OBJECTIVE--To establish guidelines for the management of a pregnancy that is complicated by acute appendicitis. DESIGN--Retrospective study. SETTING--University Hospital, Copenhagen, Denmark. SUBJECTS--16 patients operated on for symptoms of acute appendicitis during the 15 year period 1974-1988. RESULTS--In 12 patients (75%) the diagnosis was confirmed histologically. The signs and symptoms were classic, and three patients had contractions. One fetus died, in a patient with appendicitis complicated by intraperitoneal abscess. In all uncomplicated cases the pregnancy proceeded to term and the deliveries were normal. CONCLUSIONS--Pregnancy should not deter a surgeon from removing an appendix, once the diagnosis is suspected; no pregnancy was affected by removal of a normal appendix. We recommend that prophylactic antibiotics and tocolytic drugs be given in all cases. Simultaneous caesarean section should be done only if there are obstetric indications.
The main objective of our study was to determine the rates of negative appendectomies and perforated appendices at the Labrador Health Centre, and make a comparison with the rates published in the literature.
The study population consisted of all patients who underwent appendectomies during the 5-year period ending Apr. 3, 2006. The number and rates of negative appendectomies and perforated appendices were determined for each age and sex category.
Of the 64 patients who were included in the study, 11% were found to have undergone negative appendectomies and 27% had perforated appendices. There was a clear trend toward decreasing perforation rates with increasing age as well as a trend toward increasing negative appendectomy rates with increasing age.
The rates of negative appendectomies and perforated appendices at the Labrador Health Centre are comparable with those published in the literature. Trends found in the data will help to guide future improvements in patient management.
Over a 9-year period at one hospital 25 appendectomies were performed during pregnancy. In 20 cases the appendix was acutely inflamed. All mothers survived. Two women aborted and two went into premature labour. One of the premature infants survived. The fetal loss associated with acute appendicitis was 15%. Early diagnosis and operation is essential.
Notes
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Cites: Lancet. 1954 Jun 19;266(6825):1252-713164366
Cites: Br Med J. 1951 Nov 17;2(4741):1194-514879043
Cites: Aust N Z J Obstet Gynaecol. 1972 Aug;12(3):202-34511748
The results of treatment of 31 women operated on for acute appendicitis are presented. At operation, a gynecologic disease was revealed in these women. Difficulty in differential diagnosis of acute appendicitis and gynecologic disease in a pregnant woman requires joint decision-making by a surgeon and gynecologist.
Appendicitis is the most common surgical emergency in pediatric surgery. In the presence of an appendicular mass, surgical management can be difficult. We evaluate the results of appendix mass management both with immediate operation and conservative treatment over a period of 5 years. Forty children who presented with appendicular mass over a period of 5 years were reviewed. Their mean age was 7.6+/-2.7 years, and the mean duration of symptoms was 7.8+/-2.7 days. We evaluated the children in two groups: The first group included 19 children who were operated on immediately, and the second group included 21 children who were managed conservatively, followed by elective appendectomy. In the first group, mean hospitalization time was 8.7+/-3.2 days. The complication rate was found to be high (26.3%). Ileal injury occurred in two patients, intraabdominal abscess developed in one patient, and wound infection developed in another. Appendectomy could not be done in one patient who required another laparotomy 8 weeks later. In the second group, mean hospitalization time was 8.9+/-2.6 days. Two patients (8.6%) failed to respond to conservative management. Elective appendectomy was performed after 2-3 months. Two patients returned with perforated appendicitis 5 months and 12 months later, respectively, because they were not brought back for subsequent appendectomy. It can be concluded that conservative treatment of appendicular mass is safe; we also advocate elective appendectomy because of the probable risk of recurrence.
A new emergency service has been introduced in Denmark. We aimed to assess the impact of the service change for the care of acute surgical emergencies, specifically a subset of patients treated with an appendectomy.
This was a retrospective review of all the patients who had an appendectomy in a surgical department during one year prior to and one year after the implementation of a new emergency service. Data collected included patients' demographics and information related to the care such as the number of doctors involved in diagnosing appendicitis, whether preoperative radiological investigation was used, time to operation, morbidity during the first 30 days, including readmission, type of complication and required intervention.
A total of 314 patients had an appendectomy performed during the study period. After the implementation of the new emergency service, there was a significant delay in time to definitive treatment (457 minutes versus 593 minutes, p = 0.001). The total number of doctors involved in diagnosing appendicitis increased to a median of three doctors (range 1-6) from a median of two surgeons (range 1-6) (p
To investigate the pre-operative findings, accuracy, perforation rate and complication rate in 2,351 patients who underwent appendicectomy during 1986-1993.
The 2,351 records from patients who underwent surgery were analysed to determine whether the pre-operative investigations introduced can improve the diagnostic accuracy when analysed in total.
The total diagnostic accuracy which was 70.9% in 1986 increased to a statistically significant figure of 87.1% in 1993. In female patients, the figure increased from 61.7 to 82.4% and in males from 82.0 to 91.2% during the studied period. The complication rate was in total 10.4% including a mortality of 0.21% (5 patients).
We believe that with a combination of increased interest in patients with acute appendicitis, a wider use of active in-hospital observation, a more standardised pre-operative laboratory investigation and the use of ultrasonography, a high diagnostic accuracy could be reached without an increased rate of complications and perforations.
PURPOSE: The aim of this study was to determine whether the admission and active observation of children where the diagnosis of acute appendicitis is uncertain is a safe and effective way to improve the diagnostic accuracy of appendicitis and safely reduce the incidence of negative laparotomies without increasing complications. METHODS: We performed a retrospective cohort study of children who presented with a complaint of right lower quadrant pain and were hospitalized with a diagnosis of appendicitis or suspected appendicitis from 1 January to 31 December 2007. RESULTS: A total of 569 patients were included in the study. The mean age was 9.5 +/- 3.2 (range 1.1-17) years. The number of patients directly operated on with a diagnosis of appendicitis was 186 (32%) from the total of 575 while 389 patients (68%) were observed in the surgical ward as the examination and/or investigation findings were equivocal. Of the 383 patients admitted for observation, 173 (45%) were operated on with a suspicion of appendicitis after 14.4 +/- 6.7 h while 210 (55%) were discharged after 1.1 +/- 1.2 days as there seemed to have no surgical problem. Our total negative appendectomy rate was 4% (14/350) and total perforation rate was 37.4% (131/350). The patients operated on directly and those operated on after observation were similar, and there was no difference for the preoperative duration of symptom, histopathological diagnosis, postoperative complication rate, postoperative inpatient days and hospital charges. Total hospitalization duration was significantly longer and the hospital charges significantly higher in the negative appendectomy group. CONCLUSION: Both the features and results and the complication rates and costs of the group operated on after observation were the same as the directly operated on group. However, patients undergoing a negative appendectomy stayed as inpatients longer than only observation patients with higher treatment charges. We could therefore decrease the negative appendectomy rate, the associated cost and duration of hospitalization without causing extra complications if we observe and investigate patients with right lower quadrant pain with a doubtful diagnosis and did not operate on them directly.
This study evaluated how implementation of an acute care emergency surgery service (ACCESS) affected key determinants of emergency department (ED) length of stay, and particularly, surgical decision time. Also, we analyzed how ACCESS affected ED overcrowding.
We conducted a before and after study of all ED patients referred to ACCESS from January 1, 2007 to June 30, 2009. ACCESS was implemented on July 1, 2008. The primary outcome was surgical decision time; the secondary outcome was a measure of overall ED overcrowding: "time-to-stretcher" for all ED patients. The control groups were patients referred to internal medicine or urology. Patients with appendicitis were studied in order to analyze the impact on patient outcomes and to determine barriers to efficient ED patient flow.
Of 2,510 patients, 1,448 patients were pre-ACCESS, and 1,062 were after ACCESS implementation. Implementation of ACCESS was associated with a 15% reduction in surgical decision time (12.6 hours vs 10.8 hours, p
