Comparative Study between Open and Laparoscopic Appendectomy in Acute Appendicitis
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Background: Appendectomy is a widespread emergency surgery, and to date the appendectomy is still done through two approaches: open (OA) and laparoscopic (LA) and it is not known which is better than the other.Objective: This study aimed to compare OA and LA surgical approaches in patients with acute appendicitis.Patients and methods: Data were obtained from eighty patients underwent appendectomy at Baquba Teaching Hospital between September 2021 and May 2022.Forty patients in (OA) group underwent open surgery, as well as forty other patients in (LA) group underwent laparoscopic surgeries.The two groups were compared according to the operation time, hospital stay, wound infection, and return to normal daily activity.Results: LA approach was associated with shorter (1.4±0.6 days) hospitalization than OA (2.7±2.5 days).Also, the operative time of the laparoscopic approach was clearly less (30±3.2min) compared to the open approach (35±5.2min).There was no postoperative infection in the LA patients, and the laparoscopic patients returned to their daily activities faster than the open surgery group.Conclusion: Laparoscopic surgery is a safer approach to appendectomy, especially if it is performed by skilled specialist surgeons.Endometriosis of the appendix is an uncommon mimicker of acute appendicitis which makes for a diagnostic dilemma.We present a rare case of a menstruating woman presenting with classic symptoms of appendicitis, without the characteristic inflammatory changes seen on laparoscopy consistent with appendicitis. Instead, the appendix appeared unusually contracted on itself. Pathologic review of the appendix revealed microscopic findings of endometriosis.We theorize the growth and shedding of the endometrial tissue during menstruation caused compression of the neural plexi in the wall of the appendix leading to the presentation mimicking acute appendicitis.Given the potential for endometrial appendicitis, we propose appendectomy in reproductive age female patients with right lower quadrant pain, regardless of appendix appearance on laparoscopy.
Presentation (obstetrics)
Menstruation
Quadrant (abdomen)
Vermiform
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Quadrant (abdomen)
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Gangrene or perforation of the appendix is often caused by failure to make an early diagnosis of appendicitis. Variability in the anatomic location of the appendix can be responsible for atypical manifestations of appendicitis and diagnostic errors. Over a 52-month period, 125 appendectomies were done for suspected appendicitis at a military hospital. After excluding cases in which the location of the appendix was not provided, 106 cases were available for review. Fifteen patients (14%) did not have appendicitis. The appendix was found in the true pelvis, was behind the ileum or ileocolic mesentery, or was both retrocolic and retroperitoneal in 11 of 16 patients (69%) with gangrenous or perforative appendicitis. In contrast, the appendix was in one of these three sites in only four of 75 patients (5%) with simple appendicitis (P less than .001). Both physicians and patients were responsible for diagnostic delays, but the paucity of symptoms and signs in patients with a "hidden" appendix was the most likely cause of failure to diagnose appendicitis before perforation.
Gangrene
Perforation
Terminal ileum
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Objective To explore the value of non-enhanced helical CT scanning and reconstruction in diagnosis of acute appendicitis preoperatively for the location and qualitation.Materials and Methods The imaging data including CT and reconstruction images of 100 patients with acute appendicitis confirmed by surgery and 100 patients without acute appendicitis were retrospectively analyzed.The study appearance includes the location,diameter,wall thickness,content of appendix and structure around the appendix.Results Among 100 patients with acute appendicitis,the appendix ware detected in 91 cases.Among 100 cases without acute appendicitis,the appendix were detected in 82 cases.The distribution of appendix in 2 groups showed no difference by statistically significant(P0.05).The diameter,wall thickness of appendix in 2 groups showed difference by statistically significant(P 0.01).The MSCT appearances of acute appendicitis includes enlarged appendix(88%),the fecalith(22%) and air(18%) in appendix,periappendicular exudative peritonitis(62%) and periappendicular abscess(14%).Conclusion MSCT is of significant value in diagnosis of acute appendicitis including the location and qualitation.It is helpful for the evidence of operative proposal.
Helical computed tomography
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Although appendicitis is largely a clinical diagnosis, on occasions diagnostic modalities may be needed to aid with the diagnosis. Despite the use of adjuncts and exploratory surgery, the diagnosis may not be clear until a histological diagnosis is achieved. Endometriosis of the appendix mimicking appendicitis is one of these diagnoses described in several case reports. Endometriosis of the meso-appendix has been described in association with intussusception of the appendix in several case reports. However, to our knowledge, endometriosis of the meso-appendix mimicking appendicitis has not been reported to date. We present the case of a 33-year-old woman with classic clinical signs and symptoms of appendicitis endorsed on computed tomography imaging. The patient underwent a laparoscopic appendicectomy with the postoperative histology demonstrating a normal appendix with endometriosis of the meso-appendix.
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ABSTRACT We present a case report of a 49-year-old female with a history of ulcerative colitis who originally presented to the general surgery clinic after an incidental finding on computed tomography was concerning for a dilated, fluid-filled appendix. She ultimately underwent a laparoscopic appendectomy. The pathology returned consistent with early acute appendicitis, with endometrial tissue along the outer wall of the appendix. We then performed a literature review regarding appendiceal masses and the occurrence of endometriomas and/or endometriosis of the appendix. A PubMed search was performed using the key words of appendix and appendicitis and endometrioma. Specific articles were examined mentioning the occurrence of endometriomas of the appendix and isolated endometriosis of the appendix. Between 2% and 6% of cases of appendicitis present due to an appendiceal mass, usually an inflammatory phlegmon. A variety of other causes, including primary malignancy, secondary malignancy, and combinations of pathologies, may lead to the eventual removal of the appendix. Specifically, endometriosis of the appendix is reported in less than 1% of females on post-appendectomy pathologic analysis. Although specific symptoms may guide a provider, there are few distinguishing symptoms that would point a provider toward a different etiology, to include malignancy, for appendicitis. Further information is needed to determine when a patient has an increased risk for an underlying pathology when presenting with appendicitis. This information will help drive continued treatment and lead to improved screening for appendiceal masses.
Phlegmon
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Sonography now plays a vital role in noninvasive evaluation of patients with right lower quadrant pain. Sonography can differentiate appendicitis from other etiologies of pelvic pain, such as ovarian cysts, tubo-ovarian abscesses, inguinal hernias, and uterine pathologies. Successful demonstration of a normalsized appendix virtually excludes appendicitis in the patient with right lower quadrant pain. False-negative examinations may occur because of bowel gas interference, stool, perforation with decompression of the appendix, or inflammation of the appendix without abnormal enlargement. The purpose of this study was two-fold: to determine how often a normal-sized appendix is demonstrable in patients who do not have appendicitis; and to determine whether locating a normal appendix improves the negative predictive value for the absence of appendicitis.
Etiology
Perforation
Quadrant (abdomen)
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On the basis of histomorphologic examination of: 9907 biopsy specimens from appendix, obtained after its surgical removal because of appendicitis, 228 cases of senile involution of the appendix and appendix specimens from 125 children 30 days to 8 years of age who had been immunized with BCG vaccine intracutaneously and have died of miscellaneous diseases, the author debates on some poorly specified and moot points in the appendicitis problem. Appendicitis is sometimes considered a phase and in other cases a form of the disease. It is assumed that chronic appendicitis, as well as primary chronic appendicitis not preceded by acute inflammatory changes in the appendix, do exist. Sufficient morphologic criteria to distinguish chronic appendicitis from senile involution of the appendix are believed to exist.
Involution (esoterism)
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In most cases, CT of appendicitis shows a distended appendix with periappendiceal inflammation. A distended appendix, however, is not always visualized. In these patients, identifying changes at the anatomic cecal apex can secure a diagnosis of appendicitis. Cecal apical changes with appendicitis include focal cecal apical thickening, the arrowhead sign, and the cecal bar. This pictorial essay describes and illustrates the spectrum of CT appearances of cecal apical changes that can be seen with appendicitis.
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The results of six simple investigations are compared with the duration of the disease in 100 children with acute appendicitis. The results indicate that during the first day on which the appendix becomes inflamed the local defence mechanisms of the appendix are impaired sufficiently to allow invasion by the bacterial organisms in its lumen. This initially inflamed and subsequently infected appendix may develop in the manner indicated. Local and/or generalized complications may follow, i.e. acute appendicitis in its successive stages of development, which may be regarded as (a) inflamed, (b) infected and (c) complicated, and these changes take place at intervals of 1 day. Bacterial and faeoliths are present in the lumen of the appendix, whether inflamed or not, and it is suggested that they complicate the disease rather than being responsible for causing it.
Lumen (anatomy)
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