Čtyřletý chlapec s dosud bezvýznamnou anamnézou byl přijat pro krční lymfadenopatii a febrilie. Od 3. dne hospitalizace výsev drobnopapulozního exantému a bolesti břicha, pro které byla nutná laparoskopická revize, nález flegmonózní apendicitidy, provedena apendektomie. Pro suspektní toxoalergický exantém byla opakovaně měněna antibiotická léčba. I přes širokospektrá antibiotika stále stoupaly zánětlivé markery, transaminázy, lymfadenopatie výrazněji neregredovala, exantém a febrilie přetrvávaly, objevila se konjunktivitida, rozpraskané rty, artralgie. Diferenciálně diagnosticky zvažována EB viróza, parainfekční exantém, vysloveno podezření na Kawasakiho syndrom. I přes negativní nález při kardiologickém vyšetření zahájena standardní terapie Kawasakiho syndromu - jednou dávkou imunoglobulinu (IVIG) a kyselinou acetylsalicylovou (ASA). Po podání IVIG promptně poklesly teploty, regredoval exantém, lymfadenopatie, normalizoval se laboratorní nález. Uzavíráme jako Kawasakiho syndrom.

A 4-year-old boy with a previously unremarkable medical history was admitted for cervical lymphadenopathy and fever. From the 3rd day of hospitalization a small-papu­lous exanthema and abdominal pain for which laparoscopic revision was necessary, phlegmonous appendicitis was found, and appendectomy was performed. Antibiotic treatment was repeatedly changed for suspected toxoallergic exanthema. Despite broad-spectrum antibiotics, inflammatory markers, transaminases continued to rise, lymphadenopathy did not significantly regress, exanthema, febrile persisted, conjunctivitis, chapped lips, arthralgia appeared. Differential diagnostic consideration was given to EB virosis, parainfectious exanthema, Kawasaki syndrome was suspected. Despite of negative findings on cardiological examination the treatment with one dose of intravenous immunoglo­bulins (IVIG) and acetylsalicylic acid (ASA) was administered. After administration of IVIG followed prompt decrease in temperature, regression of exanthema, nodal syndrome, normalization of laboratory findings. We concluded as Kawasaki syndrome.

• MeSH
• Appendicitis surgery   diagnosis   etiology   MeSH
• Aspirin pharmacology   therapeutic use   MeSH
• Diagnosis, Differential MeSH
• Exanthema diagnosis   etiology   MeSH
• Fever of Unknown Origin diagnosis   etiology   MeSH
• Immunoglobulins, Intravenous pharmacology   therapeutic use   MeSH
• Mucocutaneous Lymph Node Syndrome * diagnosis   epidemiology   drug therapy   blood   MeSH
• Humans MeSH
• Lymphadenopathy diagnosis   etiology   MeSH
• Child, Preschool MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Child, Preschool MeSH
• Publication type
• Case Reports MeSH
• Research Support, Non-U.S. Gov't MeSH

Negative pressure wound therapy (NPWT) is a very effective method in the treatment of dehiscent, infected, and non-healing wounds. Difficult wound healing occurs especially in late pregnancy due to the rapid enlargement of the uterus and the constantly increasing tension of the entire abdominal wall. In cases of dehiscence of the surgical wound during pregnancy, proper subsequent treatment is needed, where it is necessary to consider the safety of the mother as well as the fetus. We report the case of a 30-week pregnant patient who was surgically treated for acute appendicitis in pregnancy with an open appendectomy approach. Postoperative complications resulted in wound dehiscence with complete defect in fascia, which was treated with negative V.A.C. ATS® Therapy System. The therapy was started in the 30th week of pregnancy and continued until delivery with regular check-ups and regular redressing of the vacuum-assisted closure (VAC) system. At 38 weeks of pregnancy, the patient delivered vaginally with continued VAC therapy in situ. The final suture took place 3 days after vaginal delivery. Non-healing wounds with abdominal wall defects should be treated using a multidisciplinary approach, and NPWT can be used. This therapy can also be used during pregnancy. Vaginal delivery is preferred because it reduces the risk of further formation or deepening of the abdominal wall defect after a sufficient time interval from the start of the treatment. This complex case with a literature review of surgical complications in pregnancy treated with NPWT therapy highlights the advantage of a multidisciplinary approach.

• MeSH
• Appendectomy * adverse effects   MeSH
• Appendicitis surgery   MeSH
• Surgical Wound Dehiscence * therapy   etiology   MeSH
• Adult MeSH
• Pregnancy Complications * surgery   MeSH
• Humans MeSH
• Pregnancy MeSH
• Negative-Pressure Wound Therapy * methods   MeSH
• Delivery, Obstetric methods   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH
• Review 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.

• MeSH
• Acute Disease MeSH
• Appendicitis * blood   diagnosis   MeSH
• Biomarkers * blood   MeSH
• Adult MeSH
• Ureteral Calculi * blood   diagnosis   MeSH
• Middle Aged MeSH
• Humans MeSH
• Leukocyte Count MeSH
• Retrospective Studies MeSH
• ROC Curve MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Comparative Study MeSH

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
• 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

Klinický obraz akutní apendicitidy jako nejčastější náhlé příhody břišní ovlivňuje poloha apendixu. Při atypické poloze mohou být obvyklé příznaky změněné nebo mohou zcela chybět. Hernie v jizvě je nejčastější pozdní komplikací nitrobřišních operací. Nejčastějšími strukturami lokalizovanými ve vaku hernie jsou omentum, kličky tenkého nebo tlustého střeva. Výjimečně dochází i k herniaci dalších orgánů, jako je např. apendix. Při inkarceraci může dojít k infarzaci až gangréně herniovaných orgánů. V naší kazuistice prezentujeme 59letého pacienta, který byl indikován k operaci pro známky inkarcerované hernie v místě portu po předchozí bilaterální laparoskopické operaci tříselné kýly. Předpokládaným obsahem byla infarzovaná střevní klička, ale při operaci byl překvapivým nálezem apendix s akutním zánětem. Vzhledem k zánětlivému terénu je potřeba zvýšeně dbát na sanaci zánětlivého procesu v oblasti inkarcerované hernie. Tato kazuistika ukazuje raritní formu akutní apendicitidy s atypickou lokalizací v jizvě po laparoskopickém portu. Námi uvedená kazuistika prezentuje vzácnou kombinaci dvou různých náhlých příhod břišních.

Clinical presentation of acute appendicitis, the most common cause of acute abdomen, is influenced by its location. The usual clinical signs of appendicitis may be completely changed or even absent in cases of atypical appendicular positions. Incisional hernia is the most common late complication of intra-abdominal operations. Organs most likely to be localized in the hernia sac are the omentum and small and large intestines. Occasionally other organs may also herniate, for example, the appendix. Incarcerations of these organs can lead to infarsation or even to gangrene. We present the case of a 59 years old patient who underwent surgical revision for an incarcerated hernia in the scar from his previous laparoscopic operation for bilateral inguinal hernia. We expected to find an incarcerated small intestinal loop in the hernia, but surprisingly we found an acutely inflamed appendix. Considering the inflammation, special care is needed to ensure thorough treatment of the inflammatory process at the site of the incarcerated hernia. This case report presents a rare form of acute appendicitis with atypical localization in the scar from a laparoscopic port; it is a rare combination of two different causes of acute abdomen.

• MeSH
• Abdomen, Acute etiology   MeSH
• Appendicitis * surgery   diagnosis   complications   MeSH
• Hernia, Inguinal surgery   complications   MeSH
• Cicatrix complications   MeSH
• Middle Aged MeSH
• Humans MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male 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.

• MeSH
• Appendectomy * methods   adverse effects   MeSH
• Appendicitis surgery   MeSH
• Length of Stay MeSH
• Child MeSH
• Laparoscopy methods   MeSH
• Humans MeSH
• Postoperative Complications MeSH
• Retrospective Studies MeSH
• Check Tag
• Child MeSH
• Humans MeSH

• MeSH
• Appendectomy methods   MeSH
• Appendicitis * surgery   diagnostic imaging   complications   physiopathology   pathology   therapy   MeSH
• Diagnostic Techniques, Digestive System classification   MeSH
• Diagnosis, Differential MeSH
• Conservative Treatment MeSH
• Humans MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH