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2.
BMJ Open ; 12(4): e054304, 2022 Apr 01.
Article in English | MEDLINE | ID: covidwho-1774958

ABSTRACT

INTRODUCTION: Growing evidence is showing that complicated and uncomplicated appendicitis are two different entities that may be treated differently. A correct diagnosis of the type of appendicitis is therefore essential. The Scoring system of Appendicitis Severity (SAS) combines clinical, laboratory and imaging findings. The SAS rules out complicated appendicitis in 95% (negative predictive value, NPV) and detects 95% (sensitivity) of patients with complicated appendicitis in adults suspected of acute appendicitis. However, this scoring system has not yet been validated externally. In this study, we aim to provide a prospective external validation of the SAS in a new cohort of patients with clinical suspicion of appendicitis. We will optimise the score when necessary. METHODS AND ANALYSIS: The SAS will be validated in 795 consecutive adult patients diagnosed with acute appendicitis confirmed by imaging. Data will be collected prospectively in multiple centres. The predicted diagnosis based on the SAS score will be compared with the combined surgical and histological diagnosis. Diagnostic accuracy for ruling out complicated appendicitis will be calculated. If the SAS does not reach a sensitivity and NPV of 95% in its present form, the score will be optimised. After optimisation, a second external validation will be performed in a new group of 328 patients. Furthermore, the diagnostic accuracy of the clinical perspective of the treating physician for differentiation between uncomplicated and complicated appendicitis and the patient's preferences for different treatment options will be assessed. ETHICS AND DISSEMINATION: Ethical approval was granted by the Amsterdam UMC Medical Ethics Committee (reference W19_416 # 19.483). Because of the observational nature of this study, the study does not fall under the scope of the Medical Research Involving Human Subjects Act. Results will be presented in peer-reviewed journals. This protocol is submitted for publication before analysis of the results.


Subject(s)
Appendicitis , Acute Disease , Adult , Appendicitis/complications , Appendicitis/diagnosis , Appendicitis/surgery , Cohort Studies , Humans , Observational Studies as Topic , Predictive Value of Tests , Prospective Studies
3.
Rev. Col. Bras. Cir ; 48: e20213012, 2021. graf
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-1622415

ABSTRACT

ABSTRACT Introduction: the new coronavirus pandemic has been a reality throughout 2020, and it has brought great challenges. The virus predominantly manifests in the pediatric population with mild symptoms. However, an increase in the incidence of Multisystemic Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 has been described in the literature. MIS-C manifests mainly with fever and gastrointestinal symptoms and may mimic acute abdomen due to acute appendicitis. The objective of this study is to propose a care flowchart for suspected cases of acute appendicitis in the initial phase in pandemic times, considering the possibility of MIS-C. This situation was brought up by a patient treated in a pediatric hospital in Brazil. Discussion: It was possible to identify common signs and symptoms in the reported patient and those published cases that may serve as alerts for early identification of MIS-C cases. Based on the literature review and on the similarities between the syndrome and the inflammatory acute abdomen in children, we elaborated an initial approach for these cases to facilitate the identification, early diagnosis, and management. The flowchart considers details of the clinical history, physical examination, and complementary exams prior to the indication of appendectomy in patients with initial phase symptoms. Conclusion: MIS-C, although rare and of poorly known pathophysiology, is most often severe and has a high mortality risk. The use of the proposed flowchart can help in the diagnosis and early treatment of MIS-C.


RESUMO Introdução: a pandemia do novo coronavírus arrastou-se ao longo de 2020 e trouxe grandes desafios. Acredita-se que o vírus manifesta-se na população pediátrica predominantemente com quadros leves, entretanto, aumento da incidência da Síndrome Inflamatória Multissistêmica em Crianças (SIM-C) associada à COVID-19 tem sido descrito na literatura. A SIM-C manifesta-se principalmente com febre e sintomas gastrointestinais, podendo mimetizar abdome agudo inflamatório por apendicite aguda. O objetivo deste trabalho é propor fluxograma de atendimento dos casos suspeitos de apendicite aguda em fase inicial, em tempos de pandemia, considerando-se a possibilidade de SIM-C, motivado pelo caso de paciente atendido em hospital pediátrico no Brasil. Discussão: Foi possível identificar sinais e sintomas em comum entre o paciente aqui relatado e casos publicados que podem servir de alerta para identificação precoce dos casos de SIM-C. Com base na revisão da literatura e nas semelhanças entre a síndrome e quadros de abdome agudo inflamatório na criança, foi elaborado fluxograma de abordagem inicial destes doentes para facilitar a identificação, diagnóstico precoce e condução dos pacientes. O fluxograma leva em consideração detalhes da história clínica, exame físico e exames complementares antes da indicação de apendicectomia em pacientes com sintomas na fase inicial. Conclusão: A SIM-C, apesar de rara e da fisiopatologia pouco conhecida, apresenta-se na maioria das vezes de forma grave e possui alto risco de mortalidade. O uso do fluxograma proposto pode auxiliar no diagnóstico e tratamento precoce da SIM-C.


Subject(s)
Humans , Child , Appendicitis/diagnosis , COVID-19/complications , Software Design , Systemic Inflammatory Response Syndrome , Pandemics , SARS-CoV-2
4.
BMC Gastroenterol ; 22(1): 19, 2022 Jan 11.
Article in English | MEDLINE | ID: covidwho-1622211

ABSTRACT

BACKGROUND: During a global crisis like the current COVID-19 pandemic, delayed admission to hospital in cases of emergent medical illness may lead to serious adverse consequences. We aimed to determine whether such delayed admission affected the severity of an inflammatory process regarding acute appendicitis, and its convalescence. METHODS: In a retrospective observational cohort case-control study, we analyzed the medical data of 60 patients who were emergently and consecutively admitted to our hospital due to acute appendicitis as established by clinical presentation and imaging modalities, during the period of the COVID-19 pandemic (our study group). We matched a statistically control group consisting of 97 patients who were admitted during a previous 12-month period for the same etiology. All underwent laparoscopic appendectomy. The main study parameters included intraoperative findings (validated by histopathology), duration of abdominal pain prior to admission, hospital stay and postoperative convalescence (reflecting the consequences of delay in diagnosis and surgery). RESULTS: The mean duration of abdominal pain until surgery was significantly longer in the study group. The rate of advanced appendicitis (suppurative and gangrenous appendicitis as well as peri-appendicular abscess) was greater in the study than in the control group (38.3 vs. 21.6%, 23.3 vs. 16.5%, and 5 vs. 1% respectively), as well as mean hospital stay. CONCLUSIONS: A global crisis like the current viral pandemic may significantly affect emergent admissions to hospital (as in case of acute appendicitis), leading to delayed surgical interventions and its consequences.


Subject(s)
Appendicitis , COVID-19 , Laparoscopy , Acute Disease , Appendectomy , Appendicitis/diagnosis , Appendicitis/epidemiology , Appendicitis/surgery , Case-Control Studies , Delayed Diagnosis , Humans , Length of Stay , Pandemics , Postoperative Complications/epidemiology , Retrospective Studies , SARS-CoV-2
5.
Ann R Coll Surg Engl ; 104(4): 302-307, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1562205

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has increased the risks of surgery and management of common surgical conditions has changed, with greater reliance on imaging and conservative management. The negative appendectomy rate (NAR) in the UK has previously remained high. The aim of this study was to quantify pandemic-related changes in the management of patients with suspected appendicitis, including the NAR. METHODS: A retrospective study was performed at a single high volume centre of consecutive patients aged over five years presenting to general surgery with right iliac fossa pain in two study periods: for two months before lockdown and for four months after lockdown. Pregnant patients and those with previous appendectomy, including right colonic resection, were excluded. Demographic, clinical, imaging and histological data were captured, and risk scores were calculated, stratifying patients into higher and lower risk groups. Data were analysed by age, sex and risk subgroups. RESULTS: The mean number of daily referrals with right iliac fossa pain or suspected appendicitis reduced significantly between the study periods, from 2.92 before lockdown to 2.07 after lockdown (p<0.001). Preoperative computed tomography (CT) rates increased significantly from 22.9% to 37.2% (p=0.002). The NAR did not change significantly between study periods (25.5% prior to lockdown, 11.1% following lockdown, p=0.159). Twelve (75%) out of sixteen negative appendectomies were observed in higher risk patients aged 16-45 years who did not undergo preoperative CT. The NAR in patients undergoing CT was 0%. CONCLUSIONS: Greater use of preoperative CT should be considered in risk stratified patients in order to reduce the NAR.


Subject(s)
Appendicitis , COVID-19 , Acute Disease , Adolescent , Adult , Appendectomy , Appendicitis/complications , Appendicitis/diagnosis , Appendicitis/epidemiology , COVID-19/epidemiology , Child, Preschool , Communicable Disease Control , Humans , Ilium , Middle Aged , Pain , Pandemics , Retrospective Studies , Young Adult
6.
Eur Rev Med Pharmacol Sci ; 25(22): 7115-7126, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1552078

ABSTRACT

COVID-19 is to date a global pandemic that can affect all age groups; gastrointestinal symptoms are quite common in patients with COVID-19 and a new clinical entity defined as Multisystem Inflammatory Syndrome in Children (MIS-C) has been described in children and adolescents previously affected by COVID-19. Presenting symptoms of this new disease include high fever and severe abdominal pain that can mimic more common causes of abdominal pain; patients can rapidly deteriorate presenting severe cardiac dysfunction and multiorgan failure. Some fatalities due to this serious illness have been reported. We describe the case of a ten-year-old patient presenting with persistent high fever associated with continuous and worsening abdominal pain. Various hypotheses were performed during his diagnostic workup and an initial appendectomy was performed in the suspect of acute appendicitis. As his clinical picture deteriorated, the child was subsequently diagnosed and successfully treated as a case of MIS-C. The objective of this case report and brief review of abdominal pain in children throughout the age groups is to provide the emergency pediatrician with updated suggestions in diagnosing abdominal pain in children during the COVID-19 pandemic.


Subject(s)
Abdominal Pain/etiology , COVID-19/complications , Pediatric Emergency Medicine/statistics & numerical data , Systemic Inflammatory Response Syndrome/diagnosis , Abdominal Pain/diagnosis , Acute Disease , Appendectomy/methods , Appendicitis/diagnosis , Appendicitis/surgery , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/pathology , COVID-19/therapy , COVID-19/virology , Combined Modality Therapy , Conjunctivitis/etiology , Dyspnea/diagnosis , Dyspnea/therapy , Fever/diagnosis , Fever/etiology , Humans , Immunoglobulins, Intravenous/administration & dosage , Immunoglobulins, Intravenous/therapeutic use , Male , Mucositis/etiology , Oxygen/therapeutic use , Pediatric Emergency Medicine/trends , Platelet Aggregation Inhibitors/therapeutic use , SARS-CoV-2/genetics , Steroids/therapeutic use , Systemic Inflammatory Response Syndrome/complications , Systemic Inflammatory Response Syndrome/pathology , Systemic Inflammatory Response Syndrome/therapy , Treatment Outcome
7.
Medicina (Kaunas) ; 57(11)2021 Nov 11.
Article in English | MEDLINE | ID: covidwho-1512490

ABSTRACT

Background and Objectives: Our aim was to see if the COVID-19 pandemic led to an increase of time until diagnosis, operation, and time spent in Emergency room (ER), and if it resulted in more cases of complicated appendicitis and complication rates in children. Materials and Methods: We conducted a retrospective analysis of patients admitted to the Pediatric Surgery Department with acute appendicitis during a 4-month period of the first COVID-19 pandemic and compared it to the previous year data-the same 4-month period in 2019. Results: During the pandemic, the time spent in the ER until arriving at the department increased significantly 2.85 vs. 0.98 h p < 0.001, and the time spent in the department until the operation 5.31 vs. 2.66 h, p = 0.03. However, the time from the beginning of symptoms till ER, operation time and the length of stay at the hospital, as well as the overall time until operation did not differ and did not result in an increase of complicated appendicitis cases or postoperative complications. Conclusions: The COVID-19-implemented quarantine led to an increase of the time from the emergency room to the operating room by 4 h. This delay did not result in a higher rate of complicated appendicitis and complication rates, allowing for surgery to be postponed to daytime hours if needed.


Subject(s)
Appendicitis , COVID-19 , Appendectomy , Appendicitis/diagnosis , Appendicitis/epidemiology , Appendicitis/surgery , Child , Humans , Pandemics , Retrospective Studies , SARS-CoV-2
8.
Braz J Infect Dis ; 25(6): 101651, 2021.
Article in English | MEDLINE | ID: covidwho-1509601

ABSTRACT

Coronavirus disease 2019 (COVID-19) pandemic is a global health emergency. The clinical course of COVID-19 in children is mild in most of the cases, but multisystem inflammatory syndrome in children (MIS-C) is recognized as a potential life-threatening complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Acute abdomen as a presentation of COVID-19 is rare, and its correlation to COVID-19 features and prognosis remains undetermined. Herein, we describe a case of appendicitis in a child with confirmed diagnosis of COVID-19 and subsequent SARS-CoV-2 identification in appendix tissue.


Subject(s)
Abdomen, Acute , Appendicitis , COVID-19 , Systemic Inflammatory Response Syndrome , Abdomen, Acute/etiology , Appendicitis/complications , Appendicitis/diagnosis , COVID-19/complications , COVID-19/diagnosis , Child , Humans , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/diagnosis
9.
Pril (Makedon Akad Nauk Umet Odd Med Nauki) ; 42(2): 95-101, 2021 Oct 26.
Article in English | MEDLINE | ID: covidwho-1485000

ABSTRACT

Multisystem Inflammatory Syndrome in Children (MIS-C) is characterized by an inflammation with fever, elevated inflammatory markers, conjunctivitis, rash, impaired coagulation, gastrointestinal symptoms and cardiac abnormalities that may progress to multiorgan failure. The presence of a positive COVID-19 antigen via a PCR test, serological testing for antibodies or close contact with a person diagnosed with COVID-19 helps differentiate MIS-C from other diseases. Gastrointestinal symptoms are recognized to be associated with COVID-19 infection or MIS-C in children, presenting as abdominal pain, gastrointestinal infection with watery stools, appendicitis, ileitis, pancreatitis and hepatitis, confusing the diagnosis with other gastrointestinal diseases. In this case report, we describe an 11 year old boy with MIS-C, who presents acute phlegmona of the appendix for which he undergoes appendectomy, accompanied with acute pancreatitis. These manifestations of MIS-C in our patient resolved without additional complications after a 2 month follow up. We call attention to MIS-C presenting in pediatric patients with fever and abdominal pain which might be caused by appendicitis and pancreatitis, and we recommend abdominal imaging and additional laboratory investigation to promote earlier diagnosis.


Subject(s)
Appendicitis , COVID-19 , Pancreatitis , Acute Disease , Appendicitis/diagnosis , COVID-19/complications , Child , Humans , Male , Pancreatitis/diagnosis , SARS-CoV-2 , Systemic Inflammatory Response Syndrome
11.
Ann R Coll Surg Engl ; 103(8): 604-611, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1379818

ABSTRACT

INTRODUCTION: A novel hyperinflammatory syndrome has emerged in the paediatric population: paediatric inflammatory multisystem syndrome - temporally associated with SARS-CoV-2 (PIMS-TS). Up to 50% of patients develop shock with cardiac dysfunction but presentation with acute abdominal pain is common and difficult to distinguish from appendicitis. METHOD: Prospective case series of PIMS-TS patients presenting to a single UK tertiary paediatric centre. RESULTS: As of 16 September 2020, 89 patients have presented with PIMS-TS to our institution; 19 (21.3%) were referred for surgical review. Pyrexia and acute abdominal pain were seen in all 19 patients. Diarrhoea was reported in 14 (73%) and vomiting in 12 (63%). On examination, eight (42%) had right abdominal tenderness, of which five had right iliac fossa (RIF) peritonism. C-reactive protein (CRP) was universally raised: median 176 (15-463)mg/l. Abdominal imaging was performed in 17 (89%), with 11 undergoing abdominal ultrasonography (65%) and 8 abdominal computed tomography (47%); two required both. Findings included nonspecific features of inflammation in the RIF. Eight patients (42%) had an abnormal echocardiogram at admission. Two (10%) patients, with classical signs and symptoms of appendicitis, underwent appendicectomy without radiological imaging and were subsequently diagnosed with PIMS-TS. During the same period, 18 patients underwent appendicectomy for histologically confirmed appendicitis. Serum CRP and ferritin levels were significantly higher in the PIMS-TS cohort compared with children with appendicitis. CONCLUSIONS: PIMS-TS is a novel paediatric condition that may mimic appendicitis. It should be considered in patients presenting with abdominal pain to avoid unnecessary surgery in children at risk of cardiovascular instability.


Subject(s)
COVID-19/diagnosis , Systemic Inflammatory Response Syndrome/diagnosis , Adolescent , Appendectomy , Appendicitis/diagnosis , Appendicitis/surgery , Biomarkers/blood , C-Reactive Protein/analysis , Child , Child, Preschool , Diagnosis, Differential , Female , Ferritins/analysis , Fibrin Fibrinogen Degradation Products/analysis , Humans , Infant , Male , Natriuretic Peptide, Brain/blood , Peptide Fragments/blood , Prospective Studies
12.
Pol Przegl Chir ; 93(4): 15-20, 2021 Mar 16.
Article in English | MEDLINE | ID: covidwho-1346687

ABSTRACT

<b> Objective: </b> Cecal diverticulitis may be encountered as a real etiological factor in 1/300 appendectomies. Differential diagnosis of acute appendicitis and cecal diverticulitis is crucial because of the different treatment methods. Our aim is to reveal the importance of distinguishing acute appendicitis from cecal diverticulitis. <p> <b>Methods: </b> The data of patients who were admitted to the hospital between 2015 and 2019 with the complaint of abdominal pain and then finally diagnosed with colon diverticular disease, colon diverticulitis, or acute appendicitis, analyzed retrospectively. <p><b>Results: </b> A total of 19 cecum diverticulitis patients were detected during surgery for acute appendicitis or during clinical and radiological evaluation. 1247 appendectomies were evaluated; the final diagnosis was observed as cecal diverticulitis in 5 patients (0,4%). One hundred nineteen patients diagnosed with colonic diverticulitis at admission were evaluated, while 105 (88,2%) of them had left-sided diverticulitis, 14 (11,7%) of them had solitary cecal diverticulitis. All of the solitary cecal diverticulitis patients were treated conservatively, except one patient who has Hinchey 3 diverticulitis.<p><b> Conclusion: </b> Differential diagnosis of cecum diverticulitis with acute appendicitis is important because cecum diverticulitis can be managed as conservatively in most cases. In order to prevent unnecessary surgical interventions, this importance has increased, especially during the COVID-19 pandemic period.


Subject(s)
Appendicitis , COVID-19 , Diverticulitis , Acute Disease , Appendectomy , Appendicitis/diagnosis , Appendicitis/surgery , Cecum , Diagnosis, Differential , Diverticulitis/diagnosis , Diverticulitis/surgery , Humans , Pandemics , Retrospective Studies , SARS-CoV-2
13.
Surg Endosc ; 36(5): 3460-3466, 2022 May.
Article in English | MEDLINE | ID: covidwho-1326825

ABSTRACT

BACKGROUND: Patient attendance at emergency departments (EDs) during the COVID-19 pandemic outbreak has decreased dramatically under the "stay at home" and "lockdown" restrictions. By contrast, a notable rise in severity of various surgical conditions was observed, suggesting that the restrictions coupled with fear from medical facilities might negatively impact non-COVID-19 diseases. This study aims to assess the incidence and outcome of complicated appendicitis (CA) cases during that period. METHODS: A retrospective study comparing the rate and severity of acute appendicitis (AA) cases during the COVID-19 initial outbreak in Israel during March and April of 2020 (P20) to the corresponding period in 2019 (P19) was conducted. Patient data included demographics, pre-ED status, surgical data, and postoperative outcomes. RESULTS: Overall, 123 patients were diagnosed with acute appendicitis, 60 patients during P20 were compared to 63 patients in P19. The rate of complicated appendicitis cases was significantly higher during the COVID-19 Lockdown with 43.3% (26 patients) vs. 20.6% (13 patients), respectively (p < 0.01). The average delay in ED presentation between P20 and P19 was 3.4 vs. 2 days (p = 0.03). The length of stay was 2.6 days in P20 vs. 2.3 days in P19 (p = 0.4), and the readmission rate was 12% (7 patients) vs. 4.8% (3 patients), p = 0.17, respectively. Logistic regression demonstrated that a delay in ED presentation was a significant risk factor for complicated appendicitis (OR 1.139, CI 1.011-1.284). CONCLUSION: The effect of the COVID-19 initial outbreak and Lockdown coupled with hesitation to come to medical facilities appears to have discouraged patients with acute appendicitis from presenting to the ED as complaints began, causing a delay in diagnosis and treatment, which might have led to a higher rate of complicated appendicitis cases and a heavier burden on health care systems.


Subject(s)
Appendicitis , COVID-19 , Acute Disease , Appendectomy/adverse effects , Appendicitis/diagnosis , Appendicitis/epidemiology , Appendicitis/surgery , COVID-19/epidemiology , Communicable Disease Control , Humans , Incidence , Length of Stay , Pandemics , Retrospective Studies
15.
Arch Argent Pediatr ; 119(4): 224-229, 2021 08.
Article in English, Spanish | MEDLINE | ID: covidwho-1325943

ABSTRACT

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.


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 y disminuyeron 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 retrospectivo comparativo de pacientes pediátricos con apendicitis 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 abordaje quirúrgico y las complicaciones. Resultados. Los casos totales de apendicitis se 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 de enfermedad de acuerdo con lo informado en los partes quirúrgicos. En 2019, todas las cirugías se realizaron por vía laparoscópica; en 2020, solo un 42% (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 número de 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.


Subject(s)
Appendectomy/trends , Appendicitis , COVID-19/prevention & control , Delayed Diagnosis/trends , Health Services Accessibility/trends , Practice Patterns, Physicians'/trends , Acute Disease , Adolescent , Appendectomy/methods , Appendicitis/diagnosis , Appendicitis/epidemiology , Appendicitis/surgery , Argentina/epidemiology , COVID-19/diagnosis , COVID-19/epidemiology , Child , Child, Preschool , Female , Hospitals, General , Humans , Incidence , Infant , Infant, Newborn , Laparoscopy/trends , Male , Pandemics/prevention & control , Retrospective Studies , Tertiary Care Centers
16.
Ann R Coll Surg Engl ; 103(7): 481-486, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1288678

ABSTRACT

INTRODUCTION: The first wave of COVID-19 was accompanied by global uncertainty. Delayed presentation of patients to hospitals ensued, with surgical pathologies no exception. This study aimed to assess whether delayed presentations resulted in more complex appendicectomies during the first wave of COVID-19. METHODS: Operation notes for all presentations of appendicitis (n=216) within a single health board (three hospitals) during two three-month periods (control period (pre-COVID) vs COVID pandemic) were analysed, and the severity of appendicitis was recorded as per the American Association for the Surgery of Trauma (AAST) grading system. RESULTS: Presentations of appendicitis were delayed during the COVID period with a median duration of symptoms prior to hospital attendance of two days versus one day (p=0.003) with individuals presenting with higher median white cell count than during the control period (14.9 vs 13.3, p=0.031). Use of preoperative CT scanning (OR 3.013, 95% CI 1.694-5.358, p<0.001) increased significantly. More complex appendicectomies (AAST grade >1) were performed (OR 2.102, 95% CI 1.155-3.826, p=0.015) with a greater consultant presence during operations (OR 4.740, 95% CI 2.523-8.903, p<0.001). Despite the greater AAST scores recorded during the COVID period, no increase in postoperative complications was observed (OR 1.145, 95% CI 0.404-3.244, p=0.798). CONCLUSIONS: Delayed presentations during the COVID-19 pandemic were associated with more complex cases of appendicitis. Important lessons can be learnt from the changes in practice employed as a result of this global pandemic.


Subject(s)
Appendectomy/methods , Appendicitis/diagnosis , COVID-19/epidemiology , Severity of Illness Index , Time-to-Treatment/statistics & numerical data , Adolescent , Adult , Appendectomy/adverse effects , Appendectomy/statistics & numerical data , Appendectomy/trends , Appendicitis/blood , Appendicitis/surgery , Appendix/diagnostic imaging , COVID-19/prevention & control , COVID-19/transmission , COVID-19 Testing/statistics & numerical data , Humans , Infection Control/standards , Length of Stay/statistics & numerical data , Lymphocyte Count , Male , Middle Aged , Pandemics/prevention & control , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Retrospective Studies , SARS-CoV-2/isolation & purification , Time-to-Treatment/trends , Tomography, X-Ray Computed/statistics & numerical data , Tomography, X-Ray Computed/trends , Young Adult
17.
BMJ Case Rep ; 14(6)2021 Jun 23.
Article in English | MEDLINE | ID: covidwho-1282061

ABSTRACT

This article presents an unusual case of appendicitis in pregnancy complicated by the novel coronavirus (SARS-CoV-2). The novel coronavirus has affected the way medicine is practised across most parts of the world with over 160 000 000 global cases to date. Tackling management of these cases is more complex when other pathological processes are ongoing. Appendicitis is a common occurrence in pregnancy, with most obstetric centres seeing about one or two cases a year. Though maternal morbidity and mortality are relatively unimpacted by this event, fetal loss and preterm labour are common sequelae. This case involves a 35-year-old woman presenting in her third trimester with abdominal pain and who went on to be diagnosed with concurrent appendicitis and SARS-CoV-2 infection. Although spinal anaesthesia would be most appropriate as it avoids aerosol generation, general anaesthetic techniques were indicated due to thrombocytopenia in this case. She underwent a successful appendicectomy, although preterm delivery was indicated as a result of maternal and fetal concerns.


Subject(s)
Appendicitis , COVID-19 , Pregnancy Complications, Infectious , Adult , Appendectomy , Appendicitis/complications , Appendicitis/diagnosis , Appendicitis/surgery , Female , Humans , Infant, Newborn , Pregnancy , Pregnancy Outcome , Pregnancy Trimester, Third , SARS-CoV-2
18.
Eur J Pediatr Surg ; 31(4): 311-318, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1279929

ABSTRACT

The fast-evolving nature of the coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented clinical, logistical, and socioeconomical challenges for health-care systems worldwide. While several studies have analyzed the impact on the presentation and management of acute appendicitis (AA) in the adult population, there is a relative paucity of similar research in pediatric patients with AA. To date, there is some evidence that the incidence of simple AA in children may have decreased during the first lockdown period in spring 2020, whereas the number of complicated AA cases remained unchanged or increased slightly. Despite a worrying trend toward delayed presentation, most pediatric patients with AA were treated expediently during this time with comparable outcomes to previous years. Hospitals must consider their individual capacity and medical resources when choosing between operative and non-operative management of children with AA. Testing for severe acute respiratory syndrome coronavirus type 2 is imperative in all pediatric patients presenting with fever and acute abdominal pain with diarrhea or vomiting, to differentiate between multisystem inflammatory syndrome and AA, thus avoiding unnecessary surgery. During the further extension of the COVID-19 crisis, parents should be encouraged to seek medical care with their children early in order that the appropriate treatment for AA can be undertaken in a timely fashion.


Subject(s)
Appendicitis , COVID-19 , Abdominal Pain , Appendicitis/diagnosis , Appendicitis/epidemiology , Appendicitis/therapy , COVID-19/diagnosis , Child , Diagnosis, Differential , Diarrhea , Humans , Incidence , Length of Stay , Pandemics , Postoperative Complications/epidemiology , Symptom Assessment , Systemic Inflammatory Response Syndrome/diagnosis , Vomiting
19.
J Trauma Acute Care Surg ; 91(1): 241-246, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1276289

ABSTRACT

BACKGROUND: During the coronavirus disease 2019 pandemic, New York instituted a statewide stay-at-home mandate to lower viral transmission. While public health guidelines advised continued provision of timely care for patients, disruption of safety-net health care and public fear have been proposed to be related to indirect deaths because of delays in presentation. We hypothesized that admissions for emergency general surgery (EGS) diagnoses would decrease during the pandemic and that mortality for these patients would increase. METHODS: A multicenter observational study comparing EGS admissions from January to May 2020 to 2018 and 2019 across 11 NYC hospitals in the largest public health care system in the United States was performed. Emergency general surgery diagnoses were defined using International Classification Diseases, Tenth Revision, codes and grouped into seven common diagnosis categories: appendicitis, cholecystitis, small/large bowel, peptic ulcer disease, groin hernia, ventral hernia, and necrotizing soft tissue infection. Baseline demographics were compared including age, race/ethnicity, and payor status. Outcomes included coronavirus disease (COVID) status and mortality. RESULTS: A total of 1,376 patients were admitted for EGS diagnoses from January to May 2020, a decrease compared with both 2018 (1,789) and 2019 (1,668) (p < 0.0001). This drop was most notable after the stay-at-home mandate (March 22, 2020; week 12). From March to May 2020, 3.3%, 19.2%, and 6.0% of EGS admissions were incidentally COVID positive, respectively. Mortality increased in March to May 2020 compared with 2019 (2.2% vs. 0.7%); this difference was statistically significant between April 2020 and April 2019 (4.1% vs. 0.9%, p = 0.045). CONCLUSION: Supporting our hypothesis, the coronavirus disease 2019 pandemic and subsequent stay-at-home mandate resulted in decreased EGS admissions between March and May 2020 compared with prior years. During this time, there was also a statistically significant increase in mortality, which peaked at the height of COVID infection rates in our population. LEVEL OF EVIDENCE: Epidemiological, level IV.


Subject(s)
COVID-19/prevention & control , Emergencies/epidemiology , Hospital Mortality/trends , Patient Admission/statistics & numerical data , Acute Disease/mortality , Acute Disease/therapy , Adolescent , Adult , Aged , Aged, 80 and over , Appendicitis/diagnosis , Appendicitis/mortality , Appendicitis/surgery , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/transmission , Cholecystitis/diagnosis , Cholecystitis/mortality , Cholecystitis/surgery , Emergency Service, Hospital , Hernia, Inguinal/diagnosis , Hernia, Inguinal/mortality , Hernia, Inguinal/surgery , Hernia, Ventral/diagnosis , Hernia, Ventral/mortality , Hernia, Ventral/surgery , Humans , Male , Middle Aged , Necrosis/diagnosis , Necrosis/mortality , Necrosis/surgery , New York/epidemiology , Pandemics/prevention & control , Patient Admission/trends , Peptic Ulcer/diagnosis , Peptic Ulcer/mortality , Peptic Ulcer/surgery , Retrospective Studies , SARS-CoV-2/isolation & purification , Soft Tissue Infections/diagnosis , Soft Tissue Infections/mortality , Soft Tissue Infections/surgery , Time-to-Treatment/statistics & numerical data , Time-to-Treatment/trends , Young Adult
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