rupture appendicitis

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  • 1. Ruptured appendicitis . PCT .. 9

2. Vermiform Appendix Gut biology normal flora - Biofilm secretory IgA mucin bacteria Bollinger, RR, Barbas, AS, Bush, EL, Lin, SS and Parker. W. Biofilms in the large bowel suggest an apparent function of the human vermiform appendix. J. Theoretical Biology. 2007; 249: 826-831. 3. Model of Host-Bacterial Interactions in the Gut Appendix Safe house beneficial bacteria 2 Lumen lower end cecum fecal flow biofilm : Preserve and protect re-booting Regular shedding and reinoculation latge bowel Everett, ML, Palestrant, D., Miller, SE, Bollinger, RR and Parker, W. Immune Exclusion and Immune Inclusion: a New Model of Host-Bacterial Interactions in the Gut. Clinical and Applied Immunology Reviews. 2004; 5: 321-332. 4. Acute appendicitis 2 1.Negative appendectomy : normal appendix 2.Rupture appendicitis : 10-15%:70%:15-30% Over diagnosis->Neg.App. Delay diagnosis->Rup.App. observe 5. Has misdiagnosis of appendicitis decreased over time? Flum Retrospective, population-based cohort study 63,707 12 1987-1998 Negative appendectomy15.5 % Acute appendicitis 84.5% Rupture appendicitis 25.8% u/s, CT,laparoscopy misdiagnosis rupture appendicitis Flum DR, Morris A, Koepsell T, Dellinger EP. Has misdiagnosis of appendicitis decreased over time? A population-based analysis. JAMA. 2001 Oct 10;286(14):1748-53. 6. Negative appendectomy negative appendectomy 10 15 Townsend CM, Beauchamp RD, Evers BM, Matton KL. Sabiston textbook of surgery. 6thed. Philadephia: WB Saunders Company; 1997. National Inpatient Sample from 1998 to 2007 adult>17yrs 475,651 case in US Negative appendectomy 11.83% 14.7% 1998 8.47% 2007 Seetahal SA1, Bolorunduro OB, Sookdeo TC, Oyetunji TA, Greene WR, Frederick W, Cornwell EE 3rd, Chang DC,Siram SM. Negative appendectomy: a 10-year review of a nationally representative sample. Am J Surg. 2011 Apr;201(4):433-7 7. Rupture appendicitis Incidence 20-30% Temple C, Huchcroft S, Temple W: The natural history of appendicitisin adults, a prospective study. Ann Surg 1995, 221:279-282. Acute acute inflammation appendicitis suppurative appendicitis gangrenous appendicitis without perforation Rupture perforation pus collection (localized generalized collection) 8. Rupture appendicitis Rupture appendicitis 2548 19.81 2555 21.44 2556 34.81 0.16%(2548) 0.22%(2556) . . 9. Appendicitis in BPK9 Negative appendectomy : 18.4% Rupture appendicitis : 12.5% 10. Rupture appendicitis 1. 60 4 20 2. 1.97 3. 4. rupture appendicitis 1. 37.8-37.9 oc 2.12 >38.9oc 4.6 2.PMN>90% 3.15 75% 3.Tachycardia 11. Time affects the risk of rupture appendicitis - Untreated symptoms < 36 Rupture risk 2% Untreated symptoms > 36 Rupture risk = 5% 5% 12 Nina A. Bickell, , Arthur H. Aufses Jr, Mary Rojas, Carol Bodian.How Time Affects the Risk of Rupture in Appendicitis: Journal of the American College of Surgeons Volume 202:3;401406, March 2006 12. Appendicitis in children Presentation < 5 yrs: negative appendectomy 25% Rupture appendicitis 45% DDX: : DHF, Henoch schonlein purpura, acute diarrhea,UTI : UC, ectopic pregnancy, PID, dysmenorrhea, salpingitis, acute pyrlonephritis,PU peroforation 13. Appendicitis in children 1/1/2544-31/12/2548 880 1 8 -15 : negative appendectomy 7.8 % Thai Ped J 2008; vol.15 251-258 Acute appendicitis 323 39.8% Acute suppurative appendicitis 146 18% Acute gangrenous appendicitis 68 8.4% Ruptured appendicitis 811 33.8% 14. Appendicitis in children CBC WBC PMN CT abdomen 15. Appendicitis in pregnancy 1:2000 rupture 10-20% nonpregnant pt. 57% pregnant pt. GA 16. Appendicitis in pregnancy 1. -anatomical change - -localized tender viceral-parietal per. 2.Leucocytosis left shift WBC 14,000 : 16,400 cell/mm2 Mourad J, Elliott JP, Erickson L, Lisboa L Appendicitis in pregnancy: new information that contradicts long-held clinical beliefs. Am J Obstet Gynecol. 2000;182(5):1027. 3.GI symptom: nausia, vomitting 4.Tachycardia 5.Complication of pregnancy : ectopic pregnancy, labor pain, round ligament pain etc. 6. u/s 17. Appendicitis in pregnancy CT scan Fetal exposure abdominal CT 3.5 rad Extimated fetal exposure inoized radiation 1-2 rad leukemia = 1.5-2 Chest Xray 0.02-0.07 mrad Hip film(1 film) 200 mrad Abdominal film(1 film) 100 mrad CT-head 1 rad CT-Abdominal 3.5 rad 18. Appendicitis in Elderly Incidence 5-10% > 60 Rupture appendicitis 40- 65% Morbidity, mortality Atypical presentation Communication Underlying disease CBC: leukocytosis leukopenia