Hernia de Amyand tipo 3. Reporte de caso / Amyand hernia type 3. Case report

Se describe a la hernia de Amyand como la presencia del apéndice cecal dentro de un saco herniario inguinal con un proceso inflamatorio-infeccioso o no, cuya frecuencia <1% de los casos de hernias inguinales. Exponer caso clínico y revisión bibliográfica de la hernia de Amyand tipo 3. Paciente masculino de 65 años de edad con enfermedad actual de inicio 10 días previo a su ingreso cuando posterior a esfuerzo físico presenta aumento de volumen no reductible en región inguinal derecha dolorosa, posteriormente 24 horas previo a su ingreso presenta dolor de fuerte intensidad en región inguinal derecha, persistencia del aumento de volumen y signos de flogosis, náuseas y alzas térmicas no cuantificadas, por lo cual acude a nuestra institución. Examen fisico: Abdomen blando depresible, doloroso a la palpación profunda en fosa ilíaca derecha, sin signos de irritación peritoneal, se apreciaba aumento de volumen en region inguinal derecha, no reductible, doloroso a la palpación con rubor y calor local, genitales masculinos con dolor a la palpación del testìculo derecho. Hernia inguinal derecha atascada. Intervención quirúrgica: Hernioplastia inguinal por técnica de cierre preperitoneal, sin colocación de malla, apendicectomía atípica por técnica de Pouchet. La hernia de Amyand es una patología poco frecuente, que se presenta <1% y acompañada de complicaciones <0,1%, debe sospecharse en pacientes que presente una patología herniaria derecha con leucocitosis y neutrofilia sin otro foco infeccioso demostrado, donde el diagnóstico principalmente se hace intraoperatorio como lo expone el presente caso(AU)

Amyand's hernia is described as the presence of the cecal appendix within an inguinal hernial sac with an inflammatory-infectious process or not, the frequency of which is <1% of cases of inguinal hernias. To present a clinical case and a bibliographic review of Amyand hernia type 3. A 65-year-old male patient with current disease that started 10 days before admission when, after physical effort, he presented a non-reducible increase in volume in the right inguinal region. Painful, later 24 hours before admission, he presented pain of strong intensity in the right inguinal region, persistence of increased volume and signs of phlogosis, nausea and thermal increases not quantified, for which he came to our institution. Physical exam: painful depressible soft abdomen on deep palpation in the right iliac fossa without signs of peritoneal irritation, volume increase was observed in the right inguinal region, not reducible, painful on palpation with flushing and local heat, male genitalia with pain on palpation of the right testicle. Stuck right inguinal hernia. Surgical intervention: Inguinal hernioplasty by preperitoneal closure technique without mesh placement, atypical appendectomy by Pouchet technique. Amyand's hernia is a rare pathology, which presents <1% and accompanied by complications <0.1%, it should be suspected in patients presenting a right hernia pathology with leukocytosis and neutrophilia without another proven infectious focus, where the diagnosis is mainly made intraoperatively as exposed in the present case(AU)

Correlación diagnóstica de la escala RIPASA en pacientes intervenidos quirúrgicamente por apendicitis aguda / Diagnostic correlation of the RIPASA score in patients operated on for acute appendicitis

Antecedentes: La apendicitis aguda (AA) es la urgencia quirúrgica más frecuente alrededor del mundo. Su diagnóstico precoz y certero es fundamental para evitar cirugías innecesarias y complicaciones asociadas a su evolución natural. Objetivo: Determinar la sensibilidad y especificidad diagnóstica de la escala RIPASA en pacientes con sospecha clínica de apendicitis aguda. Material y métodos: Estudio analítico, transversal, observacional y retrospectivo; se incluyeron todas las piezas de apendicectomías de pacientes de ambos sexos mayores de 18 años operados con diagnóstico clínico de apendicitis aguda que consultaron entre el 1º de enero y el 31 de diciembre de 2017. Como procedimiento de referencia (gold standard) diagnóstico se analizaron los hallazgos histopatológicos del apéndice extirpado. Se aplicó la escala RIPASA a cada uno de los pacientes (punto de corte de 7,5). Se realizó estadística descriptiva y pruebas diagnósticas (sensibilidad, especificidad, valor predictivo positivo [VPP], valor predictivo negativo [VPN]). Resultados: Se incluyeron 68 apendicectomías. Cincuenta y siete muestras (83,82%) fueron positivas para apendicitis aguda. El promedio de edad fue 43,32 años. De los 38 hombres, 32 (84,21%) tuvieron diagnóstico histopatológico de AA. De las 30 mujeres, 25 (83,33%) tuvieron AA. Para la escala RIPASA, 54 pacientes tuvieron un resultado verdadero positivo (punto de corte ≥7,5 e histología positiva para AA) resultando con una sensibilidad del 93%, especificidad del 40%, VPP del 90%, VPN del 50%, razón de verosimilitud positiva de 1,55 y razón de verosimilitud negativa de 0,175. Conclusión: El puntaje (score) RIPASA ha demostrado una excelente sensibilidad y especificidad para el diagnóstico clínico de AA de manera rápida, simple y no invasiva.

Background: Acute appendicitis (AA) is the most common surgical emergency worldwide. Its correct and early diagnosis is essential to avoid unnecessary surgeries and complications associated with its natural history. Objective: The aim of this study was to determine the diagnostic sensitivity and specificity of the RIPASA score in patients with suspected AA. Material and methods: This analytical, cross-sectional, observational and retrospective study included appendectomy specimens of patients of both sexes > 18 years operated on with clinical diagnosis of AA between January 1 and December 31, 2017. The histopathological examination of the appendectomy specimens was considered the gold standard diagnostic test. A score of 7.5 for the RIPASA score was chosen as cut-off value. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Results: A total of 68 appendectomies were included; 57 (83.82%) specimens were positive for acute appendicitis. Mean age was 43.32 years. The histological diagnosis of AA was present in 32 (84.21%) men and in 25 (83.33%) women. For the RIPASA score, 54 patients had a true positive result (cut-off point ≥ 7.5 and positive histology for AA) with a sensitivity of 93%, specificity of 40%, PPV of 90%, NPV of 50%, positive likelihood ratio of 1.55 and negative likelihood ratio of 0.175. Conclusion: The RIPASA score has demonstrated excellent sensitivity and specificity for the clinical diagnosis of AA in a fast, simple and non-invasive fashion.

La aplicación del Score de Alvarado en la sospecha de la apendicitis aguda. Estudio prospectivo y protocolizado / APPLICATION OF A CLINICAL SCORE SYSTEM ( ALVARADO´S SCORE ) FOR THE DIAGNOSIS OF ACUTE APPENDICITIS

Antecedentes: La apendicitis aguda no sospechada y diagnosticada puede evolucionar hacia la perforación o por el contrario conduce a la remoción de un apéndice normal. Objetivo: La utilización de un sistema de Score, desde un punto de vista clínico, para el diagnóstico de esta patología y lograr disminuir las apendicetomías negativas. Lugar de Aplicación: Hospital Nacional de Clínicas. Córdoba. (Argentina) Diseño: Estudio prospectivo y protocolizado. Material y Métodos: Comprende a 1119 pacientes estudiados entre agosto del 2000 y diciembre del 2015. De ellos, 588 eran del sexo masculino y 531 del femenino, con una edad promedio de 25,3 años de edad. A todos los pacientes se les realizo al ingreso el Score de Alvarado. En base a la clínica y a una segunda valoración con el Score se decidió la exploración quirúrgica en 1061 pacientes (94,8 %). De los 58 restantes (5,18 %), fueron excluidos por otra patología. El diagnóstico de apendicitis aguda fue confirmado por los hallazgos quirúrgicos y la anatomía patológica. Resultados: En los hallazgos operatorios se encontró en 962 pacientes (90,6%) que tenían una apendicitis aguda. No hubo mortalidad postoperatoria. En relación a la morbilidad hubo un 2,2% de complicaciones médicas y un 16,3% de las quirúrgicas. El informe anatomopatológico mostró en 99 pacientes un apéndice cecal normal. Por lo tanto la incidencia de las apendicetomías negativas fue del 9,3 %. Conclusiones: La utilización del Score en relación a los hallazgos quirúrgicos y anatomopatológicos confirma que fue sensible a partir de 6 puntos para el diagnóstico de apendicitis aguda.

Background: Acute appendicitis neither suspected nor diagnosed could develop a perforation or otherwise it would take to removing of a normal appendix. Objectives: Utilization of a clinical score system for aided diagnosis of this pathology and can reduce a negative appendicitis. Setting: National Clinicas Hospital. Córdoba. Argentina. Design: Prospective and protocoled study. Methods: 1119 patients were studied between August 2000 and December 2015. 588 males and 531 females their age average was 25.3 years. Alvarado score was realized in all patients when they entered. According clinic and second valuation with the score surgical exploration was decided in 1061 (94,8 %) patients. The remaining 58 (5,18 %) were excluded due to other pathology. The diagnosis in acute appendicitis was confirmed by surgical finding and histopathology studies. Results: In surgical finding we showed 962 patients (90,6%) had acute appendicitis. There was no operative mortality. Respects morbidity there was 2,2 % of medical and 16,3 % of surgical complications. The anatomo pathology report showed a normal cecal appendix in 99. Whereas the incidence of negative appendicectomy was about 9,3 %. Conclusions: The utilization of score related to the surgical and anatomo pathology finding confirmed it was appreciable from 6 points to acute appendicitis diagnosis.

Intra-Appendiceal Air at CT: Is It a Useful or a Confusing Sign for the Diagnosis of Acute Appendicitis?

OBJECTIVE: To investigate the significance of intra-appendiceal air at CT for the evaluation of appendicitis. MATERIALS AND METHODS: We retrospectively analyzed 458 patients (216 men, 242 women; age range, 18-91 years) who underwent CT for suspected appendicitis. Two independent readers reviewed the CT. Prevalence, amount, and appearance of intra-appendiceal air were assessed and compared between the patients with and without appendicitis. Performance of CT diagnosis was evaluated in two reading strategies: once ignoring appendiceal air (strategy 1), and the other time considering presence of appendiceal air as indicative of no appendicitis in otherwise indeterminate cases (strategy 2), using receiver operating characteristic (ROC) analysis. RESULTS: Of the 458 patients, 102 had confirmed appendicitis. The prevalence of intra-appendiceal air was significantly different between patients with (13.2%) and without (79.8%) appendicitis (p < 0.001). The amount of appendiceal air was significantly lesser in patients having appendicitis as compared with the normal group, for both reader 1 (p = 0.011) and reader 2 (p = 0.002). Stool-like appearance and air-fluid levels were more common in the appendicitis group than in the normal appendix for both readers (p < 0.05). Areas under the ROC curves were not significantly different between strategies 1 and 2 in reader 1 (0.971 vs. 0.985, respectively; p = 0.056), but showed a small difference in reader 2 (0.969 vs. 0.986, respectively; p = 0.042). CONCLUSION: Although significant differences were seen in the prevalence, amount, and appearance of intra-appendiceal air between patients with and without appendicitis, it has a limited incremental value for the diagnosis of acute appendicitis.

Apendicitis aguda. Estudio comparativo entre puerto único, laparoscopia convencional versus laparotomía / Acute appendicitis. Comparative study of single port, conventional laparoscopic versus laparotomy

Objetivo:Comparar las tres técnicas de abordaje para la apendicectomía: puerto único (APU), laparoscopia convencional (ALC) y laparotomía (AL) en pacientes con diagnóstico de apendicitis aguda. Métodos: se realizó AL por incisión de McBurney, ALC por tres puertos y APU. Para las cirugías por APU y ALC se utilizó pinza de LigaSure AtlasTM 37cms Hand de 10mm (Covidien®) para ligar el mesoapéndice, sutura crómico catgut® 0 o endoloop®para ligar la base de la apéndice, en abierta o laparoscopica, respectivamente. Para la APU se utilizó el SILS Port™ (Covidien®). Se realizó un estudio comparativo, prospectivo, monocéntrico, entre abril 2014 y octubre 2014, en pacientes con diagnóstico de apendicitis aguda en el Hospital General del Este "Dr. Domingo Luciani"y que cumplieron los criterios de inclusión. Resultados: Se realizaron 58 apendicectomías, 20 AL, 20 ALC y 18 APU. El tiempo quirúrgico y la estancia hospitalaria fueron menores en las ALC con promedio de 47 minutos y 33,6 horas, respectivamente. La incidencia de complicaciones intraoperatorias y postoperatorias fueron mayores el las AL estableciéndose una relación estadística-mente significativa entre la técnica quirúrgica y la infección del sitio operatorio (p < 0,05). La técnica quirúrgica influye en la manifestación de dolor en las primeras 08 horas de postoperatorio (p < 0,05). Conclusión: La decisión del abordaje quirúrgico será determinado por la experiencia del cirujano y la disponibilidad del instrumental quirúrgico, sin embargo, la evidencia actual sugiere que la ALC debe ser considerada como primera elección(AU)

Objective: To compare the three techniques approach appendectomy: single port (SPA), conventional laparoscopy (CLA) and laparotomy (LA) in patients with acute appendicitis. Methods: LA was performed by McBurney incision, CLA was performed with three ports and SPA. LigaSure clamp 10mm Hand AtlasTM 37cms (Covidien®) was used to cut the mesoappendix, chromic suture catgut® 0 or endoloop® to ensure the base of the appendix, in open or laparoscopic, respectively. The SILS™ Port (Covidien®) was used for the SPA. A comparative, prospective, single-center study was conducted between April 2014 and October 2014, in patients with a diagnosis of acute appendicitis in East General Hospital "Dr.Domingo Luciani" and who met the inclusion criteria. Results: 58 appendectomies, 20 LA, 20 CLA and 18 SPA were performed. The operative time and hospital stay were lower in the CLA average of 47 minutes and 33.6 hours, respectively. The incidence of intraoperative and postoperative complications were higher on the LA establishing a statistically significant relationship between surgical technique and surgical site infection (p <0.05). The surgical technique influences the manifestation of pain in the first 08 hours postoperatively (p <0.05). Conclusion: The decision of surgical approach will be determined by the surgeon's experience and availability of surgical instruments, however, current evidence suggests that CLA should be considered as first choice(AU)

Correlación de ecografía y anatomía patológica en apendicitis aguda / Correlation of ultrasound and pathological anatomy in acute appendicitis

INTRODUCCIÓN: Se define al término “Abdomen Agudo” como al dolor abdominal de aparición repentina e intensidad severa que requiere una medida terapéutica inmediata. Debe ser considerado una emergencia médica. El cuadro clínico de apendicitis aguda presenta las características antes mencionadas, por lo que el diagnóstico certero y precoz es de importancia relevante. No siempre puede realizarse a un diagnóstico fiable y preciso con la anamnesis, el examen físico y los resultados de laboratorio de análisis, por lo que el diagnóstico imagenológico juega un rol importante para decidir la conducta a seguir. La ecografía es un examen dinámico, en tiempo real, de bajo costo y repetible debido a que no presenta los efectos adversos de la radiación. Diferentes estudios demostraron que la tasa de apendicectomías negativas disminuyó a aproximadamente el 10% con el uso rutinario de la ecografía. OBJETIVO: Correlacionar los resultados ecográficos con el diagnóstico anatomopatológico de pacientes operados con diagnóstico de apendicitis. Determinar si es un método complementario confiable para establecer diagnóstico y determinar conducta. Evaluar la tasa de apendicectomías negativas. MATERIAL Y MÉTODOS: Éste estudio de cohorte retrospectivo relacionó la ecografía y los resultados de anatomía patológica de 219 pacientes con diagnóstico de apendicitis intervenidos quirúrgicamente, entre el 1º de enero y 30 de Junio de 2014. RESULTADOS: Se realizaron ecografía abdominal a la totalidad de los pacientes operados con diagnóstico de apendicitis. De éstas, el 60,3% fueron informadas positivas para dicho diagnóstico. Todos los apéndices resecados fueron enviados a anatomía patológica, confirmándose el diagnóstico de apendicitis en el 87,7% de las piezas. Ciento cincuenta casos fueron positivos en ecografía y anatomía patológica, lo que representa el 68,49%. Once casos fueron negativos en ecografía y anatomía patológica, lo que representa el 5,02%...

INTRODUCTION: It defines the term “acute abdomen” as the sudden onset abdominal pain and severe intensity that requires immediate therapeutic measure. Should be considered medical emergency. The clinical picture of acute appendicitis presents the above characteristics, so the accurate and early diagnosis is of significant importance. You cannot always be a reliable and accurate diagnosis with history, physical examination and laboratory results of analysis, so the diagnostic imaging plays an important role in deciding what action to take. Ultrasound testis a dynamic, real-time, low-cost, repeatable because no adverse effects of radiation. Different studies showed that negative appendectomy rate decreased to approximately 10%with routine use of ultrasound. OBJECTIVE: To correlate the sonosoon graphic findings with pathologic diagnosis of patients operated with a diagnosis of appendicitis. Determine if it is a complementary method to establish reliable diagnosis and determine be havior. Assessing the negative appendectomy rate. METHODS: This retrospective cohort study linked the ultrasound and pathology results of 219 patients diagnosed with appendicitis surgery between January 1 and June 30, 2014. RESULTS: Abdominal ultra sound to all operated patients diagnosed with appendicitis were performed. Of these, 60.3% were reported positive for the diagnosis. All resected appendices were sent to pathology, confirming the diagnosis of appendicitis in 87.7% of the parts. One hundred and fifty cases were positive in ultra sound and pathology, representing 68.49%. Eleven cases were negative on ultra sound and pathology, representing 5.02%...

Correlation between the Alvarado Scale and the macroscopic aspect of the appendix in patients with appendicitis / Correlação entre a Escala de Alvarado e o aspecto macroscópico do apêndice em pacientes com apendicite

Objective: To evaluate the possible association between the scale of Alvarado (EA) and macroscopic appearance (MA) of the appendix in patients with acute appendicitis. Methods: after receiving the diagnosis of acute appendicitis, EA data were collected. During appendectomy, MA data were collected. Data from patients without appendicitis were excluded. The Spearman correlation test was used to compare EA with Appendix MA (p < 0.05). Other variables were represented by simple frequency. The confidence interval (CI) of 95% was calculated for the correlation test. Results: Data were collected from 67 consecutive patients. The mean age was 37.1 ± 12.5 years and 77.6% of patients were male. The Spearman correlation test used for EA and MA was + 0.77 (95% CI 0.65-0.85, p < 0.0001). Conclusion: although correlation was not perfect, our data indicate that a high score on the scale of Alvarado in patients with appendicitis is correlated with advanced stages of the inflammatory process of acute appendicitis. .

Objetivo: avaliar a possível associação entre a escala de Alvarado (EA) e o aspecto macroscópico (AM) do apêndice em pacientes com apendicite aguda. Métodos: depois de receberem o diagnóstico de apendicite aguda, os dados da EA foram coletados. Durante a apendicectomia, os dados do AM foram coletados. Dados de pacientes sem apendicite foram excluídos. O teste de correlação de Spearman foi utilizado para comparar EA e o AM do apêndice (P<0,05). Outras variáveis foram representadas por frequência simples. O intervalo de confiança (IC) de 95% foi calculado para o teste de correlação. Resultados: os dados foram coletados de 67 pacientes consecutivos. A média da idade foi 37,1 ± 12,5 anos e 77,6% dos pacientes foram masculinos. O teste de correlação de Spearman usado para EA e AM foi + 0,77 (IC 95% 0,65 a 0,85, P<0,0001). Conclusão: apesar de a correlação não ser perfeita, nossos dados indicam que uma pontuação elevada da escala de Alvarado em pacientes com apendicite está correlacionada com estágios avançados do processo inflamatório da apendicite aguda. .

Situs inversus totalis / Situs inversus totalis

Situs inversus totalis (SIT) es una enfermedad rara, en la cual existe transposición de los órganos torácicos y abdominales. Se presenta el caso de una paciente de 65 años de edad, que acude a emergencias por dolor epigástrico de 20 horas de evolución que luego de unas horas migra a fosa iliaca izquierda asociado a hiporexia. En primera instancia, se sospecha del diagnóstico de diverticulitis, luego de los exámenes imagenológicos respectivos es descartada por encontrarse hallazgos correspondientes con situs inversus totalis y se plantea apendicitis del lado izquierdo. Por tal motivo, la realización de una adecuada historia clínica y examen físico apoyado en pruebas imagenológicas resultan importantes para tener en cuenta a la apendicitis como parte del diagnóstico diferencial, con el fin de evitar errores en su diagnóstico per se y tratamiento...

Situs inversus totalis (SIT) is a rare disease in which there is transposition of thoracic and abdominal organs. The symptoms of appendicitis in SIT are often confused with other intraperitoneal processes such as diverticulitis. We report the case of a 65-year-old, attended by emergency epigastric pain of 20 hours of the onset after a few hours left iliac fosse migrates associated with hyporexia. Diverticulitis is diagnosed in the first instance, and after the respective imaging tests is discarded for being relevant findings with situs inversus totalis and left poses appendicitis. Therefore, the realization of an adequate medical history and physical examination supported by imaging tests are important to keep in mind, appendicitis as part of the differential diagnosis, in order to avoid errors in diagnosis and treatment...

Apendicectomía laparoscópica versus abierta en adulto con apendicitis complicada en el Hospital Central de la Policía Nacional del Perú Luis N. Sáenz, 2004-2006 / Laparoscopic appendectomy versus open in adult with complicated appendicitis at the Central Hospital of the National Police of Peru Luis N. Saenz, 2004-2006

Objetivo: Determinar qué técnica quirúrgica laparoscópica o convencional tiene mayores ventajas en pacientes adultos con Apendicitis complicada, en el Hospital Central de La P.N.P. "Luis N. Sáenz" durante el período de enero de 2004 a diciembre 2006. Material y Método: Estudio retrospectivo, comparativo de serie de casos. La muestra está constituida por 216 historias clínicas de pacientes operados de apendicitis aguda complicada, tanto por técnica laparoscópica como por técnica abierta. Las variables estudiadas fueron edad, sexo, grupo etáreo, tiempo operatorio, tipo de cirugía, hallazgo intraoperatorio, tiempo de hospitalización, complicaciones. Resultados: 216 pacientes cumplieron los criterios de inclusión. La edad promedio fue de 40.13 años con una desviación estándar de 17.43 años (rango 15-80), en el grupo laparoscópico los pacientes operados eran pacientes más jóvenes en comparación al grupo convencional, 138 pacientes (63.9 por ciento) fueron de sexo masculino, los hombres fueron sometidos en mayor porcentaje al abordaje laparoscópico. Sin embargo, la proporción de mujeres y hombres en cada tipo de cirugía es semejante (p=0.555). 184 (85.2 por ciento) apendicectomías operadas fueron por vía laparoscópica y 32 (14.8 por ciento) fueron por vía convencional, el tiempo operatorio fue más prolongado en la apendicectomía laparoscópica (117.72 minutos vs. 108.75) sin diferencia significativa (p: 0.272). El tiempo de hospitalización promedio fue de 4.82 (rango de 3 a 15) días para la cirugía laparoscópica y de 7.89 días (rango de 3 a 20) en pacientes con apendicectomía convencional. El Hallazgo intraoperatorio más frecuente fue el de apendicitis gangrenada (55.48 por ciento del total de cirugías laparoscópicas y 56.3 por ciento del total de cirugías abiertas) y apendicitis perforada (41.3 por ciento del total de cirugías laparoscópicas y 43.8 por ciento del total de cirugías convencionales, 110 (59.2 por ciento) pacientes operados por apendicectomías...

Objective: Determining which operative techniques the laparoscopic appendectomy or conventional appendectomy has more adventage in patients with complicated Appendicitis, in the Central Hospital of The P.N.P. "Luis N. Saenz in the course of January 2004 to December 2006. Material and Method: Retrospective study, comparative follow-up of cases. The sample is composed of 216 case histories of patients managed of complicated acute appendicitis, as much for laparoscopic technique like for open technique. The studied variables were age, sex, age group, operative time, type of surgery, intraoperative finding, time of hospitalization, complications. Results: 216 patients kept the criteria of inclusion. The mean age was 40.13 years with a standard deviation of 17.43 years (status 15-80), in the laparoscopic group the operated patients the younger patients were comparatively the conventional group, 138 patients (63.9 per cent) went from male sex, men were subdued in bigger percentage to the laparoscopic boarding. However, the proportion of women and men in each type of surgery is similar (p=0.555). 184 operated (85.2 per cent) appendectomies were for laparoscopic route and 32 (14.8 per cent) took conventional route, operative time was more prolonged in the laparoscopic appendectomy (117.72 minutes vs. 108.75); not existing he tells significant (p: 0.272). Time of average hospitalization was of 4.82 (status from 3 to 15) days for the laparoscopic surgery and of 7.89 days (status from 3 to 20) in which they had sincere surgery. The intraoperative Finding more frequently found was the one of gangrenous appendicitis (55.48 per cent of the total of laparoscopic surgeries and 56.3 per cent of the total of sincere surgeries) and appendicitis perforated (41.3 per cent of the total of surgeries laparoscopic and 43.8 per cent of the total of open surgeries), 110 (59.2 per cent) patients managed by laparoscopic appendectomy had complications. 68.5 per cent of patients had...

Application of high frequency bipolar electrocoagulation LigaSureTM in appendix vermiformis of rabbits with or without acute inflammatory process / Aplicação do eletrocoagulador bipolar de alta frequência LigaSureTM no apêndice vermiforme na vigência ou não de processo inflamatório agudo

PURPOSE: To evaluate the efficacy of the use of LigaSureTM in appendectomy, with or without acute inflammatory process, and to compare with simple ligature and conventional therapy. METHODS: A total of 30 rabbits (Oryctolagus cuniculus) randomly allocated in two groups, group A and B, of 15 animals each were used. The group A without acute appendicitis and the group B with acute appendicitis were submitted to appendectomy. After, the groups were subdivided into three groups, each group containing five rabbits submitted to simple ligature, conventional therapy and application of LigaSureTM. We assessed macroscopic and microscopy parameters of appendiceal stump and operative wound. RESULTS: The group with acute appendicitis that LigaSureTM was applied had fibrosis in 100% of animals, as well as in the other operative techniques used. It suggested that application of LigaSureTM is efficient as other techniques used in healing of appendiceal stump. CONCLUSIONS: The application of LigaSureTM induces the formation of fibrosis in the appendiceal stump. The technique proved efficacy to induce enough fibrous tissue to obstruct leakage of enteric content.

OBJETIVO: Avaliar a eficácia da utilização do LigaSureTM na apendicectomia, com ou sem a presença de processo inflamatório agudo, comparando com ligadura simples ou técnica tradicional. MÉTODOS: Um total de 30 coelhos (Oryctolagus cuniculus) foi alocado em dois grupos, grupos A e B, cada um composto por 15 animais. O grupo A não apresentava apendicite aguda e o grupo B com apendicite aguda, sendo os animais submetidos à apendicitectomia. Cada grupo foi divido em três subgrupos, cada um com cinco animais onde foram então submetidos à ligadura simples, técnica tradicional ou utilização do LigaSureTM. Foram avaliados parâmetros macroscópicos assim como microscópicos do coto apendicular assim como da ferida operatória. RESULTADOS: No grupo que apresentava apendicite aguda onde foi utilizado o LigaSureTM, foi observado fibrose em 100% dos animais, assim como nos outros dois grupos. Com isto mostrou-se que a aplicação do LigaSureTM é tão eficiente quanto as outras técnicas utilizadas na cicatrizaçãoo do coto apendicular. CONCLUSÕES: A utilização do LigaSureTM induz a formação de fibrose na região do coto apencicular. A técnica foi eficaz quanto à formação de tecido fibrótico evitando o extravassamento de conteúdo entérico.

Apendicitis del muñón apendicular / Appendicitis of the appendicular stump

La apendicitis del muñón es una entidad rara, caracterizada por un proceso inflamatorio del remanente apendicular luego de una apendicectomía incompleta. Los signos y síntomas no difieren de una apendicitis aguda. Al no ser una patología usualmente pensada como posible diagnóstico diferencial del abdomen agudo inflamatorio, tiene mayor riesgo de complicaciones y morbi-mortalidad. Los métodos seccionales de diagnósticos por imágenes resultan muy beneficiosos para definir el diagnóstico. La ultrasonografía (US) y tomografía computada (TC)demuestran signos similares a los observados en cuadros habituales de inflamación aguda del apéndice cecal. Se presentan dos casos de apendicitis del muñón, uno de ellos recibió tratamiento quirúrgico y el otro tratamiento médico...

Tuba ovarian abscesses formation from decidualized ovarian endometrioma after appendiceal endometriosis presenting as acute appendicitis in pregnancy

Acute appendicitis with appendicial endometriosis is a very infrequently encountered condition during pregnancy. Decidualization is the hypertrophy of endometrial stromal cells by the effect of progesterone. Similarly, in pregnancy, ectopic stromal endometrial cells in endometriosis can also be transformed by the same mechanism and ectopic decidua [deciduosis] may occur. Here we report a 30 year old pregnant woman presenting twice with acute abdominal symptoms requiring surgery for appendicial and ovarian endometriosis and deciduosis. We emphasize that deciudualized endometriosis may first present during pregnancy with acute abdomen necessitating emergency laparotomy and complicating the course of gestation. To our knowledge only 9 cases in which decidualized endometriotic tissue causing acute abdomen necessitating surgery during pregnancy were reported in the literature. What makes our case special is that the patient needed two laparotomies during the pregnancy period which was a very stressful situation for both the patient and the physicians

Diagnostic value of C-reactive protein in suspected acute appendicitis - A prospective case control study.

Aim: To find out the Sensitivity, Specificity and Predictive value of C-reactive protein in the diagnosis of acute appendicitis. Materials and Methods: Hundred patients undergoing emergency appendicectomy were cases and thirty patients undergoing interval appendicectomy during the same period were controls. Creactive protein was measured pre-operatively. Results: CRP was reactive in 89% of cases and 3 of 30 controls (P = 0). Among the thirteen complicated cases, two had a CRP reactivity of 1.2 mg/dl, eight had 2.4 mg/dl and three had 3.6 mg/dl. In the uncomplicated cases, forty nine were reactive at 1.2 mg/dl, twenty six at 2.4 mg/dl and one at 3.6 mg/dl ( P = 0.0009). In histopathologically inflamed appendix, reactivity was 94.4% and in normal appendix reactivity was 40% ( P = 0.00007). CRP positivity had a sensitivity of 94.4% (CI 89.9-98.9) and a positive predictive value of 95.5% (CI 91.4-99.6). CRP reactivity and leucocytosis if combined, the sensitivity, specificity, PPV and NPV were 85%, 100%, 100% and 81% respectively. Threshold for CRP reactivity if raised to 2.4 mg/dl, the sensitivity, specificity, PPV and NPV are 42%, 100%, 100% and 16% respectively. Conclusion: CRP estimation is a good 'rule-in' test and not-so-good 'rule-out' test to diagnose acute appendicitis.

Duplicación del apéndice vermiforme / Double appendix: case report

We report a 37 years old male presenting with an acute appendicitis. The patient was operated, excising a gangrenous and perforated appendix. During closure a second appendix that was not inflamed, located three cm apart from the first one, was observed. It was also excised and the pathologic report confirmed that both surgical pieces corresponded to appendices, one inflamed and the other normal.

Presentamos el caso de un paciente de 37 años de edad, con clínica de apendicitis aguda que tras apendicetomía se pesquisó duplicación del apéndice vermiforme. La histología reveló inflamación aguda de uno de ellos. Esta rara anomalía ha sido descrita en menos de 100 casos. Se requiere un conocimiento de este infrecuente cuadro quirúrgico para un reconocimiento oportuno, ya que un error puede significar graves consecuencias clínicas para el paciente y médico legales para el cirujano.

Electrocoagulación monopolar del meso apendicular en apendicectomía laparoscópica: experiencia en el Hospital Central de Maracay / Monopolar electrocoagulation of the meso appendix in laparoscopic appendectomy: experience in the Hospital Central of Maracay

Evaluar la electrocoagulación monopolar del meso apendicular como una herramienta útil en apendicectomía laparoscópica en pacientes con apendicitis aguda, ingresados al servicio de Cirugía General del Hospitla Central de maracay. Diseño no experimental de corte transversal, donde la población estuvo conformada por los pacientes que acudieron a la emergencia del Hospital Central de Maracay durante el período enero-julio de 2010. Para la recolección de datos se utilizó: libro de registro, historia clínica y encuesta postoperatoria. Se analizaron por estadística descriptiva, donde se obtuvo que el tiempo quirúrgico promedio fue de 60 minutos, no se presentaron complicaciones tardias, el tiempo de hospitalización fue 2 días y los pacientes se incorporaron a sus actividades físicas en 10 días. La electrocoagulación monopolar del meso apendicular es una herramienta útil en pacientes con apendicitis aguda, ya que abarata costos, y es segura.

Assess the monopolar electrocoagulatión of the meso appendix as a useful tool in laparoscopic appendectomy in patients with acute appendicitis, admitted at service of General Surgery of the Hospital Central de Maracay. This is a non-experimental design of cross section, where the population was formed by patients attending the Hospital Central de Maracay emergency during the period between January and July 2010. Usted for data collection: clinic record and postoperative surgery. They were analyted by descriptive statistics, founding that average surgical time was 60 minutes, there were not late complications, hospitalization time was 2 days, and patients were incorporated into their physical activities in 10 days. Monopolar electrocoagulation of the meso appendicular is a useful tool in patients with acute appendicitis, as it cheaper cost, and is safe.

Small cell carcinoma metastatic to the appendix, with acute suppurative appendicitis

Malignancy of the appendix is uncommon. A small subset of these lesions is actually metastatic cancers. Metastasis to the appendix is very rare and infrequently symptomatic. Metastatic lesions can cause obstruction,

Endometriosis: a rare cause of appendicitis

Endometriosis is a relatively common disorder affecting about 15% females in the reproductive age group. It is a well-known cause of infertility but endometriosis presenting as appendicitis is rare. We present a case of a 29 years old nulliparous lady in whom appendectomy was done for appendicitis and histopathological examination of the retrieved specimen revealed endometriosis

Linfoadenitis criptococócica mesentérica: Una rara causa de abdomen agudo. Caso clínico / Mesenteric cryptococcal lymphadenitis: Report of one case

Cryptococcosis is an invasive mycotic infection caused by Cryptococcus neoformans, an encapsulated, yeast-like fungus. It is considered an opportunist infection, since it mainly affects immunocompromised subjects. However there are isolated reports of the infection in immunocompetent subjects. Cryptococcal infection of intra-abdominal organs or tissues is extremely rare. We report a 21-year-old HIV positive male that, during the treatment of a meningeal cryptococcosis, presented a clinical picture of an acute abdomen suggesting acute appendicitis. The patient was operated, finding enlarged mesenteric lymph nodes forming conglomerates and a macroscopically normal appendix. The conglomerated lymph nodes and the appendix were excised. The pathological study of the surgical piece revealed an intra abdominal cryptococcal lymphadenitis and a normal appendix.

Protocolos de atención de enfermedades quirúrgicas más frecuentes en adultos / Care protocols most common surgical diseases in adults

El Gobierno de Reconciliación y Unidad Nacional a través del Ministerio de Salud, presente el siguiente documento Protocolos de atención de enfermedades quirúrgicas más frecuentes en adultos, que es una recopilación de los servicios de los Hospitales Alemán Nicaraguense y Antonio Lenin Fonseca quienes iniciaron revisión, actualización y elaboración de guías clínicas de las principales patologías atendidas en los servicios. Este trabajo se base en la búsqueda de la unificación de criterios y la mejor utilización de recursos en función de brindar un servicio eficaz y de calidad para nuestros usuarios y usuarias...