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Clinical manifestations of acute appendicitis in hemodialysis patients

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Abstract

Purpose

Acute appendicitis has been suggested to be more aggravated in hemodialysis (HD) patients in comparison to non-HD patients but only scanty evidence demonstrates the conditions.

Methods

A retrospective cohort study was done for HD and non-HD patients with a discharge diagnosis of acute appendicitis in a single medical center.

Results

Patients with acute appendicitis on HD (n = 11), and non-HD (n = 40) were enrolled. The patients in the HD group, demonstrated older age, less leukocytosis, shorter preoperative diagnostic delay, but with no improvement of perforation rate and poor prognosis such as longer hospital stay and higher morbidity rate in comparison to the non-HD group. The differences between the HD and non-HD group still existed even with an age- and gender-matched non-HD group. A higher C-reactive protein level was a helpful index in early diagnosis and predicting the possibility of perforation. Hyponatremia was an important prognostic factor associated with a longer preoperative delay, longer hospital stay and higher morbidity rate in the HD group.

Conclusions

The diagnosis of AA in HD patients was earlier than in non-HD patients. HD patients with AA had atypical presentations and a poor prognosis especially those that presented with hyponatremia and a perforated appendicitis. Higher C-reactive protein was associated with the development of perforated appendicitis in HD patients.

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Conflict of interest

None of the authors have any conflict of interest or financial support to declare.

Author information

Authors and Affiliations

  1. Department of Medicine, Division of Nephrology, Ten-Chen Hospital, Yang-Mei, Taiwan

    Hsin-Chi Wu

  2. Department of Medicine, Division of Nephrology, Tri-Service General Hospital, National Defense Medical Center, Number 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan

    Ming-Tso Yan, Pauling Chu, Shih-Hua Lin & Chia-Chao Wu

  3. Department of Medicine, Division of Nephrology, Cardinal Tien Hospital School of Medicine, Fu-Jen Catholic University, Taipei, Taiwan

    Kuo-Cheng Lu

  4. Department of Surgery, Division of General Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

    Jyh-Cherng Yu

Authors
  1. Hsin-Chi Wu
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  2. Ming-Tso Yan
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  3. Kuo-Cheng Lu
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  4. Pauling Chu
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  5. Shih-Hua Lin
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  6. Jyh-Cherng Yu
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  7. Chia-Chao Wu
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Corresponding author

Correspondence to Chia-Chao Wu.

Additional information

H.-C. Wu and M.-T. Yan contributed equally to this article.

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Wu, HC., Yan, MT., Lu, KC. et al. Clinical manifestations of acute appendicitis in hemodialysis patients. Surg Today 43, 977–983 (2013). https://doi.org/10.1007/s00595-012-0349-8

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  • DOI: https://doi.org/10.1007/s00595-012-0349-8

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