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Abstract
Background:
Appendicitis is a common surgical disease. There are many problems for the early diagnosis of acute appendicitis in kidney transplant patients; differential diagnosis for acute rejection, limitation in imaging study, problems of immunosuppressant and non-characteristic symptoms.
Methods:
We reviewed medical records and transplant database of 2,947 renal transplant patients between April, 1979 and September, 2009 retrospectively. Patient's characteristics, diagnostic methods for appendicitis and operative/postoperative progresses were analyzed.
Results:
Of the 2,947 renal transplant patients, there were 15 (0.51%, 13 males and 2 females) acute appendicitis patients. Mean age at the diagnosis of appendicitis was 37.2±10.1 years. Fourteen (93.3%) patients suffered from prodromal symptom, such as abdominal pain, direct or rebound tenderness, nausea and vomiting. There were 12 (80%) patients with leukocytosis (WBC count ＞10,000/μ L). Computed tomography scans were performed in 5 (33.4%) patients for diagnosis. Laparoscopic appendectomies were applied for 8 (53.4%) patients. In pathologic diagnosis, 2 cases were reported as 'non pathologic diagnosis' complications occurred in 2 patients as remnant appendicitis and pancreatitis. However, there was no patient with mortality and renal failure during the hospitalization.
REFERENCES
1). Wright FH Jr, Abu-Yousef MM, Smith JL, Georgi B, Corry RJ. Appendicitis in a transplant patient. Transplantation. 1988; 45:1159.
2). Humes DJ, Simpson J. Acute appendicitis. BMJ. 2006; 333:530–4.
3). Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epi-demiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990; 132:910–25.
4). Hegde S, Moghal NE, Coulthard MG. Acute appendicitis occurring immediately post-renal transplant. Pediatr Transplant. 2006; 10:119–20.
5). Talwalkar NC, Javali D, Venkatesh K, Iyer S, Venkatesh M, Joshi UB. Acute appendicitis mistaken as acute rejection in renal transplant recipients. J Postgrad Med. 1994; 40:39–40.
6). Lao A, Bach D. Colonic complications in renal transplant recipients. Dis Colon Rectum. 1988; 31:130–3.
7). Cartwright SL, Knudson MP. Evaluation of acute abdominal pain in adults. Am Fam Physician. 2008; 77:971–8.
8). Archibald SD, Jirsch DW, Bear RA. Gastrointestinal complications of renal transplantation. 2. The colon. Can Med Assoc J. 1978; 119:1301–5. 1309.
9). Bardaxoglou E, Maddern G, Ruso L, Siriser F, Campion JP, Poqamp P, et al. Gastrointestinal surgical emergencies following kidney transplantation. Transpl Int. 1993; 6:148–52.
10). Flanigan RC, Reckard CR, Lucas BA. Colonic complications of renal transplantation. J Urol. 1988; 139:503–6.
11). Larner AJ. The aetiology of appendicitis. Br J Hosp Med. 1988; 39:540–2.
12). Chan MK, Wilcox DT, Trompeter RS. Acute appendicitis in children after renal transplantation. Arch Dis Child. 1999; 81:372.
13). Rao PM, Boland GW. Imaging of acute right lower abdominal quadrant pain. Clin Radiol. 1998; 53:639–49.
14). Bickell NA, Aufses AH Jr, Rojas M, Bodian C. How time affects the risk of rupture in appendicitis. J Am Coll Surg. 2006; 202:401–6.
15). Sauerland S, Lefering R, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev. 2004; 18:CD001546.
16). Blomqvist PG, Andersson RE, Granath F, Lambe MP, Ekbom AR. Mortality after appendectomy in Sweden, 1987-1996. Ann Surg. 2001; 233:455–60.
Table 1.
Incidence of acute appendicitis by demographics
| Demographics | No. | No. of acute appendicitis | Incidence (%) | P-value | |
|---|---|---|---|---|---|
| Gender | Male | 1,969 | 13 | 0.66 | 0.108 |
| Female | 978 | 2 | 0.20 | ||
| Age at transplantation | ＜20 | 161 | 1 | 0.62 | |
| 20∼29 | 592 | 7 (1)∗ | 1.18 | ||
| 30∼39 | 894 | 3 | 0.34 | 0.259 | |
| 40∼49 | 764 | 2 (1)∗ | 0.26 | ||
| ≥50 | 536 | 2 | 0.37 | ||
Table 2.
Clinical characteristics of acute appendicitis after kidney transplantation
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