Presentation
Among the complications of an open appendectomy is the presentation of an incisional hernia. [ncbi.nlm.nih.gov]
Acute appendicitis (AA), a common intra-abdominal surgical pathology, requires a comprehensive understanding of its presentation, evaluation, diagnosis, and overall operative management. [emedicine.medscape.com]
Entire Body System
- Pain
All patients had used an intravenous patient-controlled analgesia (PCA) device for postoperative pain control. [ncbi.nlm.nih.gov]
- Fever
The patient consulted with fever (38.1 °C) and abdominal pain, located at the right iliac fossa. Imaging studies showed signs of abscesses, located at the right iliac fossa, without clear origin of these abscesses. [ncbi.nlm.nih.gov]
In order to be discharged from the hospital, your child needs to be able to walk, eat and drink without vomiting, be without fever, and have good pain control with the pain medicines prescribed. [chop.edu]
Fever and wound erythema are classic hallmarks. The wound should be opened to allow drainage of the pus. Healing by second intention is the rule. [emedicine.medscape.com]
Appendicitis also can cause: loss of appetite fever nausea vomiting diarrhea sometimes painful or frequent urination If the appendix bursts, a child can develop a high fever, and pain will move throughout the abdominal area. [rchsd.org]
- Inflammation
Of the 53 resected appendixes, the histopathological evaluation showed 33 (62.2%) inconspicuous appendices, 11 (20.8%) post-inflammatory changes, 4 (7.5%) with chronical signs of inflammation and 3 (5.7%) with signs of acute inflammation. [ncbi.nlm.nih.gov]
It is thought that blockage of the opening of the appendix into the bowel by a hard, small stool fragment causes inflammation and infection of the appendix. The inflammation can cause infection, a blood clot, or rupture of the appendix. [umms.org]
Appendix removal may also lead to an infection, perforation or bleeding of the bowel, and sepsis or systemic inflammation of the body (although this is extremely rare). [docdoc.com.sg]
- Wound Infection
Duration of surgery, length of hospital stay (LOS), and postoperative wound infection were recorded. RESULTS: A total of 126 patients were operated, with 63 in each group. [ncbi.nlm.nih.gov]
Regarding deep wound infections and intra-abdominal infections, the questions about protection could not be answered due to the very low quality of evidence. [crd.york.ac.uk]
- Falling
These strips will fall off after 10-14 days from the surgery. Do not pick or pull at the steri-strips. Your child my take a bath or shower 24 hours after the surgery. Your child may swim after the steri-strips fall off. [uichildrens.org]
They will fall off on their own in 1 to 2 weeks. Do not remove them unless your child’s doctor says it is okay. If your child has glue (Dermabond®) over the incisions, it will fall off on its own. Do not remove it. [nationwidechildrens.org]
[…] conjunction with 44950-44960) altLabel Removal of ruptured infected appendix Appendectomy of ruptured appendix with generalized peritonitis Appendectomy of ruptured appendix with abscess APPENDEC RPTD APPENDIX ABSC/PRITONITIS Citation 001: CPT Assistant Fall [bioportal.bioontology.org]
They should fall off on their own in a week or so. Wear loose-fitting clothes. This will help cause less irritation around your incisions. You can shower as usual. Gently wash around your incisions with soap and water. [saintlukeskc.org]
Gastrointestinal
- Abdominal Pain
A 33-year-old woman was referred to our department at 39 weeks and 1 day of gestation due to abdominal pain. She was aware of her gastroepiploic pain even after the delivery. [ncbi.nlm.nih.gov]
[…] possible causes of abdominal pain. [jamanetwork.com]
- Nausea
A 17-year-old patient with an insidious onset of symptoms 4 months ago by diffuse abdominal pain that later was localized in the right iliac fossa accompanied by loss of appetite, nausea and vomiting. [ncbi.nlm.nih.gov]
Antibiotics are given intravenously (IV) in the hospital and can be given as a pill or liquid when symptoms like nausea and vomiting have resolved. [chop.edu]
Eating before taking medications such as pain medicine or antibiotics may help decrease potential side effects, such as nausea and vomiting. [livestrong.com]
- Lower Abdominal Pain
An 18-year-old male presented with a one-week history of lower abdominal pain, nausea and vomiting. He had a history of laparoscopic appendectomy for acute appendicitis. Physical examination revealed tenderness and guarding in the lower abdomen. [ncbi.nlm.nih.gov]
- Acute Abdomen
Stump appendicitis is a rare cause of acute abdomen and should be taken into consideration in the differential diagnosis. [ncbi.nlm.nih.gov]
Cope’s Early Diagnosis of the Acute Abdomen. 18th ed. New York: Oxford University Press; 1991:67-84. 15. Birnbaum BA, Balthazar EJ. Computed tomography of appendicitis and diverticulitis. Radiol Clin North Am. 1994;32:885-898. 16. [laparoscopy.blogs.com]
The possibility of appendicitis must be considered in any patient presenting with an acute abdomen, and a certain preoperative diagnosis is still a challenge [28, 29]. [wjes.biomedcentral.com]
- Right Lower Quadrant Tenderness
An 11-week-old girl was brought to the emergency department with a 48-hour history of abdominal pain, emesis, low-grade fever, and focal right lower quadrant tenderness. [ncbi.nlm.nih.gov]
Cardiovascular
- Hypotension
[…] cheaper) When surgeon prefers open procedure (lack of surgical expertise and necessary equipments for laproscopic procedure) Laproscopic procedure is contraindicated (severe pulmonary disorders, bleeding diathesis, portal hypertension, intolerance of (ie, hypotension [tube.medchrome.com]
Skin
- Erythema
Fever and wound erythema are classic hallmarks. The wound should be opened to allow drainage of the pus. Healing by second intention is the rule. [emedicine.medscape.com]
Workup
In literature there seems to be some advantage in favour of laparoscopic appendectomy; a more accurate preoperative diagnostic workup is anyway advised in consideration also of the greater incidence of neoplasias among elderly people [1, 3, 4]. [intechopen.com]
Baseline coronary artery disease or cardiac dysfunction—goals of management: According to the ACC/AHA guidelines, appendectomy falls into minimal to moderately invasive procedure; further workup is usually not recommended unless for the patients with [clinicaladvisor.com]
X-Ray
- Pneumoperitoneum
Pneumoperitoneum was performed under general anesthesia. Three trocars of 5 mm diameter were inserted through a single umbilical incision of 10 mm length into the peritoneal cavity. The exploration has revealed a swollen appendix. [ncbi.nlm.nih.gov]
Pneumoperitoneum (10-14 mm Hg) is established and maintained by insufflating carbon dioxide. Through the access, a laparoscope is inserted to view the entire abdomen cavity. [emedicine.medscape.com]
Air embolism, fat emboli, or bibasilar atelectasis may occur given the effect of pneumoperitoneum with a laparoscopic appendectomy approach. d. [clinicaladvisor.com]
Pneumoperitoneum is then established, either through the “closed” technique (use of the Veress needle) or the “open” technique (Hasson blunt port insertion). [laparoscopy.blogs.com]
Serum
- Hypercapnia
Pulmonary Reactive airway disease (asthma) Perioperative evaluation Asthma increases the risk of bronchospasm, hypoxemia, hypercapnia, inadequate cough, atelectasis, and pulmonary infection following surgery. [clinicaladvisor.com]
Colonoscopy
- Colitis
Four studies examined ulcerative colitis, two retrospective and two prospective cohort studies (34, 35, 47, 49). The median prevalence of ulcerative colitis was 0.1% (range, 0.1%–0.2%). Two of the studies had control groups (34, 47). [journals.sagepub.com]
OBJECTIVES: Ulcerative colitis (UC) is a chronic inflammatory disease usually responding well to anti-inflammatory drugs but many patients will still need colectomy. Appendectomy is associated with a lower risk of later developing UC. [ncbi.nlm.nih.gov]
Patients who underwent appendectomy are associated with a 1.6- to 2.1-fold increased risk of Crohn’s disease but are less likely to have ulcerative colitis. The inflammatory responses differ in ulcerative colitis and appendicitis post-appendectomy. [evolutionnews.org]
In some cases, removal of an inflamed appendix appears to have a protective effect : Research has shown that young people who underwent an appendectomy for appendicitis have a lower risk for developing ulcerative colitis. [everydayhealth.com]
Treatment
The network was informed primarily by indirect treatment comparisons. [ncbi.nlm.nih.gov]
Because we established a 24% minimal clinically important difference, we did not demonstrate noninferiority of antibiotic treatment for appendicitis relative to surgical treatment. [doi.org]
Prognosis
Prognosis of Appendectomy Prognosis of this procedure is based on two parameters, i.e. recovery after the surgery and the mortality linked with appendectomy. [newsmax.com]
LEVEL OF EVIDENCE: Prognosis study, level II. Copyright © 2017 Elsevier Inc. All rights reserved. [ncbi.nlm.nih.gov]
But the good news is that she is… The prognosis and everything went well. Thank God. It's been a rough 48 hours here." [blabbermouth.net]
After the surgery, it may take about 3 weeks for a complete recovery Simple Appendectomy has an excellent prognosis However, if there are complications and the appendix has ruptured the prognosis is still good. [dovemed.com]
Etiology
Stump appendicitis is a rare complication seen after appendectomy and is generally not considered a possible etiology in patients presenting with fever and right iliac fossa abdominal pain with a history of appendectomy. [ncbi.nlm.nih.gov]
This underappreciated structural characteristic of perfusion may be an important causal factor in the overall etiology of appendicitis. [laparoscopy.blogs.com]
Epidemiology
Modern epidemiology. Boston: Little, Brown, 1986:166. 25. Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 1990 ;132: 910 - 925 26. Tysk C, Jarnerot G. [nejm.org]
Year introduced: 1991(1964) PubMed search builder options Subheadings: analysis anatomy and histology blood chemically induced complications congenital diagnosis drug therapy enzymology epidemiology ethnology etiology genetics metabolism mortality pathology [ncbi.nlm.nih.gov]
The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 1990;132:910–25. Snyder TE, Selanders JR. Incidental appendectomy—yes or no? A retrospective case study and review of the literature. [m.acog.org]
The epidemiology of appendicitis and appendicectomy in the United States. Am J Epidemiology. 1990;132:910–25. 2. Seem K. Endoscopic appendectomy. Endoscopy. 1983;15:59–64. 3. Kurtz RJ, Heimann TM. [wjes.biomedcentral.com]
Pathophysiology
Then, we describe the pathophysiology of pneumatosis and review the literature regarding its origin and management. [ncbi.nlm.nih.gov]
PATHOPHYSIOLOGY The exact mechanism of AA is still unclear, but is believed to be multifactorial. [wjgnet.com]
Briefly, the pathophysiology and progressive timeline of AA are attributed to the following: Luminal obstruction causing distention Ineffective venous and lymphatic drainage Bacterial invasion Perforation with associated leakage of contents into the peritoneal [emedicine.medscape.com]
Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 120. Updated by: Debra G. [nlm.nih.gov]
Prevention
In patients with non-rheumatic atrial fibrillation, efficacy of stroke prevention with oral anticoagulant therapy has been proved. [ncbi.nlm.nih.gov]
Care for the incision as instructed to prevent infection. [wkhs.com]
The skin is swabbed with a solution that kills germs to help prevent infections along the incision. [verywellhealth.com]
More important, it does prevent future appendicitis.3-5 Some surgeons disagree, citing an increase in operative time, hospital costs, and patient morbidity as reasonable concerns. [mdedge.com]