Medicine

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Acute appendicitis in pregnancy
(Sri Lanka College of Obstetricians & Gynaecologists, 2023) Abeysuriya, V.; Dodampahala, H.S.; Chandrasena, L.
INTRODUCTION: The early diagnosis and management of appendicitis in pregnancy are essential in maternal and fetal morbidity and mortality. In this 20-year retrospective study, we aimed to assess the outcomes of pregnant patients diagnosed with acute appendicitis. METHODS: A single-center retrospective study was carried out. Randomly selected 2000 medical records of pregnant mothers referred as outpatients and hospitalized from 2002 to 2022 were retrieved. Six pregnant patients who were diagnosed and treated in Nawaloka Hospital with the diagnosis of acute appendicitis during 2002-2022 were examined retrospectively. Ethics Committee approval was received. No conflicting interest. RESULTS: The age range of our patients was 22 to 31 years, mean of 26± 3.4. The mean gestational week was 20±5.3 weeks, and most were in the second trimester 4 (68%). All patients were admitted with the complaint of abdominal pain, the majority of them had the right iliac fossa pain (RIF). All had elevated inflammatory markers. No computed tomography (CT) was performed. One patient was diagnosed clinically of having acute appendicitis without any imaging. Acute appendicitis was diagnosed in 3/5 patients who underwent ultrasound scan examination. The other two patients (one from 2nd trimester and one in the third trimester) were diagnosed with acute appendicitis on MRI examination. All patients underwent open appendectomy under general anaesthesia. No maternal or foetal morbidity or mortality was noted during pre or post-surgical and anaesthesia procedures. The mean hospital stay was 3.9±0.9 days. All appendixes were pathologically proven to have acute appendicitis. Except for minor superficial surgical site infection rest of the mothers and foetus had no morbidity or mortality recorded in the follow-up. CONCLUSION: Although appendicitis is not frequent during pregnancy, it is a disease that requires urgent surgical and obstetrics care for timely diagnosis and treatment.
Acute appendicitis during the recovery phase of dengue hemorrhagic fever: two case reports
(BioMed Central, 2022) Thadchanamoorthy, V.; Ganeshrajah, A.; Dayasiri, K.; Jayasekara, N.P.
Background: Dengue fever is one of the most common tropical diseases, with high prevalence in many tropical countries including Sri Lanka. Dengue infection can present from subclinical infection to dengue shock syndrome. Further, the disease also shows a variety of atypical presentations and has been reported to mimic a number of causes of acute abdomen. Case presentation: The authors report two children (a 6-year-old Tamil girl and an 8-year-old Muslim girl) who were diagnosed to have acute appendicitis during the early recovery phase of dengue hemorrhagic fever (DHF) and late recovery period of dengue hemorrhagic fever with platelet count of 92 × 103/cumm and 102 × 103/cumm, respectively. Both children were investigated with abdomen ultrasound as they developed severe abdominal pain and tenderness on palpation during the recovery phase, which was felt to be very unusual. Acute appendicitis was diagnosed in one child, while the other child had a ruptured appendicular abscess. Both children were treated with laparoscopic appendectomy and a 7-day course of intravenous antibiotics. Both children were reviewed in 1 month following treatment and had complete recovery. Conclusion: Although precise pathophysiology and associations of the surgical abdomen with dengue fever remain to be elucidated, there are known factors in dengue fever that can potentially lead to secondary bacterial infections and surgical abdomen. Awareness and increased suspicion by the clinician are paramount to detect such complications early, especially in children who demonstrate unusual clinical features during various stages of dengue infection.
Position and morphology of the appendix vermiformis in Sri Lankans
(College of Surgeons of Sri Lanka, 2007) Salgado, L.S.S.; Abeysuriya, V.; Kumarage, S.K.; Rupasinghe, D.K.
INTRODUCTION: The vermiform appendix varies in length and opens into the posteromedial wall of the caecum, 2cm below the ileo caecal valve. While the position of its base is constant in relation to the caecum, the appendix itself may lie in a variety of positions. OBJECTIVE: To describe the morphological characteristics of the appendix among Sri Lankans. METHOD: A prospective study was carried out among 30 patients who underwent laparoscopic appendicectomy in Colombo North Teaching Hospital and 60 dissected cadavers in the departments of Anatomy at Ragama and Sri Jayewardenepura. While the intra-abdominal position of the appendix was assessed in both laparoscopic appendicectomy patients and the dissected cadavers, the other morphological characteristics were assessed only in the cadavers. RESULTS: The mean length of the appendix was 65mm, (range 35 to 110mm). The base of the appendix opened into the posteromedial wall of the caecum in 96.6% (58/60) and into the apex of the caecum in 3.4% (2/60). The mean outer diameter of the appendix was 5.2mm (range3 to 10mm). The position of the appendix was found to be retrocaecal in 24.4% (27/90), pelvic in 6.6% (6/90), and ileal in 51.6% (46/90) comprising 30% (27/90) post-ileal and21.6%(19/90)pre-ileal. The blood supply of the appendix was the inferior division of the ileo caecal artery in 96.6% (58/60) and the posterior caecal artery in 1.6% (1/60). The mean distance between the base of the appendix and the ileocaecal valve was 21.2 mm, varying from 13 mm to 24mm. CONCLUSION: The frequency of the various positions of the appendix in our study population was different to the reported data. The ileal position of the appendix was the most common and the pelvic position the least common.

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