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Li H, Luo J, Wang H, Guo Q, Huang P, Lei H, Li W, Yang J. Non-operative treatment strategy for appendiceal abscess in children under 3 years old: a retrospective observational study. Front Pediatr 2023; 11:1234820. [PMID: 37954431 PMCID: PMC10634424 DOI: 10.3389/fped.2023.1234820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/26/2023] [Indexed: 11/14/2023] Open
Abstract
Background There are few studies on appendiceal abscess with appendicolith in children under 3 years old. This study aims to explore the success rate of non-surgical treatment of appendiceal abscess and assess the potential influence of an appendicolith on non-surgical treatment outcomes in children under 3 years old. Methods The clinical data of children under 3 years old who were diagnosed with appendiceal abscess at the Wuhan Children's Hospital, China, from February 2013 to May 2020 were collected. According to the findings of ultrasonography and CT imaging, they were divided into two groups, namely, the appendicolith group and the non-appendicolith group. Results A total of 94 children with appendiceal abscess were identified, meeting the specified study criteria, and categorized into two groups, namely, the appendicolith group (n = 51, 54.3%) and the non-appendicolith group (n = 43, 45.7%). Non-surgical treatment was unsuccessful in six out of the 94 children, yielding an overall success rate of 93.6% for non-surgical management of appendiceal abscess in children under 3 years old. The success rate for non-surgical treatment in the appendicolith subgroup was 90.2%, whereas that for the non-appendicolith subgroup was 97.7%. No statistically significant distinction was observed between the two groups (P = 0.292). Likewise, there were no significant differences in gender, age, duration of symptoms, fever, vomiting, diarrhea, rebound pain, white blood cell count, C-reactive protein level, and abscess cross-sectional area between the appendicolith group and the non-appendicolith group. However, there is a statistical difference in tenderness in the right lower abdomen. Conclusion Non-surgical treatment of appendiceal abscess has a high success rate and can be considered an effective treatment strategy. In pediatric patients under 3 years old without evidence of complete intestinal obstruction or diffuse peritonitis, non-surgical treatment may be considered for appendiceal abscess.
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Affiliation(s)
| | | | | | | | | | | | | | - Jun Yang
- Department of General Surgery, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
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Djemai K, Gouriet F, Sielezneff I, Mege D, Drancourt M, Grine G. Detection of methanogens in peri-appendicular abscesses: Report of four cases. Anaerobe 2021; 72:102470. [PMID: 34743984 DOI: 10.1016/j.anaerobe.2021.102470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 12/29/2022]
Abstract
The aetiology of appendicular abscess is predominantly microbial with aerobic and anaerobic bacteria from gut flora. In this study, by using specific laboratory tools, we co-detected Methanobrevibacter oralis and Methanobrevibacter smithii among a mixture of enterobacteria including Escherichia coli, Enterococcus faecium and Enterococcus avium in four unrelated cases of postoperative appendiceal abscesses. These unprecedented observations raise a question on the role of methanogens in peri-appendicular abscesses, supporting antibiotics as an alternative therapeutic option for appendicitis, including antibiotics active against methanogens such as metronidazole or fusidic acid.
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Affiliation(s)
- K Djemai
- Aix-Marseille Univ, IRD, MEPHI, Marseille, France; IHU Méditerranée Infection, Marseille, France
| | - F Gouriet
- Aix-Marseille Univ, IRD, MEPHI, Marseille, France; IHU Méditerranée Infection, Marseille, France
| | - I Sielezneff
- Department of Digestive Surgery, Aix Marseille Univ, APHM, Timone University Hospital, Marseille, France
| | - D Mege
- Department of Digestive Surgery, Aix Marseille Univ, APHM, Timone University Hospital, Marseille, France
| | - M Drancourt
- Aix-Marseille Univ, IRD, MEPHI, Marseille, France; IHU Méditerranée Infection, Marseille, France
| | - G Grine
- IHU Méditerranée Infection, Marseille, France; Aix-Marseille Université, UFR Odontologie, Marseille, France.
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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.
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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
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Minodier L, Charrel RN, Ceccaldi PE, van der Werf S, Blanchon T, Hanslik T, Falchi A. Prevalence of gastrointestinal symptoms in patients with influenza, clinical significance, and pathophysiology of human influenza viruses in faecal samples: what do we know? Virol J 2015; 12:215. [PMID: 26651485 PMCID: PMC4676820 DOI: 10.1186/s12985-015-0448-4] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 12/04/2015] [Indexed: 12/14/2022] Open
Abstract
This review provides for the first time an assessment of the current understanding about the occurrence and the clinical significance of gastrointestinal (GI) symptoms in influenza patients, and their correlation with the presence of human influenza viruses in stools of patients with confirmed influenza virus infection. Studies exploring how human influenza viruses spread to the patient’s GI tract after a primary respiratory infection have been summarized. We conducted a systematic search of published peer-reviewed literature up to June 2015 with regard to the above-mentioned aspects, focusing on human influenza viruses (A(H1N1), A(H1N1)pdm09, A(H3N2), and B). Forty-four studies were included in this systematic review and meta-analysis. The pooled prevalence of any digestive symptoms ranged from 30.9 % (95 % CI, 9.8 to 57.5; I2 = 97.5 %) for A(H1N1)pdm09 to 2.8 % (95 % CI, 0.6 to 6.5; I2 = 75.4 %) for A(H1N1). The pooled prevalence of influenza viruses in stool was 20.6 % (95 % CI, 8.9 to 35.5; I2 = 96.8 %), but their correlation with GI symptoms has rarely been explored. The presence of viral RNA in stools because of haematogenous dissemination to organs via infected lymphocytes is likely, but the potential to cause direct intestinal infection and faecal–oral transmission warrants further investigation. This review highlights the gaps in our knowledge, and the high degree of uncertainty about the prevalence and significance of GI symptoms in patients with influenza and their correlation with viral RNA positivity in stool because of the high level of heterogeneity among studies.
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Affiliation(s)
- Laetitia Minodier
- EA 7310, laboratory of virology, University of Corsica-Inserm, 20250, Corte, France.
| | - Remi N Charrel
- Aix Marseille Université, IRD French Institute of Research for Development, INSERM U1207, EHESP French School of Public Health, EPV UMR_D 190 "Emergence des Pathologies Virales", & IHU Méditerranée Infection, APHM Public Hospitals of Marseille, Marseille, France.
| | - Pierre-Emmanuel Ceccaldi
- Unité EPVO, Institut Pasteur, Paris-UMR CNRS 3569-Université Paris Diderot, Paris Sorbonne Cité, Cellule Pasteur, Paris, France.
| | - Sylvie van der Werf
- Unit of Molecular Genetics of RNA viruses, Institut Pasteur-UMR CNRS 3569-Université Paris Diderot-Sorbonne Paris Cité, Paris, France. .,Coordinating Center of the National Reference Center for influenza viruses, National Influenza Center (Northern-France), Institut Pasteur, Paris, France.
| | - Thierry Blanchon
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Paris, France. .,INSERM, UMR_S 1136, Paris, France.
| | - Thomas Hanslik
- INSERM, UMR_S 1136, Paris, France. .,Université Versailles Saint Quentin en Yvelines, UFR de Médecine Paris-Ile-de-France-Ouest, 9 boulevard d'Alembert, 78280, Guyancourt, France. .,Service de médecine interne, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, 92100, Boulogne Billancourt, France.
| | - Alessandra Falchi
- EA 7310, laboratory of virology, University of Corsica-Inserm, 20250, Corte, France.
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