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[PMID]: 23484582 [Au] Autor: Chaudhary S; Bhullar JS; Subhas G; Mittal VK [Ad] Endereço: Department of Surgery, Providence Hospital and Medical Centers, Southfield, MI 48075, USA. sushant107mamc@yahoo.co.in [Ti] Título: Hematocele after laparoscopic appendectomy. [So] Source: JSLS;16(4):660-2, 2012 Oct-Dec. [Is] ISSN: 1086-8089 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: Laparoscopic appendectomy is one of the most common laparoscopic surgeries performed. We report an unusual complication of hematocele after laparoscopic appendectomy. CASE DESCRIPTION: A 48-y-old male presented with swelling and discomfort in his right scrotum 11 d after he underwent laparoscopic appendectomy for acute appendicitis. Before the surgery, he had no scrotal swelling or inguinal hernia. [Mh] Termos MeSH primário: Apendicectomia/efeitos adversos Apendicite/cirurgia Hematocele/etiologia Laparoscopia/efeitos adversos [Mh] Termos MeSH secundário: Apendicectomia/métodos Hematocele/diagnóstico Humanos Masculino Meia-Idade Testículo/radiografia Testículo/ultrassonografia Tomografia Computadorizada por Raios X [Pt] Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE [Em] Mês de entrada: 1305 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 130314 [St] Status: MEDLINE [do] DOI: 10.4293/108680812X13517013316717

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[PMID]: 23484574 [Au] Autor: Burjonrappa SC; Nerkar H [Ad] Endereço: Maimonides Infants and Children's Hospital, Brooklyn, NY 11219, USA. sathyabc@yahoo.com [Ti] Título: Teaching single-incision laparoscopic appendectomy in pediatric patients. [So] Source: JSLS;16(4):619-22, 2012 Oct-Dec. [Is] ISSN: 1086-8089 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: INTRODUCTION: Laparoscopic appendectomy is accepted as the gold standard technique for the treatment of acute appendicitis. Recently single-incision laparoscopic surgery (SILS) was tried in the pediatric population and was shown to be both feasible and safe. We describe our early experience in teaching the SILS procedure for appendicitis in a large community hospital center surgical residency program. METHODS: SILS appendectomy was performed in 40 consecutive patients with acute appendicitis who were admitted by a single surgeon from May 2011 to August 2011. All patients over the age of 4 y presenting with noncomplicated and complicated appendicitis (perforated) were offered SILS appendectomy. Execution of the technical aspects of 20 SILS operations done by 3 PGY III residents was evaluated. RESULTS: The average age of the patient was 11.1 y (range, 7 to 15). SILS was performed successfully in 19 out of 20 patients. Nineteen patients underwent emergent or urgent appendectomy, while 1 patient underwent an interval procedure. Nine patients were found to have perforated appendicitis, while the other 11 had noncomplicated acute appendicitis. One patient was converted to conventional 3-port laparoscopy due to difficulties during the procedure. The mean operative time was 73 min (range, 47 to 112). A significant learning curve to successfully execute the critical steps of the SILS procedure was noted in all residents evaluated. CONCLUSION: SILS technology appears promising for the treatment of acute appendicitis. However, its successful incorporation into surgical training programs will depend on the development of innovative simulation strategies. [Mh] Termos MeSH primário: Apendicectomia/educação Apendicite/cirurgia Internato e Residência/métodos Laparoscopia/educação Ensino/métodos [Mh] Termos MeSH secundário: Doença Aguda Adolescente Apendicectomia/métodos Criança Feminino Humanos Laparoscopia/métodos Curva de Aprendizado Masculino Estudos Retrospectivos [Pt] Tipo de publicação: COMPARATIVE STUDY; JOURNAL ARTICLE [Em] Mês de entrada: 1305 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 130314 [St] Status: MEDLINE [do] DOI: 10.4293/108680812X13462882737339

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[PMID]: 23484567 [Au] Autor: Adisa AO; Alatise OI; Arowolo OA; Lawal OO [Ad] Endereço: Department of Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria. wadisc@yahoo.com [Ti] Título: Laparoscopic appendectomy in a Nigerian teaching hospital. [So] Source: JSLS;16(4):576-80, 2012 Oct-Dec. [Is] ISSN: 1086-8089 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: OBJECTIVE: Laparoscopic appendectomy in a setting where resources are poor is still controversial. This study evaluates the impact of laparoscopy on the early outcome of acute appendicitis in a developing country. METHODS: All patients who underwent appendectomy from January 2010 through June 2011 at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria were recruited for this study. RESULTS: Of the 139 patients with acute appendicitis within the study period, 83 (59.7%) had open appendectomy (OA), 19 (13.7%) whose clinical and radiological findings suggested complicated appendicitis at presentation had laparotomy, while 37 (26.6%) had laparoscopic procedures. In the laparoscopy group, initial diagnostic laparoscopy in 4 (10.8%) patients revealed a normal appendix along with other findings that precluded appendectomy. Laparoscopic appendectomy (LA) was then performed in 33 (23.7%) patients with 2 of these (6.1%) requiring conversion to open laparotomy. Mean time for the LA procedure was higher than that observed for OA (56.2 vs 38.9 min). Patients in the LA group had a shorter mean postoperative stay (1.8 vs 3.0). Wound infection occurred in 2 (6.5%) patients from the LA group and 8 (9.6%) from OA. CONCLUSION: Laparoscopic appendectomy reduced the rate of unnecessary appendectomy and postoperative hospital stay in our patients, potentially reducing crowding in our surgical wards. We advocate increased use of laparoscopy especially in young women. [Mh] Termos MeSH primário: Apendicectomia/métodos Apendicite/cirurgia Países em Desenvolvimento Hospitais de Ensino Laparoscopia/métodos [Mh] Termos MeSH secundário: Doença Aguda Adolescente Adulto Idoso Feminino Humanos Tempo de Internação/tendências Masculino Meia-Idade Nigéria Taxa de Sobrevida/tendências Resultado de Tratamento Adulto Jovem [Pt] Tipo de publicação: COMPARATIVE STUDY; JOURNAL ARTICLE [Em] Mês de entrada: 1305 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 130314 [St] Status: MEDLINE [do] DOI: 10.4293/108680812X13462882737131

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[PMID]: 23007281 [Au] Autor: Lien WC; Wang HP; Liu KL; Chen CJ [Ad] Endereço: Department of Emergency Medicine, College of Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan, Republic of China. [Ti] Título: Appendicolith delays resolution of appendicitis following nonoperative management. [So] Source: J Gastrointest Surg;16(12):2274-9, 2012 Dec. [Is] ISSN: 1873-4626 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: INTRODUCTION: Success in nonoperative management is only based on the clinical symptoms of patients with acute appendicitis. However, imaging studies can provide further insight into the status of the appendix to monitor treatment response if immediate appendectomy is not undertaken. This study investigates sonographic resolution following nonoperative management and assesses the feasibility of incorporating ultrasound into patient care. MATERIALS AND METHODS: Adult patients with acute appendicitis who had been successfully treated with nonoperative management were enrolled and received repeat sonographic examinations using 3-day intervals until sonographic resolution. The relationship between the time to achieve sonographic resolution and clinical parameters was identified using negative binomial regression models. RESULTS: From January 2003 to December 2009, 128 patients were successfully treated with nonoperative management. Eighty patients completed sonographic examinations until achieving resolution. Sonographic resolution was achieved on 17 ± 12 days (range, 3-69 days). Ninety-five percent of the patients achieved sonographic resolution within 41 days. The appendicolith was positively related to the time to achieve sonographic resolution (rate ratios, 1.63; 95 % confidence intervals, 1.06-2.51). CONCLUSIONS: Ultrasound can be used to evaluate the condition of the appendix to monitor treatment response following nonoperative management on the sixth week. An appendicolith delays sonographic resolution of appendicitis. [Mh] Termos MeSH primário: Apendicite/complicações Apendicite/terapia Apêndice Calcinose/complicações Doenças do Ceco/complicações [Mh] Termos MeSH secundário: Apendicite/ultrassonografia Calcinose/ultrassonografia Doenças do Ceco/ultrassonografia Feminino Humanos Masculino Meia-Idade Estudos Prospectivos Fatores de Tempo [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1305 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 121128 [St] Status: MEDLINE [do] DOI: 10.1007/s11605-012-2032-1

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[PMID]: 22918862 [Au] Autor: Bildzukewicz NA; Weinstein MS [Ad] Endereço: UC San Diego Health System, San Diego, CA, USA. [Ti] Título: Appendicitis following virtual colonoscopy: a case report. [So] Source: J Gastrointest Surg;16(12):2291-3, 2012 Dec. [Is] ISSN: 1873-4626 [Cp] País de publicação: United States [La] Idioma: eng [Mh] Termos MeSH primário: Apendicite/etiologia Colonografia Tomográfica Computadorizada/efeitos adversos [Mh] Termos MeSH secundário: Adulto Humanos Masculino [Pt] Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE [Em] Mês de entrada: 1305 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 121128 [St] Status: MEDLINE [do] DOI: 10.1007/s11605-012-1994-3

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[PMID]: 22595016 [Au] Autor: Hartwich JE; Carter RF; Wolfe L; Goretsky M; Heath K; St Peter SD; Lanning DA [Ad] Endereço: Department of Surgery, Division of Pediatric Surgery, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, Virginia. jhartwich@mcvh-vcu.edu [Ti] Título: The effects of irrigation on outcomes in cases of perforated appendicitis in children. [So] Source: J Surg Res;180(2):222-5, 2013 Apr. [Is] ISSN: 1095-8673 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: INTRODUCTION: Appendicitis is the most common indication for urgent abdominal operation in children. Approximately 20%-30% of patients will have a perforation at operation. Intra-abdominal abscess after appendectomy is reported in 3%-20% of patients and adds significantly to hospital stay with increased morbidity and overall cost. Surgical dogma has long advocated for irrigation in the setting of gross pus to prevent abscess formation. METHODS: Following IRB approval, data were retrospectively collected for children who had undergone appendectomy for perforated appendicitis at one of two children's hospitals over the course of 5 y. Perforation was determined by review of operative notes. All patients had free fluid in their peritoneal cavity evacuated by suction, whereas some of the patients also had their peritoneal cavity irrigated with normal saline. Postoperative intra-abdominal abscess rates were determined based on clinical symptoms and confirmatory radiologic studies. RESULTS: There were 99 patients in the suction-only group and 139 in the irrigation group. Standard demographics were relatively similar between the two groups. There were significantly lower rates of intra-abdominal abscess formation (4.0% versus 17.2%, P = 0.002) and wound infection (1.0% versus 8.6%, P = 0.003) in the suction-only group compared with the irrigation group. We further analyzed abscess rates by surgical treatment, either laparoscopic or open appendectomy. There were 85 patients in the laparoscopic group and 152 patients in the open appendectomy group. In this subgroup analysis, there were also significantly lower rates of abscess formation in patients treated with suction only compared with irrigation in the laparoscopic (3.5% versus 18.8%, P = 0.012) and open appendectomy groups (4.2% versus 16.3%, P = 0.036). CONCLUSIONS: Results of this retrospective review indicate that a suction-only approach significantly decreased rates of abscess formation and wound infections compared to irrigation in cases of perforated appendicitis in children. [Mh] Termos MeSH primário: Apendicite/cirurgia Irrigação Terapêutica/métodos [Mh] Termos MeSH secundário: Adolescente Apendicectomia Criança Feminino Humanos Masculino Estudos Retrospectivos Resultado de Tratamento [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1305 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 130318 [St] Status: MEDLINE

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[PMID]: 23180297 [Au] Autor: Heineman J [Ad] Endereço: Oregon Health & Science University, Oregon, USA. [Ti] Título: Towards evidence based emergency medicine: Best BETs from the Manchester Royal Infirmary. BET 1: An evaluation of the Alvarado score as a diagnostic tool for appendicitis in children. [So] Source: Emerg Med J;29(12):1013-4, 2012 Dec. [Is] ISSN: 1472-0213 [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: A short-cut systematic review was carried out to establish whether the Alvarado score could be used to rule in or rule out a diagnosis of appendicitis in children. A literature search identified eight studies that were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that the Alvarado score does effectively risk stratify children with suspected appendicitis. Children with an Alvarado score of less than 5 are unlikely to have acute appendicitis, although wide confidence intervals mean that more evidence is still needed before this alone can be used to exclude the diagnosis. [Mh] Termos MeSH primário: Apendicite/diagnóstico Técnicas de Diagnóstico do Sistema Digestório/instrumentação Índice de Gravidade de Doença [Mh] Termos MeSH secundário: Doença Aguda Criança Medicina de Emergência Baseada em Evidências Humanos [Pt] Tipo de publicação: JOURNAL ARTICLE; REVIEW [Em] Mês de entrada: 1305 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 121126 [St] Status: MEDLINE [do] DOI: 10.1136/emermed-2012-202054.2

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[PMID]: 22810888 [Au] Autor: Bansal V; Altermatt S; Nadal D; Berger C [Ad] Endereço: Division of Infectious Diseases and Hospital Epidemiology and Children's Research Center, University Children's Hospital of Zürich, Steinwiesstrasse 75, 8032, Zurich, Switzerland. [Ti] Título: Lack of benefit of preoperative antimicrobial prophylaxis in children with acute appendicitis: a prospective cohort study. [So] Source: Infection;40(6):635-41, 2012 Dec. [Is] ISSN: 1439-0973 [Cp] País de publicação: Germany [La] Idioma: eng [Ab] Resumo: BACKGROUND: Preoperative antimicrobial prophylaxis is widely used in pediatric patients undergoing appendectomy, but evidence showing a reduction of postoperative infectious complications is lacking. METHODS: A prospective consecutive cohort study on changing from preoperative antimicrobial prophylaxis to no prophylaxis in children undergoing urgent appendectomy was undertaken. The impact of this change in management on postoperative infectious complications was evaluated by comparing the outcome in 100 patients receiving (group A) and a subsequent 100 patients not receiving prophylaxis (group B), which consisted of a preoperative single dose of intravenous metronidazole (10 mg/kg body weight). RESULTS: Histology confirmed acute appendicitis in 92 patients of group A and 95 patients of group B. In patients with histological simple appendicitis, postoperative infectious complications were noted in 2 (3.0 %) of 69 patients from group A and in none of 70 patients from group B, and in patients with histological perforated appendicitis in 5 (22 %) of 23 and 4 (16 %) of 25 patients from groups A and B, respectively. Postoperative infectious complications were more frequent (p < 0.05) in perforated than in simple appendicitis. These infectious complications included in simple appendicitis two wound infections in group A, and in perforated appendicitis four intraabdominal abscesses and one wound infection in group A and two intraabdominal abscesses and two wound infections in group B. CONCLUSION: Postoperative infectious complications were seen more often in patients with perforated appendicitis than in those with simple appendicitis. Preoperative antimicrobial prophylaxis with metronidazole did not reduce the rates of postoperative infectious complications. [Mh] Termos MeSH primário: Anti-Infecciosos/uso terapêutico Antibioticoprofilaxia Apendicectomia/efeitos adversos Apendicite/cirurgia Infecção da Ferida Operatória/prevenção & controle [Mh] Termos MeSH secundário: Doença Aguda Adolescente Apendicite/complicações Apendicite/quimioterapia Criança Pré-Escolar Estudos de Coortes Humanos Lactente Estudos Prospectivos Infecção da Ferida Operatória/etiologia Suíça Resultado de Tratamento [Pt] Tipo de publicação: JOURNAL ARTICLE [Nm] Nome de substância: 0 (Anti-Infective Agents) [Em] Mês de entrada: 1305 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 121119 [St] Status: MEDLINE [do] DOI: 10.1007/s15010-012-0297-7

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[PMID]: 23128651 [Au] Autor: Tejani C; Phatak T; Sivitz A [Ad] Endereço: Emergency Medicine Education, Newark Beth Israel Hospital, Brookly, NY, USA. ctejani5@yahoo.com [Ti] Título: Right lower-quadrant pain-more than one diagnosis. [So] Source: Pediatr Emerg Care;28(11):1224-6, 2012 Nov. [Is] ISSN: 1535-1815 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: When a patient presents with right-lower-quadrant pain in the emergency room, the diagnosis of appendicitis must always be considered, but the differential diagnosis for this symptom includes many other etiologies. We describe a case of an 8-year-old girl with von Willebrand disease who presented with right-lower-quadrant pain and was found to have an appendiceal wall hematoma. During her evaluation, an ultrasound of the abdomen was performed, and the results were initially interpreted as an intussusception. Although ultrasound is a highly reliable way to diagnose appendicitis and intussusception, the case illustrates that the thickened abdominal wall that occurs in a mural hematoma can appear like the "target sign" that is usually associated with intussusception, and in certain clinical scenarios, alternative forms of imaging may be of value. [Mh] Termos MeSH primário: Dor Abdominal/diagnóstico Apendicite/diagnóstico Apêndice/ultrassonografia Hematoma/diagnóstico Intussuscepção/diagnóstico Doenças de von Willebrand/complicações [Mh] Termos MeSH secundário: Dor Abdominal/ultrassonografia Apendicite/complicações Apendicite/ultrassonografia Apêndice/patologia Criança Diagnóstico Diferencial Feminino Hematoma/ultrassonografia Humanos Intussuscepção/ultrassonografia [Pt] Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE [Em] Mês de entrada: 1305 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 121106 [St] Status: MEDLINE [do] DOI: 10.1097/PEC.0b013e31827205ea

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[PMID]: 23141950 [Au] Autor: Charlier P; Brun L; Ménétrier M; Lorin de la Grandmaison G [Ad] Endereço: Service d'anatomie pathologique et de médecine légale, département forensic, CHU Raymond Poincaré, 104, boulevard R. Poincaré (AP-HP, UVSQ), 92380 Garches, France. ph_charlier@yahoo.fr [Ti] Título: [An unusual appendicular lesion]. [Ti] Título: Une lésion appendiculaire inhabituelle.. [So] Source: Ann Pathol;32(5):384-6, 2012 Oct. [Is] ISSN: 0242-6498 [Cp] País de publicação: France [La] Idioma: fre [Mh] Termos MeSH primário: Apendicite/diagnóstico Apêndice/patologia Diverticulite/diagnóstico [Mh] Termos MeSH secundário: Apendicite/complicações Apendicite/patologia Autopsia Doenças do Ceco/complicações Diverticulite/complicações Diverticulite/patologia Divertículo/complicações Humanos Mucosa Intestinal/patologia Masculino Meia-Idade Infiltração de Neutrófilos Suicídio Neoplasias da Traqueia/complicações Neoplasias da Traqueia/secundário [Pt] Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE [Em] Mês de entrada: 1305 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 121112 [St] Status: MEDLINE

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