Increased use of laparoscopy in acute right iliac fossa pain – is it good for patients?

Aim The use of laparoscopy, with or without appendicectomy, is becoming more common in the management of acute right iliac fossa (RIF) pain, but little is known of the ‘unintended’ consequences of this change. This study aimed to evaluate the impact of increased use of laparoscopy on the number and type of patients treated surgically and on the rate of negative appendicectomy. Method A prospective audit was carried out of admissions to a teaching hospital over two, 3‐month periods during 2007 and 2008. The management, investigations and outcome of patients presenting with RIF pain were studied. Results Admissions were stable over the two time‐periods. There was a significant increase in the number of laparoscopic operations performed, from 22.5% (14/62) in 2007 to 85.7% (72/84) in 2008 (P < 0.0001), and the percentage of patients undergoing surgery rose from 55.4% (n = 62) in 2007 to 71.2% (n = 84) in 2008 (P < 0.01). In 2008, female patients were more likely to have surgery, an increase from 37.1% to 66.2% (P < 0.001), and were more likely to have a laparoscopic procedure, an increase from 50% to 98% (P < 0.0001). The rate of histologically confirmed appendicitis did not increase significantly (50/122 vs 57/118; P = 0.25), but the number of patients with a normal appendix either left in situ because it was macroscopically normal or found to be histologically normal following excision, increased significantly, from 9.01% in 2007 to 21.2% in 2008 (P < 0.01). The diagnostic value of pelvic ultrasound decreased from 75.6% of examinations in 2007 to 54.5% in 2008 (P = 0.039). Conclusion An increase in laparoscopic procedures has resulted in more operations in women, an associated higher negative appendicectomy rate and decreased usefulness of pelvic ultrasound. Increased use of laparoscopy needs to be balanced against the diagnostic benefits of ‘negative’ laparoscopy.     

1例幼儿“螺旋状”阑尾炎性改变超声表现

<正>患儿男,2岁,持续性腹痛伴发热、腹胀、呕吐、便血2天;当地诊所考虑为“肠胃炎”,予抗感染治疗后未见缓解;外院超声提示右下腹2.9cm×2.2cm混合回声包块,呈“同心圆”状,考虑为肠套叠。查体:全腹压痛,以右下腹为著,伴反跳痛,未触及包块。实验室检查:白细胞3.76×109/L,中性粒细胞百分比67.3%,血小板计数186×109/L,C反应蛋白167.4mg/L。腹部超声:右下腹3.2cm×2.1cm“螺旋状”走行的管状混合回声团,一端管腔直径约1.7cm,内见1.4cm×0.7cm强回声团,     

诊治失误致阑尾切除术后再手术33例临床分析

目的　探讨阑尾炎近期再手术的原因、手术方法及预防措施。方法　对我院 1989年12月至 2 0 0 2年 12月间收治的阑尾炎近期再手术 3 3例进行回顾性分析。结果　术前及术中误漏诊 17例 ,其中结肠肿瘤 8例 ,横结肠重复畸形及炎性肉芽肿各 2例 ,盲肠游动症及十二指肠升段狭窄各 1例。胃后壁穿孔、腹部卒中及急性胰腺炎各 1例并因病情发展而死亡。术中操作不当 7例。其中系膜血管出血、血肿破溃 ,网膜、阑尾残端及切口引流处皮下出血各 1例 ,残株炎 1例 ,腹腔遗留坏死组织及粪石 1例。术后并发症 9例 ,盆腔脓肿 ,阑尾残端粪瘘 ,腹壁切口疝及结核性腹壁窦道各 2例 ,肌间脓肿 1例。结论　正确诊断 ,充分准备 ,仔细操作 ,严密观察 ,及时处置 ,常能避免或减少阑尾炎近期再手术的发生。     

腹腔镜与开腹手术治疗急性阑尾炎穿孔的比较

目的：探讨腹腔镜治疗急性阑尾炎穿孔的效果和价值。方法回顾性分析2010年1月～2011年2月我院由同一组高年资医师完成的77例穿孔性阑尾炎手术的临床资料,其中腹腔镜阑尾切除术（laparoscopic appendectomy, LA）35例（LA组）,开腹阑尾切除术（open appendectomy, OA）42例（OA组）,比较2组手术时间、肠道功能恢复时间、切口感染率、腹腔脓肿发生率、住院时间、住院费用。结果2组手术时间无显著性差异[（64．1±18．1） min vs．（65．1±13．8） min,t＝0.275,P＝0．784];腹腔脓肿发生率无显著差异[2．9％（1/35） vs．4．8％（2/42）,χ2＝0．000,P＝1．000]。与OA组相比,LA组切口感染率显著降低[5．7％（2/35） vs．26．2％（11/42）,χ2＝5．704,P＝0．017];肠功能恢复时间明显缩短[（26．1±4．6）h vs．（36．1±11．9）h, t＝-4．684,P＝0．000）;住院时间明显缩短[（7．1±2．8）d vs．（9．2±4．8）d, t＝-2．283,P＝0．025];住院费用显著升高[（12．6±2．2）千元vs．（8．1±2．9）千元,t＝7．545,P＝0．000]。结论腹腔镜经验丰富的外科医生应用腹腔镜治疗穿孔性阑尾炎有显著优势,手术费用的增加是唯一缺点。     

MSCT征象及MPR、CPR重建对急性复杂性与非复杂性阑尾炎的鉴别价值分析

摘要 目的：分析多层螺旋CT（MSCT）征象及多平面重建（MPR）、曲面重建（CPR）对急性复杂性与非复杂性阑尾炎的鉴别价值。方法：选取2019年1月至2021年1月我院收治的并进行MSCT检查的165例急性阑尾炎患者为研究对象,收集其临床和MSCT资料,根据病理结果将其分为急性复杂性阑尾炎组（n=142）与非复杂性阑尾炎组（n=23）,对比两组临床特点、重建前后MSCT征象。结果：复杂组性别、年龄、合并慢性疾病、右下腹压痛、发病时间与非复杂组比较差异不显著（P>0.05）,体温、右下腹反跳痛、转移性右下腹痛、恶心呕吐、WBC、NEU和CRP水平与非复杂组比较差异有统计学意义（P<0.05）。MPR、CPR重建前后,复杂组阑尾外径增粗、阑尾周围渗出改变、阑尾穿孔、回盲部淋巴结增大、肠淤张与非复杂组比较,差异有统计学意义（P<0.05）;阑尾结石和盲肠壁增厚差异无统计学意义（P>0.05）。重建后急性阑尾炎MSCT征象中阑尾外径增粗、阑尾周围渗出显示率均高于重建前（P<0.05）,阑尾结石、阑尾穿孔、回盲部淋巴结增大、肠淤张、盲肠壁增厚与重建前比较差异均无统计学意义（P>0.05）。结论：MSCT可以有效鉴别急性复杂性与非复杂性阑尾炎,采用MPR、CPR重建可以提升鉴别价值。     

非典型急性阑尾炎32例临床分析

目的：探讨非典型急性阑尾炎的临床特点,及对其手术治疗适应证进行分析。方法：回顾性分析本院经手术治疗确诊的32例非典型急性阑尾炎患者的临床资料,汇总数据进行临床分析。结果：本组患者术后均证实为非典型急性阑尾炎,其中单纯性阑尾炎5例、化脓性阑尾炎20例、坏疽性急性阑尾炎7例。术后出现并发症共4例,其中切口感染2例,肠梗阻1例,肠瘘1例。所有患者均手术成功,治愈出院。结论：充分掌握非典型急性阑尾炎的临床表现,早诊断,早治疗,可改善预后。     

Role of Elective Laparoscopic Appendicectomy for Chronic Right Lower Quadrant Pain

Chronic right lower quadrant pain is a common clinical entity and continues to remain a diagnostic and therapeutic problem. Laparoscopy is changing the view regarding exploration in patients with chronic right lower quadrant pain. Of recent, chronic or recurrent right lower quadrant pain is an entity that has generated much interest, hence this study has been undertaken. To study the role of elective laparoscopic appendicectomy for chronic or recurrent right lower quadrant pain. To study the relationship between clinical improvement and histopathological findings of removed appendix. Forty three cases of chronic right lower quadrant pain, who met the inclusion criteria, were included in the clinical study. Three cases were excluded during initial diagnostic laparoscopy because of ovarian cyst. Laparoscopic appendicectomy was performed in 40 cases. In our study amongst 40 (100 %) patients, 36(90 %) patients were relieved of pain completely. Only 4(10 %) patients continued to have persistent right lower quadrant pain. Duration of follow up was 6 months. Postoperative pain scores favour appendicectomy (p < 0.005). There was no association between postoperative pain scores and histopathology findings. There was no mortality in our study. Persistent or recurrent right lower quadrant pain can be treated successfully by elective laparoscopic appendicectomy in properly selected cases. Laparoscopic appendectomy is a feasible and safe procedure. Histopathology of the removed appendix does not contribute to the diagnosis.     

Pericardial effusion as a rare complication of a perforated appendicitis

IntroductionWhilst pericardial effusion is a known complication of abdominal pathology, it is rarely reported following ruptured appendicitis and even more rarely requires drainage in that situation. This work has been reported in line with the SCARE criteria (Agha et al., 2016).Presentation of caseWe report a 14-year-old male who developed extensive right hepatorenal and right paracolic abscesses, bilateral pleural effusions and a large pericardial effusion following laparoscopic appendicectomy. Due to the size of the effusion, thoracoscopic pericardotomy was required.DiscussionPericardial effusion is a very rare complication of advanced appendicitis despite a demonstrable connection between the retroperitoneum and the mediastinum. Only two cases were reported in our literature search. There is no consensus as to whether percutaneous drainage or pericardiotomy is the treatment of choice.ConclusionThe report is presented as a reminder of a rare complication of a common general surgical condition.