Background:
Acute appendicitis is one of the commonest causes of acute abdomen. There is a wide discussion and controversy on the surgical and nonsurgical treatment of acute uncomplicated appendicitis. The aim of this study was to evaluate the efficacy and outcomes of the conservative management of selected cases of acute appendicitis with an antibiotic first plan.
Patients and methods:
This was a single hospital-based prospective study with a duration of 25 months. Patients with clinical and radiological features of acute appendicitis presenting within 72 h of the beginning of abdominal pain with Alvarado score ≥5 were included. The patients received a therapeutic dose of broad-spectrum antibiotics and symptomatic treatment. The follow-up period was 6 months.
Results:
90 patients were evaluated, 54 (60%) patients were female and 36 (40%) patients were male with mean age 34.4 years. Conservative treatment was successful in 68 (75.6%) patients and failed in 22 (24.4%) patients. No mortality recorded in this study. The main complications which occurred in those patients who failed to respond to conservative treatment were perforated appendicitis (3 patients), appendicular abscess (3 patients) and appendicular mass (4 patients).
Conclusion:
Majority of cases of the first attack of uncomplicated acute appendicitis can be treated successfully by conservative treatment. However, conservative treatment demands precise communication, close monitoring and follow-up to recognize failure which needs to be treated immediately by surgery.
Highlights:
Thyroid hemiagenesis (THA) is a rare congenital anomaly in which one lobe of thyroid gland fails to develop during embryological stage. Agenesis may be unilateral, total or isthmic. Left thyroid lobe is more commonly involved than right lobe in hemiagenesis. Agenesis of the isthmus was seen in 50% of cases. Left sided hemiagenesis is more common than right sided hemiagenesis with a Left to right ratio of 4:1. Clinically patients can be euthyroid, hypothyroid or hyperthyroid. Often it is diagnosed as an incidental finding during ultrasonography (USG) study of neck, which can easily diagnose this condition.
Actual incidence of THA is unknown; most cases are diagnosed in patients admitted for thyroid scan or thyroid surgery because of suspicion of other thyroid abnormalities. This explains high frequency of association of hemiagenesis with other thyroid abnormalities such as multinodular goiter, adenoma, hyperthyroidism, hypothyroidism, chronic thyroiditis, and carcinoma.
Khaladkar, et al. emphasized that surgeon when planning a thyroidectomy must be aware of rare anatomical variations because such anomalies are not noticed in the differential diagnosis, investigations and treatment.
We report a rare case of 46 years old female patient who presented with nontoxic nodular goiter and intraoperatively we found a right sided multinodular goiter including the isthmus with complete absence of the left thyroid lobe with ipsilateral inferior parathyroid adenoma which is according to the available studies is the sixth case recorded worldwide till now.
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