Abdominal pain in the female patient: A case of concurrent acute appendicitis and infected ovarian cyst

Background: Abdominal pain is a common presentation in women of child bearing age. It has a broad diagnosis that includes disorders of the gastrointestinal, gynaecological, vascular, urogenital, and pulmonary systems. It may be caused by infections, inflammatory, anatomic or neoplastic processes. Its management varies by aetiology, and accurate diagnosis is key to avoiding inappropriate treatment. In some rare instances, acute appendicitis has been shown to occur simultaneously with a variety of gynaecologic diseases, which can add to the diagnostic dilemma. Method: We report a case of concurrent acute appendicitis and infected ovarian cyst in a 49 year old P6+4A6 who presented with recurrent abdominal pain for 4 years duration. Result: She had oophorectomy and appendicectomy. She did well post operatively and was discharged to outpatient department after stitches removal. Conclusion: Abdominal pain, being from various aetiology in women of child bearing age, detail history, thorough physical examination, and necessary imaging investigations need to be done to avoid misdiagnosis and inappropriate treatment.

Corpus luteum rupture mimicking acute appendicitis

Acute abdomen is a common presentation in women in the reproductive age. It may be caused by diverse conditions. The case below presented with classical signs and symptoms of appendicitis. Haemoperitoneum seen at laparotomy suggested a diagnosis of ectopic pregnancy .The diagnosis of ruptured corpus luteum cyst (RCLC) was made only after histology. The symptoms, signs and diagnosis of RCLC are discussed. The case highlights the need for circumspection in the diagnosis of the cause of acute abdomen. The current trend favours conservative management of RCLC thus the need for a high index of suspicion is emphasized to avoid unnecessary surgery.

Evaluating the benefit of incidental appendectomy

Background: Surgeons sometimes perform appendectomies during abdominopelvic surgeries for surgical conditions unrelated to the appendix. A retrospective study of the histopathological diagnoses of incidental appendectomy specimens was performed to see the value of this practice. Materials and Methods: Records of incidentally resected appendices submitted to the Histopathology Department of the University of Benin Teaching Hospital from January 2005 to December 2014 were reviewed retrospectively. Results: A total of 129 histopathological reports of incidental appendectomy were retrospectively reviewed; 67 (51.9%) of the patients were male and 62 (48.1%) were female, giving a male­female ratio of about 1.1:1. Fifty­four cases (41.9%) had histologically normal appendices, while 75 cases (58.1%) had various histopathologically demonstrable lesions ranging from acute appendicitis (the most frequent with 27%) to neoplasia (one case of mucinous adenocarcinoma). Conclusion: Significant pathology can be uncovered on histopathological examination of the clinically normal appendix. Incidental appendectomy is thus a useful procedure

Role of computed tomography in diagnosis of appendicitis and its complications

Background: Appendicitis and its complications are the most commonly acute abdominal pain that require surgical intervention. Patients may present with a wide variety of clinical manifestation. The clinical diagnosis is based primarily on the patient history, physical examinations and white blood cell count. Clinical diagnosis mostly straight forward in patients presenting with classic signs and symptoms, while diagnostic confusion and delay in treatment may occur in patients with atypical presentations. MSCT is a highly accurate means for establishing the diagnosis. Objective: The aim of the work is to describe the value and role of Multi-slice computed tomography in diagnosing appendicitis and its complications. Methods: This study retrospective study was conducted on patients with right lower quadrant or right flank pain. The study was conducted in Health Insurance hospitals Radiology department on Fifteen patients with right lower quadrant pain or right flank pain. Results: In the present study, we concentrate on continuity and thickness of the appendiceal wall. The normal appendix thickness is less than 1 mm. When appendix got inflamed, it usually appears thickened, asymmetric and enhancing with i.v. contrast from 1 to 3 mm thickness. Conclusion: MSCT is helpful for accurate and prompt diagnosis in suspected cases of appendicitis & its complications and conditions that mimic appendicitis

Appendicitis revisited ­ a case report

Background: Schistosomiasis, previously thought to be a rural problem, is a common parasitic disease caused by flukes (trematodes) of the genus Schistosoma. More than 207 million people, 85% of whom live in Africa, are infected with schistosomiasis, and an estimated 700 million people are at risk of infection in 76 countries where the disease is considered endemic because agricultural work, domestic chores, and recreational activities expose them to infested water. The infection manifests itself as a variety of different pathologies, depending on the location of the parasite and its ova in the body.Like other developing countries, schistosomiasis is endemic in certain regions of South Africa. Rapid urbanization as a result of mass rural-urban migration has led to the appearance of many informal settlements, with its associated socioeconomic problems, near major metropolitan areas. Schistosomiasis can therefore no longer be considered as a rural disease.Schistosomiasis of the appendix, though first described more than a century ago, had remained a rare surgical manifestation of the disease with an overall prevalence of 0.024%, even in areas where the disease is reported to be endemic. A recent study in Nelspruit by Botes et al, however, showed a prevalence of 10% among all appendix samples over a 4-year period.A case of appendiceal schistosomiasis presenting with recurring abdominal pain, is reported. Consent was sought from patient before publication

Demographics of paediatric patients presenting with acute appendicitis: A 5-year retrospective review of hospitals served by the Department of Paediatric Surgery at the University of the Witwatersrand

Background. There are no recently published data on the incidence and demographics or perforation rates of paediatric patients from our local population presenting with acute appendicitis. Objective. To show the age and gender distribution of paediatric patients presenting with acute appendicitis within our communities, as well as demonstrating the incidence of perforated acute appendicitis in our paediatric population. Method. The study is a retrospective record review of all paediatric patients who presented with acute appendicitis to the Department of Paediatric Surgery at both Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), and Chris Hani Baragwanath Academic Hospital (CHBAH) from June 2010 to September 2015. Data collected included all demographic data as well as histology results of patients who underwent appendectomies. Results. The total numbers of patients included in the study were 544; 234 at CHBAH, and 311 at CMJAH. The male-to-female ratio was 1.58:1. The mean age for presentation at both hospitals combined was 8.76 years. We found that 13.41% of paediatric patients with acute appendicitis in this cohort were under the age of 6 years. A histological review showed that 50.1% of patients in our cohort presented with complicated appendicitis, and we had a negative appendectomy rate of 8.4%. Histological results of patients under the age of 6 years revealed a higher negative appendicectomy rate of 11.4%. However, the incidence of complicated appendicitis in this age group was only 45.7%, which is lower than that reported in the literature. Three patients were found to have Enterobius vermicularis in the lumen of the appendix, and Ascaris ova were identified in one patient. Histology revealed a low-grade mucinous neoplasm in one patient. Conclusion. Acute appendicitis occurred at a median age of 8.76 years in our study population, with a male-to-female ratio of 1.58:1. We found that acute appendicitis occurred relatively more frequently in our patients under the age of 6 years compared with the incidence of acute appendicitis in this age group published elsewhere. Complicated appendicitis occurred in 50.1% of our patient population, with an increased frequency of perforated appendicitis occurring in our male population. However, complicated appendicitis occurred in only 44.7% of our patients below the age of 6 years, which is in stark contrast to published literature. Helminthic infections were rare associated pathogens in our study, and an unlikely underlying pathogen of acute appendicitis in our population

Appendicectomy in private practice in Kwazulu-Natal Province, South Africa

Background. The treatment of appendicitis is regarded as a bellwether procedure that can be used to describe the delivery of essential surgical care. Little has been published on clinical outcomes in the private sector in South Africa (SA), and this study attempts to address this deficiency.Objectives. To extend our understanding of the outcomes of acute appendicitis in the public and private sectors in SA.Methods. Data on patients covered by a leading medical aid who underwent appendicectomy in 26 private hospitals in Durban and Pietermaritzburg, KwaZulu-Natal Province, during the period 2010 - 2015 were obtained and compared with existing data from a recent study of patients with appendicitis treated in the Pietermaritzburg academic complex.Results. Between January 2010 and December 2015, 397 patients covered by the medical aid underwent appendicectomy in private hospitals. Their mean age was 29.7 years (range 3.7 - 87.6), the mean length of stay 4.6 days (range 1 - 41) and the mean operation time 70.6 minutes (range 24.0 - 335.0). Of the procedures 66.5% were laparoscopic. A total of 33 patients (8.3%) required intensive care unit (ICU) admission, and 38 (9.6%) were readmitted. While there was no information on the reasons for readmission, this is a proxy marker for possible complications. The mean total event cost per patient was ZAR38 934. A total of 134 open operations were performed (33.8%). In the state sector, a total of 1 004 patients were documented. The mean patient age was 20.2 years (difference not statistically significant), mean length of stay was significantly longer at 7.3 days (p=0.02, one-tailed t-test), and 10% of patients required ICU admission. In the state hospitals only 3% of the operations were laparoscopic. None of the private sector patients but 40% of the state patients required further surgery. Conclusions. Medical aid data provide useful information on disease profiles and outcomes in private practice. The outcome of acute appendicitis in the private sector appears to be significantly better than in the state sector. Further work is required to fully elucidate the reasons for this, although late presentation in the state patients almost certainly contributes to their poor outcome. In terms of cost, SA private practice appears to be highly efficient and is relatively inexpensive in comparison with international equivalents

White blood cell count and C-reactive protein together remain useful for diagnosis and staging of acute appendicitis in children

Background. Acute appendicitis (AA) is the most common acute surgical condition of the abdomen, and the most commonly misdiagnosed.Objective. To analyse the white blood cell count (WBCC) and C-reactive protein (CRP) contribution to the diagnosis of AA in children.Methods. This was a retrospective study of 943 consecutive patients operated on with the preoperative diagnosis of AA, in whom preoperative WBCC and CRP had both been measured. Postoperatively, the patients were divided into three groups: normal appendix (no AA), simple AA and complicated AA.Results. Of the 943 patients, 616 (65.3%) had simple AA. The mean (standard deviation (SD)) age for this group was 9.8 (3.2) years (p<0.01 v. complicated AA), the mean WBCC was 16.5 (5.0) × 109/L (p<0.01 v. complicated AA and no AA), and the mean CRP level was 304.8 (409.5) nmol/L (p<0.01 v. complicated AA). The mean age of the patients with complicated AA (283/943, 30.0%) was 7.9 (3.7) years, the mean WBCC was 17.7 (6.2) × 109/L (p<0.01 v. no AA) and the mean CRP level was 1 076.2 (923.8) nmol/L (p<0.01 v. no AA). The mean age of the patients with no AA (44/943, 4.7%) was 8.8 (3.2) years, the mean WBCC was 13.1 (5.3) × 109/L and the mean CRP was 361.9 (447.6) nmol/L. The WBCC was normal in 113/899 patients with appendicitis (12.6%) and CRP in 139 (15.5%). Both the WBCC and CRP were normal in 17 patients with appendicitis (1.9%). The best receiver operating characteristic (ROC) curve was obtained for WBCC when comparing all AA with no AA: cut-off point 15.0 × 109/L, sensitivity 65%, specificity 68%, area under the curve 0.70. The best ROC curve for CRP was obtained when comparing simple AA with complicated AA: cut-off point 361.9 nmol/L, sensitivity 74%, specificity 74%, area under the curve 0.81.Conclusions. The WBCC is helpful in diagnosing simple AA and CRP in diagnosing complicated AA. If both are normal, AA is very unlikely. Together the WBCC and CRP are useful tools in diagnosing and staging AA

Appendicitis: Trends in Incidence; Age; Sex; and Seasonal Variations in South-Western Nigeria

Background : Appendicitis is a common clinical condition worldwide. Differences in incidences; sex; age; and seasonal variations have been reported widely; with paucity of information from Nigeria. Aim : To assess the trends in incidence and pattern of variation with age; sex; and seasons of the year. Materials and Methods : A review of the records of all patients with confirmed appendicitis treated in both the LAUTECH Teaching Hospital (LTH) and the Abake Medical Center (AMC); both situated in Osogbo; Nigeria; between January 2003 and December 2008; was done. LTH was a 320-bed University Hospital (with 100 surgical beds); while AMC was a 20-bed surgical center. The age; sex; and month of admission of all the histologically proven cases of appendicitis were retrieved and treated. Analysis was done using simple percentages; Student t or Chi-square tests; where applicable. Results : A total of 299 out of 321 cases of appendicitis recorded during the observed period were confirmed histologically from both hospitals (69.56from LTH). Fifty-two percent were males. It made up 0.94; 1.43; and 1.86of the total hospital admissions in 2004; 2006; and 2008; respectively. There has been an increasing incidence in both sexes almost in a similar pattern. The overall mean age was 25.79 years (M 25.94 and F 25.43 years) with 6below the age of ten and 1.3above 60 years. The highest incidence in males and females occurred in the second and third decades; respectively. Incidences were higher during the rainy season (April to September) 68; P 0.05); with peaks from June to August; when 39.5of all cases presented. Conclusion : The increasing incidence of appendicitis in both sexes in this region may be due to the change to a Western lifestyle. The age distribution has a similar pattern in both sexes and 87are 40 years or less; although the incidence is marginally higher in males. Higher prevalence of infections and allergens from pollens in the rainy season could contribute to a higher incidence of appendicitis

The Sensitivity and Specificity of the Conventional Symptoms and Signs in Making a Diagnosis of Acute Appendicitis

Introduction: Simple appendicitis can progress to perforation; which is associated with a much higher morbidity and mortality. So; surgeons have therefore been inclined to operate when the diagnosis is probable rather than wait until it is certain. Objective: This study is designed to evaluate the sensitivity and specificity of clinical examination in the diagnosis of acute appendicitis.Methods: The study included 866 patients of acute appendicitis who had undergone appendicectomy with preoperative diagnosis of acute appendicitis. They were analyzed retrospectively. The parameters evaluated were age/gender; clinical presentation (signs and symptoms) and total white blood cell counts. The operative findings were recorded and the inflammation of the appendix was graded into normal; acutely inflamed and gangrenous. Results: Clinical diagnosis was made correctly in 807 (93.2) of the patients. White blood cells count ranged from 3.70 to 45.30 /mm3 (mean 17.5353 /mm3). It was 10;000/mm3 in 133 (15.4) patients.Conclusions: Clinical assessment is the best criterion to reach a confident diagnosis. Investigations may supplement the diagnosis but are never a substitute for it

Prospective Evaluation of the Bengezi and Al-Fallouji Modified Alvarado Score for Presumptive Accurate Diagnosis of Acute Appendicitis in University of Port Harcourt Teaching Hospital; Port Harcourt

Background: The accurate diagnosis of acute appendicitis (AP) in a patient is valuable to the busy clinician. Decision making in cases of AP poses a clinical challenge especially in developing countries where advanced radiological investigations are not readily available and do not appear cost effective; clinical parameters remain the mainstay of diagnosis. Time and resources wasted on surgical intervention; with the added risks of surgery and anaesthesia; only to discover that this was unnecessary remains a big challenge. This prospective study was carried out to assess the accuracy of the Bengezi and Al-Fallouji modified Alvarado score in presumptive diagnosis of AP and its effect on the negative appendicectomy rate (NAR) at the University of Port Harcourt Teaching Hospital. Methods: A retrospective study of the NAR of this hospital between June 2000 and May 2002 was carried out. All consecutive patients (128) who presented with presumptive diagnosis of AP between June 2003 and May 2004 were scored using the Bengezi and Al-Fallouji modified Alvarado scoring system and correlated with histological diagnosis. Patients discharged without surgery based on score; were reviewed in the outpatient's clinic for one month to ascertain that they did not need surgical intervention. The NAR for all appendicectomies performed by surgeons for presumptive diagnosis of AP without scoring between June 2004 and May 2005 was determined as control. Validity of the scoring system was assessed by calculating sensitivity; specificity; positiveand negative predictive values. Results: A total of 128 patients were scored. Forty patients with scores less than 4 after eight hours observations and re-evaluation at the Accident and Emergency were discharged without surgery. Eighty eight patients had appendicectomies as treatment for scores 5- 10. There were 39 males and 49 females. In eighty patients; the appendix was histologically inflammed and 8 were normal; giving a NAR of 9.09. High sensitivity of 92.93and specificity of 92.93were recorded in the study. The NAR of the retrospective study was 26.4and 19.05for the control group operated without scoring

Un appendicite de localisation atypique : apport de la coloscopie au diagnostic

Le diagnostic de l'appendicite a gauche est fait en dehors de la laparotomie a l'imagerie medicale (echographie et scanner). Les auteurs rapportent ici un cas ou le diagnostic a ete fait a la coloscopie. Ils militent a travers une analyse basee sur le cas rapporte et ceux de la litterature en faveur de l'emploi de la coloscopie comme moyen diagnostic de confirmation des appendicites lorsque l'imagerie medicale (scanner) est inaccessible ou est pris a defaut

Laparoscopy-assisted appendectomy via the patent umbilical ring (umbilical hernia): a case report

Umbilical hernia aswell as acute appendicitis are two of the most common problems seen by paediatric surgeons; although rarely simultaneously. When detected the operative approach is adjusted. We perform the a laparoscopically assisted appendectomy trough through the an excised umbilical hernia sac opening. The operative technique is presented. The most important advantages are single general anesthesia for the two surgical procedures and the use of present openingpatent umbilical ring as an access to inflamed appendix; what is the essence of a minimally invasive surgery;. Evaluating the results of the appendectomy superior cosmetic end result; minimal scaring and lower stress index are the advantages in comparisoncompared to the conventional open surgery. Shorter procedure and reduced costs are the advantages in comparison to the three port laparoscopic appendectomy. Efficacy and safety are the same as in single umbilical hernia repair

Etude retrospective des urgences chirurgicales viscerales de l'enfant au CHU de Brazzaville (Congo)

Apprecier la frequence des urgences chirurgicales viscerales de l'enfant et en identifier les differentes causes d'une part; evaluer leur pronostic d'autre part. L'etude; retrospective; a concerne les enfants ages de 1 mois a 15 ans hospitalises dans le service de Chirurgie pediatrique du CHU de Brazzaville (Congo) et ayant une urgence chirurgicale viscerale. Sur 206 (14;1) enfants admis pour une urgence chirurgicale viscerale; 185 ont fait l'objet de l'etude. Parmi les 185 enfants ayant une urgence chirurgicale viscerale; il existait une predominance masculine (67). La plupart des patients (71;3) etait agee de plus de 5 ans. Les causes des urgences chirurgicales viscerales etaient representees par les appendicites aigues (30;3); les peritonites (28;1); les hernies etranglees (22;2); les contusions abdominales (7;6); les invaginations intestinales (6;4); les autres causes d'occlusions (2;7) et les plaies abdominales (2;7). Les peritonites etaient imputees a une perfo ration appendiculaire dans 76;9des cas ; les hernies etranglees etaient inguinales (70;7) et ombilicales (29;3) ; l'invagination intestinale; idiopathique dans tous les cas; s'observait volontiers chez les moins de 6 mois (58;3). Les suites operatoires ont ete simples dans 82;4des cas; compliquees dans 17;6des cas ; 8 deces (4;3) ont ete enregistres. En cas de deces; le delai de recours etait superieur a 3 jours dans 87;5des cas et le delai de prise en ch a rge superieur a 6 heures pour tous. Un diagnostic plus precoce et une prise en ch a rge initiale plus prompte constituent des fa c t e u rsd'amelioration du pronostic des urgences chirurgicales viscerales

Spontaneous Appendicocutaneous Fistula: A Case Report

Ruptured appendicitis is not a common cause of spontaneous enterocutaneous fistula. A case of ruptured retrocaecal appendicitis presenting as an enterocutaneous fistula in a Nigerian woman is presented. The literature on this disorder is also reviewed

Acute appendicitis in children in Kumasi, Ghana: macroscopic findings at laparotomy

Background A lot has been written about acute appendicitis in children in the developed countries but very little is written about this condition among children in the sub Saharan region. It used to be said that acute appendicitis is rare in Africa but this is no longer the case. We are unable to find, in the literature, any reference to acute appendicitis in children in Ghana. We, therefore, reviewed our experience with this pathology, especially the operative findings, in children using the Kumasi metropolitan area.Patients and Methods Ninety-six children admitted and treated for acute appendicitis from January 2001 to December 2003 were considered. The macroscopic findings at laparotomy were meticulously noted down and these form the basis for the analysis. Appendicectomy was carried out in all the 96 children.Results In all there were 67 boys and 29 girls, a boy to girl ratio of 2.2:1. the ages ranged from 1.8 years to 14.0 years with a mean age of 10.1 ± 2.8 years. Macroscopically, simple acute appendicitis (uncomplicated) was found in 13 (13.5%) and obstructive appendicitis (complicated) in 83 (86.5%) children. Postoperative complications consisted of superficial surgical site infection in 4, deep surgical site infection in 3 and incomplete wound dehiscence in 2. there was one death in the series- a mortality rate of 1.0%.Conclusion Acute appendicitis is no more a rarity in the sub-saharan setting as more and more people live affluently and adopt the western style of life. As a result of prehospital delay and also delays in diagnosis, complicated appendicitis was common among our group of patients

Les appendicites aigues de l'enfant a l'Hopital Gabriel Toure: a propos de 20 cas

L'appendicite aigue est une pathologie d'urgence chirurgicale assez frequente chez l'enfant qui pose un probleme de diagnostic et exige une prise en charge adequate. L'etude a pour objectifs de determiner la frequence des appendicites aigues par rapport aux autres urgences chirurgicales abdominales de l'enfant et de degager les facteurs pronostiques afin de preconiser des solutions visant a ameliorer le pronostic vital. Il s'agit d'une etude prospective qui a porte sur les enfants ages de 0 a 15 ans. Dans les resultats on note que: les appendicites aigues constituent la seconde cause des urgences chirurgicales abdominales chez les enfants apres les occlusions intestinales ; - elles augmentent de frequence avec l'age ; - le sexe n'a aucune influence sur la frequence ; - la guerison a ete obtenue chez tous les malades apres appendicectomie precoce ; - la constatation de 13 cas d'appendicite perforee revelee sous forme de peritonite montre le risque evolutif de l'affection. Les appendicites aigues constituent une urgence chirugicale abdominale frequente surtout chez le grand enfant et son pronostic est favorable si l'intervention chirurgicale est faite precocement

Les appendicites en Afrique tropicale

Les appendicites representent le 1/3 des activites d'un Service de Chirurgie Generale dans les regions Ouest-Africaines. Elles ont les memes etiologies que partout ailleurs. Les formes aigues sont plus frequentes (1143/1392 soit 82 pour cent). Le pronostic vital d'une appendicectomie est bon (0;25 pour cent de mortalite). Les complications sont essentiellement dues aux peritonites dont la forme la plus grave; la mortelle et la moins frequente est la peritonite generalisee