Appendectomy: Surgical removal of the vermiform appendix. (Dorland, 28th ed)Appendicitis: Acute inflammation of the APPENDIX. Acute appendicitis is classified as simple, gangrenous, or perforated.Appendix: A worm-like blind tube extension from the CECUM.Laparoscopy: A procedure in which a laparoscope (LAPAROSCOPES) is inserted through a small incision near the navel to examine the abdominal and pelvic organs in the PERITONEAL CAVITY. If appropriate, biopsy or surgery can be performed during laparoscopy.Appendiceal Neoplasms: Tumors or cancer of the APPENDIX.Umbilicus: The pit in the center of the ABDOMINAL WALL marking the point where the UMBILICAL CORD entered in the FETUS.Intestinal Perforation: Opening or penetration through the wall of the INTESTINES.Abdominal Abscess: An abscess located in the abdominal cavity, i.e., the cavity between the diaphragm above and the pelvis below. (From Dorland, 27th ed)Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region.Postoperative Complications: Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery.Mucocele: A retention cyst of the salivary gland, lacrimal sac, paranasal sinuses, appendix, or gallbladder. (Stedman, 26th ed)Surgical Wound Infection: Infection occurring at the site of a surgical incision.Natural Orifice Endoscopic Surgery: Surgical procedures performed through a natural opening in the body such as the mouth, nose, urethra, or anus, and along the natural body cavities with which they are continuous.Length of Stay: The period of confinement of a patient to a hospital or other health facility.Cecal Diseases: Pathological developments in the CECUM.Rupture, Spontaneous: Tear or break of an organ, vessel or other soft part of the body, occurring in the absence of external force.Laparotomy: Incision into the side of the abdomen between the ribs and pelvis.Retrospective Studies: Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons.Hematocele: Hemorrhage into a canal or cavity of the body, such as the space covered by the serous membrane (tunica vaginalis) around the TESTIS leading to testicular hematocele or scrotal hematocele.Enterobiasis: Infection with nematodes of the genus ENTEROBIUS; E. vermicularis, the pinworm of man, causes a crawling sensation and pruritus. This condition results in scratching the area, occasionally causing scarification.Second-Look Surgery: A followup operation to examine the outcome of the previous surgery and other treatments, such as chemotherapy or radiation therapy.Diverticulitis: Inflammation of a DIVERTICULUM or diverticula.Mesenteric Lymphadenitis: INFLAMMATION of LYMPH NODES in the MESENTERY.Unnecessary Procedures: Diagnostic, therapeutic, and investigative procedures prescribed and performed by health professionals, the results of which do not justify the benefits or hazards and costs to the patient.Hernia, Femoral: A groin hernia occurring inferior to the inguinal ligament and medial to the FEMORAL VEIN and FEMORAL ARTERY. The femoral hernia sac has a small neck but may enlarge considerably when it enters the subcutaneous tissue of the thigh. It is caused by defects in the ABDOMINAL WALL.Surgical Stapling: A technique of closing incisions and wounds, or of joining and connecting tissues, in which staples are used as sutures.Cholecystectomy: Surgical removal of the GALLBLADDER.Naval Medicine: The practice of medicine concerned with conditions affecting the health of individuals associated with the marine environment.Ambulatory Surgical Procedures: Surgery performed on an outpatient basis. It may be hospital-based or performed in an office or surgicenter.Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series.Pseudomyxoma Peritonei: A condition characterized by poorly-circumscribed gelatinous masses filled with malignant mucin-secreting cells. Forty-five percent of pseudomyxomas arise from the ovary, usually in a mucinous cystadenocarcinoma (CYSTADENOCARCINOMA, MUCINOUS), which has prognostic significance. Pseudomyxoma peritonei must be differentiated from mucinous spillage into the peritoneum by a benign mucocele of the appendix. (Segen, Dictionary of Modern Medicine, 1992)Acute Disease: Disease having a short and relatively severe course.Pain, Postoperative: Pain during the period after surgery.Abscess: Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection.Cystadenoma, Mucinous: A multilocular tumor with mucin secreting epithelium. They are most often found in the ovary, but are also found in the pancreas, appendix, and rarely, retroperitoneal and in the urinary bladder. They are considered to have low-grade malignant potential.Ovarian Cysts: General term for CYSTS and cystic diseases of the OVARY.Diagnostic Errors: Incorrect diagnoses after clinical examination or technical diagnostic procedures.Emergencies: Situations or conditions requiring immediate intervention to avoid serious adverse results.BaltimoreWorld War II: Global conflict involving countries of Europe, Africa, Asia, and North America that occurred between 1939 and 1945.Submarine Medicine: The field of medicine concerned with conditions affecting the health of people in submarines or sealabs.Decision Making: The process of making a selective intellectual judgment when presented with several complex alternatives consisting of several variables, and usually defining a course of action or an idea.Pathology, Surgical: A field of anatomical pathology in which living tissue is surgically removed for the purpose of diagnosis and treatment.Superstitions: A belief or practice which lacks adequate basis for proof; an embodiment of fear of the unknown, magic, and ignorance.Moths: Insects of the suborder Heterocera of the order LEPIDOPTERA.OhioChronology as Topic: The temporal sequence of events that have occurred.Bulimia: Eating an excess amount of food in a short period of time, as seen in the disorder of BULIMIA NERVOSA. It is caused by an abnormal craving for food, or insatiable hunger also known as "ox hunger".Pelvic Inflammatory Disease: A spectrum of inflammation involving the female upper genital tract and the supporting tissues. It is usually caused by an ascending infection of organisms from the endocervix. Infection may be confined to the uterus (ENDOMETRITIS), the FALLOPIAN TUBES; (SALPINGITIS); the ovaries (OOPHORITIS), the supporting ligaments (PARAMETRITIS), or may involve several of the above uterine appendages. Such inflammation can lead to functional impairment and infertility.Salpingitis: Inflammation of the uterine salpinx, the trumpet-shaped FALLOPIAN TUBES, usually caused by ascending infections of organisms from the lower reproductive tract. Salpingitis can lead to tubal scarring, hydrosalpinx, tubal occlusion, INFERTILITY, and ectopic pregnancy (PREGNANCY, ECTOPIC)Chlamydia Infections: Infections with bacteria of the genus CHLAMYDIA.

Introduction of appendiceal CT: impact on negative appendectomy and appendiceal perforation rates. (1/531)

OBJECTIVE To evaluate the impact of appendiceal computed tomography (CT) availability on negative appendectomy and appendiceal perforation rates. SUMMARY BACKGROUND DATA: Appendiceal CT is 98% accurate. However, its impact on negative appendectomy and appendiceal perforation rates has not been reported. METHODS: The authors reviewed the medical records of 493 consecutive patients who underwent appendectomy between 1992 and 1995, 209 consecutive patients who underwent appendectomy in 1997 (59% of whom had appendiceal CT), and 206 patients who underwent appendiceal CT in 1997 without subsequent appendectomy. RESULTS: Before appendiceal CT, 98/493 patients (20%) taken to surgery had a normal appendix. After CT availability, 15/209 patients (7%) taken to surgery had a normal appendix; 7 patients did not have CT, 5 patients had surgery despite a negative CT, and 3 patients had a false-positive CT. Negative appendectomy rates were lowered overall (20% to 7%), in men (11% to 5%), in women (35% to 11%), in boys (10% to 5%), and in girls (18% to 12%). Appendiceal perforation rates dropped from 22% to 14% after CT availability. CT excluded appendicitis in 206 patients in 1997 who avoided appendectomy and identified alternative diagnoses in 105 of these patients (51%). CONCLUSION: The availability of appendiceal CT coincided with a drop in the negative appendectomy rate from 20% to 7% in all patients, and to only 3% in patients with a positive CT. Perforation rates decreased from 22% to 14%. Appendiceal CT can be advocated in nearly all female and many male patients.  (+info)

Need to measure outcome after discharge in surgical audit. (2/531)

OBJECTIVE: To assess the accuracy of outcome data on appendicectomy routinely collected as part of a surgical audit and to investigate outcome in the non-audited period after discharge. DESIGN: Retrospective analysis of audit data recorded by the Medical Data Index (MDI) computer system for all patients undergoing emergency appendicectomy in one year; subsequent analysis of their hospital notes and notes held by their general practitioners for patients identified by a questionnaire who had consulted their general practitioner for a wound complication. SETTING: One district general hospital with four consultant general surgeons serving a population of 250,000. PATIENTS: 230 patients undergoing emergency appendicectomy during 1989. MAIN MEASURES: Comparison of postoperative complications recorded in hospital notes with those recorded by the MDI system and with those recorded by patients' general practitioners after discharge. RESULTS: Of the 230 patients, 29 (13%) had a postoperative complication recorded in their hospital notes, but only 14 (6%) patients had these recorded by the MDI system. 189 (82%) of the patients completed the outcome questionnaire after discharge. The number of wound infections as recorded by the MDI system, the hospital notes, and notes held by targeted patients' general practitioners were three (1%), eight (3%), and 18 (8%) respectively. None of 12 readmissions with complications identified by the hospital notes were identified by the MDI system. CONCLUSIONS: Accurate audit of postoperative complications must be extended to the period after discharge. Computerised audit systems must be able to relate readmissions to specific previous admissions.  (+info)

Fertility patterns after appendicectomy: historical cohort study. (3/531)

OBJECTIVE: To examine fertility patterns in women who had their appendix removed in childhood. DESIGN: Historical cohort study with computerised data and fertility data for this cohort and for an age matched cohort of women from the Swedish general population. The cohorts were followed to 1994. SETTING: General population. PARTICIPANTS: 9840 women who were under 15 years when they underwent appendicectomy between 1964 and 1983; 47 590 control women. MAIN OUTCOME MEASURES: Diagnoses at discharge. Distributions of age at birth of first child among women with perforated and non-perforated appendix and women who underwent appendicectomy but were found to have a normal appendix compared with control women by using survival analysis methods. Parity distributions at the latest update of the registry were also examined. RESULTS: Women with a history of perforated appendix had a similar rate of first birth as the control women (adjusted hazard ratio 0.95; 95% confidence interval 0.88 to 1. 04) and had a similar distribution of parity at the end of follow up. Women who had had a normal appendix removed had an increased rate of first births (1.48; 1.42 to 1.54) and on average had their first child at an earlier age and reached a higher parity than control women. CONCLUSION: A history of perforated appendix in childhood does not seem to have long term negative consequences on female fertility. This may have important implications for the management of young women with suspected appendicitis as the liberal attitude to surgical explorations with a subsequently high rate of removal of a normal appendix is often justified by a perceived increased risk of infertility after perforation. Women whose appendix was found to be normal at appendicectomy in childhood seem to belong to a subgroup with a higher fertility than the general population.  (+info)

Conditional Length of Stay. (4/531)

OBJECTIVE: To develop and test a new outcome measure, Conditional Length of Stay (CLOS), to assess hospital performance when deaths are rare and complication data are not available. DATA SOURCES: The 1991 and 1992 MedisGroups National Comparative Data Base. STUDY DESIGN: We use engineering reliability theory traditionally applied to estimate mechanical failure rates to construct a CLOS measure. Specifically, we use the Hollander-Proschan statistic to test if LOS distributions display an "extended" pattern of decreasing hazards after a transition point, suggesting that "the longer a patient has stayed in the hospital, the longer a patient will likely stay in the hospital" versus an alternative possibility that "the longer a patient has stayed in the hospital, the faster a patient will likely be discharged from the hospital." DATA COLLECTION/EXTRACTION METHODS: Abstracted records from 7,777 pediatric pneumonia cases and 3,413 pediatric appendectomy cases were available for analysis. PRINCIPAL FINDINGS: For both conditions, the Hollander-Proschan statistic strongly displays an "extended" pattern of LOS by day 3 (p<.0001) associated with declining rates of discharge. This extended pattern coincides with increasing patient complication rates. Worse admission severity and chronic disease contribute to lower rates of discharge after day 3. CONCLUSIONS: Patient stays tend to become prolonged after complications. By studying CLOS, one can determine when the rate of hospital discharge begins to diminish--without the need to directly observe complications. Policymakers looking for an objective outcome measure may find that CLOS aids in the analysis of a hospital's management of complicated patients without requiring complication data, thereby facilitating analyses concerning the management of patients whose care has become complicated.  (+info)

Counting the uninsured using state-level hospitalization data. (5/531)

OBJECTIVE: To assess the appropriateness of using state-level data on uninsured hospitalizations to estimate the uninsured population. METHODS: The authors used 1992-1996 data on hospitalizations of newborns and of appendectomy and heart attack patients in Florida to estimate the number of people in the state without health insurance coverage. These conditions were selected because they usually require hospitalization and they are common across demographic categories. RESULTS: Adjusted for the gender and ethnic composition of the population, the percentages of uninsured hospitalizations for appendectomies and heart attacks produced estimates of the state's uninsured population 1.6 percentage points lower than those reported for 1996 in the US Census March Current Population Survey. CONCLUSION: Data reported by hospitals to state agencies can be used to monitor trends in health insurance coverage and provides an alternative data source for a state-level analysis of the uninsured population.  (+info)

Day-care laparoscopic appendectomies. (6/531)

OBJECTIVE: To demonstrate the safety of laparoscopic appendectomy in a day-care setting and to compare patients selected for laparoscopic versus open appendectomy. DESIGN: A retrospective, nonrandomized study. SETTING: A community hospital in a small town in British Columbia. PATIENTS: Ninety-four consecutive patients with a clinical diagnosis of acute appendicitis. INTERVENTIONS: Each patient underwent laparoscopic or open appendectomy as selected by the operating surgeon. OUTCOME MEASURES: Duration of operation and of hospital stay, morbidity and mortality. RESULTS: The average operating time was 32 minutes for open appendectomy and 36 minutes for laparoscopic appendectomy. Two (4%) of the 52 patients who had a laparoscopic appendectomy had significant complications; 1 of them required reoperation for intra-abdominal abscess. Thirty-nine (75%) of the laparoscopic appendectomies were done as day-care procedures. The average length of stay for the remaining patients was 2.1 days. The overall complication rate for patients who underwent open appendectomy was 20%. The average length of stay for these patients was 3.2 days; no patient was discharged within 24 hours. CONCLUSIONS: Laparoscopic appendectomy can be safely performed as a day-care procedure, even for selected patients with gangrenous or perforated appendices. Patients typically selected for open appendectomy include children and those with more advanced infection.  (+info)

Hematuria: an unusual presentation for mucocele of the appendix. Case report and review of the literature. (7/531)

Mucocele of the appendix is a nonspecific term that is used to describe an appendix abnormally distended with mucus. This may be the result of either neoplastic or non-neopleastic causes and may present like most appendiceal pathology with either mild abdominal pain or life-threatening peritonitis. Urologic manifestations of mucocele of the appendix have rarely been reported. Laparoscopy can be used as a diagnostic tool in equivocal cases. Conversion to laparotomy may be indicated if there is a special concern for the ability to remove the appendix intact or if more extensive resection is warranted, as in malignancy. We here report our experience with a woman presenting with hematuria whose ultimate diagnosis was mucocele of the appendix, and we review the appropriate literature. This case highlights the mucocele as a consideration in the differential diagnosis of appendiceal pathology and serves to remind the surgeon of the importance for careful intact removal of the diseased appendix.  (+info)

Carcinoid of the appendix during laparoscopic cholecystectomy: unexpected benefits. (8/531)

Carcinoid tumors of the midgut arise from the distal duodenum, jejunum, ileum, appendix, ascending and right transverse colon. The appendix and terminal ileum are the most common location. The majority of carcinoid tumors originate from neuroendocrine cells along the gastrointestinal tract, but they are also found in the lung, ovary, and biliary tracts. We report the first case of elective laparoscopic cholecystectomy in which we found a suspicious lesion at the tip of the appendix and proceeded to perform a laparoscopic appendectomy. The lesion revealed a carcinoid tumor of the appendix.  (+info)

  • In patients who underwent laparoscopic appendectomy, the pneumoperitoneum was created by entering the abdomen with a Veress needle inserted through a 1 cm infra-umblical incision, followed by one suprapubic 5-mm trocar and another 10-mm trocar at the intersection point of the right lateral border of the umbilicus and midclavicular line under direct camera view. (
  • The most common abdominal operation performed on an emergency basis is the appendectomy, which is performed more than 250,000 times annually in the United States. (
  • The most common abdominal operation in the world is appendectomy ( 1 ) with a lifetime risk of 6% ( 2 ). (
  • By the end of the 1920s, deliveries and abortions, adenoidectomies, appendectomies, tonsillectomies, and the treatment of accident victims accounted for 60 percent of hospital admissions. (
  • Methods: A 12-month retrospective review of children undergoing appendectomy was performed at a two-hospital children's institution. (
  • As with other laparoscopic surgeries, the literature describes decreased pain, earlier resumption of diet, and decreased length of hospital stay for appendectomy versus open procedures. (
  • Appendectomy procedures are available at Primus Super Specialty Hospital with the prices starting from $63,100. (
  • Conclusions Appendectomy performed at any time in relation to UC diagnosis was not associated with a decrease in severity of disease. (