Clinical and tomographic findings of acute appendicitis in adults
Appendicitis is the acute inflammation of the vermiform appendix, characterized by abdominal pain, nausea/vomiting, and fever, and is considered the most common surgical emergency. The diagnosis is clinical, supplemented by biochemical parameters and, if necessary, a computed tomography scan (...
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Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
2023
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| Acceso en línea: | https://revistas.unc.edu.ar/index.php/med/article/view/42821 |
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I10-R327-article-42821 |
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Universidad Nacional de Córdoba |
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I-10 |
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R-327 |
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Revista de la Facultad de Ciencias Médicas de Córdoba |
| language |
Español |
| format |
Artículo revista |
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Acute Abdomen Tomography Appendix Abdomen Agudo tomografía Apéndice . |
| spellingShingle |
Acute Abdomen Tomography Appendix Abdomen Agudo tomografía Apéndice . Molina, R Jalil , C Fernández Barrenechea , V Giordano , E Castrilón , ME Clinical and tomographic findings of acute appendicitis in adults |
| topic_facet |
Acute Abdomen Tomography Appendix Abdomen Agudo tomografía Apéndice . |
| author |
Molina, R Jalil , C Fernández Barrenechea , V Giordano , E Castrilón , ME |
| author_facet |
Molina, R Jalil , C Fernández Barrenechea , V Giordano , E Castrilón , ME |
| author_sort |
Molina, R |
| title |
Clinical and tomographic findings of acute appendicitis in adults |
| title_short |
Clinical and tomographic findings of acute appendicitis in adults |
| title_full |
Clinical and tomographic findings of acute appendicitis in adults |
| title_fullStr |
Clinical and tomographic findings of acute appendicitis in adults |
| title_full_unstemmed |
Clinical and tomographic findings of acute appendicitis in adults |
| title_sort |
clinical and tomographic findings of acute appendicitis in adults |
| description |
Appendicitis is the acute inflammation of the vermiform appendix, characterized by abdominal pain, nausea/vomiting, and fever, and is considered the most common surgical emergency. The diagnosis is clinical, supplemented by biochemical parameters and, if necessary, a computed tomography scan (CTS). A CTS may be requested to confirm the diagnosis following an inconclusive ultrasound. The objective of this study is to describe the clinical and biochemical parameters of acute appendicitis, as well as to identify the most common characteristics on CTS.
A retrospective study was conducted at the Italian Hospital in Córdoba between January and May 2023. It included adults over 18 years old with suspected symptomatic appendicitis who underwent an abdominal CTS. Data recorded included age, gender, duration of symptoms, fever, white blood cell count, nausea/vomiting, abdominal rigidity, C-reactive protein (CRP) levels, and rebound tenderness. The studied tomographic findings included an increase in appendiceal diameter, increased periappendiceal fat density, periappendiceal fluid accumulation, the presence of an appendicolith, perforation, peritonitis, or gangrene.
A total of 29 patients were studied, with a mean age of 50.66 ± 16.66 years (range, 18-81), and 59% were female. 38% of patients had a fever, and the duration of symptoms was 35.21 ± 44.75 hours (range, 5-240). CRP levels were 6.99 ± 7.41 mg/dL (range, 0.28-28.18), and white blood cell count was 13.82 ± 3.75 x 10^3 mm^3 (range, 7.1-22.68). All patients experienced abdominal pain, 41% had abdominal rebound tenderness, 7% had abdominal rigidity, and 52% had nausea/vomiting. In abdominal CTS, the appendiceal diameter measured 10.72 ± 2 mm (range, 8-15), with 17% showing an appendicolith and 3% showing peritonitis, but no cases of gangrene or perforation. Predominant CTS findings included periappendiceal fat accumulation (90%) and periappendiceal fluid presence (31%).
In conclusion, patients with a higher number of symptoms/signs and abnormal inflammatory laboratory parameters were more likely to exhibit tomographic findings such as increased density of periappendiceal fat planes, periappendiceal fluid accumulation, and an enlarged appendiceal diameter, without peritoneal involvement, indicating early-stage disease. CTS imaging is a valuable tool for diagnosing acute appendicitis; however, clinical evaluation remains the best ally for making a presumptive diagnosis.
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| publisher |
Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología |
| publishDate |
2023 |
| url |
https://revistas.unc.edu.ar/index.php/med/article/view/42821 |
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I10-R327-article-428212023-10-19T21:19:00Z Clinical and tomographic findings of acute appendicitis in adults Hallazgos clínicos y tomográficos de apendicitis aguda en adultos . Molina, R Jalil , C Fernández Barrenechea , V Giordano , E Castrilón , ME Acute Abdomen Tomography Appendix Abdomen Agudo tomografía Apéndice . Appendicitis is the acute inflammation of the vermiform appendix, characterized by abdominal pain, nausea/vomiting, and fever, and is considered the most common surgical emergency. The diagnosis is clinical, supplemented by biochemical parameters and, if necessary, a computed tomography scan (CTS). A CTS may be requested to confirm the diagnosis following an inconclusive ultrasound. The objective of this study is to describe the clinical and biochemical parameters of acute appendicitis, as well as to identify the most common characteristics on CTS. A retrospective study was conducted at the Italian Hospital in Córdoba between January and May 2023. It included adults over 18 years old with suspected symptomatic appendicitis who underwent an abdominal CTS. Data recorded included age, gender, duration of symptoms, fever, white blood cell count, nausea/vomiting, abdominal rigidity, C-reactive protein (CRP) levels, and rebound tenderness. The studied tomographic findings included an increase in appendiceal diameter, increased periappendiceal fat density, periappendiceal fluid accumulation, the presence of an appendicolith, perforation, peritonitis, or gangrene. A total of 29 patients were studied, with a mean age of 50.66 ± 16.66 years (range, 18-81), and 59% were female. 38% of patients had a fever, and the duration of symptoms was 35.21 ± 44.75 hours (range, 5-240). CRP levels were 6.99 ± 7.41 mg/dL (range, 0.28-28.18), and white blood cell count was 13.82 ± 3.75 x 10^3 mm^3 (range, 7.1-22.68). All patients experienced abdominal pain, 41% had abdominal rebound tenderness, 7% had abdominal rigidity, and 52% had nausea/vomiting. In abdominal CTS, the appendiceal diameter measured 10.72 ± 2 mm (range, 8-15), with 17% showing an appendicolith and 3% showing peritonitis, but no cases of gangrene or perforation. Predominant CTS findings included periappendiceal fat accumulation (90%) and periappendiceal fluid presence (31%). In conclusion, patients with a higher number of symptoms/signs and abnormal inflammatory laboratory parameters were more likely to exhibit tomographic findings such as increased density of periappendiceal fat planes, periappendiceal fluid accumulation, and an enlarged appendiceal diameter, without peritoneal involvement, indicating early-stage disease. CTS imaging is a valuable tool for diagnosing acute appendicitis; however, clinical evaluation remains the best ally for making a presumptive diagnosis. Keywords: Apendicitis es la inflamación aguda del apéndice vermiforme, presenta dolor abdominal, náuseas/vómitos e hipertermia y es considerada la urgencia quirúrgica más frecuente. El diagnóstico es clínico, complementado con parámetros bioquímicos y eventualmente tomografía computarizada. Se solicitará para confirmar el diagnóstico, posterior a una ecografía dudosa. El objetivo de este trabajo es describir clínica y parámetros bioquímicos de apendicitis aguda; así cómo identificar las características más comunes en TC. Se realizó un estudio retrospectivo en el Hospital Italiano de Córdoba entre enero y mayo de 2023. Se incluyeron mayores de 18 años con sospecha de apendicitis sintomática, con TC de abdomen. Se consignó: Edad, sexo, duración de síntomas, fiebre, recuento de leucocitos, náuseas/emesis, rigidez abdominal, PCR y dolor de rebote. Los hallazgos tomográficos estudiados fueron aumento del diámetro apendicular y de densidad de grasa periapendicular, acumulación de líquido periapendicular, presencia de apendicolito, perforación, peritonitis o gangrena. Se estudiaron 29 pacientes con edad media de 50,66 ± 16,66 años (rango, 18-81), 59% de sexo femenino. El 38% presentaron fiebre, la duración de síntomas fue 35,21 ± 44,75hs (rango, 5-240), PCR 6,99 ± 7,41 mg/dL (rango, 0,28-28,18) y recuento de leucocitos de 13,82 ± 3,75x103 mm3 (rango, 7,1-22,68). El total cursó con dolor abdominal, 41% con dolor de rebote abdominal, 7% rigidez abdominal y 52% con náuseas/vómitos. En TC abdominal el diámetro apendicular fue de 10,72 ± 2mm (rango, 8-15), 17% con apendicolito, 3% con peritonitis, sin presencia de gangrena o perforación. Las características predominantes incluyeron acumulación de grasa periapendicular (90%) y presencia de líquido periapendicular (31%). Podemos concluir que aquellos que presentaron mayor cantidad de síntomas/signos, junto a alteración de parámetros inflamatorios del laboratorio, se destacaron por la aparición de hallazgos tomográficos, como aumento en densidad de planos grasos periapendiculares, presencia de líquido periapendicular y aumento del diámetro apendicular, sin compromiso peritoneal, dando como resultado casos de un estadio temprano de la enfermedad. LA TC es un gran aporte para el diagnóstico de apendicitis aguda, sin embargo, la clínica es el mejor aliado para realizar un diagnóstico presuntivo. . Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2023-10-19 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://revistas.unc.edu.ar/index.php/med/article/view/42821 Revista de la Facultad de Ciencias Médicas de Córdoba.; Vol. 80 (2023): Suplemento JIC XXIV Revista de la Facultad de Ciencias Médicas de Córdoba; Vol. 80 (2023): Suplemento JIC XXIV Revista da Faculdade de Ciências Médicas de Córdoba; v. 80 (2023): Suplemento JIC XXIV 1853-0605 0014-6722 spa https://revistas.unc.edu.ar/index.php/med/article/view/42821/42841 Derechos de autor 2023 Universidad Nacional de Córdoba http://creativecommons.org/licenses/by-nc/4.0 |