tag:blogger.com,1999:blog-4968787219619380438.post1502982052691289717..comments2023-09-21T04:02:29.457-04:00Comments on Skeptical Scalpel: Speed bumps & appendicitis: The factsSkeptical Scalpelhttp://www.blogger.com/profile/13206922456661320751noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-4968787219619380438.post-83673644175240860982012-12-23T20:42:41.464-05:002012-12-23T20:42:41.464-05:00Yes, that's another way to look at it.Yes, that's another way to look at it.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-37961425284467883152012-12-23T14:50:22.302-05:002012-12-23T14:50:22.302-05:00Perhaps the article should have been entitled &quo...Perhaps the article should have been entitled "Taking a history and examining the patient may be clinically useful".artigerhttps://www.blogger.com/profile/13361655152970244221noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-84471555766522367522012-12-22T07:40:24.964-05:002012-12-22T07:40:24.964-05:00I agree with everything you said, including the sc...I agree with everything you said, including the scary part.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-27044802339473781662012-12-22T00:55:09.206-05:002012-12-22T00:55:09.206-05:00Nothing like seeing a lap appy scar and then being...Nothing like seeing a lap appy scar and then being told the patient's appendix was removed, but it is still there on CT scan.<br />Last year we had a patient who had a lap chole, scars and all, who still had a gallbladder.<br />And she was done in Florida. scary.<br />I think there is essentially nil in risk with putting a stapler across the appendix once you are in.<br />RuggerMDnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-37893719110261020652012-12-21T14:46:54.280-05:002012-12-21T14:46:54.280-05:00I agree that what looks normal grossly in the OR o...I agree that what looks normal grossly in the OR often is reported as appendicitis on pathology. I always remove it. If the patient signs for an appendectomy, he gets one. There is minimal risk, and that appendix will not bother him in the future.<br /><br />In the paper about speed bumps, they found 7 other normal appear appyendices that they did not remove because other pathology was also seen. Based on that, their normal rate may have been even higher.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-35037242565661769322012-12-21T14:05:12.567-05:002012-12-21T14:05:12.567-05:00My negative rate seems to be around 0% because (ve...My negative rate seems to be around 0% because (very rarely) after 24 hrs of observation, off abxs, and pt still w/ RLQ pain, I take them to the OR and place in a laparoscope. To me the appendix looks normal. I think to myself, well that's not the problem. Then I grab the appendix with a Babcock and dissect it out.<br />Pathology always reports appendicitis and somehow the patient's problem is always resolved the next day.<br />I suppose either the pt had resolving appy and under the microscope it is appendicitis, or by grasping and manipulating it, I caused the "appendicitis".<br />However, in this day and age, the CT scans are sooo good, it is hard not to see real appendiceal inflammation. I would argue the negative rate should be <5 % for sure. RuggerMDnoreply@blogger.com