Laparoscopic appendectomy for complicated acute appendicitis does not result in increased surgical complications.

BACKGROUND/OBJECTIVES: Septic postoperative complications are debated in patients with complicated acute appendicitis treated with laparoscopic appendectomy (LA). The aim of this study was to investigate the results of LA in both complicated and uncomplicated cases of acute appendicitis. METHODS: From January to December 2009, 94 patients with acute appendicitis underwent LA by the same surgeon using the three-port technique. Data were accumulated and compared between complicated and uncomplicated acute appendicitis. RESULTS: Of the 94 patients (45 women and 49 men), 19 had complicated and 75 uncomplicated acute appendicitis. The group with complicated acute appendicitis, as compared to the uncomplicated group, was significantly older (55.7 ± 20.5 years vs. 41.0 ± 18.0 years), and had a significantly increased operation time (117.6 ± 45.5 minutes vs. 78.2 ± 39.4 minutes), longer length of hospital stay (9.0 ± 3.3 days vs. 5.2 ± 6.0 days) and higher conversion rate (21.1% vs. 2.7%). No increase in surgical complications was noted in patients with complicated acute appendicitis, as compared to those with uncomplicated acute appendicitis. CONCLUSION: This study demonstrated no increase in surgical complications after LA in patients with complicated acute appendicitis when compared with those who had uncomplicated disease. Therefore, LA may be considered the first-choice treatment option for both uncomplicated and complicated acute appendicitis.

Anatomical reduction for treatment of displaced midshaft clavicular fractures: Knowles pinning vs. reconstruction plating.

The purpose of this study was to compare Knowles pinning and fixation with cerclage wires vs reconstruction plating and fixation with extraplate wires for the treatment of displaced midshaft clavicular fractures, with anatomical reduction serving as the objective. In this retrospective study, the records of 103 consecutive patients with complete follow-up data (minimum 12 months follow-up) treated operatively for displaced midshaft clavicular fractures between 1997 and 2009 by a single surgeon were reviewed. A total of 53 patients (mean age, 35.2±14.5 years) received Knowles pinning and 50 patients (mean age, 39.9±14.8 years) received reconstruction plating. No differences were observed between the groups with respect to type of fracture, union rate (88.7% vs. 94.0%, respectively; P=.439), and surgical complication rate (13.2% vs. 10.0%, respectively; P=.761). Wound length was significantly shorter in the Knowles pinning group (5.3±0.9 cm vs. 8.4±0.5 cm, respectively; P<.001) and implant-related complications, symptomatic hardware (P<.001), visible implant (P<.001), and palpable implant (P<.015) were significantly higher in the reconstruction plating than in the pinning group. Anatomical reduction is the ultimate objective of anatomical and functional restoration when surgical intervention is indicated, and patient compliance is the major prerequisite for surgical treatment. For treatment of displaced midshaft clavicle fractures, both Knowles pinning with cerclage wires and reconstruction plating with extraplate wires provide rigid fixation and perfect union.

Infective endocarditis caused by Streptococcus bovis complicated by a superior mesenteric artery mycotic aneurysm and systemic septic emboli in a patient with colon diverticulitis.

To date, Streptococcus bovis endocarditis complicated by a superior mesenteric artery mycotic aneurysm and systemic septic emboli in a patient with colon diverticulitis has never been reported. A 46-year-old man, with a history of colon diverticulitis identified by diagnostic colon fiberscope and with hypertension, presented with a 14-day history of intermittent fever. An echocardiogram revealed severe mitral regurgitation with two large floating vegetations attached to both mitral leaflets. A blood culture grew S. bovis. Abdominal pain and left leg weakness developed 10 days after admission. Computerized tomography identified a 5×3cm mycotic aneurysm, and angiography revealed a saccular aneurysm at the distal branch of the superior mesenteric artery. A duplex study revealed an intravascular mass at the left femoral artery bifurcation. The patient accordingly underwent surgical resection of the mycotic aneurysm, removal of the mycotic thrombi, and mitral valve replacement. The patient's recovery was unremarkable.