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Thanasa A, Thanasa E, Antoniou IR, Leroutsos A, Gerokostas EE, Kontogeorgis G, Papadoulis V, Ntavanos A, Paraoulakis I, Thanasas I. Early Diagnosis of Acute Appendicitis in the Second Trimester of Pregnancy Based on Non-typical Clinical Findings: Report of a Rare Case and a Mini-Review of the Literature. Cureus 2024; 16:e61463. [PMID: 38953065 PMCID: PMC11215032 DOI: 10.7759/cureus.61463] [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: 05/31/2024] [Indexed: 07/03/2024] Open
Abstract
Acute appendicitis is the most common non-obstetric reason for exploratory laparotomy during pregnancy. This case report involves a primigravida patient who presented to the emergency department of the General Hospital of Trikala at 15 weeks of gestation due to diffuse abdominal pain, primarily in the epigastric region. She also reported watery bowel movements. The ongoing atypical clinical symptoms, along with elevated inflammatory markers, strongly indicated a diagnosis of acute appendicitis. An immediate exploratory laparotomy was performed, during which acute localized inflammation of the appendix was found, leading to an appendectomy. Histological examination confirmed the diagnosis of acute appendicitis. The patient reported pain relief immediately after the surgery. On the fourth postoperative day, she was discharged without any signs of a threatened second-trimester miscarriage. At 39 gestational weeks, she delivered by elective cesarean section due to breech presentation. This paper discusses the case and highlights the significant challenges in the early diagnosis and management of acute appendicitis during pregnancy, emphasizing the importance of preventing potentially life-threatening complications for both the mother and the fetus.
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Affiliation(s)
- Anna Thanasa
- Department of Health Sciences, Medical School, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Efthymia Thanasa
- Department of Health Sciences, Medical School, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | | | - Alexandros Leroutsos
- Department of Obstetrics and Gynecology, General Hospital of Trikala, Trikala, GRC
| | | | | | | | | | - Ioannis Paraoulakis
- Department of Obstetrics and Gynecology, General Hospial of Trikala, Trikala, GRC
| | - Ioannis Thanasas
- Department of Obstetrics and Gynecology, General Hospital of Trikala, Trikala, GRC
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Feng Y, Miao C, Zhao Y. Predicting Acute Appendicitis in Pregnant Patients Using the Neutrophil-to-Lymphocyte Ratio: A Meta-Analysis. Surg Infect (Larchmt) 2023; 24:903-909. [PMID: 38011746 DOI: 10.1089/sur.2023.269] [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: 11/29/2023] Open
Abstract
Background: To determine whether the neutrophil-to-lymphocyte ratio (NLR) can serve as a predictive indicator for acute appendicitis among pregnant females. Patients and Methods: A comprehensive search was conducted across multiple databases including PubMed, Embase, and Web of Science seeking to gather pertinent research on the NLR concerning pregnant individuals either suspected of or diagnosed with acute appendicitis. The NLR value and receiver operating characteristic (ROC) curve were utilized to assess the predictive value of the NLR in predicting acute appendicitis among pregnant patients. Results: Seven studies and 410 patients were included in the meta-analysis. The area under the curve (AUC) for identifying acute appendicitis in pregnant patients using the NLR was found to be 0.856 (95% confidence interval [CI], 0.833-0.879). Additionally, the NLR values for pregnant patients with acute appendicitis were significantly elevated, showing a mean difference (MD) of 0.80 (95% CI, 0.58-1.03; p < 0.001). Conclusions: The NLR can be considered a valuable and effective diagnostic tool for anticipating acute appendicitis in pregnant patients.
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Affiliation(s)
- Yangchong Feng
- Department of Obstetrics and Gynecology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
- Department of Reproductive Medicine, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - Chongxiu Miao
- Department of Obstetrics and Gynecology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
- Department of Reproductive Medicine, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - Yahui Zhao
- Department of Otorhinolaryngology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
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Messias B, Cubas I, Oliveira C, Hashimoto F, Mocchetti E, Ichinose T, Waisberg J, Ribeiro Junior MAF. Usefulness of serum sodium levels as a novel marker for predicting acute appendicitis severity: a retrospective cohort study. BMC Surg 2023; 23:312. [PMID: 37838701 PMCID: PMC10576296 DOI: 10.1186/s12893-023-02224-y] [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] [Received: 07/15/2023] [Accepted: 10/07/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Early and accurate preoperative diagnosis of complicated appendicitis mandates the identification of new markers. The aim of this study is to determine whether preoperative serum sodium levels are useful for predicting the severity of acute appendicitis. METHODS We retrospectively analyzed 475 patients who underwent emergency appendectomies between January 2018 and February 2023 in a general hospital in Brazil. The patients were divided into 2 groups: complicated (n = 254) and uncomplicated (n = 221). Hyponatremia was defined as serum sodium levels < 136 mEq/L. The primary outcome was to evaluate if hyponatremia is associated with complicated appendicitis. RESULTS The patients had a median age of 22 years, and the median serum sodium level was 137 mEq/L in patients with complicated appendicitis and 139 mEq/L in uncomplicated appendicitis (P < 0.001). The analysis of the receiver operating characteristic curve used as the best cutoff value of serum sodium of 136 mEq/L with a sensitivity of 45.7%, specificity of 86.4%, positive predictive value of 79.5%, and negative predictive value of 58.1% for the diagnosis of complicated AA. Of the 254 patients with complicated appendicitis, 84 (33.1%) had serum sodium levels below 136 mEq/L, while only 12 (5.4%) patients with uncomplicated appendicitis had values below this cutoff. Patients with hyponatremia were 5 times more likely to develop complicated appendicitis. (odds ratio: 5.35; 95% confidence interval: 3.39-8.45) CONCLUSIONS: Preoperative serum sodium levels are a useful tool for predicting the severity of acute appendicitis. Due to its low cost and wide availability, it has become an extremely relevant marker.
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Affiliation(s)
- Bruno Messias
- Department of Surgery, General Hospital of Carapicuiba, 95, Pedreira street, Carapicuiba, 06321-665, SP, Brazil.
- Medical School, São Camilo University Center, Nazare Avenue, São Paulo, 1501, 04263- 200, SP, Brazil.
| | - Isabella Cubas
- Department of Surgery, General Hospital of Carapicuiba, 95, Pedreira street, Carapicuiba, 06321-665, SP, Brazil
| | - Caio Oliveira
- Medical School, São Camilo University Center, Nazare Avenue, São Paulo, 1501, 04263- 200, SP, Brazil
| | - Flavia Hashimoto
- Medical School, São Camilo University Center, Nazare Avenue, São Paulo, 1501, 04263- 200, SP, Brazil
| | - Erica Mocchetti
- Department of Surgery, General Hospital of Carapicuiba, 95, Pedreira street, Carapicuiba, 06321-665, SP, Brazil
| | - Tania Ichinose
- Department of Surgery, General Hospital of Carapicuiba, 95, Pedreira street, Carapicuiba, 06321-665, SP, Brazil
| | - Jaques Waisberg
- Department of Surgery, ABC Medical School, Lauro Gomes Avenue, Santo André, 2000, 09060-870, SP, Brazil
| | - Marcelo A F Ribeiro Junior
- Critical Care and Acute Care Surgery, Sheikh Shakhbout Medical City- Mayo Clinic, P. O. Box 11001, Abu Dhabi, United Arab Emirates
- Catholic University of São Paulo, 290, Joubert Wey Street, Sorocaba, 18030-070, SP, Brazil
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Candrawinata V, Hanafi R, Baskoro BA, Irawan A, Ekapatria C, Christina NM, Koerniawan HS, Halim F. Antibiotic versus surgery in the treatment of acute appendicitis in the pregnant population: A systematic review and meta-analysis. F1000Res 2023; 12:188. [PMID: 38919838 PMCID: PMC11196932 DOI: 10.12688/f1000research.129906.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 06/27/2024] Open
Abstract
Introduction: Acute appendicitis is the most common surgical emergency in pregnant women. There has been a wide variance in clinical practice worldwide, with some favoring an antibiotic-only approach while others prefer surgery as the first-line management. Therefore, we designed the current analysis to synthesize the available evidence on the efficacy and safety of antibiotics versus surgery management. Methods: We searched PubMed, Scopus, EuropePMC, and Cochrane Central from March 4, 1904 until November 25, 2022, to look for studies comparing antibiotics and surgery in pregnant patients with acute appendicitis. We only included studies that provided a comparison between the two treatments. We included preterm delivery, fetal loss, maternal death, and complications as outcomes. The results were compared using an odds ratio and 95% confidence interval. We also performed a sensitivity analysis by excluding studies with a serious risk of bias. Results: We included five non-randomized studies for the analysis. We found that patients in the antibiotic group had a lower risk of preterm labor (OR 0.63 [95% CI 0.43-0.92]; p 0.02) but a higher risk of complications (OR 1.79 [95% CI 1.19-2.69]; p 0.005). We did not find any difference in the other outcomes. Conclusion: The increased risk of complications should caution clinicians about using antibiotics as the first-line management. More studies are required to identify patients who would benefit the most before antibiotics could be adopted as a treatment for acute appendicitis in pregnant patients.
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Affiliation(s)
- Valeska Candrawinata
- Faculty of Medicine, Pelita Harapan University, Tangerang, Banten, 15811, Indonesia
| | - Ricarhdo Hanafi
- Faculty of Medicine, Pelita Harapan University, Tangerang, Banten, 15811, Indonesia
| | - Bernard Agung Baskoro
- Division of Oncology, Department of Surgery, Faculty of Medicine, Pelita Harapan University, Siloam General Hospital, Tangerang, Banten, 15811, Indonesia
| | - Andry Irawan
- Division of Digestive Surgery, Department of Surgery, Faculty of Medicine, Pelita Harapan University, Siloam General Hospital, Tangerang, Banten, 15811, Indonesia
| | - Christofani Ekapatria
- Division of Reproductive Endocrinology and Fertility, Department of Obstetrics and Gynecology, Faculty of Medicine, Pelita Harapan University, Siloam General Hospital, Tangerang, Banten, 15811, Indonesia
| | - Natalia Maria Christina
- Department of Surgery, Faculty of Medicine, Pelita Harapan University, Siloam General Hospital, Tangerang, Banten, 15811, Indonesia
| | - Heru Sutanto Koerniawan
- Department of Surgery, Faculty of Medicine, Pelita Harapan University, Siloam General Hospital, Tangerang, Banten, 15811, Indonesia
| | - Freda Halim
- Department of Surgery, Pelita Harapan University, Tangerang, Banten, 15811, Indonesia
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Wu Z, Zhao L, Feng S, Luo J. Hyperfibrinogenemia and hyponatremia as predictors of perforated appendicitis in children: A retrospective cohort study. Int J Colorectal Dis 2023; 38:72. [PMID: 36930335 DOI: 10.1007/s00384-023-04362-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE The aim of this study was to investigate the predictive value of hyperfibrinogenemia and hyponatremia for perforated appendicitis in children. METHODS A retrospective review of 521 pediatric patients (≤ 15 years) with acute appendicitis confirmed by histopathology from January 2017 to December 2020 was performed. Patients were divided in two groups, those with non-perforated (n = 379; 73%) and perforated appendicitis (n = 142; 27%). The serum values of sodium and fibrinogen were taken before surgery. We performed the receiver operating characteristic analysis for the two biochemical markers. The sensitivity, specificity, positive and negative predictive values for perforated appendicitis in the presence of hyponatremia and hyperfibrinogenemia were calculated. RESULTS Hyperfibrinogenemia (≥ 4.0 g/L) was found in 58.45% of perforated appendicitis and 104 of 142 (73.34%) children with perforated appendicitis had hyponatremia (≤ 135 mmol/L). The perforated appendicitis group had a higher mean fibrinogen concentration (P = 0.001). There was a statistically significant difference in mean serum sodium levels between the perforated appendicitis and non-perforated appendicitis groups (P = 0.016). Receiver operating characteristic curve analysis for fibrinogen, sodium and combination of the both markers shown the combination had the largest area under the curve in identifying children with perforated acute appendicitis (0.858) (95% CI, 0.82-0.90) compared with fibrinogen (0.815) (95% CI, 0.77-0.86) and sodium 0.818 (95% CI, 0.78-0.86) alone. Furthermore, the combination of both markers had the best positive and negative predictive value for appendix perforation compared to fibrinogen and sodium. CONCLUSION Hyponatremia and/or hyperfibrinogenemia are excellent markers for predicting perforated appendicitis in children. We propose that plasma sodium and/or fibrinogen concentrations be utilized as a supplementary to guide individual treatment decisions in children with appendicitis, such as surgery timing and nonoperative management options.
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Affiliation(s)
- Zhenfei Wu
- Department of Pediatric Surgery, Hangzhou Children's Hospital, Hangzhou, China
| | - Lingling Zhao
- Department of Pathology, The First Affiliated Hospital of Zhejiang Chinese Medical University, (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Shaoguang Feng
- Department of Pediatric Surgery, Hangzhou Children's Hospital, Hangzhou, China
| | - Jinjian Luo
- Department of Pulmonary and Critical Care Medicine (PCCM), Anji Branch of the First Affiliated Hospital of Zhejiang University, Anji County People's Hospital, Huzhou, Zhejiang, 313300, China.
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Bao W, Wang J, Tang D, Li L, Meng X. Application and curative effect of laparoscopic purse-string sutures in the treatment of adult acute complicated appendicitis. BMC Surg 2023; 23:1. [PMID: 36600246 DOI: 10.1186/s12893-022-01884-6] [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: 10/21/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To investigate the effect of laparoscopic purse-string sutures in adult complicated appendicitis treatment. METHODS The data of 568 adult cases of complicated appendicitis treated by laparoscopic appendectomy at the Hefei Second People's Hospital, Anhui Province, China, from September 2018 to September 2021 were analysed retrospectively. The patients were divided into two groups: 295 cases in the laparoscopic purse-string suture treatment group (observation group) and 273 cases in the simple Hem-o-lok® clamp treatment group (control group). The baseline data collected included age, gender, preoperative body temperature, leukocyte count and percentage of neutrophils and the surgery time. The postoperative data collected included antibiotic treatment duration, drainage tube placement time and the incidence of complications. RESULTS There were no significant differences in the baseline data of the two groups, including age, gender, preoperative body temperature, leukocyte count and neutrophil percentage (all P > 0.05). Compared with the control group, the postoperative hospital length of stay, duration of antibiotic treatment, the recovery time of peripheral white blood cell and neutrophil counts and the incidence of postoperative complications in the observation group were significantly decreased (P < 0.05). CONCLUSION Purse-string sutures can effectively reduce the incidence of postoperative complications after a laparoscopic appendectomy for adult acute complicated appendicitis. There was faster postoperative recovery when patients' appendiceal stumps were treated with laparoscopic purse-string sutures.
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Affiliation(s)
- Wenzhong Bao
- Department of Surgery, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Guangde Road, Yaohai District, Hefei, 230011, Anhui, China.
| | - Jie Wang
- Department of Surgery, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Guangde Road, Yaohai District, Hefei, 230011, Anhui, China
| | - Dawei Tang
- Department of Surgery, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Guangde Road, Yaohai District, Hefei, 230011, Anhui, China
| | - Liang Li
- Department of Surgery, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Guangde Road, Yaohai District, Hefei, 230011, Anhui, China
| | - Xiangling Meng
- Department of Surgery, The First Affiliated Hospital Anhui Medical University, Hefei, 230031, Anhui, China
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Peksöz R, Cambaztepe F, Atamanalp SS. Letter to the Editor regarding "A novel Appendicitis TriMOdal prediction Score (ATMOS) for acute appendicitis in pregnancy: a retrospective observational study". Updates Surg 2023; 75:265-266. [PMID: 36342635 DOI: 10.1007/s13304-022-01414-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/28/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Rıfat Peksöz
- Department of General Surgery, Faculty of Medicine, Atatürk University, Erzurum, Turkey.
| | - Ferdi Cambaztepe
- Department of General Surgery, Faculty of Medicine, Atatürk University, Erzurum, Turkey
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Augustin G, Mikuš M, Bogdanic B, Barcot O, Herman M, Goldštajn MŠ, Tropea A, Vitale SG. A novel Appendicitis TriMOdal prediction Score (ATMOS) for acute appendicitis in pregnancy: a retrospective observational study. Updates Surg 2022; 74:1933-1941. [PMID: 36048362 DOI: 10.1007/s13304-022-01368-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/22/2022] [Indexed: 01/20/2023]
Abstract
Several scoring systems exist for the management of acute appendicitis (AA) during pregnancy. However, the systems are based on the nonpregnant adult population. The aim of this study was to create a highly accurate scoring system that can be applied to pregnant women and to compare it to the most commonly used scores in general population and pregnant women. The creation and subsequent implementation of a highly accurate score system could shorten the diagnostic period and minimize the use of (ionizing) diagnostic imaging allowing the selection of the best treatment approach in pregnant patients with acute appendicitis. A single-center, retrospective cohort observational study was conducted at the University Hospital Centre Zagreb, Zagreb, Croatia. Data were extracted from medical records of pregnant patients with suspected AA from January 2010 to December 2020. A total of 59 pregnant patients diagnosed with AA during pregnancy were identified, 41 were treated surgically, and 18 had non-surgical management. The main objective of our study was the detection of predictive factors of AA during pregnancy. Anorexia, pain migration to the right lower quadrant, rebound pain, axillary temperature over 37.3 °C, CRP/platelet ratio > 0.0422, neutrophil/lymphocyte ratio > 7.182, and ultrasonic signs of AA were scored. Scoring in Appendicitis TriMOdal Score (ATMOS) consists of positive clinical parameter, each bringing 1 point and other parameters mentioned above that bring 2 points each. The score ranges from 0 to 10. Our model of ATMOS yields a high area under the receiver-operating characteristic curve of 0.963. The positive likelihood ratio is 9.97 (95% CI 2.64-38.00), and the negative likelihood ratio is 0.1 (95% CI 0.03-0.31), meaning that 94% of cases with ATMOS > 4 have AA, while less than 13% with an ATMOS ≤ 4 have the diagnosis of AA. The potential of ATMOS differentiating AA during pregnancy was demonstrated. Future prospective, randomized trials are needed to evaluate its accuracy and whether it should be used instead of Alvarado or Tzanakis scores in clinical decision-making.Trial registration number ClinicalTrials.gov-NCT05202483. Date of registration: January 21, 2022.
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Affiliation(s)
- Goran Augustin
- Department of Surgery, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Mislav Mikuš
- School of Medicine, University of Zagreb, Zagreb, Croatia.
- Department of Obstetrics and Gynecology, University Hospital Centre Zagreb, Petrova 13, 10000, Zagreb, Croatia.
| | - Branko Bogdanic
- Department of Surgery, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ognjen Barcot
- Department of Surgery, University Hospital Split, Spinčićeva 1, Split, Croatia
| | - Mislav Herman
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Obstetrics and Gynecology, University Hospital Centre Zagreb, Petrova 13, 10000, Zagreb, Croatia
| | - Marina Šprem Goldštajn
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Obstetrics and Gynecology, University Hospital Centre Zagreb, Petrova 13, 10000, Zagreb, Croatia
| | - Alessandro Tropea
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via E. Tricomi 1, 90127, Palermo, Italy
| | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, 95124, Catania, Italy
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Peksöz R, Gür STA, Atamanalp SS. Comment on “A new approach to the management of acute appendicitis: Decision tree method”. Am J Emerg Med 2022; 59:172-173. [DOI: 10.1016/j.ajem.2022.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/13/2022] [Accepted: 04/20/2022] [Indexed: 11/17/2022] Open
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Peksöz R, Albayrak Y, Atamanalp SS. Comment to: “Inflammatory parameters as predictive factors for complicated appendicitis: A retrospective cohort study’’. Ann Med Surg (Lond) 2022; 75:103391. [PMID: 35242332 PMCID: PMC8886312 DOI: 10.1016/j.amsu.2022.103391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 02/20/2022] [Indexed: 12/05/2022] Open
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