OBJECTIVES: Acute appendicitis is the most common non-gynaecological indication for surgical intervention during pregnancy. The aim of this study was to compare perioperative and postoperative results of surgical treatment of acute appendicitis in the early and late stage of pregnancy. MATERIAL AND METHODS: This is a retrospective study focused on the evaluation of perioperative and postoperative results of appendectomy in pregnancy. The study included all pregnant patients who underwent laparoscopic or open appendectomy at the University Hospital Ostrava during the observed 10-year period (January 2012-December 2021). The patients were divided into two subgroups according to the stage of pregnancy in relation to the expected viability of the foetus (the viability limit was defined as the 23rd week of pregnancy). RESULTS: In the monitored 10-year period, a total of 25 pregnant patients underwent appendectomy. Comparing the two subgroups of patients, there were no statistically significant differences in any of the admission parameters. Laparoscopy was performed in 100% of the patients in the lower stage of pregnancy (< 23 g.w.) and in 61% of the subgroup of patients with more advanced pregnancy (> 23 g.w.); this difference was statistically significant (p = 0.039). Differences in subgroups regarding duration of surgery, risk of revision and 30-day postoperative morbidity were not statistically significant. In the subgroup of patients < 23 g.w., uncomplicated forms of appendicitis predominated (66%), whereas in the subgroup > 23 g.w., complicated forms predominated (69%); this difference was statistically significant (p = 0.026). When comparing the two subgroups of patients, there was a statistically significant difference in the length of hospitalization (p = 0.006). The mortality rate of the group was zero. CONCLUSIONS: The results of the study confirm the fact that advanced pregnancy may be related to complicated forms of appendicitis. Therefore, early appendectomy is still the method of choice. In accordance with the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) recommendations, laparoscopic approach is preferred in pregnant patients, even in advanced pregnancy.
- MeSH
- Acute Disease MeSH
- Appendectomy methods MeSH
- Appendicitis * surgery MeSH
- Length of Stay MeSH
- Hospitalization MeSH
- Laparoscopy * methods MeSH
- Humans MeSH
- Postoperative Complications surgery MeSH
- Retrospective Studies MeSH
- Pregnancy MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- MeSH
- Appendectomy methods MeSH
- Colectomy methods MeSH
- Middle Aged MeSH
- Humans MeSH
- Multiple Endocrine Neoplasia diagnosis classification pathology MeSH
- Appendiceal Neoplasms diagnosis classification MeSH
- Neuroendocrine Tumors * diagnosis drug therapy classification MeSH
- Neurofibromatosis 1 * diagnosis drug therapy genetics complications MeSH
- von Hippel-Lindau Disease diagnosis genetics MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- MeSH
- Anti-Bacterial Agents MeSH
- Appendectomy methods MeSH
- Appendicitis * surgery diagnosis complications MeSH
- Diagnostic Imaging MeSH
- Humans MeSH
- Peritonitis diagnosis etiology MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
Cíl: Akutní appendicitida je nejčastější indikací k chirurgické intervenci během těhotenství z negynekologické či neporodnické příčiny. Cílem práce bylo porovnat peroperační a pooperační výsledky akutních appendektomií u těhotných a netěhotných pacientek fertilního věku. Soubor a metodika: Retrospektivní klinická studie zaměřená na srovnání peroperačních a pooperačních výsledků akutní appendektomie u těhotných a netěhotných pacientek reprodukčního věku v období leden 2012 až prosinec 2021 ve Fakultní nemocnici Ostrava. Výsledky: Akutní appendektomii celkem podstoupilo 308 pacientek, z toho 25 těhotných a 283 netěhotných. Nebyly statisticky významné rozdíly ve věku, zařazení do ASA (American Society of Anesthesiologists) klasifikace, v délce trvání potíží, vstupních hodnotách C-reaktivního proteinu, senzitivitě či specifitě sonografie. Statisticky významný rozdíl byl nalezen v počtu leukocytů v jednotlivých podskupinách (p = 0,014) a v počtu provedených laparoskopických výkonů mezi oběma podskupinami (p < 0,001; netěhotné 98,9 % vs. těhotné 80,0 %). Statisticky významný rozdíl byl zaznamenán taktéž v délce hospitalizace, kdy v podskupině těhotných byl pobyt v nemocnici delší (p = 0,014), a statisticky významný rozdíl byl i v četnosti pooperačních komplikací mezi definovanými podskupinami (p = 0,039). Závažné komplikace byly popsány převážně v podskupině těhotných pacientek, kde dosáhly 12 %, oproti netěhotným, kde byly 2,8 %. Mortalita souboru byla nulová. Závěr: Výsledky studie potvrzují skutečnost, že těhotenství může být spojeno s komplikovanými formami akutní appendicitidy. Přesná a včasná diagnostika nejen předchází vzniku komplikovaných forem appendicitidy, ale také snižuje počty negativních appendektomií v těhotenství.
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.
- MeSH
- Appendectomy * methods statistics & numerical data MeSH
- Appendicitis * surgery complications MeSH
- Adult MeSH
- Pregnancy Complications surgery MeSH
- Laparoscopy methods statistics & numerical data MeSH
- Humans MeSH
- Young Adult MeSH
- Pregnancy MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Young Adult MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Clinical Study MeSH
- MeSH
- Appendectomy MeSH
- Appendix * anatomy & histology immunology growth & development MeSH
- Ecological and Environmental Phenomena MeSH
- Humans MeSH
- Primates MeSH
- Mammals MeSH
- Gastrointestinal Microbiome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Appendectomy MeSH
- Crohn Disease * surgery complications MeSH
- Adult MeSH
- Humans MeSH
- Lesser Pelvis pathology MeSH
- Parenteral Nutrition MeSH
- Pregnancy MeSH
- Intestine, Small surgery pathology MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- MeSH
- Appendectomy MeSH
- Crohn Disease * surgery complications MeSH
- Adult MeSH
- Humans MeSH
- Lesser Pelvis pathology MeSH
- Parenteral Nutrition MeSH
- Pregnancy MeSH
- Intestine, Small surgery pathology MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
Úvod: Akútna apendicitída patrí k najčastejším náhlym brušným príhodám. Jednou z komplikácii je aj pooperačná tvorba abscesov v peritoneálnej dutine, respektíve v retroperitoneálnom priestore. Za ich vznik sú zodpovedné, okrem iného, aj apendikolity ponechané v peritoneálnej dutine. K ich uvoľneniu z lumenu dochádza predoperačne i počas operácie. Apendikolit, aj s prítomnými baktériami na jeho povrchu, vytvára vhodné miesto pre vznik infekcie. Kazuistika: Autori prezentujú menej častý prípad retroperitoneálneho abscesu, ktorého príčinou bol retinovaný apendikolit. Nezvyčajným je dlhé obdobie medzi apendektómiou a klinickými prejavmi vyformovaného abscesu. Pacientka sa podrobila operačnej liečbe s evakuáciou abscesu a extrakciou apendikolitu. Pooperačný priebeh bol primeraný, hojenie rany bolo podporené podtlakovou terapiou. Záver: Počas apendektómie je nutné pamätať na riziko uvoľnenia apendikolitov a na ich úlohu pri infekčných komplikáciách. Je nutná svedomitá revízia peritoneálnej dutiny a tiež dobrá operačná technika. V prípade neúspechu pri lokalizácii apendikolitu dokážu pooperačne pomôcť zobrazovacie metódy.
Introduction: Acute appendicitis is one of the most common acute abdominal conditions. One of its complications is postoperative formation of abscesses in the peritoneal cavity or in the retroperitoneal space. Among other things, appendicoliths left in the peritoneal cavity are responsible for this process. Their release from the lumen occurs preoperatively and during the operation. An appendicolith, with the bacteria present on its surface, provides an environment that supports the onset of an infection. Case report: The authors present a less common case of a retroperitoneal abscess caused by an incarcerated appendicolith. Unusual is the long period between appendectomy and clinical manifestations of the abscess. The patient underwent surgical treatment with abscess evacuation and extraction of the appendicolith. The postoperative course was adequate; wound healing was supported by negative wound pressure therapy. Conclusion: During appendectomy, it is necessary to keep in mind the risk of releasing appendicoliths and their role in infectious complications. A conscientious revision of the peritoneal cavity is required, as well as a good surgical technique. If necessary, imaging methods can help to locate the appendicolith in the postoperative period.
- MeSH
- Abscess etiology MeSH
- Acute Disease MeSH
- Appendectomy methods adverse effects MeSH
- Appendicitis * surgery complications MeSH
- Abdominal Abscess * surgery etiology MeSH
- Adult MeSH
- Laparoscopy * MeSH
- Humans MeSH
- Postoperative Complications surgery etiology MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
Úvod: S rozvojem laparoskopie se v dětské chirurgii začíná používat metoda single incision laparoskopie. Cílem práce bylo zhodnocení iniciálních zkušeností se single incision laparoskopickou apendektomií na Klinice dětské chirurgie 2. LF UK a FN Motol. Metody: Retrospektivně byl vyhodnocen konsekutivní soubor dětských pacientů (≤18 let) s nekomplikovanou apendicitidou operovaných touto metodou za období od 30. 4. 2019 do 30. 4. 2021. Sledované parametry zahrnovaly demografické údaje, perioperační průběh, operační čas, počet a metodu konverze operace, délku pooperační hospitalizace, pooperační komplikace dle Clavien-Dindo klasifikace, kýly v jizvě a délku follow-up. Výsledky: Do studie bylo zařazeno 160 pacientů s nekomplikovanou apendicitidou. V souboru bylo 72 (45 %) dívek. Medián věku v době operace byl 12 (IQR: 9,9−14,9) let. Medián délky operace byl 50 (IQR: 38−60) minut. V souboru byla zaznamenána 1 konverze na multiport laparoskopii a žádná konverze na otevřenou operaci. Medián pooperační hospitalizace byl 2 (IQR: 2−3) dny. Bylo pozorováno 5 nitrobřišních a 9 ranných komplikací. Závěr: Single incision laparoskopická apendektomie je bezpečná, účinná a rychle osvojitelná metoda pro léčbu nekomplikované apendicitidy u dětí.
Introduction: Within the development of laparoscopy, the single incision laparoscopy method has been recently introduced in paediatric surgery. The aim of this study was to evaluate the initial experience with single incision laparoscopic appendectomy at the Department of Paediatric Surgery, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague. Methods: A consecutive cohort of paediatric patients (≤18 years) undergoing laparoscopic single incision surgery for uncomplicated appendicitis between 4/30/2019 and 4/30/2021 was retrospectively evaluated. The following parameters were monitored: patient’s demographic characteristics, perioperative course, surgery duration, number and method of surgery conversions, length of postoperative hospitalization, postoperative complications classified according to Clavien-Dindo classification, occurrence of incisional hernias, and length of follow-up. Results: In all, 160 patients (72 (45%) females) with uncomplicated appendicitis were included in the study. The median age at the time of surgery was 12 (IQR: 9.9−14.9) years. The median duration of surgery was 50 (IQR: 38−60) minutes. Only one conversion to multiport laparoscopy and no conversion to open surgery were reported. The median postoperative hospital stay was 2 (IQR: 2−3) days. We observed 5 intra-abdominal and 9 wound complications. Conclusion: Single incision laparoscopic appendectomy is a safe, effective and rapidly adoptable method for the treatment of uncomplicated appendicitis in children.
Stafylokokový syndrom toxického šoku (STŠ) je závažné onemocnění, které může být život ohrožující. Existují dvě formy, menstruální a nemenstruální. Za 25 let v období 1997–2022 jsme v NRL pro stafylokoky zaregistrovali v souvislosti s menstruací 102 případů STŠ. U všech pacientek došlo k uzdravení, ale někdy byl v propouštěcích zprávách uváděn těžký průběh včetně hospitalizace na jednotce intenzivní péče. Všechny pacientky měly v anamnéze používání vaginálních tamponů. V článku charakterizujeme toxinogenní kmeny S. aureus, které jsme mohli potvrdit jako původce těchto onemocnění. Nejčastěji se jednalo o producenty toxinu TSST-1 v kombinaci s enterotoxinem – obvykle typu A (64 kmenů, 62,7 %). Toxin TSST-1 produkovalo výlučně 31 kmenů, u sedmi kmenů byla potvrzena pozitivita jednom na některý typ enterotoxinu. V jednom případě v roce 2011, kdy se domníváme, že šlo o světovou premiéru, byl jako etiologické agens izolován S. aureus pozitivní na enterotoxin H. S jedinou výjimkou, se vždy jednalo o kmeny MSSA. Vzhledem k velkému spektru možných příznaků onemocnění STŠ může být zjištění klinické diagnózy obtížné. Je pro to velice potřebné včasné zjištění stafylokokové toxinové etiologie. Dokumentujeme to krátkou kazuistikou menstruálního STŠ, kdy bylo zpočátku vysloveno podezření na náhlou příhodu břišní a provedena appendektomie.
Staphylococcal toxic shock syndrome (TSS) is a serious illness that can be life-threatening. There are two forms, menstrual and non-menstrual. Over the 25 years between 1997 and 2022 we have registered 102 cases of TSS in the NRL for staphylococci in connection with menstruation. All patients recovered, but discharge reports indicated a severe course in some cases, including hospitalisation in intensive care. All patients had a history of using vaginal tampons. In this article we characterise toxigenic strains of S. aureus which we were able to confirm as the causative agent of these diseases. The most common examples were TSST-1 toxin producers in combination with enterotoxin, usually type A (64 strains, 62.7%). TSST-1 toxin was produced exclusively by 31 strains, positivity exclusively for some types of enterotoxin was confirmed in seven strains. In one case in 2011, which we believe was a world first, enterotoxin H-positive S. aureus was isolated as the aetiological agent. With one exception these were always MSSA strains. Due to the large spectrum of possible symptoms of TSS disease establishing a clinical diagnosis can be difficult. For this reason, early detection of staphylococcal toxin aetiology is highly necessary. We document this with a brief case report of menstrual TSS when a sudden abdominal event was initially suspected and an appendectomy was performed.
- MeSH
- Appendectomy MeSH
- Bacterial Toxins adverse effects MeSH
- Medical Errors MeSH
- Enterotoxins adverse effects MeSH
- Clinical Laboratory Techniques methods MeSH
- Humans MeSH
- Staphylococcal Infections * diagnosis epidemiology etiology classification MeSH
- Staphylococcus aureus isolation & purification pathogenicity MeSH
- Statistics as Topic MeSH
- Menstrual Hygiene Products * adverse effects MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- News MeSH
- Geographicals
- Czech Republic MeSH
