Right iliac fossa pain remains a challenge for clinicians, since it requires considering several differential diagnoses. Acute appendicitis continues to be one of the most important diagnoses to confirm or to rule out...Right iliac fossa pain remains a challenge for clinicians, since it requires considering several differential diagnoses. Acute appendicitis continues to be one of the most important diagnoses to confirm or to rule out in acute abdominal pain, due to the associated morbidity and mortality. Currently, imaging studies contribute to increase diagnostic certainty, but sometimes reveal unexpected findings, which may further complicate the diagnosis and therapeutic decisions. We present the case of an unusual image finding in the right iliac fossa, a calcification suggestive of gallstone ileus, in the context of an acute abdomen with an unusual transoperative finding, whose definitive diagnosis by pathology, was also rare.展开更多
Purpose: To determine whether the presence and/or location of an appendicolith can predict failure of initial non-operative management in children with ruptured appendicitis. Methods: A retrospective chart review of p...Purpose: To determine whether the presence and/or location of an appendicolith can predict failure of initial non-operative management in children with ruptured appendicitis. Methods: A retrospective chart review of pediatric patients presenting with ruptured appendicitis was performed. Patients in whom the intent to treat was with initial non-operative management and interval appendectomy (IA) were selected (n = 117). One patient was excluded due to the presence of both intraluminal and extraluminal appendicoliths. Children who failed initial non-operative management were assigned to the “failure” group (n = 22). Children that improved and underwent elective IA were assigned to the “success” group (n = 94). Age, gender, duration of symptoms, presence of an appendicolith, appendicolith location (intraluminal/extraluminal), presence of a drainable abscess, and complications were reviewed. Results: There was an overall 18.8% failure rate for IA. Patients with an appendicolith had a 41.7% failure rate, and patients without an appendicolith had a 13% failure rate (p = 0.003). Patients with intraluminal or extraluminal appendicoliths each had a 41.7% failure rate. The presence or absence of a drainable in-tra-abdominal abscess did not affect the failure rate. Children in the failure group presented to the hospital earlier (6.57 ± 2.59 vs. 10.02 ± 7.21 days;p = 0.030). Conclusions: The presence of an appendicolith increases the likelihood of failure of initial non-operative management of ruptured appendicitis in children;however, the location of the appendicolith is not a predictor of failure.展开更多
Background Appendicolith can cause appendiceal obstruction and acute appendicitis.Its high prevalence may be related to the high perforation rate in pediatric appendicitis.This study assessed the characteristics of ap...Background Appendicolith can cause appendiceal obstruction and acute appendicitis.Its high prevalence may be related to the high perforation rate in pediatric appendicitis.This study assessed the characteristics of appendicolith and its clinical significance in pediatric appendicitis.Methods A retrospective study was performed among children and adolescents younger than 17 years who were preopera-tively diagnosed with appendicitis in the pediatric emergency department(ED).A total of 269 patients with a mean age of 9.98±3.37 years were enrolled.Clinical features and contrast-enhanced computed tomography findings were analyzed.Results Among the 269 patients,147(54.6%)had appendicoliths,with a mean maximal diameter of 5.21±2.34 mm.Com-pared to the no appendicolith group,the appendicolith group demonstrated more prolonged abdominal pain(≥48 hours)before the ED visit(23.1%vs.11.5%;P=0.013),clinical features of severe appendicitis(presence of fever,vomiting,posi-tive urine ketone,and increased C-reactive protein),and higher rate of perforation(43.5%vs.9.8%;P<0.001).Multivariate risk factor analysis for perforated appendicitis in the appendicolith group revealed that maximal diameter of 5 mm or more in the appendicolith(adjusted odds ratio[aOR]2.919;95%CI 1.325-6.428,P=0.008)and proximal collapse adjacent to the appendicolith(aOR 2.943;95%CI 1.344-6.443,P=0.007)were significant.Conclusions Pediatric appendicitis with appendicolith often presents with prolonged abdominal pain and severe clinical conditions with a high risk of perforation.展开更多
Introduction: The appendix is identified as blind ending tubular structure arising from caecum and has variable intraluminal contents and position. Acute appendicitis is one of the common indications for emergency ima...Introduction: The appendix is identified as blind ending tubular structure arising from caecum and has variable intraluminal contents and position. Acute appendicitis is one of the common indications for emergency imaging studies. Aim: To describe the importance of appendix hyperattenuation and densities. Material and Methods: Contrast enhanced computed tomography images of abdomen from 120 patients with surgically/pathological proven acute appendicitis, were examined retrospectively. The images were reviewed in axial, coronal and sagittal reformations for assessing the intraluminal contents (hyperdensity and appendicolith), maximum transverse diameter and single wall thickness of appendix, periappendiceal fat stranding and other parameters related to acute appendicitis. In addition, reviewing 100 pre- and post-contrast CT scans of other abdominal conditions as a control group for documenting hyperdense appendix, appendicolith and other signs of appendicitis. Results: The hyperdense appendix sign was found in 5 patients in our study, not found in any patient of the control group (P value = 0.039, is statistically), appendicolith was found in 25% in patients with acute appendicitis, in 3% in control group (statistically significant, p < 0.0001). Conclusion: The hyperdense appendix and appendicolith have strong association with acute appendicitis in the appropriate clinical setting.展开更多
文摘Right iliac fossa pain remains a challenge for clinicians, since it requires considering several differential diagnoses. Acute appendicitis continues to be one of the most important diagnoses to confirm or to rule out in acute abdominal pain, due to the associated morbidity and mortality. Currently, imaging studies contribute to increase diagnostic certainty, but sometimes reveal unexpected findings, which may further complicate the diagnosis and therapeutic decisions. We present the case of an unusual image finding in the right iliac fossa, a calcification suggestive of gallstone ileus, in the context of an acute abdomen with an unusual transoperative finding, whose definitive diagnosis by pathology, was also rare.
文摘Purpose: To determine whether the presence and/or location of an appendicolith can predict failure of initial non-operative management in children with ruptured appendicitis. Methods: A retrospective chart review of pediatric patients presenting with ruptured appendicitis was performed. Patients in whom the intent to treat was with initial non-operative management and interval appendectomy (IA) were selected (n = 117). One patient was excluded due to the presence of both intraluminal and extraluminal appendicoliths. Children who failed initial non-operative management were assigned to the “failure” group (n = 22). Children that improved and underwent elective IA were assigned to the “success” group (n = 94). Age, gender, duration of symptoms, presence of an appendicolith, appendicolith location (intraluminal/extraluminal), presence of a drainable abscess, and complications were reviewed. Results: There was an overall 18.8% failure rate for IA. Patients with an appendicolith had a 41.7% failure rate, and patients without an appendicolith had a 13% failure rate (p = 0.003). Patients with intraluminal or extraluminal appendicoliths each had a 41.7% failure rate. The presence or absence of a drainable in-tra-abdominal abscess did not affect the failure rate. Children in the failure group presented to the hospital earlier (6.57 ± 2.59 vs. 10.02 ± 7.21 days;p = 0.030). Conclusions: The presence of an appendicolith increases the likelihood of failure of initial non-operative management of ruptured appendicitis in children;however, the location of the appendicolith is not a predictor of failure.
基金supported by a grant(2017-0202)from Asan Medical Center Children's hospital,Seoul,South Korea.
文摘Background Appendicolith can cause appendiceal obstruction and acute appendicitis.Its high prevalence may be related to the high perforation rate in pediatric appendicitis.This study assessed the characteristics of appendicolith and its clinical significance in pediatric appendicitis.Methods A retrospective study was performed among children and adolescents younger than 17 years who were preopera-tively diagnosed with appendicitis in the pediatric emergency department(ED).A total of 269 patients with a mean age of 9.98±3.37 years were enrolled.Clinical features and contrast-enhanced computed tomography findings were analyzed.Results Among the 269 patients,147(54.6%)had appendicoliths,with a mean maximal diameter of 5.21±2.34 mm.Com-pared to the no appendicolith group,the appendicolith group demonstrated more prolonged abdominal pain(≥48 hours)before the ED visit(23.1%vs.11.5%;P=0.013),clinical features of severe appendicitis(presence of fever,vomiting,posi-tive urine ketone,and increased C-reactive protein),and higher rate of perforation(43.5%vs.9.8%;P<0.001).Multivariate risk factor analysis for perforated appendicitis in the appendicolith group revealed that maximal diameter of 5 mm or more in the appendicolith(adjusted odds ratio[aOR]2.919;95%CI 1.325-6.428,P=0.008)and proximal collapse adjacent to the appendicolith(aOR 2.943;95%CI 1.344-6.443,P=0.007)were significant.Conclusions Pediatric appendicitis with appendicolith often presents with prolonged abdominal pain and severe clinical conditions with a high risk of perforation.
文摘Introduction: The appendix is identified as blind ending tubular structure arising from caecum and has variable intraluminal contents and position. Acute appendicitis is one of the common indications for emergency imaging studies. Aim: To describe the importance of appendix hyperattenuation and densities. Material and Methods: Contrast enhanced computed tomography images of abdomen from 120 patients with surgically/pathological proven acute appendicitis, were examined retrospectively. The images were reviewed in axial, coronal and sagittal reformations for assessing the intraluminal contents (hyperdensity and appendicolith), maximum transverse diameter and single wall thickness of appendix, periappendiceal fat stranding and other parameters related to acute appendicitis. In addition, reviewing 100 pre- and post-contrast CT scans of other abdominal conditions as a control group for documenting hyperdense appendix, appendicolith and other signs of appendicitis. Results: The hyperdense appendix sign was found in 5 patients in our study, not found in any patient of the control group (P value = 0.039, is statistically), appendicolith was found in 25% in patients with acute appendicitis, in 3% in control group (statistically significant, p < 0.0001). Conclusion: The hyperdense appendix and appendicolith have strong association with acute appendicitis in the appropriate clinical setting.
