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Recurrent Appendicitis


Presentation

  • A 10-year-old girl presented with fever and right-lower-quadrant pain. Computed tomography showed a multiloculated mass.[ncbi.nlm.nih.gov]
Pseudotumor
  • Conversion to open laparotomy during operation was made because of a fragmented appendix where the appendiceal base and psoas abscess cavity could not be identified well and a dense inflammatory mass which seemed to be creating a pseudotumor around the[omicsonline.org]
Abdominal Pain
  • Three patients had only one episode of abdominal pain, but had pathologic evidence of subacute inflammation.[ncbi.nlm.nih.gov]
Acute Abdomen
  • Clinical science Summary Appendicitis refers to acute inflammation of the appendix, and is the most common cause of acute abdomen requiring emergency surgery.[amboss.com]
  • Karger AG, Basel References Silen W: Appendicitis and the differential diagnosis of appendicitis; in Cope’s Early Diagnosis of the Acute Abdomen, ed 19. New York, Oxford University Press. 1996, pp 70–110.[karger.com]
  • We present two cases of AA which were clinically mimicking complicated appendicitis and manifested with symptoms of acute abdomen.[go.galegroup.com]
  • Sometimes the inflamed appendix becomes surrounded by omentum which adheres and localises the infection more effectively, forming an appendix mass or appendix abscess. [ 1 ] Epidemiology Appendicitis is the most common cause of an acute abdomen in the[patient.info]
  • Likewise, other patients initially appear ill with an "acute abdomen" only to improve dramatically during their ED stay and ultimately be discharged with gastritis or constipation as the cause.[ahcmedia.com]
Recurrent Abdominal Pain
  • Recurrent abdominal pain due to chronic appendiceal disease. South Med. J. 1991;84(7):913-66. Leardi S, Delmonaco S, Ventura T, Chiominto A, De Rubeis G, Simi M. Recurrent abdominal ain and "chronic appendicitis"; Minerva Chur. 2000;55(1-2):39-44.[ijsurgery.com]
  • Presentation Recurrent abdominal pain attacks. Patient Data Age: 4 years Gender: Male Loading images...[radiopaedia.org]
  • In some cases, however, people may develop chronic appendicitis , which causes mild, recurrent abdominal pain that often subsides on its own. These patients usually don't realize they have appendicitis until an acute episode strikes.[everydayhealth.com]
  • abdominal pain after the initial successful nonoperative management, the authors recommended interval appendectomy as it would allow evaluation for a clinically significant disease process and help avoid recurrence.[onlinejets.org]
Severe Abdominal Pain
  • Case Report We report the case of a 43 year old male who presented with sudden onset of severe abdominal pain. His symptoms were consistent with acute cholecystitis. He was unable to speak English and communicated via an interpreter.[casesjournal.biomedcentral.com]
  • When people discuss appendicitis, they're typically referring to acute appendicitis, which is marked by severe abdominal pain that quickly spreads and worsens over a matter of hours.[everydayhealth.com]
  • pain that comes on quickly.[en.wikipedia.org]
  • abdominal pain deserves special attention.[ahcmedia.com]
Rovsing's Sign
  • sign : deep palpation of the LLQ causes RLQ referred pain Psoas sign : RLQ pain with extension of the right leg against resistance (secondary to inflammation of a retrocecal appendix ) Obturator sign : RLQ pain with flexion and internal rotation of the[amboss.com]
  • Rovsing's sign may be positive: palpation of the left lower quadrant increases the pain felt in the right lower quadrant.[patient.info]
  • Physical signs classically associated with acute appendicitis include Rovsing sign, psoas sign, and obturator sign. Rovsing, N.T. (1907). "Indirektes Hervorrufen des typischen Schmerzes an McBurney's Punkt.[en.wikipedia.org]
  • ’s sign 5 Palpable mass 5 Mean Temperature 37.9 C ____________________________________________________ The fact that the appendix can be found in a variety of anatomic locations helps explain some of this variability.[ahcmedia.com]
Limping Gait
  • Unfortunately, 4 months later, she was readmitted with a 2-day history of fever, limping gait and pain in the right groin.[omicsonline.org]
Right Adnexal Tenderness
  • adnexal tenderness. 100 Many authors have tried to identify features that would differentiate these two diseases, and have suggested the following.[ahcmedia.com]

Workup

  • The existence of chronic appendicitis has been controversial in decades past, and contemporary debate surrounds the definition and workup of this condition. 10 – 12 In one hospital in Altenburg, Germany, the rate of appendectomies increased dramatically[cfp.ca]
  • The rate of negative appendectomies has declined significantly (around 6%) in the US largely due to the high rate of utilization of CT scan in the diagnostic workup.[clinicaladvisor.com]

Treatment

  • CONCLUSIONS: Since the recurrence rate is similar between NPA and PA, nonoperative treatment can be used for PA patients. Roughly 20% of the adult patients selected for nonoperative treatment experienced recurrence.[ncbi.nlm.nih.gov]
  • We took this case to review the literature concerning the treatment of appendiceal abscess and appendiceal mass, and consecutively redesigned our own treatment concept.[unboundmedicine.com]

Prognosis

  • Prognosis Special patient groups Appendicitis in pregnancy Children, the elderly, and pregnant women are at higher risk of perforation! References: [8] [9] [10][amboss.com]
  • The five-year survival rate for AA is 49 - 60%, and the prognosis is favorable when the tumor is diagnosed at an early stage of the disease [4].[go.galegroup.com]
  • Prognosis and Patient Counseling.[clinicaladvisor.com]
  • Fetal mortality is less than 1.5% but increases to 20-35% in cases of perforation. [ 3 ] Prognosis Appendicectomy is relatively safe with a mortality rate for non-perforated appendicitis of 0.8 per 1,000 and mortality after perforation of 5.1 per 1,000[patient.info]
  • Prognosis [ edit ] Most people with appendicitis recover easily after surgical treatment, but complications can occur if treatment is delayed or if peritonitis occurs.[en.wikipedia.org]

Etiology

  • Leu SY, Leonard MB, Beart RW Jr, Dozois RR (1986) Psoas abscess: Changing patterns of diagnosis and etiology. Dis Colon Rectum 29: 694-698. Procaccino JA, Lavery IC, Fazio VW, Oakley JR (1991) Psoas abscess: difficulties encountered.[omicsonline.org]
  • […] undeniable advantage thanks to its mini-invasiveness, the possibility of a methodical and thorough exploration of the entire abdominal cavity in those cases of recurrent pain, emotionally and socially debilitating, that do not find an answer in the usual etiological[ncbi.nlm.nih.gov]
  • Etiology Pathophysiology Early : mucosal hyperemia with edema and ulceration due to obstruction of the appendix ; reversible phase Suppurative : transmural spread of infection within the appendix Gangrenous : diffuse inflammatory changes in the entire[amboss.com]
  • The etiology of appendicitis. Br J Hosp Med 1988;39:540-2. 5. Addis DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 1990;132:910-25. 6. Arnbjornsson E.[onlinejets.org]
  • Even after a careful and thorough work-up by the best physicians, the end result of these patient encounters is frequently "abdominal pain of uncertain etiology."[ahcmedia.com]

Epidemiology

  • The epidemiology of appendix & appendicectomy in the US. Am J Epiodemiol. 1999;132:910-25. Koep Sell TD, Inue TS, Farewell VT. Factors affecting perforation in Acute Appendicitis. Surg. Gynaecol. Obstet. 1981;153:508-10.[ijsurgery.com]
  • Declarations Authors’ Affiliations (1) Department of Surgery, Saint Luke's Hospital, Kilkenny, Ireland References Addiss DG, Shaffer N, Fowler BS, Tauxe RV: The epidemiology of appendicitis and appendectomy in the United States.[casesjournal.biomedcentral.com]
  • Epidemiology Common cause of acute abdomen Lifetime risk : 8% Peak incidence : 10–19 years of age References: [1] [2] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132:910-925. [go to PubMed] 2. Hardin DM Jr. Acute appendicitis: review and update. Am Fam Physician. 1999;60:2027-2034. [go to PubMed] 3.[psnet.ahrq.gov]
  • Epidemiology The appendix ruptures in 15% of appendicitis cases within 36 hours. Anyone can develop appendicitis, regardless of age or sex, but it occurs most often between the ages of 10 and 20[6] and there is a slightly higher incidence in men.[ourmed.org]
Sex distribution
Age distribution

Pathophysiology

  • Abstract Cite This Article as Corresponding Author The pathophysiology and morphology of recurrent appendicitis has not been well studied.[journalijar.com]
  • Etiology Pathophysiology Early : mucosal hyperemia with edema and ulceration due to obstruction of the appendix ; reversible phase Suppurative : transmural spread of infection within the appendix Gangrenous : diffuse inflammatory changes in the entire[amboss.com]
  • The pathophysiology of chronic appendicitis is thought to be related to a partial or chronic appendiceal obstruction, and diagnosis is frequently made following an appendectomy and based on histologic findings of chronic inflammatory changes. 6, 12 It[cfp.ca]
  • Pathophysiology of Acute Appendicitis Some of the difficulties in recognizing acute appendicitis can be diminished by an understanding of how this condition develops.[ahcmedia.com]
  • If appendicitis represents the same pathophysiologic process as diverticulitis, it may be amenable to antibiotic rather than surgical treatment," the researchers said.[ibsgroup.org]

Prevention

  • Hospital for Sick Children Health A-Z Search a complete list of child health articles expand_more View All Drug A-Z Search a list of articles about medications expand_more View All Learning Hubs Browse a complete list of content groups Healthy Living & Prevention[aboutkidshealth.ca]
  • It’s not clear if you can do anything to prevent chronic appendicitis. Eating a diet rich in fiber may lower the risk of appendicitis, but research on diet, nutrition, and eating patterns for the prevention of chronic appendicitis is inconclusive.[healthline.com]
  • A new study confirms that antibiotics can prevent surgical intervention if your child's appendix becomes inflamed, potentially saving his or her life.[invisiverse.wonderhowto.com]
  • Scar tissue then wall of the appendix from rest of abdomen preventing infection from spreding. An absecessed appendix is a less urgent situation but unfortunately it can”t always be identified without surgery.[devasyahospital.com]

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