EVALUATION OF CRP (C-REACTIVE PROTEIN) AND PROCALCITONIN AS DIAGNOSTIC MARKERS IN ACUTE APPENDICITIS

Background: One of the most prevalent abdominal crises is acute appendicitis. Many efforts have been directed towards early diagnosis and intervention. Delay in diagnosis leads to increase morbidity and costs. Present study was aimed to evaluate the correlation of CRP and PCT with perioperative ?ndings in suspected cases of acute appendicitis and to ?nd whether they can aid in the diagnosis of acute appendicitis. Present Material and Methods: study was hospital based screening test study, conducted patients of age > 18 years, either gender, who presented with right iliac fossa pain lasting < 48 hours and were tentatively diagnosed with acute appendicitis, underwent surgery. Among Results: 115 patients with acute appendicitis, most of patients belong to age group of 21 to 30 years (45.2 %) followed by 31 to 40 and 10 to 20 years (18.3 %). Out of 115 patients 40 (34.8%) patients were females and 75 (65.2%) patients were males. CRP was positive in 84 (73.04%) and procalcitonin was positive in 66 (57.39%) patients with acute appendicitis. CRP had a sensitivity of 72.82%, a speci?city of 25%, a positive predictive value of 89.29%, and a negative predictive value of 9.68 %. Procalcitonin had a sensitivity of 57.28 %, a speci?city of 41.67 %, a positive predictive value of 89.39 %, and a negative predictive value of 10.20%. Conclusion: Elevation in CRP as well as procalcitonin levels only cannot be used for ?nal diagnosis of acute appendicitis, but it can act as an adjunct when evaluating the available clinical and laboratory

Modified Alvarado score versus Tzanaki’s Score in diagnosing acute appendicitis: An observational study

Background: Appendix is a blind muscular tube derived from the midgut. During the embryogenic development, in the 6th week appendix and cecum appear as out pouching from midguts caudal limb. Acute appendicitis is one the most common diagnosis made whenever patient presents with right illac fossa pain and mostly encountered in young and middle-aged individuals. The diagnosis and management of acute appendicitis depend on clinical presentation, that is, clinical signs and symptoms. The most common presentations in these cases have abdominal pain along with fever, anorexia, nausea, and vomiting. Various Scoring systems are developed to diagnose acute appendicitis based mainly on the presenting signs and symptoms, but widely none of them are used as an uniform scoring system. Aims and Objectives: The purpose of this study was to assess effectiveness and comparison of modified Alvarado score and Tzanaki’s Score in the early diagnosis of acute appendicitis. Materials and Methods: A prospective observational study was done in department of General Surgery JLN Medical College Hospital, Ajmer which included 200 patients presenting with the signs and symptoms of acute appendicitis, clinically. During admission the patients were evaluated by Modified Alvarado score and Tzanaki’s Score and final surgical decision was taken by the treating surgeon. Finally, the scores were compared with the histopathological examination of the surgically operated specimen. Results: The sensitivity and specificity of Modified Alvarado Score was 84.26% and 72.7%, respectively, with a positive predictive value of 96.15% and negative predictive value of 36.3%. The sensitivity and specificity of Tzanaki’s score was 88.2% and 72.7%, respectively, with a positive predictive value of 96.31% and negative predictive value of 43.24%. The diagnostic accuracy of Alvarado score was 83% and that of Tzanaki’s score was 86.5%. Conclusions: Our study showed that Modified Alvarado scoring system is a simple tool with limited features for bedside diagnosis of acute appendicitis, but its effectiveness is not as good as that of Tzanaki’s scoring system.

Apendicitis aguda no complicada en situs inversus totalis. Reporte de un caso

Introducción: El situs inversus totalis es una malformación congénita rara, caracterizado por una posición invertida de los órganos torácicos y abdominales, influyendo negativamente en la aproximación diagnóstica y en el tratamiento quirúrgico. Reporte: Se diagnosticó apendicitis aguda en un paciente varón de 28 años que conocía su anormalidad anatómica y se corroboró con imágenes tomográficas y la exploración laparoscópica. Ingresó a emergencia con 30 horas de dolor abdominal con inicio en epigastrio y posterior irradiación hacia la fosa iliaca izquierda. La tomografía confirmó su condición de situs inversus totalis y signos patológicos en la apendicitis localizada en FII; se realizó la intervención por laparoscopia sin complicaciones. Discusión: En pacientes con dolor en el cuadrante inferior izquierdo es importante un adecuado diagnóstico diferencial y el conocimiento previo de una anormalidad anatómica comunicada oportunamente hace viable un diagnóstico adecuado y una resolución quirúrgica exitosa.

Introduction: Situs inversus totalis is a rare congenital malformation, characterized by an inverted position of the thoracic and abdominal organs, negatively influencing the diagnostic approach and surgical treatment. Report: Acute appendicitis was diagnosed in a 28-year-old male patient who knew his anatomical abnormality and was corroborated with tomographic images and laparoscopic exploration. He was admitted to the emergency room with 30 hours of abdominal pain with onset in the epigastrium and subsequent radiation to the left iliac fossa. The tomography confirmed his condition of situs inversus totalis and pathological signs in localized appendicitis in FII; The laparoscopic intervention was performed without complications. Discusions: In patients with pain in the left lower quadrant, an adequate differential diagnosis is important and prior knowledge of an anatomical abnormality communicated in a timely manner, that makes feasible an adequate diagnosis and successful surgical resolution.

Evaluation of Necessity of Appendectomy After Conservative Treatment of Uncomplicated Acute Appendicitis in Children

Background: Acute appendicitis is one of the most common emergency clinical conditions among children. It has two-way treatment options, one is surgical procedures, and another is a conservative approach. In the modern arena conservative treatment approach for acute appendicitis is one of the most preferred options. The aim of the study was to find out the solution to clinical conditions and reduce the procedure of injudicious appendectomy.Material & Methods:This prospective observational study was carried out at the Department of Paediatric Surgery, Dhaka Medical College Hospital, Dhaka to assess the necessity of appendectomy following conservatively managed uncomplicated acute appendicitis. A total of 62 children with uncomplicated acute appendicitis were included in the study. Then a conservative treatment started with the combination of inj. Ceftriaxone (100 mg/kgper day), inj. Metronidazole (1.5 mg/kg/ tds) and inj. Amikacin (7.5 mg/kg/ bd) therapy for five days with associated supportive management. The patients were assessed after 24 hours of treatment, who responded to the above management were the continued for same treatment at least five days then discharged and were followed up for 6 months.Results:Mean age was 8.95 ± 2.10 years within range from 4 years12 years. The male-female ratio was 1.58:1. The mean duration of hospital stay was 5.26 ± 0.63 days. On day 5, 59 (95.1%) were discharged and 3 (4.9%) underwent surgery during the conservative treatment period. A total of 8(13of .0%) cases have recurred during the first 6 months after treatment. Conclusions:Antibiotic treatment in patients with acute appendicitis is quite effective, the success rate is 95.1% during the period of treatment, and the recurrence rate is 13.0%.

Role Of Raised C-Reactive Protein (CRP) As the Indicator for Surgical Intervention in Clinically Diagnosed Acute Appendicitis

Background: The diagnosis of acute appendicitis relies more on the clinical acumen of the surgeon than on the investigations. As the condition is associated with an acute-phase reaction the analysis of WBC, neutrophil percentage and serum level of CRP has been demonstrated to be important diagnostic tools. Surprisingly the level of CRP becomes proportionately raised with increasing severity of the histopathological variety of the appendix. Aim of the study: The aim of this study was to compare the preoperative CRP level with postoperative histological findings and find out a predictive value of CRP as an indicator for surgical intervention in acute appendicitis.Material & Methods:It was a prospective, cross-sectional, observational study executed in the Department of Surgery, Dhaka Medical College Hospital from January to December of 2015 where 107 patients were included in this study. Preoperative level of CRP and WBC count was done in all selected patients. Histopathological severity of the resected specimen of the appendix was determined postoperatively. The correlation between preoperative clinical factors and the actual histological severity and identification of surgical indication markers was assessed to determine whether only the CRP level significantly differs between the surgical treatment necessary group and the possible non-surgical treatment group.Results:54% (58) of the patients were female out of a total of 107. Peak incidence (25.2%) was in the 16-20 years age group. Neither age nor gender had any significance with the type of appendicitis. Among the patients 28.1% (30) had gangrenous appendicitis. In patients with histopathologically proven acute appendicitis, both the WBC count and serum CRP level were raised. But only the CRP level significantly differs between gangrenous appendicitis and uncomplicated appendicitis (p-value<0.0001). The specificity and sensitivity of serum CRP for gangrenous appendicitis were 97% and 71% respectively. The ROC curve indicated that the cutoff value of CRP for gangrenous appendicitis is 6.2 mg/dl. Conclusions:A normal pre-operative serum CRP measurement in patients with suspected acute appendicitis is most likely associated with a normal or uncomplicated inflammation of the appendix. The rate of unnecessary appendectomies would probably reduce in this patient group by deferring surgery. Only the CRP level is consistent with the severity of appendicitis and can be considered to be a surgical indication marker for acute appendicitis.

Abdomen agudo quirúrgico relacionado con síndrome inflamatorio multisistémico asociado a covid-19 en pediatría: reporte de caso / Acute surgical abdomen related to multisystem inflamatory syndrome associated with covid-19 in pediatrics

Resumen En el contexto de la enfermedad por el nuevo coronavirus SARS-CoV-2, se ha descrito una afección poco usual denominada síndrome inflamatorio multisistémico en niños, asociada a COVID-19, en la cual los síntomas más frecuentes son los gastrointestinales. El dolor abdominal agudo severo se presenta hasta en un 60 % de los casos, requiriendoprincipalmente un diagnóstico diferencial con la apendicitis aguda. Se reporta el caso clínico de un adolescente quién presentó dolor abdominal, distensión, fiebre y diarrea, con proteína C reactiva muy elevada y hallazgos tomográficos compatibles con apendicitis aguda, por lo que se llevó a cirugía. Fue diagnosticado posteriormente con la enfermedad mencionada, tras reconsultar con fiebre y dolor abdominal. La apendicitis aguda en este síndrome se asocia con isquemia por la vasculitis intestinal y es una complicación inmunológica potencialmente mortal que debe considerarse por riesgo de perforación intestinal.

Abstract In the context of the disease caused by the new coronavirus SARS-CoV-2, an unusual condition called multisystem inflammatory syndrome in children associated with COVID-19 has been described, and its most common symptoms are gastrointestinal. Severe acute abdominal pain occurs in up to 60% of cases, requiring mainly a differential diagnosis with acute appendicitis. It is described the clinical case of an adolescent who presented abdominal pain, bloating, fever and diarrhea, with very high C-reactive protein and tomographic findings compatible with acute appendicitis, for which he underwent surgery. He was later diagnosed with the disease, after consulting again with fever and abdominal pain. Acute appendicitis related to this syndrome is associated with ischemia due to intestinal vasculitis and is a life-threatening immunological complication due to the risk of intestinal perforation.

Diverticulitis apendicular, como diagnóstico diferencial / Appendiceal diverticulitis as differential diagnosis

RESUMEN La diverticulitis apendicular (DA) es una patología poco frecuente, considerada clínicamente indistinguible de la apendicitis aguda, aunque podría presentar una sintomatología más leve. Este es el caso de un paciente masculino de 59 años, que concurre al Servicio de Urgencias presentando signos y síntomas sugestivos de una apendicitis aguda; una ecografía informa un asa tubular parcialmente compresible de 7,8 mm de diámetro y una fina banda de líquido laminar, compatible con proceso apendicular agudo. La apendicectomía se realizó de manera convencional evidenciándose un apéndice inflamado principalmente en su región distal. La histología reveló diverticulitis apendicular complicada con rotura. El paciente evolucionó favorablemente y se externó a las 24 horas. Existe una asociación de DA y neoplasia apendicular, por lo que se recomienda una colonoscopia y el seguimiento de este tipo de pacientes.

ABSTRACT Appendiceal diverticulitis (AD) is a rare condition considered clinically identical to acute appendicitis although it may present milder symptoms. We report the case of a 59-year-old male patient who visited the emergency department due to signs and symptoms suggestive of acute appendicitis. An abdominal ultrasound showed partially compressible tubular loop with a diameter of 7.8 mm and a thin band of laminar fluid, consistent with acute appendiceal process. During conventional appendectomy the appendix had signs of inflammation, mainly in the distal region. The histology revealed appendiceal diverticulitis complicated with rupture. The patient had favorable outcome and was discharged 24 hours later. As, there is a clear association between AD and appendiceal neoplasms, colonoscopy and patient monitoring is recommended.

A Clinical Study and Management of Non Traumatic Acute Abdomen

Background: The acute abdomen is a condi?on that demands urgent a?en?on and treatment, ranging from trivial to life threatening condi?ons. The aim of this study was to know in detail the epidemiology and outcome in nontrauma?c acute abdomen. Methods: An ins?tu?on based, cross-sec?onal study was conducted from December 2019 to April 2020, at Department of General Surgery Govt. Medical College Kota Rajasthan. The study included 100 cases of non-trauma?c abdomen. Results: Non- trauma?c acute abdominal pain was more common in 2ndto 6thdecade of life. The males to female ra?o is 2.85:1. Hollow viscus perfora?on (30%) forms the commonest cause of acute abdomen followed by acute appendici?s, Sub acute intes?nal obstruc?on, renal/ureteric colic, cholelithiasis, pancrea??s, non-specific pain abdomen, OBG related pathology, liver abscess, Meckel’s diver?culi?s and splenic abscess in 24%, 23%, 8%, 4%, 3%, 3%, 2%, 1%, 1% and 1% respec?vely. Sixteen pa?ents managed conserva?vely. Most common surgical procedures done were exploratory laparotomy with needful for hollow viscus perfora?on and open/laparoscopic appendicectomy for acute appendici?s. Conclusions: Proper history taking, clinical examina?on with suppor?ve imaging findings are most important to narrow the differen?al diagnosis and for immediate interven?on to limit morbidity and mortality.

Histopathological Analysis of Biopsy Cases Processed at Diagnostic Centers of PAF Faisal And Masroor Hospital - A Prospective Study

Background: Histopathological patterns help to define the orientation as well as the duration of disease. The findings identified through this tool aids in the identification and selection of treatment modality as well as provides a prognostic assessment of the condition. Methods: A prospective study design was opted for this research. A total of 221 patients from either gender, ages between 31 to 38 years, undergoing different types of surgical procedures were en rolled from the Faisal and Masroor Base Hospital, Karachi Pakistan. After receiving consent, a biopsy specimen was taken and transferred to the laboratory for staining and further processing for histopathological examination. Results: The major findings i solated among specimens constituted of samples from the Appendix; 67.87% (150/221) followed by stomach; 18.10% (40/221). Among the appendix specimens, 82% (41/221) patients were suffering from acute appendicitis and the remaining had peri - appendicitis. Ami d the stomach specimens 65% (26/221) patients were diagnosed with (Mild) Chronic Superficial Gastritis, followed by 20% (8/221) patients with H - Pylori associated (Mild) Chronic Superficial Gastritis and the remaining were normal gastric antrum and chronic gastritis with partial villous atrophy. Conclusion: By using histopathological examination, the outcome of many diseases can be determined at an earlier stage thereby assisting in lowering the levels of morbidity and mortality among the population. In our research we were able to distinguish a variety of infections among different areas/ organs of the body.

Are thiol-disulfide homeostasis & neutrophil-to-lymphocyte ratio useful in the differential diagnosis of acute familial Mediterranean fever attacks & acute appendicitis?

Background & objectives: Continuous subclinical inflammation can be seen in patients with familial Mediterranean fever (FMF) during the attack-free period. The importance of oxidative stress parameters in acute appendicitis (AA) progression has also been shown in previous studies. So, oxidative stress and the oxidant/antioxidant balance may play a role in this persistent subclinical inflammation. With this background the main objective of this study was to investigate the usefulness of combining the thiol-disulfide homeostasis parameters and the neutrophil-to-lymphocyte ratio (NLR) in the differential diagnosis of AA and an acute FMF attack. Methods: The present study was conducted prospectively with 84 patients who were admitted to the emergency department between May 1, and December 31, 2018. Another 40 healthy individuals were assigned as the control group. The homeostasis parameters of thiol-disulfide were measured by a spectrophotometric method and NLR was measured in the patient and control groups. Results: Native thiol and total thiol values were lower, while disulfide values were insignificantly higher in patients with AA than in patients with FMF. The white blood cell (WBC), neutrophil and NLR values were significantly higher in the AA group (P<0.001, P<0.001, P<0.001, respectively). When the neutrophil cut-off value for AA was set at 8.55, the calculated sensitivity was 80 per cent, the specificity was 72.2 per cent, and the area under the curve was 0.837. Interpretation & conclusions: The results of this study suggest that neutrophil, WBC and NLR values can be useful in the differentiation of AA from an acute FMF attack.

Application of multi-slice spiral CT and abdominal ultrasound in clinical diagnosis of acute appendicitis in children / 中国基层医药

Objective:To investigate the application value of multi-slice spiral CT and abdominal ultrasound methods in the clinical diagnosis of acute appendicitis in children.Methods:We included 50 children patients who were pathologically diagnosed with acute appendicitis by the Department of Surgery, Dongyang Maternal and Child Health Hospital from August 2016 to August 2019. Before surgery, all patients underwent multi-slice spiral CT and abdominal ultrasound examinations. We recorded the time taken to complete multi-slice spiral CT and abdominal ultrasound examinations. Taking pathological results as the diagnosis criteria, we also calculated the coincidence rate of each imaging method.Results:The time we took to complete multi-slice spiral CT examination was shorter than that for abdominal ultrasound examination [(13.34 ± 3.86) minutes vs. (23.45 ± 4.77) minutes, t = 11.65, P < 0.05]. The coincidence rate of multi-slice spiral CT in identifying acute simple appendicitis, acute phlegmonous appendicitis, and acute gangrenous appendicitis was 95.24%, 95.00%, and 100.0%, respectively, and it was 71.73%, 70.00%, 88.89%, respectively for abdominal ultrasound examination. The coincidence rates in identifying acute simple appendicitis, acute phlegmonous appendicitis, and acute gangrenous appendicitis were significantly different between multi-slice spiral CT and abdominal ultrasound examinations ( χ2 = 4.29, 4.33, 1.06, all P < 0.05). Conclusion:Compared with abdominal ultrasound, multi-slice spiral CT is easier to operate, takes a shorter time in manipulation, provides more distinct images, and has a higher coincidence rate. Therefore, multi-slice spiral CT is of great diagnostic value for acute appendicitis in children.

Effects of laparoscopic surgery versus open surgery on acute appendicitis in children / 中国基层医药

Objective:To investigate the effects of laparoscopic surgery versus open surgery on acute appendicitis in children. Methods:We retrospectively analyzed the data of 50 children with acute appendicitis who underwent surgery in Zhoushan Women and Children Hospital from December 2016 to December 2019. They were randomly divided into observation ( n = 27) and control ( n = 23) groups. The observation group underwent three-port laparoscopy. The control group underwent open surgery. Operation-related indicators, postoperative recovery, parental satisfaction, and complications were compared between the two groups. Results:Operative time was significantly longer in the observation group than in the control group [(56.57 ± 5.35) minutes vs. (40.23 ± 6.31) minutes, t = 9.78, P < 0.001). Intraoperative blood loss was significantly less in the observation group than in the control group [(10.11 ± 2.36) mL vs. (18.36 ± 3.21) mL, t = 10.45, P < 0.001]. Duration of pain was significantly shorter in the observation group than in the control group [(1.23 ± 0.23) days vs. (2.98 ± 0.87) days, t = 10.06, P < 0.001). Time to postoperative exhaust was significantly shorter in the observation group than in the control group [(21.39 ± 4.35) minutes vs. (39.88 ±5.39) minutes, t = 13.35, P < 0.001]. Time to defection was significantly shorter in the observation group than in the control group [(50.12 ± 3.35) minutes vs. (61.23 ± 4.21) minutes, t = 10.33, P < 0.001]. Time to first diet was significantly shorter in the observation group than in the control group [(13.25 ± 2.56) hours vs. (19.96 ± 2.67) hours, t = 9.07, P < 0.001]. Length of hospital stay in the observation group was significantly shorter in the observation group than in the control group [(4.13 ± 1.12) days vs. (7.98 ± 1.96) days, t = 8.53, P < 0.001). Parental satisfaction was significantly higher in the observation group than in the control group [96.30% vs. 47.83%, χ2 = 13.360, P < 0.001]. The incidence of complications was significantly lower in the observation group than in the control group [7.41% vs. 52.17%, χ2 = 10.58, P < 0.001]. Conclusion:Laparoscopic surgery is superior and safer to open surgery in the treatment of acute appendicitis in children.

Ultrasonographic findings of child acute appendicitis incorporated into a scoring system

INTRODUCTION@#This study aimed to investigate the ultrasonographic features of paediatric acute appendicitis and incorporate them into a scoring algorithm that will quantify the risk of complications and the strength of recommendation for surgical intervention.@*METHODS@#179 patients with suspected appendicitis who had undergone ultrasonographic examination were included in this study. Based on their medical evaluation and post-surgical histopathological results, patients were categorised into confirmed appendicitis (n = 101) and non-appendicitis (n = 78) groups.@*RESULTS@#In the appendicitis group, the appendix was visualised in 66 (65.3%) patients. In cases where the appendix was not visualised, we looked out for secondary inflammatory signs, which were present in 32 (31.7%) patients. Using stepwise logistic regression, Blumberg's sign, free fluid or collection, hyperaemia, non-compressible appendix and an appendix diameter > 7 mm were found to be significant predictive factors for appendicitis. A new scoring system called POPs was developed, combining inflammatory predictors and ultrasonography findings, with an area under the receiver operating characteristic curve of 0.958 (95% confidence interval 0.929-0.986).@*CONCLUSION@#The newly developed POPs-based diagnosis scheme proved a promising alternative to existing scoring systems such as the Alvarado score. Although further calibration would be beneficial, the proposed scoring scheme is simple and easy to understand, memorise and apply in the emergency room.

Cuerpo extraño como causa de apendicitis aguda complicada / Foreign body as a cause of complicated acute appendicitis

La apendicitis aguda es una de las patologías más comunes en el ámbito hospitalario. Las formas complicadas pueden ser causadas por objetos puntigudos, afilados, delgados o alargados, ingeridos de forma accidental, y representan una causa inusual con una prevalencia del 0,0005 %

Acute appendicitis is one of the most common pathologies in the hospital setting. The complicated forms can be caused by pointed, sharp, thin or elongated objects, accidentally ingested, and represent an unusual cause with a prevalence of 0.0005%.

Tumor neuroendocrino, mucocele y adenoma tubulo-velloso: tres lesiones infrecuentes en el apéndice cecal / Neuroendocrine tumours, mucocele, and tubulovillous adenoma: three uncommon lesions in the cecal appendix

Introducción: los tumores del apéndice cecal constituyen un grupo heterogéneo de neoplasias con evolución y pronóstico variables; representan una pequeña parte de todas las neoplasias gastrointestinales y de las apendicetomías. Objetivo: realizar la comunicación de la presentación de tumores infrecuentes del apéndice cecal y revisar la literatura con énfasis la importancia del diagnóstico histopa-tológico. Presentación de caso: durante la necropsia del paciente HC: 199584 se realizó el diagnóstico histopatológico de un tumor neuroendocrino y mucocele apendicular y en la pieza quirúrgica del paciente HC: 223360 correspondiente a una apendicectomía se realizó el diagnóstico de adenoma tubulo-velloso, dadas que estas lesiones son poco frecuente se decide su comunicación y la revisión del tema en la literatura en idioma inglés y español a través de las bases de datos MEDLINE/PubMed, Elsevier, SciELO, EBSCO, Hinari y búsqueda avanzada en Google Scholar, encontrándose un total de 29 publicaciones entre 1990 a 2019. Conclusiones: el diagnóstico de tumores del apéndice cecal se realiza en forma incidental en el estudio anatomopatológico después de una apendicectomía por apendicitis aguda, es por ello que siempre se debe realizar el estudio histológico de la pieza quirúrgica, no solo para confirmar o negar el diagnostico que motivo la apendicetomía, sino para descartar la presencia de lesiones neoplásicas benignas o malignas.

Introduction: Tumors of the cecal appendix constitute a heterogeneous group of neoplasms with variable evolution and prognosis; they represent a small part of all gastrointestinal neoplasms and appendectomies. Objective: To communicate the presentation of infrequent tumours of the cecal appendix and to review the literature with emphasis on the importance of histopathological diagnosis. Case presentation: During the necropsy of patient HC: 199584, a histopathological diagnosis of carcinoid tumours and appendicular mucocele was made, and in the surgical specimen of patient HC: 223360 correspondings to an appendectomy, the diagnosis of tubu-lovillous adenoma were made, given that These lesions are rare, it is decided to communicate and review the subject in the literature in English and Spanish through the MEDLINE / PubMed, Elsevier, SciELO, EBSCO, Hinari and Advanced Search in Google Scholar data-bases, finding a total of 29 publications between 1990 to 2019. Conclusions: The diagnosis of tumours of the cecal appendix is made incidentally in the pathological study after an appendectomy for acute appendicitis, which is why the histological study of the surgical piece should always be carried out, not only to confirm or deny the diagnosis. What reason for the appendectomy but to rule out the presence of benign or malignant neoplastic lesions.

Fuentes de energía en apendicectomía laparoscópica en un programa académico de Cirugía general en Colombia / Energy sources in laparoscopic appendectomy in an academic program of General Surgery in Colombia

Introducción. La apendicectomía por laparoscopia se considera el patrón de oro en el tratamiento de la apendicitis aguda. Sin embargo, su disponibilidad es limitada en nuestro sistema de salud, principalmente por los costos asociados. El objetivo de este estudio fue evaluar la relación entre el uso de los diferentes tipos de energía y los métodos de ligadura de la base apendicular, con las complicaciones postoperatorias, al igual que describir los costos asociados. Métodos. Estudio observacional analítico de una cohorte retrospectiva de pacientes mayores de 15 años a quienes se les realizó apendicectomía por laparoscopia, en un hospital universitario entre los años 2014 y 2018. Se utilizaron modelos de regresión logística y lineal para evaluar la relación entre métodos de ligadura del meso y base apendicular, desenlaces operatorios y costos. Resultados. Se realizaron 2074 apendicectomías por laparoscopia, 58,2 % (n=1207) en mujeres, la edad mediana fue de 32 años. En el 71,5 % (n=1483) la apendicitis aguda no fue complicada. La energía monopolar para la liga-dura del meso apendicular fue la utilizada más frecuentemente en 57,2 % (n=1187) y el Hemolok® el más utilizado para la ligadura de la base apendicular en el 84,8 % (n=1759) de los pacientes. No se observaron diferencias estadísticamente significativas en la tasa de infección del sitio operatorio, reintervención o íleo. El uso de energía simple redujo los costos del procedimiento de manera significativa durante el período evaluado. Discusión. El uso de energía monopolar demostró ser una técnica segura, reproducible y de menor costo en comparación con el uso de energía bipolar, independientemente de la fase de la apendicitis aguda. Lo anterior ha permitido que se realicen más apendicectomías por laparoscopia y que los médicos residentes de cirugía general puedan realizar procedimientos laparoscópicos de forma más temprana

Introduction. Laparoscopic appendectomy is considered the gold standard in the treatment of acute appendicitis. However, its availability is limited in our health system mainly due to the associated costs. The objective of this study is to evaluate the relationship between the use of different types of energy and the methods of ligation of the appendicular base with postoperative complications, as well as to describe the associated costs. Methods. Retrospective observational study of a cohort of patients older than 15 years old who underwent laparoscopic appendectomy in a university hospital between 2014 and 2018. Logistic and linear regression models were used to evaluate the relationship between methods of ligation of the meso and appendicular base, operative outcomes and costs. Results: 2074 laparoscopic appendectomies were performed. Of those, 58.2% (n=1207) were women, median age was 32 years. In 71.5% (n=1483), acute appendicitis was uncomplicated. Monopolar energy for ligation was the most frequently used for ligation of the appendicular meso in 57.2% (n=1187) and Hem-o-lok® the most used for ligation of the appendicular base in 84.8% (n=1759) of the patients. There were no statistically significant differences in the rate of surgical site infection, reoperation, or ileus. The use of simple energy reduced the costs of the procedure significantly during the study period. Discussion. The use of monopolar energy proved to be a safe, reproducible and a lower cost technique compared to the use of bipolar energy, regardless of the phase of acute appendicitis. This has allowed more laparoscopic appendectomies to be performed and the general surgery residents to perform laparoscopic procedures earlier

Neoplasia mucinosa apendicular / Appendiceal mucinous neoplasms

RESUMEN La neoplasia mucinosa apendicular es una entidad poco frecuente que representa el 0,2 al 0,7% de todas las apendicectomías. La forma de presentación más frecuente es el hallazgo incidental. También puede diagnosticarse du rante el estudio de un dolor abdominal crónico en el cuadrante inferior derecho o, de manera retros pectiva, por el hallazgo en la anatomía patológica en el marco de una apendicitis aguda. La apendicectomía es el tratamiento indicado; la técnica tiene como objeto impedir la perforación del apéndice para evitar el vuelco a la cavidad peritoneal de moco o células neoplásicas y de esa manera prevenir el desarrollo del pseudomixoma peritoneal.

ABSTRACT Appendiceal mucinous neoplasms are rare and represent 0.2-0.7% of all appendectomies. They usual present as an incidental finding. The diagnosis can be made during the evaluation of chronic abdomi nal pain in the right lower quadrant or may emerge in the pathology report in the setting of an acute appendicitis. Appendectomy is the treatment of choice and care must be taken to avoid perforation of the appendix with dissemination of neoplastic cells or mucus into the peritoneum and thus prevent the develop ment of pseudomyxoma peritonei.

Cirugía transumbilical asistida versus multipuerto en pacientes pediátricos con diagnóstico de apendicitis aguda / Assisted versus multiport transumbilical surgery for acute appendicitis in pediatric patients

Introducción. La prevención de las complicaciones en el manejo de la apendicitis aguda sigue siendo un reto para el cirujano pediatra; por lo que es de gran importancia comparar las opciones de manejo quirúrgico, para saber si es posible prevenir dichos resultados, que finalmente llevan a un aumento en el uso de recursos necesarios para tratar a un paciente. El objetivo de este estudio fue comparar las complicaciones postoperatorias y los costos de la laparoscopia transumbilical asistida y la laparoscopia multipuerto, en pacientes pediátricos en un hospital general de cuarto nivel de la ciudad de Bogotá, D.C., Colombia, entre octubre de 2011 y enero de 2019. Métodos. Estudio observacional, descriptivo, retrospectivo, de corte transversal, con muestreo no probabilístico a conveniencia, en el que se incluyeron los pacientes entre 0 y 16 años de edad, con historia clínica completa y diagnóstico postquirúrgico de apendicitis aguda, los cuales fueron intervenidos mediante cirugía laparoscópica transumbilical asistida o por multipuerto. Se hizo un análisis descriptivo univariado y bivariado. Resultados. De los 850 pacientes operados en ese periodo, la técnica quirúrgica más usada fue multipuerto (n=528, 62,1%) y se presentaron complicaciones en 59 (6,94%) de los pacientes. El diagnóstico postquirúrgico más frecuente fue apendicitis no perforada (n=762, 89,6%). Al comparar los dos grupos se encontró un valor de p de 0,9685 para la edad, 0,5364 para el diagnóstico postquirúrgico, 0,1127 para las complicaciones postoperatorias y 0,0085 para el costo. Discusión. El costo de hospitalización y las complicaciones de los pacientes a quienes se les practicó apendicectomía transumbilical asistida es similar a la técnica por multipuerto

Introduction. The prevention of complications in the management of acute appendicitis remains a challenge for the pediatric surgeon. Therefore, it is of great importance to compare the surgical management options, to know if it is possible to prevent these results, which ultimately lead to an increase in the use of resources necessary to treat a patient. The objective of this study was to compare the postoperative complications and costs of assisted transumbilical laparoscopy and multiport laparoscopy in pediatric patients. Method. Observational, descriptive, retrospective, cross-sectional study with non-probabilistic convenience sampling, where patients between 0 and 16 years old with a complete medical history, with a postsurgical diagnosis of acute appendicitis, who underwent assisted transumbilical surgery or by multiport performed at a fourth level general hospital in Bogotá, Colombia, between October 2011 and January of 2019. A descriptive univariate and bivariate analysis was performed. Results. Of the 850 patients operated on in this period, the most used surgical technique was multiport (n=528; 62.1%) and complications occurred in 59 (6.94%) of the patients. The most frequent postsurgical diagnosis was non-perforated appendicitis (n=762; 89.6%). Comparing the two groups, a p-value of 0.9685 was found for age, 0.5364 for postsurgical diagnosis, 0.1127 for postoperative complications, and 0.0085 for cost. Discussion. The cost of hospitalization and complications for patients who underwent assisted transumbilical appendectomy is similar to the multiport technique

Impacto de la pandemia por COVID-19 en los resultados del tratamiento de la apendicitis aguda: estudio observacional retrospectivo / Impact of the COVID-19 pandemic on acute appendicitis treatment outcomes: a retrospective observational study

Introducción. Debido a la pandemia por COVID-19, se decretó el aislamiento social, preventivo y obligatorio. El miedo de asistir al hospital, generado por la pandemia, pudo provocar una demora en la consulta y el retraso en el diagnóstico de pacientes con apendicitis, llevando a complicaciones como perforación, absceso, peritonitis, sepsis y muerte. Métodos. Se realizó un análisis comparativo de los hallazgos quirúrgicos y su desenlace, en los pacientes con diagnóstico de apendicitis, previo a la pandemia y durante ella. Resultados. No se encontró diferencia en el tiempo de la consulta, pero durante la pandemia se observó una diferencia estadísticamente significativa en las características del apéndice. Discusión. Los hallazgos durante la pandemia muestran cuadros de apendicitis aguda más avanzados que antes de la misma, sin impactar en las complicaciones quirúrgicas y postoperatorias

Introduction. Due to the COVID-19 pandemic, and as social and preventive isolation was mandatory, the fear of going to the hospital generated by the pandemic, could cause a delay in the consultation and delay in the diagnosis of appendicitis, leading to complications such as perforation, abscess, peritonitis, sepsis and death. Method. A comparative analysis of the surgical findings and their outcome was performed in patients with a diagnosis of appendicitis prior to and during the pandemic. Results. No difference was found at the time of consultation, but during the pandemic a statistically significant difference was observed in the characteristics of the appendix. Discussion. The findings during the pandemic show more advanced acute appendicitis than before, without impacting on surgical and postoperative complications