Complicated and Uncomplicated Acute Appendicitis Are Different Diseases-Do Not Compare Apples With Oranges

Patient backgrounds and short‐term outcomes of complicated appendicitis differ from those of uncomplicated appendicitis

Background

Appendicitis is classified as either complicated (CA) or uncomplicated (UA). Some authors have shown that the epidemiologic trends of CA and UA may differ. The aim of this study was to clarify differences in backgrounds and surgical outcomes between CA and UA patients.

Methods

This study was a cohort study. We extracted case data from the Japanese Diagnosis Procedure Combination (DPC) database from January 2014 to December 2017. Patients were classified into three groups, depending on whether they underwent emergency appendectomy for CA (CA group), emergency appendectomy for UA (UA group), or elective appendectomy (EA group). We evaluated patient characteristics and surgical outcomes for each group.

Results

We included 89,355 adult patients in the study, comprising 29,331 CA, 48,691 UA, and 11,333 EA patients. Old age, larger body mass index, smoking, and medication with antidiabetic drugs, oral corticosteroids, oral antiplatelet drugs, and oral anticoagulant drugs were independent risk factors for CA. The percentage of CA increased with age. In‐hospital mortality (0.15%, 0.02%, and 0.00%) and 30‐d mortality (0.09%, 0.01%, and 0.00%), respectively, of CA patients were significantly higher than those of the UA and EA groups. The duration of postoperative antibiotic administration, duration of fasting, and time before removal of a prophylactic drain were significantly longer in the CA group than in the UA and EA groups.

Conclusion

Backgrounds and treatment outcomes of CA and UA patients after emergency surgery are entirely different. Thus, the treatment strategy of CA and UA patients should differ accordingly.

An asymptomatic detachment of the appendix evolved to giant abscess and complete colliquative necrosis: pivotal role of computed tomography in patient management

Acute appendicitis (AA) is one of the most common causes of acute abdominal pain and it generally affects young males in the second or third decade of their life. Due to its often insidious presentations, the diagnosis is challenging and, if delayed, can lead to life-threatening complications. This report describes a rare case of an almost asymptomatic complicated appendicitis caused by an appendicolith followed by spontaneous detachment of the vermiform appendix and its complete colliquative necrosis with abscess formation. Thus far this is the first case of spontaneous appendix avulsion in an adult where the appendix is entirely colliquated into an abscess.