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Appendicitis Diagnosis and Management

Works Count: 51867

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This cluster of papers focuses on the diagnosis and management of appendicitis in both adults and children. It covers topics such as the use of antibiotic therapy versus surgery, the role of CT scans in diagnosis, and guidelines for treatment. The cluster also explores complications, outcomes, and global perspectives on the condition.

Keywords

Appendicitis; Diagnosis; Management; Antibiotic Therapy; Surgery; CT Scan; Guidelines; Children; Complications; Meta-Analysis

Appendectomy versus Antibiotic Treatment in Acute Appendicitis. A Prospective Multicenter Randomized Controlled Trial

2006-04-27

Johan Styrud , Staffan Eriksson , Ingemar Nilsson +6 more

Coelioscopic Cholecystectomy

1990-01-01

F Dubois , P Icard , G Berthelot +1 more

DUBOIS, F. M.D.; ICARD, P. M.D.; BERTHELOT, G. M.D.; LEVARD, H. M.D. Author Information DUBOIS, F. M.D.; ICARD, P. M.D.; BERTHELOT, G. M.D.; LEVARD, H. M.D. Author Information

Diagnosis and Management of Complicated Intra-Abdominal Infection in Adults and Children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America

2010-02-01

Joseph S. Solomkin , John E. Mazuski , John S. Bradley +7 more

Evidence-based guidelines for managing patients with intra-abdominal infection were prepared by an Expert Panel of the Surgical Infection Society and the Infectious Diseases Society of America. These updated guidelines replace … Evidence-based guidelines for managing patients with intra-abdominal infection were prepared by an Expert Panel of the Surgical Infection Society and the Infectious Diseases Society of America. These updated guidelines replace those previously published in 2002 and 2003. The guidelines are intended for treating patients who either have these infections or may be at risk for them. New information, based on publications from the period 2003–2008, is incorporated into this guideline document. The panel has also added recommendations for managing intra-abdominal infection in children, particularly where such management differs from that of adults; for appendicitis in patients of all ages; and for necrotizing enterocolitis in neonates.

The Clinical and Economic Correlates of Misdiagnosed Appendicitis

2002-07-01

David R. Flum , Thomas D. Koepsell

Negative appendectomy (NA)--the nonincidental removal of a normal appendix--occurs commonly but the associated clinical- and system-level costs are not well studied.The frequency of adverse clinical outcomes and associated financial burden … Negative appendectomy (NA)--the nonincidental removal of a normal appendix--occurs commonly but the associated clinical- and system-level costs are not well studied.The frequency of adverse clinical outcomes and associated financial burden of hospitalizations during which NA is performed is greater than previously recognized and varies widely among demographic groups.Population-based, retrospective cohort study.The 1997 Nationwide Inpatient Sample of the Health Care Utilization Project.All surveyed patients assigned International Classification of Diseases, Ninth Revision procedure codes for appendectomy but without an associated diagnosis of acute appendicitis.The age- and sex-stratified rates of NA, the incidence of associated infectious complications and case fatality, and the average length of stay and hospitalization charges during those admissions.Nationwide, an estimated 261 134 patients underwent nonincidental appendectomies in 1997, and 39 901 (15.3%) were negative for appendicitis. Women had a higher rate of NA as did patients younger than 5 years and older than 60 years. When compared with patients with appendicitis, NA was associated with a significantly longer length of stay (5.8 vs 3.6 days, P<.001), total charge-admission ($18 780 vs $10 584, P<.001), case fatality rate (1.5% vs 0.2%, P<.001), and rate of infectious complications (2.6% vs 1.8%, P<.001). An estimated $741.5 million in total hospital charges resulted from admissions in which a NA was performed.There are significant clinical and financial costs incurred by patients undergoing NA during the treatment of presumed appendicitis. These should be considered when evaluating system-level interventions to improve the management of appendicitis.

Has Misdiagnosis of Appendicitis Decreased Over Time?

2001-10-10

David R. Flum , Arden M. Morris , Thomas D. Koepsell +1 more

THE most frequently performed surgical procedures in the United States and the most common surgical emergency of the abdomen.Despite a lifetime cumulative incidence of nearly 7%, 1 diagnosis of appendicitis … THE most frequently performed surgical procedures in the United States and the most common surgical emergency of the abdomen.Despite a lifetime cumulative incidence of nearly 7%, 1 diagnosis of appendicitis remains a challenge.The risk of 2 primary adverse outcomes must be balanced in management of presumed appendicitis: perforation, often occurring in the prehospital setting, 2 and misdiagnosis, resulting in removal of a normal appendix.Although reduction of the frequency of appendiceal perforation has received much scrutiny, the factors leading to misdiagnosis are less understood.To reduce the incidence of perforation, the surgical community traditionally accepts that approximately 15% of appendectomies overall and 20% in women will yield a noninflamed appendix. 3,46][7] This relatively high rate of unnecessary appendectomy is being challenged in some quarters as an outdated standard, given the dramatic expansion of diagnostic testing options for appendicitis during the last decade. 8Indeed, many investigators have demonstrated that in research environ-ments, advanced diagnostic testing using computed tomography (CT), ultrasonography (US), and laparoscopy decreases the frequency of misdiagnosis. 9-14These diagnostic tests are often targeted toward populations deemed at increased risk for misdiagnosis: children, the elderly, and women of reproductive age.The purpose of this study was to evaluate changes in the frequency of

A Prospective Study of Ultrasonography in the Diagnosis of Appendicitis

1987-09-10

J. B. C. M. Puylaert , P.H. Rutgers , Roy Lalisang +4 more

The diagnosis of appendicitis is frequently difficult. We studied prospectively the diagnostic accuracy and clinical impact of abdominal ultrasonography in 111 consecutive patients thought to have appendicitis. Ultrasonography was performed … The diagnosis of appendicitis is frequently difficult. We studied prospectively the diagnostic accuracy and clinical impact of abdominal ultrasonography in 111 consecutive patients thought to have appendicitis. Ultrasonography was performed with small high-resolution, linear-array transducers, with the abdomen compressed to displace or compress bowel and fat. Among 52 patients later shown in surgery to have appendicitis, ultrasonography was unequivocally positive in 39 (sensitivity, 75 percent). Of 31 patients in whom appendicitis was definitely excluded, none had a positive ultrasound examination (specificity, 100 percent). The sensitivity in those with a perforated appendix (28.5 percent) was much lower than in those with acute nonperforating appendicitis (80.5 percent) or appendiceal mass (89 percent), but the low sensitivity did not influence clinical management, since the need for surgery in patients with a perforated appendix was clinically obvious. Ultrasonography resulted in changes in the proposed management in 29 of the 111 patients (26 percent). It also led to the correct diagnosis in the 16 patients who were found to have a disease other than appendicitis. We conclude that ultrasonography is a useful aid in the diagnosis of appendicitis. (N Engl J Med 1987; 317: 666–9.)

Acute appendicitis in children: Emergency department diagnosis and management

2000-07-01

Steven G. Rothrock , Joseph Pagane

Effect of Computed Tomography of the Appendix on Treatment of Patients and Use of Hospital Resources

1998-01-15

Patrick M. Rao , James T. Rhea , Robert A. Novelline +2 more

In patients with clinically suspected appendicitis, computed tomography (CT) is diagnostically accurate. However, the effect of routine CT of the appendix on the treatment of such patients and the use … In patients with clinically suspected appendicitis, computed tomography (CT) is diagnostically accurate. However, the effect of routine CT of the appendix on the treatment of such patients and the use of hospital resources is unknown.

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The C-reactive protein

1999-11-01

Brian Clyne , Jonathan S. Olshaker

A practical score for the early diagnosis of acute appendicitis

1986-05-01

Alfredo Alvarado

Appendectomy and Protection against Ulcerative Colitis

2001-03-15

Roland E. Andersson , Gunnar Olaison , Curt Tysk +1 more

A history of appendectomy is rare in patients with ulcerative colitis. This suggests a protective effect of appendectomy or that appendicitis and ulcerative colitis are alternative inflammatory responses. We sought … A history of appendectomy is rare in patients with ulcerative colitis. This suggests a protective effect of appendectomy or that appendicitis and ulcerative colitis are alternative inflammatory responses. We sought to characterize this inverse relation further.

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A prospective, randomized comparison of laparoscopic appendectomy with open appendectomy

1995-02-01

Adrián E. Ortega , John G. Hunter , Jeffrey H. Peters +2 more

Laparoscopic Versus Open Appendectomy

2003-12-12

Ulrich Güller , Sheleika Hervey , Harriett Purves +4 more

To compare length of hospital stay, in-hospital complications, in-hospital mortality, and rate of routine discharge between laparoscopic and open appendectomy based on a representative, nationwide database.Numerous single-institutional randomized clinical trials … To compare length of hospital stay, in-hospital complications, in-hospital mortality, and rate of routine discharge between laparoscopic and open appendectomy based on a representative, nationwide database.Numerous single-institutional randomized clinical trials have assessed the efficacy of laparoscopic and open appendectomy. The results, however, are conflicting, and a consensus concerning the relative advantages of each procedure has not yet been reached.Patients with primary ICD-9 procedure codes for laparoscopic and open appendectomy were selected from the 1997 Nationwide Inpatient Sample, a database that approximates 20% of all US community hospital discharges. Multiple linear and logistic regression analyses were used to assess the risk-adjusted endpoints.Discharge abstracts of 43757 patients were used for our analyses. 7618 patients (17.4%) underwent laparoscopic and 36139 patients (82.6%) open appendectomy. Patients had an average age of 30.7 years and were predominantly white (58.1%) and male (58.6%). After adjusting for other covariates, laparoscopic appendectomy was associated with shorter median hospital stay (laparoscopic appendectomy: 2.06 days, open appendectomy: 2.88 days, P < 0.0001), lower rate of infections (odds ratio [OR] = 0.5 [0.38, 0.66], P < 0.0001), decreased gastrointestinal complications (OR = 0.8 [0.68, 0.96], P = 0.02), lower overall complications (OR = 0.84 [0.75, 0.94], P = 0.002), and higher rate of routine discharge (OR = 3.22 [2.47, 4.46], P < 0.0001).Laparoscopic appendectomy has significant advantages over open appendectomy with respect to length of hospital stay, rate of routine discharge, and postoperative in-hospital morbidity.

The Alvarado score for predicting acute appendicitis: a systematic review

2011-12-01

Robert Ohle , Fran O’Reilly , Kirsty O’Brien +2 more

Abstract Background The Alvarado score can be used to stratify patients with symptoms of suspected appendicitis; the validity of the score in certain patient groups and at different cut points … Abstract Background The Alvarado score can be used to stratify patients with symptoms of suspected appendicitis; the validity of the score in certain patient groups and at different cut points is still unclear. The aim of this study was to assess the discrimination (diagnostic accuracy) and calibration performance of the Alvarado score. Methods A systematic search of validation studies in Medline, Embase, DARE and The Cochrane library was performed up to April 2011. We assessed the diagnostic accuracy of the score at the two cut-off points: score of 5 (1 to 4 vs. 5 to 10) and score of 7 (1 to 6 vs. 7 to 10). Calibration was analysed across low (1 to 4), intermediate (5 to 6) and high (7 to 10) risk strata. The analysis focused on three sub-groups: men, women and children. Results Forty-two studies were included in the review. In terms of diagnostic accuracy, the cut-point of 5 was good at 'ruling out' admission for appendicitis (sensitivity 99% overall, 96% men, 99% woman, 99% children). At the cut-point of 7, recommended for 'ruling in' appendicitis and progression to surgery, the score performed poorly in each subgroup (specificity overall 81%, men 57%, woman 73%, children 76%). The Alvarado score is well calibrated in men across all risk strata (low RR 1.06, 95% CI 0.87 to 1.28; intermediate 1.09, 0.86 to 1.37 and high 1.02, 0.97 to 1.08). The score over-predicts the probability of appendicitis in children in the intermediate and high risk groups and in women across all risk strata. Conclusions The Alvarado score is a useful diagnostic 'rule out' score at a cut point of 5 for all patient groups. The score is well calibrated in men, inconsistent in children and over-predicts the probability of appendicitis in women across all strata of risk.

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Acute appendicitis: US evaluation using graded compression.

1986-02-01

J. B. C. M. Puylaert

Ultrasound (US) examination during graded compression was performed in 60 consecutive patients with clinical signs of acute appendicitis. In 25 (89%) of 28 patients with confirmed appendicitis, the inflamed appendix … Ultrasound (US) examination during graded compression was performed in 60 consecutive patients with clinical signs of acute appendicitis. In 25 (89%) of 28 patients with confirmed appendicitis, the inflamed appendix was visualized by US. Perforation was predictable in six of seven patients. In 32 patients without appendicitis, the appendix was not visualized. Graded-compression US is the examination of choice if there is doubt whether an appendectomy should be performed.

Systematic Review: Computed Tomography and Ultrasonography To Detect Acute Appendicitis in Adults and Adolescents

2004-10-05

Teruhiko Terasawa , C. Craig Blackmore , Stephen Bent +1 more

Background: Although clinicians commonly use computed tomography or ultrasonography to diagnose acute appendicitis, the accuracy of these imaging tests remains unclear. Purpose: To review the diagnostic accuracy of computed tomography … Background: Although clinicians commonly use computed tomography or ultrasonography to diagnose acute appendicitis, the accuracy of these imaging tests remains unclear. Purpose: To review the diagnostic accuracy of computed tomography and ultrasonography in adults and adolescents with suspected acute appendicitis. Data Sources: The authors used MEDLINE, EMBASE, bibliographies, review articles, textbooks, and expert opinion to retrieve English- and non–English-language articles published from 1966 to December 2003. Study Selection: The authors included prospective studies evaluating computed tomography or ultrasonography followed by surgical confirmation or clinical follow-up in patients at least 14 years of age with suspected appendicitis. Data Extraction: One assessor (for non–English-language studies) or 2 assessors (for English-language studies) independently reviewed each article to abstract relevant study characteristics and results. Data Synthesis: Twelve computed tomography studies and 14 ultrasonography studies met inclusion criteria. Computed tomography had an overall sensitivity of 0.94 (95% CI, 0.91 to 0.95), a specificity of 0.95 (CI, 0.93 to 0.96), a positive likelihood ratio of 13.3 (CI, 9.9 to 17.9), and a negative likelihood ratio of 0.09 (CI, 0.07 to 0.12). Ultrasonography had an overall sensitivity of 0.86 (CI, 0.83 to 0.88), a specificity of 0.81 (CI, 0.78 to 0.84), a positive likelihood ratio of 5.8 (CI, 3.5 to 9.5), and a negative likelihood ratio of 0.19 (CI, 0.13 to 0.27). Verification bias and inappropriate blinding of reference standards were noted in all of the included studies. Limitations: The summary assessment of the diagnostic accuracy for both tests was limited by the small number of studies, heterogeneity among study samples, and poor methodologic quality in the original studies. Conclusions: Computed tomography is probably more accurate than ultrasonography for diagnosing appendicitis in adults and adolescents. Prospective studies that apply gold standard diagnostic testing to all study participants would more reliably estimate the true diagnostic accuracy of these tests.

Appendicitis Near Its Centenary

1984-11-01

J Allan Berry , Ronald A. Malt

In an analysis of the first 72 cases treated after the formulation of the appendicitis syndrome in 1886 compared with the experience from 1929-1959 and with 307 randomly selected recent … In an analysis of the first 72 cases treated after the formulation of the appendicitis syndrome in 1886 compared with the experience from 1929-1959 and with 307 randomly selected recent cases, the major therapeutic trend has been an emphasis on appendectomy before perforation and abscess formation occur. The rate of infection nonetheless remains approximately 17%. Although the overall mortality rate has declined from 26% overall (40% for surgery) to 0.8%, the current rate of perforation is 28%, with a diagnostic accuracy of 82%. Among 13,848 patients from several reports the perforation rate increases linearly with diagnostic accuracy; therefore, a balance must be sought. Delay awaiting a diagnosis is a major determinant of perforation, but diagnostic aids are of limited help. Clinical acuity and prudent decisiveness are the keys to proper action.

Randomized clinical trial of antibiotic therapy <i>versus</i> appendicectomy as primary treatment of acute appendicitis in unselected patients

2009-04-08

Jeanette Hansson , Ulla Körner , Amir Khorram‐Manesh +2 more

Abstract Background A trial in selected men suggested that antibiotic therapy could be an alternative to appendicectomy in appendicitis. This study aimed to evaluate antibiotic therapy in unselected men and … Abstract Background A trial in selected men suggested that antibiotic therapy could be an alternative to appendicectomy in appendicitis. This study aimed to evaluate antibiotic therapy in unselected men and women with acute appendicitis. Methods Consecutive patients were allocated to study (antibiotics) or control (surgery) groups according to date of birth. Study patients received intravenous antibiotics for 24 h and continued at home with oral antibiotics for 10 days. Control patients had a standard appendicectomy. Follow-up at 1 and 12 months was carried out according to intention and per protocol. Results Study and control patients were comparable at inclusion; 106 (52·5 per cent) of 202 patients allocated to antibiotics completed the treatment and 154 (92·2 per cent) of 167 patients allocated to appendicectomy had surgery. Treatment efficacy was 90·8 per cent for antibiotic therapy and 89·2 per cent for surgery. Recurrent appendicitis occurred in 15 patients (13·9 per cent) after a median of 1 year. A third of recurrences appeared within 10 days and two-thirds between 3 and 16 months after hospital discharge. Minor complications were similar between the groups. Major complications were threefold higher in patients who had an appendicectomy (P &lt; 0·050). Conclusion Antibiotic treatment appears to be a safe first-line therapy in unselected patients with acute appendicitis. Registration number: NCT00469430 (http://www.clinicaltrials.gov).

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Disconnect Between Incidence of Nonperforated and Perforated Appendicitis

2007-05-21

Edward H. Livingston , Wayne A. Woodward , George A. Sarosi +1 more

Appendicitis has been declining in frequency for several decades. During the past 10 years, its preoperative diagnosis has been made more reliable by improved computed tomography (CT) imaging. Thresholds for … Appendicitis has been declining in frequency for several decades. During the past 10 years, its preoperative diagnosis has been made more reliable by improved computed tomography (CT) imaging. Thresholds for surgical exploration have been lowered by the increased availability of laparoscopic exploration. These innovations should influence the number of appendectomies performed in the United States. We analyzed nationwide hospital discharge data to study the secular trends in appendicitis and appendectomy rates.

Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management

2015-09-01

Aneel Bhangu , Kjetil Søreide , Salomone Di Saverio +2 more

US or CT for Diagnosis of Appendicitis in Children and Adults? A Meta-Analysis

2006-10-01

Andréa S. Doria , Rahim Moineddin , Christian J. Kellenberger +5 more

Purpose: To perform a meta-analysis to evaluate the diagnostic performance of ultrasonography (US) and computed tomography (CT) for the diagnosis of appendicitis in pediatric and adult populations. Materials and Methods: … Purpose: To perform a meta-analysis to evaluate the diagnostic performance of ultrasonography (US) and computed tomography (CT) for the diagnosis of appendicitis in pediatric and adult populations. Materials and Methods: Medical literature (from 1986 to 2004) was searched for articles on studies that used US, CT, or both as diagnostic tests for appendicitis in children (26 studies, 9356 patients) or adults (31 studies, 4341 patients). Prospective and retrospective studies were included if they separately reported the rate of true-positive, true-negative, false-positive, and false-negative diagnoses of appendicitis from US and CT findings compared with the positive and negative rates of appendicitis at surgery or follow-up. Clinical variables, technical factors, and test performance were extracted. Three readers assessed the quality of studies. Results: Pooled sensitivity and specificity for diagnosis of appendicitis in children were 88% (95% confidence interval [CI]: 86%, 90%) and 94% (95% CI: 92%, 95%), respectively, for US studies and 94% (95% CI: 92%, 97%) and 95% (95% CI: 94%, 97%), respectively, for CT studies. Pooled sensitivity and specificity for diagnosis in adults were 83% (95% CI: 78%, 87%) and 93% (95% CI: 90%, 96%), respectively, for US studies and 94% (95% CI: 92%, 95%) and 94% (95% CI: 94%, 96%), respectively, for CT studies. Conclusion: From the diagnostic performance perspective, CT had a significantly higher sensitivity than did US in studies of children and adults; from the safety perspective, however, one should consider the radiation associated with CT, especially in children. Supplemental material: radiology.rsnajnls.org/cgi/content/full/2411050913/DC1 © RSNA, 2006

Appendicitis

1975-05-01

Frank R. Lewis

One thousand cases of appendicitis seen from 1963 to 1973 were reviewed. The overall negative appendectomy rate was 20%, but in women between ages 20 and 40 it exceeded 40%. … One thousand cases of appendicitis seen from 1963 to 1973 were reviewed. The overall negative appendectomy rate was 20%, but in women between ages 20 and 40 it exceeded 40%. Two thirds of the negative appendectomies were due to nonsurgical lesions. Mesenteric adenitis, gastroenteritis, and abdominal pain of unknown cause accounted for one third of the errors in females and two thirds in males. These diseases were best distinguished from appendicitis on the basis of temperature and white blood cell count. The remainder of the errors in females were due to pelvic inflammatory disease or other gynecologic diagnoses and were best distinguished from appendicitis on the basis of history and physical findings. The rate of perforation was 21% overall. The incidence of wound infection was 8.5%. Use of systemic antibiotics did not affect the wound infection rate.

Pediatric appendicitis score

2002-06-01

Madan Samuel

Guidelines for the Selection of Anti-infective Agents for Complicated Intra-abdominal Infections

2003-10-08

Joseph S. Solomkin , John E. Mazuski , Ellen Jo Baron +7 more

These guidelines, from the Infectious Diseases Society of America (IDSA), the Surgical Infection Society, the American Society for Microbiology, and the Society of Infectious Disease Pharmacists, contain evidence-based recommendations for … These guidelines, from the Infectious Diseases Society of America (IDSA), the Surgical Infection Society, the American Society for Microbiology, and the Society of Infectious Disease Pharmacists, contain evidence-based recommendations for selection of antimicrobial therapy for adult patients with complicated intra-abdominal infections.Complicated intra-abdominal infections extend beyond the hollow viscus of origin into the peritoneal space and are associated either with abscess formation or with peritonitis.These guidelines also address timing of initiation of antibiotic therapy, when and what to culture, modification of therapy based on culture results, and duration of therapy.Infecting flora.The anticipated infecting flora in these infections and, therefore, the agent(s) selected are determined by whether the infection is community acquired or health care associated.Health care-associated intra-abdominal infections are most commonly acquired as complications of previous elective or emergent intra-abdominal operations and are caused by

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Incidence of Acute Nonperforated and Perforated Appendicitis: Age‐specific and Sex‐specific Analysis

1997-03-01

Hartwig Kørner , Karl Søndenaa , Jon Arne Søreide +4 more

Meta-analysis of the clinical and laboratory diagnosis of appendicitis

2004-01-01

Roland E. Andersson

Abstract Background The importance of specific elements in the clinical diagnosis of appendicitis is controversial. This review analyses the diagnostic value of elements of disease history, clinical findings and laboratory … Abstract Background The importance of specific elements in the clinical diagnosis of appendicitis is controversial. This review analyses the diagnostic value of elements of disease history, clinical findings and laboratory test results in suspected appendicitis. Methods A systematic Medline search was made of all published studies on the clinical and laboratory diagnosis of appendicitis in patients admitted to hospital with suspected disease. Meta-analyses of receiver–operator characteristic (ROC) areas, and positive and negative likelihood ratios, of 28 diagnostic variables described in 24 studies are presented. Results Inflammatory response variables (granulocyte count, proportion of polymorphonuclear blood cells, white blood cell count and C-reactive protein concentration), descriptors of peritoneal irritation (rebound and percussion tenderness, guarding and rigidity) and migration of pain were the strongest discriminators, with ROC areas of 0·78 to 0·68. The discriminatory power of the inflammatory variables was particularly strong for perforated appendicitis, with ROC areas of 0·85 to 0·87. Appendicitis was likely when two or more inflammatory variables were increased and unlikely when all were normal. Conclusion Although all clinical and laboratory variables are weak discriminators individually, they achieve a high discriminatory power when combined. Laboratory examination of the inflammatory response, clinical descriptors of peritoneal irritation, and a history of migration of pain yield the most important diagnostic information and should be included in any diagnostic assessment.

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Antibiotic Therapy vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis

2015-06-16

Paulina Salminen , Hannu Paajanen , Tero Rautio +7 more

An increasing amount of evidence supports the use of antibiotics instead of surgery for treating patients with uncomplicated acute appendicitis.To compare antibiotic therapy with appendectomy in the treatment of uncomplicated … An increasing amount of evidence supports the use of antibiotics instead of surgery for treating patients with uncomplicated acute appendicitis.To compare antibiotic therapy with appendectomy in the treatment of uncomplicated acute appendicitis confirmed by computed tomography (CT).The Appendicitis Acuta (APPAC) multicenter, open-label, noninferiority randomized clinical trial was conducted from November 2009 until June 2012 in Finland. The trial enrolled 530 patients aged 18 to 60 years with uncomplicated acute appendicitis confirmed by a CT scan. Patients were randomly assigned to early appendectomy or antibiotic treatment with a 1-year follow-up period.Patients randomized to antibiotic therapy received intravenous ertapenem (1 g/d) for 3 days followed by 7 days of oral levofloxacin (500 mg once daily) and metronidazole (500 mg 3 times per day). Patients randomized to the surgical treatment group were assigned to undergo standard open appendectomy.The primary end point for the surgical intervention was the successful completion of an appendectomy. The primary end point for antibiotic-treated patients was discharge from the hospital without the need for surgery and no recurrent appendicitis during a 1-year follow-up period.There were 273 patients in the surgical group and 257 in the antibiotic group. Of 273 patients in the surgical group, all but 1 underwent successful appendectomy, resulting in a success rate of 99.6% (95% CI, 98.0% to 100.0%). In the antibiotic group, 70 patients (27.3%; 95% CI, 22.0% to 33.2%) underwent appendectomy within 1 year of initial presentation for appendicitis. Of the 256 patients available for follow-up in the antibiotic group, 186 (72.7%; 95% CI, 66.8% to 78.0%) did not require surgery. The intention-to-treat analysis yielded a difference in treatment efficacy between groups of -27.0% (95% CI, -31.6% to ∞) (P = .89). Given the prespecified noninferiority margin of 24%, we were unable to demonstrate noninferiority of antibiotic treatment relative to surgery. Of the 70 patients randomized to antibiotic treatment who subsequently underwent appendectomy, 58 (82.9%; 95% CI, 72.0% to 90.8%) had uncomplicated appendicitis, 7 (10.0%; 95% CI, 4.1% to 19.5%) had complicated acute appendicitis, and 5 (7.1%; 95% CI, 2.4% to 15.9%) did not have appendicitis but received appendectomy for suspected recurrence. There were no intra-abdominal abscesses or other major complications associated with delayed appendectomy in patients randomized to antibiotic treatment.Among patients with CT-proven, uncomplicated appendicitis, antibiotic treatment did not meet the prespecified criterion for noninferiority compared with appendectomy. Most patients randomized to antibiotic treatment for uncomplicated appendicitis did not require appendectomy during the 1-year follow-up period, and those who required appendectomy did not experience significant complications.clinicaltrials.gov Identifier: NCT01022567.

Appendicitis at the Millennium

2000-05-01

Bernard A. Birnbaum , Stephanie R. Wilson

Acute appendicitis is a common clinical problem. Accurate and prompt diagnosis is essential to minimize morbidity. While the clinical diagnosis may be straightforward in patients who present with classic signs … Acute appendicitis is a common clinical problem. Accurate and prompt diagnosis is essential to minimize morbidity. While the clinical diagnosis may be straightforward in patients who present with classic signs and symptoms, atypical presentations may result in diagnostic confusion and delay in treatment. Helical computed tomography (CT) and graded compression color Doppler ultrasonography (US) are highly accurate means of establishing the diagnosis. These imaging modalities have now assumed critical roles in the treatment of patients suspected to have appendicitis. The purpose of this article is threefold: to provide an update on new information regarding the pathophysiology, clinical diagnosis, and laparoscopic treatment of acute appendicitis; to describe the state-of-the art use of CT and US in diagnosing this disease entity; and to address the role of medical imaging in this patient population.

The pathology of acute appendicitis

2000-02-01

Norman J. Carr

THE EPIDEMIOLOGY OF APPENDICITIS AND APPENDECTOMY IN THE UNITED STATES

1990-11-01

David G. Addiss , Nathan Shaffer , BARBARA S. FOWLER +1 more

To describe the epidemiology of appendicitis and appendectomy in the United States, the authors analyzed National Hospital Discharge Survey data for the years 1979-1984. Approximately 250,000 cases of appendicitis occurred … To describe the epidemiology of appendicitis and appendectomy in the United States, the authors analyzed National Hospital Discharge Survey data for the years 1979-1984. Approximately 250,000 cases of appendicitis occurred annually in the United States during this period, accounting for an estimated 1 million hospital days per year. The highest incidence of primary positive appendectomy (appendicitis) was found in persons aged 10-19 years (23.3 per 10,000 population per year); males had higher rates of appendicitis than females for all age groups (overall rate ratio, 1.4:1). Racial, geographic, and seasonal differences were also noted. Appendicitis rates were 1.5 times higher for whites than for nonwhites, highest (15.4 per 10,000 population per year) in the west north central region, and 11.3% higher in the summer than in the winter months. The highest rate of incidental appendectomy was found in women aged 35-44 years (43.8 per 10,000 population per year), 12.1 times higher than the rate for men of the same age. Between 1970 and 1984, the incidence of appendicitis decreased by 14.6%; reasons for this decline are unknown. A life table model suggests that the lifetime risk of appendicitis is 8.6% for males and 6.7% for females; the lifetime risk of appendectomy is 12.0% for males and 23.1% for females. Overall, an estimated 36 incidental procedures are performed to prevent one case of appendicitis; for the elderly, the preventive value of an incidental procedure is considerably lower.

Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy study

2009-06-26

Wytze Laméris , Adriënne van Randen , H. Wouter van Es +7 more

To identify an optimal imaging strategy for the accurate detection of urgent conditions in patients with acute abdominal pain.Fully paired multicentre diagnostic accuracy study with prospective data collection.Emergency departments of … To identify an optimal imaging strategy for the accurate detection of urgent conditions in patients with acute abdominal pain.Fully paired multicentre diagnostic accuracy study with prospective data collection.Emergency departments of two university hospitals and four large teaching hospitals in the Netherlands.1021 patients with non-traumatic abdominal pain of >2 hours' and <5 days' duration. Exclusion criteria were discharge from the emergency department with no imaging considered warranted by the treating physician, pregnancy, and haemorrhagic shock.All patients had plain radiographs (upright chest and supine abdominal), ultrasonography, and computed tomography (CT) after clinical and laboratory examination. A panel of experienced physicians assigned a final diagnosis after six months and classified the condition as urgent or non-urgent.Sensitivity and specificity for urgent conditions, percentage of missed cases and false positives, and exposure to radiation for single imaging strategies, conditional imaging strategies (CT after initial ultrasonography), and strategies driven by body mass index and age or by location of pain.661 (65%) patients had a final diagnosis classified as urgent. The initial clinical diagnosis resulted in many false positive urgent diagnoses, which were significantly reduced after ultrasonography or CT. CT detected more urgent diagnoses than did ultrasonography: sensitivity was 89% (95% confidence interval 87% to 92%) for CT and 70% (67% to 74%) for ultrasonography (P<0.001). A conditional strategy with CT only after negative or inconclusive ultrasonography yielded the highest sensitivity, missing only 6% of urgent cases. With this strategy, only 49% (46% to 52%) of patients would have CT. Alternative strategies guided by body mass index, age, or location of the pain would all result in a loss of sensitivity.Although CT is the most sensitive imaging investigation for detecting urgent conditions in patients with abdominal pain, using ultrasonography first and CT only in those with negative or inconclusive ultrasonography results in the best sensitivity and lowers exposure to radiation.

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Imaging Patients with Acute Abdominal Pain

2009-09-29

Jaap Stoker , Adriënne van Randen , Wytze Laméris +1 more

Acute abdominal pain may be caused by a myriad of diagnoses, including acute appendicitis, diverticulitis, and cholecystitis. Imaging plays an important role in the treatment management of patients because clinical … Acute abdominal pain may be caused by a myriad of diagnoses, including acute appendicitis, diverticulitis, and cholecystitis. Imaging plays an important role in the treatment management of patients because clinical evaluation results can be inaccurate. Performing computed tomography (CT) is most important because it facilitates an accurate and reproducible diagnosis in urgent conditions. Also, CT findings have been demonstrated to have a marked effect on the management of acute abdominal pain. The cost-effectiveness of CT in the setting of acute appendicitis was studied, and CT proved to be cost-effective. CT can therefore be considered the primary technique for the diagnosis of acute abdominal pain, except in patients clinically suspected of having acute cholecystitis. In these patients, ultrasonography (US) is the primary imaging technique of choice. When costs and ionizing radiation exposure are primary concerns, a possible strategy is to perform US as the initial technique in all patients with acute abdominal pain, with CT performed in all cases of nondiagnostic US. The use of conventional radiography has been surpassed; this examination has only a possible role in the setting of bowel obstruction. However, CT is more accurate and more informative in this setting as well. In cases of bowel perforation, CT is the most sensitive technique for depicting free intraperitoneal air and is valuable for determining the cause of the perforation. Imaging is less useful in cases of bowel ischemia, although some CT signs are highly specific. Magnetic resonance (MR) imaging is a promising alternative to CT in the evaluation of acute abdominal pain and does not involve the use of ionizing radiation exposure. However, data on the use of MR imaging for this indication are still sparse.http://radiology.rsna.org/content/253/1/31/suppl/DC1.

Trial of Short-Course Antimicrobial Therapy for Intraabdominal Infection

2015-05-20

Robert G. Sawyer , Jeffrey A. Claridge , Avery B. Nathens +7 more

The successful treatment of intraabdominal infection requires a combination of anatomical source control and antibiotics. The appropriate duration of antimicrobial therapy remains unclear.We randomly assigned 518 patients with complicated intraabdominal … The successful treatment of intraabdominal infection requires a combination of anatomical source control and antibiotics. The appropriate duration of antimicrobial therapy remains unclear.We randomly assigned 518 patients with complicated intraabdominal infection and adequate source control to receive antibiotics until 2 days after the resolution of fever, leukocytosis, and ileus, with a maximum of 10 days of therapy (control group), or to receive a fixed course of antibiotics (experimental group) for 4±1 calendar days. The primary outcome was a composite of surgical-site infection, recurrent intraabdominal infection, or death within 30 days after the index source-control procedure, according to treatment group. Secondary outcomes included the duration of therapy and rates of subsequent infections.Surgical-site infection, recurrent intraabdominal infection, or death occurred in 56 of 257 patients in the experimental group (21.8%), as compared with 58 of 260 patients in the control group (22.3%) (absolute difference, -0.5 percentage point; 95% confidence interval [CI], -7.0 to 8.0; P=0.92). The median duration of antibiotic therapy was 4.0 days (interquartile range, 4.0 to 5.0) in the experimental group, as compared with 8.0 days (interquartile range, 5.0 to 10.0) in the control group (absolute difference, -4.0 days; 95% CI, -4.7 to -3.3; P<0.001). No significant between-group differences were found in the individual rates of the components of the primary outcome or in other secondary outcomes.In patients with intraabdominal infections who had undergone an adequate source-control procedure, the outcomes after fixed-duration antibiotic therapy (approximately 4 days) were similar to those after a longer course of antibiotics (approximately 8 days) that extended until after the resolution of physiological abnormalities. (Funded by the National Institutes of Health; STOP-IT ClinicalTrials.gov number, NCT00657566.).

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Diagnosis and Management of Complicated Intra-abdominal Infection in Adults and Children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America

2009-12-24

Joseph S. Solomkin , John E. Mazuski , John S. Bradley +7 more

Evidence-based guidelines for managing patients with intra-abdominal infection were prepared by an Expert Panel of the Surgical Infection Society and the Infectious Diseases Society of America. These updated guidelines replace … Evidence-based guidelines for managing patients with intra-abdominal infection were prepared by an Expert Panel of the Surgical Infection Society and the Infectious Diseases Society of America. These updated guidelines replace those previously published in 2002 and 2003. The guidelines are intended for treating patients who either have these infections or may be at risk for them. New information, based on publications from the period 2003-2008, is incorporated into this guideline document. The panel has also added recommendations for managing intra-abdominal infection in children, particularly where such management differs from that of adults; for appendicitis in patients of all ages; and for necrotizing enterocolitis in neonates.

Amoxicillin plus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: an open-label, non-inferiority, randomised controlled trial

2011-05-01

C. Vons , Caroline Barry , Sophie Maître +7 more

Pregnancy outcome following non-obstetric surgical intervention

2005-08-15

Raanan Cohen‐Kerem , Craig J. Railton , Dana Oren +2 more

Helical CT technique for the diagnosis of appendicitis: prospective evaluation of a focused appendix CT examination.

1997-01-01

Patrick M. Rao , James T. Rhea , Robert A. Novelline +4 more

PURPOSE: To evaluate a focused, helical computed tomographic (CT) technique for imaging the appendix in patients suspected of having appendicitis. MATERIALS AND METHODS: One hundred patients prospectively underwent appendix CT … PURPOSE: To evaluate a focused, helical computed tomographic (CT) technique for imaging the appendix in patients suspected of having appendicitis. MATERIALS AND METHODS: One hundred patients prospectively underwent appendix CT examination, with use of oral and colon contrast media and contiguous, thin-collimation, helical CT imaging of the right lower quadrant. Results were correlated with the results of surgery and pathologic examination from 61 patients or from clinical follow-up in 39 patients. RESULTS: CT scans were positive for appendicitis in 59 patients: true-positive in 56 patients on the basis of surgery and pathologic examination, and false-positive in two patients on the basis of clinical follow-up; in the case of the other positive scan, the clinical outcome was indeterminate. CT scans were negative for appendicitis in 41 patients: true-negative in five patients on the basis of surgery and pathologic examination, and true-negative in 36 patients on the basis of clinical follow-up. CT had a sensitivity of 100%, a specificity of 95%, a positive predictive value of 97%, a negative predictive value of 100%, and an accuracy of 98%. The normal appendix was always identified. CT helped establish alternative diagnoses in 33 of the 41 patients (80%) in whom the results of CT were negative for appendicitis. CONCLUSION: Appendix CT examination can help diagnose or exclude appendicitis and establish an alternative diagnosis.

Surgical complications of diagnostic and operative gynaecological laparoscopy: a series of 29,966 cases

1998-04-01

Charles Chapron , Denis Querleu , MA Bruhat +4 more

A multicentre study was carried out in seven top French centres for laparoscopic gynaecological surgery. This series covers a period of 9 years, in which 29,966 diagnostic and operative laparoscopic … A multicentre study was carried out in seven top French centres for laparoscopic gynaecological surgery. This series covers a period of 9 years, in which 29,966 diagnostic and operative laparoscopic operations were performed. The risk of complications has been assessed according to the complexity of the laparoscopic procedure in question. The means of diagnosis and treatment of the complications have been analysed, together with the importance of the surgeon's degree of experience. The mortality rate was 3.33 per 100,000 laparoscopies. The overall complication rate was 4.64 per 1000 laparoscopies (n = 139). The rate of complications requiring laparotomy was 3.20 per 1000 (n = 96). The complication rate was significantly correlated with the complexity of the laparoscopic procedure (P = 0.0001). One in three complications (34.1%; n = 43) occurred while setting up for laparoscopy, and one in four (28.6%) were not diagnosed during the operation. As new indications for laparoscopic surgery in gynaecology have appeared, there has been a parallel and statistically significant increase in the rate of urological complications (P = 0.001). Increased experience by the surgeons has had three consequences: a statistically significant drop in the number of bowel injuries (P = 0.0003), a drop in the rate of complications requiring laparotomy for those laparoscopic surgical procedures that are well defined (P = 0.01), and a change in the way complications are treated, with a significant increase in the proportion of incidents treated by laparoscopy (P = 0.0001).

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Guidelines for Computed Tomography and Magnetic Resonance Imaging Use During Pregnancy and Lactation

2008-08-01

Morie M. Chen , Fergus V. Coakley , Anjali J. Kaimal +1 more

In Brief There has been a substantial increase in the use of computed tomography (CT) and magnetic resonance imaging (MRI) in pregnancy and lactation. Among some physicians and patients, however, … In Brief There has been a substantial increase in the use of computed tomography (CT) and magnetic resonance imaging (MRI) in pregnancy and lactation. Among some physicians and patients, however, there are misperceptions regarding risks, safety, and appropriate use of these modalities in pregnancy. We have developed a set of evidence-based guidelines for the use of CT, MRI, and contrast media during pregnancy for selected indications including suspected acute appendicitis, pulmonary embolism, renal colic, trauma, and cephalopelvic disproportion. Ultrasonography is the initial modality of choice for suspected appendicitis, but if the ultrasound examination is negative, MRI or CT can be obtained. Computed tomography should be the initial diagnostic imaging modality for suspected pulmonary embolism. Ultrasonography should be the initial study of choice for suspected renal colic. Ultrasonography can be the initial imaging evaluation for trauma, but CT should be performed if serious injury is suspected. Pelvimetry now is used rarely for suspected cephalopelvic disproportion, but when required, low-dose CT pelvimetry can be performed with minimal risk. Although iodinated contrast seems safe to use in pregnancy, intravenous gadolinium is contraindicated and should be used only when absolutely essential. It seems to be safe to continue breast-feeding immediately after receiving iodinated contrast or gadolinium. Although teratogenesis is not a major concern after exposure to prenatal diagnostic radiation, carcinogenesis is a potential risk. When used appropriately, CT and MRI can be valuable tools in imaging pregnant and lactating women; risks and benefits always should be considered and discussed with patients. Computed tomography, magnetic resonance imaging, and contrast media can be used in pregnancy and lactation after appropriate consideration of the potential risks and benefits.

WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis

2016-07-18

Salomone Di Saverio , Arianna Birindelli , Micheal Denis Kelly +7 more

Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together … Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued. In July 2015, during the 3rd World Congress of the WSES, held in Jerusalem (Israel), a panel of experts including an Organizational Committee and Scientific Committee and Scientific Secretariat, participated to a Consensus Conference where eight panelists presented a number of statements developed for each of the eight main questions about diagnosis and management of AA. The statements were then voted, eventually modified and finally approved by the participants to The Consensus Conference and lately by the board of co-authors. The current paper is reporting the definitive Guidelines Statements on each of the following topics: 1) Diagnostic efficiency of clinical scoring systems, 2) Role of Imaging, 3) Non-operative treatment for uncomplicated appendicitis, 4) Timing of appendectomy and in-hospital delay, 5) Surgical treatment 6) Scoring systems for intra-operative grading of appendicitis and their clinical usefulness 7) Non-surgical treatment for complicated appendicitis: abscess or phlegmon 8) Pre-operative and post-operative antibiotics.

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Diagnosis and management of acute appendicitis. EAES consensus development conference 2015

2016-09-22

Ramon R. Gorter , Hasan H. Eker , Marguerite Gorter-Stam +7 more

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The Surgical Infection Society Revised Guidelines on the Management of Intra-Abdominal Infection

2017-01-01

John E. Mazuski , Jeffrey M. Tessier , Addison K. May +7 more

Background: Previous evidence-based guidelines on the management of intra-abdominal infection (IAI) were published by the Surgical Infection Society (SIS) in 1992, 2002, and 2010. At the time the most recent … Background: Previous evidence-based guidelines on the management of intra-abdominal infection (IAI) were published by the Surgical Infection Society (SIS) in 1992, 2002, and 2010. At the time the most recent guideline was released, the plan was to update the guideline every five years to ensure the timeliness and appropriateness of the recommendations. Methods: Based on the previous guidelines, the task force outlined a number of topics related to the treatment of patients with IAI and then developed key questions on these various topics. All questions were approached using general and specific literature searches, focusing on articles and other information published since 2008. These publications and additional materials published before 2008 were reviewed by the task force as a whole or by individual subgroups as to relevance to individual questions. Recommendations were developed by a process of iterative consensus, with all task force members voting to accept or reject each recommendation. Grading was based on the GRADE (Grades of Recommendation Assessment, Development, and Evaluation) system; the quality of the evidence was graded as high, moderate, or weak, and the strength of the recommendation was graded as strong or weak. Review of the document was performed by members of the SIS who were not on the task force. After responses were made to all critiques, the document was approved as an official guideline of the SIS by the Executive Council. Results: This guideline summarizes the current recommendations developed by the task force on the treatment of patients who have IAI. Evidence-based recommendations have been made regarding risk assessment in individual patients; source control; the timing, selection, and duration of antimicrobial therapy; and suggested approaches to patients who fail initial therapy. Additional recommendations related to the treatment of pediatric patients with IAI have been included. Summary: The current recommendations of the SIS regarding the treatment of patients with IAI are provided in this guideline.

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The Global Incidence of Appendicitis

2017-03-11

Mollie Ferris , Samuel Quan , Belle Kaplan +7 more

We compared the incidence of appendicitis or appendectomy across the world and evaluated temporal trends.Population-based studies reported the incidence of appendicitis.We searched MEDLINE and EMBASE databases for population-based studies reporting … We compared the incidence of appendicitis or appendectomy across the world and evaluated temporal trends.Population-based studies reported the incidence of appendicitis.We searched MEDLINE and EMBASE databases for population-based studies reporting the incidence of appendicitis or appendectomy. Time trends were explored using Poisson regression and reported as annual percent change (APC) with 95% confidence intervals (CI). APC were stratified by time periods and pooled using random effects models. Incidence since 2000 was pooled for regions in the Western world.The search retrieved 10,247 citations with 120 studies reporting on the incidence of appendicitis or appendectomy. During the 21st century the pooled incidence of appendicitis or appendectomy (in per 100,000 person-years) was 100 (95% CI: 91, 110) in Northern America, and the estimated number of cases in 2015 was 378,614. The pooled incidence ranged from 105 in Eastern Europe to 151 in Western Europe. In Western countries, the incidence of appendectomy steadily decreased since 1990 (APC after 1989=-1.54; 95% CI: -2.22, -0.86), whereas the incidence of appendicitis stabilized (APC=-0.36; 95% CI: -0.97, 0.26) for both perforated (APC=0.95; 95% CI: -0.25, 2.17) and nonperforated appendicitis (APC=0.44; 95% CI: -0.84, 1.73). In the 21st century, the incidence of appendicitis or appendectomy is high in newly industrialized countries in Asia (South Korea pooled: 206), the Middle East (Turkey pooled: 160), and Southern America (Chile: 202).Appendicitis is a global disease. The incidence of appendicitis is stable in most Western countries. Data from newly industrialized countries is sparse, but suggests that appendicitis is rising rapidly.

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The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections

2017-07-10

Massimo Sartelli , Alain Chichom‐Mefire , Francesco M. Labricciosa +7 more

Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in the emergency departments worldwide. The cornerstones of effective treatment of IAIs are … Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in the emergency departments worldwide. The cornerstones of effective treatment of IAIs are early recognition, adequate source control, and appropriate antimicrobial therapy. Prompt resuscitation of patients with ongoing sepsis is of utmost important. In hospitals worldwide, non-acceptance of, or lack of access to, accessible evidence-based practices and guidelines result in overall poorer outcome of patients suffering IAIs. The aim of this paper is to promote global standards of care in IAIs and update the 2013 WSES guidelines for management of intra-abdominal infections.

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Five-Year Follow-up of Antibiotic Therapy for Uncomplicated Acute Appendicitis in the APPAC Randomized Clinical Trial

2018-09-25

Paulina Salminen , Risto Tuominen , Hannu Paajanen +7 more

<h3>Importance</h3> Short-term results support antibiotics as an alternative to surgery for treating uncomplicated acute appendicitis, but long-term outcomes are not known. <h3>Objective</h3> To determine the late recurrence rate of appendicitis … <h3>Importance</h3> Short-term results support antibiotics as an alternative to surgery for treating uncomplicated acute appendicitis, but long-term outcomes are not known. <h3>Objective</h3> To determine the late recurrence rate of appendicitis after antibiotic therapy for the treatment of uncomplicated acute appendicitis. <h3>Design, Setting, and Participants</h3> Five-year observational follow-up of patients in the Appendicitis Acuta (APPAC) multicenter randomized clinical trial comparing appendectomy with antibiotic therapy, in which 530 patients aged 18 to 60 years with computed tomography–confirmed uncomplicated acute appendicitis were randomized to undergo an appendectomy (n = 273) or receive antibiotic therapy (n = 257). The initial trial was conducted from November 2009 to June 2012 in Finland; last follow-up was September 6, 2017. This current analysis focused on assessing the 5-year outcomes for the group of patients treated with antibiotics alone. <h3>Interventions</h3> Open appendectomy vs antibiotic therapy with intravenous ertapenem for 3 days followed by 7 days of oral levofloxacin and metronidazole. <h3>Main Outcomes and Measures</h3> In this analysis, prespecified secondary end points reported at 5-year follow-up included late (after 1 year) appendicitis recurrence after antibiotic treatment, complications, length of hospital stay, and sick leave. <h3>Results</h3> Of the 530 patients (201 women; 329 men) enrolled in the trial, 273 patients (median age, 35 years [IQR, 27-46]) were randomized to undergo appendectomy, and 257 (median age, 33 years, [IQR, 26-47]) were randomized to receive antibiotic therapy. In addition to 70 patients who initially received antibiotics but underwent appendectomy within the first year (27.3% [95% CI, 22.0%-33.2%]; 70/256), 30 additional antibiotic-treated patients (16.1% [95% CI, 11.2%-22.2%]; 30/186) underwent appendectomy between 1 and 5 years. The cumulative incidence of appendicitis recurrence was 34.0% (95% CI, 28.2%-40.1%; 87/256) at 2 years, 35.2% (95% CI, 29.3%-41.4%; 90/256) at 3 years, 37.1% (95% CI, 31.2%-43.3%; 95/256) at 4 years, and 39.1% (95% CI, 33.1%-45.3%; 100/256) at 5 years. Of the 85 patients in the antibiotic group who subsequently underwent appendectomy for recurrent appendicitis, 76 had uncomplicated appendicitis, 2 had complicated appendicitis, and 7 did not have appendicitis. At 5 years, the overall complication rate (surgical site infections, incisional hernias, abdominal pain, and obstructive symptoms) was 24.4% (95% CI, 19.2%-30.3%) (n = 60/246) in the appendectomy group and 6.5% (95% CI, 3.8%-10.4%) (n = 16/246) in antibiotic group (<i>P</i> < .001), which calculates to 17.9 percentage points (95% CI, 11.7-24.1) higher after surgery. There was no difference between groups for length of hospital stay, but there was a significant difference in sick leave (11 days more for the appendectomy group). <h3>Conclusions and Relevance</h3> Among patients who were initially treated with antibiotics for uncomplicated acute appendicitis, the likelihood of late recurrence within 5 years was 39.1%. This long-term follow-up supports the feasibility of antibiotic treatment alone as an alternative to surgery for uncomplicated acute appendicitis. <h3>Trial Registration</h3> ClinicalTrials.gov Identifier:NCT01022567

Laparoscopic versus open surgery for suspected appendicitis

2018-11-28

Thomas Jaschinski , Christoph Mösch , Michaela Eikermann +2 more

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Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

2020-04-15

Salomone Di Saverio , Mauro Podda , Belinda De Simone +7 more

Abstract Background and aims Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are … Abstract Background and aims Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June 2019 and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of non-operative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and peri-operative antibiotic therapy. Methods This executive manuscript summarizes the WSES guidelines for the diagnosis and treatment of AA. Literature search has been updated up to 2019 and statements and recommendations have been developed according to the GRADE methodology. The statements were voted, eventually modified, and finally approved by the participants to the consensus conference and by the board of co-authors, using a Delphi methodology for voting whenever there was controversy on a statement or a recommendation. Several tables highlighting the research topics and questions, search syntaxes, and the statements and the WSES evidence-based recommendations are provided. Finally, two different practical clinical algorithms are provided in the form of a flow chart for both adults and pediatric (< 16 years old) patients. Conclusions The 2020 WSES guidelines on AA aim to provide updated evidence-based statements and recommendations on each of the following topics: (1) diagnosis, (2) non-operative management for uncomplicated AA, (3) timing of appendectomy and in-hospital delay, (4) surgical treatment, (5) intra-operative grading of AA, (6) ,management of perforated AA with phlegmon or abscess, and (7) peri-operative antibiotic therapy.

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Gastrointestinal Disease: Pathophysiology, Diagnosis, Management.

1984-01-01

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Endoscopic Appendectomy

1983-03-01

K. Semm

These newly developed endoscopic methods in gynaecology for haemostasis during surgical pelviscopy (Endocoagulation Roeder-loop ligation, endoligature, endo-suture with intra- and extracorporeal knotting) make it possible to carry out appendectomy by … These newly developed endoscopic methods in gynaecology for haemostasis during surgical pelviscopy (Endocoagulation Roeder-loop ligation, endoligature, endo-suture with intra- and extracorporeal knotting) make it possible to carry out appendectomy by endoscopy for any of the following indications: Postoperative adhesion of the appendix especially in "sterility" patients, elongated appendix extending into the small pelvis, endometriosis of the appendix, subacute and chronic appendicitis. The instrument-set employed in this method permits the performance of all the usual classical operative steps (purse-string suture, and Z-suture acc. to McBurney and Sprengel). The point for resection has to be sterilized over 20-30 sec. at 212 degrees F using the crocodile forceps (endocoagulation procedure) before division and extraction of the appendix is effected.

A Randomized Trial Comparing Antibiotics with Appendectomy for Appendicitis

2020-10-05

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, … 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.

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Assessing the Efficacy of Ultrasound Imaging for Diagnosing Appendicitis in Male Patients: A Retrospective Study

2025-06-25

Waleed Khan , Ciara Mallon , Zahid Bahli +5 more | Cureus

Outcomes after appendicostomy and neo-appendicostomy in a single institution

2025-06-24

A.Donald Merritt , Lauren Evans , Emily H Cooper +3 more | Pediatric Surgery International

KẾT QUẢ SỚM PHẪU THUẬT ĐIỀU TRỊ NỘI SOI MỞ ỐNG MẬT CHỦ LẤY SỎI TẠI BỆNH VIỆN ĐA KHOA TỈNH NAM ĐỊNH GIAI ĐOẠN 2019-2023

2025-06-23

Dinh Nguyễn Văn , Chiều Đỗ Văn | Tạp chí Y học Việt Nam

Mục tiêu nghiên cứu: Đánh giá kết quả sớm phẫu thuật điều trị nội soi mở ống mật chủ lấy sỏi tại Bệnh viện đa khoa tỉnh Nam Định giai … Mục tiêu nghiên cứu: Đánh giá kết quả sớm phẫu thuật điều trị nội soi mở ống mật chủ lấy sỏi tại Bệnh viện đa khoa tỉnh Nam Định giai đoạn 2019-2023. Đối tượng và phương pháp nghiên cứu: NC mô tả cắt ngang hồi cứu kết hợp tiến cứu trên 34 BN được được phẫu thuật nội soi mở ống mật chủ lấy sỏi tại Bệnh viện đa khoa tỉnh Nam Định từ tháng 6 năm 2019 đến tháng 5 năm 2023. Kết quả: Kết quả sớm sau mổ: Không có tai biến trong mổ, thời gian đau sau mổ trung bình là 2,8±0,4 ngày, tỉ lệ biến chứng sau phẫu thuật là 5,9%, tỉ lệ sót sỏi sau phẫu thuật là 5,9%. Thời gian nằm viện trung bình là 9,9 ngày. Kết luận: điều trị phẫu thuật nội soi mở ống mật chủ lấy sỏi tại bệnh viện đa khoa tỉnh Nam Định là phẫu thuật ít xâm lấn, an toàn, ít đau và nhanh hồi phục.

DỰ BÁO NGUY CƠ GÃY XƯƠNG THEO MÔ HÌNH FRAX VÀ 1 SỐ YẾU TỐ LIÊN QUAN Ở BỆNH NHÂN BỆNH THẬN MẠN TÍNH CHƯA ĐIỀU TRỊ THAY THẾ THẬN TẠI BỆNH VIỆN ĐA KHOA TỈNH THÁI BÌNH

2025-06-23

Thủy Trần Xuân , Hùng Vũ Phi , Anh Bùi Thị Lan | Tạp chí Y học Việt Nam

Mục tiêu: Dự báo nguy cơ gãy xương theo mô hình FRAX và 1 số yếu tố liên quan ở bệnh nhân bệnh thận mạn tính chưa điều trị thay … Mục tiêu: Dự báo nguy cơ gãy xương theo mô hình FRAX và 1 số yếu tố liên quan ở bệnh nhân bệnh thận mạn tính chưa điều trị thay thế thận tại bệnh viện đa khoa tỉnh Thái Bình. Phương pháp nghiên cứu: nghiên cứu mô tả cắt ngang thực hiện trên 84 bệnh nhân bệnh thận mạn chưa điều trị thay thế thận tại khoa Nội thận -cơ xương khớp Bệnh viện đa khoa tỉnh Thái Bình. Kết quả nghiên cứu: Đối tượng nghiên cứu có tuổi trung bình 66 ± 12,7 tuổi. Các yếu tố nguy cơ loãng xương theo mô hình FRAX: tiền sử gãy xương chiếm 6,0%, sử dụng corticoid kéo dài chiếm 7,1%, uống rượu chiếm 17,9%. Xác suất gãy xương hông sau 10 năm theo mô hình FRAX ở bệnh nhân BTM là 2,13 ± 1,33. Xác suất gãy xương hông nhỏ nhất là 0,1% (giai đoạn IV và V). Xác suất gãy xương hông lớn nhất là 5,8% (giai đoạn IIIb). Nguy cơ gãy xương chính trung bình trong 10 năm (FRAX) theo mật độ xương ở nhóm loãng xương (12,14 ± 7,48%) cao hơn so với nhóm không loãng xương. Nguy cơ gãy xương hông trung bình trong 10 năm (FRAX) theo mật độ xương ở nhóm loãng xương (2,81 ± 1,51%) cao hơn so với nhóm không loãng xương. Có 8,3% nguy cơ gãy xương chính cao và 91,7% có nguy cơ gãy xương chính thấp. Có 22,6% nguy cơ gãy xương hông cao và 77,4% có nguy cơ gãy xương hông thấp. Tuổi, nồng độ canxi toàn phần và mức lọc cầu thận là yếu tố tác động đến nguy cơ gây gẫy xương hông ở bệnh nhân bệnh thận mạn.

Pinworm in the Appendix: An Unusual Cause of Appendiceal Inflammation; A Case Report

2025-06-23

Mohammed Iqbal Syed , Muddassir Shaikh , Fabeha Hilal Makhdoomi | Research Square (Research Square)

<title>Abstract</title> Purpose <italic>Enterobius Vermicularis</italic>, usually causing perianal pruritus in children, can rarely become the cause of acute appendicitis. It is imperative to discuss this unique manifestation of this parasitic infestation. … <title>Abstract</title> Purpose <italic>Enterobius Vermicularis</italic>, usually causing perianal pruritus in children, can rarely become the cause of acute appendicitis. It is imperative to discuss this unique manifestation of this parasitic infestation. Methods The Medline database was extensively searched for literature covering the different aspects of this clinical manifestation to discuss alongside the unusual case presentation. Results <italic>Enterobius Vermicularis</italic> is a nematode endemic to various parts of the developing world with a significantly rising prevalence. Colonizing humans as a primary host, the parasite usually causes perianal pruritus. In rare instances, however, after successful migration and obstruction of the appendiceal lumen, acute appendicitis may ensue. Acute appendicitis, diagnosed via clinical presentation and radiologic investigation, warrants surgical intervention. Conclusion Parasitic manifestation may be visible perioperatively or become evident upon histopathology. Anti-helminthic therapy commencement should not be delayed to effectively reduce transmission risk and inevitably cure the condition.

NHẬN XÉT KẾT QUẢ SỚM ĐIỀU TRỊ SỎI THẬN BẰNG PHƯƠNG PHÁP TÁN SỎI THẬN QUA DA TẠI BỆNH VIỆN ĐẠI HỌC Y THÁI BÌNH

2025-06-23

Don Hoang , Hùng Nguyễn Đình , Quân Nguyễn Văn +1 more | Tạp chí Y học Việt Nam

Mục tiêu: Nhận xét kết quả sớm điều trị sỏi thận bằng phương pháp tán sỏi thận qua da (TSTQD) tại Bệnh viện Đại Học Y Thái Bình. Đối tượng, … Mục tiêu: Nhận xét kết quả sớm điều trị sỏi thận bằng phương pháp tán sỏi thận qua da (TSTQD) tại Bệnh viện Đại Học Y Thái Bình. Đối tượng, phương pháp nghiên cứu: nghiên cứu tiến cứu trên 198 bệnh nhân được thực hiện tán sỏi thận qua da tại khoa Ngoại, Bệnh viện Đại học Y Thái Bình trong thời gian từ tháng 05 năm 2022 đến tháng 05 năm 2024. Kết quả: Vị trí sỏi hay gặp nhất là ở bể thận và 1 nhóm đài, chiếm 35,9%. Trước mổ có 66,9% BN có giãn đài bể thận độ II. Tỉ lệ sạch sỏi sau mổ lần 1 và sau mổ 1 tháng lần lượt là 66,2% và 68,2%. Sốt là biến chứng hay gặp nhất sau mổ, chiếm tỉ lệ 3%. Thời gian nằm viện sau mổ trung bình là 6,88 ± 2,28 ngày. Phần lớn BN có kết quả tốt sau mổ lần 1 và sau mổ 1 tháng, chiếm tỉ lệ lần lượt là 66,2% và 68,2%. Kết luận: Tán sỏi thận qua da là phương pháp hiệu quả và an toàn trong điều trị sỏi thận với tỉ lệ sạch sỏi cao, ít biến chứng sau mổ và mang lại kết quả điều trị tốt.

ĐÁNH GIÁ KẾT QUẢ ĐIỀU TRỊ SỎI THẬN BẰNG NỘI SOI THẬN NGƯỢC DÒNG SỬ DỤNG ỐNG SOI MỀM TẠI BỆNH VIỆN ĐẠI HỌC Y THÁI BÌNH

2025-06-23

Duc Hoang , Tran Ngoc , Khải Nguyễn Xuân | Tạp chí Y học Việt Nam

Mục tiêu: Đánh giá kết quả điều trị sỏi thận bằng nội soi thận ngược dòng sử dụng ống soi mềm tại Bệnh viện Đại học Y Thái Bình. Đối … Mục tiêu: Đánh giá kết quả điều trị sỏi thận bằng nội soi thận ngược dòng sử dụng ống soi mềm tại Bệnh viện Đại học Y Thái Bình. Đối tượng, phương pháp nghiên cứu: Nghiên cứu tiến cứu trên 62 bệnh nhân (BN) được chẩn đoán sỏi thận và điều trị bằng phương pháp phẫu thuật (PT) nội soi thận ngược dòng sử dụng ống soi mềm tại Bệnh viện Trường Đại học Y Thái bình từ tháng 01/2021 đến tháng 6/2024. Kết quả: Sạch sỏi tức thì ngay trong phẫu thuật chiếm tỷ lệ 67,74%. Phần lớn BN không có tai biến trong PT, chiếm 88,70%. Tỷ lệ bệnh nhân sạch sỏi trước khi xuất viện chiếm 98,38%. Đa số BN không có biến chứng sau PT, chiếm 85,48%. Thời gian hậu phẫu trung bình là 6,2 ± 1,7 ngày. Kết luận: Điều trị sỏi thận bằng phương pháp nội soi thận ngược dòng sử dụng ống soi mềm là phương pháp an toàn, khả thi, tỷ lệ sạch sỏi cao, tai biến - biến chứng thấp, thời gian nằm viện ngắn ngày.

Perforated appendix

2025-06-21

Sally El Bahy | Radiopaedia.org

Retrospective Analysis of Clinical Characteristics Treatment Outcomes and Risk Factors in Appendicitis and Colitis

2025-06-20

Haitao Wang | Journal of Surgery & Anesthesia Research

Background: Appendicitis and colitis are common gastrointestinal inflammatory disorders with distinct etiologies and management approaches. This retrospective study compared clinical profiles, treatment modalities, and risk factors for adverse outcomes between … Background: Appendicitis and colitis are common gastrointestinal inflammatory disorders with distinct etiologies and management approaches. This retrospective study compared clinical profiles, treatment modalities, and risk factors for adverse outcomes between appendicitis and colitis. Methods: Data from 1,000 patients (800 appendicitis, 200 colitis) treated at a tertiary center (2021–2023) were analyzed. Demographics, symptoms, laboratory findings, treatments, and outcomes were compared. Univariate/multivariate logistic regression identified risk factors for complications (appendicitis) and severe flares (colitis). Results: Appendicitis patients were younger (median age 32 vs. 45 years, p<0.001), with higher rates of acute abdominal pain (98% vs. 75%, p<0.001). Colitis patients more frequently had chronic diarrhea (82% vs. 15%, p<0.001) and weight loss (65% vs. 20%, p<0.001). Laparoscopic appendectomy was performed in 78% of appendicitis cases (complication rate 10.2%), while 60% of colitis patients received biologic therapy (response rate 68%). Multivariate analysis showed perforated appendicitis (OR=3.5, 95%CI:2.3–5.2, p<0.001) and corticosteroid resistance (OR=2.8, 95%CI:1.7–4.5, p=0.002) as independent risk factors for poor outcomes. Conclusion: Appendicitis and colitis exhibit distinct clinical and therapeutic profiles. Early surgical intervention for complicated appendicitis and targeted biologic therapy for refractory colitis improve outcomes.

Retrospective Analysis of Risk Factors for Complications and Treatment Outcomes in Adult Appendicitis: A Single-Center Study

2025-06-20

Haitao Wang | Journal of Surgery & Anesthesia Research

Background: Appendicitis remains a common surgical emergency, but risk factors for complications and optimal treatment strategies require further clarification. This study analyzed clinical characteristics, treatment outcomes, and risk factors for … Background: Appendicitis remains a common surgical emergency, but risk factors for complications and optimal treatment strategies require further clarification. This study analyzed clinical characteristics, treatment outcomes, and risk factors for complications in adult appendicitis patients. Methods: Data from 850 adult appendicitis patients (≥18 years) treated at a tertiary center (2021–2023) were retrospectively reviewed. Patient demographics, clinical features, surgical methods, and postoperative complications were analyzed. Univariate/multivariate logistic regression identified risk factors for complications. Results: Median age was 38 years (IQR: 26–52), with 56% male patients. Perforated appendicitis occurred in 28% (238/850), and 12% (102/850) had comorbidities (diabetes/hypertension). Laparoscopic appendectomy (LA) was performed in 78% (663/850), associated with lower complication rates (9.1% vs. 18.6%, p<0.001) and shorter hospital stay (3 vs. 5 days, p<0.001) compared to open appendectomy (OA). Multivariate analysis identified perforation (OR=3.21, 95%CI:2.14–4.83, p<0.001), age ≥60 years (OR=2.58, 95%CI:1.62–4.13, p<0.001), and comorbidities (OR=1.92, 95%CI:1.27–2.91, p=0.002) as independent risk factors for complications. Conclusion: Perforation, advanced age, and comorbidities increase complication risk. LA is associated with superior outcomes and should be prioritized in uncomplicated cases.

Retrospective Analysis of Clinical Characteristics, Treatment Outcomes and Risk Factors for Complications in Appendicitis Patients

2025-06-20

Haitao Wang | Journal of Surgery & Anesthesia Research

Background: Appendicitis is a common acute abdominal disease. This retrospective study aimed to analyze the clinical characteristics, treatment outcomes, and risk factors for complications in appendicitis patients. Methods: Data of … Background: Appendicitis is a common acute abdominal disease. This retrospective study aimed to analyze the clinical characteristics, treatment outcomes, and risk factors for complications in appendicitis patients. Methods: Data of 620 appendicitis patients treated at our hospital from January 2021 to December 2023 were retrospectively reviewed. Patient demographics, clinical manifestations, treatment methods, and postoperative outcomes were collected. Univariate and multivariate logistic regression analyses were used to identify risk factors for complications. Results: The median age of the patients was 35 years (IQR: 22-48), with 58.1% being male. Acute appendicitis accounted for 89.2% (553/620), and 32.1% (199/620) of patients presented with perforated appendicitis. Laparoscopic appendectomy was performed in 75.8% (470/620) of cases, showing shorter postoperative hospital stay (median: 3 days vs. 5 days, p < 0.001) and lower complication rates (12.1% vs. 21.7%, p = 0.003) compared to open appendectomy. Multivariate analysis identified advanced age (≥ 60 years, OR = 2.35, 95% CI: 1.42-3.88, p = 0.001), perforated appendicitis (OR = 3.12, 95% CI: 1.98-4.89, p < 0.001), and comorbidities (OR = 1.89, 95% CI: 1.23-2.89, p = 0.003) as independent risk factors for postoperative complications. Conclusion: Advanced age, perforated appendicitis, and comorbidities increase the risk of complications in appendicitis patients. Laparoscopic appendectomy is associated with better postoperative outcomes and should be the preferred treatment when feasible.

Perbandingan Luaran Apendektomi Terbuka dan Apendektomi Laparoskopi pada Pasien Apendisitis di Asia

2025-06-20

Luna M. Soetarman , Angelica M. J. Wagiu , Stephanus J. Ch. Tangel | Medical Scope Journal

Abstract: Appendectomy is one of the treatments for appendicitis which can be done using either the open or laparoscopic approach. The choice of surgical technique is often determined by several … Abstract: Appendectomy is one of the treatments for appendicitis which can be done using either the open or laparoscopic approach. The choice of surgical technique is often determined by several factors such as medical expertise, availability of healthcare facilities, and patient-related factors. In Asia, with its diverse healthcare systems and population characteristics, the comparison of outcomes between these two techniques remains underexplored. This study aimed to compare the outcomes of both methods in appendicitis patients, focusing on studies conducted in Asia. This was a literature review study using articles searched on PubMed and Google Scholar databases. Comparative analysis of outcomes between both methods was performed descriptively. The results obtained a total of 48 articles that met the inclusion and exclusion criteria. Laparoscopic appendectomy had a significantly shorter hospital stay and lower postoperative pain compared to open appendectomy. However, in terms of postoperative complications, inconsistencies were found in the literature due to various factors. In conclusion, laparoscopic appendectomy is superior to open appendectomy in terms of shorter hospital stays and lower levels of postoperative pain. However, regarding postoperative complications, neither method showed a significant advantage over the other. Keywords: open appendectomy; laparoscopic appendectomy; appendicitis Abstrak: Apendektomi adalah salah satu tatalaksana apendisitis yang dapat dilakukan dengan metode terbuka atau laparoskopi. Pemilihan teknik pembedahan sering kali ditentukan oleh faktor seperti keahlian medis, ketersediaan fasilitas kesehatan, dan faktor pasien. Di Asia, dengan sistem kesehatan dan karakteristik populasi yang beragam, perbandingan luaran kedua teknik ini masih kurang dieksplorasi. Penelitian ini bertujuan untuk membandingkan luaran kedua metode pada pasien apendisitis, dengan fokus pada penelitian yang dilakukan di Asia. Penelitian ini merupakan suatu literature review dari artikel-artikel yang ditelusuri pada database PubMed dan Google Scholar. Analisis perbandingan luaran kedua metode dilakukan secara deskriptif. Hasil penelitian mendapatkan sebanyak 48 artikel memenuhi kriteria inklusi dan eksklusi. Apendektomi laparoskopi memiliki durasi rawat inap yang lebih singkat dan nyeri pasca operasi yang lebih ringan secara bermakna dibandingkan apendektomi terbuka. Dalam hal komplikasi pasca operasi, ditemukan adanya inkonsistensi dalam literatur yang disebabkan oleh berbagai macam faktor. Simpulan penelitian ini ialah apendektomi laparoskopi lebih unggul dibandingkan apendektomi terbuka dalam hal durasi rawat inap dan tingkat nyeri pasca operasi. Namun, dalam hal komplikasi pasca operasi, tidak ada metode yang menunjukkan keunggulan bermakna dibandingkan metode lainnya. Kata kunci: apendektomi terbuka; apendektomi laparoskopi; apendisitis

Open appendectomy for subhepatic appendicitis in an adult male: A case report

2025-06-20

Roshan Chaudhary , Ijendra Prajapati , Amisha Mahato +1 more | International Journal of Surgery Case Reports

Retrospective Analysis of Clinical Characteristics, Treatment Outcomes and Risk Factors in Appendicitis and Typhlitis

2025-06-20

Haitao Wang | Journal of Surgery & Anesthesia Research

Background: Appendicitis and typhlitis are distinct gastrointestinal inflammatory conditions with overlapping symptoms, posing diagnostic challenges. This retrospective study compared their clinical features, treatments, and outcomes, and identified associated risk factors. … Background: Appendicitis and typhlitis are distinct gastrointestinal inflammatory conditions with overlapping symptoms, posing diagnostic challenges. This retrospective study compared their clinical features, treatments, and outcomes, and identified associated risk factors. Methods: Data from 800 appendicitis and 200 typhlitis patients treated at a tertiary hospital (2021–2023) were analyzed. Demographics, symptoms, lab results, treatments, and outcomes were examined. Univariate and multivariate logistic regressions determined risk factors. Results: Appendicitis patients were younger (median 32 years) than typhlitis patients (median 45 years). Abdominal pain was common in both (98% vs. 92%), but typhlitis patients more often had fever (88% vs. 65%) and diarrhea (75% vs. 12%). Laparoscopic appendectomy was done in 78% of appendicitis cases (10.2% complication rate), while 70% of typhlitis patients received conservative treatment (18% mortality). Multivariate analysis showed perforated appendicitis (OR = 3.2, 95% CI: 2.1–4.8, p < 0.001) and severe neutropenia (OR = 4.1, 95% CI: 2.5–6.8, p < 0.001) were key risk factors for adverse outcomes in each group. Conclusion: Appendicitis and typhlitis have distinct profiles. Early diagnosis and targeted treatment based on risk factors improve outcomes. Clinicians should distinguish between them to optimize management.

Ultrasound measurement of appendiceal diameter for identifying neonatal appendicitis

2025-06-19

Shuai Chen , Qinghua Liu , Congcong Liu +2 more | Pediatric Radiology

An overlooked diagnosis: stump appendicitis. Case report

2025-06-19

Semih Sağlık , Sinan Sayır | Medical Ultrasonography

Stump appendicitis (SA) is a very rare complication after appendectomy. Although the clinical features are the same as appendicitis, the rate of missed or delayed diagnosis is high due to … Stump appendicitis (SA) is a very rare complication after appendectomy. Although the clinical features are the same as appendicitis, the rate of missed or delayed diagnosis is high due to a history of previous appendectomy. This condition can potentially lead to serious complications such as perforation or sepsis, and even mortality. It should always be included in the differential diagnosis in patients presenting with acute abdomen with a history of appendectomy. As imaging plays an important role in the diagnosis of this condition, it is vital that radiologists are aware of this rare but serious condition. In this case report, we report two cases who underwent appendectomy and were subsequently diagnosed with stump appendicitis.

Comment on “While the Laparoscopic Appendectomy Is the Gold Standard in the Treatment of Acute Appendicitis, What Should Be the Preference for Closure of the Appendix Stump?”

2025-06-19

Betül Güzelyüz | Düzce Tıp Fakültesi Dergisi

Comment on “While the Laparoscopic Appendectomy Is the Gold Standard in the Treatment of Acute Appendicitis, What Should Be the Preference for Closure of the Appendix Stump?” Comment on “While the Laparoscopic Appendectomy Is the Gold Standard in the Treatment of Acute Appendicitis, What Should Be the Preference for Closure of the Appendix Stump?”

Analysis of the impact of emergency care on the incidence of in-hospital complications in patients with acute abdomen and the incidence of complications

2025-06-19

R. Jin , Yunxin Deng , Jing Yang | Frontiers in Public Health

Objective To investigate the effect of graded emergency nursing intervention on the incidence of in-hospital complications in patients with acute abdomen and to evaluate patient satisfaction with nursing care. Methods … Objective To investigate the effect of graded emergency nursing intervention on the incidence of in-hospital complications in patients with acute abdomen and to evaluate patient satisfaction with nursing care. Methods Between June 2021 and June 2023, 100 patients with acute abdomen (85 with acute appendicitis) were randomly assigned to a control group (routine nursing care, n = 50) or an emergency care (EC) group (graded emergency intervention, n = 50). Graded emergency nursing intervention was implemented based on the Emergency Severity Index (ESI) version 4, which stratifies patients from Level I (life-threatening) to Level V (non-urgent). The EC group received structured emergency triage by trained nursing teams, including systematic protocols for patient observation, inquiry, physical examination, and condition analysis. Outcomes included emergency care efficiency indicators (consultation time, examination time, emergency department stay, trauma control time, hospital stay), complication rates (e.g., abdominal infection, hemorrhage, puncture site infection, subcutaneous emphysema), clinical symptom recovery (abdominal pain duration, gastrointestinal recovery time), and nursing satisfaction scores. Data were analyzed using t-tests and chi-square tests via SPSS 21.0, with significance set at p &lt; 0.05. Results The EC group showed significantly lower rates of in-hospital complications (2% vs. 14%, p &lt; 0.05), faster clinical response times (shorter consultation and examination times, reduced emergency department and hospital stay durations), and quicker symptom recovery compared to the control group ( p &lt; 0.05). Nursing satisfaction scores were also significantly higher in the EC group ( p &lt; 0.05). Conclusion Graded emergency nursing intervention—based on triage acuity, structured symptom assessment, and trained response teams—effectively reduces the incidence of complications, enhances emergency response efficiency, shortens recovery and hospital stay durations, and improves patient satisfaction. This approach is clinically valuable and recommended for broader implementation.

Laparoscopic appendectomy as the gold standard: What role remains for open surgery, conversion, and disease severity?

2025-06-18

Claus Schildberg , Ulrike Weber , V. König +5 more | World Journal of Emergency Surgery

Endoscopic direct-vision appendicitis therapy for the treatment of chronic appendicitis with multiple appendicoliths

2025-06-18

Lihua Ren , Yuan Ding , Yuanyuan Li +4 more | Endoscopy

KINDER – Appendizitis: Summenwert der Querdurchmesser als diagnostischer Marker

2025-06-18

| RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren

Perioperative Anesthetic Care for Laparoscopic Appendectomy in a Pregnant Woman: A Case Report

2025-06-17

John Samuel , I Ketut Apang Nrarta | International Journal of Research and Review

Introduction: Acute appendicitis is the most common non-obstetric surgical emergency during pregnancy and poses significant diagnostic and management challenges. Physiological and anatomical changes during gestation can obscure classical clinical signs, … Introduction: Acute appendicitis is the most common non-obstetric surgical emergency during pregnancy and poses significant diagnostic and management challenges. Physiological and anatomical changes during gestation can obscure classical clinical signs, leading to delays in diagnosis and increased risk of maternal and fetal morbidity. Prompt surgical intervention is essential, and laparoscopy has become increasingly favored for its benefits in postoperative recovery and complication reduction. Anesthetic care in this population must account for altered maternal physiology, fetal safety, and perioperative risks. Case Presentation: We report a case of a 31-year-old woman at 18 weeks of gestation who presented with right lower quadrant abdominal pain, nausea, and vomiting. Physical examination revealed localized tenderness and rebound pain, with a total Alvarado score of 8. Laboratory findings showed leukocytosis. Obstetric ultrasound confirmed a viable intrauterine pregnancy. Abdominal ultrasound demonstrated an enlarged non-compressible tubular structure suggestive of appendicitis. The patient underwent emergency laparoscopic appendectomy under general anesthesia using propofol, fentanyl, rocuronium, and sevoflurane, with intra-abdominal pressure maintained below 12 mmHg and left uterine displacement applied. Intraoperative fluid management included gelafusal, Ringer lactate, and normal saline. Multimodal analgesia was administered, and fetal heart tones remained reassuring throughout. Postoperative recovery was uneventful, and the patient was discharged on postoperative day four. Discussion: This case illustrates the complexity of managing non-obstetric surgical emergencies during pregnancy. The choice of laparoscopic approach in the second trimester is supported by growing evidence indicating safety when physiologic parameters are maintained. Anesthetic management requires in-depth understanding of pregnancy physiology to avoid maternal hypoxemia, aspiration, and uteroplacental hypoperfusion. Fluid therapy must be balanced to support maternal hemodynamics while avoiding overload. Multimodal analgesia plays a critical role in minimizing opioid exposure and ensuring early recovery. Conclusion: Emergency laparoscopic appendectomy in pregnancy can be performed safely with individualized anesthetic management and multidisciplinary coordination. The principles of maternal-fetal physiology should guide perioperative decisions to optimize outcomes. Keywords: Pregnancy, Appendicitis, Laparoscopic Appendectomy, Anesthesia, Perioperative Care, Maternal-Fetal Safety

A Comparison of the Effectiveness of Antibiotic Therapy and Surgical Treatment in Patients with Acute Appendicitis

2025-06-17

Bartłomiej Józef Rdzanek , Jakub Żelazo , Katarzyna Wacławek +7 more | Quality in Sport

Acute appendicitis is one of the most common causes of abdominal pain requiring emergency surgical intervention. While appendectomy has long been the standard treatment, recent evidence has explored the use … Acute appendicitis is one of the most common causes of abdominal pain requiring emergency surgical intervention. While appendectomy has long been the standard treatment, recent evidence has explored the use of antibiotics as a non-operative alternative, particularly for uncomplicated cases. In this study, we want to compare the effectiveness, safety, and long-term outcomes of antibiotic therapy versus surgical appendectomy in the management of acute appendicitis. A comprehensive review of recent randomized controlled trials (RCTs), including the APPAC and CODA trials, as well as meta-analyses, was conducted to evaluate treatment success rates, recurrence, complications, costs, and patient preferences. Results: Antibiotic therapy successfully avoided surgery in most of the cases (approximately 73%) of patients within one year,. However, recurrence rates reached up to 39%. Surgical treatment was associated with lower recurrence (<5%) but higher direct costs and longer recovery. Antibiotic therapy resulted in shorter hospital stays and reduced overall treatment costs. Patient-centered decision-making was found to play a crucial role in selecting the appropriate therapy. Conclusions: Antibiotic therapy represents a safe and cost-effective alternative to appendectomy for selected patients with uncomplicated acute appendicitis. However, shared decision-making and proper patient selection are essential to optimize outcomes and minimize risks. Further research is needed to refine the criteria for non-operative management and ensure long-term safety. The aim of the study: This study aims to compare the effectiveness, safety, and long-term outcomes of antibiotic therapy versus surgical appendectomy in the management of acute appendicitis.

Pinworms and Appendicitis: About 10 Cases with Review of Literature

2025-06-17

Fernando Nantote , El Azzaoui Imad , Imane El Messaoudi +5 more | Asian Journal of Medicine and Health

The pinworm is due to helminthes, Enterobius Vermicularis. It is a cosmopolitan digestive parasitosis and very frequent. It is a colic parasitosis because adult’s pinworms live in the cecum. Since … The pinworm is due to helminthes, Enterobius Vermicularis. It is a cosmopolitan digestive parasitosis and very frequent. It is a colic parasitosis because adult’s pinworms live in the cecum. Since the pinworm was found in the lumen of the appendix, its role in triggering inflammatory processes responsible for appendicitis was raised, with the persisting question: what is the role of pinworms in the appendicitis? In our retrospective study, we analyzed a series of 10 cases of appendicular pinworms (5 males/ 5 females, aged between 6 and 54 years) among 1224 appendectomies, collected over the period (February 2008-December 2015) at the 5th Military Hospital of Guelmim. We studied epidemiological, clinical, paraclinical, therapeutic and pathological aspects. A literature review has been given, in order to compare our data with those published from different hospitals around the world. An important part of the literature, concerning the appendicular pinworm, has raised the issue related to the high rates of negative appendectomies. Indeed, the presence of pinworms in the appendix can lead to appendicular syndrome independently of the presence of a histological inflammation. Moreover, the low incidence of pinworms in appendectomy specimens and the high rate of negative appendectomies with presence of Enterobius Vermicularis, support the hypothesis that pinworms do not cause appendicitis. As conclusion of this work, we emphasize the importance of thinking about the possibility of pinworms infection for patients with appendicitis syndrome. In the absence of surgical emergencies, a comprehensive examination with repeated parasitic scotch-test is recommended. The positivity of these tests would reduce the number of negative appendectomies. In this case, a simple antiparasitic treatment is sufficient.

Unique Microbial Profiles and Severity-Associated Alterations in the Peritoneal Fluid of Children with Acute Appendicitis

2025-06-17

Tsubasa Aiyoshi , Tomo Kakihara , Eiichiro Watanabe +7 more | Journal of Infection and Chemotherapy

Intra-abdominal abscesses (IAA) after appendectomy for acute appendicitis (AA) result from residual bacteria in the abdominal cavity. However, the microbiota of the peritoneal fluid (PF) in children with AA has … Intra-abdominal abscesses (IAA) after appendectomy for acute appendicitis (AA) result from residual bacteria in the abdominal cavity. However, the microbiota of the peritoneal fluid (PF) in children with AA has not been well-characterized, particularly through culture-independent methods. This study aimed to characterize the PF microbiota using next-generation sequencing. This observational study prospectively enrolled 21 pediatric AA patients (simple appendicitis [SA], n=11; complicated appendicitis [CA], n=10) who underwent appendectomy. PF and appendiceal lumen samples were collected, and their microbiota was analyzed using 16S rRNA amplicon sequencing. The most abundant bacterial genera in the PF microbiota were Bacteroides, Parvimonas, Prevotella, Streptococcus, Blautia, and Fusobacterium, each exhibiting an average relative abundance of ≥5%. Redundancy analysis revealed a significant correlation between serum C-reactive protein levels and the composition of the PF microbiota (P = 0.011). In addition, nine bacterial genera showed significantly higher relative abundances in SA than in CA. The microbiota of the PF and appendiceal lumen differed regarding alpha- and beta-diversity and the average relative abundance of 19 bacterial genera. The PF microbiota exhibits a unique composition distinct from that of the appendiceal lumen. Furthermore, it demonstrates alterations associated with the severity of AA, reflecting both the degree of inflammatory response, as indicated by serum CRP levels, and pathological severity, as defined by the distinction between SA and CA. These findings provide new insights into the pathogenesis of postoperative IAA.

Phẫu thuật nội soi sau phúc mạc điều trị ứ nước thận ở bệnh nhân thận xoay bất thường có kèm theo bất thường mạch máu rốn thận, báo cáo hai trường hợp hiếm gặp

2025-06-16

Nguyễn Huy Hoàng , Đỗ Ngọc Sơn | Tạp chí Nghiên cứu Y học

Hẹp niệu quản trên thận xoay bất thường là một bệnh lý hiếm gặp nhưng rất khó để giải quyết triệt để nguyên nhân gây bệnh. Chúng tôi báo cáo … Hẹp niệu quản trên thận xoay bất thường là một bệnh lý hiếm gặp nhưng rất khó để giải quyết triệt để nguyên nhân gây bệnh. Chúng tôi báo cáo hai trường hợp hẹp niệu quản trên thận xoay bất thường kèm theo có bất thường mạch máu vùng rốn thận được phẫu thuật nội soi sau phúc mạc chuyển vị và tạo hình niệu quản. Kết quả trong và sau mổ tiến triển tốt, bệnh nhân được rút JJ sau 1 tháng. Khám lại ở thời điểm 1 và 2 năm cho thấy thận giảm độ giãn lưu thông nước tiểu tốt.

Evaluating Ensemble-Based Machine Learning Models for Diagnosing Pediatric Acute Appendicitis: Insights from a Retrospective Observational Study

2025-06-16

Zeynep Küçükakçalı , Sami Akbulut , Cemil Çolak | Journal of Clinical Medicine

Background: Pediatric acute appendicitis (AAP) is a common cause of abdominal pain in children, yet accurate classification into negative, uncomplicated, and complicated forms remains clinically challenging. Misclassification may lead to … Background: Pediatric acute appendicitis (AAP) is a common cause of abdominal pain in children, yet accurate classification into negative, uncomplicated, and complicated forms remains clinically challenging. Misclassification may lead to unnecessary surgeries or delayed treatment. This study aims to evaluate and compare the diagnostic accuracy of five machine learning models (AdaBoost, XGBoost, Stochastic Gradient Boosting, Bagged CART, and Random Forest) for classifying pediatric AAP subtypes. Methods: In this retrospective observational study, a dataset of 590 pediatric patients was analyzed. Demographic information and laboratory parameters-including C-reactive protein (CRP), white blood cell (WBC) count, neutrophils, lymphocytes, and appendiceal diameter-were included as features. The cohort consisted of negative (19.8%), uncomplicated (49.2%), and complicated (31.0%) AAP cases. Five ensemble machine learning models (AdaBoost, XGBoost, Stochastic Gradient Boosting, Bagged CART, and Random Forest) were trained on 80% of the dataset and tested on the remaining 20%. Model performance was evaluated using accuracy, sensitivity, specificity, and F1 score, with cross-validation employed to ensure result stability. Results: Random Forest demonstrated the highest overall accuracy (90.7%), sensitivity (100.0%), and specificity (61.5%) for distinguishing negative and uncomplicated AAP cases. Meanwhile, XGBoost outperformed other models in identifying complicated AAP cases, achieving an accuracy of 97.3%, sensitivity of 100.0%, and specificity of 78.3%. The most influential biomarkers were neutrophil count, appendiceal diameter, and WBC levels, highlighting their predictive value in AAP classification. Conclusions: ML models, particularly Random Forest and XGBoost, exhibit strong potential in aiding pediatric AAP diagnosis. Their ability to accurately classify AAP subtypes suggests that ML-based decision support tools can complement clinical judgment, improving diagnostic precision and patient outcomes. Future research should focus on multi-center validation, integrating imaging data, and enhancing model interpretability for broader clinical adoption.

Diagnostic Accuracy of Alvarado Versus Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) Scores With Histopathology As Gold Standard for Acute Appendicitis: A Cross-Sectional Study

2025-06-16

Raja Muhammad Mussab , Shehzadi Rimsha , Maria Kausar +4 more | Cureus

Kết quả điều trị u nguyên bào thận theo phác đồ siop tại Bệnh viện Nhi Trung ương

2025-06-16

Bùi Ngọc Lan , Nghiêm Ngọc Linh | Tạp chí Nghiên cứu Y học

U nguyên bào thận (Wilms) là một trong những u đặc phổ biến nhất ở trẻ em. Nghiên cứu nhằm đánh giá kết quả điều trị theo phác đồ SIOP … U nguyên bào thận (Wilms) là một trong những u đặc phổ biến nhất ở trẻ em. Nghiên cứu nhằm đánh giá kết quả điều trị theo phác đồ SIOP tại Bệnh viện Nhi Trung ương trên 72 bệnh nhân được chẩn đoán bằng mô bệnh học từ tháng 1/2018 đến tháng 8/2024. Tuổi trung bình khi chẩn đoán là 23 tháng (1 ngày đến 72 tháng), nữ chiếm ưu thế. U thận trái chiếm 45,2%, phải 42,4%, hai bên 10,9%. Tỷ lệ sống toàn bộ và sống không bệnh sau 5 năm lần lượt là 89,6% và 84,9%. Nhóm nguy cơ thấp và trung bình có tỷ lệ sống không bệnh cao hơn nhóm nguy cơ cao (91% so với 80%). Bệnh nhân có thể tích u sau điều trị < 500cm³ có tỷ lệ sống toàn bộ và sống không bệnh cao hơn nhóm ≥ 500cm³. Tỷ lệ tái phát và tử vong lần lượt là 7% và 9,7%. Kết quả điều trị theo phác đồ SIOP tại Bệnh viện Nhi Trung ương cho thấy hiệu quả cao, cho thấy vai trò của việc phân nhóm nguy cơ và thể tích u sau điều trị trong tiên lượng bệnh.

Đánh giá kết quả phẫu thuật điều trị lác cơ năng tại Bệnh viện Mắt Hà Đông

2025-06-16

Hoang Le | Tạp chí Nghiên cứu Y học

Lác cơ năng là hình thái lác thường gặp nhất. Điều trị lác cơ năng bao gồm chỉnh quang, chỉnh thị và chỉnh thẳng trục nhãn cầu. Hiện nay, xu … Lác cơ năng là hình thái lác thường gặp nhất. Điều trị lác cơ năng bao gồm chỉnh quang, chỉnh thị và chỉnh thẳng trục nhãn cầu. Hiện nay, xu hướng trên thế giới là phẫu thuật sớm để tạo thuận lợi cho điều trị nhược thị và phục hồi thị giác hai mắt. Nghiên cứu của chúng tôi nhằm đánh giá kết quả phẫu thuật điều trị lác cơ năng tại Bệnh viện Mắt Hà Đông. Nghiên cứu gồm 18 bệnh lác cơ năng được phẫu thuật từ tháng 9/2019 đến hết tháng 9/2022 với thời gian theo dõi ít nhất 6 tháng. Kết quả cho thấy có 83,3% có kết quả cân bằng trục nhãn cầu tốt, 11,1% đạt kết quả trung bình, 5,6% đạt kết quả kém; tỷ lệ nhược thị giảm từ 22,2% xuống 16,7%; tỷ lệ có thị giác 2 mắt tăng từ 38,8% lên 50%; tỷ lệ gặp biến chứng là 16,7%. Như vậy, phẫu thuật điều trị lác cơ năng đem lại kết quả chỉnh thẳng trục nhãn cầu tốt tuy nhiên kết quả cải thiện chức năng thị giác còn hạn chế.

Acute Abdomen: Differential Diagnosis and Surgical Approach - A Brief Review

2025-06-15

Pedro Barros , Ian Caldeira Ruppen , Fernando Dutra +7 more | Journal of Medical Research and Surgery

Acute abdomen is one of the most frequent and challenging medical and surgical emergencies, accounting for up to 10% of emergency-department visits and for substantial morbidity and mortality when diagnosis … Acute abdomen is one of the most frequent and challenging medical and surgical emergencies, accounting for up to 10% of emergency-department visits and for substantial morbidity and mortality when diagnosis and intervention are delayed. It is characterised by sudden-onset or progressively worsening abdominal pain, often accompanied by systemic signs such as fever, tachycardia or hypotension, and may evolve to sepsis and shock. The most common aetiologies include inflammatory processes notably appendicitis and cholecystitis, obstructive, perforative and vascular causes. Clinical reasoning must integrate detailed anamnesis, thorough physical examination and complementary tests. Among the latter, Computed Tomography (CT) is the gold standard for clarifying complex situations, whereas ultrasonography remains important for pregnant women, children and populations in whom radiation exposure should be minimised. In the therapeutic setting, the advent of laparoscopic surgery marked a turning point by enabling less operative trauma, fewer complications and faster functional recovery, although laparotomy remains indispensable in diffuse peritonitis or haemodynamic instability. Structured care protocols and a multidisciplinary approach have proved essential to reduce variability in management and optimise resources. The combination of experienced clinical assessment, high-performance diagnostic methods and individualised surgical techniques is therefore central to better outcomes and patient safety.

Enterobius in Acute Appendicitis – An Unheralded Guest- A Case Report

2025-06-15

Birundha Baskaran , Senthil Kumaran Selvaraj , Jeya Shambavi | INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY

Enterobius vermicularis infestation is a global public health concern. The exact pathogenesis of Enterobius species causing acute appendicitis is debatable and only a few cases have been reported in India … Enterobius vermicularis infestation is a global public health concern. The exact pathogenesis of Enterobius species causing acute appendicitis is debatable and only a few cases have been reported in India and different countries of the world. Recognition of worms inside the appendix is important as it affects the definitive management of the patients depending on the stage of the disease. Here, intend to present such a rare case of acute appendicitis in association with Enterobius vermicularis parasite. A 46-year-old male patient presented to the Emergency Department with complaints of right lower abdominal pain and nausea. Investigations were done and the patient was clinically suspected of acute appendicitis. Appendicectomy was performed and grossing of the specimen was done according to the protocol. Histopathological examination revealed ulcerated mucosa with evidence of transmural inflammation. Lumen of the appendix showed Enterobius vermicularis worm containing multiple eggs. High worm burden can cause appendiceal obstruction and other devastating complications. Detailed clinical-pathological evaluation is necessary to identify the etiology in a case of acute appendicitis. This helps in the definitive management of the patient and uncomplicated cases may be managed with conservative treatment.

[Therapeutic value of visual endoscopic retrograde appendicitis therapy in children with acute suppurative appendicitis].

2025-06-14

Anding Zhang , Na Fan , Mian Wang +7 more | PubMed

Objective: To investigate the therapeutic value of visual endoscopic retrograde appendicitis therapy (vERAT) in pediatric patients with acute suppurative appendicitis (ASA). Methods: This was a retrospective cohort study. A total … Objective: To investigate the therapeutic value of visual endoscopic retrograde appendicitis therapy (vERAT) in pediatric patients with acute suppurative appendicitis (ASA). Methods: This was a retrospective cohort study. A total of 55 ASA patients who underwent vERAT at the Pediatric Department of the Tangdu Hospital of Air Force Medical University between November 2023 and January 2025 were selected and divided into groups based on the presence or absence of fecaliths: fecalith group and non-fecalith group. The baseline characteristics, initial treatment success rates, treatment costs, hospital stay duration, procedure time, and recurrence rates between two groups were compared. Mann-Whitney U test and χ2 test were used to evaluate group differences. Results: A total of 55 ASA patients were enrolled, including 38 males and 17 females, with the age of 11.2 (9.2, 13.1) years. Based on the presence of fecaliths, patients were divided into two groups: fecalith group (32 cases) and non-fecalith group (23 cases). No statistically significant differences were observed between the two groups in terms of age, gender, duration of abdominal pain, white blood cell count, neutrophil percentage, diameter of appendix, thickness of appendix clinical symptoms or signs (all P>0.05). The initial treatment success rates were 91% (29/32) in fecalith group and 96% (22/23) in non-fecalith group, with no statistically significant difference (P=0.632). However, significant differences were noted in stent placement (χ2=5.85, P=0.026) and procedure time (Z=4.75, P<0.001). The follow-up duration time was 6.0 (2.0, 12.0) and 7.0 (2.0, 8.5) months for the fecalith and non-fecalith groups, respectively, with no significant difference (Z=0.05, P=0.962). The recurrence rates were 14% (4/29) in fecalith group and 5% (1/22) in non-fecalith group, with no statistically significant difference (P=0.375). Conclusions: vERAT can safely and effectively treat pediatric ASA, regardless of the presence or absence of fecaliths. It can provide a new treatment option for ASA.

The Safety and Feasibility of Single-Stage Versus Staged Laparoscopic Approach for Acute Appendicitis with Inguinal Hernia in Pediatric Patients: A Comparative Study

2025-06-14

Zenon Pogorelić , Anders Ødeverp , Miro Jukić | Journal of Clinical Medicine

Background: The simultaneous surgical treatment of acute appendicitis and inguinal hernia in children is still controversial. However, there are no established guidelines for the simultaneous surgical treatment of pediatric patients … Background: The simultaneous surgical treatment of acute appendicitis and inguinal hernia in children is still controversial. However, there are no established guidelines for the simultaneous surgical treatment of pediatric patients with acute appendicitis and inguinal hernia. The aim of this study is to evaluate the safety and efficacy of a simultaneous laparoscopic approach for acute appendicitis and inguinal hernia in a pediatric population. Methods: The case records of 2254 pediatric patients who underwent appendectomy at our institution between 1 January 2012 and 1 January 2025 were reviewed. Finally, 44 patients who met the inclusion criteria and had an inguinal hernia at the time of laparoscopic appendectomy were selected for further analysis. The patients who underwent single-stage surgery (simultaneous laparoscopic appendectomy and hernia repair) were assigned to group I (n = 25), while the patients who underwent delayed laparoscopic hernia repair were assigned to group II (n = 19). The groups were compared for final outcome, complications, rate of readmissions within 30 days of index surgery, duration of surgery, and length of hospital stay. Results: The mean age of all the included patients was 11.5 ± 4.0 years, with males slightly outnumbering females (n = 25, 56.8%). The study population consisted of two comparable groups in terms of age, anthropometric measures, gender distribution, and baseline clinical characteristics. A major difference between the two methods was the operation time, which was significantly longer in the single-stage group (53.5 ± 11.2 min vs. 41.5 ± 10.9 min; p = 0.001). Despite the difference in operative time, the length of hospital stay (3.5 ± 2.0 days vs. 3.5 ± 2.2 days; p = 0.899) was almost identical between the two groups, suggesting that the additional intraoperative time was not reflected in a prolonged recovery time. In addition, postoperative complications were rare and evenly distributed between both surgical strategies (n = 2 (8%) vs. n = 2 (10.5%); p = 0.772). All the complications were minor and were treated conservatively. Importantly, there was no recurrence of hernia in either group during the follow-up period. Conclusions: From a clinical perspective, these results suggest that the single-stage approach is feasible and safe, even in complicated appendicitis, particularly in cases where the postponement of hernia repair is not desirable. The longer operative time associated with the single-stage approach must be weighed against the potential benefits of avoiding a second surgical procedure and unnecessary anesthesia, reducing overall healthcare utilization, and minimizing patient burden.

Pioneering minimally invasive solutions for chronic appendicitis: EUS-assisted endoscopic appendicitis therapy (with video)

2025-06-13

Xiao-Hai Huang , Yu‐Chieh Weng , Yang‐Bor Lu | Endoscopic Ultrasound

Post appendectomy complications and associated factors among children in Amhara region, ethiopia: Multi-center retrospective follow up study

2025-06-13

Molla Azmeraw , Dessie Temesgen , Tegene Atamenta Kitaw +4 more | Langenbeck s Archives of Surgery

Assessment of Acute Abdominal Pain in Children Presenting to the Emergency Department: A Retrospective Observational Study

2025-06-13

Faisal Ghazi Almalki , Najeeb Alqarni , M. Y. Aabed Al-Thagafi +6 more | Cureus

Role of Ultrasonography in the Diagnosis of Chronic Appendicitis: An Observational Study of 400 Cases

2025-06-11

Manohar Kachare , Zaid Peerpasha Inamdar , Sanjay Kulkarni +1 more | Journal of Medical Ultrasound

Abstract Background: Chronic appendicitis is an uncommon clinical entity. Unlike acute appendicitis, the presence of nonspecific clinical features makes it a challenging diagnosis. Imaging modalities such as ultrasonography and computed … Abstract Background: Chronic appendicitis is an uncommon clinical entity. Unlike acute appendicitis, the presence of nonspecific clinical features makes it a challenging diagnosis. Imaging modalities such as ultrasonography and computed tomography (CT) scans aid in the diagnosis of chronic appendicitis. CT scan has been widely described as the investigation of choice in previous studies. However, ultrasonography of the abdomen is a readily available and cheap alternative which provides comparable results and protects from radiation hazards. The aim of this study was to identify the core imaging features of chronic appendicitis on ultrasonography, their correlation with histopathology findings and to establish the most sensitive parameters for radiological diagnosis of chronic appendicitis. Methods: This was an observational research study which employed a descriptive study design. All patients suffering from chronic/recurrent abdominal pain in the epigastric, periumbilical region or right lower quadrant were included in the study. The patients were subjected to history taking and clinical examination. Ultrasonography was performed by graded compression technique with high-frequency linear transducer. The specimens of the patients undergoing open or laparoscopic appendectomy were sent for histopathology. The preoperative ultrasonography diagnosis was confirmed on histopathology examination. Results: Based on the statistical analysis of various major and minor criteria that were described in this study, the presence of localized pain in the right iliac fossa coupled with the ultrasonography features of irregularity of appendiceal lumen (sensitivity = 84.2%) and loss of wall stratification (sensitivity = 96.5%), showed a combined sensitivity of more than 99%, which were determined to be the most sensitive parameters for clinicoradiological diagnosis of chronic appendicitis. Conclusion: Chronic appendicitis has often been misdiagnosed due to atypical symptoms at the time of presentation. Radiological investigations are used in the evaluation of patients with a high degree of clinical suspicion. This article has demonstrated the superiority of ultrasonography over CT scan for imaging of chronic appendicitis due to its advantages such as similar efficacy rates, higher spatial resolution in identifying features of chronic appendicitis, lack of ionizing radiation, cost-effectiveness, and easy availability. However, a definitive diagnosis is achieved by demonstrating evidence of chronic inflammation in the appendectomy specimen at histopathology.

Emergency Laparotomy

2025-06-09

| Cambridge University Press eBooks

Prophylactic Drain Placement After Emergency General Surgery Procedures? A Scoping Review of the Literature Challenging Common Practice

2025-06-06

Matthias Stephan Groothoff , Mariann Nocera Kelley , Belinda De Simone +2 more | The American Journal of Surgery