Systematic review of blunt abdominal trauma as a cause of acute appendicitis

Abstract

Ann R Coll Surg Engl 2010; 92: 477-482 477Appendicitis is a very common surgical condition. Approximately 7% of people in Western countries have appendicitis at some time during their lives. Obstruction of the proximal lumen of the appendix has long been considered to be the major cause of acute appendicitis. In many cases, the cause of obstruction is unknown. The evidence from temporal and geographical clustering of cases suggests primary infectious aetiology.1 Trauma has been known to be a rare cause of appendicitis for a long time.2 However, several current textbooks omit trauma as a cause of appendicitis. Cases of acute appendicitis caused by blunt abdominal trauma are rare, but have been reported sporadically in the literature. The aim of this systematic review was to collate and report the clinical presentations and experience of such cases. The systematic review was initiated after we were presented with a case of acute appendicitis following blunt trauma which we present briefly first. Case historyAn 11-year-old boy presented with right iliac fossa (RIF) pain after direct trauma to the right lower quadrant of his abdomen. While lying on a trampoline, his brother landed with his elbow on the patient's abdominal right lower quadrant after a high jump. His abdominal pain started immediately. Apart from the pain; he had nausea, vomiting and anorexia. Symptoms persisted until his admission 3 days later. He was previously fit and well and he did not have similar symptoms prior to the traumatic incident. The patient was pyrexial, tachycardic but normotensive. His abdomen was soft but tender in the right lower quadrant and right flank. A chest X-ray showed no free intraperitoneal gas, urinalysis showed only a trace of blood and haematological and biochemical investigations showed raised inflammatory markers. A computed tomography (CT) scan was performed which showed appendicitis with We present a systematic review of appendicitis following blunt abdominal trauma. The aim of this review was to collate and report the clinical presentations and experience of such cases. SUBJECTS AND METHODS A literature review was performed using PubMed, Embase and Medline and the keywords 'appendicitis', 'abdominal' and 'trauma'. RESULTS The initial search returned 381 papers, of which 17 articles were included. We found 28 cases of acute appendicitis secondary to blunt abdominal trauma reported in the literature between 1991 and 2009. Mechanisms of injury included roadtraffic accidents, falls, assaults and accidents. Presenting symptoms invariably included abdominal pain, but also nausea, vomiting and anorexia. Only 12 patients had computed tomography scans and 10 patients had ultrasonography. All reported treatment was surgical and positive for appendicitis. CONCLUSIONS Although rare, the diagnosis of acute appendicitis must be considered following direct abdominal trauma especially if the patient complains of abdominal right lower quadrant pain, nausea and anorexia. Haemodynamically stable patients who present shortly after bl...

Traumatic appendicitis in minor blunt abdominal injury

“…Furthermore, a retrocaecal appendix is unlikely to be injured in isolation. Conversely, an appendix lying in an inguinal hernia (Amyand's hernia) can be more vulnerable to injury, allowing blunt trauma to compress the appendix against the underlying pubic bone 8 …”

“…Conversely, an appendix lying in an inguinal hernia (Amyand's hernia) can be more vulnerable to injury, allowing blunt trauma to compress the appendix against the underlying pubic bone. 8 In cases of injury severity score of less than 4, a multifactor complex mechanism exists. An indirect mechanism of increased intraluminal pressure can play a role to the formation of TA.…”

“…Pathophysiological mechanisms of blunt trauma-induced appendicitis. Adapted information from the literature 1,2,8. …”

Appendicitis: A Traumatic Etiology

“…Appendicitis following trauma is a rare sequalae. It has been previously reported following blunt abdominal trauma including falls, road traffic accidents, assault, bicycle handle and crush injures [2,3].…”

Diagnostic Challenges in Acute Appendicitis

“…It has been suggested that this is due to the ischaemia that results when the blood vessels get blocked by the sickled red blood cells. Abdominal trauma has also been seen to result in acute appendicitis (Toumi et al, 2010). This is believed to be mediated by processes that result in the obstruction of the appendiceal lumen.…”