Acute appendicitis in the pregnant patient

Article Abstract:

During pregnancy the most frequent reason for emergency surgery is acute appendicitis, inflammation of the appendix. Pregnancy can mask the symptoms and result in delayed treatment; this delay contributes to complications and illness in both the mother and baby. In an effort to devise a strategy for better and quicker diagnosis and treatment, a study was undertaken of 84 pregnant women who underwent exploratory abdominal surgery for acute appendicitis. This number represented a rate of 1 case of maternal appendicitis for 1,400 births. There were 27 patients (32 percent) in the first trimester; 37 patients (44 percent) in the second trimester; and 13 patients (16 percent) in the third trimester of pregnancy. The classic symptom of appendicitis, diffuse mid-abdominal pain migrating to the right lower abdomen, was present in 26 women (48 percent). Lower abdominal pain was the only symptom in 15 patients (28 percent). For 54 women (64 percent) the diagnosis of appendicitis was confirmed by pathology specimen; 15 patients (18 percent) had other abdominal abnormalities. Among the different trimesters, no significant difference was found in symptoms, laboratory results, or in the incidence of pathologic confirmation. Of the 54 patients with confirmed appendicitis, perforation occurred in 23 patients (43 percent); all patients had symptoms for longer than 24 hours. In five cases, the fetus did not survive; there were no cases of maternal death, but nine wound infections occurred. It is concluded that pregnancy obscures the diagnosis of appendicitis; trimester does not influence the course of appendicitis; and complications may be avoided by prompt surgery and avoidance of perforation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Pregnant women, Pregnancy, Complications of, Pregnancy complications

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A reappraisal of appendicitis in the elderly

Article Abstract:

The incidence of appendicitis (inflammation of the appendix of the cecum, or first portion of the large intestine) has increased among the elderly. It is generally believed that appendicitis in this age group has a higher than usual rate of complications and death. In an effort to address this issue, the medical records of 96 elderly patients (over 60 years of age) treated over a 10-year period for acute appendicitis were reviewed. The typical symptoms of appendicitis (nausea or vomiting, fever, right lower abdominal tenderness and elevated white blood cell count) were present in only 19 patients (20 percent). Only 59 patients (61 percent) complained of the abdominal pain usually associated with appendicitis. One-third of the patients did not seek medical attention until two or more days after the onset of symptoms. Only 51 percent of the patients were admitted to the hospital with the diagnosis of possible appendicitis. Surgery was performed within 24 hours on 80 patients (83 percent). At surgery, perforation was present in 69 patients (72 percent), and 29 patients (30 percent) had formation of an abscess. There were four deaths occurring in patients who had coexistent cancer. Of the 92 patients who survived, 29 (32 percent) had postoperative complications; 83 percent of these were patients with perforated appendix. It is suggested that acute appendicitis be considered a possible diagnosis in all elderly patients who have abdominal pain. The signs and symptoms of appendicitis in this age group are often atypical and may be confusing. Early diagnosis and surgery are necessary to avoid perforation and further complications. (Consumer Summary produced by Reliance Medical Information, Inc.)

Aged, Elderly, Demographic aspects

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Are blood cultures effective in the evaluation of fever in perioperative patients?

Article Abstract:

Evaluation of fever occurring in a patient during the perioperative period (before or after surgery) is usually done by blood culture. Although routinely performed, the usefulness of such blood cultures has not been determined. A study was undertaken to assess the incidence of positive blood culture in hospitalized adult surgical patients with fever (temperature of 101.5 F. or higher). A total of 364 blood cultures were obtained following 108 episodes of fever in 72 patients. These patients did not have other symptoms of serious infection. Prior to developing fever, 89 percent of the patients had undergone surgery. Of nine cultures in which organisms were isolated, positive results were due to contamination in four cases. There were only five confirmed positive blood cultures; two of these occurred in patients with an identifiable source of infection. The total cost of performing the 364 blood cultures was $13,992, or $2,798 per patient with a positive blood culture. In no patient did the identification of a positive blood culture have an effect on reducing patient morbidity or mortality. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis, Evaluation, Infection, Economic aspects, Causes of, Blood, Fever, Bacteremia, Postoperative care

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