The impact of smoking on the complications of acute appendicitis

Introduction: The pathophysiology of appendicitis likely stems from obstruction of the appendiceal orifice leading to an increase in intraluminal and intramural pressure, resulting in small vessel occlusion and lymphatic stasis. Organ supplied by an end artery, such as the appendix, are more prone to the deleterious effects of arterial occlusion. The continuous cigarette smoking might be associated with a greater risk for developing atherosclerosis. Objectives: The aim is to evaluate the effect of cigarette smoking on the incidence of complications of acute appendicitis. Methods: Patients suffered from symptoms and signs suggesting acute appendicitis were examined and investigated. a multiple items collecting data questionnaire including smoking status and exclusion of confounders were constructed. The complicated and non-complicated appendicitis were compared concerning their smoking status. Results: Seventy-two Patients were included in this study; the mean age of studied patients was 24.13 ± 9.1 years. The age of 57% of patients were below the mean age and considered as younger age group, while the remaining 43% of patients were equal or above the mean age which considered as older age group. Thirty-three percentage of patients had ≥ 36 hours prehospital delay and considered as delay group, while the remaining 67% of patients had < 36 hours prehospital delay which considered no delay group, males constitute 54% of studied patients. smokers constitute 29% while the remaining 71% of studied patients were nonsmokers, 61.9% of the smokers developed complications of appendicitis. Conclusion: Perforated acute appendicitis is higher among current tobacco smokers. (AU)

Trombosis de vena mesentérica superior como complicación de apendicitis aguda: una entidad poco frecuente / Superior mesenteric vein thrombosis as a complication of acute appendicitis: a rare entity

Las complicaciones de la apendicitis aguda ha sido ampliamente descrita en la literatura; la trombosis venosa mesenterica es una manifestación poco común de esta patologia correspondiento a menos del 1 % de frecuencia, esto puede desorientar al cirujano general al coexistir en el cuadro de apendicitis aguda. Presentamos el caso de un paciente masculino de 58 años, con dolor abdominal de 5 días de evolución, con sintomatologia poco especifica para el diagnóstico concreto de apendicitis. Se realizó una tomografía computarizada de abdomen con hallazgos de apendicitis aguda y trombososis venosa mesenterica con un coágulo de 11.5 cm. Se hizó también apendicectomia abierta y se inició anticoagulación al egreso hospitalario.

The complications of acute appendicitis have been widely described in the literature; Mesenteric venous thrombosis is a rare manifestation of this pathology corresponding to less than 1% frequency, this can confuse the general surgeon as it coexists with acute appendicitis. We present the case of a 58-year-old male patient, with abdominal pain of 5 days of evolution, with symptoms that are not very specific for the specific diagnosis of appendicitis. Computed tomography of the abdomen was performed with findings of acute appendicitis and mesenteric venous thrombosis with a clot of 11.5 cm. An open appendectomy was performed and anticoagulation was started on hospital discharge.

Apendicitis aguda en una gestante lúpica / Acute appendicitis in pregnant lupus

El lupus eritematoso sistémico es una enfermedad autoinmune que se caracteriza por un proceso inflamatorio crónico y el aumento de la producción de autoanticuerpos como mecanismos patogénicos. Se presenta con mayor frecuencia en pacientes femeninas y en edad fértil. La gestación en pacientes con esta enfermedad se considera como una condición de extrema precaución, ya que existe influencia de la gestación en la actividad clínica del lupus y del lupus en la evolución de la gestación. Las complicaciones quirúrgicas, como es el caso de una apendicitis aguda, aportan mayor riesgo al binomio madre-feto. El objetivo del presente trabajo es comunicar la experiencia de tratamiento de una paciente de 31 años de edad, con diagnóstico de lupus eritematoso sistémico y a quien a las 35,6 semanas de gestación se le presentó un cuadro de apendicitis aguda que no solo provocó la actividad de la enfermedad, sino que causó la interrupción de la gestación. La paciente y el recién nacido presentaron una evolución favorable sin complicaciones posteriores.

Systemic lupus erythematosus is an autoimmune disease that includes the presence of a chronic inflammatory process and increased production of autoantibodies as etiopathogenic mechanisms. As a disease, it occurs more frequently in female patients and those of childbearing age. Pregnancy in patients with this disease is considered an element of extreme caution since there is an influence of pregnancy on the clinical activity of lupus and lupus on the evolution of pregnancy. The presence of surgical complications, as is the case of acute appendicitis, brings greater risk to the mother-fetus binomial. The objective of this report is to communicate the treatment experience of a 31-year-old patient, diagnosed with systemic lupus erythematosus and who at 35.6 weeks of gestation presented acute appendicitis that not only causes disease activity, but it generates the need to interrupt the pregnancy. The patient and the newborn had a favorable evolution, with no subsequent complications.

Pileflebitis como complicación de apendicitis aguda en paciente gestante / Pylephlebitis as a Complication of Acute Appendicitis in a Pregnant Patient

Introducción: La pileflebitis, trombosis séptica del sistema portal por cuadros inflamatorios agudos abdominales, se presenta con manifestaciones clínicas variables en dependencia de la causa de origen y por rama portal afectado. El diagnóstico incluye función hepática normal o ligeramente alterada con leucocitosis, hemocultivos positivos, eco doppler o tomografía computarizada que corrobore la enfermedad. Objetivo: Describir la pileflebitis como una complicación inusual en una paciente embarazada con apendicitis aguda, desde su concepto, fisiopatología, presentación clínica, diagnóstico y medidas terapéuticas. Caso clínico: Paciente femenina de 18 años, gestante, que refirió dolor abdominal de gran intensidad, acompañado de vómito y deposiciones diarreicas y tinte ictérico. Por tales motivos fue trasladada al Hospital General Docente Ambato. Se diagnosticó sepsis de origen abdominal por apendicitis aguda perforada, peritonitis generalizada complicada con pileflebitis. Se realizó intervención quirúrgica y resolución del cuadro clínico. Conclusiones: La pileflebitis presenta una gran dificultad diagnóstica, por lo que herramientas como la ecografía doppler y la tomografía computarizada son de ayuda en estos casos. Los pilares del tratamiento incluyen control del foco séptico abdominal y tratar la pileflebitis(AU)

Introduction: Pylephlebitis, septic thrombosis of the portal system due to acute abdominal inflammatory conditions, it presents with variable clinical signs depending on the cause of origin and the affected portal branch. Diagnosis includes normal or mildly impaired liver function with leukocytosis, positive blood cultures, Doppler echocardiography, or computed tomography confirming the disease. Objective: To describe pylephlebitis as an unusual complication in a pregnant patient with acute appendicitis, referring to its concept, pathophysiology, clinical presentation, diagnosis and therapeutic measures. Clinical case report: This is the case of an 18-year-old female pregnant patient, who had severe abdominal pain, accompanied by vomiting, diarrhea and jaundiced stools. For such reasons, she was transferred to the Ambato General Teaching Hospital. Sepsis of abdominal origin was diagnosed due to acute perforated appendicitis, generalized peritonitis complicated with pylephlebitis. Surgical intervention was performed and the clinical condition was solved. Conclusions: Pylephlebitis represents a great diagnostic difficulty, hence tools such as Doppler ultrasound and computed tomography are helpful in these cases. The mainstays of treatment include control of the abdominal septic focus and treating pylephlebitis(AU)

Comparación de antibióticoterapia en la apendicitis complicada en pediatría / Comparison of antibiotic therapy in complicated appendicitis in pediatrics

INTRODUCCIÓN. La apendicitis aguda es una patología pediátrica quirúrgica que en su fase complicada requiere uso de antibióticos en el postoperatorio; encontrar la mejor opción como experiencia local, fue necesario. OBJETIVO. Comparar un esquema de antibioticoterapia triple vs un doble respecto a variables: demográficas, clínicas y de costos en pacientes pediátricos con apendicitis complicada. MATERIALES y MÉTODOS. Estudio analítico transversal. Población de 133 pacientes y una muestra de 93, operados por apendicitis complicada; 58 recibieron ampicilina + metronidazol + gentamicina y 35 ceftriaxona + metronidazol. Se comparó las variables: estadía hospitalaria, complicaciones y costo monetario de cada esquema. Se realizó en la Unidad de Cirugía Pediátrica del Hospital de Especialidades Carlos Andrade Marín, en el periodo enero de 2017 a octubre de 2018. Los datos fueron analizados con R-Studio 1.8.366 para Windows. RESULTADOS. No hubo diferencia estadística con respecto a: estadía hospitalaria (p=0,261); complicaciones como infección del sitio quirúrgico (p=0,196), re-intervención quirúrgica (p=0,653) y costo (p=0,059). CONCLUSIÓN. Se comparó el esquema de antibioticoterapia triple vs un doble, utilizados en apendicitis complicada en pediatría. No se encontró diferencias estadísticamente significativas en este reporte preliminar, con la diferencia de que con el esquema doble la frecuencia de administración fue menor y se evitó la exposición a los efectos colaterales de los aminoglicósidos.

INTRODUCTION. Acute appendicitis is a pediatric surgical pathology that in its complicated phase requires the use of antibiotics during the postoperative period; finding the best option as local experience was a must. OBJECTIVE. Compare a triple vs a double antibiotic therapy scheme respect demographic, clinical and cost variables in pediatric patients whit complicated apendicitis. MATERIALS AND METHODS. Cross-sectional analytical study. Population of 133 patients and sample of 93, with complicated appendicitis; 58 received ampicillin + metronidazole + gentamicin and 35 ceftriaxone + metronidazole. The following variables were compared; hospital stay, complications and monetary cost of each scheme. It was performed in the Pediatric Surgery Unit of the Hospital of Specialties Carlos Andrade Marin, during january 2017, through october 2018. The data were analyzed with R-Studio 1.8.366 for Windows. RESULTS. There was no statistical difference regarding hospital stay (p=0.261); complications such as surgical site infection (p=0.196), re-surgical intervention (p=0.653); nor cost (p=0.059). CONCLUSION. Triple vs. Double antibiotic therapy scheme used in complicated appendicitis in pediatrics was compared. No statistically significant differences were found in this preliminary report, how ever with the double scheme the frequency of administration was lower and exposure to side effects of aminoglycosides was avoided.

Duplicación del apéndice vermiforme. Reporte de caso / Vermiform appendix duplication - case report

Dar a conocer una presentación inusual de una patología frecuente. Se presenta caso de paciente masculino de 27 años con cuadro clínico de apendicitis aguda. Se realiza apendicetomía abierta en la cual se identifican dos apéndices vermiformes. Se confirma el diagnóstico por medio de anatomía patología, una con apendicitis aguda perforada y otra con peri-apendicitis. Es importante el conocimiento de esta patología para que se pueda reconocer y evitar errores de juicio durante el procedimiento quirúrgico y futuras complicaciones para el paciente. (AU)

Report an unusual presentation of a common pathology. A case of a 27-year-old male with a clinical picture of acute appendicitis is presented. An open appendectomy is performed in which two vermiform appendages are identified. The diagnosis is confirmed by pathology, one with perforated acute appendicitis and the other with peri-appendicitis. Knowledge of this pathology is important so that errors of judgment can be recognized and avoided during the surgical procedure and future complications for the patient. (AU)

Síndrome de brugada en el paciente quirúrgico de urgencia. Reporte de caso / Brugada syndrome in the emergency surgical patient. Case report.

Introducción: El síndrome de Brugada es una condición genética rara, el diagnóstico se establece por un patrón electrocardiográfico en particular que se asocia a un riesgo de fibrilación ventricular y muerte súbita; Objetivo: Presentar un caso interesante de un paciente joven quién ingreso a quirófano con la impresión clínica de apendicitis aguda para realizar apendicetomía video laparoscópica. Durante el procedimiento presento múltiples episodios de taquiarritmias; desencadenando Fibrilación Ventricular de difícil manejo trans y post operatorio, debido a los medicamentos peri-operatorios, agresión quirúrgica y fiebre. Material y Métodos: Se documento y presentó un caso interesante; Presentación de Caso: Paciente masculino de 26ª, sin antecedentes médicos, con impresión clínica de apendicitis aguda ingresa a quirófano, durante el acto quirúrgico presenta arritmias, documentándose Fibrilación Ventricular con inestabilidad hemodinámica que amerito desfibrilación externa, revirtió a ritmo sinusal. Al concluir el acto quirúrgico, se realiza EKG, evidenciando supradesnivel del segmento ST en V1 y V2 e inversión de la onda T por lo que pasa a unidad de cuidados intensivos, sin reversión anestésica y con tubo orotraqueal. Paciente se monitoriza en UTI, se realiza EKG evidencia ritmo nodal. Se extuba a las 12h post operatorias y se traslada a cardiología en 48h donde establecen que paciente cursa con patrón de Brugada. Conclusiones: Con el creciente número de pacientes con trastornos de conducción heredadas que se presentan para cirugía no cardiaca que están en riesgo de muerte súbita; el éxito en el manejo peri, trans y post operatorio depende de un conocimiento detallado de estas condiciones. (AU)

Introduction: Brugada syndrome is a rare genetic condition, the diagnosis is established by a particular electrocardiographic pattern and is associated with a risk of ventricular fibrillation and sudden death; Objective: To present an interesting case of a young patient who enters the operating room with the clinical impression of acute appendicitis to perform laparoscopic appendectomy and that during the procedure present multiple episodes of tachyarrhythmias; triggering Ventricular Fibrillation, what causes him difficult trans and postoperative management, due to peri-operative medications, surgical aggression and fever. Material and Methods: An interesting case was documented and presented; Case Presentation: Male patient of 26 years old, without medical history, with clinical impression of acute appendicitis was admitted to the operating room, during the surgical act it presents arrhythmias, showing Ventricular Fibrillation with hemodynamic instability that warrants external defibrillation, reversed at sinus pace, EKG is performed showing elevation gain of the ST segment in V1 and V2 and inversion of the T wave at the end of the surgical act, so it goes to intensive care unit, without anesthetic reversal and with orotracheal tube. Patient is monitored in ICU, EKG shows nodal rhythm, extubates at 12h post op and at 48h was transferred to cardiology where they establish that patient studies suggest Brugada pattern; Conclusions: With the increasing number of patients with inherited driving disorders who present the thee for non-cardiac surgery who are at risk of sudden death; success in peri, trans and postoperative management depends on a detailed knowledge of these conditions. (AU)

Tratamiento quirúrgico de la apendicitis aguda durante la pandemia: el daño colateral del COVID-19 / Surgical treatment of acute appendicitis in pandemic: COVID -19 collateral damage

RESUMEN Antecedentes: la pandemia por COVID-19 generó cambios en el manejo de pacientes con todo tipo de patologías. Mostramos la experiencia respecto de los pacientes con apendicitis aguda (AA) operados en un hospital universitario de la Ciudad Autónoma de Buenos Aires durante los meses de confina miento y su comparación con el mismo período del año 2019 a fin de evaluar las diferencias. Material y métodos: se analizó en forma retrospectiva una base confeccionada de forma prospectiva. Se compararon pacientes operados de AA, consignando los datos respecto del período preoperatorio, comparando datos inherentes a la cirugía y sus resultados en los períodos marzo-julio de 2019 y 2020. Resultados: fueron incluidos 127 pacientes, 46 de ellos operados durante la pandemia. Los pacientes operados durante la pandemia presentaron mayor incidencia de peritonitis (61,7% vs. 76,1%; p: 0,09) y mayor requerimiento de drenaje abdominal (9,9% vs. 23,9%; p: 0,03). También tuvieron mayor in cidencia de complicaciones (10,9 vs. 4,9%; p: 0,21), reoperaciones (8,7 vs. 1,23%, p: 0,03), reinterna ciones (6,5 vs. 0%, p: 0,02) y requerimiento de antibioticoterapia endovenosa prolongada (6,5 vs. 0%; p: 0,02). La estadía hospitalaria fue mayor para la cohorte operada durante la pandemia: 3,24 días (Desvío estándar [D.E.]: 7,31) vs. 1,89 días (D.E: 2,04). Conclusiones: durante la pandemia por COVID-19, el número de pacientes operados por AA disminuyó con respecto al año 2019; se observaron estadios más avanzados de la enfermedad, mayores compli caciones en el posoperatorio y mayor estadía hospitalaria.

ABSTRACT Background: COVID-19 pandemic has generated changes regarding the management of patients with all kind of pathologies. Here we show the experience concerning the surgical treatment of acute appendicitis (AA) in a teaching hospital in the city of Buenos Aires during the lockdown, and its comparison with the same period of 2019 in order to assess the differences between the timing for consultation, intraoperative findings and the treatment outcome. Material and methods: A prospective database was retrospectively analyzed. We compared patients undergoing surgical treatment for AA in March-July of 2019 v. March-July 2020, taking into account the preoperative period and comparing the outcome regarding the surgical intervention and the impact in the postoperative period between the two groups. Results: 127 patients were included, 46 treated during the pandemic. Patients undergoing surgical treatment during the pandemic had a higher incidence of peritonitis (61.7% vs. 76.1%; p = 0.09) and higher requirement of abdominal drainage (9.9% vs. 23.9%; p = 0.03). There was an increase in the incidence of complications (10.9 vs. 4.9%; p: 0.21), reoperations (8.7 vs. 1.23%, p: 0.03), readmissions (6.5 vs. 0%, p: 0.02) and need for out-patient intravenous antibiotics (6.5 vs. 0%; p: 0.02). The average hospital length was of 1.89 (SD 2.04) and 3.24 (SD 7.31) for the groups operated before and during pandemic, respectively. Conclusions: During the COVID-19 pandemic, the number of patients undergoing surgical intervention because of AA decreased compared to the previous year, with increased complications in the postoperative period, higher compromise of the appendix, and longer hospital stay.

Un estudio comparativo de complicaciones agudas Apendicitis en el Hospital Universitario Al-Basra. Un estudio clínico prospectivo / A Comparison Study of Acute Complicated Appendicitis in Al-Basra Teaching Hospital. A Prospective Clinical Study

Background: Acute appendicitis is one of the most frequent surgical emergencies and is a common cause of non-traumatic acute abdominal emergencies that require surgical intervention. Most complicated appendicitis started de novo as simple appendicitis raising the notion that it is a disease in evolution that has become of clinical importance due to delayed or missed diagnosis. Complicated appendicitis has been associated with a significant risk of postoperative septic complications, including wound infections and intra-abdominal abscess formation. This study aimed to evaluate the types of complicated appendicitis and their relationship to patient's demographic data, postoperative course and the length of hospital stay in Al-Basra Teaching Hospital. Methods: This was a prospective clinical study involving patients with acute appendicitis admitted to Al-Basra Teaching Hospital from January 2017 to October 2019. The demographic data, types of complicated appendicitis, hospitalization duration, and postoperative complications were evaluated. The patients were divided into six groups according to age. All data were recorded and analyzed. Results: A total of 1210 patients, age from 6 to 69 years, mean age of patients was 23.45, males out-numbered females. Perforated appendicitis represents the main type of complicated appendicitis, and it was reported mostly among elderly patients. Patients with complicated appendicitis had a longer hospitalization and more postoperative complications than patients with non-complicated appendicitis. Conclusion: we concluded that nearly one third of the patients with acute appendicitis had complicated appendicitis, so they need a special pre and postoperative care and old age had non classical clinical picture with poor outcome.

Mucocele apendicular / Apendicular mucocele

Introducción: El mucocele es una dilatación apendicular por secreción mucosa secundaria a la obstrucción de la luz, su incidencia estimada es de 0,2-0,3 por ciento de todas las apendicectomías realizadas y el 8-10 por ciento de todos los tumores apendiculares. Objetivo: Presentar un caso inusual de cirugía de urgencia, con dolor abdominal en fosa ilíaca derecha, sugestivo de apendicitis aguda operado en el servicio de urgencia. Caso clínico: Paciente femenina de 32 años de edad, que consulta por dolor abdominal en fosa ilíaca derecha asociado a náuseas, con dolor a la palpación en dicha zona, defensa muscular y dolor a la descompresión brusca del abdomen, fue intervenida quirúrgicamente con el diagnóstico presuntivo apendicitis aguda. Se encuentra durante videolaparoscopia al apéndice cecal aumentado de tamaño, sin compromiso de su base, por lo cual se decide realizar laparotomía y apendicectomía convencional. La paciente fue egresada a las 48 horas de operada con evolución favorable y pendiente de resultado anatomopatológico, el cual informó mucocele apendicular. Conclusiones: El mucocele apendicular es una entidad poco frecuente, que predomina en el sexo femenino y edades entre 50 y 60 años. El tratamiento de elección es el quirúrgico(AU)

Introduction: The mucocele is the abnormal mucous accumulation inside the light of the appendix. Objective: To present an unusual case of surgery of urgency with abdominal pain and suspicion of appendicitis operated in emergency. Clinical case: Female patient of 32 years old that consults for abdominal pain in the right iliac fossa, accompanied by nausea. Physical examination we find pain to the palpation in the right iliac fossa and peritoneal reaction being operated with suspicion of appendicitis, during intervention we find the appendix augmented of volume and apendicectomy was made. The histopathological study informed a apendicular mucocele. The patient was discharged after 48 hours without further complications. Conclusions: Apendicular mucocele is very uncommon disease that predominates in female sex and persons between fifty and sixty years old. Treatment is surgical(AU)

Apendicitis aguda perforada secundaria a una tuberculosis como causa de sepsis posparto / Acute perforated appendicitis secondary to tuberculosis as a cause of postpartum infection

Resumen La tuberculosis gastrointestinal es una manifestación extrapulmonar poco frecuente, correspondiendo al 3% de los casos y que compromete principalmente la región ileocecal; la afectación apendicular es poco frecuente. La apendicitis tuberculosa se puede presentar como un cuadro agudo indistinguible de las otras causas de apendicitis y el diagnóstico generalmente se hace por el hallazgo histopatológico, lo que retrasa el tratamiento y puede llevar a complicaciones. El período posparto es de riesgo de una reactivación de una tuberculosis, debido a cambios en el sistema inmunológico que se manifiestan como un síndrome de reconstitución inmune. Se presenta el caso de una paciente puérpera que ingresa por un choque séptico secundario a una apendicitis perforada. La histopatología demostró una inflamación granulomatosa crónica, con posterior confirmación por biología molecular de una tuberculosis pulmonar.

Abstract Gastrointestinal tuberculosis is a rare extrapulmonary manifestation, it represents 3% of cases and mainly involves the ileocecal region; appendiceal involvement is rare. Tuberculous appendicitis can present as an acute condition indistinguishable from other causes of appendicitis and the diagnosis is generally made by histopathological finding, which delays treatment and can lead to complications. The postpartum period is at risk of a reactivation of tuberculosis, due to changes in the immune system that manifests as an immune reconstitution syndrome. We present the case of a postpartum patient admitted for septic shock secondary to perforated appendicitis, the pathology reported chronic granulomatous inflammation and subsequent confirmation by molecular technique of pulmonary tuberculosis.

Respuesta del score RIPASA versus el histopatológico como predictor diagnóstico de apendicitis aguda en el Hospital Vicente Corral Moscoso año 2018 / Response of the RIPASA score versus the histopathology as a diagnostic predictor of acute appendicitis at the Vicente Corral Moscoso Hospital in 2018

Antecedentes: la Apendicitis Aguda (A.A) es una urgencia quirúrgica que requiere un diagnóstico y tratamiento oportuno. Muchas veces puede ser un gran reto para el cirujano por su relación con otras patologías, de allí la importancia de precisar su diagnóstico. Objetivo: validar la precisión diagnóstica del score RIPASA en apendicitis aguda comparándolo con el examen histopatológico. Metodología: se realizó un estudio de validación de pruebas diagnósticas con la información de 300 historias clínicas de pacientes apendicectomizados, atendidos en el Hospital Vicente Corral Moscoso durante el año 2018. Se evaluó mediante el score RIPASA al ingreso y se comparó con los resultados de histopatología como prueba gold standar. Se calculó la sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo, además se obtuvo Odds Ratio con su IC al 95% para establecer la validez predictiva de esta escala. Resultados: la media de edad fue de 32 años ± 13,7 (DS), más de la mitad fueron: sexo femenino 52%, área urbana 74.7% y bachillerato 62.7%, predominó la etnia mestiza 99.7%. Hubo una asociación de riesgo entre una alta probabilidad de apendicitis según el score RIPASA con A.A (OR 96,36; IC95%: 16,03­578,68; p= 0,000). El score RIPASA tiene una sensibilidad de 98.97%, especificidad 50.0%, VPP 98.63%, VPN 57,14%, RVP 1.98% Y RVN 0.2%. Conclusiones: RIPASA tiene alta probabilidad para detectar a personas con apendicitis aguda, pero no así a las sanas, por lo cual se requiere continuar con más estudios para establecer tal validez

Background: Acute Appendicitis (A.A) is a surgical emergency that requires timely diagnosis and treatment. Many times it can be a great challenge for the surgeon because of its relationship with other pathologies, hence the importance of specifying its diagnosis. Objective: To validate the diagnostic accuracy of the RIPASA score in acute appendicitis by comparing it with the histopathological examination. Methodology: A study of validation of diagnostic tests was carried out with the information of 300 medical records of appendectomized patients, treated at the Vicente Corral Moscoso Hospital during 2018. It was evaluated by means of the RIPASA score at admission and compared with the histopathology results. as gold standard test. Sensitivity, specificity, positive predictive value, negative predictive value were calculated, in addition Odds Ratio was obtained with its 95% CI to establish the predictive validity of this scale. Results: The mean age was 32 years ± 13.7 (SD), more than half were: female 52%, urban area 74.7% and high school 62.7%, mixed race ethnicity predominated 99.7%. There was a risk association between a high probability of appendicitis according to the RIPASA score with A.A (OR 96.36; 95% CI: 16.03­578.68; p = 0.000). The RIPASA score has a sensitivity of 98.97%, specificity 50.0%, PPV 98.63%, NPV 57.14%, RVP 1.8% and RVN 0.2% Conclusions: RIPASA has a high probability of detecting people with acute appendicitis, but not healthy ones, so it is necessary to continue with more studies to find such validity

Apendicitis aguda en niños, Hospital José Carrasco Arteaga. Cuenca, 2012 - 2016 / Acute appendicitis in children, José Carrasco Arteaga Hospital. Cuenca, 2012-2016

De entre las emergencias pediátricas, la apendicitis aguda es la patología más frecuente, siendo importante observar su comportamiento en nuestro medio y por variables como la edad y diagnósticos diferenciales. Objetivo: determinar las características de los pacientes menores de 16 años ingresados al Servicio de Cirugía Pediátrica del Hospital José Ca-rrasco con diagnóstico de apendicitis aguda entre enero 2012 y diciembre 2016.Métodos: estudio descriptivo basado en las historias clínicas de niños in-gresados a emergencia con dolor abdominal en el período enero 2012 a diciembre 2016 y diagnosticados de apendicitis. Los datos fueron analiza-dos y tabulados en Excel. Se tomaron en cuenta consideraciones éticas.Resultados: se analizaron 614 niños con dolor abdominal; 334 fueron diagnosticados de apendicitis aguda (246 niños) y peritonitis apendicular (88 niños), corresponden al sexo masculino 54.19%. La media de edad fue 9.9 años; la leucocitosis fue el hallazgo de laboratorio más frecuente encontrado en 82.93%. El estudio ecográfico resultó positivo para apendi-citis en 55.69%. Todos recibieron tratamiento laparoscópico por el mismo equipo quirúrgico, las complicaciones se presentaron en el 8.69%.Conclusiones: la apendicitis aguda es la principal causa de cirugía de emergencia en pacientes pediátricos, afecta más al género masculino, en-tre 6 y 11 años de edad (media 9.9 años), es requiere un diagnóstico y tratamiento inmediato para evitar complicaciones; el tratamiento laparos-cópico es un procedimiento seguro.(AU)

Among pediatric emergencies, acute appendicitis is the most frequent pathology, it is important to observe their behavior in our environment and variables such as age and differential diagnoses should be taken into account.Objective: to determine the characteristics of patients under 16 admitted to the Pediatric Surgery Service of the José Carrasco Hospital with a diagnosis of acute appendicitis between January 2012 and December 2016.Methods: It is a descriptive study based on the medical records of children admitted to the emergency department with abdominal pain in the period January 2012 to December 2016 and diagnosed with appendicitis. The data was analyzed and tabulated in the Excel program. All ethical considerations were taken into account.Results: 614 children with abdominal pain were analyzed; 334 were diagnosed with acute appendicitis (246 children) and appendicular peritonitis (88 children), 54.19% correspond to the male sex. The average age was 9.9 years; the leukocytosis was the most frequent laboratory finding in 82.93%. The ultrasound study was positive for appendicitis in 55.69%. All received laparoscopic treatment by the same surgical team, complications occurred in 8.69%.Conclusions: acute appendicitis is the main cause of emergency surgery in pediatric patients, it affects more to the male gender, between 6 and 11 years of age (average 9.9 years), immediate diagnosis and treatment is required to avoid complications; laparoscopic treatment is a safe procedure.(AU)

Triple versus monoterapia antibiótica en apendicitis complicada: ensayo clínico abierto, Instituto Hondureño de Seguridad Social, Tegucigalpa / Triple versus antibiotic monotherapy in complicated appendicitis: open clinical trial, Honduran Social Security Institute, Tegucigalpa

Antecedentes: En Honduras no se dispone de evidencia publicada sobre diferencias en eicacia de esquemas terapéuticos basados en antibióticos para el manejo post-quirúrgico para apendicitis aguda complicada en niños. Objetivo: Determinar la eicacia y seguridad de triple versus monoterapia antibiótica en pacientes pediátricos con apendicitis aguda complicada, Hospital de Especialidades, Instituto Hondureño de Seguridad Social (IHSS), Tegucigalpa, 2011-2013. Métodos: Ensayo clínico abierto, dos esquemas terapéuticos: Triple Terapia (Ampicilina+Amikacina+Clindamicina, GrupoTT) y Ertapenem (GrupoE) durante 7 días. Se incluyeron pacientes con diagnóstico de apendicitis aguda complicada y sometidos a apendicectomía abierta. Los pacientes fueron evaluados en Consulta Externa, 7 días post-quirúrgicos. Se obtuvo aprobación por Comité de Etica en Investigación IHSS. Se utilizó prueba Chi-cuadrado, Riesgo Relativo, intervalo de conianza de 95% y valor de p<0.05 para determinar diferencias entre grupos. Resultados: Seincluyeron 58 pacientes en GrupoTT y 29 en Grupo E, edad media fue 7.3 años (IC95% 6.7-7.9) GrupoTT y 8 años (IC95% 7-9) GrupoE. La evolución promedio del cuadro clínico fue 31.6 horas GrupoTT y 43.8 horas GrupoE (p=0.034). No se encontró diferencias signiicativas respecto a efectos adversos de importancia clínica, complicaciones postoperatorias, estancia intrahospitalaria en días, o necesidad de readmisión por recurrencia/complicación posterior al alta. Discusión: La monoterapia con ertapenem presentó similar eicacia y seguridad que la triple terapia con Ampicilina+Amikacina+Clindamicina empleada actualmente en el tratamiento del paciente pediátrico con apendicitis complicada. El estudio está limitado por que los dos grupos de estudio fueron diferentes en la evolución de la enfermedad...(AU)

Pileflebitis asociada a apendicitis aguda complicada. A propósito de un caso / Pileflebitis associated with complicated acute appendicitis. About a case

The aim of this study was to analyse a patient dignosed in our hospital as having pylephlebitis. The patient is a 29 years old male, and we must consider that pylophlebitis refers to the septic thrombosis of the portal venous system, associated to some kind of infectious process. Can occur related to acute appendicitis, colonic diverticulitis and cholangitis, among others. Is a rare but close to a significant morbidity and mortality, since it can develop to an abdominal sepsis. The management review of the case reported, is presented (AU)

Hypothermia post-cardiopulmonary resuscitation with low inputs: an experience report / Hipotermia post-ressuscitación cardiopulmonar con bajos insumos: relato de experiencia / Hipotermia pós ressuscitação cardiopulmonar com baixos insumos: relato de experiência

ABSTRACT Objective: to report the experience of conducting directed temperature control of a post-cardiopulmonary resuscitation patient, with reduced and basic inputs available at the institution. Method: an experience report of directed temperature control in patient (age 15 years), after four hours of cardiopulmonary resuscitation in an Intensive Care Unit of a hospital in São Paulo State countryside in 2016, according to the protocol suggested by the American Heart Association, in 2015. There were applications of cold compresses, plastic bags with crushed ice and rectal temperature control. Results: after eight hours, temperature had reached 93.2 ºF. Body cooling was maintained for 24 hours. However, bags with crushed ice were used in the first 6 hours. Conclusion: conduct of nurses to obtain the body cooling with reduced and basic inputs was effective during the stay at the Intensive Care Unit.

RESUMEN Objetivo: relatar la experiencia de la conducción de control dirigido de la temperatura de una paciente después de la resucitación cardiopulmonar, con insumos reducidos y básicos disponibles en la institución. Método: el informe de experiencia de control direccionado de la temperatura en paciente (edad 15 años), después de cuatro horas de resucitación cardiopulmonar en una Unidad de Terapia Intensiva de un hospital del interior del estado de São Paulo, en el año 2016, conforme protocolo sugerido por la American Heart Association en 2015. Se utilizaron aplicaciones de compresas embebidas en agua helada, bolsas plásticas con hielo triturado y control de la temperatura rectal. Resultados: en ocho horas, la temperatura alcanzó los 34 ºC. El enfriamiento corporal se mantuvo durante 24 horas, sin embargo, las bolsas con hielo triturado se utilizaron en las primeras 6 horas. Conclusión: la conducta de los enfermeros para obtener el enfriamiento corporal con insumos reducidos y básicos, se mostró efectiva durante la permanencia en la Unidad de Terapia Intensiva.

RESUMO Objetivo: relatar a experiência da condução de controle direcionado da temperatura de uma paciente pós ressuscitação cardiopulmonar, com insumos reduzidos e básicos disponíveis na instituição. Método: relato de experiência de controle direcionado da temperatura em paciente (idade 15 anos) após quatro horas de ressuscitação cardiopulmonar em uma unidade de terapia intensiva de um hospital do interior do Estado de São Paulo, no ano de 2016, conforme protocolo sugerido pela American Heart Association 2015. Utilizou-se aplicações de compressas embebidas em água gelada, sacos plásticos com gelo triturado e controle da temperatura retal. Resultados: em oito horas a temperatura atingiu 34ºC. O resfriamento corporal foi mantido por 24 horas, todavia os sacos com gelo triturado foram utilizados nas primeiras 6 horas. Conclusão: a conduta dos enfermeiros para obter o resfriamento corporal com insumos reduzidos e básicos, mostrou-se efetiva durante a permanência na unidade de terapia intensiva.

Apendicectomías: ¿llega tarde el paciente o las complicamos nosotros? / Appendicectomies: Does the patients arrive late or otherwise are complicated by us?

Appendicitis is the inflammation of the vermiform appendix. Acute appendictis is the most common surgical emergency, and the most frequent cause of abdominal pain. It is considered that between 7 to 12% of the world population will develop the disease in some ciurcumstances of their lifes, being more frequent during the second and third decades. The aim of this study was to evaluate the comlications derivated from the delay in the anagement of the patients with this complaint. Usually, the signs and symptoms are frequently typical and the diagnosis quickly made. However, the classic syndrome may not be evident and the correct diagnosis may be obscure, in whom a delay in diagnosis can result in a lifebreatening situation. Inflammation of the appendix usually results from the obstruction of the appendiceal lumen. The diagnosis of appendicitis depends primarily on the history and physical findings, but confirmation of the diagnosis usually requires appropriate laboratory, radiographic or endoscopic studies. Pain is usually the first simptom. vomiting usually develops. Acute appendicitis should always be included in the differential diagnosis of abdominal pain. Low-grade fewer is usual. The most characteristic sign is point tenderness at Mc-Burney's pint, which is located one third of the distance from the anterior-superior iliac spine to the umbilicus.We present a retrospective analysis, descriptive and observational. In our study the Alvarado score was empliye. The complications observed are detailed, and the results obtained are commented

Riesgo de apendicitis complicada en el paciente diabético / Risk of complicated appendicitis in the diabetic patient

Resumen La apendicitis aguda es una de las causas quirúrgicas de dolor abdominal más frecuentes en el mundo. Se presenta en diversos grupos etarios y su presentación clínica puede variar de un grupo a otro. Además hay una variedad de patologías crónicas que pueden opacar la sintomatología usual de la enfermedad, entre ellas la diabetes mellitus. En las últimas décadas la incidencia de diabetes mellitus se ha elevado considerablemente por lo que es más común que un paciente diabético padezca de apendicitis. También, el retraso entre el inicio de los síntomas y el diagnóstico de apendicitis, es un factor de riesgo para el desarrollo de apendicitis aguda complicada. Por ende, es importante conocer tanto las complicaciones como el impacto que puede tener la diabetes mellitus sobre la presentación clínica típica de la apendicitis aguda, para de esta manera, realizar un diagnóstico temprano y preciso.

Abstract Acute Appendicitis is one of the most common surgical causes for abdominal pain in the world. It occurs in a variety of age groups and its clinical presentation vary from one group to another. Additionally, there are several chronic conditions that can blurry the usual symptomatology of the disease, among them diabetes mellitus. In the last decades the incidence of diabetes mellitus has increased considerably, therefore it is more common for a diabetic patient to suffer from appendicitis. Also the delay between the beginning of the symptoms and the diagnosis of appendicitis is a risk factor for the development of complicated acute appendicitis. Thus it is important to know the complications and the impact that diabetes mellitus can have over the clinical presentation of acute appendicitis, thereby an accurate diagnose can be made in the shortest time possible.

Pancreatitis y apendicitis aguda como complicación en una paciente con enfermedad mixta del tejido conectivo / Pancreatitis and acute appendicitis as a complication in a patient with mixed connective tissue disease

Introducción: la enfermedad mixta del tejido conectivo es una afección que incluye manifestaciones clínicas de diversas enfermedades reumáticas. Se caracteriza sobre todo por la presencia de afectación en todos los órganos y sistemas de órganos del cuerpo humano. Las complicaciones relacionadas con el aparato digestivo han sido señaladas como una de las que con mayor frecuencia se presentan. La pancreatitis y la apendicitis suelen presentarse de forma aislada, pero al presentarse al unísono complican más aún la evolución del paciente. Objetivo: dar a conocer los elementos clínicos, de laboratorio e imagenológicos que posibilitan llegar al diagnóstico de apendicitis y pancreatitis en una paciente con enfermedad mixta del tejido conectivo. Caso clínico: se presenta el caso de una paciente de 29 años de edad con diagnóstico de enfermedad mixta del tejido conectivo de 3 años de evolución que es remita al servicio de emergencia con elementos clínicos, de laboratorio e imagenológicos que permiten llegar al diagnóstico de una apendicitis y pancreatitis de presentación conjunta. Conclusiones: la enfermedad mixta del tejido conectivo es una enfermedad sistémica que cursa con una amplia variedad de manifestaciones clínicas y complicaciones. Los procesos agudos como la apendicitis y la pancreatitis suponen un peligro sobreañadido y un factor desencadenante de la actividad de la enfermedad(AU)

Introduction: mixed connective tissue disease is a condition that includes clinical manifestations of various rheumatic diseases. It is characterized above all by the presence of affectation in all organs and organ systems of the human body. Complications related to the digestive system have been identified as one of the most frequent. Pancreatitis and appendicitis usually occur in isolation, but when presented in unison, they complicate the evolution of the patient even more. Objective: to present the clinical, laboratory and imaging elements that make it possible to reach the diagnosis of appendicitis and pancreatitis in a patient with mixed connective tissue disease. Clinical case: the case of a 29-year-old patient with a diagnosis of mixed connective tissue disease of 3 years of evolution is presented, which is referred to the emergency service with clinical, laboratory and imaging elements that allow to reach the diagnosis of a appendicitis and pancreatitis of joint presentation. Conclusions: Mixed connective tissue disease is a systemic disease that presents with a wide variety of clinical manifestations and complications. Acute processes such as appendicitis and pancreatitis pose an added danger and a triggering factor in the activity of the disease(AU)

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