Case report and systematic review of blunt abdominal trauma as a cause of acute appendicitis

Acute appendicitis commonly presents as an acute abdomen. Cases of acute appendicitis caused by blunt abdominal trauma are rare. The aetiology and pathphysiology of appendicitis have been well investigated. However, the occasional cases of co-existent appendicitis and blunt abdominal trauma raise questions regarding a possible cause/effect relationship. We present a case and review of appendicitis following blunt abdominal trauma. The aim of this study is to collate and report the clinical presentations and experience of such case by internet search using PubMed and the keywords 'appendicitis', 'abdominal' and 'trauma' a literature review was carried out. The initial search returned 382 papers, of which 18 articles were included. We found 29 cases of acute appendicitis secondary to blunt abdominal trauma reported in the literature between 1991 and 2010. Mechanisms of injury included road traffic accidents, falls, assaults and accidents. Presenting symptoms invariably included abdominal pain, also nausea, vomiting and anorexia. Only 13 patients had computed tomography scans and 10 patients had ultrasonography. All reported treatment was surgical and positive for appendicitis. Although rare, the diagnosis of acute appendicitis must be considered following direct abdominal trama especially if the patient complains of abdominal right lower quadrant pain, nausea and anorexia. Haemodynamically stable patients who present shortly after blunt abdominal trauma with right lower quadrant pain and tenderness should undergo urgent imaging with a plan to proceed to appendicectomy if the imaging suggested an inflammatory process within the right iliac fossa

reliability of modified Alvarado score as a tool for diagnosis of acute appendicitis in Sudanese adults

Decision making in cases of acute appendicitis may be difficult especially for junior surgeons as diagnosis of that condition is sometimes difficult. In conditions like acute appendicitis, it is not possible to have definitive diagnosis by gold standard test [histopathology] before surgery, so various diagnostic modalities are introduced to establish accurate diagnosis. Modified Alvarado score [MAS] system is one of the examples. This work was carried out to evaluate the reliability and sensitivity of modified Alvarado scoring system in Sudanese adult patients with suspected diagnosis of acute appendicitis This prospective study included 866 [452 males and 414 females] who underwent appendicectomy in different centers in Khartoum, Sudan in the period from January 2006 to August 2007. It included all adult patients above 16 years with clinical diagnosis of acute appendicitis. Modified Alvarado score system was calculated for all patients; however decision to operate was clinical.The results showed that the overall sensitivity, specificity and accuracy were 87.78%, 24.78% and 79e.56% respectively. Our data suggested that the modified Alvarado scoring system had little applicability to the local adult population. Its sensitivity was high but the specificity was too low. So, we conclude that the modified Alvarado scoring system is not accurate in the diagnosis of suspected cases of acute appendicitis in Sudanese adult patients

study of the hospital stay in laparoscopic cholecystectomy versus open cholecystectomy

Each year, large numbers of Sudanese have gallbladder surgery. Surgery options include the standard procedure, called laparoscopic cholecystectomy, and an older more invasive procedure, called open cholecystectomy. While elective cholecystectomy now carries extremely low morbidity and mortality rates, the operation does incur sizable expense in terms of hospitalization and time lost from work. The advantages of hospital stay in laparoscopic cholecystectomy versus open cholecystectomy were questioned because the recovery from open cholecystectomy is brief