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1.
Rev. Assoc. Med. Bras. (1992) ; 68(2): 121-124, Feb. 2022.
Article in English | LILACS | ID: biblio-1365342
2.
Rev. colomb. cir ; 37(2): 298-304, 20220316. fig, tab
Article in Spanish | LILACS | ID: biblio-1362976

ABSTRACT

Las neoplasias apendiculares se presentan hasta en el 50 % de los casos como un episodio de apendicitis aguda. Existen características demográficas, clínicas y radiológicas que aumentan las posibilidades de un tumor apendicular subyacente, sin embargo, en la mayoría de los casos, son los hallazgos intraoperatorios los que alertan al cirujano. A pesar de que el tipo histológico determina la radicalidad del manejo quirúrgico de estos pacientes, algunas características macroscópicas pueden orientar a las patologías específicas y a una conducta adecuada. En general, los objetivos del manejo quirúrgico inicial se cumplen con una resección limitada al apéndice cecal, asociada a la citología de mucina y biopsia de los implantes peritoneales si están presentes, reservando las resecciones extendidas, como hemicolectomía derecha oncológica, para los pacientes con compromiso extenso de la base o del mesenterio apendicular ante la sospecha de neoplasias neuroendocrinas o adenocarcinoma del apéndice cecal.


Appendicular neoplasms present in up to 50% of cases as an episode of acute appendicitis. There are demographic, clinical and radiological characteristics that increase the chances of an underlying appendicular tumor; however, in most cases are the intraoperative findings that alert the surgeon. Although the histological type determines the radical nature of the surgical management of these patients, some macroscopic characteristics can guide specific pathologies and appropriate behavior. In general, the objectives of initial surgical management are met with a limited resection of the cecal appendix, associated with mucin cytology and biopsy of peritoneal implants if present, reserving extended resections such as oncological right hemicolectomy for patients with extensive compromise of the base or appendicular mesentery when neuroendocrine neoplasms or adenocarcinoma of the cecal appendix are suspected.


Subject(s)
Humans , Appendectomy , Appendiceal Neoplasms , Incidental Findings , Appendicitis , Adenocarcinoma, Mucinous
3.
Rev. Col. Bras. Cir ; 49: e20222446, 2022. tab, graf
Article in English | LILACS | ID: biblio-1365393

ABSTRACT

ABSTRACT Introduction: Laparoscopic appendectomy does not have a single protocol on its technical systematization, access routes, and use of energy and staplers. The cost of disposable materials can prevent its widespread use. Alternatives to decrease cost can help disseminate the laparoscopic access to appendectomy. Objective: to introduce a low-cost laparoscopic appendectomy method with good aesthetic results through the location of incisions; to show its viability through its application in 1,552 cases of laparoscopic appendectomy operated between 2000 and 2019 with three portals and very low-cost regarding materials used. Methods: we applied three punctures - an umbilical one for the camera (5 or 10mm in diameter), a 10mm puncture in the right iliac fossa, and one 5mm puncture in the left iliac fossa. The materials used were permanent use trocars, grasping forceps, hook, scissors, and needle holder, without the need for any disposable device. Results: 1.552 patients were operated between 2000 and 2019, 56.2% being female, mean age 32.66 years (9-93), average hospital stay of 1.74 days (1-10), and median of 1.2 days. Conclusion: the technique we describe uses three metallic trocars and four permanent instruments, in addition to a single cotton suture. It is, therefore, a very low-cost laparoscopic procedure. Its application has shown good results and low morbidity, which may become the preferred indication for laparoscopic surgery in the treatment of acute appendicitis.


RESUMO Introdução: a apendicectomia videolaparoscópica não tem protocolo único sobre sistematização técnica, vias de acesso, uso de energia e grampeadores. O custo de materiais descartáveis pode inviabilizar o emprego mais generalizado. Alternativas para diminuir o custo podem ajudar a disseminar o acesso laparoscópico para a realização de apendicectomia. Objetivo: introduzir um método para realizar a apendicectomia videolaparoscópica de baixo custo e visando bom resultado estético por meio da localização das incisões; mostrar a viabilidade por meio de aplicação em 1.552 casos de apendicectomia videolaparoscópica operados entre 2000 e 2019 com três portais, de muito baixo custo em insumos utilizados. Métodos: três punções - uma punção umbilical para introdução da câmera (de 5 ou 10mm de diâmetro), uma punção de 10mm em fossa ilíaca direita e uma punção em fossa ilíaca esquerda de 5mm. Os materiais utilizados - trocartes, pinças de apreensão, gancho, tesoura e porta-agulhas são de uso permanente, sem necessidade de qualquer material descartável. Resultados: foram operados 1.552 pacientes entre 2000 e 2019, sendo 56,25% do sexo feminino, média de idade de 32,66 anos (9 a 93 anos), tempo médio de internação de 1,74 dias (1 a 10 dias) e mediana de 1,2 dias. Conclusão: a técnica que descrevemos utiliza três trocartes metálicos e quatro instrumentos permanentes, além de um único fio de algodão. Trata-se, portanto, de procedimento laparoscópico de muito baixo custo. A aplicação demonstrou bons resultados e baixa morbidade, podendo tornar-se rotina a indicação preferencial da vídeocirurgia no tratamento da apendicite aguda.


Subject(s)
Humans , Male , Female , Adult , Appendicitis/surgery , Laparoscopy/methods , Appendectomy/methods , Umbilicus , Length of Stay
4.
Rev. colomb. cir ; 37(1): 122-128, 20211217. fig
Article in Spanish | LILACS | ID: biblio-1357596

ABSTRACT

Introducción. La hernia de Garengeot se caracteriza por contener el apéndice cecal dentro del saco femoral, y forma parte de una variedad de hernias que reciben el epónimo de acuerdo con su localización anatómica. Entre ellas se encuentra la hernia de Richter, la hernia de Amyand, la hernia de Littré y la hernia de Spiegel. Se presenta una revisión de los abordajes laparoscópicos para estas diversas variantes. Caso clínico. Paciente femenina de 82 años de edad quien consultó al servicio de urgencias por dolor inguinal derecho de ocho días de evolución, asociado a clínica de obstrucción intestinal. Se hizo diagnóstico de hernia inguinal encarcelada y se llevó a cirugía encontrando una hernia de Garengeot. Discusión. Además de los tipos de hernia tradicionalmente conocidos, existen variantes inusuales de hernias de la pared abdominal, que deben ser sospechadas y tenidas en cuenta como diagnóstico diferencial, lo que permitirá realizar su tratamiento de forma oportuna disminuyendo el riesgo de que ocurra una perforación intestinal. Conclusiones. Las variantes de hernia inguinal o de localización inusual, son susceptibles de tratamiento quirúrgico mediante abordajes laparoscópicos con adecuados resultados.


Introduction. Garengeot's hernia is characterized by containing the cecal appendix within the femoral sac, and is part of a variety of hernias that receive their eponymous according to their anatomical location. These include Richter's hernia, Amyand's hernia, Littré's hernia, and Spiegel's hernia. We present a review of the laparoscopic approaches for these variants. Clinical case. An 82-year-old female patient consulted to the emergency department for right groin pain of eight days of evolution, associated with symptoms of intestinal obstruction. With a diagnosis of incarcerated inguinal hernia, she underwent surgery finding a Garengeot ́s hernia. Discussion. In addition to the traditionally known types of hernia, there are unusual variants of hernias of the abdominal wall, which must be suspected and taken into account as a differential diagnosis, which will allow treatment to be carried out in a timely manner, reducing the risk of intestinal perforation. Conclusions. Variants of inguinal hernia or unusual location are susceptible to surgical treatment by laparoscopic approaches with adequate results.


Subject(s)
Humans , Hernia , Appendicitis , Laparoscopy , Intestinal Obstruction
5.
Rev. colomb. cir ; 37(1): 139-141, 20211217. fig
Article in Spanish | LILACS | ID: biblio-1357600

ABSTRACT

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%.


Subject(s)
Humans , Appendicitis , Foreign Bodies , Laparoscopy , Abdomen, Acute , Intestinal Perforation
6.
Arch. argent. pediatr ; 119(4): 224-229, agosto 2021. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1280889

ABSTRACT

Introducción. La apendicitis constituye la principal causa de abdomen agudo quirúrgico en pediatría. Durante la pandemia por COVID-19, se replantearon las estrategias de manejo ydisminuyeron las consultas en las guardias, lo que podría asociarse a diagnósticos tardíos y complicaciones. El objetivo de este estudio fue analizar el impacto de la pandemia en los niños con apendicitis aguda. Métodos. Estudio analítico retrospectivocomparativo de pacientes pediátricos conapendicitis aguda durante los cinco meses del confinamiento por COVID-19 versus los meses equivalentes del año previo. Se analizaron la incidencia, la clínica, el estadio, el abordajequirúrgico y las complicaciones. Resultados. Los casos totales de apendicitisse redujeron un 25 % (n = 67 versus n = 50 en 2020). El tiempo medio hasta la consulta fue de 24 horas en ambos períodos (p = 0,989). La incidencia de peritonitis fue del 44 % (n = 22) versus el 37 % (n = 22) (p = 0,22) en 2019. No se evidenció diferencia en los estadios deenfermedad de acuerdo con lo informado en los partes quirúrgicos. En 2019, todas las cirugías se realizaron por vía laparoscópica; en 2020, solo un42 % (n = 21). La incidencia de complicaciones fue del 6 %, contra 7,5 % en el período previo (p = 0,75). Un paciente fue COVID-19 positivo. Conclusión. A pesar de la reducción en el númerode casos de apendicitis, no se evidenció una demora en la consulta en nuestra población. El mayor impacto se asoció a la readecuación del manejo, evitando el abordaje laparoscópico para reducir la diseminación del virus.


Introduction. Appendicitis is the leading cause of surgical acute abdomen in pediatrics. During the COVID-19 pandemic, management strategies were reassessed and the number of visits to the emergency department dropped down, which may be associated with delayed diagnoses and complications. The objective of this study was to analyze the impact of the pandemic on children with acute appendicitis. Methods. Analytical, retrospective, comparative study of pediatric patients with acute appendicitis in the 5 months of COVID-19 lockdown versus the same period in the previous year. Incidence, clinical data, stage, surgical approach, and complications were analyzed. Results. The total number of appendicitis cases went down by 25 % (n = 67 versus n = 50 in 2020). The mean time to consultation was 24 hours in both periods (p = 0.989). The incidence of peritonitis was 44 % (n = 22) versus 37 % (n = 22) (p = 0.22) in 2019. No differences were  observed in terms of appendicitis stage based on surgery reports. In 2019, all surgeries were laparoscopic; while in 2020, only 42 % (n = 21). The incidence of complications was 6 % versus 7.5 % in the previous period (p = 0.75). One patient was COVID-19 positive. Conclusion. Although in our population the number of appendicitis cases dropped down, consultation was not delayed. The greater impact was associated with the reformulation of management strategies, in which the laparoscopic approach is avoided to reduce virus transmission.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Appendectomy/trends , Appendicitis/surgery , Appendicitis/diagnosis , Appendicitis/epidemiology , Practice Patterns, Physicians'/trends , Delayed Diagnosis/trends , COVID-19/prevention & control , Health Services Accessibility/trends , Appendectomy/methods , Argentina/epidemiology , Acute Disease , Incidence , Retrospective Studies , Laparoscopy/trends , Pandemics/prevention & control , Tertiary Care Centers , COVID-19/diagnosis , COVID-19/epidemiology , Hospitals, General
7.
Medicina (B.Aires) ; 81(4): 649-651, ago. 2021. graf
Article in Spanish | LILACS | ID: biblio-1346520

ABSTRACT

Resumen La apendicitis del muñón es una complicación poco frecuente de la apendicectomía. Puede aparecer desde unas semanas a varios años luego del procedimiento quirúrgico. Para arribar a su diagnóstico es necesario un alto índice de sospecha. El objetivo de esta publicación es hacer una reseña de dos casos de esta entidad ocurridos en nuestra institución y mencionar sus hallazgos imagenológicos más frecuentes. La tomografía computarizada es un excelente método para valorar esta entidad, no solo para su diagnóstico sino también para descartar otras patologías que presentan un cuadro clínico similar.


Abstract Stump appendicitis is a rare complication of appendectomy. It may develop from a few weeks to several years after the surgical procedure. To achieve its diagnosis a high index of suspicion is necessary. The objective of this publication is to make a re view of two cases of this entity that occurred in our institution and to mention its most frequent imaging findings. Computed tomography is an excellent method to assess this entity, not only for its diagnosis but also to rule out other pathologies that present similar clinical features.


Subject(s)
Humans , Appendicitis/surgery , Appendicitis/etiology , Appendicitis/diagnostic imaging , Appendectomy , Postoperative Complications/etiology , Postoperative Complications/diagnostic imaging , Tomography, X-Ray Computed , Diagnosis, Differential
9.
Rev. colomb. cir ; 36(4): 626-636, 20210000. fig, tab
Article in Spanish | LILACS | ID: biblio-1291156

ABSTRACT

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


Subject(s)
Humans , Appendicitis , Laparoscopy , Appendectomy , Bioelectric Energy Sources , Cost Control , Ligation
10.
Cambios rev. méd ; 20(1): 21-25, 30 junio 2021. tabs.
Article in Spanish | LILACS | ID: biblio-1292703

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Appendicitis/complications , Gentamicins , Cephalexin , Ampicillin , Metronidazole , Anti-Bacterial Agents/therapeutic use , Pediatrics , Postoperative Complications , General Surgery , Cost-Benefit Analysis
11.
Infectio ; 25(2): 138-141, abr.-jun. 2021. graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1250081

ABSTRACT

Resumen Balantidium coli es el único miembro de la familia Balantidiidae capaz de producir infección en seres humanos. Presentamos un caso en un hombre de 43 años que ingresa para corrección quirúrgica de hernia ventral durante la cual se realizó apendicetomía profiláctica. En el estudio histopatológico se observó apéndice cecal con arquitectura conservada, sin la presencia de apendicitis ni periapendicitis. En la luz se reconocieron estructuras grandes (aproximado de 50 μm) redondas con citoplasma amplio con vacuolas grandes, cilias periféricas y núcleos densos, los cuales correspondieron a trofozoitos de Balantidium coli.


Abstract Balantidium coli is the only member of the Balantidiiae family capable of infecting human beings. We present one in a 43 years-old male admitted for a surgical co rrection of an incisional hernia with prophylactic appendicectomy. Histopathological findings reported the cecal appendix within normal architecture, appendicitis and peri-appendicitis free. At the lumen big, rounded shape structures (aprox. 50 mm) were visible with broad cytoplasm, big vacuoles, peripheral cilia and dense nucleus, corresponding to Balantidium coli trophozoites.


Subject(s)
Humans , Male , Adult , Appendix , Balantidium , Incidental Findings , Appendicitis , Coliforms , Infections
12.
Rev. colomb. cir ; 36(3): 481-486, 20210000. fig, tab
Article in Spanish | LILACS | ID: biblio-1254307

ABSTRACT

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


Subject(s)
Humans , Appendicitis , Minimally Invasive Surgical Procedures , Appendectomy , Postoperative Complications , Costs and Cost Analysis
13.
Rev. colomb. cir ; 36(3): 487-492, 20210000. tab
Article in Spanish | LILACS | ID: biblio-1254326

ABSTRACT

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


Subject(s)
Humans , Appendicitis , COVID-19 , Peritonitis , Pandemics , SARS-CoV-2 , Abdomen, Acute
14.
Rev. colomb. cir ; 36(2): 283-300, 20210000. fig, tab
Article in English | LILACS | ID: biblio-1223987

ABSTRACT

Introducción. La apendicitis aguda es la patología quirúrgica más frecuente en Colombia y en el mundo, con un riesgo de presentación del 7-8 % en la población general. El tratamiento de elección es la apendicectomía, la cual puede realizarse por vía convencional o por vía laparoscópica. El objetivo de este estudio fue comparar los desenlaces clínicos y costos de un modelo de estandarización en el manejo de la apendicitis aguda versus la no estandarización. Métodos. Estudio observacional, analítico, para comparar el manejo de atención estandarizado y no estandarizado. Se incluyeron pacientes mayores de 18 años, que ingresaron al servicio de urgencias con diagnóstico de apendicitis aguda en el período de enero de 2016 a diciembre de 2018, y quienes fueron llevados a apendicectomía convencional o laparoscópica en la institución. Resultados. Se incluyeron 1392pacientes, 591 que cumplieron los criterios del modelo estandarizado y 801 que cumplieron los criterios del modelo no estandarizado. Al comparar los procesos de estandarización y no estandarización, se encontraron diferencias estadísticamente significativas en los resultados crudos de estancia hospitalaria y costos totales. En los estimativos ajustados por variables de confusión no se encontraron diferencias en los costos totales. Discusión. El modelo de estandarización demostró una disminución en los días de hospitalización. No encontró diferencias en términos de costos totales


Introduction. Acute appendicitis is the most frequent surgical pathology in Colombia and in the world, with a risk of presentation of 7-8% in the general population. The treatment of choice is appendectomy, which can be performed conventionally or laparoscopically. The objective of this study is to compare the clinical outcomes and costs of a standardization model in the management of acute appendicitis.Methods. Observational, analytical study to compare standardized versus non-standardized care management. Patients older than 18 years, who were admitted to the emergency department with a diagnosis of acute appendicitis in the period from January 2016 to December 2018 and underwent conventional or laparoscopic appendectomy at the institution were included. Results. 1392 patients were included; 591 met the criteria of the standardized model and 801 met the criteria of the non-standardized model. When comparing the standardization versus non-standardization processes, statistically significant differences were found in the hospital stay and total costs. In the estimates adjusted for confounding variables, no differences were found in total costs. Discussion. The standardization model showed a decrease in hospital length of stay. No differences were found in terms of total costs


Subject(s)
Humans , Appendicitis , General Surgery , Health Evaluation , Forecasting
15.
Acta méd. colomb ; 46(1): 42-44, ene.-mar. 2021. graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1278155

ABSTRACT

Resumen Introducción: la apendicitis es la emergencia quirúrgica abdominal más frecuente, pero la tuberculosis como agente etiológico hace especial este caso, debido a su muy baja frecuencia entre 0.1 y 0.6%, su hallazgo incidental nos orienta a buscar otros órganos comprometidos y a iniciar tratamiento específico, este es el primer reporte de caso en nuestra región. Reporte de caso: mujer de 33 años, con antecedentes de insuficiencia suprarrenal primaria, en tratamiento con fludrocortisona, quien consultó por presentar dolor en cuadrante inferior derecho abdominal, picos febriles y episodios eméticos, lo anterior asociado a biometría hemática con leucocitosis más desviación a la izquierda, uroanálisis patológico, se sospecha infección del tracto urinario, iniciando antibioticoterapia sin obtener mejoría, por lo que se evalúa por cirugía general que considera abdomen agudo de origen en apendicitis, realizando abordaje quirúrgico con posterior estudio histopatológico que sugiere inflamación granulomatosa caseificante compatible con tuberculosis, con la consecuente demostración de BAAR mediante tinción de Ziehl Neelsen. Conclusión: la tuberculosis extrapulmonar tiene presentaciones clínicas diversas, por lo tanto, debemos mantener sospecha ante manifestaciones atípicas de la patología, la apendicitis aguda tuberculosa, generalmente se da en el contexto de un paciente inmunosuprimido y su diagnóstico etiológico es realizado en el posoperatorio, por lo tanto, es indispensable vigilar y revisar el resultado de la biopsia y las tinciones que nos permitan realizar tratamientos específicos.


Abstract Introduction: appendicitis is the most frequent abdominal surgical emergency, but tuberculosis as the etiological agent makes this case special, due to its very low frequency of 0.1 to 0.6%. Its incidental finding guided us to seek other involved organs and begin specific treatment. This is the first case report in our region. Case report: a 33-year-old woman with a history of primary adrenal insufficiency being treated with fludrocortisone consulted due to right lower quadrant abdominal pain, fever and emesis, associated with leukocytosis with a left shift and a pathological urinalysis. A urinary tract infection was suspected, and antibiotic therapy was begun with no improvement. She was therefore seen by general surgery, who suspected acute abdomen arising from appendicitis. She underwent surgery with a subsequent histopathological study which suggested caseifying granulomatous inflammation compatible with tuberculosis, with ensuing proof of acid-fast bacilli using Ziehl Neelsen staining. Conclusion: Extrapulmonary tuberculosis has diverse clinical presentations. Therefore, when faced with atypical manifestations of this disease we should maintain a level of suspicion. Acute tuberculous appendicitis generally presents in the context of an immunosuppressed patient, and its etiological diagnosis is carried out after surgery. Therefore, it is essential to be vigilant and review the biopsy result and stains, which will allow specific treatments to be carried out.


Subject(s)
Humans , Male , Adult , Appendicitis , Tuberculosis , Abdomen, Acute
16.
Acta méd. colomb ; 46(1): 38-41, ene.-mar. 2021. graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1278154

ABSTRACT

Resumen Introducción: la apendicitis es la emergencia quirúrgica abdominal más frecuente, pero la tuberculosis como agente etiológico hace especial este caso, debido a su muy baja frecuencia entre 0.1 y 0.6%, su hallazgo incidental nos orienta a buscar otros órganos comprometidos y a iniciar tratamiento específico, este es el primer reporte de caso en nuestra región. Reporte de caso: mujer de 33 años, con antecedentes de insuficiencia suprarrenal primaria, en tratamiento con fludrocortisona, quien consultó por presentar dolor en cuadrante inferior derecho abdominal, picos febriles y episodios eméticos, lo anterior asociado a biometría hemática con leucocitosis más desviación a la izquierda, uroanálisis patológico, se sospecha infección del tracto urinario, iniciando antibioticoterapia sin obtener mejoría, por lo que se evalúa por cirugía general que considera abdomen agudo de origen en apendicitis, realizando abordaje quirúrgico con posterior estudio histopatológico que sugiere inflamación granulomatosa caseificante compatible con tuberculosis, con la consecuente demostración de BAAR mediante tinción de Ziehl Neelsen. Conclusión: la tuberculosis extrapulmonar tiene presentaciones clínicas diversas, por lo tanto, debemos mantener sospecha ante manifestaciones atípicas de la patología, la apendicitis aguda tuberculosa, generalmente se da en el contexto de un paciente inmunosuprimido y su diagnóstico etiológico es realizado en el posoperatorio, por lo tanto, es indispensable vigilar y revisar el resultado de la biopsia y las tinciones que nos permitan realizar tratamientos específicos.


Abstract Introduction: appendicitis is the most frequent abdominal surgical emergency, but tuberculosis as the etiological agent makes this case special, due to its very low frequency of 0.1 to 0.6%. Its incidental finding guided us to seek other involved organs and begin specific treatment. This is the first case report in our region. Case report: a 33-year-old woman with a history of primary adrenal insufficiency being treated with fludrocortisone consulted due to right lower quadrant abdominal pain, fever and emesis, associated with leukocytosis with a left shift and a pathological urinalysis. A urinary tract infection was suspected, and antibiotic therapy was begun with no improvement. She was therefore seen by general surgery, who suspected acute abdomen arising from appendicitis. She underwent surgery with a subsequent histopathological study which suggested caseifying granulomatous inflammation compatible with tuberculosis, with ensuing proof of acid-fast bacilli using Ziehl Neelsen staining. Conclusion: Extrapulmonary tuberculosis has diverse clinical presentations. Therefore, when faced with atypical manifestations of this disease we should maintain a level of suspicion. Acute tuberculous appendicitis generally presents in the context of an immunosuppressed patient, and its etiological diagnosis is carried out after surgery. Therefore, it is essential to be vigilant and review the biopsy result and stains, which will allow specific treatments to be carried out.


Subject(s)
Humans , Female , Adult , Appendicitis , Tuberculosis , Pathology , Women , Abdomen, Acute
17.
Clin. biomed. res ; 41(3): 232-236, 20210000. tab
Article in English | LILACS | ID: biblio-1348029

ABSTRACT

Introduction: To evaluate the prevalence of appendix neoplasia correlating with patient profile, histological types and frequency. Methods: Data collection was performed in the Pathology Department of a General Hospital, with the objective of identifying patients diagnosed with malignant cecal appendix tumors by histopathologic study of specimens from acute appendicitis. Results: The prevalence of malignant primary epithelial neoplasia of the appendix was 1%. Fifty percent of the cases were neuroendocrine tumors, 35% were mucinous, and 15% were adenocarcinomas. The mean age at diagnosis was 41.3 (SD, 20.4) years (range 16-81), with a women/men ratio of 3:1. Discussion: Appendiceal neoplasms are rare and should be suspected manly in women over 40 years of age with suggestive symptoms of acute appendicitis. The size, location, extent, margins and presence of mucin are essential findings for the treatment of these patients. (AU)


Subject(s)
Humans , Male , Female , Appendiceal Neoplasms/diagnosis , Appendicitis , Adenocarcinoma , Neuroendocrine Tumors , Neoplasms, Cystic, Mucinous, and Serous
18.
Rev. Col. Bras. Cir ; 48: e20213010, 2021. tab
Article in English | LILACS | ID: biblio-1340673

ABSTRACT

ABSTRACT Acute appendicitis is the leading cause of abdominal emergency surgery worldwide and appendectomy continues to be the definitive treatment of choice. This cost-effectiveness analysis evaluates laparoscopic versus open appendectomies performed in public health services in the state of Bahia (Brazil). We conducted a retrospective observational study using the database from the Department of Informatics of the Unified Health System (DATASUS). Available data on appendectomies between 2008 and 2019 were included, and we evaluated the temporal trend of hospital admissions, procedure-related mortality rates, length of stay, and costs. Statistical analysis was performed using the R-software (R Foundation, v.4.0.3) and the BioEstat software (IMDS, v. 5.3), considering p<0.05 as significant. During 2008-2019, 53,024 appendectomies were performed in the public health services in Bahia, of which 94.9% were open surgeries. The open technique was associated with a higher mortality rate (4.9/1,000 procedures; p<0.05) and a higher risk of death (RR=4.5; p<0.05) compared to laparoscopy (1.1/1,000 procedures). Laparoscopic appendectomy (median of 2.7 days) had a shorter length of stay compared to laparotomy (median of 4.15 days) (p<0.05). There was no difference in the medians of costs nor hospital services, per procedure (p=0.08 and p=0.08, respectively). Laparoscopic professional median costs were higher by US$ 1.39 (p<0.05). Minimally invasive surgery for appendicitis is a safe and efficacious procedure in Brazilian public health care services, as it provides advantages over the open method (including lower procedure-related mortality rate and earlier discharges), and it did not imply higher expenses for public service budgets in the state of Bahia.


RESUMO Apendicite aguda é a principal causa de cirurgia abdominal de emergência no mundo e a apendicectomia continua sendo o tratamento definitivo de escolha. A presente investigação avalia desfechos e custos das apendicectomias laparoscópicas versus abertas realizadas em serviços públicos de saúde no estado da Bahia (Brasil). Realizou-se estudo observacional retrospectivo, utilizando a base de dados do DATASUS. Incluiu-se dados disponíveis sobre apendicectomias na Bahia entre 2008 e 2019, avaliando-se a tendência temporal de internações, taxas de mortalidade por procedimentos, tempo de permanência e custos. A análise estatística foi realizada no R-software (Fundação R, v.4.0.3) e no software BioEstat (IMDS, v.5.3), considerando p<0,05 significativo. Entre 2008 e 2019, realizou-se 53.024 apendicectomias no serviço público de saúde na Bahia, das quais 94,9% foram cirurgias abertas. A laparotomia foi associada à maior taxa de mortalidade (4,9/1.000 procedimentos; p<0,05) e maior risco de morte (RR=4,5; p<0,05) do que laparoscopia (1,1/1.000 procedimentos). Apendicectomia laparoscópica (mediana de 2,7 dias) obteve menor tempo de internamento do que cirurgia laparotômica (mediana de 4,15 dias) (p<0,05). Não houve diferença entre as medianas dos custos e nem dos serviços hospitalares por procedimento (p=0,08 e p=0,08, respectivamente). A mediana do custo de profissionais na laparoscopia foi significativamente mais elevada, em US$ 1,39 (p<0,05). A cirurgia minimamente invasiva para apendicite é um procedimento seguro e eficaz, proporcionando vantagens sobre a laparotomia (incluindo menor taxa de mortalidade e alta precoce), não implicando, por sua vez, em maiores despesas para cofres públicos no estado da Bahia.


Subject(s)
Humans , Appendicitis/surgery , Laparoscopy , Appendectomy , Retrospective Studies , Treatment Outcome , Cost-Benefit Analysis , Laparotomy , Length of Stay
19.
Rev. Col. Bras. Cir ; 48: e20202717, 2021. graf
Article in English | LILACS | ID: biblio-1340671

ABSTRACT

ABSTRACT Acute appendicitis (AA) is a frequent cause of abdominal pain requiring surgical treatment. During the COVID-19 pandemic, surgical societies considered other therapeutic options due to uncertainties in the evolution of the disease. The purpose of this study is to assess the treatment of AA by members of two Brazilian surgical societies in this period. A common questionnaire was sent in 2020. There were 382 responses. Most surgeons had more than 15 years of profession (68.3%) and treated more than five cases per month (44.8%). About 72.5% would indicate chest CT to investigate COVID-19 in patients with AA. For those patients sustaining uncomplicated AA, without COVID-19, 60.2% would indicate laparoscopic appendectomy (VLA), followed by open appendectomy (OA) (31.7%) and non-operative management (NOM) (1.3%). For those with mild COVID-19, OA was suggested by 51.0%, followed by VLA (29.6%) and NOM (6.0%). For those with severe COVID-19, OA was proposed by 35.3%, followed by NOM (19.9%) and VLA (18.6%). For patients with periappendiceal abscesses, without COVID-19, VLA was suggested by 54.2%, followed by OA (33.2%) and NOM (4.4%). For those with mild COVID-19, OA was proposed in 49.5%, followed by VLA (29.3%) and NOM (8.9%). In those with severe COVID-19, OA was proposed in 36.6%, followed by NOM (25.1%) and VLA (17.3%). This information, based on two recognized Brazilian surgical societies, can help the surgeon to select the best approach individually.


RESUMO A apendicite aguda (AA) é causa frequente de abdome agudo cirúrgico. Durante a pandemia de COVID-19, devido às incertezas na evolução da doença, sociedades consideraram outras opções terapêuticas. Nosso objetivo é descrever o tratamento da AA por membros do CBC e SBAIT neste período. O questionário foi enviado em 2020. Houve 382 respostas. A maioria dos profissionais tinha mais de 15 anos de profissão (68,3%) e atendia mais de cinco casos por mês (44,8%). Cerca de 72,5% realizariam TC de tórax para investigação de COVID-19 em pacientes com AA. Nos com AA não complicada, sem COVID-19, 60,2% optariam pela apendicectomia videolaparoscópica (AVL), seguido de apendicectomia aberta (AAB) (31,7%) e tratamento não operatório (TNO) (1,3%). Nos com COVID-19 leve, AAB foi proposta por 51,0%, seguido da AVL (29,6%) e TNO (6,0%). Nos com COVID-19 grave, a AAB foi proposta por 35,3%, seguido de TNO (19,9%) e AVL (18,6%). Nos com AA complicadas com abscesso, sem COVID-19, AVL foi sugerida por 54,2%, seguida da AAB (33,2%) e TNO (4,4%). Nos com COVID-19 leve, a AAB foi proposta em 49,5%, seguidos da AVL (29,3%) e TNO (8,9%). Nos com COVID-19 grave, a AAB foi proposta em 36,6%, seguido de TNO (25,1%) e AVL (17,3%). Estas são opções de cirurgiões de duas sociedades cirúrgicas reconhecidas e podem auxiliar o colega que está na linha de frente a definir a melhor conduta individualmente.


Subject(s)
Humans , Appendicitis/surgery , Appendicitis/epidemiology , Laparoscopy , COVID-19 , Appendectomy , Acute Disease , Retrospective Studies , Pandemics , SARS-CoV-2 , Length of Stay
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