1
|
Peng S, Deng C, Chen J, Liu Z, Cui J, Liu S, Hu B, Chen G. TU-LESS procedure for acute abdomen in late pregnancy: a retrospective study. Arch Gynecol Obstet 2024; 310:713-718. [PMID: 38871965 DOI: 10.1007/s00404-024-07573-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 05/27/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Acute abdominal conditions during pregnancy are significant risks to maternal and fetal health, necessitating timely diagnosis and intervention. The choice of surgical approach is a major concern for obstetricians. OBJECTIVE To evaluate the safety and efficacy of the TU-LESS procedure for acute abdomen in late pregnancy. METHODS We retrospectively analyzed 12 patients who underwent TU-LESS for acute abdominal conditions in the third trimester from 2020 to 2023. We reviewed medical records for clinical characteristics, surgical interventions, postoperative complications, and pregnancy outcomes. RESULTS The study included patients with a median age of 27 (range 20-35) and a BMI of 24.33 kg/m2 (range 21.34-31.96). The median gestational age at surgery was 30 weeks (range, 28 + 3-32 + 4 weeks), with surgeries lasting an average of 60 min (range, 30-163 min). Blood loss was 2-20 mL, and the median hospital stay post-surgery was 6 days (range, 2-16 days). There were no significant complications. The median time to delivery after TU-LESS was 56 days (range, 26-66 days), resulting in 8 full-term deliveries, 2 preterm cesareans, and 2 preterm vaginal deliveries. All newborns were healthy, with no fetal losses or neonatal deaths. CONCLUSION TU-LESS, performed by experienced obstetricians and gynecologists with proper preoperative preparation, is safe and effective for managing acute abdomen in late pregnancy, without the need to delay surgery due to gestational age.
Collapse
Affiliation(s)
- Shumin Peng
- Department of Obstetrics, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Chao Deng
- Department of Obstetrics and Gynecology, Junlian County People's Hospital, Sichuan, China
| | - Jun Chen
- Department of Obstetrics, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Zhaoming Liu
- Department of Obstetrics, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jingen Cui
- Department of Obstetrics, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Shikai Liu
- Department of Obstetrics, Cangzhou Central Hospital, Hebei, China.
| | - Bin Hu
- Department of Gynecology, The Second Affiliated Hospital of Zhengzhou University, Henan, China.
| | - Gongli Chen
- Department of Obstetrics, Women and Children's Hospital of Chongqing Medical University, Chongqing, China.
| |
Collapse
|
2
|
Hashim T, AlTahan YA, Elgassim MA, Zaki HA, Elgassim M, Abdelrahman A. Atypical Presentation and Diagnostic Challenges of Appendicitis in an 85-Year-Old Male: A Case Report. Cureus 2024; 16:e65622. [PMID: 39205785 PMCID: PMC11350477 DOI: 10.7759/cureus.65622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2024] [Indexed: 09/04/2024] Open
Abstract
Acute appendicitis in elderly individuals is uncommon and poses a significant challenge due to atypical symptomatology. An 85-year-old male presented to the emergency department (ED) with abdominal pain associated with nausea and reduced oral intake. Physical examination revealed diffuse abdominal tenderness. He was initially treated for constipation with an enema and discharged. Two days later, the patient returned with worsened pain and a new onset of fever. Examination revealed guarding. Lab results showed significant elevation in C-reactive protein (CRP) and white blood count (WBC). A contrast-enhanced computed tomography (CT) scan showed evidence of a perforated appendix. He was admitted into the surgical ward and improved on conservative treatment. This case describes an atypical presentation of acute appendicitis in an elderly patient, emphasizing the importance of recognizing unusual presentations in this population. Early use of contrast-enhanced CT scans is crucial for accurate diagnosis and improving patients outcomes.
Collapse
Affiliation(s)
- Thamir Hashim
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | - Yara A AlTahan
- Community Medicine, Hamad Medical Corporation, Doha, QAT
| | | | - Hany A Zaki
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | | | | |
Collapse
|
3
|
Donald N, Halliday L, Smith G, Dighe S. Risk Factors Associated With Negative Appendicectomy Rates: A Retrospective Cohort Study. Cureus 2024; 16:e64509. [PMID: 39139307 PMCID: PMC11320375 DOI: 10.7759/cureus.64509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Acute appendicitis (AA) is the most common emergency general surgical condition worldwide. Diagnosis is challenging and incorporates clinical, biochemical and radiological investigations. Our aim was to provide data from routine practice investigating widely utilised diagnostic methods from a single centre within the United Kingdom. METHODS We conducted a retrospective observational cohort study of patients who underwent a laparoscopic appendicectomy for AA between April 2022 and March 2023. AA was defined as the presence of transmural polymorphonuclear leukocytes in histology. Subgroup analysis was performed on paediatric patients. Factors associated with AA were investigated, and the diagnostic utility of biochemical and radiological investigations was examined. RESULTS A total of 330 appendicectomies were analysed. We found an overall negative appendicectomy rate (NAR) of 38% and 48% in paediatric patients. Independent factors associated with AA on the multivariate analysis included elevated neutrophil counts (>7 × 109/L) (OR 4.04), elevated CRP (>5 mg/L) (OR 3.04) and a radiological diagnosis (OR 8.0). Computerised tomography (CT) and ultrasound had sensitivity/specificity of 98%/47% and 35%/86%, respectively. The positive-predictive values were 85% for CT and 50% for ultrasound, and the negative-predictive values were 86% for CT and 77% for ultrasound. CONCLUSION Our study has highlighted the importance of utilising a combination of factors to improve the diagnostic certainty of AA. However, our routine practice data have shown different sensitivities and specificities of imaging in comparison to existing literature, resulting in a high NAR. Further real-world data are needed to understand whether these differences from the existing data are seen in other clinical settings.
Collapse
Affiliation(s)
- Neil Donald
- General Surgery, Dartford and Gravesham NHS Trust, Dartford, GBR
| | - Laura Halliday
- General Surgery, Dartford and Gravesham NHS Trust, Dartford, GBR
- Surgery and Cancer, Imperial College London, London, GBR
| | - Gillian Smith
- General Surgery, Dartford and Gravesham NHS Trust, Dartford, GBR
| | - Shwetal Dighe
- General Surgery, Dartford and Gravesham NHS Trust, Dartford, GBR
| |
Collapse
|
4
|
Luksaite-Lukste R, Gecaite I, Marcinkeviciute K, Dumskis E, Samuilis A, Zvirblis T, Jasiunas E, Bausys A, Drungilas M, Luksta M, Kryzauskas M, Petrulionis M, Beisa A, Uselis S, Valeikaite-Taugininene G, Rackauskas R, Strupas K, Poskus T. Observation Safely Reduces the Use of the Computerized Tomography in Medium-to-Low-Risk Patients with Suspected Acute Appendicitis: Results of a Randomized Controlled Trial. J Clin Med 2024; 13:3363. [PMID: 38929896 PMCID: PMC11203661 DOI: 10.3390/jcm13123363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/28/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
Objectives-The objective was to compare the effectiveness of observation in standard-of-care computed tomography (CT) in adult patients with suspected acute appendicitis (AA). Methods-Patients with clinically suspected AA and inconclusive diagnosis after primary clinical examination, laboratory examination, and transabdominal ultrasound (TUS) were eligible for the study, and they were randomized (1:1) to parallel groups: observation-group patients were observed for 8-12 h and then, repeated clinical and laboratory examinations and TUS were performed; CT group (control group) patients underwent abdominopelvic CT scan. The study utilized Statistical Analysis System 9.2 for data analysis, including tests, logistic regression, ROC analysis, and significance evaluation. Patients were enrolled in the study at Vilnius University Hospital Santaros Klinikos in Lithuania between December 2018 and June 2021. Results-A total of 160 patients (59 men, 101 women), with a mean age of 33.7 ± 14.71, were included, with 80 patients in each group. Observation resulted in a reduced likelihood of a CT scan compared with the CT group (36.3% vs. 100% p < 0.05). One diagnostic laparoscopy was performed in the observation group; there were no cases of negative appendectomy (NA) in the CT group. Both conditional CT and observation pathways resulted in high sensitivity and specificity (97.7% and 94.6% vs. 96.7% and 95.8%). Conclusions-Observation including the repeated evaluation of laboratory results and TUS significantly reduces the number of CT scans without increasing NA numbers or the number of complicated cases.
Collapse
Affiliation(s)
- Raminta Luksaite-Lukste
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (M.L.); (M.K.); (M.P.); (A.B.); (S.U.); (G.V.-T.); (R.R.); (K.S.); (T.P.)
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (I.G.); (E.D.); (A.S.)
| | - Igne Gecaite
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (I.G.); (E.D.); (A.S.)
| | | | - Eimantas Dumskis
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (I.G.); (E.D.); (A.S.)
| | - Arturas Samuilis
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (I.G.); (E.D.); (A.S.)
| | - Tadas Zvirblis
- Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (K.M.); (T.Z.); (A.B.)
- Department of Mechanical and Material Engineering, Vilnius Gediminas Technical University, LT-03224 Vilnius, Lithuania
| | - Eugenijus Jasiunas
- Vilnius University Hospital Santaros Klinikos, LT-08406 Vilnius, Lithuania; (E.J.); (M.D.)
| | - Augustinas Bausys
- Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (K.M.); (T.Z.); (A.B.)
| | - Mantas Drungilas
- Vilnius University Hospital Santaros Klinikos, LT-08406 Vilnius, Lithuania; (E.J.); (M.D.)
| | - Martynas Luksta
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (M.L.); (M.K.); (M.P.); (A.B.); (S.U.); (G.V.-T.); (R.R.); (K.S.); (T.P.)
| | - Marius Kryzauskas
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (M.L.); (M.K.); (M.P.); (A.B.); (S.U.); (G.V.-T.); (R.R.); (K.S.); (T.P.)
| | - Marius Petrulionis
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (M.L.); (M.K.); (M.P.); (A.B.); (S.U.); (G.V.-T.); (R.R.); (K.S.); (T.P.)
| | - Augustas Beisa
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (M.L.); (M.K.); (M.P.); (A.B.); (S.U.); (G.V.-T.); (R.R.); (K.S.); (T.P.)
| | - Simonas Uselis
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (M.L.); (M.K.); (M.P.); (A.B.); (S.U.); (G.V.-T.); (R.R.); (K.S.); (T.P.)
| | - Gintare Valeikaite-Taugininene
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (M.L.); (M.K.); (M.P.); (A.B.); (S.U.); (G.V.-T.); (R.R.); (K.S.); (T.P.)
| | - Rokas Rackauskas
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (M.L.); (M.K.); (M.P.); (A.B.); (S.U.); (G.V.-T.); (R.R.); (K.S.); (T.P.)
| | - Kestutis Strupas
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (M.L.); (M.K.); (M.P.); (A.B.); (S.U.); (G.V.-T.); (R.R.); (K.S.); (T.P.)
| | - Tomas Poskus
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (M.L.); (M.K.); (M.P.); (A.B.); (S.U.); (G.V.-T.); (R.R.); (K.S.); (T.P.)
| |
Collapse
|
5
|
Messer N, Benov A, Rov A, Bar-On T, Zlotnik O, Chen J, Paran H. Poor Compliance to Clinical Guidelines in the Diagnosis of Acute Appendicitis: Insights from a National Survey. J Clin Med 2024; 13:2862. [PMID: 38792404 PMCID: PMC11122132 DOI: 10.3390/jcm13102862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 04/30/2024] [Accepted: 05/05/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Many scoring systems, algorithms, and guidelines have been developed to aid in the evaluation and diagnosis of acute appendicitis (AA). Many of these algorithms advocate against the routine use of radiological investigations when there is a high clinical suspicion of AA. However, there has been a significant rise in the use of imaging techniques for diagnosing AA in the past two decades. This is a national study aimed at assessing the adherence of residents assigned to the emergency department to the clinical guidelines for diagnosing AA. Methods: We introduced a case study of a male patient with highly suspicious clinical findings of AA to all surgical and emergency medicine residents assigned to the emergency department with the autonomy to make critical decisions to determine the preferred way of diagnosing AA. Results: A total of 62.4% of all relevant residents participated in this survey; 69.6% reported that the Alvarado score was eight or higher, and 82.1% estimated that the next step recommended by most clinical guidelines was appendectomy without further abdominal imaging tests. However, 83.4% chose to perform an imaging test to establish the diagnosis of AA. Conclusions: Our study revealed a notable non-adherence to clinical guidelines in diagnosing AA. Given the significance of these guidelines, we assert that adopting medical recommendations should not solely depend on individual education but should also be incorporated as a departmental policy.
Collapse
Affiliation(s)
- Nir Messer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (A.R.); (T.B.-O.); (O.Z.); (J.C.); (H.P.)
- Department of Surgery A, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Avi Benov
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan 5262504, Israel;
- The Azrieli Faculty of Medicine, Bar Ilan University, Safed 1311502, Israel
| | - Adi Rov
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (A.R.); (T.B.-O.); (O.Z.); (J.C.); (H.P.)
- Department of Surgery A, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Tali Bar-On
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (A.R.); (T.B.-O.); (O.Z.); (J.C.); (H.P.)
| | - Oran Zlotnik
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (A.R.); (T.B.-O.); (O.Z.); (J.C.); (H.P.)
- Department of Surgery, Rabin Medical Center, Petach Tikva 4941492, Israel
| | - Jacob Chen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (A.R.); (T.B.-O.); (O.Z.); (J.C.); (H.P.)
- Hospital Administration, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Haim Paran
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (A.R.); (T.B.-O.); (O.Z.); (J.C.); (H.P.)
- Department of Surgery A, Meir Medical Center, Kfar Saba 4428164, Israel
| |
Collapse
|
6
|
Bahta NNA, Gram-Hanssen A, Jonsson I, Petersen SM, Rosenberg J, Fonnes S. Clinical decision rules for appendicitis are not used by surgeons in training: A survey. World J Surg 2024; 48:1086-1093. [PMID: 38411218 DOI: 10.1002/wjs.12108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 02/09/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUNDS We aimed to investigate surgeons in training knowledge of clinical decision rules (CDR) for diagnosing appendicitis and their attitudes toward implementing them. METHODS We included surgeons in training practicing in East Denmark who independently could decide to perform a diagnostic laparoscopy for suspected appendicitis. The survey was developed in Research Electronic Data Capture and face-validated before use. It consisted of three parts: (1) the characteristics of the surgeons, (2) their diagnostic approach, and (3) their knowledge and attitude toward introducing CDR in the clinic. Data were collected in January 2023. RESULTS We achieved 83 (90%) responses, and 52% of surgeons in training believed that appendicitis was difficult to diagnose. Their diagnostic approach mostly included symptoms and physical examinations for abdominal pain, and C-reactive protein. A total of 48% knew of at least one clinical decision rule, and 72% had never used a clinical decision rule. Regarding the necessity of CDR in clinical practice, surgeons in training options were divided into thirds: not needed, neither needed nor not needed, and needed. Surgeons in training indicated that CDR needed to be validated and easily applied before they would implement them. CONCLUSION Approximately 3/4 of surgeons in training had never utilized a clinical decision rule to diagnose appendicitis, and only half knew of their existence. The symptoms and findings incorporated in most CDR aligned with their diagnostic approach. They were conflicted if CDR needed to be implemented in clinical practice.
Collapse
Affiliation(s)
- Nadir Noureldin Abdella Bahta
- Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Anders Gram-Hanssen
- Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
- Department of Surgery, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Isabella Jonsson
- Department of Surgery, Holbaek Hospital, University of Copenhagen, Holbaek, Denmark
| | - Stine Mette Petersen
- Department of Surgery, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Siv Fonnes
- Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| |
Collapse
|
7
|
Pacilli M, Kamaleswaran R. New Genetic Biomarkers to Diagnose Pediatric Appendicitis. JAMA Pediatr 2024; 178:341-342. [PMID: 38372987 DOI: 10.1001/jamapediatrics.2023.6731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Affiliation(s)
- Maurizio Pacilli
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Rishikesan Kamaleswaran
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta
| |
Collapse
|
8
|
Przeslawski C, Iorio L, Gerken J. Aberrant Diagnostic Imaging Resulting in Misdiagnosed Acute Perforated Appendicitis: A Case Report. Cureus 2024; 16:e54304. [PMID: 38496122 PMCID: PMC10944640 DOI: 10.7759/cureus.54304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/19/2024] Open
Abstract
A 31-year-old male with a history of diverticulitis presented for acute abdominal pain and was found to have several small areas of free air on computed tomography (CT) of the abdomen/pelvis. Due to inflammatory changes seen around the sigmoid colon and small bowel, he was diagnosed with perforated diverticulitis. The patient complained of significant right-sided abdominal pain with significant tenderness on abdominal examination. The patient was initially treated with diagnostic laparoscopy and was actually found to have acute perforated appendicitis with mild appendiceal adherence to the sigmoid colon. This case highlights the importance of careful history and physical examination in an era where imaging often precedes the surgeon's evaluation. The case also provides support for laparoscopy in select cases of pneumoperitoneum, sparing patients the morbidity of undergoing an open laparotomy.
Collapse
Affiliation(s)
- Christian Przeslawski
- General Surgery, Corewell Health Southeast - Farmington Hills Campus, Farmington Hills, USA
| | - Leanne Iorio
- General Surgery, Corewell Health Southeast - Farmington Hills Campus, Farmington Hills, USA
| | - Jeffrey Gerken
- General Surgery, Corewell Health Southeast - Farmington Hills Campus, Farmington Hills, USA
| |
Collapse
|
9
|
Aziz O, Nevin S, Serhan Y, Hakan B, Abdulkadir A. What is the margin of error of surgeons and radiological imaging in diagnosing acute appendicitis? Niger J Clin Pract 2023; 26:881-888. [PMID: 37635570 DOI: 10.4103/njcp.njcp_284_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Background Acute appendicitis is the most common emergency requiring surgical intervention in general surgery. Negative appendectomy is defined as the removal of a pathologically normal appendix. Aim In this study, we aimed to show our negative appendectomy rate. Materials and Methods This study was carried out among 2990 patients who were operated on for appendicitis between 2015-2020 at the Health Sciences University, İstanbul Kanuni Sultan Suleyman Training, and Research Hospital. Accrual and historical records of the patients were analyzed using NCSS (Number Cruncher Statistical System) 2007 Statistical Software (Utah, USA) package program. The results were evaluated at the significance level of P < 0.05. Results The mean age of all patients was 33. Of the patients, 1011 were women and 1979 were men. 27 of the women patients were pregnant. We requested a blood test (WBC count) and an abdominal ultrasound for all our patients who came with the complaint of abdominal pain in the right lower quadrant. Negative appendectomy was performed with ultrasonography in 622 patients with pathological diagnoses of lymphoid hyperplasia and fibrous obliteration (20.8%). We had abdominal computerized tomography (CT) for 285 patients and abdominal magnetic resonance imaging (MRI) for 16 of 27 pregnant women (59.25%) due to unclear clinical picture. Diagnostic laparoscopy was performed in 36 of the patients who underwent CT and 4 of the patients who underwent MRI since the diagnosis could not be made. We performed unnecessary appendectomy in 21.2% of the patients. Conclusion With the increasing clinical follow-up experience of surgeons and developing technology in radiology, our aim is to minimize the negative appendectomy rate as much as possible.
Collapse
Affiliation(s)
- O Aziz
- General Surgery Department, Health Sciences University, İstanbul Kanuni Sultan Suleyman Training and Research Hospital, İstanbul, Turkey
| | - S Nevin
- General Surgery Department, İstanbul Medipol University, İstanbul, Turkey
| | - Y Serhan
- General Surgery Department, Health Sciences University, İstanbul Kanuni Sultan Suleyman Training and Research Hospital, İstanbul, Turkey
| | - B Hakan
- General Surgery Department, Health Sciences University, İstanbul Kanuni Sultan Suleyman Training and Research Hospital, İstanbul, Turkey
| | - A Abdulkadir
- Radiology Department, Medipol Bahcelievler Hospital, İstanbul, Turkey
| |
Collapse
|
10
|
Zülfikaroğlu B, Akkurt G, Akın M, İşman FK, Yastı AÇ, Özmen MM. Role of serum levels of tumour necrosis factor-like weak inducer of apoptosis (TWEAK) in predicting severity of acute appendicitis. Turk J Surg 2023; 39:121-127. [PMID: 38026909 PMCID: PMC10681112 DOI: 10.47717/turkjsurg.2023.5747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 03/23/2023] [Indexed: 12/01/2023]
Abstract
Objectives One of the most prevalent abdominal crises is acute appendicitis (AA). Clinical diagnosis, even for skilled surgeons, is frequently challenging, as indicated by the high proportion of negative investigations. The purpose of this study was to see if serum TWEAK levels might be used to diagnose acute appendicitis. Material and Methods Between June 2017 and May 2019, all patients who had surgery with the original diagnosis of AA were included in the study. TWEAK, WBC, CRP, and bilirubin levels were compared. Results The levels of WBC, CRP, and bilirubin were compared to pathology. All three blood indicators increased significantly in AA patients. However, no statistically significant difference in the levels of all three blood indicators was seen between individuals with simple AA and those with severe AA. TWEAK plasma concentrations were considerably greater in patients with severe AA than in the healthy control and NAA groups. TWEAK levels were significantly greater in individuals with severe AA compared to patients with simple AA. Conclusion Serum TWEAK levels that are elevated may be used to diagnose acute appendicitis as well as prognostic indicators for the severity of appendicitis.
Collapse
Affiliation(s)
- Barış Zülfikaroğlu
- Clinic of General Surgery, Ankara Numune Training and Research Hospital, Ankara, Türkiye
| | - Gökhan Akkurt
- Clinic of General Surgery, Ankara Numune Training and Research Hospital, Ankara, Türkiye
| | - Merve Akın
- Clinic of General Surgery, Ankara Numune Training and Research Hospital, Ankara, Türkiye
| | - Ferruh Kemal İşman
- Clinic of Clinical Chemistry, Göztepe Training and Research Hospital, İstanbul, Türkiye
| | - Ahmet Çınar Yastı
- Clinic of General Surgery, Ankara Numune Training and Research Hospital, Ankara, Türkiye
| | - Mehmet Mahir Özmen
- Department of Surgery, İstinye University Faculty of Medicine, İstanbul, Türkiye
| |
Collapse
|
11
|
Echevarria S, Rauf F, Hussain N, Zaka H, Farwa UE, Ahsan N, Broomfield A, Akbar A, Khawaja UA. Typical and Atypical Presentations of Appendicitis and Their Implications for Diagnosis and Treatment: A Literature Review. Cureus 2023; 15:e37024. [PMID: 37143626 PMCID: PMC10152406 DOI: 10.7759/cureus.37024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2023] [Indexed: 05/06/2023] Open
Abstract
Appendicitis, an acute inflammation of the appendix, affects all demographic groups and exhibits various incidences and clinical manifestations. While acute appendicitis typically presents with colicky periumbilical abdominal pain that localizes to the right lower quadrant, atypical presentations are more common in children, geriatric, and pregnant patient populations, leading to delays in diagnosis. Clinical evaluation, clinical scoring systems, and inflammatory markers are commonly used, but their limitations have led to the increased use of diagnostic imaging in patients suspected of appendicitis. Acute appendicitis is managed by non-operative and operative management, depending on whether it is uncomplicated or complicated. Developing diagnostic pathways to improve outcomes and reduce complications is crucial. Although medical advancements have been made, diagnosing and managing appendicitis can be challenging, mainly when patients are present atypically. This literature review aims to comprehensively review typical and atypical presentations of appendicitis and their current implications for diagnosis and treatment modalities in pediatric, adult, pregnant, and geriatric patient populations.
Collapse
Affiliation(s)
| | - Fatima Rauf
- Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | - Nabeel Hussain
- Internal Medicine, Saba University School-Medicine, Devens, USA
| | - Hira Zaka
- Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Umm-E- Farwa
- Surgery, Jinnah Sindh Medical University, Karachi, PAK
| | - Nayab Ahsan
- Internal Medicine, Quaid-e-Azam Medical College, Bahawalpur, PAK
| | - Alison Broomfield
- Family Medicine, Spartan Health Sciences University, Vieux Fort, LCA
| | - Anum Akbar
- Pediatrics, University of Nebraska Medical Center, Omaha, USA
| | - Uzzam Ahmed Khawaja
- Pulmonary and Critical Care Medicine, Jinnah Medical and Dental College, Karachi, PAK
- Clinical and Translational Research, Dr Ferrer BioPharma, South Miami, USA
| |
Collapse
|
12
|
Barie PS, Kao LS, Moody M, Sawyer RG. Infection or Inflammation: Are Uncomplicated Acute Appendicitis, Acute Cholecystitis, and Acute Diverticulitis Infectious Diseases? Surg Infect (Larchmt) 2023; 24:99-111. [PMID: 36656157 DOI: 10.1089/sur.2022.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: It is recognized increasingly that common surgical infections of the peritoneal cavity may be treated with antibiotic agents alone, or source control surgery with short-course antimicrobial therapy. By extension, testable hypotheses have emerged that such infections may not actually be infectious diseases, but rather represent inflammation that can be treated successfully with neither surgery nor antibiotic agents. The aim of this review is to examine extant data to determine which of uncomplicated acute appendicitis (uAA), uncomplicated acute calculous cholecystitis (uACC), or uncomplicated mild acute diverticulitis (umAD) might be amenable to management using supportive therapy alone, consistent with the principles of antimicrobial stewardship. Methods: Review of pertinent English-language literature and expert opinion. Results: Only two small trials have examined whether uAA can be managed with observation and supportive therapy alone, one of which is underpowered and was stopped prematurely because of challenging patient recruitment. Data are insufficient to determine the safety and efficacy of non-antibiotic therapy of uAA. Uncomplicated acute calculous cholecystitis is not primarily an infectious disease; infection is a secondary phenomenon. Even when bactibilia is present, there is no high-quality evidence to suggest that mild disease should be treated with antibiotic agents. There is evidence to indicate that antibiotic prophylaxis is indicated for urgent/emergency cholecystectomy for uACC, but not in the post-operative period. Uncomplicated mild acute diverticulitis, generally Hinchey 1a or 1b in current nomenclature, does not benefit from antimicrobial agents based on multiple clinical studies. The implication is that umAD is inflammatory and not an infectious disease. Non-antimicrobial management is reasonable. Conclusions: Among the considered disease entities, the evidence is strongest that umAD is not an infectious disease and can be treated without antibiotic agents, intermediate regarding uACC, and lacking for uAA. A plausible hypothesis is that these inflammatory conditions are related to disruption of the normal microbiome, resulting in dysbiosis, which is defined as an imbalance of the natural microflora, especially of the gut, that is believed to contribute to a range of conditions of ill health. As for restorative pre- or probiotic therapy to reconstitute the microbiome, no recommendation can be made in terms of treatment, but it is not recommended for prevention of primary or recurrent disease.
Collapse
Affiliation(s)
- Philip S Barie
- Department of Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Lillian S Kao
- Department of Surgery, UTHealth Houston John P. and Kathrine G. McGovern Medical School, Houston, Texas, USA
| | - Mikayla Moody
- Department of Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA
| | - Robert G Sawyer
- Department of Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA
| |
Collapse
|
13
|
Tong L, Nataraja RM, VanHaltren K, Sulaksana TH, Vinycomb TI, Pacilli M. The utility of sonographic signs to diagnose simple and complicated appendicitis in children. Pediatr Surg Int 2023; 39:114. [PMID: 36764977 PMCID: PMC9918567 DOI: 10.1007/s00383-023-05397-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Acute appendicitis is classified into simple (SA) and complicated (CA). Ultrasound scans (USS) can be useful in clinically equivocal cases, by visualising primary and secondary signs. This study explores the utility of sonographic signs to diagnose and differentiate appendicitis in children. METHODS Single-centre retrospective cohort study over a 2-year period. Consecutive USS for suspected appendicitis were included; sonographic signs were extracted from standardised institutional worksheets. USS results were compared with pre-defined intraoperative criteria for SA and CA, confirmed with histological analysis. Data are reported as median [interquartile range], percentages (number), area under the curve (AUC), conventional diagnostic formulae and adjusted odds ratios following multiple logistic regression (p < 0.05 considered significant). RESULTS A total of 934 USS were included, with median age 10.7 [8.0-13.4] years, majority were female (54%). One quarter (n = 226) had SA, 12% (n = 113) had CA, 61% (n = 571) had no appendectomy and 3% (n = 24) had negative appendicectomy. Appendix visualisation rate on USS was 61% (n = 569), with 62% (n = 580) having a conclusive report. Sonographic signs suggesting appendicitis included an appendiceal diameter > 7 mm (AUC 0.92, [95% CI: 0.90-0.94]), an appendicolith (p = 0.003), hyperaemia (p = 0.001), non-compressibility (p = 0.029) and no luminal gas (p = 0.004). Secondary sonographic signs included probe tenderness (p < 0.001) and peri-appendiceal echogenic fat (p < 0.001). Sonographic signs suggesting CA over SA comprised a diameter > 10.1 mm (AUC 0.63, [95% CI: 0.57-0.69]), an appendicolith (p = 0.003) and peri-appendiceal fluid (p = 0.004). CONCLUSION Presence of specific sonographic signs can aid diagnosis and differentiation of simple and complicated appendicitis in children.
Collapse
Affiliation(s)
- Lauren Tong
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Ramesh M Nataraja
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Department of Surgery, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Department of Paediatric Surgery, Monash Children's Hospital, Level 5, 246 Clayton Road, Clayton, Melbourne, VIC, 3168, Australia
| | - Keith VanHaltren
- Department of Paediatric Radiology, Monash Children's Hospital, Melbourne, VIC, Australia
| | - Tania H Sulaksana
- Department of Paediatric Surgery, Monash Children's Hospital, Level 5, 246 Clayton Road, Clayton, Melbourne, VIC, 3168, Australia
| | - Toby I Vinycomb
- Department of Paediatric Surgery, Monash Children's Hospital, Level 5, 246 Clayton Road, Clayton, Melbourne, VIC, 3168, Australia
| | - Maurizio Pacilli
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
- Department of Surgery, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
- Department of Paediatric Surgery, Monash Children's Hospital, Level 5, 246 Clayton Road, Clayton, Melbourne, VIC, 3168, Australia.
| |
Collapse
|
14
|
Many diagnostic tools for appendicitis: a scoping review. Surg Endosc 2023; 37:3419-3429. [PMID: 36735050 DOI: 10.1007/s00464-023-09890-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/15/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND We aimed to provide an overview of all diagnostic tools developed to diagnose appendicitis with their reported accuracy and to further characterize these including their need for diagnostic equipment. METHODS This scoping review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews and a protocol was registered at Open Science Framework. We performed a systematic literature search in PubMed, Embase, China National Knowledge Infrastructure, Índice Bibliográfico Espanhol de Ciências da Saúde, and Latin American and Caribbean Health Sciences Literature. We included original articles of all languages with the purpose to derive an accessible diagnostic tool. We extracted data regarding study- and diagnostic tool characteristics, and the accuracy of each diagnostic tool. RESULTS The search led to 6419 records, where 74 studies were included, yielding 82 diagnostic tools reported in seven different languages. Among these tools, 35% included patient characteristics, 85% symptoms, 93% physical examinations, 37% vital signs, 78% laboratory values, and 16% imaging. Among the diagnostic tools, 35% relied on a medical doctor/surgeon with access to a laboratory, and six diagnostic tools did not require a bedside medical doctor/surgeon. The median positive predictive value, negative predictive value, sensitivity, and specificity across diagnostic tools were 91%, 94%, 89%, and 86%, respectively. CONCLUSIONS We identified 82 diagnostic tools that most frequently were based on symptoms and physical examinations. Most diagnostic tools relied on a medical doctor/surgeon with access to laboratory values. The accuracy was high across the diagnostic tools.
Collapse
|
15
|
Risk of appendicitis associated with the use of clozapine: A pharmacovigilance study. Asian J Psychiatr 2022; 77:103264. [PMID: 36150349 DOI: 10.1016/j.ajp.2022.103264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/14/2022] [Accepted: 09/14/2022] [Indexed: 11/21/2022]
|
16
|
Ayeni A, Mahmood F, Mustafa A, Mcleish B, Kulkarni V, Singhal S, Akingboye A. Predicting the Severity of Acute Appendicitis in Children Using Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR). Cureus 2022; 14:e28619. [PMID: 36185898 PMCID: PMC9523736 DOI: 10.7759/cureus.28619] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction The ability to predict risk of perforation in acute appendicitis (AA) could direct timely management and reduce morbidity. Platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) are surrogate severity markers in infections. This study investigates the use of PLR and NLR as a marker for distinguishing uncomplicated (UA) and complicated appendicitis (CA) in children. Materials and methods This retrospective single-center study collected data between January 1, 2014, and December 31, 2020. Children between five and 17 years of age with histologically confirmed appendicitis were included. Cut-off values for NLR and PLR were determined by employing the receiver operating characteristic (ROC) curve with sensitivity and specificity in addition to regression analysis. Results A total of 701 patients were included with a median age of 13 years. Out of which 52% of the cohort was female. The difference between the NLR and PLR ratios between UA and CA was significant (p=0.05, Kruskal-Wallis). For UA, the area under the ROC curve (AUC) and cut-off for NLR and PLR were 0.741, 3.80 with 95% CI of 0.701-0.781 and 0.660, 149.25 with 95% CI of 0.618-0.703, respectively. In CA, using NLR and PLR, AUC and cut-off were 0.776, 8.86 with 95%CI of 0.730-0.822 and 0.694, 193.67 with 95%CI of 0.634-0.755, respectively. All were significant with p<0.001. Conclusions NLR and PLR are reliable, synergistic markers predicting complicated appendicitis which can guide non-operative management in children.
Collapse
|
17
|
Does Multisystem Inflammatory Syndrome Only Mimic Acute Appendicitis in Children or Can It Coexist: When Should We Suspect MIS-C? MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081101. [PMID: 36013568 PMCID: PMC9416076 DOI: 10.3390/medicina58081101] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/05/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Acute abdominal pain in children has been noticed to be a primary reason to seek medical attention in multisystem inflammatory disorder (MIS-C), which can prevail separately or together with acute appendicitis. Our aim was to distinguish regular appendicitis cases from MIS-C and to suggest the best clinical and laboratory criteria for it. Materials and methods: Cases of patients, admitted to the Pediatric Surgery Department over a six-month period in 2021, were retrospectively analyzed. Confirmed MIS-C or acute appendicitis cases were selected. MIS-C cases were either separate/with no found inflammation in the appendix or together with acute appendicitis. Acute appendicitis cases were either regular cases or with a positive COVID-19 test. Four groups were formed and compared: A-acute appendicitis, B-MIS-C with acute appendicitis, C-MIS-C only and D-acute appendicitis with COVID-19. Results: A total of 76 cases were overall analyzed: A-36, B-6, C-29 and D-5. The most significant differences were found in duration of disease A—1.4 days, B—4.5 days, C—4 days, D—4 days (p < 0.0001), C reactive protein (CRP) values A-19.3 mg/L B-112.5 m/L, C-143.8 mg/L and D-141 mg/L (p < 0.0001), presence of febrile fever A-13.9%, B-66.7%, C-96.6% and D-40% (p < 0.0001) and other system involvement: A 0%, B 100%, C 100% and D 20%. A combination of these factors was entered into a ROC curve and was found to have a possibility to predict MIS-C in our analyzed cases (with or without acute appendicitis) with an AUC = 0.983, p < 0.0001, sensitivity of 94.3% and specificity of 92.7% when at least three criteria were met. Conclusions: MIS-C could be suspected even when clinical data and performed tests suggest acute appendicitis especially when at least three out of four signs are present: CRP > 55.8 mg, symptoms last 3 days or longer, febrile fever is present, and any kind of other system involvement is noticed, especially with a known prior recent COVID-19 contact, infection or a positive COVID-19 antibody IgG test.
Collapse
|
18
|
Diagnostic, Therapy and Complications in Acute Appendicitis of 19,749 Cases Based on Routine Data: A Retrospective Multicenter Observational Study. J Clin Med 2022; 11:jcm11154495. [PMID: 35956110 PMCID: PMC9369616 DOI: 10.3390/jcm11154495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/30/2022] [Accepted: 07/31/2022] [Indexed: 12/19/2022] Open
Abstract
Background: Acute appendicitis is one of the most common emergencies in general surgery. The gold standard treatment is surgery. Complications may occur during or after an appendectomy. In addition to age, clinically important factors for the outcome after appendicitis seems to be the comorbidities and the stage of the appendicitis at the time of the operation. Large observational data describing these facts are missing. Methods: In this retrospective multicenter observational study, all inpatients over the age of 17 years with a diagnosis of acute appendicitis in 47 hospitals of the Clinotel Hospital Group between 2010 and 2017 were included. Results: A total of 19,749 patients with acute appendicitis were operated on. The number of patients with more than five secondary diagnoses has increased from 8.4% (2010) to 14.5% (2017). The number of secondary diagnoses correlates with the ages of the patients and leads to a significantly longer hospital stay. Computer tomography (CT) has gained in importance in recent years in the diagnosis of acute appendicitis. A total of 19.9% of patients received a CT in 2017. Laparoscopic appendectomy increased from 88% in 2010 to 95% in 2017 (p < 0.001). The conversion rate did not change relevant in the study period (i.e., 2.3% in 2017). Appendicitis with perforation, abscess, or generalized peritonitis was observed in 24.8% of patients. Mortality was 0.6% during the observation period and was associated with age and the number of secondary diagnoses. The analysis is based on administrative data collected primarily for billing purposes, subject to the usual limitations of such data. This includes partially incomplete clinical data. Conclusions: Multimorbidity is increasingly present in patients with acute appendicitis. Mortality is still in an acceptably low range with no increase. A CT scan is necessary for a precise diagnosis in unclear clinical situations to avoid unnecessary operations and was performed more often at the end of the study than at the beginning.
Collapse
|
19
|
The Diagnostic Differentiation Challenge in Acute Appendicitis: How to Distinguish between Uncomplicated and Complicated Appendicitis in Adults. Diagnostics (Basel) 2022; 12:diagnostics12071724. [PMID: 35885627 PMCID: PMC9322371 DOI: 10.3390/diagnostics12071724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/07/2022] [Accepted: 07/12/2022] [Indexed: 11/24/2022] Open
Abstract
(1) Background: How to best define, diagnose and differentiate uncomplicated from complicated acute appendicitis remains debated. Hence, the aim of this review was to present an overview of the current knowledge and emerging field of acute appendicitis with a focus on the diagnostic differentiation of severity currently subject to ongoing investigations. (2) Methods: We conducted a PubMed search using the MeSH terms “appendicitis AND severity” and “appendicitis AND classification”, with a focus on studies calling appendicitis as ‘uncomplicated’ or ‘complicated’. An emphasis on the last 5 years was stressed, with further studies selected for their contribution to the theme. Further studies were retrieved from identified full-text articles and included per the authors’ discretion. (3) Results: The assumption that appendicitis invariably will proceed to perforation has been outdated. Both uncomplicated and complicated appendicitis exist with likely different pathophysiology. Hence, this makes it important to differentiate disease severity. Clinicians must diagnose appendicitis, but, in the next step, also differentiate between uncomplicated and complicated appendicitis in order to allow for management decisions. Diagnostic accuracy without supportive imaging is around 75–80% and, based on clinical judgement and blood tests alone, the negative appendectomy rate has been described as high as 36%. More research is needed on available biomarkers, and the routine use of imaging still remains debated. Scoring systems have the potential to improve diagnostic accuracy, but no scoring system has yet been validated for differentiating disease severity. Currently, no universally agreed definition exists on what constitutes a complicated appendicitis. (4) Conclusions: Uncomplicated and complicated appendicitis appear to have different pathophysiology and should be treated differently. The differentiation between uncomplicated and complicated appendicitis remains a diagnostic challenge.
Collapse
|
20
|
Hyperbilirubinemia and Hyponatremia as Predictors of Complicated Appendicitis. Med Sci (Basel) 2022; 10:medsci10030036. [PMID: 35893118 PMCID: PMC9326721 DOI: 10.3390/medsci10030036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/25/2022] [Accepted: 06/30/2022] [Indexed: 11/16/2022] Open
Abstract
Several studies have reported elevated serum bilirubin or reduced serum sodium levels in patients with complicated appendicitis (CA). This study examined the efficacy of hyperbilirubinemia, hyponatremia, and both combined in the preoperative diagnosis of CA. Patients who underwent surgery for acute appendicitis were included in this retrospective review. In total, 247 patients were included in the final analysis. Of these, 36 (14.2%) had early appendicitis, 177 (72.0%) had acute suppurative appendicitis, 32 (13.0%) had necrotizing/gangrenous acute appendicitis, and 2 (0.8%) had other types of appendicitis. The mean total bilirubin (TBIL) level was significantly higher in patients with CA than in those with uncomplicated appendicitis. Conversely, the mean serum sodium level was significantly lower in patients with CA than in those with uncomplicated appendicitis. The levels of TBIL (odds ratio: 1.098, 95% CI: 1.052–1.147) and serum sodium (odds ratio: 0.743, 95% CI: 0.646–0.855) were associated with CA. Hyponatremia combined with hyperbilirubinemia yielded significant discriminatory value for the diagnosis of CA. TBIL and serum sodium levels can be considered as adjuvant parameters in the diagnosis of perforated/necrotizing appendicitis. Although hyperbilirubinemia and hyponatremia together were better able to determine the risk of CA than either marker alone, other markers are required to definitively predict CA. Furthermore, large-scale studies are needed to confirm these findings.
Collapse
|
21
|
Lluís N, Parra J, Villodre C, Zapater P, Jalali A, Cantó M, Mena L, Ramia JM, Lluís F. Prediction of peritoneal soiling in acute appendicitis with simple clinical and laboratory data. Prospective, multicenter, cohort study of 2,645 adult patients nationwide. Int J Surg 2022; 104:106741. [PMID: 35772594 DOI: 10.1016/j.ijsu.2022.106741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/24/2022] [Accepted: 06/16/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND AIMS In order to facilitate the preoperative prediction of complicated appendicitis, we propose a complementary approach by selecting an endpoint defined by the intraoperative finding of peritoneal soiling (PS). METHODS Over a 6-month period, 38 centers (5% of all public hospitals) attending emergency general surgery patients on a 24-hour, 7-days a week basis, enrolled consecutive adult patients requiring appendectomy. Patients were stratified according to the absence or the finding of PS during the surgical procedure. RESULTS A total of 2645 patients were included; median age (IQR) was 35 (22-51) years, 44.3% were female. The laparoscopic approach was used in 70.8% of appendectomies. In a third of patients (31.7%), there was PS with pus around the appendix, or bowel contents, free pus, or blood in the peritoneal cavity. To develop the prediction model, 1764 patients were randomly selected for the derivation cohort and the remaining 881 patients were assigned to the validation cohort. On multivariable logistic regression analysis of all patients, two clinical variables (age, and pulse) and three laboratory variables (serum urea, serum sodium, and white blood cell count) were individually associated (P < .05) with a greater probability of having PS (Hosmer-Lemeshow chi, 1.63; P = .99; C-statistic, 0.7). Based on the multivariable regression model, both static and dynamic nomograms were developed for the prediction of PS in patients with acute appendicitis. CONCLUSIONS The entry of simple clinical and laboratory variables in the dynamic nomogram may be useful in guiding the initial management of patients with acute appendicitis in resource-limited settings.
Collapse
Affiliation(s)
- N Lluís
- Hepatobiliary and Pancreas Surgery, Department of Surgical Oncology, Miami Cancer Institute, Miami, FL, USA
| | - J Parra
- Department of Surgery, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
| | - C Villodre
- Department of Surgery, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain.
| | - P Zapater
- Department of Clinical Pharmacology, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
| | - A Jalali
- School of Mathematical Sciences, University College Cork, Cork, Ireland
| | - M Cantó
- Computing, BomhardIP, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
| | - L Mena
- Department of Clinical Documentation, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
| | - J M Ramia
- Department of Surgery, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
| | - F Lluís
- Department of Surgery, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
| | | |
Collapse
|
22
|
The role of neutrophil-to-lymphocyte ratio as an outcome predictor factor in acute appendicitis: a single medical center’s experience. REV ROMANA MED LAB 2022. [DOI: 10.2478/rrlm-2022-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract
Introduction: Acute abdominal pain persists in defying modern diagnostic procedures. Inflammatory response variables in urine and blood tests can help rule out other disorders and support a clinical diagnosis of acute appendicitis (AA), but there is no specific blood test that can diagnose AA. In order to address this, our study sought to establish the value of (NLR) as a prognostic and severity predictor in patients with AA.
Material and method: We conducted an observational retrospective study of 356 patients who had undergone surgery for AA, assessing NLR as an outcome metric. The NLR was estimated using the differential WBC (white blood count) reported on admission; the data obtained were then recorded in a database and statistically analyzed.
Results: The NLR medians correlated (p<0.001) in uncomplicated AA, AA with localized peritonitis, and AA with generalized peritonitis (Kruskal-Wallis test). The ROC curve identified 81.4 % sensitivity, 62.5 % specificity, and a 73 % AUC in localized peritonitis. The NLR value was associated with generalized peritonitis with a sensitivity of 63.7 %, specificity of 64.3 %, and AUC of 68.2%. The NLR-patient death association had 100% sensitivity, 80.3% specificity, and 93.5 AUC.
Conclusion: NLR determination in individuals with acute appendicitis may be useful in predicting complications. NLR values greater than 7.86 are usually related with generalized peritonitis, while values larger than 12.9 may predict an increased risk of patient death. Calculating NLR from a complete blood count is a straightforward and cost-effective method of analyzing complicated AA in resource-constrained settings.
Collapse
|
23
|
Yalcin A, Demir B, Demir M, Firinci B, Polat G, Pirimoglu B, Sade R. Association of Gallbladder Volume and Wall Thickness With Acute Appendicitis in Pediatric Patients. Pediatr Emerg Care 2022; 38:e443-e446. [PMID: 35100748 DOI: 10.1097/pec.0000000000002625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Ultrasonography in a child with suspected appendicitis is primarily performed to detect inflamed appendix, whereas secondary findings are important in patients with a nonvisualized appendix. The aim of this study is to evaluate the gallbladder wall thickness and volume in patients with suspected appendicitis and search an association between these parameters and appendicitis. METHODS Between January 2018 and August 2018, 113 patients with suspected appendicitis were included in this prospective study. Gallbladder and right lower quadrant were evaluated in separate sessions by different radiologists. The wall thickness along with the width, length, and height of the gallbladder was measured and recorded for each patient. Assessment of the appendix was classified as acute appendicitis, normal, and equivocal. Statistically significant association was sought between the thickness of the gallbladder wall and diagnosis of appendicitis. RESULTS Gallbladder wall thickness was significantly higher in patients without appendicitis (P = 0.017), whereas significantly increased gallbladder volume was observed in patients with appendicitis (P = 0.004). Receiver operating characteristic analysis showed gallbladder wall thickness threshold of 0.5 mm with a sensitivity of 83.3, specificity of 93.9, and volume threshold of 41.6 mL with a sensitivity of 100 and a specificity of 0.69. CONCLUSIONS Gallbladder wall thickness and volume measurements were associated with the diagnosis of appendicitis in pediatric patients.
Collapse
Affiliation(s)
- Ahmet Yalcin
- From the Department of Radiology, Faculty of Medicine, Erzincan University
| | - Berrin Demir
- Section of Radiology, Palandoken Government Hospital
| | - Muhammed Demir
- Section of Pediatric Surgery, Education and Research Hospital
| | - Binali Firinci
- Department of Pediatric Surgery, Faculty of Medicine, Ataturk University
| | - Gokhan Polat
- Department of Radiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Berhan Pirimoglu
- Department of Radiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Recep Sade
- Department of Radiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| |
Collapse
|
24
|
The Dynamics of Inflammatory Markers in Patients with Suspected Acute Appendicitis. Medicina (B Aires) 2021; 57:medicina57121384. [PMID: 34946329 PMCID: PMC8709480 DOI: 10.3390/medicina57121384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/12/2021] [Accepted: 12/15/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Laboratory tests of inflammatory mediators are routinely used in the diagnosis of acute appendicitis (AA). The aim of this study was to evaluate the differences of dynamics of inflammatory markers of the blood in patients with suspected acute appendicitis between complicated AA (CAA), non-complicated AA (NAA), and when AA was excluded (No-AA). Methods: This was a retrospective analysis of prospectively collected data of patients presented to the Emergency Department (ER) of a tertiary hospital center during a three-year period. All patients suspected of acute appendicitis were prospectively registered from 1 January 2016 to 31 December 2018. The dynamics of inflammatory markers of the blood between different types of AA (No-AA, NAA or CAA) during different periods of time are presented. Results: A total of 453 patients were included in the study, with 297 patients in the No-AA group, 99 in the NAA group, and 57 in the CAA group. White blood cell (WBC) count in the No-AA decreased with time, with a statistically significant difference between the <8 h and 25–72 h group. The neutrophils (NEU) percentage decreased in the No-AA group and was statistically significantly different between the <8 h and 25–72 h and <8 h and >72 h groups. C-reactive protein (CRP) increased significantly in the No-AA group throughout all time intervals, and from the first 24 h to the 25–72 h in the NAA and CAA groups. There was a statistically significant difference between the WBC count between No-AA, NAA, and No-AA and CAA groups during the first 24 and 24–48 h. There was a statistically significant difference between NEU percentage and LYMP percentage and in the NEU/LYMP ratio between No-AA and CAA groups through all time periods. CRP was significantly higher in the first 24 h in the CAA than in the No-AA group, and in the 24–48 h in the CAA group than in the No-AA and NAA groups. The linear logistic regression model, involving inflammatory mediators and clinical characteristics, showed mediocre diagnostic accuracy for diagnosing AA with an AUC of 0.737 (0.671–0.802). Conclusions: Increasing concentrations of inflammatory markers are more characteristic in CAA patients than in No-AA during the first 48 h after onset of the disease. A combination of laboratory tests with clinical signs and symptoms has a mediocre diagnostic accuracy in suspecting AA.
Collapse
|
25
|
Abstract
Abdominal pain is the most common chief complaint in the Emergency Department. Abdominal pain is caused by a variety of gastrointestinal and nongastrointestinal disorders. Some frequently missed conditions include biliary pathology, appendicitis, diverticulitis, and urogenital pathology. The Emergency Medicine clinician must consider all aspects of the patient's presentation including history, physical examination, laboratory testing, and imaging. If no diagnosis is identified, close reassessment of pain, vital signs, and physical examination are necessary to ensure safe discharge. Strict verbal and written return precautions should be provided to the patient.
Collapse
Affiliation(s)
- Maglin Halsey-Nichols
- University of North Carolina at Chapel Hill, Houpt Building (Physician Office Building) Suite 1116, 170 Manning Drive- CB-7594, Chapel Hill, NC 27599-7594, USA.
| | - Nicole McCoin
- Department of Emergency Medicine, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA 70121, USA
| |
Collapse
|
26
|
Yigit B, Cerekci E, Cakir Y, Citgez B. Efficacy of Preoperative Imaging Features and Blood Tests in Predicting the Increased Risk of Conversion in Laparoscopic Appendectomy Surgery. Cureus 2021; 13:e17092. [PMID: 34527479 PMCID: PMC8432436 DOI: 10.7759/cureus.17092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 11/24/2022] Open
Abstract
Background In this study, we identified preoperative risk factors, including imaging features and blood tests, to predict conversion from laparoscopic appendectomy to open appendectomy. Thus, we aimed to prevent patients from being exposed to the risks of laparoscopy by choosing patients for whom proceeding directly to an open surgery as an initial approach was appropriate. Patients and methods The cohort of 632 patients who underwent laparoscopic appendectomy due to acute appendicitis in our center between January 2017 and March 2021 were analyzed, and 521 of these patients comprised the study population. Baseline characteristics, medical history, preoperative laboratory tests, imaging features, and postoperative pathologic findings of all patients according to groups who underwent laparoscopic appendectomy or conversion to open appendectomy were examined. Results Among 521 patients, the appendectomy procedure was completed laparoscopically in 498 (95.6%) patients, and conversion to open appendectomy was occurred in 23 (4.4%) patients. 223 (42.8%) patients were female, and 298 (57.2%) patients were male. The mean age of all patients was 35.17±12.61 years (range, 16-80 years). Preoperative ultrasonography feature associated with a higher rate of conversion was free fluid collection (p=0.001). The levels of C-reactive protein, neutrophil, and neutrophil/lymphocyte ratio on admission were found to be significantly higher in the conversion group compared to the laparoscopy group (p=0.001, p=0.027, p=0.02, respectively). Conclusions Free fluid collection detected by ultrasonography, and elevation of C-reactive protein, neutrophil, and neutrophil/lymphocyte ratio may be useful in the prediction of a high risk of conversion appendectomy. Despite the unquestionable advantages of laparoscopic surgery, there are still substantial conversion rates. Within this framework, our study will help the surgeons to choose the most appropriate surgical methods for patients by evaluating them individually, and to inform them of the possibility of conversion to the open approach, and other risks before surgery.
Collapse
Affiliation(s)
- Banu Yigit
- General Surgery, Elazig Fethi Sekin City Hospital, Elazig, TUR
| | - Esma Cerekci
- Radiology, Sisli Hamidiye Etfal Medical Practice and Research Center, University of Health Sciences, Istanbul, TUR
| | - Yasin Cakir
- General Surgery, Sisli Hamidiye Etfal Medical Practice and Research Center, University of Health Sciences, Istanbul, TUR
| | - Bulent Citgez
- General Surgery, Sisli Hamidiye Etfal Medical Practice and Research Center, University of Health Sciences, Istanbul, TUR
| |
Collapse
|
27
|
Di Vincenzo AO, Parmeggiani A, Casavola M, Leonardo S, Golfieri R. An asymptomatic detachment of the appendix evolved to giant abscess and complete colliquative necrosis: pivotal role of computed tomography in patient management. BJR Case Rep 2021; 7:20200125. [PMID: 33841902 PMCID: PMC8008465 DOI: 10.1259/bjrcr.20200125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/28/2020] [Accepted: 11/25/2020] [Indexed: 11/29/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Anna Olga Di Vincenzo
- Department of Radiology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Anna Parmeggiani
- Department of Radiology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Mario Casavola
- Department of Radiology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Stefano Leonardo
- Department of Radiology, Azienda USL di Imola, Santa Maria della Scaletta Hospital, Imola, Italy
| | - Rita Golfieri
- Department of Radiology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| |
Collapse
|
28
|
MoulaBux K, Parveen S, Iqbal M, Mehboob A. The effect of acute complicated appendicitis on liver function test. Pak J Med Sci 2021; 37:351-354. [PMID: 33679912 PMCID: PMC7931276 DOI: 10.12669/pjms.37.2.3356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives To determine the diagnostic role of hyperbilirubinemia in acute appendicitis like suppurative and gangrenous appendicitis. Methods This observational study was conducted at Ward-3, Jinnah Postgraduate Medical Center (JPMC), Karachi from 1st June 2019 to 1st June 2020. Males and females above 12 years of age were included. Serum liver function tests and leukocyte counts were carried out. Appendectomies were done, the operative findings and histopathology reports were noted. Hyperbilirubinemia was related with the stages of appendicitis. Results were analyzed by SPSS version 25. Results There were one hundred twenty patients. Thirty-eight (31.66%) were females and eighty-two (68.33%) were males. Age range was 13 to 60 years. Ten patients (8.33%) were between 13 - 20 years, sixty five (54.16%) were 21 to 30 years, thirty (25%) were 31 - 40 years, ten (8.33%) were 41 - 50 years and five patients (4.17%) were above 50 years of age. Sixty-two (51.66%) patients had simple appendicitis and fifty-four (45%) had complicated appendicitis like suppurative (26.66%) and (16.66%) gangrenous appendicitis. Negative appendectomy was found in four (3.33%). Hyperbilirubinemia was found (100%) in gangrenous, (94.12%) in suppurative and (12.3%) in catarrhal appendicitis. Enzymes like Alanine transaminase and Aspartate transaminase were raised (50%) in gangrenous, (50%) in suppurative and (9.67%) in catarrhal appendicitis. TLC was raised in 112 (96.55%) out of 116 patients and total leukocyte count was normal in negative appendectomies. Conclusions It is concluded that hyperbilirubinemia is strong diagnostic predictor for complicated appendicitis.
Collapse
Affiliation(s)
- Kulsoom MoulaBux
- Dr. Kulsoom MoulaBux, MBBS, FCPS-I. Department of General Surgery, Ward-3, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Sughra Parveen
- Dr. Sughra Parveen, MBBS, FCPS, FRCS. Department of General Surgery, Ward-3, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Mazhar Iqbal
- Dr. Mazhar Iqbal, MBBS, FCPS. Department of General Surgery, Ward-3, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Ayesha Mehboob
- Dr. Ayesha Mehboob, MBBS, FCPS-I. Department of General Surgery, Ward-3, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| |
Collapse
|
29
|
Petroianu A, Barroso TVV, Buzelin MA, Theobaldo BDM, Tafuri LSDA. Neuroendocrine apendicopathy in morphologically normal appendices of patients with diagnosis of acute appendicitis: Diagnostic study. Ann Med Surg (Lond) 2020; 60:344-351. [PMID: 33224488 PMCID: PMC7666303 DOI: 10.1016/j.amsu.2020.10.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/19/2020] [Indexed: 01/16/2023] Open
Abstract
Background About 15%–25% of appendices removed to treat acute appendicitis present normal macro- and macroscopic morphology. The objective of this study was to verify an association of proinflammatory, neuroendocrine and immune mediators with morphologically normal appendices removed from patients with clinical laboratorial and imaging characteristics of acute appendicitis. Materials and methods Appendices removed from 121 adult patients of both genders were distributed into three groups according to their following characteristics: group 1: 53 macro- and microscopically normal appendices from patients with clinical, laboratorial and imaging diagnosis of acute appendicitis; group 2: 24 inflamed appendices from patients with clinical, laboratorial, imaging and histopathological diagnosis of acute appendicitis; group 3: 44 normal appendices from patients submitted to right colectomy to treat localized ascending colon adenocarcinoma. All appendices were immunohistochemically studied for gastrin inhibitor peptide, mast cell tryptase, vascular endothelial growth factor; intestinal vasoactive peptide, tumor necrosis factor alpha, interleukin 1, prostaglandin E2, gene-protein product 9.5, CD8 T lymphocytes, synaptophysine, enolase, and S100 protein. Results The group 1 revealed increased levels of synaptophysine, enolase, mast cell tryptase and PGP-9.5 comparing with the other two groups. The group 2 presented increased levels of interleukin 1, CD8 T lymphocytes and prostaglandin E2 comparing with the other two groups. The group 3 confirmed the normal levels of all these neuroendocrine, immune and proinflammatory mediators. Conclusions Morphologically normal appendices removed from patients with clinical and complementary exams indicating acute appendicitis have appendicular neuroimmunoendocrine disorder associated with the mediators synaptophysin, enolase, mast cell-related tryptase and gene-protein product 9.5. 15 % to 25% of the appendices removed to treat acute appendicitis have normal appearance with no inflammatory signs. All patients with normal appendices removed due to acute appendicitis do not present similar clinical manifestation anymore. Inflammatory and neuroendocrine appendicopathies present similar clinical laboratorial and imaging characteristics. Morphologically normal appendices removed from patients indicating acute appendicitis have neuroimmunoendocrine disorders. Synaptophysin, enolase, mast cell tryptase and gene-protein product 9.5 are associated with neuroimmunoendocrine disorders.
Collapse
Key Words
- Appendicitis
- CD8, CD8 T lymphocytes
- Diagnosis
- G1, group 1
- G2, group 2
- G3, group 3
- GIP, gastrin inhibitor peptide
- Histology
- IL-1, interleukin 1
- Immunohistochemistry
- Neuroendocrine peptide
- Neuroimmune peptide
- PGE-2, prostaglandin E 2
- PGP 9.5, gene-protein product 9.5
- TNFα, tumor necrosis factor alpha
- Tryptase, mast cell-related tryptase
- VEGFA, vascular endothelial growth factor
- VIP, intestinal vasoactive peptide
Collapse
Affiliation(s)
- Andy Petroianu
- Department of Surgery, School of Medicine, Federal University of Minas Gerais, Brazil
| | | | | | | | | |
Collapse
|
30
|
Keohane D, O'Leary P, Nagle M, Cichelli K, McCormack T. A Correlation of Blood Panel Results and Histologically Confirmed Appendicitis. Cureus 2020; 12:e10641. [PMID: 33133811 PMCID: PMC7586359 DOI: 10.7759/cureus.10641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Appendicitis is the most common indication for emergency surgery in the world. There is no one laboratory or radiological test that is used to diagnose it. Various routine and novel blood markers have been identified, however none have proved to be conclusive. The aim of this study was to combine routine blood markers to increase the sensitivity and specificity in diagnosing histologically confirmed appendicitis. Methods We retrospectively reviewed the theatre logs for the calendar year of 2015 to identify all of the appendectomies which were performed. We reviewed all of the admission bloods for the patients - including their white blood cell (WBC) count, their neutrophil count, and their C-Reactive protein (CRP) value. We also reviewed all of the histology to identify the inflamed appendices, and analysed all of this information together. Results The neutrophil count is the most sensitive of the three blood markers with a score of 82%. It has a specificity of 63%. The CRP value is the most specific of the three blood markers with a value of 67% and a sensitivity of 76%. WBC has a sensitivity of 75% and a specificity of 63%. Combining all of the blood values (i.e. elevated white blood cell count or elevated neutrophil count or elevated CRP) demonstrates a sensitivity of 96% and a specificity of 45%. Conclusion Combining routine admission blood markers (WBC, neutrophil count, and CRP) can assist in diagnosing appendicitis in unwell patients with abdominal pain.
Collapse
Affiliation(s)
- David Keohane
- General Surgery, University Hospital Kerry, Tralee, IRL
| | - Peter O'Leary
- General Surgery, Cork University Hospital, Cork, IRL
| | | | - Kim Cichelli
- Internal Medicine, Medical University of South Carolina, Charleston, USA
| | - Tom McCormack
- General Surgery, University Hospital Kerry, Tralee, IRL
| |
Collapse
|
31
|
Mackay TG, Dissanayake B, Yuide PJ, Burstow MJ, Gundara JS, Chua TC. Cohort study of 1241 patients to identify predictors of negative appendicectomy. ANZ J Surg 2020; 90:1984-1990. [PMID: 32808480 DOI: 10.1111/ans.16203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/01/2020] [Accepted: 07/09/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Acute Appendicitis is the most common surgical presentation within Australia. Despite the increasing use of radiological investigations to aid clinical diagnosis, many appendectomies result in a histologically normal appendix. This study examines the histological negative appendicectomy rate (NAR) in a metropolitan hospital and determine factors associated with a negative appendicectomy (NA). METHODS Patients who underwent emergency appendicectomy for suspected acute appendicitis at Logan Hospital, Australia, between February 2016 and March 2019 inclusive were included. Clinicopathologic and imaging variables were analysed for associations with NA. RESULTS A total of 1241 patients underwent emergency appendicectomy of which 121 patients (9.8%) had a NA. The NAR for clinical diagnosis alone (no imaging) was 9.9%, 14.5% for ultrasonography alone and computed tomography scan alone was 4.9%. Univariate analysis revealed age <27 years (P < 0.001), absence of hypertension (P = 0.008), symptoms >48 hours (P < 0.001), absence of leucocytosis (P < 0.001), undergoing ultrasonography only (P < 0.001), undergoing computed tomography scan only (P < 0.001), macroscopically normal appendix (P < 0.001) and time to operation >24 hours (P < 0.001) were associated with NA. Multivariate analysis identified symptoms >48 h at presentation (odds ratio (OR) 1.98, 95% confidence interval (CI) 1.20-3.24; P = 0.007), absence of leucocytosis (OR 2.41, 95% CI 1.52-3.81; P < 0.001) and macroscopically normal appendix (OR 5.70, 95% CI 3.49-9.33; P < 0.001) to be associated with a NA. CONCLUSION The NAR reported is lowest in an Australian institution. The identified predictors of NA will be useful in identifying patients who would truly benefit from an appendicectomy versus those would have a higher rate of NA who may be suitable to be treated non-operatively to be spared the unnecessary morbidity of surgery.
Collapse
Affiliation(s)
- Thomas G Mackay
- Division of Surgery, Logan Hospital, Metro South Health, Logan, Queensland, Australia.,Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - Bhanuka Dissanayake
- Division of Surgery, Logan Hospital, Metro South Health, Logan, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Peter J Yuide
- Division of Surgery, Logan Hospital, Metro South Health, Logan, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Matthew J Burstow
- Division of Surgery, Logan Hospital, Metro South Health, Logan, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Justin S Gundara
- Division of Surgery, Logan Hospital, Metro South Health, Logan, Queensland, Australia.,Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Terence C Chua
- Division of Surgery, Logan Hospital, Metro South Health, Logan, Queensland, Australia.,Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| |
Collapse
|
32
|
Gelpke K, Hamminga JTH, van Bastelaar JJ, de Vos B, Bodegom ME, Heineman E, Hofker HS, El Moumni M, Haveman JW. Reducing the negative appendectomy rate with the laparoscopic appendicitis score; a multicenter prospective cohort and validation study. Int J Surg 2020; 79:257-264. [PMID: 32387211 DOI: 10.1016/j.ijsu.2020.04.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 04/05/2020] [Accepted: 04/15/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Approximately nine percent of all acute appendectomies are unintentionally performed on a normal appendix. Failure of treatment (negative appendectomy or missed appendicitis) is associated with higher morbidity and mortality when compared to appendectomy for uncomplicated appendicitis. The Laparoscopic APPendicitis (LAPP) score was developed in order to systematically evaluate the appendix for the presence of inflammation. This study aims to determine whether the LAPP score reduces the negative appendectomy rate without missing appendicitis. METHODS From September 2013 through May 2016, 322 adult patients presenting with a clinical suspicion of acute appendicitis and an indication for diagnostic laparoscopy were included and analyzed in this multicenter prospective validation study. Depending on the LAPP score, the appendix was either removed (n = 300) or left in situ (n = 22). These patients were compared to a historical control group of 584 patients treated at the same hospitals. The appendix was examined by a pathologist and the negative appendectomy rate was calculated. RESULTS The negative appendectomy rate was significantly lower when the LAPP score was used (4,7% vs. 8,4%; P = 0,034). None of the patients with a negative LAPP score, in which the appendix remained in situ, developed acute appendicitis within three months. There were no significant differences in operation time, complications, or readmissions. Using the LAPP score was associated with significantly higher rates of preoperative radiological imaging (98% vs. 70%; P < 0,001). After adjusting for covariables, including radiological imaging, use of the LAPP score led to fewer treatment failures when compared to not using the LAPP score (OR: 0,48, 95% C.I. 0,251 to 0,914; P = 0,025). CONCLUSION The LAPP score is a safe and simple tool to reduce the negative appendectomy rate during laparoscopic surgery without missing cases of acute appendicitis.
Collapse
Affiliation(s)
- Koen Gelpke
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jenneke T H Hamminga
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - James J van Bastelaar
- Department of Surgery, Zuyderland Medical Center, Sittard-Geleen & Heerlen, the Netherlands
| | - Bart de Vos
- Department of Surgery, Wilhelmina Hospital, Assen, the Netherlands
| | - Maarten E Bodegom
- Department of Surgery, Bethesda Hospital, Hoogeveen, the Netherlands
| | - Erik Heineman
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - H Sijbrand Hofker
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Mostafa El Moumni
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jan Willem Haveman
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| |
Collapse
|
33
|
ERTAN N, AKDAĞ T, SUBAŞI İD, KAYA İO, HEKİMOGLU B. Can Appendix Bending Angle Be An Additional Finding To Detect Acute Appendicitis On MDCT? ACTA MEDICA ALANYA 2020. [DOI: 10.30565/medalanya.622116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
34
|
Cacciatori FA, Ronchi AD, Sasso SE. Outcomes prediction score for acute abdomen: a proposal. Rev Col Bras Cir 2020; 46:e20192285. [PMID: 32022109 DOI: 10.1590/0100-6991e-20192285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 09/11/2019] [Indexed: 04/11/2023] Open
Abstract
OBJECTIVE to establish a correlation between objective data collected at the initial evaluation and the outcomes in cases of acute abdominal pain. METHODS we conducted a retrospective, case-control study in which we reviewed medical records of patients treated at an emergency room in 2016, diagnosed with abdominal and pelvic pain. RESULTS of the 2,352 medical records evaluated, we considered 330 valid for the study. Of these patients, 235 (71.2%) were discharged and the remaining 95 (28.8%) were hospitalized, submitted to surgery, or died. The statistical analysis demonstrated that male gender, age ≥50, axillary temperature >37.3ºC, anemia, leukocytosis >10,000/mm3, neutrophil count above 7,700/mm3, lymphocyte count less than 2,000/mm3 and hyperamylasemia were variables in independently associated with worse outcome. CONCLUSION the presence of three or more of the evaluated variables greatly increases the chances of a patient suffering the outcomes of surgery or death, the chance of death being greater the greater the number of variables present.
Collapse
Affiliation(s)
- Felipe Antônio Cacciatori
- Universidade do Extremo Sul Catarinense (UNESC), Curso de Medicina, Criciúma, SC, Brasil.,Hospital São José, Serviço de Cirurgia Geral, Criciúma, SC, Brasil
| | - Arthur Dajori Ronchi
- Universidade do Extremo Sul Catarinense (UNESC), Curso de Medicina, Criciúma, SC, Brasil.,Hospital São José, Serviço de Anestesiologia, Criciúma, SC, Brasil
| | - Sérgio Emerson Sasso
- Universidade do Extremo Sul Catarinense (UNESC), Curso de Medicina, Criciúma, SC, Brasil
| |
Collapse
|
35
|
Factors influencing surgical management of acute appendicitis in a large university hospital without a dedicated emergency theatre. Ir J Med Sci 2019; 189:649-653. [PMID: 31773540 DOI: 10.1007/s11845-019-02135-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/05/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Acute appendicitis is the most common surgical emergency. Its management reflects the efficacy of acute care surgery. Limited theatre space is an escalating issue, especially without dedicated emergency theatre access. Pre-operative delays are associated with longer length of stay, higher costs and post-operative complications. AIMS Calculate time to theatre (TTT) from admission to appendicectomy and investigate factors impacting TTT. METHODS A retrospective review of all emergency appendicectomies from June 2017 to October 2018. Demographic, clinico-pathological and radiological data were extracted from electronic patient record. RESULTS One hundred forty-eight patients underwent emergency appendicectomy during the study period. Fifty-six percent (n = 84) were male, and the median (range) age was 30.5 (17-76) years. Sixty-one percent had pre-operative imaging. The median (range) TTT was 18.37 (2-114) h; 7.5% (n = 11) waited > 48 h, 29.7% (n = 44) were operated on after 8 p.m. and 26% (n = 38) were done on elective lists. Male gender, admission CRP > 100 and admission before 12 p.m. significantly shortened TTT (p = 0.030, p = 0.004 and p = 0.001, respectively). However, pre-operative ultrasound, previous acute appendicitis and surgery on an elective list significantly prolonged TTT (p = 0.015 and p = 0.024, respectively). The median (range) LOS was 3 (1-24) nights. Ten percent (n = 15) had post-operative complications; however, longer TTT was not associated with higher complication rates (p = 0.196). CONCLUSIONS This review highlights the impact of limited theatre access for on-call emergency admissions, with a significant portion of appendicectomies being done on elective lists or out-of-hours.
Collapse
|
36
|
The utility of the speed bump sign for diagnosing acute appendicitis. Am J Emerg Med 2019; 38:1551-1553. [PMID: 31466911 DOI: 10.1016/j.ajem.2019.158406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 08/18/2019] [Accepted: 08/19/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Acute appendicitis is the most common abdominal complaint in the emergency department. This study was made in order to determine whether there is any evidence to support the practice of inquiring about pain over speed bumps in patient suspected to have acute appendicitis and to discover its predictive power as a diagnostic sign. METHOD A prospective study was conducted in the emergency department of Al Ain Hospital over one year. A convenient sample of 100 consecutive adult patients over the age of 15 years who presented with an abdominal pain and symptoms suggestive of acute appendicitis were recruited over the study period. They all underwent questionnaire of whether they had pain, or their pain increased while they travelled over speed bumps. RESULTS The study shows that 80 of the 90 participants were "speed bump positive." Eighty-five had a confirmed diagnosis of appendicitis, 77 of whom had worsened pain over speed bumps, giving a sensitivity of 90.5% and a specificity of 40%. The positive predictive value was 96.25% and the negative predictive value was 20%. The likelihood ratios were 1.5 for a positive test result and 0.23 for a negative result. CONCLUSION The pain over speed bump can be considered as a significant "rule out" criterion of appendicitis due to the high sensitivity observed in this study. However, with its low specificity, many patients with this sign would not undoubtedly have appendicitis, meaning it is a poor "rule-in" test.
Collapse
|
37
|
Sepas HN, Negahi A, Mousavie SH, Nasiri M. Evaluation of the Potential Association of Platelet Levels, Mean Platelet Volume and Platelet Distribution Width with Acute Appendicitis. Open Access Maced J Med Sci 2019; 7:2271-2276. [PMID: 31592065 PMCID: PMC6765097 DOI: 10.3889/oamjms.2019.244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND: The occurrence and early management of acute appendicitis among children are especially important due to the difficult diagnosis and nonspecific symptoms of the disease. Diagnosis of appendicitis in children is very difficult due to similarity of its symptoms to other diseases, and also its self-limiting nature Platelet indexes such as mean platelet volume (MPV) and platelet distribution width (PDW) have been suggested as a biomarker of inflammation. AIM: Therefore, we examined the association of MPV and PDW with acute appendicitis in children. METHODS: This cross-sectional study was conducted on 464 patients with suspected acute appendicitis under the age of 18 years referred to the specialised hospitals of the ten studied provinces between October 2014 and October 2015. All data obtained regarding patient’s lab tests, i.e. platelet count, MPV and PDW and also radiological studies and surgical reports were gathered in datasheets and analysed to evaluate the potential association of platelet levels, mean platelet volume (MPV) and platelet distribution width (PDW) with acute appendicitis RESULTS: Our results showed that the MPV was significantly higher in acute appendicitis in comparison to perforated appendicitis as well as acute gangrenous appendicitis. PDW was significantly higher in acute appendicitis in comparison to perforated appendicitis and acute gangrenous appendicitis. The current project indicated that PDW < 10.05 had a sensitivity of 35% and specificity of 75%, platelet count < 229500 had a sensitivity of 24% and specificity of 75% and MPV < 8.95 had a sensitivity of 70% and specificity of 71%. CONCLUSION: Our study suggested that platelet indexes such as MPV and PDW could significantly correlate with acute appendicitis in pediatric patients. Hence, we believe that both MPV and PDW could use as a simple and low-cost lab test for diagnosing acute appendicitis. Also, this study revealed that the MPV lower than 8.95 could be a novel index for diagnosing acute appendicitis with sensitivity of 70% and specificity of 71%.
Collapse
Affiliation(s)
- Hossein Najd Sepas
- Department of Vascular Surgery, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Negahi
- Department of General Surgery, Rasool-e-Akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Seyed Hamzeh Mousavie
- Department of General Surgery, Rasool-e-Akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Mohammad Nasiri
- Department of General Surgery, Rasool-e-Akram Hospital, Iran University of Medical Science, Tehran, Iran
| |
Collapse
|
38
|
Lee WH, O'Brien S, Skarin D, Cheek JA, Deitch J, Nataraja R, Craig S, Borland ML. Accuracy of clinician gestalt in diagnosing appendicitis in children presenting to the emergency department. Emerg Med Australas 2019; 31:612-618. [PMID: 30665265 DOI: 10.1111/1742-6723.13220] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 11/09/2018] [Accepted: 11/29/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Abdominal pain is a common paediatric presentation to the ED. Accurate diagnosis of acute appendicitis is challenging, with the best-performing clinical scoring systems having sensitivities between 72% and 100%. The aim of this study is to assess the diagnostic accuracy of clinician gestalt according to seniority in diagnosing paediatric acute appendicitis in ED. METHODS This is a prospective multi-centre observational study of clinician's prediction of appendicitis in children under the age of 16 years presenting to four EDs with abdominal pain over a 1 month period at each site. Clinician-estimated likelihood of acute appendicitis was compared with the final diagnosis determined by histopathology or operative findings and supplemented by telephone follow up for those without an operation. The primary outcome was diagnostic accuracy of clinician gestalt according to clinician seniority in diagnosing appendicitis. RESULTS There were 381 children enrolled with completed clinician questionnaires, and 224 children had complete follow up or underwent appendicectomy. The median age was 9 years (interquartile range 6-12) and the incidence of appendicitis was 31/224 (13.8%, 95% confidence interval 9.3-18.4). The area under the curve (AUC), sensitivity, specificity, positive predictive value and negative predictive value of clinician gestalt were 0.84 (0.76-0.91), 81% (63-93%), 76% (69-82%), 35% (28-42%) and 96% (92-98%), respectively, giving an overall diagnostic accuracy of 76% (70-82%). AUC stratified by clinician seniority (junior, intermediate and senior) were 0.89 (0.80-0.98), 0.82 (0.69-0.95) and 0.76 (0.56-0.96), respectively. CONCLUSIONS The diagnostic accuracy of ED clinician gestalt in paediatric appendicitis is comparable to current clinical scoring systems irrespective of seniority.
Collapse
Affiliation(s)
- Wei Hao Lee
- Emergency Department, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Sharon O'Brien
- Emergency Department, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Dmitry Skarin
- Emergency Department, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - John A Cheek
- Emergency Department, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jessica Deitch
- Department of Medicine, Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Ramesh Nataraja
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Simon Craig
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Medicine, Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Paediatric Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Meredith L Borland
- Emergency Department, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,Divisions of Emergency Medicine and Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | | |
Collapse
|
39
|
Gómez López JR, Martín Del Olmo JC, Montenegro Martín MA, Concejo Cutoli P, Martín Esteban ML, Toledano Trincado M, López Mestanza IC, Vaquero Puerta C. Laparoscopic Appendectomy in the Setting of Clinical Prediction Rules. J Laparoendosc Adv Surg Tech A 2018; 29:184-191. [PMID: 30585754 DOI: 10.1089/lap.2018.0707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Acute appendicitis (AA) is the most frequent surgical entity in the emergency department, but its correct diagnosis remains challenging. To improve diagnosis, clinical prediction rules (CPRs) have been created to establish objective scores for the probability of suffering AA. In this study, we establish scores indicating whether laparoscopy would be superior to clinical observation or repeat diagnostic test. METHODS A retrospective observational study was conducted with 433 patients submitted to surgery for suspected AA using a laparoscopic approach. The Alvarado, Raja Isteri Pengiran Anak Saleha Appendicitis, appendicitis inflammatory response, and adult appendicitis score scales were applied in each case to establish a high, medium, or low probability of suffering AA. RESULTS Of the 433 patients analyzed, 381 (88.0%) had AA. Twelve (2.8%) were converted to open surgery, and complications were observed in 54 (12.5%) cases. The CPRs studied showed statistically significant differences between AA and negative appendectomies. However, in patients with intermediate probability scores, the diagnostic accuracy of the CPRs evaluated was not adequate. CONCLUSIONS Laparoscopic surgery can serve as a diagnostic tool for patients with intermediate AA probability scores because of its low associated morbidity and mortality and because it affords a direct diagnosis of the problem, allowing determination of the appropriate treatment.
Collapse
|
40
|
Fromer I, Belani KG. Anesthesia for Intestinal Obstruction. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
41
|
Hori T, Machimoto T, Kadokawa Y, Hata T, Ito T, Kato S, Yasukawa D, Aisu Y, Kimura Y, Sasaki M, Takamatsu Y, Kitano T, Hisamori S, Yoshimura T. Laparoscopic appendectomy for acute appendicitis: How to discourage surgeons using inadequate therapy. World J Gastroenterol 2017; 23:5849-5859. [PMID: 28932077 PMCID: PMC5583570 DOI: 10.3748/wjg.v23.i32.5849] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/25/2017] [Accepted: 08/02/2017] [Indexed: 02/06/2023] Open
Abstract
Acute appendicitis (AA) develops in a progressive and irreversible manner, even if the clinical course of AA can be temporarily modified by intentional medications. Reliable and real-time diagnosis of AA can be made based on findings of the white blood cell count and enhanced computed tomography. Emergent laparoscopic appendectomy (LA) is considered as the first therapeutic choice for AA. Interval/delayed appendectomy at 6-12 wk after disease onset is considered as unsafe with a high recurrent rate during the waiting time. However, this technique may have some advantages for avoiding unnecessary extended resection in patients with an appendiceal mass. Non-operative management of AA may be tolerated only in children. Postoperative complications increase according to the patient’s factors, and temporal avoidance of emergent general anesthesia may be beneficial for high-risk patients. The surgeon’s skill and cooperation of the hospital are important for successful LA. Delaying appendectomy for less than 24 h from diagnosis is safe. Additionally, a semi-elective manner (i.e., LA within 24 h after onset of symptoms) may be paradoxically acceptable, according to the factors of the patient, physician, and institution. Prompt LA is mandatory for AA. Fortunately, the Japanese government uses a universal health insurance system, which covers LA.
Collapse
Affiliation(s)
- Tomohide Hori
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Takafumi Machimoto
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Yoshio Kadokawa
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Toshiyuki Hata
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Tatsuo Ito
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Shigeru Kato
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Daiki Yasukawa
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Yuki Aisu
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Yusuke Kimura
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Maho Sasaki
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Yuichi Takamatsu
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Taku Kitano
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Shigeo Hisamori
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Tsunehiro Yoshimura
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| |
Collapse
|