Thursday, 5 December 2013

Appendicitis: Complications and Diseases associated to Appendicitis

Appendicitis is defined as a condition of inflammation of Appendix. It is classified as an emergency, in many required the removal of the appendix. If burst, or perforate, spilling infectious materials into the abdominal cavity can be life threatening.
III. Complications and Diseases associated to Appendicitis
A. Complications
1. Pyogenic liver abscess [PLA]
Pyogenic liver abscess [PLA] is a rare and life-threatening disease in children. Appendicitis was the leading source of PLA in the pre-antibiotic era, but it essentially has been eliminated in recent times. There is a report of a 12-year old girl with PLA after laparotomy for perforated appendix. She developed persistent fever and respiratory distress post operatively. Physicians had an impression of pneumonia but abdominal ultrasound showed cystic mass with mobile internal echoes within the right lobe of the liver suggesting an abscess. Patient was successfully managed by percutaneous drainage under ultrasound guidance(16).
2. A ruptured appendix
Although the finding of appendiceal duplication is uncommon, its misdiagnosis and mismanagement may yield poor clinical outcomes and serious medicolegal consequences. Laparoscopic surgical exploration was performed on a 17-year-old male patient with right lower quadrant pain and a history of a previous appendectomy. Inspection of the cecum revealed a second appendix, which was retrocecal, ruptured, and gangrenous(17). Other study found that appendicitis is the most common abdominal condition leading to urgent surgery in children. With the goal of identifying signs and symptoms that will allow prompt diagnosis of rupture of the appendix and thus decrease associated morbidities, our aim was to determine factors associated with ruptured appendicitis in children diagnosed with appendicitis(17).
B. Diseases associated to Appendicitis
1. Thoracic empyema
Appendicitis and thoracic empyema are rarely presented together. There is a report of a thoracic empyema due to bacterial translocation in a patient, after she underwent appendicectomy for nonperforated acute appendicitis, according tp the Ankara Training and Research Hospital(18).
2. De Garengeot hernia
he presence of the appendix within a femoral hernia sac is a rare condition known as De Garengeot hernia. There is a report of a case of De Garengeot hernia with concomitant appendicitis, according to the University of Cagliari(19).
3. Simultaneous Meckel’s diverticulitis
There is a report a case of a 24-year-old woman who was delivered via cesarean section at 39 weeks and presented in the puerperium with symptoms of worsening abdominal pain and septicaemia. Preoperative ultrasonography suggested the presence of a pelvic collection. Explorative laparotomy revealed the simultaneous presence of Meckel’s diverticulitis and appendicitis without bowel perforation(20).
4. Acute myeloid leukemia
There is a report of a 59-year-old Caucasian female was admitted to the surgical service with acute right lower quadrant pain, nausea, and anorexia. She was noted to have leukocytosis, anemia, and thrombocytopenia. Abdominal imaging demonstrated appendicitis with retroperitoneal and mesenteric lymphadenopathy for which she underwent laparoscopic appendectomy. Peripheral smear, bone marrow biopsy, and surgical pathology of the appendix demonstrated acute myeloid leukemia (AML) with nonsuppurative appendicitis(21).
5. Leukemia and lymphoma of the appendix
There is a report of a first detailed description of acute myeloid leukaemia involving the appendix, and three cases of lymphomatous infiltration of the appendix presenting with appendicitis(22).
6. Adenocarcinoma
Acute inflammation of the appendix secondary to luminal obstruction is the chief reason for appendectomy. The rare association of a malignant neoplastic process with the inflammatory process is usually an unexpected finding and is often not diagnosed until the histologic study has been completed. There is a report of two patients with adenocarcinoma of the appendix(23).
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