APPENDICITIS – A COLLECTION OF ESSAYS FROM AROUND THE WORLD Edited by Anthony Lander Appendicitis – A Collection of Essays from Around the World Edited by Anthony Lander Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. 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DepositPhotos First published December, 2011 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Appendicitis – A Collection of Essays from Around the World, Edited by Anthony Lander p. cm. ISBN 978-953-307-814-4 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Chapter 1 Epidemiologic Features of Appendicitis 1 Robert B. Sanda Chapter 2 Diagnostic Challenges in Acute Appendicitis 21 Sanjay Harrison and Harrison Benziger Chapter 3 Imaging in Suspected Appendicitis 43 Nadim M. Muallem, Antoine N. Wadih and Maurice C. Haddad Chapter 4 Clinical Scoring Systems in the Management of Suspected Appendicitis in Children 63 Graham Thompson Chapter 5 Recent Trends in the Treatment of the Appendicular Mass 87 Arshad M. Malik and Noshad Ahmad Shaikh Chapter 6 What Is the Role of Conservative Antibiotic Treatment in Early Appendicitis? 95 Inchien Chamisa Chapter 7 Appendicitis in the Elderly 107 Stephen Garba and Adamu Ahmed Chapter 8 Appendicitis in Children 133 Ngozi Joy Nwokoma Chapter 9 Demographic and Epidemiologic Features of Acute Appendicitis 169 Barlas Sulu Chapter 10 Current Evidence and Recommendations for Laparoscopic Appendectomy 179 Hurng-Sheng Wu, James Wall, Hung-Wen Lai and Jacques Marescaux VI Contents Chapter 11 Laparoscopic Appendicectomy 189 Maheswaran Pitchaimuthu Chapter 12 An Animal Model of Sepsis in Appendicitis: Assessment of the Microcirculation 207 Eduardo Ryoiti Tatebe, Priscila Aikawa, José Jukemura, Paulina Sannomiya and Naomi Kondo Nakagawa Chapter 13 Parasitic Appendicitis 217 Omer Engin, Bulent Calik and Sebnem Calik Preface This book is a collection of essays and papers from around the world, written by surgeons who look after patients of all ages with abdominal pain, many of whom have appendicitis. Some of these authors are previously unpublished and this route has given them a voice. In these pages, there are some novel thoughts and something for all surgical readers. I have enjoyed working with the authors to help shape their thoughts into publishable papers. Much of the correspondence has been stimulating and a privilege for me. I have learned new things. All general surgeons maintain a fascination with this important condition because it is so common and yet so easy to miss. All surgeons have a view on the literature and any gathering of surgeons embraces a spectrum of opinion on management options. Many aspects of the disease and its presentation and management remain controversial. This book does not answer those controversies, but should prove food for thought. The reflections of these surgeons are presented in many cases with novel data. The chapters encourage us to consider new epidemiological views and explore clinical scoring systems and the literature on imaging. Appendicitis is discussed in patients of all ages and in all manner of presentations. I remain a Luddite who believes that a good history and clinical examination, including a temperature properly taken, followed by repeated clinical examination by the same surgeon over the subsequent 24 hours, will lead to few negative appendicectomies. However, with shorter training, and the European working directive, there may be a real role for scoring systems. Persistent guarding in the right illiac fossa on repeated examination is the key to the diagnosis, but imaging is getting better and is more widely used. Laparoscopic appendicectomy is now the treatment of choice if equipment and skills are available, but the arguments for conservative management are by no means weak. These are all explored in this book. I do hope you enjoy this collection of papers. Dr. Anthony Lander Birmingham Children's Hospital, UK [...]... (Wikipedia Foundation Inc., 2011) In addition it is questioned whether the epidemiology of appendicitis and appendicular fecaliths in Aboriginal Canadians based on dietary habits resembled Caucasian Canadians at all Similarly, Johannesburg during the period of study had a population that was not representative of the native African continent The US Bureau of 4 Appendicitis – A Collection of Essays from Around. .. various publications A search of the literature from around the world using the standardized annual incidence rates shows a wide range of estimates of the incidence of appendicitis Importantly, most publications reporting incidence rates do not differentiate between calcular appendicitis and the non-calcular variety Table 1 shows a comparison of annual incidence rates from around the world in the last... calculate incidence rates and trend Ideally this should be based on agespecific annual rates but since the peak incidence of appendicitis appears to vary slightly from one region of the world to another, a crude rate using all cases is an acceptable alternative Because of the variable negative appendectomy rates it is ideal to compare rates of histologically confirmed cases These data are unfortunately... JH, et al 2010) This figure is more than 12 times the rate in Ghana (Ohene-Yeboah & Abantanga, 2009) Saudi Arabia, another country that is attaining rapid improvement in health indices, maybe showing this trend as a post-hoc analysis of the data in our study shows that in the city of Hail with a population of around 356,000 an estimated average of 526 cases of appendicitis were recorded annually from. .. and his team suggested that the observed increase in the incidence of appendicitis at the end of the 19th century was a consequence of the adoption of a housing policy in Britain and Ireland which enforced the provision of safe-drinking water and sanitary measures like sewage and waste disposal (Barker, et al 1982, 198 8a; Morris, et al., 6 Appendicitis – A Collection of Essays from Around the World 1987)... presentation The typical history usually attributed to an underlying inflamed appendix is a central abdominal pain which gets progressively worse and localises to the right iliac fossa This 22 Appendicitis – A Collection of Essays from Around the World is usually associated with anorexia, nausea, vomiting and a low grade pyrexia The initial central abdominal pain is described as dull and becomes sharp... can study the incidence of appendicectomies but this is not to say we are studying appendicitis To measure the incidence of appendicitis a definition of the disease is required and a 14 Appendicitis – A Collection of Essays from Around the World confidence that all cases are ascertained These criteria are not well met Finding mucosal inflammation in the appendix in a significant portion of incidental... study from the USA comparing the incidence of appendicitis in various ethnic groups concluded that the rate was lower in Negroes and Asians in comparison to Caucasians and Hispanics (Luckmann & Davis, 1991) A case-control study from Brazil comparing the people of that country on the basis of skin colour claimed that race was a factor in the incidence of appendicitis After excluding native Indians the. .. non-operative treatments and to foresee a future when some cases of appendicitis can be prevented 2 What is a normal appendix ? The histological features of pathological inflammation in most tissues are well defined The inflammatory cell types encountered and the tissue architecture enable a precise diagnosis of 2 Appendicitis – A Collection of Essays from Around the World acute or chronic inflammation... degranulation (Santosh & Aravindan, 2008; Aravindan, et al., 2010) Seasonal variation of appendicitis with its peak associated with a season characterized by high ambient pollen and other phyto-allergens or sandstorm is an observation that can neither be explained by diet nor fecaliths but may have a bearing on immune modulation playing a role 7 Conclusion The epidemiology of appendicitis is important . APPENDICITIS – A COLLECTION OF ESSAYS FROM AROUND THE WORLD Edited by Anthony Lander Appendicitis – A Collection of Essays from Around the World Edited by Anthony. mounted against invading pathogens is appropriate and proportionate so as to minimize collateral damage from immunological over reaction. Appendicitis – A Collection of Essays from Around the World. Caucasian Canadians at all. Similarly, Johannesburg during the period of study had a population that was not representative of the native African continent. The US Bureau of Appendicitis – A Collection