Aim To compare the different outcomes in a single institution between patients with generalised purulent peritonitis from complicated appendicitis diagnosed intraoperatively which were managed laparoscopically to those managed via the open approach. Methods Data was collected from all cases admitted at Sebokeng Hospital over the past two years (2008 & 2009) with an intraoperative diagnosis of generalised purulent peritonitis from complicated appendicitis. Cases which were managed laparoscopically or by the open approach were analysed. The parameters analysed were the demographic findings, the theater duration, complications, and days to the commencement of full ward diet, and length of hospital stay. Results During the study period, a total of 120 cases of appendicectomies with generalised purulent peritonitis were performed. Of these, 58 cases underwent open appendicectomy (OA) and 62 cases had laparoscopic appendicectomy (LA). Both groups were comparable in the demographics and preoperative findings. The theater duration was significantly higher in the LA group (115.8 minutes for LA compared to 86.7 minutes for OA. The rate of intraabdominal sepsis was also higher in the LA group (12.9% for LA and 8.6% for OA). Both groups showed no statistical significant difference between the wound sepsis or port site sepsis rate, the days to commencement of full ward diet and length of hospital stay. More time was spent in ICU/HCU in the OA group an average of 3.7 days as opposed to 2 days in the LA group. However age, the duration of symptoms, the clinical presentation and the white blood cell count (WBC) were influencing factors to the outcome of the OA group. Conclusion Generalised purulent peritonitis from complicated appendicitis can be managed successfully laparoscopically. Both approaches are feasible, safe and have comparable outcomes. Where facilities are adequately skilled and resourced, the laparoscopic approach should be considered the procedure of choice for complicated purulent appendicitis because it is less influenced by preoperative findings and shows a trend towards less postoperative complications.

Inflammatory bowel disease-(IBD) is a chronic relapsing and remitting disorder of the gastrointestinal tract characterised by inflammation. The underlying immunopathogenesis is unknown but excessive effector and defective regulatory immune responses play a significant role. The aetiology of IBD is not yet fully resolved, but interactions between genetic and environmental factors, including the gut flora, contribute significantly to the development of IBD. Appendicectomy for intra-abdominal inflammatory conditions before the age of 20 protects against colitis. The mechanism underlying this protective effect is unclear. This thesis examined the hypothesis that appendiceal regulatory T lymphocytes (Treg) mediate the protection. Despite human and murine data showing that the appendix is involved in the prevention of colitis, few studies of human or murine appendices have been reported. A novel murine model of appendicitis was created using an operative technique of band-ligation of an induced-tubular-appendix. Histological assessment showed that this model recapitulated all of the histological features of human acute appendicitis, namely mucosal ulceration, transmural neutrophilic and lymphocytic infiltration and serositis. This local pathology was associated with a systemic host response, evidenced by raised serum Creactive- protein. The impact of inflammation on the appendiceal lymphocyte constituents was assessed by flow cytometry. The inflammation caused a shift from B-lymphocyte to T-lymphocyte predominance. In particular there was a 75% increment in Treg numbers, which was restricted to juvenile mice only (&lt 10 weeks old). Furthermore, appendiceal Treg expressed the gut-homing chemokine-receptor, CCR9, and the intestine-specific integrin, α4β7. These cells were shown to preferentially migrate to the colonic lamina propria. Lastly, appendicitis and appendicectomy protected against TNBS-colitis which was also restricted to juvenile mice. Evidence for antigen dependence was suggested by the effect being heightened when mice were pre-sensitised against TNBS. Exploration of the colonic lamina propria (cLP) lymphocyte population showed an increase in Treg, especially CD8+Foxp3+- Treg, in ??protected?? mice only, which may have originated in the appendix. Intracytoplasmic cytokine detection showed that these cLP-Treg were potent producers of the regulatory cytokine, IL-10. These findings strongly suggest that appendicitis triggers an expansion of Treg which then emigrate to the colon and mediate long-lasting protection against colitis.

No description available.

Inflammatory bowel disease-(IBD) is a chronic relapsing and remitting disorder of the gastrointestinal tract characterised by inflammation. The underlying immunopathogenesis is unknown but excessive effector and defective regulatory immune responses play a significant role. The aetiology of IBD is not yet fully resolved, but interactions between genetic and environmental factors, including the gut flora, contribute significantly to the development of IBD. Appendicectomy for intra-abdominal inflammatory conditions before the age of 20 protects against colitis. The mechanism underlying this protective effect is unclear. This thesis examined the hypothesis that appendiceal regulatory T lymphocytes (Treg) mediate the protection. Despite human and murine data showing that the appendix is involved in the prevention of colitis, few studies of human or murine appendices have been reported. A novel murine model of appendicitis was created using an operative technique of band-ligation of an induced-tubular-appendix. Histological assessment showed that this model recapitulated all of the histological features of human acute appendicitis, namely mucosal ulceration, transmural neutrophilic and lymphocytic infiltration and serositis. This local pathology was associated with a systemic host response, evidenced by raised serum Creactive- protein. The impact of inflammation on the appendiceal lymphocyte constituents was assessed by flow cytometry. The inflammation caused a shift from B-lymphocyte to T-lymphocyte predominance. In particular there was a 75% increment in Treg numbers, which was restricted to juvenile mice only (&lt 10 weeks old). Furthermore, appendiceal Treg expressed the gut-homing chemokine-receptor, CCR9, and the intestine-specific integrin, α4β7. These cells were shown to preferentially migrate to the colonic lamina propria. Lastly, appendicitis and appendicectomy protected against TNBS-colitis which was also restricted to juvenile mice. Evidence for antigen dependence was suggested by the effect being heightened when mice were pre-sensitised against TNBS. Exploration of the colonic lamina propria (cLP) lymphocyte population showed an increase in Treg, especially CD8+Foxp3+- Treg, in ??protected?? mice only, which may have originated in the appendix. Intracytoplasmic cytokine detection showed that these cLP-Treg were potent producers of the regulatory cytokine, IL-10. These findings strongly suggest that appendicitis triggers an expansion of Treg which then emigrate to the colon and mediate long-lasting protection against colitis.

Inflammatory bowel disease-(IBD) is a chronic relapsing and remitting disorder of the gastrointestinal tract characterised by inflammation. The underlying immunopathogenesis is unknown but excessive effector and defective regulatory immune responses play a significant role. The aetiology of IBD is not yet fully resolved, but interactions between genetic and environmental factors, including the gut flora, contribute significantly to the development of IBD. Appendicectomy for intra-abdominal inflammatory conditions before the age of 20 protects against colitis. The mechanism underlying this protective effect is unclear. This thesis examined the hypothesis that appendiceal regulatory T lymphocytes (Treg) mediate the protection. Despite human and murine data showing that the appendix is involved in the prevention of colitis, few studies of human or murine appendices have been reported. A novel murine model of appendicitis was created using an operative technique of band-ligation of an induced-tubular-appendix. Histological assessment showed that this model recapitulated all of the histological features of human acute appendicitis, namely mucosal ulceration, transmural neutrophilic and lymphocytic infiltration and serositis. This local pathology was associated with a systemic host response, evidenced by raised serum Creactive- protein. The impact of inflammation on the appendiceal lymphocyte constituents was assessed by flow cytometry. The inflammation caused a shift from B-lymphocyte to T-lymphocyte predominance. In particular there was a 75% increment in Treg numbers, which was restricted to juvenile mice only (&lt 10 weeks old). Furthermore, appendiceal Treg expressed the gut-homing chemokine-receptor, CCR9, and the intestine-specific integrin, α4β7. These cells were shown to preferentially migrate to the colonic lamina propria. Lastly, appendicitis and appendicectomy protected against TNBS-colitis which was also restricted to juvenile mice. Evidence for antigen dependence was suggested by the effect being heightened when mice were pre-sensitised against TNBS. Exploration of the colonic lamina propria (cLP) lymphocyte population showed an increase in Treg, especially CD8+Foxp3+- Treg, in ??protected?? mice only, which may have originated in the appendix. Intracytoplasmic cytokine detection showed that these cLP-Treg were potent producers of the regulatory cytokine, IL-10. These findings strongly suggest that appendicitis triggers an expansion of Treg which then emigrate to the colon and mediate long-lasting protection against colitis.

Proefschrift Universiteit van Amsterdam. / Met lit. opg. - Met samenvatting in het Nederlands.

BACKRGOUND: Appendicitis is the condition in which the appendix, a finger-length appendage located in the right lower quadrant (RLQ) of the abdomen, becomes inflamed due to a bacterial infection. Every year, nearly 300,000 cases of appendicitis are diagnosed at hospitals and clinics throughout the United States. In the U.S., the current standard of care for appendicitis is an appendectomy; surgery that completely removes the appendix from the body. Numerous studies in Europe, however, have demonstrated that antibiotics can be an equally safe and effective treatment for treating appendicitis. This clinical research study hypothesizes that antibiotics for intra-abdominal infections like appendicitis can be an effective treatment. METHODS: Patients that met eligibility were randomized to either antibiotic treatment or appendectomy treatment. If patients decided not to randomize, they had the option to join the Electronic Medical Record (EMR) cohort in which they could choose the treatment that they received. Patients in both cohorts were followed along via EMRs for the span of two years after initial treatment. Individuals who consented to the randomization group also received follow-up phone calls at specified points in time. RESULTS: A total of 374 patients were approached between March 2016 – March 2018. 100 patients consented to the randomization group and 118 patients elected into the EMR group. In the randomization group, 49 patients were randomized to appendectomy and 51 were randomized to antibiotic treatment. 21 patients in the antibiotic treatment group (41.1%) returned back to the hospital within two years of their index visit for an appendectomy. From the EMR cohort, 109 patients chose to receive appendectomies, and 9 patients received antibiotics. CONCLUSION: Treatment with antibiotics can serve as an alternative to surgery. However, due to the recurrence rate of 41% after two years, antibiotics should only be used as a means to delay permanent treatment. If a patient’s current situation is not immediately life-threatening, they should be granted the option to decide whether they would prefer to take antibiotics or elect into surgery. / 2021-06-14T00:00:00Z

A dissertation submitted to the Faculty of Medicine, University of Witwatersrand, Johannesburg for the Degree of Master of Medicine / Background To date, no randomized control trial has been performed comparing open appendicectomy (OA) to laparoscopic appendicectomy (LA) in complicated appendicitis. A systematic review and meta-analysis in 2010 concluded LA is advantageous to OA with less surgical site sepsis in complicated appendicitis; however, the level of evidence is weak (level 3a). The aim of the study was to determine whether LA is safe in the treatment of complicated appendicitis. Methods One hundred and fourteen patients were randomized prospectively to either OA or LA using a computer generated blind method. Patients who were either less than 12 years of age, had previous abdominal surgery or were pregnant were excluded. A team of senior surgeons capable of doing both OA and LA performed all procedures. Primary outcome included all-cause mortality and procedure-related mortality; secondary outcomes included intra-operative duration, rates of wound sepsis and re-intervention, length of hospital stay and re-admission rates. The trial was registered with Current Control Trials (ISRCTN92257749). Results The intra-operative duration, the rate of wound sepsis, the number of re-operations, the length of hospital stay and the rate of re-admissions between the OA and LA groups did not differ statistically. Conclusion Laparoscopic appendicectomy is safe in complicated appendicitis. / MT2016

Thesis Erasmus University Rotterdam. / With bibliogr., with a summary in Dutch.

Thesis (doctoral)--Kiel, 1980.