Acute abdomen represents a large complex of acute situations in general surgery. There could be inflammatory (such as acute appendicitis, acute cholecystitis etc.), non-inflammatory (ileus), hemorrhage or traumatic situations (perforation of the gastrointestinal tract etc.). Our work presents two case reports of two not significantly ill female patients with an uncommon inflammatory process of the caecum. Acute typhlitis is an archaism for most of surgeons. It used to be a synonym for acute appendicitis; however, the modern literature defines this diagnose as a different disease - neutropenic enterocolitis. It is a rare but serious disease causing a right lower quadrant pain, often mimics acute appendicitis. Usually, it occurs in immunocompromised patients (patients after an immunosuppressive therapy, neutropenic patients, people with hematologic malignancies, AIDS positive patients, etc.); however, a few case reports of entirely healthy patients have been published. Nevertheless, there is however a limited number of these cases.

• Klíčová slova
• Neutropenia, acute abdomen, caecal necrosis, caecum, case report, ischemic colitis, neutropenic enterocolitis, typhlitis,
• MeSH
• akutní bolest břicha etiologie   MeSH
• apendicitida chirurgie   diagnóza   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci slepého střeva * chirurgie   diagnóza   MeSH
• tyflitida diagnóza   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Referrals to emergency services are frequently made for acute appendicitis and renal colic. This conundrum of patients with acute appendicitis and right ureteral stones frequently presents itself to emergency physicians. The hematological parameters of patients suffering from acute appendicitis and right ureteral stones were compared in this study. From May 2022 to April 2023 the patients who applied to emergency department were reviewed retrospectively. Of these patients, age, sex, complete blood test results including white blood cell, procalcitonin and C-reactive protein were recorded. The platelet to lymphocyte ratio and the neutrophil to lymphocyte ratio were calculated by dividing the platelet count by the lymphocyte, and the neutrophil count by the lymphocyte count, respectively. We used the receiver operating characteristic curves to assess the diagnostic efficacy of hematological markers. There were 106 patients in the study. The mean age of the patients was 43.83 ± 15.82 years. The significant difference was found for age, white blood cell, neutrophil, lymphocyte, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio and monocyte between groups. The white blood cell and neutrophil to lymphocyte ratio have the biggest area than the other parameters in the receiver operating characteristic curves. Patients with acute appendicitis have a high level of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio than ureteral stones. Further studies are needed to define the diagnostic efficacy of hematological markers for acute appendicitis and ureteral stones.

• Klíčová slova
• Acute appendicitis, Emergency, Neutrophil to lymphocyte ratio, Ureteral stone,
• MeSH
• akutní nemoc MeSH
• apendicitida * krev   diagnóza   MeSH
• biologické markery * krev   MeSH
• dospělí MeSH
• kameny v močovodu * krev   diagnóza   MeSH
• lidé středního věku MeSH
• lidé MeSH
• počet leukocytů MeSH
• retrospektivní studie MeSH
• ROC křivka MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH
• Názvy látek
• biologické markery * MeSH

OBJECTIVE: Acute appendicitis is the most common indication for surgical intervention during pregnancy for non-gynaecological or non-obstetric causes. The aim of this study was to compare perioperative and postoperative outcomes of acute appendectomies in pregnant and non-pregnant patients of childbearing age. METHODS: A retrospective clinical study focused on the comparison of perioperative and postoperative outcomes of acute appendectomy in pregnant and non-pregnant patients of reproductive age between January 2012 and December 2021 at the University Hospital in Ostrava. RESULTS: A number of 308 patients underwent acute appendectomy, 25 pregnant and 283 non-pregnant. There were no statistically significant differences in age, ASA (American Society of Anesthesiologists) classification, duration of complaints, baseline C-reactive protein values, sensitivity or specificity of sonography. A statistically significant difference was found in the leukocyte count between subgroups (P = 0.014) and in the number of laparoscopic procedures performed between the two subgroups (P < 0.001; 98.9% non-pregnant vs. 80.0% pregnant). There was also a statistically significant difference in the length of hospital stay, with the pregnant subgroup having a longer hospital stay (P = 0.014) and a statistically significant difference in the rate of postoperative complications between the defined subgroups (P = 0.039). Serious complications were described predominantly in the subgroup of pregnant patients, where they reached 12% compared to non-pregnant patients, where they were 2.8%. The mortality rate of the cohort was zero. CONCLUSION: The results of the study support the fact that pregnancy may be associated with complicated forms of acute appendicitis. Accurate and early diagnosis not only prevents the development of complicated forms of appendicitis but also reduces the number of negative appendectomies in pregnancy.

• Klíčová slova
• acute appendicitis, appendectomy, laparoscopy, morbidity, mortality, pregnancy,
• MeSH
• akutní nemoc MeSH
• apendektomie škodlivé účinky   metody   MeSH
• apendicitida * diagnóza   chirurgie   MeSH
• laparoskopie * metody   MeSH
• lidé MeSH
• pooperační komplikace etiologie   MeSH
• retrospektivní studie MeSH
• těhotenství MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

Primary torsion of large omentum is a rare cause of abdominal pain. The knowledge of this disease is essential for surgeons. It plays an important role in differential diagnosis of acute abdomen. The authors present two cases of primary omental torsion. They describe the diagnostic and therapeutic process. Diagnosis of omental torsion is difficult. Frequently, it presents with abdominal pain and imitates other acute abdominal diseases such as acute appendicitis in most cases. It is difficult to diagnose before surgical revision is approached. Laboratory and paraclinical examinations may not provide any clear findings. Laparoscopic revision is the method of choice, with confirmation of the diagnosis and laparoscopic resection of the ischemic part of omentum.

• Klíčová slova
• acute abdomen, omental torsion,
• MeSH
• akutní bolest břicha * etiologie   chirurgie   MeSH
• apendicitida * diagnóza   MeSH
• diferenciální diagnóza MeSH
• lidé MeSH
• nemoci peritonea * diagnóza   diagnostické zobrazování   MeSH
• omentum chirurgie   MeSH
• torzní deformity diagnóza   diagnostické zobrazování   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Acute appendicitis is the most frequent and challenging condition requiring emergent intrabdominal surgery in children. The diagnosis of appendicitis becomes more difficult and challenging in children, especially with other medical problems. Computed tomography is the primary tool for diagnosing or excluding appendicitis in cases with atypical presentation. Salmonella infections may present as acute abdominal problems in children. We present a clinical combination that has never been previously reported, of a diabetic girl with non-typhoid Salmonella infection, diagnosed with acute appendicitis. We wonder about the causal correlation of these diseases, versus their simple coexistence.

• Klíčová slova
• Appendicitis, Children, Diabetes, Salmonella,
• MeSH
• akutní nemoc MeSH
• apendicitida * diagnóza   diagnostické zobrazování   MeSH
• diabetes mellitus * MeSH
• dítě MeSH
• lidé MeSH
• počítačová rentgenová tomografie MeSH
• salmonelóza * komplikace   diagnóza   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

INTRODUCTION: The diagnostic process of acute appendicitis is based on clinical symptoms, evaluation of laboratory biomarkers of inflammation and imaging examinations results. Accurate preoperative diagnosis is a key factor in reducing the number of so-called negative appendectomies. The aim of our study was to evaluate the importance of ultrasound in the diagnostic algorithm of acute appendicitis. We also compared the accuracy of the intraoperative diagnosis evaluated by the surgeon with the histopathological findings. METHODS: We performed a retrospective analysis of patients operated for acute appendicitis at our surgical department in time period from 2015 to 2017. We compared the results of preoperative imaging examinations (ultrasound, CT) and intraoperative diagnosis (from the surgical record) with final histopathological findings. RESULTS: 386 patients were operated on for acute appendicitis. Histopathological examination revealed 33 patients (9%) with no signs of inflammation, 309 patients (80%) with inflammatory changes, 37 cases (10%) with chronic appendicitis and 7 other histological findings (2%). Ultrasound was performed in 382 patients (99%). False negative ultrasound was obtained in 18 (6%) of 309 patients with histologically confirmed inflammation. Ultrasound gave a false positive finding in 16 (48%) of 33 patients whose histology revealed no signs of inflammation. Equivocal ultrasound was obtained in 104 patients (27%). Intraoperative diagnosis of appendix without inflammation was described by the surgeon in 27 patients (7%). Of these, 12 cases (44%) were histologically non-inflammatory, 7 cases (26%) with acute inflammation, 7 cases (26%) with chronic inflammation and 1 other finding (4%). CONCLUSION: Ultrasound is a suitable imaging method to confirm the diagnosis of acute appendicitis but not to rule it out. Intraoperative assessment of the appendix by the surgeon is not reliable. Any appendix intraoperatively evaluated as showing no signs of inflammation should be removed.

• Klíčová slova
• acute appendicitis, appendectomy, histopathology, ultrasound,
• MeSH
• akutní nemoc MeSH
• apendektomie MeSH
• apendicitida * diagnóza   patologie   MeSH
• apendix * diagnostické zobrazování   patologie   MeSH
• diferenciální diagnóza MeSH
• lidé MeSH
• retrospektivní studie MeSH
• ultrasonografie * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: This article stresses an impact of appropriate management work up in the diagnosis of acute apendicitis in puerperium. Atypical clinical symptoms may cause doubts in diagnosis and may delay necessary surgical intervention. DESIGN: Case report. SETTINGS: Department of Gynecology and Obstetrics, 1st Faculty of Medicine, Charles University, and Hospital Na Bulovce, Prague. METHODS: We present a case report describing an atypical presentation of acute apendicitis in early puerperium. Due to atypical course of the disease and atypical imaging locality and morphology, there were doubts about the diagnosis of acute apendicitis, patient was treated conservativelly and the disease later resulted in extensive surgical intervention. CONCLUSION: Acute appendicitis is the most common cause of non-urogenital morbidity in puerperium. Management of work up and timing of surgical intervention have key impact on maternal mortality and morbidity.

• Klíčová slova
• apendicitis, non-urogenital morbidity, postpartal, sepsis, surgical intervention,
• MeSH
• akutní nemoc MeSH
• apendicitida diagnóza   MeSH
• gynekologie MeSH
• lidé MeSH
• morbidita MeSH
• poporodní období * MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Acute appendicitis with its characteristic clinical course is one of the most common diagnoses that require urgent surgery. The following three case reports present patients with symptoms typical of acute appendicitis which was, however, not confirmed intraoperatively. Preoperative CT or MRI were not requested because symptoms clearly indicated acute appendicitis. The first case describes a male patient with right-sided diverticulitis, the second case report involves a pregnant woman in 33rd week of gestation with right adnexal torsion due to a dermoid cyst, and in the last report, a case of spontaneous perforation of appendiceal mucinous neoplasm is presented.Key words: right-sided diverticulitis - dermoid cyst - adnexal torsion - mucinous neoplasm - pseudomyxoma peritonei - appendicitis.

• MeSH
• akutní nemoc MeSH
• apendicitida * diagnóza   MeSH
• diferenciální diagnóza MeSH
• divertikulitida * diagnóza   MeSH
• komplikace těhotenství * diagnóza   MeSH
• lidé MeSH
• nádory apendixu * diagnóza   MeSH
• peritoneální nádory * diagnóza   MeSH
• pseudomyxom peritonea * diagnóza   MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• přehledy MeSH

Appendicitis is the most common abdominal emergency. While the clinical diagnosis may be easy in patients who present with classic signs and symptoms. Atypical presentations may result in diagnostic embarrassment and delay in treatment. Typical sign is abdominal pain. Furthermore, it can be nausea, vomiting and anorexia. Abdominal examination reveals localised tenderness and muscular rigidity in the right lower abdominal quadrant. Laboratory data usually reveal an elevated leukocytosis with a left shift and elevated C-reactive protein. To establish the diagnosis greatly help native abdominal X-ray, ultrasound or CT. In 1889, an appendectomy was accepted as the standard treatment, because they save lives and since then dictum: removal of the inflamed appendix changed, it is necessary!

• MeSH
• apendektomie MeSH
• apendicitida diagnóza   chirurgie   MeSH
• bolesti břicha etiologie   MeSH
• C-reaktivní protein analýza   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• C-reaktivní protein MeSH

INTRODUCTION: In general, pain in the lower right abdomen is the most frequent reason for hospital surgical admissions, acute appendicitis representing the most common cause of operation for acute abdomen. Timely appendectomy remains the only treatment in the early stages of inflammation and is usually uncomplicated, requiring only a short hospital stay. A differential diagnostic analysis necessitates a search for other, particularly long-term symptoms that might be driven to the background in cases of acute exacerbation. CASE REPORT: The case report presents a 38-year-old female patient who was admitted for lower right abdominal pain. Clinical examination and a blood test both suggested typical acute uncomplicated appendicitis, and therefore the patient underwent appendectomy. Haemorrhagic peritoneal fluid and nodularity of the appendix not typical for appendicitis was found. Oedema of the terminal ileum and a right adnexal tumour were a surprising finding. A more extensive surgical procedure involving ileocaecal resection and right-side adnexectomy was finally performed with regard to the intraoperative finding. The definitive diagnosis of appendiceal endometriosis, endometrial mass in the terminal intestine and ovarian endometriosis was established by histological evaluation. Long-term follow-up revealed microadenocarcinoma of cervix uteri. CONCLUSION: It is generally very difficult to confirm appendiceal endometriosis before operation, and revealing primary appendiceal endometriosis is virtually impossible. It is advisable to consider endometriosis in fertile women with chronic abdominal pain of unclear aetiology and gynaecological symptoms in their personal history. The best diagnostic and therapeutic method, respectively, is laparoscopy enabling exploration of the entire peritoneal cavity including the minor pelvis, and performing appendectomy as well as excision of suspicious endometrial lesions. The definitive diagnosis is usually established by histopathological evaluation. Gynaecological assessment and follow-up is highly recommended after surgery.

• MeSH
• akutní bolest břicha diagnóza   etiologie   chirurgie   MeSH
• akutní nemoc MeSH
• apendektomie metody   MeSH
• apendicitida diagnóza   MeSH
• diferenciální diagnóza MeSH
• dospělí MeSH
• endometrióza diagnóza   chirurgie   MeSH
• laparoskopie metody   MeSH
• lidé MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH