RESUMEN
INTRODUCTION: Femoral hernias have a high risk of strangulation or obstruction, and their acute presentations are associated with a high risk of mortality, occurring in up to 60% of cases with complications. The presence of the appendix within the femoral sac has been described in a maximum of 1% of cases, which has been called Garengeot hernia, but only 0.08% with concomitant appendicitis. CASE REPORT: Woman 56 years old, cholecystectomized, with no other relevant history, 5 months of evolution, right femoral region volume increase, consultation for 24 hours of evolution of habitual pain exacerbation, CT scan showing complicated hernia, with appendix inside of the hernial sac. The right inguinal approach is performed, the cecal appendix is the only content within the hernial sac, with signs of acute appendicitis, appendectomy and hernia repair with Prolene mesh. Diagnosis is confirmed with biopsy. DISCUSSION AND CONCLUSION: Acute appendicitis within De Garengeot's hernia is extremely rare and often difficult to diagnose. The diagnosis of a femoral hernia appendicitis is often obscured by nonspecific clinical findings that indicate a complicated hernia. Computed tomography may be useful to definitively diagnose acute appendicitis contained within a femoral hernia. It is important to always consider De Garengeot hernia as a differential diagnosis in patients with inguinal mass of acute pain, so as not to delay its detection and management.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Apéndice/diagnóstico por imagen , Hernia Femoral/diagnóstico por imagen , Apendicitis/diagnóstico , Apéndice/cirugía , Apéndice/irrigación sanguínea , Registros Médicos , Hernia Femoral/cirugía , Hernia Femoral/complicacionesRESUMEN
INTRODUCTION: Laparoscopic appendectomy is now the standard of treatment for acute appendicitis in medical centers where advanced minimally invasive surgery is performed, and it has become the standard of care in our institution. The techniques for laparoscopic appendectomy are widely described in surgical textbooks, but the vascular control of the appendicular artery is diverse. In this article, we compare the benefits and possible complications of different techniques to obtain vascular control. SUBJECTS AND METHODS: This is a retrospective study of prospectively collected data including all cases of laparoscopic appendectomy from September 1990 to August 2009. Here we describe the different methods used, and we present a large series of 729 cases of laparoscopic appendectomy. In the majority of the cases the diagnosis was acute appendicitis followed by laparoscopic appendectomy. In only 124 cases was an incidental appendectomy performed associated with another laparoscopic procedure. RESULTS: In 350 cases (48%) monopolar cauterization was used to obtain vascular control of the appendicular artery. In the other 379 cases the artery was either clipped or stapled (52%). There were no postoperative complications reported. There was no difference in patient outcome with either approach to obtain adequate vascular control. CONCLUSIONS: The vascular control of the appendicular artery obtained with monopolar cautery is a safe, fast, and economic approach easily done during a laparoscopic or needlescopic appendectomy with no increased risks or complications.
Asunto(s)
Apendicectomía/métodos , Apendicitis/cirugía , Apéndice/irrigación sanguínea , Laparoscopía/métodos , Electrocoagulación , Femenino , Humanos , Ligadura/métodos , Masculino , Estudios Retrospectivos , Instrumentos Quirúrgicos , Grapado QuirúrgicoRESUMEN
AIM: To determine whether colour Doppler sonograms can be used to differentiate between the normal appendix and acute appendicitis. MATERIAL AND METHODS: This prospective study examined 50 consecutive children with suspected appendicitis using grey-scale and colour Doppler US. Appendicitis was diagnosed when the appendix diameter was greater than 6 mm. Blood flow on the appendiceal wall was measured and classified as non-existent (0 pixels), low (1-2), moderate (3-4) or abundant (>4). Likelihood ratios were calculated for each of these levels. The diagnosis of acute appendicitis was confirmed by pathological findings, and ruled out by clinical follow-up or pathological findings. RESULTS: Of the 50 patients examined, 24 had appendicitis and 26 had a normal appendix. For 25 of the patients with a normal appendix, appendicitis was ruled out by clinical follow-up, and for one patient, by pathological findings. The abnormal appendix was identified in all patients with appendicitis. In the group of 26 patients without appendicitis, the normal appendix was visualized in 23 cases, one of which was false positive (100% sensitivity, 96% specificity). Abnormal appendices showed moderate to abundant flow in 62% of the cases and non-existent or low flow in 38%. Normal appendices had non-existent or low flow in 82% of the cases, but moderate or abundant in 18%. Significant differences were only found when the number of pixels was >4. CONCLUSION: Although the vascularity of normal and inflamed appendices may be different, this difference was not a good diagnostic indicator of appendicitis.
Asunto(s)
Apendicitis/diagnóstico por imagen , Apéndice/diagnóstico por imagen , Ultrasonografía Doppler en Color/métodos , Enfermedad Aguda , Apéndice/irrigación sanguínea , Niño , Preescolar , Femenino , Humanos , Funciones de Verosimilitud , Masculino , Estudios Prospectivos , Flujo Sanguíneo Regional , Sensibilidad y EspecificidadRESUMEN
OBJETIVOS: Avaliar a isquemia parcial ou total, através da ligadura com fio inabsorvível dos vasos do mesoapêndice do apêndice vermiforme de coelhos, bem como a obstrução mecânica, através da ligadura com fio inabsorvível da base do apêndice vermiforme, a 1 cm do ceco. Avaliar a histologia do apêndice ( normal e acometido ). Estudar a flora bacteriana residente no apêndice vermiforme ( normal e acometido ) e do exsudato peritoneal. MÉTODOS: Foram utilizados 72 coelhos ( "Oryctogalus cuniculos" ), machos da linhagem Nova Zelândia, com peso médio de 3,000 gramas. Foram divididos em grupos: piloto ( A ), flora bacteriana ( B ), controle ( H ) e experimento ( C, D, E, F e G ) com períodos de observação de 96 horas e 192 horas. Fez-se a ligadura dos vasos do mesoapêndice, com fio inabsorvível nos grupos ( D, E, F e G ) e da base do apêndice vermiforme a 1 cm do ceco, no grupo ( C ) . No grupo experimento (D,E,F e G ) foi praticado o modelo isquêmico. No grupo experimento ( C ) foi realizada a obstrução mecânica e no grupo controle ( H ) foi feita somente a simulação da cirurgia. RESULTADOS: No grupo controle ( H ), não ocorreu apendicite aguda. No grupo experimento ( C,D,E,F, e G ) ocorreu apendicite aguda. CONCLUSÃO: O procedimento utilizado causa apendicite aguda com alterações anatomopatológicas distintas. A bactéria residente encontrada na flora fisiológica do suco entérico do apêndice vermiforme e no exsudato peritoneal foi a Escherichia coli.
Asunto(s)
Animales , Masculino , Conejos , Apendicitis/patología , Apéndice/irrigación sanguínea , Modelos Animales de Enfermedad , Isquemia/patología , Enfermedad Aguda , Apendicitis/microbiología , Apéndice/patología , Estudios de Casos y Controles , Distribución de Chi-CuadradoRESUMEN
PURPOSE: To evaluate partial or total ischemia, through ligature with an unabsorbed thread of vessels from the vermiform appendix of rabbits, as well as the mechanical obstruction, through ligature with an unabsorbed thread at the basis of the vermiform appendix, at 1 cm from the cecum, of the acute appendicitis disease. To evaluate the histology of the appendix (normal and affected). To study the bacterium flora resident in the vermiform appendix (normal and affected) and the exudates peritonitis. METHODS: Seventy-two male rabbits (Oryctogalus cuniculus), from New Zealand lineage were used, weighing approximately 3,000 grams. The animals were divided into: pilot (A), bacterium flora (B), control (H) and experimental (C, D, E, F and G) groups, and were observed in periods of 96 and 192 hours. It was done the ligature with an unabsorbed thread of vessels from the meso appendix, and the base of the appendix within 1 cm from the cecal. In the (C) experimental group, the mechanical obstruction was carried out. In the (D, E, F and G) experimental groups, the ischemic model was used, and in the (H) control group, only the surgical simulation was done. RESULTS: In the control group (H), the acute appendicitis didn't happen. In the experimental group (C, D, E, F and G) the acute appendicitis happened. CONCLUSION: The method used causes acute appendicitis with distinct anatomopathological alterations. The main bacteria found at the physiological flora of the enteric juice from the vermiform appendix and at the exudates peritonitis was the Escherichia coli.
Asunto(s)
Apendicitis/patología , Apéndice/irrigación sanguínea , Modelos Animales de Enfermedad , Isquemia/patología , Enfermedad Aguda , Animales , Apendicitis/microbiología , Apéndice/patología , Estudios de Casos y Controles , Distribución de Chi-Cuadrado , Masculino , ConejosRESUMEN
Os autores pesquisaram a origem e a situaçao anatômica da artéria apendicular humana durante oito anos e, embora ainda estejam desenvolvendo a pesquisa, obtiveram material para apresentar resultados iniciais.
Asunto(s)
Humanos , Niño , Adulto , Apéndice/irrigación sanguínea , Arterias/anatomía & histologíaRESUMEN
Os autores pesquisaram a origem e a situaçäo anatômica da artéria apendicular humana durante oito anos e, embora ainda estejam desenvolvendo a pesquisa, obtiveram material para apresentar resultados iniciais
Asunto(s)
Humanos , Apéndice/irrigación sanguínea , Arterias/anatomía & histologíaRESUMEN
The authors tried to establish the most frequents anatomo-radiological patterns of the irrigation on the vermiform appendix. The search was done in one hundred cases they found six different patterns of arterial irrigation.