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The New England Journal of Medicine Nov 2020Antibiotic therapy has been proposed as an alternative to surgery for the treatment of appendicitis. (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
Antibiotic therapy has been proposed as an alternative to surgery for the treatment of appendicitis.
METHODS
We conducted a pragmatic, nonblinded, noninferiority, randomized trial comparing antibiotic therapy (10-day course) with appendectomy in patients with appendicitis at 25 U.S. centers. The primary outcome was 30-day health status, as assessed with the European Quality of Life-5 Dimensions (EQ-5D) questionnaire (scores range from 0 to 1, with higher scores indicating better health status; noninferiority margin, 0.05 points). Secondary outcomes included appendectomy in the antibiotics group and complications through 90 days; analyses were prespecified in subgroups defined according to the presence or absence of an appendicolith.
RESULTS
In total, 1552 adults (414 with an appendicolith) underwent randomization; 776 were assigned to receive antibiotics (47% of whom were not hospitalized for the index treatment) and 776 to undergo appendectomy (96% of whom underwent a laparoscopic procedure). Antibiotics were noninferior to appendectomy on the basis of 30-day EQ-5D scores (mean difference, 0.01 points; 95% confidence interval [CI], -0.001 to 0.03). In the antibiotics group, 29% had undergone appendectomy by 90 days, including 41% of those with an appendicolith and 25% of those without an appendicolith. Complications were more common in the antibiotics group than in the appendectomy group (8.1 vs. 3.5 per 100 participants; rate ratio, 2.28; 95% CI, 1.30 to 3.98); the higher rate in the antibiotics group could be attributed to those with an appendicolith (20.2 vs. 3.6 per 100 participants; rate ratio, 5.69; 95% CI, 2.11 to 15.38) and not to those without an appendicolith (3.7 vs. 3.5 per 100 participants; rate ratio, 1.05; 95% CI, 0.45 to 2.43). The rate of serious adverse events was 4.0 per 100 participants in the antibiotics group and 3.0 per 100 participants in the appendectomy group (rate ratio, 1.29; 95% CI, 0.67 to 2.50).
CONCLUSIONS
For the treatment of appendicitis, antibiotics were noninferior to appendectomy on the basis of results of a standard health-status measure. In the antibiotics group, nearly 3 in 10 participants had undergone appendectomy by 90 days. Participants with an appendicolith were at a higher risk for appendectomy and for complications than those without an appendicolith. (Funded by the Patient-Centered Outcomes Research Institute; CODA ClinicalTrials.gov number, NCT02800785.).
Topics: Absenteeism; Administration, Intravenous; Adult; Anti-Bacterial Agents; Appendectomy; Appendicitis; Appendix; Fecal Impaction; Female; Health Status; Hospitalization; Humans; Laparoscopy; Male; Middle Aged; Postoperative Complications; Quality of Life; Surveys and Questionnaires; Treatment Outcome
PubMed: 33017106
DOI: 10.1056/NEJMoa2014320 -
Nature Reviews. Gastroenterology &... Sep 2023The appendix is thought to have a role in the pathogenesis of ulcerative colitis, but the nature and basis of this association remains unclear. In this Perspective, we... (Review)
Review
The appendix is thought to have a role in the pathogenesis of ulcerative colitis, but the nature and basis of this association remains unclear. In this Perspective, we consider the biology of the appendix with respect to its immunological function and the microbiome, and how this relates to evidence that supports the involvement of the appendix in ulcerative colitis. In experimental models, removal of the inflamed appendix prevents colitis, and in human observational studies, appendectomy is associated with protection against ulcerative colitis. Further, among people who develop ulcerative colitis, appendectomy before diagnosis might influence the course and outcomes of the disease - some evidence suggests that it protects against colectomy but could increase the risk of colorectal cancer. Appendectomy after onset of ulcerative colitis seems to have disparate consequences. Clinical trials to understand whether appendectomy has a role in the treatment of ulcerative colitis are ongoing. Major questions about the role of the appendix in the pathogenesis of ulcerative colitis remain unanswered, and further research is needed to establish whether the connection is clinically relevant.
Topics: Humans; Colitis, Ulcerative; Appendix; Appendectomy; Colitis
PubMed: 37081213
DOI: 10.1038/s41575-023-00774-3 -
The New England Journal of Medicine Sep 2021
Review
Topics: Acute Disease; Adult; Analgesics; Anti-Bacterial Agents; Appendectomy; Appendicitis; Appendix; Female; Humans; Lithiasis; Patient Participation; Practice Guidelines as Topic
PubMed: 34525287
DOI: 10.1056/NEJMcp2107675 -
Human Pathology Feb 2023Low-grade appendiceal mucinous neoplasms are unique tumors of the appendix, characterized by low-grade mucinous epithelium with villiform, undulating, or flat... (Review)
Review
Low-grade appendiceal mucinous neoplasms are unique tumors of the appendix, characterized by low-grade mucinous epithelium with villiform, undulating, or flat architecture. These tumors lack infiltrative growth or destructive invasion, but can extend into the appendiceal wall by a "pushing" pattern of invasion, with a broad front that can mimic a diverticulum. These neoplasms have a propensity for peritoneal dissemination, resulting in the clinical presentation of pseudomyxoma peritonei. The pathologic staging of these neoplasms is challenging and fraught with confusing terminology and numerous classification systems. This review focuses on the AJCC pathologic staging of these tumors with a focus on challenging situations.
Topics: Humans; Peritoneal Neoplasms; Pseudomyxoma Peritonei; Appendiceal Neoplasms; Appendix; Neoplasms, Glandular and Epithelial
PubMed: 35843338
DOI: 10.1016/j.humpath.2022.07.004 -
BMJ Case Reports Sep 2023The vermiform appendix (VA) is known to exhibit a wide range of anatomic variability, with clinical presentation correlating with certain known anatomic positioning. To...
The vermiform appendix (VA) is known to exhibit a wide range of anatomic variability, with clinical presentation correlating with certain known anatomic positioning. To the best of our knowledge, we describe the second known case of a retro-psoas muscle VA variant and the first known case of appendicitis in such a location. Retroperitoneal access was obtained, and the appendix was freed from the intermuscular recess between the psoas and iliacus. The peritoneal defect was primarily repaired, and the patient was discharged on postoperative day 1 in good condition.
Topics: Humans; Appendicitis; Appendix; Abdominal Muscles; Patient Discharge; Peritoneum
PubMed: 37730427
DOI: 10.1136/bcr-2022-253128 -
Advances in Experimental Medicine and... 2020The pathological features of the appendix tumors fundamentally recall those of the more frequent colorectal neoplasms, although with a higher relative incidence of... (Review)
Review
The pathological features of the appendix tumors fundamentally recall those of the more frequent colorectal neoplasms, although with a higher relative incidence of carcinoids, due to the abundant presence of enteroendocrine cells in the appendix wall. Moreover, different types of lymphomas, Hodgkin and non-Hodgkin, arising from the extra-nodal mucosal-associated lymphatic tissue, can be encountered. The appendix tumor microenvironment (TME) consists of a cellular component and of a noncellular component: the former includes the immunocompetent cells, while the latter represents the support stroma. Particularly in carcinoids, the immune cell reaction can be explicated by tumor-infiltrating lymphocytes, which, in some circumstances, may arrange around and inside the tumor in a brisk fashion influencing favorably the prognosis. This active reaction has to be distinguished from any preexisting inflammatory condition of the appendix and from superimposed tumor complications, such as infection or ischemia. In practice, we consider the appendix TME a complex framework with immunological, mechanic, and metabolic functions, all supported by a marked neo-lymphoangiogenesis.
Topics: Appendiceal Neoplasms; Appendix; Carcinoid Tumor; Humans; Prognosis; Tumor Microenvironment
PubMed: 32030678
DOI: 10.1007/978-3-030-36214-0_7 -
Archives of Pathology & Laboratory... Jun 2021The 5th edition of the World Health Organization classification of digestive system tumors discusses several advancements and developments in understanding the etiology,... (Review)
Review
What is New in the 2019 World Health Organization (WHO) Classification of Tumors of the Digestive System: Review of Selected Updates on Neuroendocrine Neoplasms, Appendiceal Tumors, and Molecular Testing.
CONTEXT.—
The 5th edition of the World Health Organization classification of digestive system tumors discusses several advancements and developments in understanding the etiology, pathogenesis, and diagnosis of several digestive tract tumors.
OBJECTIVE.—
To provide a summary of the updates with a focus on neuroendocrine neoplasms, appendiceal tumors, and the molecular advances in tumors of the digestive system.
DATA SOURCES.—
English literature and personal experiences.
CONCLUSIONS.—
Some of the particularly important updates in the 5th edition are the alterations made in the classification of neuroendocrine neoplasms, understanding of pathogenesis of appendiceal tumors and their precursor lesions, and the expanded role of molecular pathology in establishing an accurate diagnosis or predicting prognosis and response to treatment.
Topics: Appendiceal Neoplasms; Appendix; Digestive System; Digestive System Neoplasms; Gastrointestinal Neoplasms; Genomics; Humans; Molecular Diagnostic Techniques; Neuroendocrine Tumors; World Health Organization
PubMed: 32233993
DOI: 10.5858/arpa.2019-0665-RA -
World Journal of Surgery Apr 2023Save for the contribution of Charles McBurney, who described his eponymous point and the appendicectomy incision, the history of appendicectomy is largely unknown among... (Review)
Review
BACKGROUND
Save for the contribution of Charles McBurney, who described his eponymous point and the appendicectomy incision, the history of appendicectomy is largely unknown among the medical profession. This review traces the history from the first anatomical depiction of the appendix to the development of open appendicectomy and the recent minimally invasive and non-operative methods.
METHODS
Historical articles, monographs and books containing anatomical descriptions of the vermiform appendix and reports of appendicitis and its surgical treatment were retrieved after searching the PubMed, Google Scholar and Embase databases from their inception to 31 March 2022.
RESULTS
The first inadvertent appendicectomy was performed during an operation for a groin hernia by Cookesley in 1731, and Mestivier was the first to drain a right iliac fossa abscess, due to appendicitis, in 1757. Krönlein performed the first appendicectomy for acute appendicitis in 1884 but his patient died. The first successful appendicectomy for acute appendicitis leading to patient survival was by Morton in 1887. In 1976, Wirschafter and Kaufman performed an inadvertent colonoscopic appendicectomy and, in 1980, Semm carried out the first laparoscopic appendicectomy. The first appendicectomy via a natural orifice (transgastric) appendicectomy was by Rao and Reddy in 2004.
CONCLUSION
This historical review charts the development of surgical knowledge concerning the management of appendicitis, from the first anatomical drawings of the appendix and descriptions of appendicitis to the development of surgical and conservative treatments up to the present day. It also corrects some inaccuracies of attribution in previous historical reviews.
Topics: Humans; Appendicitis; Appendectomy; Appendix; Acute Disease; Abscess; Laparoscopy
PubMed: 36581691
DOI: 10.1007/s00268-022-06874-6 -
Khirurgiia 2022Appendiceal cancer is one of the rarest tumors. In most patients, this disease is diagnosed during appendectomy or after autopsy. The authors report a patient with...
Appendiceal cancer is one of the rarest tumors. In most patients, this disease is diagnosed during appendectomy or after autopsy. The authors report a patient with appendiceal cancer identified during the treatment of appendicular infiltrate and analyze literature devoted to this issue. Clinical case confirms that appendiceal cancer is difficult for differential diagnosis due to peculiarities and variability of its course. This aspect prevents timely treatment of disease. Timely and accurate diagnosis requires not only clinical experience, but also introduction of new technologies and clinical tests that could reduce the risk of damage and increase the accuracy of diagnostic data.
Topics: Appendectomy; Appendiceal Neoplasms; Appendicitis; Appendix; Diagnosis, Differential; Humans
PubMed: 35147005
DOI: 10.17116/hirurgia202202179 -
Radiology Dec 2023
Topics: Humans; Fistula; Appendix
PubMed: 38112543
DOI: 10.1148/radiol.231939