Ultrasonography findings of appendicular wall thickness in acute appendicitis and recurrent appendicitis with pathological correlation

Background: Appendicitis is among most common cause for acute abdominal pain requiring operative management. This study is to establish relationship between wall thickness of acute appendicitis and recurrent appendicitis with its pathological outcome.Methods: In this prospective study, 24 patients of acute appendicitis and 8 patients of recurrent appendicitis presenting as acute appendicitis were examined by High resolution Ultrasonography within 48 hrs of acute onset of symptoms following a detailed clinical examination. Alvarado scoring was done in all patients. Acute appendicitis and recurrent appendicitis were differentiated on the basis of clinical details and timeline of illness. Post operatively all specimens underwent gross and histopath examination and were divided into subgroups and tabulated as “early acute appendicitis”, “acute suppurative appendicitis” and “acute gangrenous Appendicitis”.Results: Wall thickness of acute appendicitis and recurrent appendicitis (presenting with acute onset of symptoms) were tabulated. Patients with wall thickness of <3mm had statistically significant higher prevalence of acute gangrenous appendicitis on pathological correlation. Patients with recurrent appendicitis had higher incidence of wall thickness <3mm, consequently increased incidence of acute gangrenous appendicitis. The value of z was 6.0715. The value of p is <0.00001. The result was significant at p <0.01 according to SPSS 16, which correlates well with findings.Conclusions: Wall thickness is an important indicator in the management of acute or recurrent appendicitis, wall thickness of <3mm or >3mm was decisive in patient management. Reduced wall thickness of appendix in patients with acute or recurrent appendicitis correlate with higher incidence of acute gangrenous appendicitis therefore are at higher risk of perforation and should be managed aggressively by surgical intervention to avoid complications.

Apendicitis aguda recurrente en pacientes apendicectomizados / Relapsed appendicitis in appendectomized patients

RESUMEN Introducción: La apendicitis aguda es la causa más común de abdomen agudo, que precisa de tratamiento quirúrgico mediante apendicectomía abierta o laparoscópica. La apendicitis del muñón o recurrente, en la que ocurre la inflamación del remanente apendicular, es una complicación tardía infrecuente de la apendicectomía. Objetivo: Identificar las posibles causas de la apendicitis recurrente, así como las medidas relacionadas con su prevención. Métodos: Se realizó una revisión de la literatura actualizada sobre el tema en formato digital, en publicaciones en idioma inglés y español. Conclusiones: La prevención de la apendicitis del muñón se basa en resecar el apéndice a menos de 0,5 cm de su base; los pacientes, con frecuencia, presentan síntomas análogos a los de antes de la primera cirugía, sin embargo, existe un incremento del riesgo de peritonitis y de graves complicaciones debido al retraso diagnóstico y terapéutico; es una causa poco frecuente de dolor abdominal en pacientes apendicectomizados, por lo que se debe guardar una alta sospecha para su diagnóstico precoz y tratamiento oportuno(AU)

ABSTRACT Introduction: Acute appendicitis is the most common cause of acute abdomen, which requires surgical treatment by open or laparoscopic appendectomy. Recurrent appendicitis of the stump, in which inflammation of the appendicular remnant occurs, is an infrequent late complication of appendectomy. Objective: To identify the possible causes of recurrent appendicitis, as well as the measures related to its prevention. Methods: A review of the updated literature on the subject was carried out in digital format, in publications in English and Spanish. Conclusions: Prevention of appendicitis of the stump is based on resecting the appendix less than 0.5 cm from its base; Patients frequently present symptoms similar to those before the first surgery, however, there is an increased risk of peritonitis and serious complications due to delayed diagnosis and therapy; It is a rare cause of abdominal pain in appendectomized patients, so high suspicion should be kept for its early diagnosis and prompt treatment(AU)

Apendicite crônica e apendicite recorrente: artigo de revisão e apresentação de casuística

Chronic and recurrent appendicitis are pathologic conditions that differ from acute appendicitis, the most common affection of the vermiform appendix. The purpose of the present study was to describe in detail the clinical features, diagnosis and pathology of those conditions.

A apendicite crônica e a apendicite recorrente são condições patológicas que diferem da apendicite aguda, a afecção mais comum do apêndice vermiforme. O propósito desse artigo é decifrar com critério os aspectos clínicos, o diagnóstico e a histopatologia da apendicite crônica e da apendicite recorrente. Os dados da literatura e as experiências clínica e cirúrgica dos autores, demonstradas por 10 pacientes com idade média entre 40 e 45 anos, com distribuição similar quanto ao sexo, sendo 6 pacientes com apendicite recorrente e 4 com apendicite crônica, permitem concluir que a apendicite crônica e a recorrente já não devem ser mais uma controvérsia ou dúvida, mas um fato inequívoco de importâncias clínica e acadêmica. Portanto, seus conceitos merecem difusão na literatura científica e nas escolas médicas.