Chapters authored
Neglected Appendicitis
Prompt diagnosis and surgical excision of inflamed appendix vermiformis is a goal that is often elusive in clinical practice. An overall delay more than 36 hours from the onset of symptoms can be defined as neglected appendicitis. Factors responsible for delay may be pre-hospital versus in-hospital, physician centered versus patient centered, medical versus socioeconomic and modifiable versus unmodifiable. Consequences of neglected diagnosis or treatment may be perforation, general peritonitis, adhesive bowel obstruction, prolonged ileus, mass formation, appendicular and metastatic abscesses, pyelephlebitis, stump appendicitis and fecal fistula. Non-operative antibiotic treatment followed by interval appendicectomy is recommended in neglected appendicitis to avoid collateral surgical injury to inflamed cecum. If surgical excision is unavoidable in acute phase, mucosa coring salvage (MUCOSAL) appendicectomy is preferred. It is important to recognize that clinical neglect is not the same as criminal neglect.
Part of the book: Appendicitis - Causes and Treatments