ABSTRACT
UNLABELLED: Accurate diagnosis of acute appendicitis (AA) is still a problem and is not always easy, even for experienced surgeons. Studies have shown that 20 to 30% of the appendices removedwere normal. Therefore, various scoring systems have been developed to aid in the diagnosis of doubtful cases and reduce the number of unnecessary appendectomies. The aim of this study was to assess the diagnostic value of different scoring systems in acute appendicitis. MATERIAL AND METHODS: The study involved 94 patients who underwent laparotomy due to suspected acute appendicitis. Medical examination at hospital admission was performed by a resident and a general surgery specialist. The probability of AA was evaluated using six different scoring systems: Alvarado, Fenyo, Eskelinen, Ohman, Tzankis, and RIPASA. The resident calculated the results in individual systems. The decision to perform the operation was taken by a specialist surgeon who did not know the results. RESULTS: Normal appendix was removed in 26% of cases. Eskelinen, RIPASA and Alvarado systems showed highest sensitivity (99%, 88% and 85%, respectively). Tzankis and Fenyo systems showed highest specificity (62% and 50%, respectively). CONCLUSIONS: Our study has shown limited value of scoring systems for the diagnosis of acute appendicitis. The systems may improve diagnostic accuracy as they require obtaining a more detailed medical history, and making a more thorough and organized data analysis. However, the scoring systems should be treated only as an aid to diagnosis.
Subject(s)
Appendectomy , Appendicitis/classification , Appendicitis/diagnosis , Severity of Illness Index , Acute Disease , Appendicitis/epidemiology , Appendicitis/surgery , Databases, Factual , Female , Humans , MaleABSTRACT
An enteric fistula that occurs in an open abdomen is called an enteroatmospheric fistula (EAF) and is the most challenging complication for a surgical team to deal with. The treatment of EAF requires a multidisciplinary approach. First of all, sepsis has to be managed. Any fluid, electrolyte and metabolic disorders need to be corrected. Oral intake must be stopped and total parenteral nutrition introduced. The control and drainage of the effluent from the fistula is a separate issue. Since there are no fixed algorithms for the treatment of EAF, surgeons need to develop their own, often highly unconventional solutions. We present the case of a 24-year-old man who developed enteroatmospheric fistula after laparotomy and relaparotomy due to acute necrotic pancreatitis. Both the laparostomy and the fistula were successfully managed using modified negative pressure wound therapy. The literature regarding this issue was also reviewed.
Subject(s)
Intestinal Fistula/etiology , Intestinal Fistula/therapy , Laparotomy/adverse effects , Negative-Pressure Wound Therapy/methods , Postoperative Complications/etiology , Abdominal Wound Closure Techniques , Adult , Humans , Male , Pancreatitis, Acute Necrotizing/surgery , Treatment Outcome , Wound HealingABSTRACT
Schwannomas are benign tumors derived from glial cells of peripheral nerve sheaths. They usually occur in association with Von Recklinghausen's disease and most commonly are observed on the head, neck, and upper extremities. Rare morphological variants may be misinterpreted as a malignancy under microscopic examination. The study presented a case of a sporadic "ancient" Schwannoma cell tumor located in the retroperitoneum. Literature data concerning diagnosis and treatment of the above-mentioned pathology was also reviewed.
