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All patients included in this study gave informed consent. The correct assignment of patients to the group of cases was confirmed by pathologic examination of the surgical specimen resected.
The medical records of the patients included in the study were reviewed and we recorded the following data: Age and age group, sex, smoking status, symptoms, diagnostic procedure, peripheral blood leukocytosis, site of the diverticula, type of diverticula, presence of appendicular plastron, presence of perforation, gangrene, ulceration or mucocele, duration of symptoms before the indication for surgery, duration of surgery and postoperative hospital stay in both groups.
We also analyzed the possible relationship of AAD with mucinous cystadenomas, carcinoid tumors and colon cancer. Statistical analysis Analysis of the distribution of quantitative variables whether they followed a normal distribution or not was assessed using Kolmogoroz-Smirnov test. Student's t test or Mann Whitney U test were used, as appropriate.
Odds ratios OR were calculated to assess the magnitude of the non- association between these variables. All statistical calculations were performed using SPSS version Results The study included 27 cases of AAD and 54 controls with acute appendicitis. AAD was present in 0. Table I shows the demographic characteristics and smoking status of patients with AAD versus acute appendicitis.
The results showed significantly earlier presentation of acute appendicitis than AAD This difference was particularly evident in patients younger than 40 years, with only 5 cases of AAD compared to 40 cases of appendicitis. For the age groups above 40 years, no differences were observed between cases and controls. No gender differences in presentation were observed; however, on analysis of age of presentation according to gender, statistically significant differences were found between men Nor did we find significant gender differences on analysis of smoking status data collected for 66 patients.
No differences in clinical symptoms were found for the two processes Table II. Abdominal pain alone or associated with other clinical manifestations was the most common symptom in both. In most patients, the preoperative diagnosis made in the ED was of acute appendicitis; none were diagnosed with AAD. A diagnosis other than appendicitis was suspected in only three patients who were subsequently diagnosed with AAD. Specifically, two had concomitant sigmoid diverticulitis and the third patient had septic shock of abdominal origin secondary to perforated appendiceal diverticulitis and secondary peritonitis.
The study of symptom duration before ED attendance showed that patients with AAD reported having symptoms for longer periods than those who had acute appendicitis Analysis of preoperative laboratory test results showed no significant differences between groups.
Leukocytosis in peripheral blood was analyzed using an upper limit of 12,, above which systemic inflammatory response syndrome SIRS was deemed to be present. By this criterion, The mean number of diverticula found at pathologic examination was 1. Finally, analysis of postoperative hospital stay showed significant differences between groups, with significantly longer stay for the AAD group 9.
Discussion Appendiceal diverticulosis was first described in by Kelynack 1, Its incidence varies in different series between 0. In our series, the incidence of AAD was 0. Appendiceal diverticula are classified as congenital or acquired Congenital diverticula involve all the layers -mucosa, submucosa, muscular and serous, and are therefore rarely perforated. The congenital form is exceedingly rare, having been observed in only 0. The acquired form is characterized by absence of the muscular layer, which explains its higher tendency to perforation 15, AAD is known to present at an older age than acute appendicitis, with a cutoff around 30 years of age.
In our patients, acute appendicitis presented earlier than diverticulitis Above this age, we found no significant difference in the distribution of patients. Although male gender has been described as a risk factor for AAD ,17,18 , in our series the distribution and the mean age at presentation by sexes were not different for women AAD is habitually underdiagnosed by clinicians, radiologists and surgeons, because of its clinical features.
Classically, AAD primarily presents with pain not associated with nausea, vomiting or anorexia 1,2, In our study, pain was consistently the most common symptom in both groups. As reported previously 4 , AAD in our series was not diagnosed preoperatively in any case.
Thus, certain ultrasound or CT data have been described that could help establish the preoperative diagnosis of AAD Regarding ultrasonography, useful findings for the diagnosis of this entity have been found. According to these and other studies 19 , an inflamed diverticulum presents with a hypoechoic signal surrounded by echogenic fat.
Other authors 5 referring to acute suppurative appendicitis have reported that edematous mucosa and submucosa is typically seen as a hyperechoic ring within which there is a ring filled with liquid, while in AAD all inflamed appendix layers are thicker and echogenic, as is their interior, indicating the presence of air.
The retrospective analysis performed in our study revealed no useful radiological criteria for the preoperative diagnosis of appendiceal diverticulitis.
On the one hand, this may be because ultrasound imaging is a technician-dependent technique and radiologist unfamiliarity with this disease makes it difficult to diagnose, and because of technological differences of ultrasound equipment used over a relatively long period of time.
On the other hand, although CT is considered the most useful tool for detecting AAD 20 , the low number of CT scans performed in our patients meant we lacked sufficient data for statistical analysis.
A prospective study would be required to assess the usefulness of these radiological findings. The average number of leukocytes found on preoperative laboratory analysis was lower in the AAD group Descargar PDF Plastron apendicular. Tratamiento 4. TA di itiApendicitiss.. Apendicitis Aguda Y las complicaciones pueden ser: Peritonitis focal, difusa o generalizada. Plastron Apendicular. Absceso Apendicular. Apendicitis Aguda y Apendicectomia - scribd.
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