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American Journal of Clinical Pathology Nov 2023Mucosal appendicitis is defined by neutrophilic infiltration limited to the mucosa, with no transmural invasion; it is currently a controversial entity. The aim of our...
OBJECTIVES
Mucosal appendicitis is defined by neutrophilic infiltration limited to the mucosa, with no transmural invasion; it is currently a controversial entity. The aim of our study was to determine whether mucosal appendicitis represents an early stage of acute appendicitis (AA) or should be considered a negative appendectomy.
METHODS
A retrospective study was performed of children with suspected AA who underwent surgical treatment between 2017 and 2020. The participants were divided into 2 groups according to histologic appendiceal findings: mucosal appendicitis (MA) and negative appendicitis (NA). Demographic, clinical, ultrasound, and laboratory features were compared between the groups.
RESULTS
A total of 1269 patients with suspected appendicitis in whom appendectomy was performed were included, with a median age of 10.5 years. Mucosal appendiceal inflammation was histologically confirmed in 30 cases (MA group), while no inflammation or other pathologic findings were observed in 25 cases (NA group), with no differences in demographic, clinical, or ultrasound features between the groups. Those in the MA group presented with significantly higher leukocyte and neutrophil counts and higher neutrophil to lymphocyte ratios (NLRs) than those in the NA group (P < .001). The NLR was the parameter with the highest area under the curve (0.736) for the diagnosis of MA. A cutoff of 3.20 was established, with a maximum sensitivity and specificity of 62.5% and 78.9%, respectively.
CONCLUSIONS
Mucosal appendicitis presents with laboratory and histologic inflammatory features that can be distinguished from nonappendicitis and should therefore be considered a pathologic entity within the spectrum of AA. Preoperative leukocyte and neutrophil counts and NLRs may help reduce the number of negative appendectomies.
Topics: Child; Humans; Appendicitis; Retrospective Studies; Leukocyte Count; Lymphocytes; Mucous Membrane; Acute Disease
PubMed: 37477500
DOI: 10.1093/ajcp/aqad079 -
The Surgeon : Journal of the Royal... Dec 2023To investigate the risk factors and the value of clinical prediction model for complicated appendicitis (CA) during pregnancy.
OBJECTIVE
To investigate the risk factors and the value of clinical prediction model for complicated appendicitis (CA) during pregnancy.
METHODS
Prospective analysis of pregnant patients who underwent appendectomy at a single tertiary care center between February 2020 and February 2023 and who ultimately had pathologically confirmed acute appendicitis (AA). According to intraoperative conditions and postoperative pathology, they were divided into the CA group and the uncomplicated appendicitis (UA) group. The two groups of patients were then compared in terms of demographic characteristics, disease features, ancillary tests and predictive models of acute appendicitis.
RESULTS
A total of 90 patients with AA in pregnancy were included, 21 of whom had CA in pregnancy and 69 had UA in pregnancy. Multivariate regression analysis showed that gestational week, neutrophil ratio and C-reactive protein (CRP) were independent risk factors for CA during pregnancy. Relative to the first trimester, the third trimesters had an increased risk of complicated appendicitis (OR = 12.48, 95% CI: 1.56-99.57, P = 0.017). Neutrophil ratio ≥85.30% (OR = 24.54, 95% CI: 2.59-232.72, P = 0.005) and CRP ≥34.26 mg/L (OR = 7.86, 95% CI: 2.18-28.38, P = 0.002) had a significantly increased risk of CA. The AIR and AAS score models were statistically different between the two groups, but with a lower sensitivity of 52.38% and 42.86%, respectively.
CONCLUSION
The third trimesters, neutrophil ratio ≥85.30% and CRP ≥34.26 mg/L may be key predictors of CA in pregnancy. The current scoring model is inadequate to identify complex appendicitis in pregnancy and further research is needed.
Topics: Pregnancy; Female; Humans; Appendicitis; Models, Statistical; Prospective Studies; Prognosis; C-Reactive Protein; Risk Factors; Acute Disease; Retrospective Studies
PubMed: 37210282
DOI: 10.1016/j.surge.2023.05.001 -
Canadian Family Physician Medecin de... Jun 2016While the diagnosis of acute appendicitis is relatively straightforward, chronic appendicitis is an entity that can be controversial and is often misdiagnosed. How and...
QUESTION
While the diagnosis of acute appendicitis is relatively straightforward, chronic appendicitis is an entity that can be controversial and is often misdiagnosed. How and when should clinicians be investigating chronic appendicitis as a cause of chronic and recurrent abdominal pain in the pediatric population?
ANSWER
Chronic appendicitis is a long-standing inflammation or fibrosis of the appendix that presents clinically as prolonged or intermittent abdominal pain. It is often a challenging diagnosis and might result in complications such as intra-abdominal infections or bowel obstruction or perforation. Clinical presentation, along with imaging studies, can help the clinician rule out other conditions, and among those who are diagnosed, for many children, appendectomy results in partial or complete resolution of pain symptoms.
Topics: Abdominal Pain; Adolescent; Appendectomy; Appendicitis; Child; Chronic Disease; Diagnosis, Differential; Diagnostic Errors; Humans; Intestinal Obstruction; Magnetic Resonance Imaging; Recurrence; Tomography, X-Ray Computed; Ultrasonography
PubMed: 27303020
DOI: No ID Found -
European Review For Medical and... Dec 2021Chronic appendicitis (CA) is a rare medical condition. CA is characterized by a less severe and almost continuous abdominal pain. It has a clinical picture lasting...
OBJECTIVE
Chronic appendicitis (CA) is a rare medical condition. CA is characterized by a less severe and almost continuous abdominal pain. It has a clinical picture lasting longer than 1-2 days and extending over weeks, months, even years. The exact etiology of CA is unclear. Certain resources have reported it as the cause of partial obstruction in the lumen of the appendix.
PATIENTS AND METHODS
Our study was carried out with the approval of the Clinical Research Ethics Committee. A retrospective analysis was performed between August 2018 and March 2020.
RESULTS
It was determined that 207 appendectomies were performed during the retrospective scan period. The data of 182 of these patients could be accessed fully and we could get answers to the criteria we thought. Only 8 of the patients screened were likely to be diagnosed with chronic appendicitis in the preoperative period. CA was found in 1 of the 8 patients (12.5%) who underwent surgery after a preliminary diagnosis of CA. Two patients were reported as malignant (25%), 3 patients (37.5%) as reactive lymphoid hyperplasia, and 1 patient as peri appendicitis (12.5%). Bleeding and congestion were reported in the last patient (12.5%).
CONCLUSIONS
The diagnosis of chronic appendicitis is made by pathological examination. It may not always be possible to consider "chronic appendicitis" as a preliminary diagnosis. This should still be kept in mind. In our opinion, it is a bit difficult to make a preliminary diagnosis of chronic appendicitis and make a surgical decision. We believe that controlled and prospective studies can shed more light on chronic appendicitis.
Topics: Adult; Appendicitis; Appendix; Chronic Disease; Female; Humans; Male; Preoperative Period; Retrospective Studies; Young Adult
PubMed: 34982452
DOI: 10.26355/eurrev_202112_27639 -
African Journal of Paediatric Surgery :... 2022Acute appendicitis is a common surgical emergency amongst the paediatric population. Available diagnostic tools are focussed to make a diagnosis of acute appendicitis. A... (Observational Study)
Observational Study
BACKGROUND
Acute appendicitis is a common surgical emergency amongst the paediatric population. Available diagnostic tools are focussed to make a diagnosis of acute appendicitis. A definitive predictive factor for the diagnosis of complicated appendicitis is lacking. Thus, this aims to analyse hyperbilirubinaemia as a predictor of complicated appendicitis amongst the paediatric population.
MATERIALS AND METHODS
A prospective observational study was conducted in a tertiary hospital from November 2018 to October 2019. All children undergoing emergency appendectomy were included in the study. Preoperatively, patients were evaluated clinically, and routine investigations including total and direct serum bilirubin were sent. All patients were grouped as 'simple appendicitis' or 'complicated appendicitis' based on intra-operative and histological findings. Bilirubin level was compared between these groups and analysed.
RESULTS
A total of 52 children fulfilling the inclusion criteria were included. The mean age was 13.2 ± 4.2 years, and the male: female ratio was 2.1:1. Thirty-four (65.4%) had simple appendicitis and 18 (34.6%) had complicated appendicitis. Total bilirubin was 23.83 ± 5.94 mmol/L in the complicated appendicitis group and 13.15 ± 3.29 mmol/L in the simple appendicitis group. Direct bilirubin was 5.28 ± 2.22 mmol/L in complicated appendicitis and 2.62 ± 0.83 mmol/L in simple one. Both total and direct bilirubin were significantly high in the complicated group (P < 0.001) compared to the simple appendicitis group. On the Receiver operating curve (ROC), the best cutoff value for total and direct bilirubin was 21 and 5.5 mmol/L, respectively. The sensitivity and specificity of total and direct bilirubin were 72.2%, 100%, and 61.1%, and 85.3%, respectively.
CONCLUSION
It is concluded that hyperbilirubinaemia is a good predictor for paediatric complicated appendicitis.
Topics: Adolescent; Appendectomy; Appendicitis; Bilirubin; Child; Female; Humans; Hyperbilirubinemia; Male; Retrospective Studies
PubMed: 35017372
DOI: 10.4103/ajps.AJPS_131_20 -
MMW Fortschritte Der Medizin Jun 2017
Review
Topics: Appendicitis; Humans; Severity of Illness Index
PubMed: 28608070
DOI: 10.1007/s15006-017-9789-9 -
Asian Journal of Surgery Sep 2022
Topics: Appendicitis; Child; Foreign Bodies; Humans; Seafood
PubMed: 35410830
DOI: 10.1016/j.asjsur.2022.03.085 -
Journal of Pediatric Surgery Apr 2023Nonoperative management (NOM) of uncomplicated appendicitis is a safe and effective treatment alternative to surgery that may be preferred by some families. Surgery and... (Review)
Review
Nonoperative management (NOM) of uncomplicated appendicitis is a safe and effective treatment alternative to surgery that may be preferred by some families. Surgery and NOM differ significantly in their associated risks and benefits. Choosing a treatment for acute appendicitis requires patients and their caregivers to make timely, informed decisions that allow for incorporation of personal perspectives, values, and preferences. This article will address the concept of shared decision-making and establish its role in patient-centered care. It will demonstrate the effectiveness of shared decision-making in a high acuity surgical setting for children and highlight how the choice for management of acute appendicitis may be impacted by patients' and families' individualized circumstances and values.
Topics: Child; Humans; Appendicitis; Anti-Bacterial Agents; Appendectomy; Treatment Outcome; Acute Disease
PubMed: 36379750
DOI: 10.1016/j.jpedsurg.2022.10.009 -
BMJ Open Apr 2022Growing evidence is showing that complicated and uncomplicated appendicitis are two different entities that may be treated differently. A correct diagnosis of the type...
INTRODUCTION
Growing evidence is showing that complicated and uncomplicated appendicitis are two different entities that may be treated differently. A correct diagnosis of the type of appendicitis is therefore essential. The Scoring system of Appendicitis Severity (SAS) combines clinical, laboratory and imaging findings. The SAS rules out complicated appendicitis in 95% (negative predictive value, NPV) and detects 95% (sensitivity) of patients with complicated appendicitis in adults suspected of acute appendicitis. However, this scoring system has not yet been validated externally. In this study, we aim to provide a prospective external validation of the SAS in a new cohort of patients with clinical suspicion of appendicitis. We will optimise the score when necessary.
METHODS AND ANALYSIS
The SAS will be validated in 795 consecutive adult patients diagnosed with acute appendicitis confirmed by imaging. Data will be collected prospectively in multiple centres. The predicted diagnosis based on the SAS score will be compared with the combined surgical and histological diagnosis. Diagnostic accuracy for ruling out complicated appendicitis will be calculated. If the SAS does not reach a sensitivity and NPV of 95% in its present form, the score will be optimised. After optimisation, a second external validation will be performed in a new group of 328 patients. Furthermore, the diagnostic accuracy of the clinical perspective of the treating physician for differentiation between uncomplicated and complicated appendicitis and the patient's preferences for different treatment options will be assessed.
ETHICS AND DISSEMINATION
Ethical approval was granted by the Amsterdam UMC Medical Ethics Committee (reference W19_416 # 19.483). Because of the observational nature of this study, the study does not fall under the scope of the Medical Research Involving Human Subjects Act. Results will be presented in peer-reviewed journals. This protocol is submitted for publication before analysis of the results.
Topics: Acute Disease; Adult; Appendicitis; Cohort Studies; Humans; Observational Studies as Topic; Predictive Value of Tests; Prospective Studies
PubMed: 35365522
DOI: 10.1136/bmjopen-2021-054304 -
The Journal of Surgical Research Jan 2022There are significant practice variations in antibiotic treatment for appendicitis, ranging from short-course narrow spectrum to long-course broad-spectrum. We sought to...
BACKGROUND
There are significant practice variations in antibiotic treatment for appendicitis, ranging from short-course narrow spectrum to long-course broad-spectrum. We sought to describe the modern microbial epidemiology of acute and perforated appendicitis in adults to help inform appropriate empiric coverage and support antibiotic stewardship initiatives.
METHODS
This is a post-hoc secondary analysis of the Multicenter Study of the Treatment of Appendicitis in America: Acute, Perforated, and Gangrenous (MUSTANG) which prospectively enrolled adult patients (age ≥ 18 years) diagnosed with appendicitis between January 2017 and June 2018 across 28 centers in the United States. We included all subjects with positive microbiologic cultures during primary or secondary (rescue after medical failure) appendectomy or percutaneous drainage. Culture yield was compared between low- and high-grade appendicitis as per the AAST classification.
RESULTS
A total of 3,471 patients were included: 230 (7%) had cultures performed, and 179/230 (78%) had positive results. Cultures were less likely to be positive in grade 1 compared to grades 3, 4, or 5 appendicitis with 2/18 (11%) vs 61/70 (87%) (p < .001). Only 1 subject had grade 2 appendicitis and culture results were negative. E. coli was the most common pathogen and cultured in 29 (46%) of primary appendectomy samples, 16 (50%) of secondary, and 44 (52%) of percutaneous drainage samples.
CONCLUSION
Culturing low-grade appendicitis is low yield. E. coli is the most commonly cultured microbe in acute and perforated appendicitis. This data helps inform empiric coverage for both antibiotics alone and as an adjunct to operative or percutaneous intervention.
Topics: Adolescent; Adult; Anti-Bacterial Agents; Antimicrobial Stewardship; Appendectomy; Appendicitis; Drainage; Escherichia coli; Humans; Retrospective Studies; United States
PubMed: 34520984
DOI: 10.1016/j.jss.2021.07.026