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appendectomy in patient with suspected COVID-19 with negative COVID-19 results: A case report

World Journal of Clinical Cases 2020年第10期8卷 1944-1949页

作者： Changho Kim Jong Kun Kim In Hwan Yeo Jae Young Choe Jeong Eun Lee So Jeong Kang Chan Sub Park Ki Tae Kwon Soyoon Hwang Department of Emergency Medicine School of MedicineKyungpook National UniversityDaegu 41944South Korea Department of Anesthesiology and Pain Medicine School of MedicineKyungpook National UniversityKyungpook National University HospitalDaegu 41944South Korea Department of Surgery School of MedicineKyungpook National UniversityKyungpook National University HospitalDaegu 41944South Korea Department of Internal Medicine School of MedicineKyungpook National UniversityDaeguKoreaDepartment of Infection ControlKyungpook National University Chilgok HospitalDaegu 41944South Korea

BACKGROUND Even at present,we are in the middle of the novel coronavirus disease 2019(COVID-19)pandemic and are facing challenges in trial and ***,emergency surgery for patients with suspected COVID-19 is burdensome not only for patients but also for healthcare ***,we established a surveillance system in the emergency room and established principles for managing patients suspected of COVID-19 who require emergency *** SUMMARY A 67-year-old man was diagnosed with appendicitis in March *** wife was diagnosed with COVID-1910 d earlier,and the patient was in close contact with *** patient tested negative twice on an upper respiratory COVID-19 reverse transcription–polymerase chain reaction screening test,but chest X-ray and chest computed tomography revealed patchy ground-glass opacity in both upper lobes of the patient’s *** same emergency surgery procedure for patients with confirmed COVID-19 was applied to this patient suspected of having the disease to ensure that surgery was not delayed while waiting for the reverse transcription–polymerase chain reaction results.A few hours after surgery,the upper respiratory tract specimen taken in the emergency room was negative for COVID-19 but the lower respiratory tract specimen was found to be positive for the *** When COVID-19 is suspected,emergency surgery should be performed as for confirmed COVID-19 without delay.

关键词： COVID-19 Appendicitis appendectomy Emergency room Infection control Case report

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appendectomy and Clostridium difficile colitis:Relationships revealed by clinical observations and immunology

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World Journal of Gastroenterology 2013年第34期19卷 5607-5614页

作者： Nathan L Sanders R Randal Bollinger Ryan Lee Steven Thomas William Parker Department of Surgery Duke University Medical Center

Advances in understanding the interaction between the human immune system and the microbiome have led to an improved understanding of the function of the vermiform appendix as a safe-house for beneficial bacteria in the *** advances have been made despite long standing clinical observations that the appendectomy is a safe and effective ***,more recent clinical data show that an appendectomy puts patients at increased risk for recurrent Clostridium difficile(***)-associated colitis,and probably other diseases associated with an altered *** the same time,appendectomy does not apparently put patients at risk for an initial onset of ***-associated *** clinical observations point toward the idea that the vermiform appendix might not effectively protect the microbiome in the face of broad spectrum antibiotics,the use of which precedes the initial onset of ***-associated ***,these observations point to the idea that historically important threats to the microbiome such as infectious gastrointestinal pathogens have been supplanted by other threats,particularly the use of broad spectrum antibiotics.

关键词： appendectomy Clostridium difficile Colitis Diarrheal illness Vermiform appendix

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Laparoscopic versus open appendectomy: Which way to go?

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World Journal of Gastroenterology 2008年第31期14卷 4909-4914页

作者： Ioannis Kehagias Stavros Nikolaos Karamanakos Spyros Panagiotopoulos Konstantinos Panagopoulos Fotis Kalfarentzos Department of Surgery School of Medicine University Hospital of Patras Rion University Hospital Patras 26500 Greece

AIM: To compare the outcome of laparoscopic versus open appendectomy. METHODS: Prospectively collected data from 293 consecutive patients with acute appendicitis were studied. These comprised of 165 patients who underwent conventional appendectomy and 128 patients treated laparoscopically. The two groups were compared with respect to operative time, length of hospital stay, postoperative pain, complication rate and cost. RESULTS: There were no statistical differences regarding patient characteristics between the two groups. Conversion to laparotomy was necessary in 2 patients (1.5%). Laparoscopic appendectomy was associated with a shorter hospital stay (2.2 d vs 3.1 d, P = 0.04), and lower incidence of wound infection (5.3% vs 12.8%, P = 0.03). However, in patients with complicated disease, intra-abdominal abscess formation was more common after laparoscopic appendectomy (5.3% vs 2.1%, P = 0.002). The operative time and analgesia requirements were similar in the two groups. The cost of treatment was higher by 370 € in the laparoscopic group. CONCLUSION: Laparoscopic appendectomy is as safe and effi cient as open appendectomy, provided surgical experience and equipment are available.

关键词： Laparoscopy Appendicitis appendectomy Conventional appendectomy

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Patient and physician perception of natural orifice transluminal endoscopic appendectomy

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World Journal of Gastroenterology 2012年第15期18卷 1800-1805页

作者： Tomas Hucl Adela Saglova Marek Benes Matej Kocik Martin Oliverius Zdenek Valenta Julius Spicak Department of Gastroenterology and Hepatology Institute for Clinical and Experimental Medicine14021 PragueCzech Republic Department of Transplantation Surgery Institute for Clinical and Experimental Medicine14021 PragueCzech Republic Department of Medical Informatics Institute of Computer Science AS CR18207 PragueCzech Republic

AIM:To investigate perception of natural orifice transluminal endoscopic surgery(NOTES)as a potential technique for ***:One hundred patients undergoing endoscopy and 100 physicians were given a questionnaire describing in detail the techniques of NOTES and laparoscopic *** were asked about the reasons for their preference,choice of orifice,and extent of complication risk they were willing to ***:Fifty patients(50%)and only 21 physicians(21%)preferred NOTES(Pappendectomy than male physicians(P=0.02).CONCLUSION:The preference of NOTES for appendectomy was greater in patients than physicians and was related to reduced pain and absence of hernia rather than lack of scarring.

关键词： Natural orifice transluminal endoscopic surgery Patient perception Physician perception appendectomy Laparoscopy

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Suture granuloma of the abdominal wall with intra-abdominal extension 12 years after open appendectomy

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World Journal of Gastroenterology 2009年第32期15卷 4083-4086页

作者： Goran Augustin Dragan Korolija Mate Skegro Jasminka Jakic-Razumovic Department of Surgery Division of Abdominal SurgeryUniversity Hospital Center ZagrebKipatieva 1210000 ZagrebCroatia Department of Pathology University Hospital Center Zagreb Kipatieva 1210000 ZagrebCroatia

Most complications after appendectomy occur within ten days; however, we report the unusual case of a suture granuloma 12 years after open appendectomy. The afebrile 75-year-old woman presented with a slightly painful palpable mass in the right lower abdomen. There was no nausea or vomiting and bowel movements were normal. She lost 10 kg during the 3 mo before presentation. The patient had undergone an appendectomy 12 years previously. Physical examination revealed a tender mass, 10 cm in diameter, under the appendectomy scar. The preoperative laboratory findings, tumor markers and plain abdominal radiographs were normal. Multi-slice computed tomography scanning showed an inhomo-genous abdominal mass with minimal vascularization in the right lower abdomen 8.6cm×8cm×9 cm in size which communicated with the abdominal wall. The abdominal wall was thickened, weak and bulging. The abdominal wall mass did not communicate with the cecum or the ascending colon. Complete excision of the abdominal wall mass was performed via median laparotomy. Histopathological examination revealed a granuloma with a central abscess. This case report demonstrates that a preoperative diagnosis of abdominal wall mass after open appendectomy warrants the use of a wide spectrum of diagnostic modalities and consequently different treatment options.

关键词： appendectomy Differential diagnosis Postoperative complication Suture granuloma

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Unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis

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World Journal of Gastroenterology 2013年第25期19卷 4015-4022页

作者： Mehmet Yilmaz Sami Akbulut Koray Kutluturk Nurhan Sahin Ebru Arabaci Cengiz Ara Sezai Yilmaz Department of Surgery Liver Transplant Institute Inonu University Faculty of Medicine Department of Pathology Inonu University Faculty of Medicine

AIM: To investigate the prevalence and implications of unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis. METHODS: The demographic and histopathological data of 1621 patients (≥ 16 years-old) who underwent appendectomy to treat an initial diagnosis of acute appendicitis between January 1999 and November 2011 were retrospectively assessed. Microscopic findings were used to classify the patients under six categories: appendix vermiformis, phlegmonous appendicitis, gan- grenous appendicitis, perforated appendicitis, supurative appendicitis, and unusual histopathologic findings. The demographic and clinicopathologic characteristics of patients with unusual histopathologic findings were evaluated in detail, and re-analysis of archived resected appendix specimens was carried out. RESULTS: A total of 912 males and 709 females, from16 to 94 years old, were included in the study and comprised 789 cases of suppurative appendicitis, 370 cases of appendix vermiformis, 243 cases of perforated gangrenous appendicitis, 53 cases of flegmaneous appendicitis, 32 cases of gangrenous appendicitis, and 134 (8.3%) cases of unusual histopathological findings. The unusual histopathological findings included fibrous obliteration (n = 62), enterobius vermicularis (n = 31), eosinophilic infiltration (n = 10), mucinous cystadenoma (n = 8), carcinoid tumor (n = 6), granulomatous inflammation (n = 5), adenocarcinoma (n = 4; one of them mucinous), and mucocele (n = 3), adenomatous polyp (n = 1), taenia sup (n = 1), ascaris lumbricoides (n = 1), appendiceal diverticula (n = 1), and B cell non-hodgkin lymphoma (n = 1). None of the 11 patients with subsequent diagnosis of tumor were suspected of cancer prior to the appendectomy. CONCLUSION: Even when the macroscopic appearance of appendectomy specimens is normal, histopathological assessment will allow early diagnosis of many unusual diseases.

关键词： Appendicitis appendectomy specimens Histopathology Unusual findings Appendiceal malignancy

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Prior appendectomy and the phenotype and course of Crohn's disease

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World Journal of Gastroenterology 2006年第8期12卷 1235-1242页

作者： Jacques Cosnes Philippe Seksik Isabelle Nion-Larmurier Laurent Beaugerie Jean-Pierre Gendre Service de Gastroentérologie et Nutrition h■pital St-AntoineParisFrance

AIM： To determine whether prior appendectomy modifies the phenotype and severity of Crohn＇s disease. METHODS： appendectomy status and smoking habits were specified by direct interview in 2838 patients consecutively seen between 1995 and 2004. Occurrence of complications and therapeutic needs were reviewed retrospectively. Additionally, annual disease activity was assessed prospectively between 1995 and 2004 in patients who had not had ileocecal resection and of a matched control group. RESULTS： Compared to 1770 non-appendectomized patients, appendectomized patients more than 5 years before Crohn＇s disease diagnosis （n=716） were more often females, smokers, with ileal disease. Cox regression showed that prior appendectomy was positively related to the risk of intestinal stricture （adjusted hazard ratio, 1.24; 95% confidence interval, 1.13 to 1.36; P=0.02） and inversely related to the risk of perianal fistulization （adjusted hazard ratio, 0.75; 95% confidence interval, 0.68 to 0.83; P=0.002）. No difference was observed between the two groups regarding the therapeutic needs, except for an increased risk of surgery in appendectomized patients, attributable to the increased prevalence of ileal disease. Between 1995 and 2004, Crohn＇s disease was active during 50% of years in appendectomized patients （1318 out of 2637 patientyears） and 51% in non-appendectomized patients （1454 out of 2841 patient-years; NS）. CONCLUSION： Prior appendectomy is associated with a more proximal disease and has an increased risk of stricture and a lesser risk of anal fistulization. However, the severity of the disease is unaffected.

关键词： Crohn's disease appendectomy Surgery Smoking

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Post-appendectomy pelvic abscess with extended-spectrum beta-lactamase producing Escherichia coli : A case report and review of literature

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World Journal of Clinical Cases 2018年第16期6卷 1175-1181页

作者： Andrew Tse Rajkumar Cheluvappa Selwyn Selvendran Department of Surgery St George Public Hospital St George and Sutherland Clinical School University of New South Wales BN Program Discipline of Nursing and Midwifery University of Canberra

BACKGROUND Appendicitis, the inflammation of the appendix, is the most common abdominal surgical emergency requiring expedient surgical intervention. Extendedspectrum beta-lactamases(ESBLs) are bacterial enzymes that catalyse the degradation of the betalactam ring of penicillins and cephalosporins(but without carbapenemase activity), leading to resistance of these bacteria to beta-lactam antibiotics. Recent increases in incidence of ESBL-producing bacteria have caused alarm worldwide. Proportion estimates of ESBLEnterobacteriaceae hover around 46% in China, 42% in East Africa, 12% in Germany, and 8% in the United *** SUMMARY The impact of ESBL-producing bacteria on appendiceal abscesses and consequent pelvic abscesses are yet to be examined in depth. A literature review using the search words "appendiceal abscesses" and "ESBL Escherichia coli(E. coli)" revealed very few cases involving ESBL E. coli in any capacity in the context of appendiceal abscesses. This report describes the clinical aspects of a patient with appendicitis whodeveloped a postoperative pelvic abscess infected with ESBL-producing E. coli. In this report, we discuss the risk factors for contracting ESBL E. coli infection in appendicitis and post-appendectomy pelvis abscesses. We also discuss our management approach for postappendectomy ESBL E. coli pelvic abscesses, including drainage, pathogen identification, and pathogen characterisation. When ESBL E. coli is confirmed, carbapenem antibiotics should be promptly administered, as was done efficaciously with this patient. Our report is the first one in a developed country involving ESBL E. coli related surgical complications in association with a routine laparoscopic *** Our report is the first involving ESBL E. coli and appendiceal abscesses, and that too consequent to laparoscopic appendectomy.

关键词： appendectomy Appendiceal abscess Appendicitis Beta-Lactam Antibiotic resistance Beta-Lactamase Carbanepem Cephalosporin Escherichia coli Extended-spectrum beta-lactamase Infection Pelvic abscess Penicillin Case report

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Single-incision laparoscopic appendectomy vs conventional laparoscopic appendectomy:Systematic review and meta-analysis

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World Journal of Gastroenterology 2013年第31期19卷 5165-5173页

作者： Yu-Long Cai Xian-Ze Xiong Si-Jia Wu Yao Cheng Jiong Lu Jie Zhang Yi-Xin Lin Nan-Sheng Cheng Department of Bile Duct Surgery West China Hospital Sichuan University

AIM: To assess the differences in clinical benefits and disadvantages of single-incision laparoscopic appendectomy(SILA) and conventional laparoscopic appendectomy(CLA).METHODS: The Cochrane Library,MEDLINE,Embase,Science Citation Index Expanded,and Chinese Biomedical Literature Database were electronically searched up through January 2013 to identify randomized controlled trails(RCTs) comparing SILA with *** was extracted from eligible studies to evaluate the pooled outcome effects for the total of 1068 *** meta-analysis was performed using Review Manager *** dichotomous data and continuous data,the risk ratio(RR) and the mean difference(MD) were calculated,respectively,with 95%CI for *** continuous outcomes with different measurement scales in different RCTs,the standardized mean difference(SMD) was calculated with 95%*** and subgroup analyses were performed when ***: Six RCTs were identified that compared SILA(n = 535) with CLA(n = 533).Five RCTs had a high risk of bias and one RCT had a low risk of *** was associated with longer operative time(MD = 5.68,95%CI: 3.91-7.46,P < 0.00001),higher conversion rate(RR = 5.14,95%CI: 1.25-21.10,P = 0.03) and better cosmetic satisfaction score(MD = 0.52,95%CI: 0.30-0.73,P < 0.00001) compared with *** significant differences were found for total complications(RR = 1.15,95%CI: 0.76-1.75,P = 0.51),drain insertion(RR = 0.72,95%CI: 0.41-1.25,P = 0.24),or length of hospital stay(SMD = 0.04,95%CI:-0.08-0.16,P = 0.57).Because there was not enough data among the analyzed RCTs,postoperative pain was not ***: The benefit of SILA is cosmetic satisfaction,while the disadvantages of SILA are longer operative time and higher conversion rate.

关键词： Single incision Laparoscopic appendectomy Meta-analysis Systematic review

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Revisiting delayed appendectomy in patients with acute appendicitis

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World Journal of Clinical Cases 2021年第20期9卷 5372-5390页

作者： Jian Li Department of General Surgery The Third Hospital of MianyangSichuan Mental Health CenterMianyang 621000Sichuan ProvinceChina

Acute appendicitis(AA)is the most common acute abdomen,and appendectomy is the most common nonelective surgery performed *** the long history of understanding this disease and enhancements to medical care,many challenges remain in the diagnosis and treatment of *** of these challenges is the timing of *** recent decades,extensive studies focused on this topic have been conducted,but there have been no conclusive *** the onset of symptoms to appendectomy,many factors can cause delay in the surgical *** are inevitable,and some can be modified and *** favorable and unfavorable results of these factors vary according to different *** purpose of this review is to discuss the causes of appendectomy delay and its risk-related *** review also explores strategies to balance the positive and negative effects of delayed appendectomy.

关键词： Acute appendicitis appendectomy Delay Perforation Postoperative complications

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