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  1. sokol
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    J Pediatr Surg. 1996 Feb;31(2):291-4.

    Recurrent appendicitis after initial conservative management of appendiceal abscess.

    Price MR, Haase GM, Sartorelli KH, Meagher DP Jr.

    Department of Pediatric Surgery, The Children's Hospital, Denver, CO, USA.

    Therapy for children with appendiceal abscess remains controversial. The authors present two such cases initially treated conservatively, without interval appendectomy, that later had recurrent appendicitis. An 8-year-old boy presented with fever, abdominal pain, and a right-lower-quadrant abscess (noted by ultrasonography). During laparotomy, the abscess was drained and the appendix was not found. He was lost to follow-up but returned 2 1/2 years later with perforated appendicitis. An appendectomy was performed, and image-guided drainage of a postoperative abscess was required. A 10-year-old girl presented with fever and right-lower-quadrant pain. Computed tomography showed a multiloculated mass. During laparotomy, the cecum was found to be densely adherent to the pelvic organs and bowel, so the surrounding abscess was drained. Interval appendectomy was refused. The patient returned 8 months later with recurrent acute appendicitis and an appendiceal abscess requiring appendectomy and drainage. Although initial drainage alone of appendiceal abscess is efficacious, the authors strongly advocate interval appendectomy as a critical component of the complete management of this entity.

  2. Anna29
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    Spontaneously Resolving Appendicitis: Frequency and Natural History in 60 Patients

    PURPOSE: To establish the frequency and natural history of ultrasonographically (US) documented spontaneously resolving appendicitis following conservative treatment.

    MATERIALS AND METHODS: From July 1987 to July 1997, the authors encountered 106 patients with US-diagnosed spontaneously resolving appendicitis. We retrospectively studied clinical data and US findings obtained at admission and follow-up relating to 60 patients who were treated conservatively. Over the same 10 years, 1,280 appendectomies for acute appendicitis were performed in the authors' hospital.

    RESULTS: Of 60 patients, 23 (38%) had recurrent appendicitis after a median of 14 weeks (range, 2254 weeks), with 16 (70%) having recurrence within 1 year of the first attack. US findings indicated that patients with an appendiceal diameter of at least 8 mm were more prone to recurrence than patients with an appendiceal diameter of less than 8 mm; the recurrence rates were 47% (21 of 45 patients) and 13% (two of 15 patients). The other parameters did not show a statistically significant difference.

    CONCLUSION: Spontaneously resolving appendicitis occurs in at least one in 13 cases of appendicitis and has an overall recurrence rate of 38%, with the majority of cases reccurring within 1 year.

  3. Domovenok
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    Acute appendicitis is a common clinical problem. Accurate and prompt diagnosis is essential to minimize morbidity. While the clinical diagnosis may be straightforward in patients who present with classic signs and symptoms, atypical presentations may result in diagnostic confusion and delay in treatment. Helical computed tomography (CT) and graded compression color Doppler ultrasonography (US) are highly accurate means of establishing the diagnosis. These imaging modalities have now assumed critical roles in the treatment of patients suspected to have appendicitis. The purpose of this article is threefold: to provide an update on new information regarding the pathophysiology, clinical diagnosis, and laparoscopic treatment of acute appendicitis; to describe the state-of-the art use of CT and US in diagnosing this disease entity; and to address the role of medical imaging in this patient population.

    Index terms: Appendicitis, 751.291 Appendix, CT, 751.12112, 751.12115 Appendix, US, 751.12983 State of the Art

    Appendicitis is the most common cause of acute abdominal pain that requires surgical intervention in the Western world (1). Patients with the disease may present with a wide variety of clinical manifestations, and the diagnosis may elude even the most experienced clinicians (2). Prompt diagnosis is essential to minimize morbidity, which remains substantial if perforation occurs. The advent of antibiotics and effective surgical management have substantially reduced appendicitis-related mortality; however, deaths from appendicitis still occur, particularly in the elderly.

    Appendicitis was rare in the past and remains so in underdeveloped countries (3). There appears to be no record of early physicians, from Hippocrates to Moses Maimonides, recognizing this disease entity (3). Although the anatomy of the appendix was well known by the 18th century, it was not until this time that it was recognized that the appendix could become inflamed, with possibly fatal consequences (4). Early reports of perityphlitis and typhlitis in the 19th century appeared to describe a new clinical phenomenon (3,4). Confusion over this right-lower-quadrant entity existed until Reginald H. Fitz presented his landmark article in 1886, in which he coined the term "appendicitis" and correctly classified this disease by describing the appendix as the primary source of inflammation in acute typhlitis (5). Fitz described the signs and symptoms of acute and perforated appendicitis, outlined the progression from acute right-lower-quadrant inflammation through peritonitis and iliac fossa abscess formation, and recommended early appendectomy if there were signs of spreading peritonitis or of clinical deterioration. Shortly thereafter, Charles McBurney and other pioneering surgeons began to intervene early in acute appendicitis (6,7). These clinicians advocated prompt clinical diagnosis and surgical intervention. Their surgical aim was to operate in a timely fashion before appendiceal perforation and peritonitis developed.

    The goal of modern surgical management essentially is the same and focuses on a balance between the rate of false-negative laparotomy and the rate of perforation at the time of surgical exploration (810). It is tradition that surgeons have diagnosed appendicitis on the basis of patient history and physical examination results. The relatively recent introduction of new imaging technologyin particular, graded compression color Doppler US and helical computed tomography (CT)potentially has changed "the rules of the game." The purpose of this article is to document recent advances in our understanding of appendicitis and to define the role of medical imaging in patients with this condition.

  4. natalia_17
    http://www.springerlink.com/app/home/contribution.asp?wasp=a367d993aeaf4ac9a6786e69628b 90a1&referrer=parent&backto=issue,7,51;jou rnal,17,67;linkingpublicationresults,1:401176,1

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  6. Lada
    http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowPDF&ArtikelNr=64216&am p;ProduktNr=223996&Ausgabe=228523&filename =64216.pdf

    The Need for Interval Appendectomy after Resolution of an Appendiceal Mass Questioned

    Paul J. Willemsena, Lidewij E. Hoorntjeb, Eric-Hans Eddesb, Rutger J. Ploega

    aDepartment of Surgery, University Hospital Groningen, and

    bDepartment of Surgery, Deventer Ziekenhuis, Deventer, The Netherlands

    Address of Corresponding Author

    Digestive Surgery 2002;19:216-222 (DOI: 10.1159/000064216)


    Background: Our current treatment of an appendiceal mass is initially conservative, followed by an interval appendectomy. The necessity of this routine interval appendectomy is debatable. A study was conducted to evaluate whether surgical factors and pathological features of the excised appendices support interval appendectomy. Methods: We performed a retrospective study at the University Hospital Groningen and the Deventer Ziekenhuis. All patients diagnosed with an appendiceal mass in the period January 1991 to January 1997 were identified using the hospital database. The medical records of all these patients (n = 233, 108 M, 125 F) were reviewed. The clinical course of the appendiceal mass patients was split up into three distinct episodes: initial diagnosis and treatment of the appendiceal mass, the interval period and the interval appendectomy. Presenting symptoms, findings at clinical examination and additional imaging (ultrasound) were registered, as well as the course of the primary hospitalisation, the interval period, and the interval appendectomy. Results of histological examination of all resected specimens were reviewed. Results: It was found that clinical findings alone were not specific enough to diagnose an appendiceal mass; 47% had a palpable abdominal mass and the median temperature was 38.2C ranging from 36 to 40.5C. Ultrasound examination was done in 69% of patients and showed an appendiceal mass in 72%. During the interval period, 4 patients presented with an appendiceal mass needing drainage, and 3 with acute appendicitis requiring emergency appendectomy. At interval appendectomy, histological examination of resection specimen showed a normal appendix without signs of previous inflammation in 30% of cases. In addition, complications due to interval appendectomy were seen in 18% of patients, including sepsis, bowel perforation, small bowel ileus, and various wound abscesses. Conclusions: We conclude that when causes for the appendiceal mass other than appendicitis are excluded, interval appendectomy seems unnecessary in patients who respond well to initial conservative treatment.

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