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1.
Cir. Urug ; 7(1): e306, 2023. ilus, tab
Article in Spanish | LILACS, UY-BNMED, BNUY | ID: biblio-1505952

ABSTRACT

Las masas inflamatorias de origen apendicular son cuadros de presentación poco frecuente, el 3 % de las apendicitis agudas. Su manejo terapéutico puede ser sistematizado en cirugía de inicio o tratamiento conservador. Este último consiste en antibioticoterapia exclusiva, o asociada al drenaje percutáneo. Es una alternativa frente a emprender una apendicectomía demandante, con riesgo de no identificar el apéndice cecal, lesión visceral y necesidad de conversión o resecciones extendidas. Sin embargo, en estos pacientes, la ausencia de la confirmación diagnóstica anatomo-patológica obliga a un seguimiento protocolizado a fin de descartar diagnósticos diferenciales de mayor relevancia pronóstica. Objetivo: Presentar el caso de un paciente en el que se realizó manejo conservador y apendicetomía electiva. Se realizó una revisión bibliográfica de las pautas de seguimiento e indicación de la apendicectomía electiva. Discusión y conclusiones: Las masas inflamatorias de origen apendicular representan un desafío diagnóstico y terapéutico, requiriendo un manejo y seguimiento específico. La indicación de apendicectomía electiva es controversial, es planteable frente a la persistencia de imágenes patológicas y dudas diagnósticas, o en pacientes con apendicitis recurrentes.


Inflammatory masses of appendiceal origin are infrequent; represent 3 % of acute appendicitis. Its therapeutic management can be systematized in initial surgery or conservative treatment. The latter consists of exclusive antibiotic therapy, or associated with percutaneous drainage. it is an alternative to undertaking a demanding appendectomy, with the risk of not identifying the cecal appendix, visceral injury, and the need for conversion or extended resections. However, the absence of pathological diagnostic confirmation requires protocolized follow-up in order to rule out differential diagnoses of greater prognostic relevance. Objective: present the case of a patient who underwent conservative management and elective appendectomy. a bibliographic review was carried out in the databases: pubmed, cochrane library, scielo and lilacs. Discussion and conclusions: inflammatory masses of appendiceal origin represent a diagnostic and therapeutic challenge, requiring specific management and follow-up. The indication for elective appendectomy is controversial, it is considered in the presence of persistent pathological images and diagnostic doubts, or in patients with recurrent appendicitis.


Massas inflamatórias de origem apendicular são quadros de apresentação pouco frequentes, 3 % de as apendicites agudas. seu manejo terapêutico pode ser sistematizado em cirurgia inicial ou tratamento conservador. esta última consiste na antibioticoterapia exclusiva, ou associada à drenagem percutânea. é uma alternativa à realização de uma apendicectomia exigente, com risco de não identificação do apêndice cecal, lesão visceral e necessidade de conversão ou ressecções extensas. no entanto, nesses pacientes, a ausência de confirmação diagnóstica patológica requer acompanhamento protocolarizado para afastar diagnósticos diferenciais de maior relevância prognóstica. Objetivo: apresentar o caso de um paciente submetido a tratamento conservador e apendicectomia eletiva. foi realizada revisão bibliográfica nas bases de dados: pubmed, biblioteca cochrane, scielo e lilacs. Discussão e conclusões: as massas inflamatórias de origem apendicular representam um desafio diagnóstico e terapêutico, exigindo manejo e seguimento específicos. a indicação de apendicectomia eletiva é controversa, sendo considerada na presença de imagens patológicas persistentes e dúvidas diagnósticas, ou em pacientes com apendicite recorrente.


Subject(s)
Humans , Male , Adult , Appendectomy , Appendicitis/surgery , Appendicitis/diagnostic imaging , Appendicitis/drug therapy , Abdominal Pain , Elective Surgical Procedures , Diagnosis, Differential , Anti-Bacterial Agents
2.
Int. j. med. surg. sci. (Print) ; 9(4): 1-5, Dec. 2022. ilus
Article in Spanish | LILACS | ID: biblio-1519478

ABSTRACT

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.


Subject(s)
Humans , Male , Middle Aged , Appendicitis/complications , Thrombosis , Mesenteric Ischemia/etiology , Appendectomy , Appendicitis/surgery , Appendicitis/diagnostic imaging , Tomography, X-Ray Computed , Mesenteric Ischemia/drug therapy , Mesenteric Ischemia/diagnostic imaging , Anticoagulants/therapeutic use
3.
Rev. argent. cir ; 114(2): 181-184, jun. 2022. graf
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1387603

ABSTRACT

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


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


Subject(s)
Humans , Male , Middle Aged , Appendicitis/diagnostic imaging , Diverticulitis/diagnosis , Appendectomy , Appendicitis/surgery , Diagnosis, Differential , Diverticulitis/pathology , Ilium/pathology
4.
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
6.
In. Fernández, Anabela. Manejo de la embarazada crítica y potencialmente grave. Montevideo, Cuadrado, 2021. p.495-505, ilus.
Monography in Spanish | LILACS, UY-BNMED, BNUY | ID: biblio-1377885
7.
Rev. argent. cir ; 112(4): 517-525, dic. 2020. tab
Article in Spanish | BINACIS, LILACS | ID: biblio-1288164

ABSTRACT

RESUMEN Antecedentes: La apendicitis aguda (AA) es una de las principales patologías quirúrgicas en México y el mundo. A pesar de ser una patología frecuente, el manejo quirúrgico presenta una tasa del 10-20% de apendicitis blancas (AB) o hiperplasia folicular linfoide (HPL) por histopatología. Objetivo: Comparar los hallazgos clínicos, de laboratorio y radiológicos de pacientes con sospecha de AA con su diagnóstico por histopatología. Material y métodos: El estudio es retrospectivo, observacional y transversal. Se analizaron los datos de los pacientes con diagnóstico clínico de apendicitis aguda, desde febrero de 2013 hasta diciembre de 2017, atendidos en un hospital de tercer nivel en Monterrey, México. Se compararon los hallazgos de los pacientes con diagnóstico de AA vs. HPL, AA no complicadas vs. AA complicadas y pacientes pediátricos vs. adultos. Se realizó un análisis descriptivo por medio de frecuencias y porcentajes, y mediana y rango intercuartil (RIC), dada la distribución no paramétrica de estas variables. Se compararon los hallazgos por laboratorio mediante la prueba de Mann-Whitney. Se consideró una p< 0,05 como estadísticamente significativa. Resultados: En nuestro medio, ambos sexos tienen la misma frecuencia de presentación de AA. El tiempo de evolución es significativo en la presentación frecuente de AA complicada. Existe asociación entre leucocitosis, neutrofilia total y porcentual y recuento plaquetario mayor en presencia de AA vs. HPL. Conclusión: Los estudios de laboratorio no muestran cambios significativos en pacientes pediátricos con AA. En adultos con AA no complicada vs. apendicitis complicada, el aumento en WBC, NEU y NEU% son estadísticamente significativos.


ABSTRACT Background: Acute appendicitis (AA) is one of the main surgical pathologies in our country and worldwide. Despite being a surgery that is frequently done, it is still reported a 10-20% of negative appendectomies (NA). Objective: The objective of the study is to compare clinical, laboratory and radiology results with the histopathology diagnosis. Material and methods: A retrospective study was done analyzing the data of patients with clinical diagnosis of AA from February 2013 to December 2017, in a tertiary hospital in Monterrey, Mexico. They were classified by their histopathological results into different groups: AA or NA; and the AA was subdivided into complicated AA and uncomplicated AA. Finally, these groups were also subdivided by ages, into pediatric and adult groups of each category. A descriptive analysis was made using frequencies, percentages, median and the interquartile range. Laboratory results were compared with the Mann-Whitney test. Considering a p-value of p < 0.05 as statistically significant. Results: In our group of patients both genders had AA in a similar frequency, the time between the appearance of symptoms and reaching for medical advice was an important factor for having complicated AA. There is a correlation between leukocytosis, neutrophil count and platelet count elevated in presence of AA against NA. Conclusion: Laboratory studies did not report significant changes in pediatric patients with AA. In adults with uncomplicated AA vs. complicated AA, white blood cell count, and neutrophil count are statistically significant.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Young Adult , Appendectomy , Appendicitis/diagnosis , Pseudolymphoma/diagnosis , Appendicitis/diagnostic imaging , Tomography, X-Ray Computed , Cross-Sectional Studies , Retrospective Studies , Ultrasonography , Clinical Laboratory Techniques
8.
Arch. argent. pediatr ; 118(2): 102-108, abr. 2020. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1099859

ABSTRACT

Objetivos. El objetivo de este estudio fue evaluar el riesgo clínico de la apendicitis con apendicolito y su importancia al elegir las estrategias terapéuticas.Métodos. Se analizó retrospectivamente a niños con diagnóstico de apendicitis aguda entre junio de 2011 y enero de 2017. Se dividió en un grupo con apendicolito(GA) y un grupo sin apendicolito (GSA) según la presencia o no de apendicolito durante la cirugía abierta. Se revisaron y compararon la presentación clínica, de laboratorios, los resultados de la tomografía computada y los cambios patológicos.Resultados. De 163 pacientes, se incluyó a 23 (media de edad: 6,1 años) en el GA y a 140 (media de edad: 8,1 años) en el GSA. Los pacientes en el GA tuvieron una hospitalización más extensa, mayor temperatura corporal, mayor frecuencia de diarrea, signo de Blumberg, aumento del porcentaje de neutrófilos, proteína C-reactiva y mayor riesgo de perforación. La puntuación en las escalas de Alvarado (8,3 ± 1,2 frente a 7,0 ± 1,3; P < 0,05) y de respuesta inflamatoria a apendicitis (10,7 ± 1,6 frente a 7,7 ± 1,9; P < 0,05) fue mayor en el GA que en el GSA; la presencia de fiebre y apendicolito se asoció con una mayor tasa de apendicitis perforada.Conclusiones. La apendicitis pediátrica con apendicolito representa un mayor riesgo clínico y tiende a causar apendicitis complicada


Objectives. This study aims to assess the clinical risk of pediatric appendicitis with appendicolith and its guiding significance in therapeutic strategies' selection.Methods. Children diagnosed with acute appendicitis from June 2011-January 2017 were analyzed retrospectively. Patient cohort was divided to appendicolith group (AG) and non- appendicolith group (NAG) based on whether the appendicolith presents or not in the open surgery. Clinical presentations, laboratory parameters, computed tomography findings, and pathological changes were reviewed and compared between two groups. Results. Among 163 patients, 23 (meanage,6.1yearsold)weredefinedin AG and 140; mean age, 8.1 years old) in NAG. The patients in AG demonstrated prolonged length of stay (12.4 ± 5.6d vs. 8.7 ± 5.0d, P <0.05), higher body temperature (38.2 ± 0.8 °C vs. 37.3 ± 0.8 °C, P <0.05), higher frequency of diarrhea (17 % vs. 3%, P <0.05), rebound tenderness (100 % vs. 87 %, P <0.05), increased neutrophil percentage (81.4 ± 8.0 % vs. 65.3 ± 22.8 %, P <0.05), C-reactive protein (33.13 ± 10.3 mg/L vs. 23.7 ± 13.7 mg/L, P <0.05), and great risk of perforation (78 % vs. 29 %, P <0.05). Alvarado score (8.3 ± 1.2 vs. 7.0 ± 1.3, P <0.05) and AIR score (10.7 ± 1.6 vs. 7.7 ± 1.9, P <0.05) of AG, were higher than NAG he presence of fever and appendicolith was associated with a high rate of perforated appendicitis.Conclusions. Pediatric appendicitis with appendicolith has greater clinical risk and tends to causing complicated appendicitis


Subject(s)
Humans , Male , Female , Child , Appendectomy , Appendicitis/diagnostic imaging , Fecal Impaction/complications , Appendicitis/surgery , Comparative Study , Tomography, X-Ray Computed/methods , Retrospective Studies , Inflammation
9.
In. Machado Rodríguez, Fernando; Liñares, Norberto; Gorrasi, José; Terra Collares, Eduardo Daniel. Manejo del paciente en la emergencia: patología y cirugía de urgencia para emergencistas. Montevideo, Cuadrado, 2020. p.31-43, tab.
Monography in Spanish | LILACS, UY-BNMED, BNUY | ID: biblio-1342981
10.
Einstein (Säo Paulo) ; 18: eRC5415, 2020. graf
Article in English | LILACS | ID: biblio-1142881

ABSTRACT

ABSTRACT A 34-years-old pregnant woman admitted in the emergency unit complaining about worsening right iliac fossa pain for 2 days. Acute appendicitis was the suspected diagnosis. Laboratory exams were ordered and results were within normal limits for infectious and inflammatory aspects. Ultrasound scan revealed a pregnancy in course without alterations and a thickness of the appendix wall without inflammatory signs in the surrounding tissue. Because the suspicion of acute appendicitis remained, a magnetic resonance was done and confirmed the diagnosis of a cecal appendix lipomatosis.


RESUMO Paciente de 34 anos, do sexo feminino, grávida, chega ao pronto-socorro com queixa de dor na fossa ilíaca direita piorando nos últimos 2 dias com suspeita de apendicite aguda. Foram solicitados exames laboratoriais, que estavam dentro dos limites de normalidade para aspectos infecciosos e inflamatórios. Exame de imagem também foi solicitado, sendo a ultrassonografia o método de escolha, que revelou gravidez em curso sem alterações e espessura da parede do apêndice sem sinais inflamatórios. Ainda com suspeita de apendicite aguda, foi realizada ressonância magnética, confirmando a hipótese de lipomatose do apêndice cecal.


Subject(s)
Humans , Female , Adult , Appendicitis/diagnostic imaging , Appendix/diagnostic imaging , Lipomatosis , Acute Disease , Ultrasonography , Diagnosis, Differential
11.
Rev. cuba. cir ; 58(4): e776, oct.-dic. 2019. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1126393

ABSTRACT

RESUMEN La reparación de la hernia en la región inguinocrural es una de las operaciones más frecuentes en la práctica quirúrgica. Pueden encontrarse hallazgos inusuales, como el apéndice cecal parcial o completamente contenido en el saco herniario, lo que se denomina hernias de Amyand y Garengeot. Se presentan en aproximadamente el 1 por ciento de los pacientes con hernia inguinocrural, mientras que representan cerca del 0,1 por ciento de los casos de apendicitis. Clínicamente se presentan como una hernia inguinocrural incarcerada, y la ecografía o la tomografía axial computarizada pueden ayudar en el diagnóstico preoperatorio. El estado del apéndice cecal determina el acceso quirúrgico y el tipo de reparación herniaria. El objetivo de este artículo es desarrollar un material de apoyo a los profesionales implicados en la atención de estas raras entidades quirúrgicas(AU)


ABSTRACT Hernia repair in the inguinocrural region is one of the most frequent interventions in the surgical practice. Unusual findings can be found, such as the cecal appendix partially or completely contained within the hernial sac, called Amyand and Garengeot hernias. They occur in approximately 1 percent of patients with inguinocrural hernia, while they represent about 0.1 percent of the cases of appendicitis. Clinically, they present as an incarcerated inguinocrural hernia; ultrasound or computed tomography (CT) can assist in the preoperative diagnosis. The state of the cecal appendix determines surgical access and type of hernia repair. The objective of this article is to develop a support material for the professionals involved in the care of these rare surgical entities(AU)


Subject(s)
Humans , Herniorrhaphy/methods , Appendectomy/methods , Appendicitis/diagnostic imaging
12.
Rev. cir. (Impr.) ; 71(2): 118-121, abr. 2019. graf
Article in Spanish | LILACS | ID: biblio-1058243

ABSTRACT

OBJETIVOS: El uso de la tecnología ha transformado gradualmente el diagnóstico de la apendicitis, el cual continúa siendo un reto diagnóstico. Los objetivos de nuestro estudio fueron a) Describir la variación del diagnóstico de apendicitis en el tiempo y b) Evaluar las tasas de apendicectomías en blanco con el uso de diferentes medios diagnósticos. MATERIALES Y MÉTODOS: Revisión retrospectiva de base de datos. Descripción de la variación del diagnóstico de la apendicitis en el tiempo de 1.645 pacientes llevados a apendicectomía en una clínica de Bogotá de enero de 2011 a diciembre de 2016. Adicionalmente, se evaluó la tasa de apendicectomías en blanco con los diferentes métodos diagnósticos. RESULTADOS: El diagnóstico por hallazgos clínicos y ecográficos disminuyó, a la vez que el diagnóstico por tomografía se incrementó. La tasa de apendicectomías en blanco con el diagnóstico clínico fue 14,5%, mientras que con el uso de ecografía y tomografía fue 7,5% y 5,3% respectivamente. El número de apendicectomías disminuyó de 362 a 215 en seis años. Discusión: La disponibilidad de tecnología, su fácil realización y uso deliberado en urgencias, han transformado el diagnóstico de apendicitis, disminuyendo el número de pacientes operados y las apendicectomías en blanco. CONCLUSIÓN: Los resultados de este estudio sugieren que, el uso de tomografía abdominal ha incrementado con el tiempo, disminuyendo el diagnóstico por hallazgos clínicos y ecográficos; el número de apendicectomías en blanco es menor con el uso de la ecografía y la tomografía.


BACKGROUND: Technology changed progresively diagnosis of appendicitis, who is a challenge. The aims of our study were to a) Describe the variation of the diagnosis of appendicitis over time and b) Evaluate the rate of negative appendectomies with the use of different diagnostic tools. METHODS: Retrospective database review. Description of the variation of the diagnosis of appendicitis in time of 1645 patients in whom an appendectomy was performed in a health institution in Bogota from January 2011 to December 2016. In adition, The rate of negative appendectomy was also evaluated with the use of different diagnostic tools. RESULTS: The number of patients diagnosed by the clinical and ultrasound findings decreased in time, while the diagnosis by tomography increased. The rate of negative appendectomies with clinical evaluation was 14.5%, abdominal ultrasound 75% and tomography 5.3%. The number of appendectomies decreased from 362 to 215 in six years. DISCUSSION: The availability of technology, its easy realization and deliberate use in the emergency room, have gradually transformed the diagnosis of appendicitis, decreasing the number of patients operated and the rate of negative appendectomies. CONCLUSIONS: The results of this study suggest that a) the use of tomography has increased in time, decreasing the diagnosis of clinical and ultrasound findings, and b) the number of negative appendectomies was lower with the use of ultrasound and tomography.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Appendectomy/statistics & numerical data , Appendicitis/surgery , Appendicitis/diagnostic imaging , Time Factors , Tomography, X-Ray Computed , Retrospective Studies , Ultrasonography , Colombia
13.
Rev. cuba. cir ; 58(1): e729, ene.-mar. 2019. graf
Article in Spanish | LILACS | ID: biblio-1093148

ABSTRACT

RESUMEN Introducción: El ultrasonido es una prueba de imagen segura y efectiva que ha ayudado a los médicos por más de medio siglo en el diagnóstico de enfermedades y se ha convertido en el estetoscopio del siglo XXI. El dolor abdominal agudo es una causa muy frecuente en los departamentos urgencia y emergencias de todo el mundo. Objetivo: Exponer la utilidad del ultrasonido en la evaluación del dolor abdominal agudo. Método: Se realizó una revisión bibliográfica del tema en las bases de datos PubMed, BVS-BIREME y Cochrane. Se consideraron en la búsqueda todo tipo de estudios publicados desde enero de 1958 hasta junio de 2018, a los cuales se tuvo acceso. Los idiomas utilizados en la búsqueda fueron el español y el inglés. Resultados: De forma general, la tomografía axial computarizada es el estudio por imagen de mayor sensibilidad y especificidad en evaluación del dolor abdominal agudo, lo que supera objetivamente al ultrasonido. Sin embargo, la utilización del ultrasonido por médicos no radiólogos, como complemento del examen físico gana cada día más espacio, sobre todo después del surgimiento del Point-of-Care Ultrasonography. Conclusiones: El ultrasonido realizado por radiólogos es una herramienta útil en la evaluación del dolor abdominal agudo. El cirujano general puede diagnosticar con precisión los cálculos biliares pero el diagnóstico de colecistitis y de apendicitis es más desafiador. Son necesarios más estudios para avalar la utilización del ultrasonido por cirujanos generales en la evaluación del dolor abdominal agudo(AU)


ABSTRACT Introduction: Ultrasound is a safe and effective imaging test that has helped physicians for more than half a century in the diagnosis of diseases and has become the stethoscope of the 21st century. Acute abdominal pain is a common cause in urgency departments and emergency rooms worldwide. Objective: To present the usefulness of ultrasound in the assessment of acute abdominal pain, performed in the department of radiology, emergency and by general surgeons. Method: A literature review of the subject was carried out in the databases PubMed, BVS-BIREME and Cochrane. All types of studies published from January 1958 to June 2018, which were accessed, were considered in the search. The languages used in the search were Spanish and English. Results: Generally speaking, the computed tomography is the imaging study of greater sensitivity and specificity in the assessment of acute abdominal pain, objectively surpassing ultrasonography. However, the use of ultrasound by non-radiological physicians, as a complement to the physical examination, gains more space each day, especially after the emergence of point-of-care ultrasonography. Conclusions: Ultrasonography performed by radiologists is a useful tool in the assessment of acute abdominal pain. The general surgeon can accurately diagnose gallstones, but the diagnosis of cholecystitis and appendicitis is more challenging. More studies are needed to support the use of ultrasound by general surgeons in the assessment of acute abdominal pain(AU)


Subject(s)
Humans , Appendicitis/diagnostic imaging , Tomography, X-Ray Computed/methods , Abdominal Pain/diagnostic imaging , Cholecystitis, Acute/diagnostic imaging , Review Literature as Topic , Databases, Bibliographic
14.
Rev. méd. Urug ; 35(1): 27-35, mar. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-981538

ABSTRACT

Introducción: el dolor en la fosa ilíaca derecha (FID) es un motivo de consulta habitual en los servicios de urgencias. El principal desafío es diferenciar si es un cuadro quirúrgico o no. Objetivo: conocer qué rol ocupa la laparoscopía diagnóstica (LD), la ecografía de abdomen y la tomografía computada (TC) en el algoritmo de estudio de los pacientes con dolor en FID con diagnóstico incierto en Uruguay. Método: estudio observacional, descriptivo, prospectivo, multicéntrico, sobre pacientes que consultaron por dolor en FID desde el 1º de junio al 31 de agosto de 2017 en centros asistenciales de Uruguay. Se recolectaron los siguientes datos en una planilla electrónica: sexo, edad, sintomatología, hallazgos físicos, exámenes solicitados, conducta tomada, hallazgos intraoperatorios, complicaciones. Resultados: se completaron 159 planillas. Luego de una valoración primaria se planteó duda diagnóstica en 69 (43,4%) pacientes. La TC se solicitó en 29 (42%) pacientes. Se realizó TC al 78% de los mayores de 50 años versus 18% entre los de 15 y 29 años. Del total, 13 (44,8%) se informaron como normales, confirmando en el intraoperatorio cuatro (30,7%) apendicitis agudas. Se realizaron 29 LD en los casos con duda diagnóstica, dos tercios fueron en pacientes de 15 a 29 años. En 22 (76%) casos se arribó a un diagnóstico. No hubo complicaciones. Conclusiones: la LD permitió realizar diagnóstico y tratamiento en la mayoría de los casos. La sensibilidad de la TC fue baja en comparación con datos internacionales. El algoritmo diagnóstico debe ser individualizado, basado en protocolos adaptados a los recursos de cada institución. (AU)


Introduction: right iliac fossa (RIF) pain is a frequent reason for consultation at the Emergency Units. The main challenge lies in defining whether it is a surgical condition or not. Objective: to learn about the role of diagnostic laparoscopy, abdominal ultrasound and CT scan in the studies algorithm of patients with RIF pain of unknown etiology in Uruguay. Method: observational, descriptive, prospective, multi-center study of patients who consulted for RIF from June 1st to August 31, 2017 in Health Institutions in Uruguay. The following data were gathered in an excel sheet: sex, age, symptoms, physical findings, tests requested, conduct adopted, intraoperative findings and complications. Results: 159 sheets were completed. Upon a primary assessment a diagnostic doubt was arose in 69 patients (43.4%). A CT scan was requested to 29 patients, and a CT was performed to 78% of patients older than 50 years old vs 18% of those between 15 and 29 years. Conclusions: the diagnostic laparoscopy allowed for diagnosis in most cases. Sensitivity of the CT scan was low when compared to international data. The diagnostic algorithm needs to me individualized, based on protocols adapted to the resources of every institution.


Introdução: a dor na fossa ilíaca direita (FID) é um motivo habitual de consulta habitual nos Serviços de Urgências. O principal desafio é diferenciar entre um quadro cirúrgico e um não cirúrgico. Objetivo: conhecer o papel da laparoscopia diagnóstica (LD), do ultrassom de abdômen e da tomografia computada (TC) no algoritmo de estudo dos pacientes com dor na FID com diagnóstico incerto no Uruguai. Método: estudo observacional, descritivo, prospectivo, multicêntrico sobre pacientes que consultaram por dor na FID no período 1º de junho - 31 de agosto del 2017 em Centros Assistenciais no Uruguai. Em una planilha electrónica foram incluídos os seguintes dados: sexo, idade, sintomatologia, achados físicos, exames solicitados, conduta tomada, achados intra-operatórios e complicações. Resultados: foram preenchidas 159 planilhas. Depois de uma avaliação primaria foram definidas dúvidas diagnósticas em 69 (43,4%) pacientes. Foram solicitadas TC a 29 (42%) pacientes; 78% dos pacientes com mais de 50 anos vs 18% dos pacientes com idades entre 15 e 29 anos. 13 (44,8% do total) tiveram laudo "normal", confirmando apendicite aguda em 4 (30,7%) durante cirurgia. Foram realizadas 29 LD nos casos com dúvida diagnóstica sem dos terços em pacientes de 15 a 29 anos. Em 22 (76%) casos foi possível definir um diagnóstico. Não se registraram complicações. Conclusões: a LD permitiu realizar diagnóstico e tratamento na maioria dos casos. A sensibilidade da TC foi baixa em comparação com dados internacionais. O algoritmo diagnóstico deve ser individualizado, baseado em protocolos adaptados aos recursos de cada instituição.


Subject(s)
Pain , Appendicitis/diagnostic imaging , Acute Disease , Laparoscopy , Ilium
15.
Hosp. Aeronáut. Cent ; 13(1): 41-7, 2018. tabl
Article in Spanish | LILACS, BINACIS | ID: biblio-980309

ABSTRACT

Introducción: La apendicitis aguda es una de las causas de abdomen agudo quirúrgico más frecuente en nuestro medio, y su diagnóstico es principalmente clínico. Sin embargo, la tasa de apendicetomías negativas o en blanco continúan constantes. Es por ello que el conocimiento de la clínica, el uso de escalas diagnósticas y el uso criterioso de exámenes complementarios aportan hacia un diagnóstico más certero. Objetivo: Correlación clínica con los hallazgos intra-operatorios y anatomo-patológicos. Evaluar la utilidad de las escalas diagnosticas para disminuir los casos negativos. Material y Métodos: Se analizaron pacientes que ingresaron por guardia al Servicio de Cirugía General del Hospital Aeronáutico Central con diagnóstico de Síndrome de fosa iliaca derecha (FID), en el periodo comprendido entre Enero del 2017 y Enero del 2018. Se utilizaron escalas diagnosticas de Alvarado y RIPASA. Se evaluó la utilización de estudios imageneológicos complementarios. Se discriminó según sexo y edad. Se cotejo con los resultados de Anatomía Patológica. Diseño: Prospectivo. Observacional. Comparativo. Resultados: Se analizaron los datos de 118 pacientes que ingresaron por guardia. Masculinos: 61,86 %. Edad promedio masculino: 24 años (R:19-44).Femenino: 28 años (R: 18 -68). Frecuencia de presentación de signos-síntomas: Dolor : 100%. Dolor migratorio: 95,76%. Anorexia: 91,52%. Nauseas: 85,58%. Vómitos: 74,57%. Fiebre: 59,32%. Leucocitosis: 81,35%. Escala de Alvarado: Sensibilidad: 87,28%. Especificidad: 66,01%. Escala de RIPASA: Sensibilidad: 94,78%. Especificidad: 73,3%. Métodos complementarios: Radiografía: 100%, Ecografía abdominal: 93,22%, Patológica: 82,20%. TAC: 11,86%, Patológica: 85,71%. Promedio de hospitalización: 3 días. Ubicación de apéndice cecal: Descendente interna: 55,08%, Retrocecal: 34,74%, otras: 10,16%. Anatomía Patológica: Flegmonosa: 41,52%, Congestiva: 31,35%, Gangrenosa: 16,10%, Perforada: 4,23%, Normal: 4,23%.Conclusión:RIPASA resulto ser el método de mejor desempeño cuando se cotejaron sus resultados con los de anatomía patológica. Es por ello que la clínica y los scores diagnósticos consideramos son fundamentales para acercarnos a un diagnóstico de certeza y disminuir la taza de apendicetomías negativas. En cuanto a los métodos imageneológicos complementarios, usados criteriosamente ante duda diagnostica pueden ser de utilidad


Introduction: Acute appendicitis is one of the most frequent causes of acute surgical abdomen in our environment, and its diagnosis is mainly clinical. However , the rate of negative or blank appendectomies remain constant. For this reason, the knowledge of the clinic, the use of diagnostic scales and of complementary studies contribute to a more accurate diagnosis. Objective: Clinical correlation with intraoperative and anatomopathological findings. Evaluate the utility of diagnostic scales to reduce negative cases. Material and Methods: Patients admitted to the General Surgery Service of the Central Aeronautical Hospital with right iliac fossa syndrome (FID) diagnosis were checked by guard in the period between January 2017 and January 2018. Alvarado and RIPASA diagnostic scales were used. The use of complementary imaging studies was evaluated. It was discriminated according to sex and age. It was compared with the Anatomo Pathological results. Design: Prospective. Observational Comparative. Results: Data from 118 patients admitted by guard were annalized. Male: 61.86%. Male average age: 24 years old (R: 19-44). Female: 28 years old (R: 18 -68). Frequency of presentation of signs and symptoms: Pain: 100%. Migratory pain: 95.76%. Anorexia: 91.52%. Nausea: 85.58%. Vomiting: 74.57%. Fever: 59.32%. Leukocytosis: 81.35%. Alvarado scale: Sensitivity: 87.28%. Specificity: 66.01%. RIPASA scale: Sensitivity: 94.78%. Specificity: 73.3%. Complementary methods: Radiography: 100%, Abdominal ultrasound: 93.22%, Pathological: 82.20%. TAC: 11.86%, Pathological: 85.71%. Average hospitalization: 3 days. Location of cecal appendix: Internal descending: 55.08%, Retrocecal: 34.74%, other: 10.16%. Pathological Anatomy: Phlegmonous: 41.52%, Congestive: 31.35%, Gangrenous: 16.10%, Perforated: 4.23%, Normal: 4.23%.Conclusion: RIPASA turned out to be the best performance method when results were compared with those of pathological anatomy. That is why the clinical and diagnostic scores we consider are fundamental to approach a diagnosis of certainty and decrease the rate of negative appendectomies. As for the complementary imaging methods, used judiciously before diagnostic doubt can be useful


Subject(s)
Appendicitis/diagnosis , Appendicitis/diagnostic imaging , Health Status Indicators
16.
J. pediatr. (Rio J.) ; 93(6): 625-631, Nov.-Dec. 2017. tab
Article in English | LILACS | ID: biblio-894064

ABSTRACT

Abstract Objectives: Computed tomography should be performed after careful consideration due to radiation hazard, which is why interest in low dose CT has increased recently in acute appendicitis. Previous studies have been performed in adult and adolescents populations, but no studies have reported on the efficacy of using low-dose CT in children younger than 10 years. Methods: Patients (n = 475) younger than 10 years who were examined for acute appendicitis were recruited. Subjects were divided into three groups according to the examinations performed: low-dose CT, ultrasonography, and standard-dose CT. Subjects were categorized according to age and body mass index (BMI). Results: Low-dose CT was a contributive tool in diagnosing appendicitis, and it was an adequate method, when compared with ultrasonography and standard-dose CT in terms of sensitivity (95.5% vs. 95.0% and 94.5%, p = 0.794), specificity (94.9% vs. 80.0% and 98.8%, p = 0.024), positive-predictive value (96.4% vs. 92.7% and 97.2%, p = 0.019), and negative-predictive value (93.7% vs. 85.7% and 91.3%, p = 0.890). Low-dose CT accurately diagnosed patients with a perforated appendix. Acute appendicitis was effectively diagnosed using low-dose CT in both early and middle childhood. BMI did not influence the accuracy of detecting acute appendicitis on low-dose CT. Conclusion: Low-dose CT is effective and accurate for diagnosing acute appendicitis in childhood, as well as in adolescents and young adults. Additionally, low-dose CT was relatively accurate, irrespective of age or BMI, for detecting acute appendicitis. Therefore, low-dose CT is recommended for assessing children with suspected acute appendicitis.


Resumo Objetivos: A tomografia computadorizada deve ser feita após cautelosa consideração devido ao perigo de radiação, motivo pelo qual o interesse na TC de baixa dosagem tem aumentado recentemente em casos de apendicite aguda. Estudos anteriores foram feitos em populações adultas ou adolescentes, porém nenhum relatou a eficácia do uso da TC de baixa dosagem em crianças com menos de 10 anos. Métodos: Recrutamos pacientes (n = 475) com menos de 10 anos examinados com relação a apendicite aguda. Os indivíduos foram divididos em três grupos de acordo com os exames feitos: TC de baixa dosagem, ultrassonografia e TC de dosagem padrão. Os indivíduos foram categorizados de acordo com a idade e o índice de massa corporal. Resultados: A TC de baixa dosagem foi uma ferramenta de grande contribuição no diagnóstico de apendicite e um método adequado em comparação com a ultrassonografia e a TC de dosagem padrão em termos de sensibilidade (95,5% em comparação com 95% e 94,5%, p = 0,794), especificidade (94,9% em comparação com 80% e 98,8%, p = 0,024), valor preditivo positivo (96,4% em comparação com 92,7% e 97,2%, p = 0,019) e valor preditivo negativo (93,7% em comparação com 85,7% e 91,3%, p = 0,890). A TC de baixa dosagem diagnosticou de forma precisa pacientes com um apêndice perfurado. A apendicite aguda foi diagnosticada de maneira efetiva com a TC de baixa dosagem tanto na primeira quanto na segunda infância. O IMC não influenciou a precisão da detecção de apendicite aguda na TC de baixa dosagem. Conclusão: A TC de baixa dosagem é eficaz e precisa no diagnóstico de apendicite aguda na infância, bem como em adolescentes e jovens adultos. Além disso, a TC de baixa dosagem foi relativamente precisa, independentemente de idade ou IMC, na detecção de apendicite aguda. Assim, a TC de baixa dosagem é recomendada na avaliação de crianças com suspeita de apendicite aguda.


Subject(s)
Humans , Male , Female , Child , Appendicitis/diagnostic imaging , Tomography, X-Ray Computed/methods , Radiation Dosage , Acute Disease , Predictive Value of Tests , Ultrasonography , Sensitivity and Specificity
17.
Article in Spanish | LILACS, UY-BNMED, BNUY | ID: biblio-1253184

ABSTRACT

Objetivos: La apendicitis aguda es una de las patologías quirúrgicas más frecuentes en pediatría y la apendicectomía un procedimiento históricamente probado para su tratamiento. Sin embargo, se ha llamado la atención sobre la morbilidad y costos que implican los casos de apendicectomías no terapéuticas (ANT). Realizamos un estudio para determinar la proporción de ANT en nuestro hospital, analizar sus características y plantear hipótesis de trabajo que nos permitan disminuir su incidencia. Métodos: Se realizó un análisis retrospectivo incluyendo todos los pacientes que fueron intervenidos quirúrgicamente desde el 1/1/13 hasta el 31/12/13 con diagnóstico clínico presuntivo de apendicitis aguda, en el Hospital Pediátrico del Centro Hospitalario Pereira Rossell. Se analizaron la edad, el sexo, la vía de abordaje, los hallazgos intra-operatorios, el diagnóstico anátomo-patológico y el uso y los resultados del hemograma y la ecografía. Resultados: En el período mencionado se realizaron 287 apendicectomías en pacientes con diagnóstico de apendicitis aguda, de los cuales 146 (50,87%) fueron operados por medio de un abordaje convencional y 141 (49,13%) por abordaje laparoscópico. El índice de ANT fue de 10,1% siendo similares las tasas para ambas vías de abordaje (10,27% convencional vs 9,92% laparoscópica). Por otra parte, se evidenció una mayor incidencia de ANT en el sexo femenino (16,6% vs 5,8%). Respecto a la franja etaria, la tasa de ANT fue mayor entre los pacientes de 11-15 años(12,19%), mientras que para las edades comprendidas entre 6-10 años fue de 8,08% y para los pacientes de 0-5 años fue de 4,16%. De los 29 pacientes que presentaron apéndice sano, 12 presentaban adenitis mesentérica, una paciente presentaba una rotura folicular y una paciente presentaba una peritonitis de causa médica. En 15 pacientes no se encontraron otras alteraciones. Conclusiones: El índice de apendicectomías no terapéuticas en nuestro hospital fue del 10,10% en el año 2013. La experiencia internacional y algunos trabajos nacionales demuestran que este resultado es mejorable. Se plantea la utilización de algoritmos clínicos para mejorar la presunción diagnóstica y hacer el mejor uso de los recursos diagnósticos disponibles, así como la instauración de un sistema de registro y análisis prospectivo de los resultados clínicos en apendicitis aguda.


Objectives: Acute appendicitis is one of the most frequent pediatric surgical diseases and appendectomy is a historically proved treatment. However, attention has been directed at morbidity and costs of negative appendectomy (NA). Here we analyze the incidence of NA at our hospital and its characteristics in order to propose a working hypothesis that allows a decrease in its incidence. Methods: A retrospective analysis including all patients who underwent surgery from 01/01/13 to 31/12/13, with presumptive clinical diagnosis of acute appendicitis, in the Pediatric Hospital of the Pereira Rossell Hospital Center, was done. Age, sex, surgical approach, operative findings, pathologic diagnosis and the use and results of laboratory and ultrasound, were analyzed. Results: In the referred period, appendectomies were performed in 287 patients with diagnosis of acute appendicitis, of which 146 (50.87%) were operated by a conventional approach and 141 (49.13%) by laparoscopic approach. The NA were 10.10%, with similar rates for both approaches (10.27% vs 9.92%, conventionalvs laparoscopic).A higher incidence of of NA was evident in girls, (16,6% vs 5,8% conventionalvs. laparoscopic ).With respect to the age group, the rate of NA was higher among 11-15 years old patients (12,19%), while for those aged between 6-10 years it was 8.08 % and for patients aged 0-5 years it was 4.16%. Of the 29 patients who had a healthy appendix, 12 had mesenteric adenitis, one patient had a follicular rupture and other had a medical peritonitis. In 15 patients no other abnormalities were found. Conclusions: The NA rate at our Hospital was 10.10% during 2013. The international experience and some national works prove that this result is improvable. We propose the utilization of clinical scores in order to improve clinical diagnostic and rational use of ancillary resources and the installation of a prospective registry and analysis system of results in acute appendicitis.


Objetivos: A apendicite aguda é uma das patologias cirúrgicas mais frequentes em pediatria e apendicectomia, um procedimento historicamente comprovado para seu tratamento. Entretanto, a atenção e a morbidade e os custos envolvidos em casos de apendicectomias não terapêuticas (ANT) chamaram a atenção. Realizamos um estudo para determinar a proporção de ANT em nosso hospital, analisamos suas características e propomos hipóteses de trabalho que nos permitem reduzir sua incidência. Métodos: Realizamos uma análise retrospectiva, incluindo todos os pacientes submetidos à cirurgia de 1/1/13 a 12/31/13 com diagnóstico clínico presumível de apendicite aguda no Hospital Pediátrico do Centro Hospitalar Pereira Rossell. Analisamos a idade, sexo, abordagem, achados intra-operatórios, diagnóstico anatomopatológico e o uso e resultados de hemograma e ultra-som. Resultados: no período mencionado, foram realizadas 287 apendicectomias em pacientes com apendicite aguda, dos quais 146 (50,87%) foram operados por abordagem convencional e 141 (49,13%) por abordagem laparoscópica. O índice ANT foi de 10,1% com taxas semelhantes para ambas as abordagens (10,27% versus 9,92% laparoscópicas). Por outro lado, houve maior incidência de ANT no sexo feminino (16,6% vs 5,8%). Em relação à faixa etária, a taxa de ANT foi maior entre os pacientes com idades entre 11-15 anos (12,19%), enquanto que para as idades 6-10 anos foi de 8,08% e para pacientes de 0 -5 anos foi de 4,16%. Dos 29 pacientes com apêndice saudável, 12 apresentavam adenite mesentérica, um paciente apresentava ruptura folicular e um paciente apresentava peritonite de grau médico. Não foram encontradas outras alterações em 15 pacientes. Conclusões: A taxa de apendicectomias não terapêuticas em nosso hospital foi de 10,10% no ano de 2013. A experiência internacional e alguns estudos nacionais mostram que esse resultado pode ser melhorado. O uso de algoritmos clínicos para melhorar a presunção diagnóstica e fazer o melhor uso dos recursos diagnósticos disponíveis, bem como o estabelecimento de um sistema de registro e análise prospectiva dos resultados clínicos em apendicite aguda.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Appendectomy/statistics & numerical data , Appendicitis/surgery , Diagnostic Errors/statistics & numerical data , Appendicitis/blood , Appendicitis/diagnostic imaging , Appendix/pathology , Uruguay , Acute Disease , Epidemiology, Descriptive , Retrospective Studies , Ultrasonography , Age and Sex Distribution , Leukocyte Count/statistics & numerical data
18.
Rev. Asoc. Méd. Argent ; 130(4): 20-24, dic. 2017. tab
Article in Spanish | LILACS | ID: biblio-973087

ABSTRACT

INTRODUCCIÓN. La apendicitis aguda es la causa más frecuente de dolor abdominal agudo o dolor abdominal quirúrgico. El examen clínico usando la escala de Alvarado para su diagnóstico permite realizar una práctica evaluación de su condición. OBJETIVO. Unificar criterios en la atención médica ambulatoria, en emergencias y servicios de cirugía para lograr una adecuada y eficaz atención. MATERIAL Y MÉTODOS. Se realizó un estudio observacional y el análisis de varios estudios, siendo las variables más consideradas la edad, presentación clínica, anatomopatología, antibioticoterapia y complicaciones del posoperatorio. RESULTADOS. Predomina el grupo de edad comprendido entre los 10 a 30 años, sexo masculino, el análisis anatomopatológico indica mayor número de la forma supurativa, la profilaxis antibiótica preoperatoria y la antibioticoterapia posoperatoria disminuyen las complicaciones posoperatorias. CONCLUSIONES. Una adecuada utilización de medios diagnósticos y terapéuticos redunda en beneficios para el paciente y la institución.


INTRODUCTION. Acute appendicitis is the most common cause of acute abdominal pain or surgical abdominal pain. The clinical examination using the Alvarado scale for its diagnosis allows a practical evaluation of its emergencies and surgical services to achieve adequate and effective care. MATERIAL AND METHODS. An observational study and analysis of several studies were carried out, being the variables most considered the age, clinical presentation, anatomopathology, antibiotic therapy and postoperative complications. RESULTS. Prevalence of the age group between 10 and 30 years old, male, anatomopathological analysis indicates the highest number of suppurative form, preoperative antibiotic prophylaxis and postoperative antibiotic therapy reduce postoperative complications. CONCLUSIONS. An adequate use of diagnostic and therapeutic means benefits the patient and the institution.


Subject(s)
Male , Humans , Adolescent , Adult , Child , Young Adult , Appendicitis/blood , Appendicitis/diagnosis , Appendicitis/surgery , Ambulatory Care/standards , Abdominal Pain/etiology , Appendicitis/diagnostic imaging , Appendicitis/drug therapy , Appendectomy/methods , Diagnostic Errors/prevention & control , Observational Study , Postoperative Care
20.
Rev. Assoc. Med. Bras. (1992, Impr.) ; 62(7): 622-627, Oct. 2016. tab
Article in English | LILACS | ID: biblio-829519

ABSTRACT

Summary Objective: To investigate whether the diagnosis of acute appendicitis is affected by pregnancy or not. Method: A retrospective study with the analysis of the medical records of all women suspected of having appendicitis who underwent appendectomy at our hospital between June 2010 and March 2015 were reviewed. The patients were divided into two groups according to whether they were pregnant or not during the surgery: group I, pregnant women, and group II, non-pregnant women. Results: During the study period, 38 pregnant women and 169 non-pregnant women underwent appendectomy. The time from admission to the operation was not statistically different (2.17±1.47 days in group I vs. 1.98±1.66 day in group II; p=0.288). The pregnant group had longer hospital stay than the non-pregnant group (p=0.04). Ultrasonography (USG) was used as the first diagnostic modality in 36/38 patients in group I and 161/169 in group II. The non-visualized appendix on ultrasound was seen in 17 patients in group I and 51 patients in group II, which was not statistically different. Sensitivity and specificity of USG in diagnosis of acute appendicitis were 61.29 and 80.00% in group I, and 93.0 and 31.6% in group II, respectively. Conclusion: Although the diagnosis of appendicitis in pregnant women is not delayed, careful assessment of these patients suspected of having appendicitis should be encouraged when USG examination is normal or nondiagnostic.


Resumo Objetivo: investigar se o diagnóstico de apendicite aguda é afetado por gravidez ou não. Método: estudo retrospectivo com análise dos prontuários médicos de todas as mulheres que tiveram suspeita de apendicite e foram submetidas à apendicectomia em nosso hospital entre junho de 2010 e março de 2015. As pacientes foram divididas em dois grupos, de acordo com a presença de gravidez durante a cirurgia: grupo I, mulheres grávidas; grupo II, mulheres não grávidas. Resultados: durante o período do estudo, 38 mulheres grávidas e 169 mulheres não grávidas foram submetidas à apendicectomia. O tempo desde a internação até a cirurgia não foi estatisticamente diferente (2,17±1,47 dias no grupo I vs. 1,98±1,66 dia no grupo II, p=0,288). O grupo das grávidas apresentou uma estadia hospitalar mais longa que o grupo das não grávidas (p=0,04). A ultrassonografia foi usada como primeira modalidade de diagnóstico em 36/38 pacientes no grupo I e em 161/169 no grupo II. O apêndice não visualizado na ultrassonografia foi visto em 17 pacientes no grupo I e 51 pacientes no grupo II, e não foi estatisticamente diferente. A sensibilidade e especificidade da ultrassonografia no diagnóstico de apendicite aguda foram 61,29 e 80,00% no grupo I e 93,0 e 31,6% no grupo II, respectivamente. Conclusão: embora o diagnóstico de apendicite em mulheres grávidas não seja protelado, recomenda-se uma avaliação cuidadosa quando o exame de ultrassonografia for normal ou não diagnóstico nessas pacientes.


Subject(s)
Humans , Female , Pregnancy , Adult , Young Adult , Appendicitis/diagnostic imaging , Appendectomy/methods , Appendicitis/surgery , Acute Disease , Retrospective Studies , Risk Factors , Ultrasonography/methods , Sensitivity and Specificity , Laparoscopy/methods , Statistics, Nonparametric , Middle Aged
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