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Diagnostic Value of Ultrasound Findings in Mesenteric Lymphadenitis in Children with Acute Abdominal Pain
A. Alamdaran,M. Hiradfar,B. Zandi,M. Orei
Iranian Journal of Radiology , 2005,
Abstract: Backgrounds/Objective: The aim of this study was to compare abdominal sonographic features of patients with mesenteric lymphadenitis versus sonographic features of the asymptomatic children, in order to identify diagnost ic criteria for mesenteric lymphadenitis. Patients and Methods: Ultrasound data from 113 children with acute abdominal pain whose suspected sonographic diagnosis was mesenteric adenitis or ileitis was inspected in a child hospital in March 2004 to March 2005. The fina l diagnoses were established after patient management and follow-up. As for the control group, a hundred asymptomatic children were referred from health centers or kindergartens. Results: No para-aortic lymphadenopathy was found in any of the subjects from the study and the control groups. The number of enlarge d mesenteric lymph nodes observed in symptomatic children was significantly greater than the figure in asymptomatic children (P0.0001). The highest rate of sensitivity was seen with the presence of RLQ lymphadenopathy (94.7%) and the highest rate of specifici ty was seen with the presence of lymphadenopathy in two or three areas of LUQ or mi d-abdomen together; lymphadenopathies larger than 6mm in RLQ; presence of more than 4 lymph nodes (with any size) in a sonographic image from RLQ; or thickening of terminal il eum more than 8mm (92%-100%) in the diagnosis of mesenteric lymphadenitis. Conclusion: In children with acute abdominal pain due to causes such as appendicitis which cannot be confirmed by ultrasound and the f indings consist of only enlarged mesenteric lymph nodes (≥4mm) and/or mural thickening of the terminal ileum ( ≥8mm), the probable diagnosis would be mesenteric adenitis-ileitis and surgery is not required; but close observation is recommended.
A new radiographic sign of acute appendicitis: fecal loading in the cecum for differential diagnosis of acute appendicitis in comparision with other abdominal inflammatory diseases.A prospective study
Andy Petroianu,Luiz Ronaldo Alberti,Renata Indelicato Zac
Einstein (S?o Paulo) , 2007,
Abstract: Objective: The purpose of this investigation was to verify theimportance of the radiographic sign of fecal loading in the cecum forthe differential diagnosis of acute appendicitis. Methods: A total of470 consecutive patients of both sexes was admitted to hospital dueto acute abdomen and pain in the right flank and prospectively studied.The patients were divided as follows: Group 1 (n = 170) – diagnosedwith acute appendicitis and subdivided into two subgroups: Subgroup1A – (n = 100) – patients submitted to an abdominal radiographicstudy a few hours before surgical treatment, Subgroup 1B – (n = 70)– patients submitted to two radiographic studies of the abdomen, onebefore the surgical procedure and the other on the next day; Group 2(n = 100) – patients of both sexes with right nephrolithiasis submittedto an abdominal radiography during the episode of pain caused by thecalculus; Group 3 (n = 100) – women diagnosed with right acuteinflammatory pelvic disease that underwent an abdominal radiographicstudy during the pain crisis; Group 4 (n = 100) – patients of both sexeswho underwent surgery due to acute cholecystitis and were submittedto abdominal radiography during the pain episode that preceded thesurgical procedure. Results: The sign of fecal loading in the cecumwas present in 97 patients of Subgroup 1A, in 68 patients of Subgroup1B, in 19 patients of Group 2, in 12 patients of Group 3 and in 13patients of Group 4. During the postoperative period the radiographicsign disappeared in 66 of the 68 cases who presented the sign. Thesensitivity of the radiographic sign for acute appendicitis was 97.05%and specificity was 85.33%. The positive predictive value for acuteappendicitis was 78.94% and its negative predictive value was 98.08%.Conclusion: The radiographic image of fecal loading in the cecum isassociated with acute appendicitis. The image usually disappears soonafter the appendix is removed. This sign is uncommon in other acuteinflammatory diseases of the right side of the abdomen.
Acute Myeloid Leukemia Presenting as Acute Appendicitis  [PDF]
Sherri Rauenzahn,Caroline Armstrong,Brendan Curley,Sarah Sofka,Michael Craig
Case Reports in Hematology , 2013, DOI: 10.1155/2013/815365
Abstract: Appendicitis in leukemic patients is uncommon but associated with increased mortality. Additionally, leukemic cell infiltration of the appendix is extremely rare. While appendectomy is the treatment of choice for these patients, diagnosis and management of leukemia have a greater impact on remission and survival. A 59-year-old Caucasian female was admitted to the surgical service with acute right lower quadrant pain, nausea, and anorexia. She was noted to have leukocytosis, anemia, and thrombocytopenia. Abdominal imaging demonstrated appendicitis with retroperitoneal and mesenteric lymphadenopathy for which she underwent laparoscopic appendectomy. Peripheral smear, bone marrow biopsy, and surgical pathology of the appendix demonstrated acute myeloid leukemia (AML) with nonsuppurative appendicitis. In the setting of AML, prior cases described the development of appendicitis with active chemotherapy. Of these cases, less than ten patients had leukemic infiltration of the appendix, leading to leukostasis and nonsuppurative appendicitis. Acute appendicitis with leukemic infiltration as the initial manifestation of AML has only been described in two other cases in the literature with an average associated morbidity of 32.6 days. The prompt management in this case of appendicitis and AML resulted in an overall survival of 185 days. 1. Introduction Early and prompt diagnosis of AML has been proven to decrease morbidity and mortality [1]. Acute appendicitis has infrequently been described in the setting of known acute leukemia and is generally associated with patients receiving active chemotherapy [2]. Leukemic cell infiltration of the appendix, first reported by Rappaport in 1967, is even less-well described [3]. Despite the infrequent occurrence, appendicitis in leukemic patients is associated with a higher mortality rate [2, 4]. While appendectomy is accepted as the treatment of choice for appendicitis in patients with acute leukemia [5], diagnosis and prompt management of the leukemia have a greater impact on achieving a complete remission and, thus, overall survival. This case of acute appendicitis demonstrates the importance of maintaining a broad differential and seeking prompt diagnostic consultation. 2. Case Presentation A 59-year-old Caucasian female, with no significant past medical history, presented to the surgical service for management of acute appendicitis. The patient described two days of lower abdominal pain that she noted to be worse on the right with sudden onset and increasing severity. She noted associated diarrhea two days prior to
A ruptured infected mesenteric cyst diagnosed on laparoscopy for suspected appendicitis
Stephen T. Ward,Baljinder Singh,Terence J. Jones,Charles S. Robertson
Annals of Gastroenterology , 2011,
Abstract: Lower abdominal pain of acute onset in young women with a negative pregnancy test is a frequent reason for referral to the general surgical team and the differential diagnoses include acute appendicitis, complicated ovarian cysts and pelvic inflammatory disease. Intestinal and mesenteric cystic disease is a rare entity and less than half of cases present acutely. We present a case of a 25-year-old woman who underwent diagnostic laparoscopy for acute lower abdominal pain and was diagnosed with a ruptured, infected mesenteric cyst. Keywords laparoscopy, mesenteric cyst, appendicitis, abdomen, acute, general surgery Ann Gastroenterol 2011; 24 (2): 137-139
Mesenteric lymphatic malformation associated with acute appendicitis: a case report
Catherine Hunter, Meghan Connelly, Steven Lee, Larry Wang, Nam Nguyen
Journal of Medical Case Reports , 2009, DOI: 10.4076/1752-1947-3-9030
Abstract: We describe the first case of a mesenteric lymphatic malformation associated with acute appendicitis in a 13-year-old Caucasian boy. The patient is well six months after surgical excision of the tumor.The reader should be aware that growth and/or development of mesenteric lymphatic malformations may be associated with trauma and other pro-inflammatory processes.Mesenteric lymphatic malformations (MLM) are rare, benign tumors that most commonly develop in children [1]. The nomenclature of lymphatic malformations is at times confusing; microcystic lymphatic malformation was previously called lymphangioma and macrocystic was called cystic hygroma. Lymphangiomas are commonly located in the skin and subcutaneous tissues, although they have been described in deeper tissues including the neck, axilla, and retroperitoneum. The incidence of intra-abdominal MLM is low, with less than 200 cases in the literature [2]. One institution reported 193 cases of children with lymphangiomas, with the following distribution: cervical (31.4%), craniofacial (18.9%), extremity (18.9%), trunk (9.2%), abdominal (9.2%), cervicoaxillothoracic (4.9%), cervicomediastinal (2.2%), intrathoracic (1.6%) and multiple (3.8%) [3]. The etiology of lymphatic malformations is unclear. They may be congenital or may develop secondary to infection or trauma. We present the first case report of a child who developed MLM associated with acute appendicitis.A 13-year-old Caucasian boy presented with acute appendicitis, characterized by right lower quadrant pain. He underwent a laparoscopic appendectomy, and a pathology report confirmed the diagnosis of focal acute appendicitis. No intra-abdominal masses were noted at the time of surgery. However, after the operation, the patient experienced persistent drainage of serosanginous fluid from a trochar site. Once this drainage ceased, the patient was discharged home ten days after admission.During the next six months he continued to experience intermittent abdominal
Computed Tomography Diagnosis of Acute Appendicitis—Pictorial Essay  [PDF]
Aarthi Govindarajan, Bhawna Dev, Roy Santosham, Joseph Santhosh
Surgical Science (SS) , 2011, DOI: 10.4236/ss.2011.23022
Abstract: Acute appendicitis is a common surgical emergency with varied clinical presentations. Early diagnosis is absolutely necessary to minimize morbidity whereas delayed or missed diagnosis can cause adverse consequences. Computed tomography is a highly accurate imaging technique for diagnosing appendicitis. Hence it plays a valuable role in selected patients with suspected appendicitis; [1]. In this essay, we review the normal Computed tomography anatomy of the appendix and the right lower quadrant and illustrate the Computed tomography signs of appendicitis and important differential diagnostic entities. The Computed tomography appearance of complications of acute appendicitis is also presented, as are issues concerning clinical presentation and duration of the symptoms. Computed tomography signs can be varied and overlooked as they say what is easy to see is also easy to miss.
Integral Diagnosis of Acute Appendicitis  [PDF]
R.R. Kasimov,А.А. Mukhin
Sovremennye Tehnologii v Medicine , 2012,
Abstract: Dissatisfaction with the results of acute appendicitis diagnostics has given rise to the development of an integral diagnostic technique based on the use of diagnostic scores. The objects of the research were conscripts admitted to a military hospital with suspected acute appendicitis. In addition to routine diagnosis, there was developed Acute Appendicitis Initial Diagnosis Score and Acute Appendicitis Diagnosis Score, in which there was used a new criterion — C-reactive protein concentration in venous blood. The characteristics of the test were the following: sensitivity — 58.8%, specificity — 92.3%, overall accuracy — 73.3%, false-negative response – 41.2%, false-positive — 7.7%, positive predicted value — 90.9%. On integrating the data matrixes of these retrospective and prospective studies, there was developed the final score of acute appendicitis diagnosis with the following characteristics: sensitivity — 94.1%, specificity — 100%, overall accuracy — 96.7%, false-negative response — 5.9%, false-positive response — 0%, positive predicted value — 100%. The test was approved on 30 patients. There were no cases of resection of normal or catarrhal vermix. In 17 cases destructive appendicitis was diagnosed. 13 patients were discharged with the diagnosis of appendicular colic. The proposed complex integral approach enables to improve the efficiency of noninvasive diagnostics of acute appendicitis.
Septic Mesenteric Venous Thrombophlebitis: A Rare Complication of Acute Appendicitis
Stylianos Kykalos,Georgios C. Sotiropoulos,Spiridon Vernadakis
Case Reports in Medicine , 2011, DOI: 10.1155/2011/858563
Abstract: Mesenteric venous thrombophlebitis represents a very rare complication of acute appendicitis. Based on the findings of a 45-year-old patient with mesenteric venous thrombophlebitis due to acute appendicitis, we herein describe the diagnostic difficulties and therapeutic options in this uncommon disease. The treatment in our case consisted of simple appendectomy and perioperative anticoagulation therapy.
Ultrasonography in the diagnosis of acute appendicitis
Luciano Augusto Botter,George Rachid Oliveira,Janos Lima de Farias,Alexandre Maurano
Einstein (S?o Paulo) , 2005,
Abstract: Objective: To evaluate the role of sonography in diagnosis ofacute appendicitis, with an emphasis on early evolution cases.Methods: From 240 cases with the diagnosis of appendicitis, aretrospective study of 149 patients submitted to appendicectomyat the Hospital Israelita Albert Einstein, in 2002, was carried out.The appendix of these 149 patients was visualized in apreoperative sonography and the diagnosis was confirmed byhistological examination. Patients were distributed into twogroups - initial and advanced - according to the measure of thelargest external diameter of the appendix. The statistical dataanalysis included demographic information (sex and age) anddirect and indirect signs of acute appendicitis. Results: Therewere more cases of acute appendicitis in the groups aged 10-30years, mean age of 18.3 years in the initial group and 26.4 yearsin the advanced group. There was no statistically significantdifference regarding sex. The advanced group presented 4.5%of false-positive results and the initial group, 23.1%. Among thedirect signs, non-compressibility of the appendix stood out andwas observed in more than half cases; with regard to indirectsigns, hyperechogenicity of periappendiceal tissues wasobserved in up to 75% of cases in both groups. Conclusion: Therewas a statistically significant difference in false-positive cases,which were more often observed in the initial group. Therefore,sonographic follow-up is recommended in these cases.
The Usefulness of Procalcitonin in the Diagnosis of Appendicitis in Children: A Pilot Study  [PDF]
Abu N. G. A. Khan,Abdel Sawan,Antonios Likourezos,Mark Schnellinger,Estavan Garcia
Emergency Medicine International , 2012, DOI: 10.1155/2012/317504
Abstract: Objective. To assess the predictive value of procalcitonin in detecting acute appendicitis (AP) in children, and to determine a cutoff value of procalcitonin which can safely include/exclude the diagnosis of acute appendicitis in children with acute abdominal pain. Methods. Prospective cohort study of children aged 5–17 years presenting to the emergency room with right lower quadrant (RLQ) tenderness and strong suspicion for acute AP. In addition to standard diagnostic workup for acute AP, a quantitative procalcitonin level was measured using immunoluminometric assay. Recursive partitioning model was used to assess the usefulness of procalcitonin in the diagnosis of appendicitis. Results. Of the 50 children studied, 48% were diagnosed to have AP. The mean procalcitonin level was higher among the children with appendicitis ( ). Using the recursive partitioning model, we identified a cutoff value of procalcitonin level of 0.39 with a likelihood ratio presence of appendicitis 3.25 and absence of appendicitis 0.8. None of the study subjects with procalcitonin level <0.39 and WBC count of <6.76?K had appendicitis. Conclusions. In conjunction with the clinical symptoms, a procalcitonin level and WBC count could be a strong predictor of acute appendicitis in children. 1. Introduction Abdominal pain is one of the most frequently encountered complaints in the pediatric emergency room (ER). The approach to a child with abdominal pain often presents a dilemma to the pediatric ER staff. The pediatric ER physician and surgeon must be able to develop a differential diagnosis based on the clinical presentation of the child, in order to formulate a final diagnosis. Amongst the numerous etiologies of abdominal pain in children, acute appendicitis is one of the most common one that requires immediate intervention. Appendicitis affects 6% of the population [1, 2]. Morbidity and mortality rates are related to the time from the first onset of symptoms to the definitive diagnosis. Complications of misdiagnosing appendicitis include intraabdominal abscess, wound infection, adhesion formation, bowel obstruction, and infertility. The ability to diagnose acute appendicitis, reliably, is not clear-cut. Along the way, various predictive indicators have been researched to help make the diagnosis of acute appendicitis easier. In general, any patient with abdominal pain and more specifically, right lower quadrant tenderness, is approached with the goal of eliciting enough evidence to be able to rule in or out acute appendicitis. Information is gathered via clinical examination,
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