Keywords : acute appendicitis

CT-guided Drainage of Pelvic Collection Following Acute Appendicitis: Technical Success and Possible Complications

Mohammed Abd Kadhim

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 1, Pages 12-17

Acute appendicitis is a common clinical problem with an incidence of approximately 1 case per 1,000 persons per year. Perforation is a common complication of appendiceal inflammation, with an overall incidence of approximately 30% in pediatric populations and as high as 66% in children younger than 5 years and up to 100% in 1-year-olds. Computed tomography (CT)-guided abscess drainage has also been shown to provide definitive treatment for 70–90% of abdominal abscesses
The aims were to report the role of CT-guided drainage of pelvic collection following acute appendicitis, technical success and possible complications.
A prospective study was done in Al-Kadhimyia teaching hospital,between March 2009 and November 2012. The study included 48 consecutive patients with pelvic abscess following appendicectomy for acute appendicitis. Age range was 10–58 years; 26 male, 12 female. All patients underwent sonography and contrast-enhanced abdominal CT was performed to confirm the diagnosis. CT guided drainage with a pigtail multi-sidehole catheter of 12 – 14 French was done. Post-drainage scans were obtained to assess the position of the catheter and to exclude early complications (e.g., hematoma). Catheters were flushed with 10-15 ml of 0.9% sterile saline every 8 hr. to maintain patency.
The decision for catheter removal was based on the following criteria: clinical improvement (normal body temperature and white blood cell (WBC) count, no clinical symptoms), drainage output of 10 mL/d or less, and ultrasound findings of complete resolution of the target fluid collection.
The study included 48 patients. The depth of the collections was ranged from 4-8cm (mean of 6cm). Of the 48 patients, 40 had single drainage procedure, and 8 returned for a second procedure. The (8/48) necessitated a second drainage procedure (5cases of catheter displacement and 3 cases of catheter obstruction). Treatment failure was seen in 3/48 (6.25%) patients and were treated with surgical drainage. Clinical success of the procedures was (93.75%). The volume of fluid drained ranged from 200 ml to 4,500 ml (mean 440 ml). Fluid culture reveals Escherichia coli in 27%, and Enterococcus spp in 15% and polymicrobial in 58% of cases. hospital stay was 13±6.4 days (8–28 days), while those who underwent two procedures had an average stay of 20.2±6.5 days. No catheter-related wound sepsis was noted at the time of discharge or follow-up, and no catheter tract failed to close spontaneously.
CT _guided drainage of pelvic abscess following acute appendicitis is an effective method of treatment with no catheter-related wound sepsis and no major periprocedural complications.

Diagnostic Value of C Reactive Protein Measurement in Patients with Acute Appendicitis

Maitham H. Kenber

Iraqi Postgraduate Medical Journal, 2007, Volume 6, Issue 4, Pages 347-351

To evaluate the role of crude measurement of C-reactive protein in the diagnosis of acute appendicitis.
Appendicectomy for suspected acute appendicitis is a common procedure. The rate of normal appendices unnecessarily removed remain high(15%-30%) ; despite several techniques and investigations used to improve the diagnostic accuracy . Many studies investigated the role of raised C-reactive protein (CRP ) in improving the diagnosis of acute appendicitis, but with conflicting results.
This is a randomized prospective study from February to July 2006 . A total of 100patients were included in this study that presented to our hospital with acute right iliac fossa pain and later on operated and had appendicectomy .Blood for the measurement of serum C-reactive protein(CRP) was collected preoperatively from all the patients. The patients divided in to two groups ,those who are positive appendicitis proved by operative finding and histopathological examination and those with negative appendicitis proved by histopathological examination.
A total of 100 patients were included in this study, and out of these 16 (16%) had normal appendix giving an over all negative appendicectomy rate of 16% out of these 5 were males and 11 were females ,the age range was (6-47 years) with a median age of ( 25.92) years . Among the 84 who had appendicitis, 64 patients had obstructive type of appendicitis which were noticed during the operation ,and CRP was positive in all patients, but only 9 of them were with CRP negative . 4 perforated appendicitis were found in which all of them were CRP positive, and 16 patients with catarrhal appendicitis were diagnosed by histopathological examination and only 3 patients out of those had negative CRP while the remainder were positive.
The positivity of CRP was related to the severity of inflammation; but it is more reliable to depend on negative results to postpone the operation and observe the patient .Thus unnecessary removal of normal appendices may be reduced.