis and perityphlitis, until Reginald Fitz at the end of the last century classified its pathology and the disease appendicitis was born. The author has described the efforts of the early surgeons as they grew to understand the symptomatology of appendicitis and to realize that only by early operation could the tragic outcome of delay be averted. Credit is given to those whose contributions have advanced the frontiers of surgery-- Lawson Tait was the first to diagnose and remove a diseased appendix in 1880 in England and Abraham Groves the first on the North American continent, in 1883, in Ontario. Within a decade, the early surgical treatment of appendicitis became established. The writings of men like Charles McBurney and John B. Murphy are shown to be as pertinent today as they were at the turn of the century.